To compare the effectiveness of reducing discomfort during flexible nasal endoscopy using simple distraction techniques compared to topical anaesthetic spray and a control group that does not receive topical anaesthetic spray or a distraction technique.

In this randomised controlled study patients will be randomly allocated into one of four groups; the first group will receive topical (co-phenylcaine) anaesthetic spray without distraction, the second group will receive topical (co-phenylcaine) anaesthetic spray with distraction, the thirds group will receive no topical (co-phenylcaine) anaesthetic spray without distraction and the fourth group will receive no topical (co-phenylcaine) anaesthetic spray with distraction. The distraction technique that will be employed is counting backwards from 30 to 1 in even numbers only. All flexible nasal endoscopies will be performed by either of the two most senior clinicians involved in the study. The procedure will be carried out in standard outpatient clinic room setting. Post procedural discomfort assessments will be undertaken using a visual analogue scale (VAS). Power calculations shows that >24 patients would result in an adequately powered study (>80%). Data analysis will be undertaken by SPSS and independent T-tests will be performed to assess for statistical significance.

Inclusion Criteria:

• Male and Female participants aged 18+
• Patient requires flexible fiberoptic transnasal laryngoscopy.
• Patient has no preferences in relation to which arm of the study they would like to be in.

Exclusion Criteria:

• Flexible nasal endoscopy not indicated
• Local anaesthetic required for other reasons - e.g. vasoconstrictor effects
• Patient has a clear preference to which group they are randomised to
• Significant sino-nasal disease
• Patient under the age of 18