To Numb or Not To Numb: When Using Flexible Endoscopy

If you have ever watched an exam for voice or swallowing, you’ve possibly seen 2 different scopes being used. The rigid scope is placed on the tongue, and can view vibratory dynamics when paired with a stroboscopy light. A flexible scope is sent through the nose to view either vibratory dynamics when paired with a stroboscopy light OR to view swallow function with a constant light. Patients and clinicians alike wonder, should I use a numbing agent when using the flexible scope…Let’s discuss:


As a person who has been trained in the use of a flexible endoscope on others, who has used it on herself, and has had it used on her as a patient, I can say that there is nothing easy about this in your nose. It feels very thick and dry, and sometimes feels like it burns. It makes my eyes water, and the tip feels like an itchy bug at the back of my throat when I’m swallowing. I have had patients with an array of reactions to the scope, from, “Is that it?” to “You’re breaking my nose.” You need to educate your patients on the chance of vasovagal (fainting) response to this as well, which is a rare but valid reaction to this exam. Listening to your patient, pacing yourself and responding to their discomfort will truly help you build and keep a patient-caregiver bond and rapport.


The scope finding its way through the nasal passages is the most uncomfortable part of this exam. Knowing that you don’t need to spend all day in that area can help you explain to the patient that the worst part is almost over, or is over. When training to complete this exam, you’ll need to “follow the dark” and quickly, because you want to provide comfort when possible. You also want to keep the scope tip as straight as possible when sending it into the nose, as well as when you’re pulling it out. This means letting go of the toggle when you exit, and possibly toggling downward when you’re entering the nose to stay on the floor of the nasal passages.


According to Leder et al 1997, no significant differences were found among patients who received different types of nasal preparations. They applied a placebo (saline and flavoring), a topical anesthetic (tetracaine hydrochloride) and a vasoconstrictor (a drug that shrinks the inner tissues of the nose, this study used OTC ephedrine nasal solution) to 3 different groups among 152 patients. Still, they added 50 more patients with no substance on the flexible scope AT ALL and there were still no significant differences found.

What does this mean? According to that study and Singh 1997, you can feel confident that experienced clinicians can perform transnasal endoscopy without any substance on the scope or in the nose to people with comfort that is comparable to using lubricant, numbing agent, or a drug to make the nasal passages more spacious.


Lots of things need to be considered when administering a flexible endoscope for swallowing or voice evaluations, but patient preference, research and clinician experience aid in decision making.


  1. Singh, V., Brockbank, M.J., Todd, G.B. Flexible transnasal endoscopy: is local anesthetic necessary? Journal of Laryngology and Otology. July 1997;111:616-618.
  2. Leder, S.B., Ross, D.A., Briskin, K.B., Sasaki, C.T. A prospective, double-blind, randomized study on the use of a topical anesthetic, vasoconstrictor, and placebo during transnasal flexible fiberoptic endoscopy. Journal of Speech, Language and Hearing Research. 1997;40:1352-1357.

About the Author:

Kristie Knickerbocker, MS, CCC-SLP, is a speech-language pathologist and singing voice specialist in Fort Worth, Texas. She evaluates and rehabilitates voice, upper airway disorders and swallowing at her private practice, ATEMPO Voice Center, and lectures on voice science internationally. She is a classically trained mezzo soprano with a minor in vocal performance from Texas Christian University. She is a member of ASHA Special Interest Group 3, Voice and Upper Airway Disorders. She has collaborated on and authored multiple peer reviewed published research articles about her community-based voice specialty clinic. She continues to develop a line of instantly downloadable voice assessment and voice therapy materials on TPT or her ATEMPO voice center website. Follow her on Pinterest, on Instagram or like her on Facebook. Kristie is a founding member and co-owner of The Confident Clinician Cooperative and mentors on voice, upper airway, business and private practice through


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