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Office-based laryngology: the 2026 European consensus, lasers, injection augmentation and TNO

Indications from the European Practice Consensus on Office-Based Laryngology, evidence on in-office photoangiolytic and blue laser, awake vocal fold injection, transnasal oesophagoscopy and office biopsy.

Published · IN OFFICE Course editorial team

Laryngology was one of the first ENT fields to move procedures from the operating room to the clinic, using flexible endoscopes with working channels, topical anaesthesia and fibre-delivered lasers. This article summarises the current European consensus and the published evidence on the main awake procedures.

The 2026 European consensus

The European Practice Consensus on Office-Based Laryngology (Lechien et al., Laryngoscope 2026) brought together 25 laryngologists from the British Laryngological Association, the European Laryngological Society and the Union of European Phoniatricians. Using a Delphi process with at least 80% agreement required, it approved 60 statements in two voting rounds. Primary indications include polyps, Reinke's oedema, varices and leukoplakia, together with biopsies, granulomas, papillomatosis and selected vocal fold augmentation.

Lasers in the office

  • The AAO-HNS position statement on in-office photoangiolytic laser treatment of laryngeal pathology (2014, revised October 2024) describes it as an established surgical treatment, performed under local or topical anaesthesia with a flexible endoscope.
  • A review by Tibbetts and Simpson (2019) describes the 532 nm KTP laser as the laser of choice for in-office management of a variety of laryngeal lesions, delivered through fibres passed along the working channel of the flexible laryngoscope.
  • In a series of 443 office-based laryngeal laser cases with three wavelengths (Koufman et al., 2007), there were no significant complications.
  • For the 445 nm blue laser, Hess et al. (2018) reported tissue effects comparable to the KTP laser with additional cutting properties. The authors present it as a preliminary report and call for further systematic studies.

Injection augmentation with the patient awake

In a multicentre review of 460 vocal fold injections (Sulica et al., Laryngoscope 2010), 51% were performed in awake, unsedated patients. Technical success was 99% awake and 97% under general anaesthesia, with complication rates of 3% and 2%, and the awake share rose from 11% to 43% between 2003 and 2008. A Canadian cost minimisation analysis (Tam et al., 2017) estimated C$943.19 per patient for injection laryngoplasty against C$2,499.10 for medialisation thyroplasty.

Transnasal oesophagoscopy and office biopsy

  • In a prospective study of transnasal oesophagoscopy in the office (European Archives of Oto-Rhino-Laryngology, 2019), 35 of 41 attempted procedures (85.3%) were completed, vasovagal reactions occurred in 4.9%, and the cost for suspected hypopharyngeal carcinoma was 583.54 euros against 1,414.95 euros under general anaesthesia.
  • A health technology assessment by the Malaysian Ministry of Health (MaHTAS) found no reported oesophageal perforation or major complication and concluded that TNE is well tolerated and can be performed safely in the office with topical anaesthesia, while grading the evidence as fair.
  • A systematic review of office-based laryngeal biopsy (Swaminathan et al., 2023; 35 studies) found sensitivity and specificity between 60% and 100%, and identified low sensitivity as the main barrier.

What this means in practice

Office laryngology is supported by a European consensus and by large case series, but much of the evidence remains observational, and diagnostic sensitivity limits office biopsy. Training in topical anaesthesia, flexible endoscopy with working channels and laser safety is the basis for starting these procedures.

How the IN OFFICE 2026 course covers this topic

The International IN OFFICE Breathing Disorders Surgery Course runs from 10 to 12 December 2026 at Hospital Dr. Nélio Mendonça in Funchal, Madeira, with lectures, live surgery and supervised hands-on training in groups of 4. The programme lists the sessions on this topic with the course day and the speaker.

Programme sessions on this topic · Registration and fees

Sources

  1. Lechien JR, et al. European Practice Consensus on Office-Based Laryngology. Laryngoscope. 2026. doi:10.1002/lary.70869
  2. AAO-HNS. Position Statement: In-Office Photoangiolytic Laser Treatment of Laryngeal Pathology. 2014, revised 2024
  3. Tibbetts KM, Simpson CB. Office-based 532-nanometer pulsed KTP laser procedures in laryngology. Otolaryngol Clin North Am. 2019;52(3):537-557. doi:10.1016/j.otc.2019.02.011
  4. Koufman JA, et al. Office-based laryngeal laser surgery: a review of 443 cases using three wavelengths. Otolaryngol Head Neck Surg. 2007;137(1):146-151. doi:10.1016/j.otohns.2007.02.041
  5. Hess MM, et al. New 445 nm blue laser for laryngeal surgery combines photoangiolytic and cutting properties. Eur Arch Otorhinolaryngol. 2018;275(6):1557-1567. doi:10.1007/s00405-018-4974-8
  6. Sulica L, et al. Current practice in injection augmentation of the vocal folds. Laryngoscope. 2010;120(2):319-325. doi:10.1002/lary.20737
  7. Tam S, et al. Medialization thyroplasty versus injection laryngoplasty: a cost minimization analysis. J Otolaryngol Head Neck Surg. 2017;46:14. doi:10.1186/s40463-017-0191-5
  8. Prospective study of office-based transnasal oesophagoscopy. Eur Arch Otorhinolaryngol. 2019. doi:10.1007/s00405-019-05357-0
  9. MaHTAS, Ministry of Health Malaysia. Transnasal Oesophagoscopy (TNE). Health Technology Assessment report
  10. Swaminathan R, et al. A systematic review on efficacy, safety and cost-effectiveness of office-based laryngeal biopsy. J Laryngol Otol. 2023;137(9):946-952. doi:10.1017/S0022215122001566

Written for healthcare professionals. This summary does not replace the original publications or clinical judgement.

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