Contact endoscopy is a technique of obtaining detailed magnified images of living epithelium, using a modified glass rod lens endoscope placed on the surface of the tissue. The technique has been extensively described in gynaecological, and more recently, laryngeal and nasal tissues. However, no quantitative studies of its diagnostic accuracy yet exist. A prospective partially blinded controlled study of eight cases with a variety of laryngeal pathologies is described. A single pathologist with no knowledge of the ultimate histological diagnoses successfully identified six of eight laryngeal pathologies on contact endoscopic findings, while the other two cases were identified to a degree of accuracy that was sufficient to positively identify the need for standard tissue biopsy. The advantages and disadvantages of the technique are described, along with suggestions for its role in clinical practice.