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Effects of Topical Nasal Anesthetic on Fiberoptic Endoscopic Examination of Swallowing with Sensory Testing (FEESST)

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Abstract

Objections to the use of topical nasal anesthesia (TNA) during fiberoptic endoscopic evaluation of swallowing (FEES) with sensory testing (FEESST) have been raised, primarily because of the possibility of desensitizing the pharyngeal and laryngeal mucosa and affecting both the sensory and motor aspects of the swallow. Furthermore, it has been suggested that TNA is not necessary during FEES as it does not improve patient comfort or make the procedure easier for the endoscopist. The purpose of this double-blind, randomized, controlled, crossover clinical trial was to determine how gel TNA during flexible endoscopic evaluation of swallowing with sensory testing affects sensation, swallowing, and comfort rating scores in healthy nondysphagic participants. Laryngopharyngeal sensory thresholds and swallowing durations were compared between two conditions: TNA and sham. Transition duration decreased statistically significantly during the TNA condition compared to the sham for 10 ml only (p < 0.05). All other swallowing measures did not change between the conditions. Laryngopharyngeal sensory thresholds and perceptions did not change between conditions. No change was observed for subject comfort scores, ease of exam, or quality of view. Future studies should evaluate TNA administration variables, including concentration, dosage amount, and method of application, to determine the optimal strategy for providing comfort while avoiding altered swallowing.

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Acknowledgments

This study was supported in whole by NIH/NINDS R21 HD055677 and in part by NICHHD HD055269, NCRR RR20146, DC011824, GM103425, and UL1TR000039.

Disclosures

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Audiology and Speech Pathology, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 826, Little Rock, AR, 72205, USA

    Erin E. Kamarunas

  2. Arkansas Consortium for the Ph.D. in Communication Sciences, 4301 West Markham, Slot 826, Little Rock, AR, 72205, USA

    Erin E. Kamarunas

  3. Department of Speech-Language Pathology, University of Central Arkansas, 201 Donaghey Ave, UCA Box 4985, Conway, AR, 72034, USA

    Gary H. McCullough

  4. Department of Neurobiology and Developmental Sciences, University of Arkansas for Medical Sciences, 4301 West Markham, Slot 826, Little Rock, AR, 72205, USA

    Tiffany J. Guidry & Mark Mennemeier

  5. Department of Neurology, Conway Regional Hospital, 2200 Ada Ave, St 305, Conway, AR, 72034, USA

    Keith Schluterman

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  1. Erin E. Kamarunas
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  2. Gary H. McCullough
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  3. Tiffany J. Guidry
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Correspondence to Erin E. Kamarunas.

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Kamarunas, E.E., McCullough, G.H., Guidry, T.J. et al. Effects of Topical Nasal Anesthetic on Fiberoptic Endoscopic Examination of Swallowing with Sensory Testing (FEESST). Dysphagia 29, 33–43 (2014). https://doi.org/10.1007/s00455-013-9473-x

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  • DOI: https://doi.org/10.1007/s00455-013-9473-x

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