Diagnostic Value of Bronchoscopy in Detecting Laryngopharyngeal Disorders: Clinical Utility and Limitations

Background and Objectives: Flexible bronchoscopy is widely used for evaluating intrathoracic airway and pulmonary diseases. However, its diagnostic value in upper airway abnormalities, including those involving the larynx, pharynx, and proximal trachea, remains underexplored. We evaluated the diagnostic significance and effectiveness of bronchoscopy in assessing upper airway diseases, including those involving the larynx, based on real-world data. Materials and Methods: We conducted a retrospective observational study involving 2229 patients who underwent bronchoscopy between March 2019 and December 2023. Patients with abnormal upper airway findings during bronchoscopy were referred for further otolaryngological evaluation. Patients were categorized according to the experience of their bronchoscopist (with ≥100 procedures defining experienced). Abnormal findings were analyzed according to anatomical region (oral cavity, larynx, and vocal cords), disease status (benign vs. malignant), and patient demographics. Multivariate logistic regression was used to identify predictors of abnormal findings. Results: Among 2229 patients (mean age 65.4 years), 72 (3.2%) exhibited visible upper airway abnormalities. No significant differences were observed in the abnormality detection rates between experienced and inexperienced operators across all anatomical regions. However, the presence of malignant disease was significantly associated with a higher likelihood of detecting abnormalities (5.4% vs. 1.9%, p < 0.001). Multivariate analysis revealed that male sex (odds ratio [OR] 2.069, p = 0.017), age < 74 years (OR 2.404, p = 0.009), and malignancy (OR 3.030, p < 0.001) were independent predictors of abnormal findings. Conclusions: Flexible bronchoscopy can incidentally detect upper airway abnormalities, particularly in patients with malignancy, male sex, or younger age. These findings suggest that systematic inspection of the upper airway during bronchoscopy may offer additional diagnostic value, regardless of the operator's experience. The integration of upper airway assessment into routine bronchoscopic practice may enhance the early detection of clinically significant lesions and improve comprehensive patient care.