Effect of Hypertonic Saline during Flexible Nasopharyngeal Laryngoscopy: A Double-Blinded, Randomized, Controlled Trial

Abstract

Objectives

Flexible nasopharyngeal laryngoscopy (NPL) is a cost-effective, simple procedure that provides visualization of the nasal airways. However, it involves a number of challenges for both the clinician and the patient. Hypertonic saline nasal wash is used to prevent nasal secretion in acute/chronic sinusitis and after nasal surgery. We aimed to determine the efficacy of hypertonic saline by comparing the clinician’s and patients’ experiences during NPL.

Methods

This prospective, double-blinded, randomized, controlled study was performed at a tertiary referral university hospital. Two hundred patients were randomly divided into hypertonic saline, lidocaine, xylometazoline, and isotonic saline groups. During NPL, the clinician’s experiences in terms of the quality of the field of view and the patients’ experiences in terms of pain and discomfort resulting from the 4 premedication drugs were compared.

Results

The groups differed significantly in terms of the clinician’s field of view, and patients’ pain scores and levels of discomfort (P < 0.025). The field of view results were the highest in the hypertonic saline group, and the lowest in the lidocaine group. The pain scores were the lowest in the lidocaine group, whereas they were the highest in the hypertonic saline group. The discomfort scores were the lowest in the xylometazoline group, but the highest in the lidocaine and isotonic saline groups.

Conclusion

The use of hypertonic saline facilitated the NPL procedure by improving the clinician’s field of view. Moreover, intranasal hypertonic saline reduced the patient’s discomfort. Intranasal hypertonic saline can be a good alternative to premedication before NPL.

Keywords:

• Hypertonic saline solutions
• sea water
• xylometazoline
• lidocaine
• satisfaction
• endoscopy

Acknowledgments

We would like to thank Mrs. Oya Erkan, who is an endoscopy nurse and who has contributed to this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

Conceiving and designing the study; or collecting the data; or analyzing and interpreting the data; MO, BC, OE; Writing the manuscript or providing critical revisions that are important for the intellectual content; MO, BC, OE, OO; Approving the final version of the manuscript; MO, BC, OO, NA.