Microlaryngoscopy-Surgery of vocal cords for hoarseness of voice

CONSENT INFORMATION – MICROLARYNGOSCOPY

PLEASE READ THIS SHEET BEFORE YOU CONSENT FOR YOUR PROCEDURE

This information sheet provides general information to a person having a Microlaryngoscopy. It does not provide advice to the individual. It is important that the content is discussed between the patient and the concerned doctors who understand the level of fitness and medical condition.

 What is “Microlaryngoscopy”?

Laryngoscopy is a procedure that allows your physician to look at your larynx (voice box) using a laryngoscope. "Micro" refers to getting a very close (magnified) view of the area to see every tiny detail. This can be done with a special telescope or operating microscope.


What are the indications for Microlaryngoscopy?

Microlaryngoscopy is especially useful for conditions in which evaluation or treatment of the vocal cords or immediate surrounding airway needs to be performed.

Nerve or structural injury
Voice problems, such as a hoarse voice, weak voice or no voice
Throat pain
Bloodstained saliva or sputum
Difficulty in swallowing
A sensation of a lump in the throat
Injuries to the throat
Narrowing of the throat
Obstructions or masses in the throat
 
We can perform some surgical procedures during the microlaryngoscopy, these include:
 
Removing foreign objects
Taking a biopsy, which is a small tissue sample
Removing polyps from the vocal cords
Performing laser treatment, which uses a tiny intense, focused beam of light to cut tissue.
What happens before the procedure?
When microlaryngoscopy is performed in the operating room, it is usually done with the patient asleep (general anesthesia). You should tell your anesthesiologists of any problems you have had in the past or any concerns you have about having anesthesia. In particular, if you have had trouble with nausea or vomiting in the past, your anesthesiologist may be able to adjust your medications to decrease the chance of stomach acid irritating your vocal folds as it comes back up.


What is involved with Microlaryngoscopy?

With the head tilted back (to make the airway as straight as possible), a laryngoscope is placed in the mouth to look at the larynx (voice box). It also pushes the tongue out of the way. If the patient is old enough to have upper teeth, they are protected with a tooth guard. The involved area is then visualized and the view is magnified (enlarged) using an endoscope (telescope). This is usually attached to a small video camera.
Procedures that may be performed during microlaryngoscopy are numerous, and include removal of polyps or masses on or around the vocal cords or to correct deformities of the vocal cords themselves. These procedures involve the use of special tools and techniques, and may include use of the CO2 laser.
The length of surgery depends on the reason the procedure is being performed (to simply evaluate the area, or to actually remove bumps or masses). The procedure usually does not last more than an hour.

How will I feel after the operation?

After microlaryngoscopy you may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the voice box. Any discomfort settles quickly with simple painkillers and usually only lasts a day or two.

Some patients feel their neck is slightly stiff after the operation. If you have a history of neck problems, you should inform the surgeon about this before your operation.
You can usually eat and drink later the same day. You should be able to use your voice as normal after the procedure. However, if the surgeon has taken a biopsy from your voice box, he may advise you to rest your voice for a short period.

When can I go home?

Often you can go home the same day as the operation, as long as you have someone with you. Depending on how you feel afterwards, you may need to stay overnight for observation.
You may be advised to stay off work for a few days to rest your throat, depending on your job.
General Risks of having the procedure:

These have been mentioned in the “Anesthesia Consent Form.” Please discuss this with your Anesthetist before signing the Anesthesia Consent Form.

What are the risks of the procedure?

While majority of patients have an uneventful procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below:

There are some risks/ complications, which include:

(a) Injury to the lips, teeth, gums or tongue. Dental injury may result in teeth being chipped, broken or dislodged. Crowns may also be dislodged.
(b) Swelling of the tissues of the airway. This may lead to difficulty breathing requiring the insertion of a breathing tube through the mouth and support with breathing until the swelling resolves. Rarely, a tracheostomy (insertion of a breathing tube through the neck) may be required.
(c) Bleeding into the airway. This may lead to difficulty breathing requiring the insertion of a breathing tube through the mouth, until the bleeding is controlled. Rarely, a tracheostomy (insertion of a breathing tube through the neck) may be required.
(d) Collapsed lung (Pneumothorax). A small hole in the surface of the lung. Air then leaks from the lung, causing the lung to collapse. The lung may come back up itself, or a tube may need to be put into the chest through the skin to remove the air from around the lung. This may need a longer hospital stay.
(e) Voice change. The larynx (voice box) or the nerves controlling the larynx may be injured by the instruments used for the microlaryngoscopy. Voice change may also result from excision or biopsy of the abnormal tissue in the larynx. The voice change may be persistent and not respond to further treatment.
(f) Persistence or recurrence of the original disease may occur.
(g) Undiagnosed neck/spinal problems.

Consent Acknowledgement:

The doctor has explained my medical condition and the proposed surgical procedure.
I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes. The doctor has explained other relevant treatment options and their associated risks, the prognosis and the risks of not having the procedure.
I have been given an Anesthesia Informed Consent Form.
I have been given a Patient Information Sheet about the Condition, the Procedure, and associated risks.
I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options.
My questions and concerns have been discussed and answered to my satisfaction.
I understand that the procedure may include a blood / blood product transfusion.
I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated as appropriate.
It has been explained to me, that during the course of or subsequent to the Operation/Procedure, unforeseen conditions may be revealed or encountered which may necessitate urgent surgical or other procedures in addition to or different from those contemplated. In such exigency, I further request and authorize the above named Physician / Surgeon or his designee to perform such additional surgical or other procedures as he or they consider necessary or desirable.

On the basis of the above statements,

I REQUEST TO HAVE THE PROCEDURE.

Name of Patient/Substitute Decision Maker…………………………………………….
Relationship …………………………………….
Signature………………………………………
Date………………………………………………

Name of the Witness…………………………
Relationship/Designation………………………
Signature………………………………………..
Date……………………………




INFORMED CONSENT: MICROLARYNGOSCOPY

A. INTERPRETER
An interpreter service is required.Yes______________No_______________
If Yes, is a qualified interpreter present.Yes_____________No___________

B. CONDITION AND PROCEDURE
The doctor has explained that I have the following condition:
(Doctor to document in patient’s own words)
_______________________________________________and I have been advised to undergo the following treatment/procedure____________________________________________________________________________________________________________________________________________________________
 
See patient information sheet- “Microlaryngoscopy” for more

C.ANAESTHETIC

Please see your “Anesthesia Consent Form”. This gives you information of the General Risks of Surgery. If you have any concern, talk these over with your anesthetist.

D.RISKS OF THIS PROCEDURE

While majority of patients have an uneventful surgery/procedure and recovery, few cases may be associated with complications. These are seen infrequently and not all the ones listed below are applicable to one individual. However it is important that you are aware of the complications/risks that may arise out of this procedure which are as below:

There are some risks/ complications, which include:

(a) Injury to the lips, teeth, gums or tongue. Dental injury may result in teeth being chipped, broken or dislodged. Crowns may also be dislodged.
(b) Swelling of the tissues of the airway. This may lead to difficulty breathing requiring the insertion of a breathing tube through the mouth and support with breathing until the swelling resolves. Rarely, a tracheostomy (insertion of a breathing tube through the neck) may be required.
(c) Bleeding into the airway. This may lead to difficulty breathing requiring the insertion of a breathing tube through the mouth, until the bleeding is controlled. Rarely, a tracheostomy (insertion of a breathing tube through the neck) may be required.
(d) Collapsed lung (Pneumothorax). A small hole in the surface of the lung. Air then leaks from the lung, causing the lung to collapse. The lung may come back up itself, or a tube may need to be put into the chest through the skin to remove the air from around the lung. This may need a longer hospital stay.
(e) Voice change. The larynx (voice box) or the nerves controlling the larynx may be injured by the instruments used for the microlaryngoscopy. Voice change may also result from excision or biopsy of the abnormal tissue in the larynx. The voice change may be persistent and not respond to further treatment.
(f) Persistence or recurrence of the original disease may occur.
(g) Undiagnosed neck/spinal problems.

SIGNIFICANT RISKS AND RELEVANT TREATMENT OPTIONS:F. SIGNIFICANT RISKS AND

The doctor has explained any significant risks and problems specific to me, and the likely outcomes if complications occur.

The doctor has also explained relevant treatment options as well as the risks of not having the procedure.
(Doctor to document in Medical Record if necessary. Cross out if not applicable. )

PATIENT CONSENT: CONSENT

I acknowledge that:
 
The doctor has explained my medical condition and the proposed procedure. I understand the risks of the procedure, including the risks that are specific to me, and the likely outcomes.
The doctor has explained other relevant treatment options and their associated risks. The doctor has explained my prognosis and the risks of not having the procedure.
I have been given a Patient Information Sheet on Anesthesia.
I have been given the patient information sheet regarding the condition, procedure, risks and other associated information.
I was able to ask questions and raise concerns with the doctor about my condition, the procedure and its risks, and my treatment options. My questions and concerns have been discussed and answered to my satisfaction.
I understand that the procedure may include a blood transfusion.
I understand that if organs or tissues are removed during the surgery, that these may be retained for tests for a period of time and then disposed of sensitively by the hospital.
The doctor has explained to me that if immediate life-threatening events happen during the procedure, they will be treated accordingly.
I understand that photographs or video footage maybe taken during my operation. These may then be used for teaching health professionals. (You will not be identified in any photo or video).
I understand that no guarantee has been made that the procedure will improve the condition, and that the procedure may make my condition worse.
On the basis of the above statements,

I hereby authorize Dr……………………………………………………………………and those he may designate as associates or assistants to perform upon me the following medical treatment, surgical operation and / or diagnostic / therapeutic procedure…………………………………………………………..

I REQUEST TO HAVE THE PROCEDURE

Name of Patient/Substitute Decision Maker…………………………………………….
Relationship …………………………………………………………………………………….
Signature……………………………………………Date……………………………………….
Name of the Witness…………………………………………………………………………
Relationship/Designation………………………………………………………………………
Signature……………………………………………Date………………………………………
FERENCES

INTERPRETER’S STATEMENT:
I have given a translation in……………………………………………………………………
Name of interpreter…………………………………………………………………………….
Signature……………………………………………Date………………………………………

DOCTOR’S STATEMENTS
I have explained
The patient ‘s condition
Need for treatment
The procedure and the risks
Relevant treatment options and their risks
Likely consequences if those risks occur
The significant risks and problems specific to this patient
I have given the Patient/ Guardian an opportunity to:
Ask questions about any of the above matters
Raise any other concerns, which I have answered as fully as possible.

I am of the opinion that the Patient/ Substitute Decision Maker understood the above information.
Name of doctor…………………………………………………………………………..
Designation………………………………………………………………………………
Signature………………………………………Date……………………………………