Intranasal Topical Local Anesthetic and Decongestant for Flexible Nasendoscopy in Children

Abstract

This study revealed no statistically significant difference in the discomfort experienced by children undergoing flexible nasendoscopy after placebo, decongestant, or TLA with decongestant. Decongestant was associated with the least discomfort (on child, caregiver, and observer-rated pain scale scores) and the lowest rating for difficulty of procedure. With these findings, the study suggests that there is no significant benefit of topical decongestant with or without TLA compared with placebo in reducing pain associated with pediatric flexible nasendoscopy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01351298.

Delayed presentation of an undiscovered nasopharyngeal foreign body

“…However, as there was documented evidence that no foreign body was seen on examination under anaesthetic it was placed further down the differential diagnosis list and initially not considered at all. Atypical symptoms such as halitosis, intermittent epistaxis, snoring and obstructive sleep apnoea,3 all which our patient had, should perhaps push clinicians to investigate more promptly in the context of a previous foreign body inhalation. Investigations should also be expedited even in the case of cancellations.…”

“…Recent studies have shown that there is no statistical difference in discomfort for children undergoing flexible nasendoscopy after a placebo, topical anaesthetic or nasal decongestants 3. It should therefore be attempted however, if not tolerable the examination of the postnasal space should take place at the time of general anaesthesia.…”

Emergency Department care of childhood epistaxis

“…In young children for whom topical anaesthesia is contraindicated, the administration of oral analgesia, such as acetaminophen, should be performed to decrease suffering. Only one randomised double-blind study13 in children (aged 3–12 years) compared the use of a local anaesthetic (lidocaine hydrochloride 1%) combined with a decongestant (xylometazoline hydrochloride, Nasa Rhinathiol 0.05%) to the use of a decongestant alone (xylometazoline hydrochloride 0.05% nasal spray) or to a placebo (normal saline solution) before performing a flexible nasal endoscopy. This study showed no statistically significant difference between the three solutions as to the level of pain; decongestant nasal spray alone was associated with the lowest score of pain.…”

Consensus statement by the American Association of Clinical Endocrinology (AACE) and the American Head and Neck Society Endocrine Surgery Section (AHNS‐ES) on Pediatric Benign and Malignant Thyroid Surgery

“…Committee consensus: between agree and strongly agree (7.6) multifocal or bilateral malignant thyroid disease (see below). 23,24 Laryngeal US may be considered as an alternative to endoscopy to evaluate vocal fold motion if the examination adequately demonstrates glottic function. 25…”