(220) Flexible Laryngoscopy in Resource-Limited Settings: A Review and Low-Cost Prototype Proposal

Introduction: Limited access to resources such as flexible laryngoscopes (FLs) in low-middle-income countries can hinder comprehensive otolaryngologic care. The availability of a low-cost FL that meets cleaning standards, provides clear laryngeal visualization and enables anesthesia-free diagnostics could improve patient outcomes in under-resourced settings. This study addresses the needs of otolaryngologists in resource-limited settings to guide the development of an affordable, durable FL for effective diagnosis.

Methods: A systematic review following PRISMA guidelines was conducted to assess designs, materials, and cost analysis of FLs currently used in low-resource settings. Inclusion and exclusion criteria were determined a priori by authors. PubMed and ScienceDirect were searched from 2016 until December 2024. Following the review, we defined specific needs criteria and sought affordable materials to develop an FL of comparable quality.

Results: Seventeen articles were reviewed, highlighting a lack of affordable otolaryngologic visualization methods in low-middle-income countries, with 11 studies emphasizing financial barriers. In response, we propose a low-cost FL prototype featuring an ergonomic handle, a control lever for distal bending, tubing with angulation wires, a distal chip camera, and an external light source and display, which incur one-time costs. Affordable, CDC-compliant materials compatible with Cidex OPA solution were identified for each component. The projected cost per unit, including disinfection, is $170—significantly lower than the $2,000–$12,000 market price—offering a viable solution for resource-limited settings.

Conclusions: FLs enable otolaryngologists to visualize the larynx but require high image quality and reliability. Developing an affordable, durable, and reusable FL for low-middle-income countries could address the high prevalence of otolaryngologic conditions caused by cost-driven disparities. Our proposed prototype offers a low-cost, ergonomic, durable, and CDC-compliant solution that is tailored to these needs.