Pain Experience and Tolerance of Awake In-Office Upper Airway Procedures: Influencing Factors

Chad W. Whited, Jonathan Lubin, Nicholas Marka, Ian J. Koszewski, Matthew R. Hoffman, Stephen Schoeff, Seth H. Dailey

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objectives/Hypothesis: Awake, unsedated in-office upper airway procedures are performed frequently and have high completion rates, yet less is known about the patients' pain experience and potentially influencing factors. It is also unclear if patients' pain experiences become worse with repeated procedures. We identified procedure- and patient-related factors that might influence procedural completion and pain scores. Study Design: Retrospective chart review. Methods: Pre-, intra-, and post-procedure pain scores were collected prospectively for awake unsedated upper airway procedures performed at a single institution over a 5-year period. Patient factors reviewed were demographics, body mass index, psychiatric and/or pain diagnosis, and related medications. Procedure factors reviewed were procedure type, route, side, and performance of the same procedure multiple times. Patients reported their pain level before, during, and after the procedure using a standard 0 to 10 scale. Maximum pain score change (PΔmax), or the difference between highest and lowest reported pain levels, was calculated. Descriptive and multivariate analyses were performed. Results: Procedure completion was 98.7% for 609 first time patients and 99.0% in 60 patients undergoing 292 repeat procedures. PΔmax did not covary with age, gender, or BMI. PΔmax covaried with pain and psychiatric conditions and associated medications. PΔmax was highest for injection medialization and lowest for tracheoscopy. PΔmax decreased over time for those undergoing multiple identical procedures. Conclusions: Procedures were performed with a very high completion rate and low pain scores. Age, sex, and BMI did not affect pain experience. A combination of pain and psychiatric conditions did. Injection medialization had the highest PΔmax and tracheoscopy the lowest. Level of Evidence: 4 Laryngoscope, 131:E1580–E1588, 2021.

Original languageEnglish (US)
Pages (from-to)E1580-E1588
Issue number5
StatePublished - Nov 16 2020

Bibliographical note

Funding Information:
The authors wish to acknowledge the additional statistical support of Glen Leverson, PhD, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI and Zhumin Zhang, PhD Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Publisher Copyright:
© 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA)


  • Laryngology
  • Patient experience
  • in-office procedure
  • pain


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