Avoiding the Operating Room: The Advantages of Office-Based Laryngology and Esophagology

TNE has also turned out to be a useful tool in screening for Barrett’s esophagus, he said, citing recently published articles in the gastroenterological literature suggesting that transnasal esophagoscopy may indeed be the best screening tool for Barrett’s.

We have also seen a lot of people with chronic cough and have been very surprised at how many of these had pathology in the esophagus, so that is certainly an indication for performing TNE, Dr. Zeitiels said. We’ve used it for the placement of wireless pH capsules without sedation. We dilate strictures using concentric radial expansion balloons without sedation, and we can do a ton of other cool procedures.

Regarding the economic efficacy of TNE, Dr. Zeitels said it is extraordinarily well reimbursed in the office, but cautions physicians to keep in mind that, in order to be reimbursed, the esophagoscopy has to be compatible with the diagnosis.

With transnasal esophagoscopy, we can biopsy virtually anything, anywhere. …We have taken literally thousands of biopsies and have yet to have a single complication. – -Gregory Postma, MD

Chronic cough, for example, will be denied, he said. So when I see my chronic cough patients, I’m actually looking for something like esophagitis or reflux or dysphagia, so that my diagnosis is compatible with the procedure.

Injection Laryngoplasty

Office-based injection laryngoplasty is certainly nothing new, but had become something of a lost technique, mainly due to the paucity of substances that could be directly injected into the vocal folds, said Milan Amin, MD, Assistant Professor of Otolaryngology and Director of the NYU Voice Center Department at the New York University Medical Center in New York City.

A lot of things moved into the operating room and fat was injected until collagen came along and, for quite a while, that was the only other injectable substance available, he said. Recently, though, there’s been a resurgence because of some of the new materials out there. Things have kind of gone back toward office-based injection laryngoplasty.

Dr. Amin said some of the indications for injection laryngoplasty include vocal cord paralysis and vocal fold bowing due to atrophy, paresis, or presbylaryngis, noting that the materials can be injected for either temporary use or for permanent correction.

So if somebody comes in and has a presumed injury, but you’re not sure about the folds, you can certainly inject them and buy them some time to see if the injury will recover, he said. I have really started to do a lot more diagnostic testing with the injection procedure. Instead of just taking them to the operating room, I may inject them with a temporary substance and just see if their symptoms improve. If that works out, then I can go back in and do something more permanent.