Comparison of tolerance and cost-effectiveness of two nasal anesthesia techniques for transnasal flexible laryngoscopy.
OBJECTIVE
(1) Compare tolerance of aerosolized spray versus syringe administration of topical anesthesia for transnasal flexible laryngoscopy (TFL), (2) analyze cost-effectiveness of both techniques.


METHODS
Prospective, blinded, randomized trial.


METHODS
Tertiary academic laryngology practice.


METHODS
One hundred and eight patients underwent TFL over 3 months. Patients were randomized to receive equivalent dose 1:1 neosynephrine/4% plain lidocaine mixture via aerosolized spray ("spray") or application with 1-cc syringe ("syringe"). Patients and physicians independently rated comfort of TFL on 5-point scale (1 = not at all comfortable to 5 = very comfortable). Data were collected on patient and endoscopist experience with TFL and reasons for poor tolerance of laryngoscopy. Cost analyses of disposable spray tips and syringes were calculated.


RESULTS
Both patients and physicians reported very high tolerance of TFL. Patient tolerance appears to be similar between spray- versus syringe-administered anesthesia, although study limitations preclude definitive analysis. Poor tolerance of laryngoscopy was reported in 6.5% with comparable distribution between anesthetic delivery methods. There was no impact of patient prior experience with TFL, and there was no difference between anesthetic methods for TFL performed by resident, fellow, or attending. The difference between costs of the disposable spray tip versus syringe was $1.32 per unit.


CONCLUSIONS
Use of a 1-cc syringe is an effective method to provide topical nasal anesthesia for TFL and saves $1.32 per unit compared to disposable spray tips. In our practice, transition to syringe-administered nasal anesthesia is projected to save $1300 per 1000 patients, or an anticipated $1000 per year per physician, with excellent patient tolerance of TFL.
University of Pittsburgh Voice Center Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
VyVy N
VN
Young
Libby J
LJ
Smith
Clark A
CA
Rosen
D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000772:Anesthesia, Local / Q000191:economics* / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D015552:Injections, Intralesional / Q000191:economics; D020704:Laryngoscopes; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods*; D008012:Lidocaine / Q000008:administration & dosage* / Q000191:economics; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000187:drug effects; D059085:Nasal Sprays; D010147:Pain Measurement / Q000187:drug effects; D017060:Patient Satisfaction; D011446:Prospective Studies; D016037:Single-Blind Method; D013594:Syringes / Q000191:economics
D000779:Anesthetics, Local; D059085:Nasal Sprays; D008012:Lidocaine
anesthesia; cost effectiveness; laryngoscopy; office procedure; patient tolerance