Objective: Airway endoscopy is often performed in older and developmentally normal children to rule out laryngeal sources of orpharyngeal dysphagia. This study examines whether office-based flexible laryngoscopy (FL) can accurately identify laryngeal factors involved in dysphagia. Method: Nine-year retrospective chart review of children >2 years old who underwent microscopic laryngoscopy and rigid bronchoscopy (MLB) at a tertiary pediatric hospital. FL documentation was reviewed, and the findings were compared to MLB results. Children who did not undergo FL prior to MLB were excluded. Results: From the 763 records reviewed, 59 children over the age of 2 years underwent FL in clinic followed by MLB under anesthesia (M = 36, F = 23, mean age = 5.05 years, median age = 3 years). Diagnoses in clinic prior to MLB included oropharyngeal dysphagia (41%), chronic respiratory symptoms (ie, asthma, stridor, chronic cough; 37%), obstructive sleep apnea (25%), hoarseness (14%), and hemoptysis (2%). No patient was found to have a laryngeal cleft on either FL or MLB. However, laryngomalacia, airway erythema/edema, and subglottic stenosis were the most common laryngeal findings on FL (27%, 25%, 22%) and MLB (25%, 27%, 25%), respectively. Conclusion: Flexible laryngoscopy may be sufficient to rule out laryngeal cleft in older children with oropharyngeal dysphagia. Similarly, laryngomalacia, laryngeal edema, and subglottic stenosis are accurately diagnosed by FL when compared to MLB in children.