A Prospective, Double-Blind, Randomized Study on the Use of a Topical Anesthetic, Vasoconstrictor, and Placebo During Transnasal Flexible Fiberoptic Endoscopy

Abstract

The purpose of the present study was to compare patient comfort levels following administration of a topical anesthetic, vasoconstrictor, placebo, or nothing to the nasal mucosa prior to flexible fiberoptic transnasal endoscopy. Using a prospective, double-blind, randomized design, 152 consecutive patients were randomly assigned to receive a topical anesthetic (N = 54), vasoconstrictor (N = 50), or placebo (N = 48). No significant differences were found among the three variables. An additional 50 consecutive patients had endoscopy performed without administration of any substance to the nares, and no significant differences were found among the four variables (N = 202). It was concluded that speech-language pathologists can perform independent and comfortable transnasal endoscopy without administration of any substance to the nasal mucosa. Flexible fiberoptic endoscopy, however, should be performed by experienced clinicians with care taken to examine visually the patency of both nares for ease and comfort of scope insertion.

An Epidemiologic Study on Aging and Dysphagia in the Acute Care Hospitalized Population: 2000–2007

“…Briefly, each naris was examined visually and the scope passed through the most patent naris without administration of a topical anesthetic or vasoconstrictor to the nasal mucosa, thereby eliminating any potential adverse anesthetic reaction and assuring the endoscopist of a safe physiologic examination [12] . The base of the tongue, pharynx and larynx were viewed and swallowing was evaluated directly with 6 food boluses, each approximately 5 ml in volume.…”

A randomised controlled trial assessing the efficacy of co-phenylcaine nasal spray in flexible transnasal pharyngolaryngoscopy

“…Similar to our findings, other trials have shown that using a topical nasal spray does not reduce the severity of discomfort during NPL. 6,9,11 One of these studies, however, used sheaths, which increase the diameter of the endoscope, and also a one-minute interval between the spray and examination, which is insufficient for topical local anaesthesia to reach maximum effect. 11 The only trials that have shown significant reduction in discomfort were the two studies performed by Bonaparte et al 4,5 As both of these also included use of a Listerine ® oral rinse before performing NPL, the improved scores for discomfort could be attributed to the effect of the mouthwash rinse offsetting the overall bad taste of the nasal spray.…”

“…These include reduced sensitivity of the oropharynx and pharynx (which can affect the safety of swallowing, choking and gagging sensations) along with the remote possibility of hypersensitivity reactions. 8,11 Another common side effect is the unpleasant taste. This sensation can be very bothersome for the patient and may on its own result in refusal of anaesthetic spray before the examination.…”

Nasal and instrument preparation prior to rigid and flexible nasendoscopy: a systematic review

“…The latter study compared only vasoconstrictor and local anaesthetic ( finding no difference) and, as the study included no control group using no nasal preparation, it is not possible to conclude that use of a vasoconstrictor resulted in less unpleasantness. Indeed, as De Freitas and Hannah rightly point out, Leder and colleagues' four-arm trial 4 found no difference between anaesthetic, vasoconstrictor, placebo and nothing.…”