Twenty-five laryngologists from the British Laryngological Association, European Laryngological Society and Union of European Phoniatricians used a modified Delphi process, requiring at least 80% agreement, to define indications, contraindications and periprocedural care for office-based laryngology. Sixty statements were approved over two rounds and graded with GRADE.
The statements cover pre-procedure assessment, indications and contraindications, technique, vocal fold augmentation, post-procedure care and success criteria, and environmental and economic outcomes. The primary indications named were vocal fold polyps, Reinke's oedema, varices, leukoplakia, biopsies, granulomas, recurrent respiratory papillomatosis, and selected cases for vocal fold augmentation.
Office procedures under local anaesthesia avoid general anaesthesia and theatre time, which matters for older and comorbid patients and for units with long theatre waits. Indian laryngology units adopting flexible-channel endoscopes and office lasers now have a European reference for building protocols. This is expert consensus, not comparative outcome data.
- Consider office-based biopsy for leukoplakia and suspicious lesions in patients at high anaesthetic risk
- Write local protocols covering topical anaesthesia, anticoagulation and contraindications before starting office procedures
- Define success criteria and follow-up for each procedure type
- Keep a low threshold for conversion to microlaryngoscopy when sampling is inadequate
Why it matters
Many laryngeal procedures no longer need general anaesthesia, and a shared standard helps units move them safely out of theatre.
Don't overread it
Delphi consensus — it does not show that office procedures give equivalent outcomes to theatre for each indication.
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