With the arrival of flexible fibreoptic laryngoscope some 35 years ago, the examination of the laryngopharynx has become remarkably easier and saves immense time and costs since the days of mirror examination when this examination was not truly satisfactory in at least half the number of patients. However, despite using an anaesthetic spray, there is a noticeable proportion of patients who reel under discomfort and some need to be called in as they cannot tolerate the procedure. There have been some publications in the past which did not show any clear benefits of using local anaesthetic sprays, but this is probably the first study which assesses the role of visual distraction in alleviating discomfort at the time of this outpatient procedure. Twenty-four patients were divided into four groups, two with and without anaesthetic but no visual distraction and the other two with and without the local anaesthetic but with visual distraction.

It was noted that it did not make any statistically significant difference whether or not local anaesthetic was applied, but use of visual distraction, namely the patient watching the procedure on the monitor, significantly reduced the discomfort level.

The authors are aware of the small numbers used but the study should help in making this common outpatient procedure more tolerable.

The use of visual distraction to improve the tolerability of flexible laryngoscopy.
Biggs TC, Henderson A, Shelton F, Patel NN.
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Madhup K Chaurasia

Mid and South Essex NHS Foundation Trust, UK.

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