Clinical Medicine Insights: Ear, Nose and Throat

Background: Nasal preparation prior to flexible laryngoscopy is a common ENT practice. Co-phenylcaine is increasingly used because it is safe and has both anaesthetic and vasoconstrictive properties. Lidocaine 4% and epinephrine 1:1000 nasal packing is another method used in our department.

Methods: A prospective case series was performed on eighty-one patients requiring flexible laryngoscopy. Patients were enrolled into either a co-phenylcaine or a lidocaine/epinephrine packing group. Visual analogue scales (VAS) were used to record unpleasantness of nasal preparation and flexible laryngoscopy. Decongestion and ease of endoscope passage were recorded by the doctors.

Results: Bad taste was statistically significantly worse when using cophenylcaine for nasal preparation (P = 0.001). However, there was no statistically significant difference in overall unpleasantness from nasal preparation or from subsequent flexible laryngoscopy between the two groups. There was no statistically significant difference in degree of decongestion or ease of endoscope passage between the two groups.

Conclusion: There is no statistically significant advantage of using cophenylcaine spray over non-proprietary lidocaine 4% and epinephrine 1:1000 nasal packing. However cost and bad taste is less with nasal packing.