title: Use of topical nasal anesthesia during flexible endoscopic evaluation of swallowing in dysphagic patients.
abstract: OBJECTIVE
  This study aimed to determine the effect of topical lidocaine on Penetration-Aspiration Scale (PAS) scores and patient comfort and tolerance of flexible endoscopic evaluation of swallowing (FEES) examinations in dysphagic patients.
  
  
  METHODS
  Adults with dysphagia referred for swallowing evaluation were recruited to participate in consecutive nonanesthetized and then anesthetized FEES examinations. Under endoscopic visualization, participants consumed 6 swallows consisting of graduated volumes of milk, pudding, and cracker in each condition and recorded their discomfort and tolerance in the 2 conditions. Penetration-Aspiration Scale scores were assigned in blinded fashion for each swallow.
  
  
  RESULTS
  Twenty-five adults participated in the study. Although there was no statistically significant effect of anesthesia on PAS scores (P=.065), the odds of a higher PAS score were 33% higher during anesthetized swallows. The anesthetized condition yielded significantly less discomfort and pain during the examination, significantly less pain and discomfort during insertion and removal of the endoscope, and significantly greater overall tolerance than the nonanesthetized condition.
  
  
  CONCLUSIONS
  The use of topical lidocaine during FEES may impair swallowing ability in patients with dysphagia, but this result does not achieve statistical significance. Topical nasal anesthesia significantly reduces subjective pain and discomfort and improves tolerance during FEES.
authors.affiliation: Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
authors.forename: Tim A
authors.initials: TA
authors.lastname: Fife
authors.affiliation: Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA sbutler@wakehealth.edu.
authors.forename: Susan G
authors.initials: SG
authors.lastname: Butler
authors.affiliation: Department of Otolaryngology, Boston Medical College, Boston, Massachusetts, USA.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Langmore
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Lester
authors.affiliation: Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
authors.forename: S Carter
authors.initials: SC
authors.lastname: Wright
authors.affiliation: Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
authors.forename: Shannon
authors.initials: S
authors.lastname: Kemp
authors.affiliation: The Analysis Factor, Brooktondale, New York, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Grace-Martin
authors.affiliation: Department of Otolaryngology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, USA.
authors.forename: Catherine Rees
authors.initials: CR
authors.lastname: Lintzenich
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003679:Deglutition / Q000502:physiology*; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000503:physiopathology; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000779:Anesthetics, Local
keywords: anesthesia; aspiration; dysphagia; endoscopy