Pain and Discomfort during Flexible Nasolaryngoscopy: A Randomized, Controlled Trial Assessing the Efficacy of Oral Mouthwash and Topical Lidocaine

Purpose: To test the hypothesis that using Listerine mouthwash prior to administration of topical nasal lidocaine will result in improved pain and comfort outcomes during flexible nasolaryngoscopy (FNL). Design: Randomized, controlled trial. Subjects: A total of 120 patients were randomized to receive a combination of either treatment or placebo mouthwash followed by treatment or placebo nasal spray prior to an FNL examination. Outcome Measures: Pain and discomfort using a 100 mm visual analogue scale. Results: The use of lidocaine significantly reduced pain (p = .011) and discomfort (p = .008) compared to placebo nasal spray. Using Listerine prior to administration of lidocaine resulted in the largest reductions. Patients having an extended nasal examination reported more pain (p = .001) and discomfort (p = .03) levels while demonstrating a greater benefit of topical lidocaine compared to those undergoing a primary laryngeal examination (p < .001). Discussion: Using Listerine prior to application of lidocaine nasal spray reduces the pain and discomfort of FNL. This effect was most clinically significant in patients undergoing an extended or full bilateral nasal examination.