Which one is favorable in the elderly? Transoral rigid laryngoscopy or transnasal flexible fiberoptic laryngoscopy.

Abstract

To determine whether transoral rigid laryngeal endoscopy (TORLE) or transnasal flexible fiberoptic laryngoscopy (TNFFL) is more favorable for laryngeal endoscopic examination in the elderly population. This randomized prospective study carried out in a tertiary reference center. TORLE or TNFFL were performed to patients who were over 65years at their first visit according to randomization list. At their second visit, other method was performed. Patients' physiological parameters (Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and oxygen (O2) saturation before and immediately after laryngeal examination were recorded. Patients' pain-irritation, gag reflex, and dyspnea status were evaluated using visual analog scale after first and second endoscopic examinations. Further patient preferences for TORLE and TNFFL were recorded. Of 96 patients included in the study, 69.8% (n=67) preferred TORLE while 30.2% (n=29) preferred TNFFL. Major factor influencing patient preferences was pain-irritation in TNFFL. Pain-irritation scores were significantly higher in TNFFL than those in TORLE (p<0.001). However, no significant difference was found between two methods with respect to gag reflex and dyspnea scores (p=0.194, p=0.327, respectively). In TORLE, there was no statistically significant difference between the values measured before and after examination in terms of SBP, DBP, HR, and O2 saturation (p=0.641, p=0.134, p=0.119, p=0.414, respectively). However, in TNFFL, statistically significant decrease was observed after examination in HR and O2 saturation (p<0.001, p<0.001, respectively). TORLE is more suitable for laryngeal examination in elderly patients since it is more comfortable for patient and does not change physiological parameters.