Publication date: Jul 10, 2025

Since the COVID-19 outbreak in 2019 raised concerns about aerosol generation and germ spread during spray application for topical anesthesia before transnasal flexible laryngoscopy (TNF) procedure, and with the advent of smaller-diameter TNF scopes, we believed that patient satisfaction could still be achieved without topical anesthesia. This study aims to compare patient satisfaction during TNF using different topical anesthetic methods: lidocaine hydrochloride (HCl) spray, lidocaine HCl jelly, and no anesthesia. Single-center, double-blinded randomized controlled trial. A tertiary care otorhinolaryngology clinic. This study involved 210 patients aged 18-60 who underwent diagnostic TNF between October 2021 and December 2023 using 3 mm diameter TNF. Patients were enrolled and allocated into three groups. Postprocedure, patients rated their satisfaction and pain scores. Simultaneously, the clinician assessed satisfaction, difficulty of TNF insertion, and visualization quality. Procedural duration and adverse effects were also recorded. There were no statistically significant differences between groups for all outcomes, including patient satisfaction and pain scores, which were rated as “very satisfied,” with a median pain score of 0 in all groups (P values of 0. 21 and 0. 70, respectively). Similarly, no significant differences were observed among groups for physician satisfaction, TNF insertion difficulty, and visualization (P values of 0. 95, 0. 85, and 0. 55, respectively). Operation time also did not show a statistically significant increase (P value = 0. 96). Diagnostic TNF can be performed with or without topical lidocaine in the nasal spray or jelly, while maintaining high levels of patient and physician satisfaction when using smaller-diameter scopes. We recommend using lubricant alone as the standard approach in situations where minimizing the risk of aerosol generation is a priority, with lidocaine HCl jelly offered as an option for patients who express concern about procedural discomfort.

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