title: Topical nasal anesthesia for transnasal fiberoptic laryngoscopy: a prospective, double-blind, cross-over study.
abstract: BACKGROUND
  Transnasal fiberoptic laryngoscopy (TFL) is frequently performed by otolaryngologists, speech language pathologists, and various other health care providers. Historically, topical sprays have been administered to patients to decongest and anesthetize the nasal mucosa, thus minimizing the discomfort of the procedure. Recently, it was reported that patients undergoing TFL with topical anesthesia experienced no improvement in comfort compared with those who received oxymetazoline or saline. This observation is in direct opposition to our clinical experience that patients tolerate the procedure better with topical anesthesia.
  
  
  OBJECTIVE
  We sought to compare patient comfort levels during TFL after the administration of cocaine, oxymetazoline, or saline.
  
  
  METHODS
  Fifteen subjects undergoing TFL were prospectively evaluated. Each had TFL performed on 3 separate occasions. Before TFL, each patient received either 4% cocaine, 0.05% oxymetazoline, or saline topically administered via an atomizer to both nasal cavities (1 spray of 2-second duration). By the conclusion of the study, each patient had undergone TFL with each of the test agents. The subjects rated the discomfort they experienced on a scale ranging from 1 (minimal discomfort) to 5 (severe discomfort). Both patient and examiner were blinded to the test agent used.
  
  
  RESULTS
  The mean nasal discomfort score for saline was 2.8 +/- 1.1. The scores for oxymetazoline and cocaine were 3.4 +/- 0.9 and 2.0 +/- 0.9, respectively. Compared with saline and oxymetazoline independently, TFL with topical cocaine appeared to provide more comfort (P < 0.05 and P < 0.005).
  
  
  CONCLUSIONS
  The continued routine use of topical anesthetics such as cocaine before the performance of TFL is justified because it significantly decreases the patient's discomfort.
authors.affiliation: Center for Voice Disorders of Wake Forest University, Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Johnson
authors.forename: Peter C
authors.initials: PC
authors.lastname: Belafsky
authors.forename: Gregory N
authors.initials: GN
authors.lastname: Postma
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000772:Anesthesia, Local; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007828:Laryngoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009666:Nose; D010146:Pain / Q000517:prevention & control*; D011446:Prospective Studies