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Flexible transnasal pharyngolaryngoscopy (NPL) is one of the most common procedures in otolaryngology performed in both outpatient and ward settings. Although NPL is safe and straightforward, it is often uncomfortable and sometimes intolerable. A small proportion of patients may also refuse to allow the procedure to be repeated.
The efficacy of topical anaesthesia before NPL remains controversial. Two studies published in 2008 (a meta-analysis)1 and 2011 (a Cochrane review)2 did not find any evidence to support the use of topical treatment before flexible nasal endoscopy. However, the majority of the studies included in the Cochrane review were impaired by small sample sizes and poor data reporting, and failed to address significant confounding variables. The authors concluded that further randomised controlled trials should be performed and that the trials should follow the recommendations of the CONSORT (Consolidated Standards of Reporting Trials) statement3 in order to ensure that reporting is clear, that the methods can be properly assessed and that the data are in a form that can be used in meta-analysis.
There have also been two recently published randomised controlled trials, which have shown a significant reduction in the discomfort associated with flexible nasal endoscopic examination after using topical lidocaine spray with Listerine® mouthwash (Johnson & Johnson, New Brunswick, NJ, US).4,5 Furthermore, our personal experiences indicate that there are still variations in practice within and between ear, nose and throat (ENT) departments across the UK. We therefore conducted a double blind randomised controlled trial to assess whether preparation of the nose prior to NPL is effective.
Methods
A parallel randomised controlled trial was conducted at a district general hospital in August 2014. Allocation of the participants was carried out using a computer generated list of random numbers (http://www.sealedenvelope.com/). Participants were stratified with 1:1 allocation using block sizes of 4, 6 and 8. For this trial, co-phenylcaine (5% lidocaine and 0.5% phenylephrine) topical nasal spray (Aurum Pharmaceuticals, Brentwood, UK) was chosen as the investigative medicine as it is one of the most commonly used and readily available nasal sprays in ENT departments in the UK. The co-phenylcaine spray and placebo spray were prepared in identical bottles, numbered consecutively for each patient according to the randomisation schedule. One of the research coordinators who...