Having an airway endoscopy or MLTB

What is an airway endoscopy or MLTB?

MLTB stands for ‘microlaryngotracheobronchoscopy’.

An endoscopy is a procedure which is performed whilst your child is under a general anaesthetic. It enables the ear, nose and throat (ENT) surgeon to closely examine your child’s upper airway (tongue, pharynx, larynx, epiglottis and windpipe). The surgeon uses a special piece of equipment called a ‘rigid scope’ which has a camera attached to it.

If examination of your child’s lungs is needed then a different procedure called a ‘bronchoscopy’ is required.

Why does my child need an airway endoscopy?

Your child will have been examined by an ENT doctor and found to be suffering from any of the following symptoms:

• noisy breathing
• difficulty breathing
• a change to their normal voice

Whilst performing this investigation the surgeon is able to diagnose and sometimes treat your child’s problem.

Is there an alternative to the operation?

The ENT doctor will have discussed with you whether it is an option to wait and see whether your child’s symptoms go away without treatment. However your child’s symptoms may be too severe and require more urgent investigation.

On the day of the operation

What time will my child have their operation?

You will have been informed whether your child’s operation is in the morning or afternoon in the letter you received from the hospital.

What time should I bring my child to the ward?

You will receive a letter telling you the date of your child’s operation and the time you need to bring them into hospital.

If your child’s operation is in the morning you need to arrive on the ward at 8am or 7.45am if your child is being admitted to the Theatre Admissions Unit.

If your child’s operation is in the afternoon you need to arrive on the ward at 11am or 12pm (midday) if your child is being admitted to the Theatre Admissions Unit.

What should I do if my child has a sore throat, a temperature or is unwell a few days before or the day of their operation?

You need to telephone the hospital on 0114 271 7286 and tell us. You will then be told whether it would be safe for your child to have their operation as planned.

What time should I give my child their last food and drink?

If your child’s operation is in the morning they can eat until midnight the night before and then have juice or water until 6am.

If your child’s operation is in the afternoon they must have finished their breakfast by 7.30am. They can continue to drink juice or water until 10.30am.

What will happen when we arrive on the ward?

An anaesthetist will visit your child and make sure they are fit for their operation. They may prescribe some magic cream for your child’s hand so that it doesn’t hurt when a tiny tube is inserted into their hand to allow the anaesthetic to be given. This tube is inserted when they are in the anaesthetic room.

The surgeon will also see you and your child before their operation.

A nurse will take your child’s temperature, weigh them and put a name band on their wrist. Your child will be asked to put on a theatre gown or their pyjamas. If your child has long hair they will need to tie it up in a ponytail with a non-metallic band. All jewellery and nail varnish must be removed. The nurse will then apply the magic cream to their hands.

Your child will either walk or be taken to theatre on a trolley. One parent or guardian may go to the anaesthetic room and stay with them until they are asleep.

How long will the operation take?

The airway endoscopy takes about 30 minutes although your child may be away from the ward for about 1 to 2 hours altogether.

What happens during the airway endoscopy?

Your child will have a general anaesthetic.

The ENT surgeon will carefully and gradually insert the rigid scope through your child’s mouth. They will then be able to see each part of your child’s airway clearly.

They may take some tiny pieces of tissue (biopsy) if they believe it is necessary. Quite often they will take some photographs of the problem area so that they can keep a record in your child’s medical notes.

What are the risks of the operation?

Your child may have a sore throat or a hoarse voice.

Rarely your child’s teeth may be damaged (especially if they are loose) when the surgeon introduces the rigid scope into your child’s mouth.

Your child may sometimes have noisy breathing immediately after the operation.

After the operation

Will I be there when my child wakes up?

The theatre escort that takes you and your child to the anaesthetic room will tell you how you will be contacted so that you can be with your child once their surgery is finished.

Will my child have any pain?

Your child will have been given some strong painkillers in theatre before they wake up.

They may have a sore throat later but the nurse will give them some medication to ease this.

When can my child have something to eat or drink?

Your child can have their first drink usually as soon as they wake up after the operation. Sometimes a local anaesthetic will have been sprayed onto your child’s vocal cords during the procedure. In this instance your child may have to wait longer before they can have a drink. Your child’s nurse will tell you if this is the case.

Once they have had a drink the nurse will tell you when they can have something to eat. This is usually a slice of toast or a biscuit depending upon your child’s age.

When can my child go home?

This depends upon your child’s surgeon, the age of your child and also how quickly your child recovers from their operation.

Your child may need to stay in hospital for 1 night so that their breathing and oxygen levels can be monitored.

How do I look after my child at home?

You will be given some painkillers which you should give your child if they find it difficult to eat or drink. This discomfort usually goes away after a few days.

When can my child go back to school?

Your surgeon will tell you if your child needs to have any time off from school.

Will I need to see the ENT doctor again?

This will depend on what the ENT surgeon found during the airway endoscopy. You will be told whether your child needs to see their ENT doctor again before they are discharged home.