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The use of visual distraction to improve the tolerability of flexible laryngoscopy

  • T C Biggs (a1), A Henderson (a1), F Shelton (a1) and N N Patel (a1)



Flexible laryngoscopy is a commonly performed procedure in otolaryngology. Although this procedure is not considered painful, many patients describe it as uncomfortable. This study investigated the role of visual distraction as a form of pain relief during flexible laryngoscopy.


The study included patients undergoing flexible laryngoscopy at the University Hospital Southampton. Patients were self-allocated to one of four groups: with or without co-phenylcaine anaesthetic spray; and with and without visual distraction. Visual distraction involved the patient watching the procedure concurrently with the clinician, via a video monitor. Pre- and post-procedural discomfort was assessed using a visual analogue scale.


The use of topical anaesthetic spray was not associated with significantly reduced discomfort scores (p > 0.05). Discomfort scores were significantly reduced in the visual distraction groups (p = 0.04), irrespective of the use of topical anaesthetic spray.


This small study showed that visual distraction should be considered as a simple and cost-effective alternative to local anaesthetic for flexible laryngoscopy.


Corresponding author

Author for correspondence: Mr Timothy Biggs, Department of Otolaryngology, Head and Neck Surgery, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK E-mail:


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Mr T Biggs takes responsibility for the integrity of the content of the paper



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1Holsinger, FC, Kies, MS, Weinstock, YE, Lewin, JS, Hajibashi, S, Nolen, DD et al. Videos in clinical medicine. Examination of the larynx and pharynx. N Engl J Med 2008;358:e2
2Leder, SB, Ross, DA, Briskin, KB, Sasaki, CT. A prospective, double-blind, randomized study on the use of a topical anesthetic, vasoconstrictor, and placebo during transnasal flexible fiberoptic endoscopy. J Speech Lang Hear Res 1997;40:1352–7
3Smith, JC, Rockley, TJ. A comparison of cocaine and ‘co-phenylcaine’ local anaesthesia in flexible nasendoscopy. Clin Otolaryngol Allied Sci 2002;27:192–6
4Pothier, DD, Awad, Z, Whitehouse, M, Porter, GC. The use of lubrication in flexible fibreoptic nasendoscopy: a randomized controlled trial. Clin Otolaryngol 2005;30:353–6
5Singh, V, Brockbank, MJ, Todd, GB. Flexible transnasal endoscopy: is local anaesthetic necessary? J Laryngol Otol 1997;111:616–18
6National Institute for Health and Care Excellence. Lidocaine with phenylephrine. In: [26 January 2018]
7Johnson, PE, Belafsky, PC, Postma, GN. Topical nasal anesthesia for transnasal fiberoptic laryngoscopy: a prospective, double-blind, cross-over study. Otolaryngol Head Neck Surg 2003;128:452–4
8Choudhury, N, Amer, I, Daniels, M, Wareing, MJ. Audiovisual distraction reduces pain perception during aural microsuction. Ann R Coll Surg Engl 2013;95:34–6
9Lee, DW, Chan, AC, Wong, SK, Fung, TM, Li, AC, Chan, SK et al. Can visual distraction decrease the dose of patient-controlled sedation required during colonoscopy? A prospective randomized controlled trial. Endoscopy 2004;36:197201
10Marsdin, E, Noble, JG, Reynard, JM, Turney, BW. Audiovisual distraction reduces pain perception during shockwave lithotripsy. J Endourol 2012;26:531–4



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