Vol.:(0123456789) 1 3 European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-019-05519-0 MISCELLANEOUS A pilot study to determine the efects of nasal co‑phenylcaine on drug‑induced sleep endoscopy Alfonso Luca Pendolino 1,2  · Ivor Kwame 1  · Anne‑Lise Poirrier 3  · Maral J. Rouhani 1  · Samit Unadkat 1  · Giuliana Preti 4  · Giancarlo Ottaviano 2  · Peter J. Andrews 1,5  · Bhik Kotecha 1 Received: 13 April 2019 / Accepted: 11 June 2019 © The Author(s) 2019 Abstract Purpose The use of nasal decongestant and nasal anaesthesia is currently not recommended during drug-induced sleep endoscopy (DISE) according to the European position paper. The evaluation of the efects of nasal decongestant/anaesthesia on DISE has not been performed before and our aim is to perform a pilot study to determine whether nasal decongestants/ anaesthesia afects DISE outcomes. Methods 27 patients undergoing DISE for OSA or for simple snoring were included. On each patient, DISE was performed twice, before and approximately 10 min after the administration of two pufs of co-phenylcaine nasal spray (lidocaine hydrochloride 5%, phenylephrine 0.5%, and benzalkonium chloride 0.01%) into each nostril. A nasal peak inspiratory fow was used for the objective assessment of nasal airway obstruction. During the frst and the second DISE the loudness of the snoring was also recorded. Results Change in DISE total grading after nasal spray administration was not statistically signifcant. For the same grading, changes in percentage of contribution to collapse were not statistically signifcant. Sex, AHI, BMI, tonsils grade, presence of rhinitis, turbinate hypertrophy, nasal septal deviation, or nasal peak inspiratory fow limitation had no infuence on the efect of nasal spray. Co-phenylcaine did not signifcantly infuence the loudness of snoring. Conclusions Our pilot study supports the use of co-phenylcaine nasal spray during DISE and the positive efects of the nasal spray do not infuence the grading outcome. Importantly, the decongestant enhances the nasal assessment during DISE and potentially aids in the diagnosis of nasal obstruction while the nasal anaesthetic component may be benefcial by reducing nasal discomfort during DISE and thereby helping to reduce the total dose of intravenous anaesthetic administered. However, further studies on a larger population are needed to confrm our results. Keywords Drug-induced sleep endoscopy · Obstructive sleep apnoea · Snoring · Nasal obstruction · Nasal decongestants · Nasal anaesthesia Introduction Obstructive sleep apnoea (OSA) is the most common sleep- disordered breathing (SDB) disease encountered with a prevalence of 3–17% in the adult population and is associ- ated with an increasing rate of morbidity and mortality [1, 2]. Drug-induced sleep endoscopy (DISE) is a widespread procedure and is considered today as the most common diag- nostic procedure for upper airway (UA) endoscopic evalua- tion for snoring and obstructive sleep apnoea (OSA). Since its first description in 1991, DISE has gained increasing popularity, and evidence reports a good correla- tion between DISE fndings and treatment outcomes [3, 4]. UA evaluation in awake OSA patients has limited usefulness * Peter J. Andrews peterandrews@nhs.net Alfonso Luca Pendolino alfonso.pendolino@nhs.net 1 Department of ENT, Royal National Throat, Nose and Ear Hospital, 330 Grays Inn Rd, Kings Cross, London WC1X 8DA, UK 2 Department of Neurosciences, Otolaryngology Section, University of Padova, Padova, Italy 3 ENT Department, University Hospital of Liege, Liege, Belgium 4 Otolaryngology Section, Koelliker Hospital, Turin, Italy 5 Ear Institute, UCL, London, UK