Patient tolerance of awake, in-office laryngeal procedures: A Multi-Institutional Perspective


  • Clark Rosen, MD, is a consultant for Merz Aesthetics, Inc. VyVy Young, MD, has been a paid speaker for Merz Aesthetics, Inc. The authors have no other funding, financial relationships, or conflicts of interest to disclose.



An increasing number of laryngeal procedures are performed in the office. However, little is known about how well these procedures are tolerated and what factors determine success or failure.

Study Design:

Prospectively collected patient and physician surveys from five surgeons at two institutions describe patient tolerance of awake, in-office laryngeal procedures (AIOLPs).


There were 154 procedures performed in a 6-month period, including vocal fold injection (VFI) (72%), laser treatment (19%), and transnasal esophagoscopy (3%). Average duration of procedure was 13 ± 8 minutes.


Patients reported an average of 37 of 100 on a discomfort scale, with 0 representing no discomfort and 100 representing maximal discomfort. Ninety-three percent of patients would undergo another procedure, and 96% would recommend AIOLPs to other patients. Procedures were completed successfully in 92%. Most common surgeon-reported difficulties included copious secretions and uncontrolled gag reflex. Procedures that involved such difficulties had a significantly lower rate of procedure completion, 73% vs. 96%, P = .0001. High preprocedure anxiety did not adversely impact patient comfort or procedure completion rate. There was no difference in discomfort scores based on VFI approach or patient familiarity with AIOLPs. There was a significant difference in discomfort score between patients with successful first-approach VFI and those who required a change in VFI approach, 36.0 vs. 61.3, respectively, P = .003. The rate of requiring a second and third VFI approach was 4.6% and 2.8%, respectively.


This study encompasses multiple diagnoses, procedures, VFI techniques, and methods of anesthesia. AIOLPs are exceptionally well tolerated by patients, resulting in extremely high completion and satisfaction rates.