title: Patient tolerance of awake, in-office laryngeal procedures: a multi-institutional perspective.
abstract: OBJECTIVE
  An increasing number of laryngeal procedures are performed in the office. However, little is known about how well these procedures are tolerated and what factors determine success or failure.
  
  
  METHODS
  Prospectively collected patient and physician surveys from five surgeons at two institutions describe patient tolerance of awake, in-office laryngeal procedures (AIOLPs).
  
  
  METHODS
  There were 154 procedures performed in a 6-month period, including vocal fold injection (VFI) (72%), laser treatment (19%), and transnasal esophagoscopy (3%). Average duration of procedure was 13 ± 8 minutes.
  
  
  RESULTS
  Patients reported an average of 37 of 100 on a discomfort scale, with 0 representing no discomfort and 100 representing maximal discomfort. Ninety-three percent of patients would undergo another procedure, and 96% would recommend AIOLPs to other patients. Procedures were completed successfully in 92%. Most common surgeon-reported difficulties included copious secretions and uncontrolled gag reflex. Procedures that involved such difficulties had a significantly lower rate of procedure completion, 73% vs. 96%, P = .0001. High preprocedure anxiety did not adversely impact patient comfort or procedure completion rate. There was no difference in discomfort scores based on VFI approach or patient familiarity with AIOLPs. There was a significant difference in discomfort score between patients with successful first-approach VFI and those who required a change in VFI approach, 36.0 vs. 61.3, respectively, P = .003. The rate of requiring a second and third VFI approach was 4.6% and 2.8%, respectively.
  
  
  CONCLUSIONS
  This study encompasses multiple diagnoses, procedures, VFI techniques, and methods of anesthesia. AIOLPs are exceptionally well tolerated by patients, resulting in extremely high completion and satisfaction rates.
authors.affiliation: University of Pittsburgh Voice Center, Department of Otolaryngology-Head and Neck Surgery, Pittsburgh, Pennsylvania, USA. youngvn@upmc.edu
authors.forename: Vyvy N
authors.initials: VN
authors.lastname: Young
authors.forename: Libby J
authors.initials: LJ
authors.lastname: Smith
authors.forename: Lucian
authors.initials: L
authors.lastname: Sulica
authors.forename: Priya
authors.initials: P
authors.lastname: Krishna
authors.forename: Clark A
authors.initials: CA
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods / Q000523:psychology*; D016292:Procedural Sedation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007818:Laryngeal Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods / Q000523:psychology*; D010045:Outpatients / Q000523:psychology*; D017060:Patient Satisfaction; D011379:Prognosis; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014851:Wakefulness; D055815:Young Adult