Effects of Topical Nasal Anesthesia on Fiberoptic Endoscopic Examination of Swallowing with Sensory Testing

Abstract

Purpose: Objections to the use of topical nasal anesthesia (TNA) during Fiberoptic Endoscopic Evaluation of Swallowing (FEES) with sensory testing (FEESST) have been raised, primarily the possibility of desensitizing the pharyngeal and laryngeal mucosa and affecting both the sensory and motor aspects of the swallow. Furthermore, it has been suggested that TNA is not necessary during FEES as it does not improve patient comfort or make the procedure easier for the endoscopist. Previous investigations into TNA with FEES and FEESST have utilized spray TNA, which is contrary to the recommendations of the original FEES protocol. The purpose of this study is to determine how gel TNA during Flexible Endoscopic Evaluation of Swallowing with Sensory Testing (FEESST) affects sensation, swallowing, and comfort rating scores in healthy nondysphagic participants.

Method: This was a double-blind, randomized, controlled, crossover clinical trial with 36 participants enrolled in which measures are taken under two conditions occurring on separate days: .4 mL of 2% viscous lidocaine vs. .4 mL of lubricant (sham) applied to the same naris. Laryngopharyngeal sensory thresholds and swallowing durations were compared between the two conditions. Comfort level, ease of exam, and quality of view are determined by general labeled magnitude scale and compared between the two conditions.

Results: Transition duration decreased statistically significantly during the TNA condition compared to the sham for 10 ml only (p<.05). All other swallowing measures did not change between the conditions. Laryngopharyngeal sensory thresholds and perceptions did not change between conditions. No change was observed for subject comfort scores, ease of exam, or quality of view.

Conclusion: The amount of gel lidocaine used in this study applied to the naris prior to flexible endoscopic exam does not detrimentally alter the sensory or motor aspects of the swallow, no does it improve the experience for the patient or make the procedure easier for the endoscopist. Future studies should evaluate TNA administration variables, including concentration, dosage amount, and method of application to determine the optimal strategy for providing comfort while avoiding altered swallowing.