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Laryngo-pharyngeal RefluxNCT07696429

Effect of Topical Anesthesia on the Phonation Process During High-Speed Digital Imaging Laryngoscopy in Patients With Laryngopharyngeal Reflux

A study testing Lidocaine 10% Spray in people with Laryngo-pharyngeal Reflux, run by Mario Bilić at 1 site in Croatia.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The goal of this clinical trial is to learn if topical anesthesia (lidocaine spray) affects the phonation process during High-Speed Digital Imaging (HSDI) laryngoscopy in adults with laryngopharyngeal reflux (LPR). Read more about this study

Who is it for?
Ages 18 to 45 years
Conditions the study is for
Laryngo-pharyngeal Reflux
What is being tested?
Lidocaine 10% Spray
Could I receive a placebo?
Yes, some participants may receive a placebo
How many people
70 participants
Where
1 siteCroatia
Study dates
1 Mar 2019to 5 Dec 2021
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 45 years
  • All sexes
  • No healthy volunteers
  • Adult

Who may be able to join

  • Newly diagnosed laryngopharyngeal reflux (LPR), defined as Reflux Symptom Index (RSI) >13 and Reflux Finding Score (RFS) >7 Age 18-45 years No prior HSDI recording Ability to tolerate HSDI examination without topical anesthesia

Who cannot join

  • Known allergy to lidocaine and/or other allergens Acute respiratory infection within the preceding month Current smokers or regular alcohol consumers Chronic rhinosinusitis Prior surgery and/or radiotherapy of the larynx, neck, or thyroid gland Inability to visualize the full length of the vocal folds during the 2-second HSDI recording for anatomical reasons

Trial locations and contacts

1 site in 1 country.

Croatia1 site
  • University Hospital Centre Zagreb (KBC Zagreb), Department of ORL Head and Neck Surgery

    Zagreb, 10000

Other trials in Croatia

About this study

Official title: The Effect of Topical Anesthesia on the Phonation Process During High-Speed Digital Imaging Laryngoscopy in Patients With Laryngopharyngeal Reflux: A Randomized Double-Blind Placebo-Controlled Crossover Study

The goal of this clinical trial is to learn if topical anesthesia (lidocaine spray) affects the phonation process during High-Speed Digital Imaging (HSDI) laryngoscopy in adults with laryngopharyngeal reflux (LPR). The main questions it aims to answer are:

Does topical anesthesia change phonation process parameters (such as mucosal wave amplitude, glottal closure pattern, phase symmetry, and periodicity) as assessed on the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) form? Does topical anesthesia change the type of glottal insufficiency observed during phonation?

Read more

Researchers will compare HSDI recordings performed with topical anesthesia (lidocaine spray) to recordings performed with placebo (physiological saline) to see if topical anesthesia alters phonation process findings.

Participants will:

Undergo HSDI laryngoscopy recording on two consecutive days, once with topical anesthesia and once with placebo, in a randomized, double-blind order Have a detailed medical history taken and complete the Reflux Symptom Index (RSI) questionnaire Undergo fiberendoscopic examination for determination of the Reflux Finding Score (RFS) Return for a follow-up examination within three months, during which they will continue proton pump inhibitor therapy and hygienic-dietary measures

Read the detailed description

Standard clinical practice for rigid transoral laryngoscopy, including High-Speed Digital Imaging (HSDI), includes the elective use of topical anesthesia of the oral cavity and oropharynx; however, clearly defined recommendations and indications for its use are lacking, and its potential effect on the phonation process has not been unequivocally established. Upon application to the oral cavity and oropharynx, anesthetic may drain into the larynx and desensitize the mucosa, potentially affecting sensorimotor aspects of laryngeal function. Existing studies on the effect of topical anesthesia on phonation during laryngoscopy are limited and report contradictory findings.

This prospective, randomized, double-blind, placebo-controlled crossover study assigned each participant a unique number via random number generator, determining the order of recording modalities (even numbers recorded first with topical anesthesia, odd numbers first without). Once assigned, the order could not be changed. Randomization and testing order were concealed from the examiner performing the HSDI recording.

Topical anesthesia (lidocaine spray, 100 mg/ml, 0.1 ml per actuation) or physiological saline (placebo) was applied by a junior physician, blinded to the substance used, to the base of the tongue, posterior pharyngeal wall, and soft palate (one actuation per site). HSDI recording was performed 5 minutes after application. Each participant underwent recording in both modalities on two consecutive days, a period considered sufficiently short to avoid confounding phonotraumatic, hormonal, or health-related changes.

HSDI recordings were performed by an experienced otorhinolaryngologist and phoniatrician (>5 years of experience) using a rigid 90° endoscope (Wolf 5562 HRES ENDOCAM with Wolf Auto LP 5132 Hlight light source, Richard Wolf GmbH, Knittlingen, Germany). Participants were seated upright with the tongue held protruded; the endoscope was passed along the midline of the tongue to visualize the full length of the vocal folds. Participants phonated the vowel /a/ dynamically and frequentially, and a 2-second HSDI recording was captured. Recordings were reviewed for quality (minimum 1,000 clear, focused, consecutive images of the full vocal fold length during the steady phonation phase); inadequate recordings were repeated. Fundamental frequency and phonation intensity were recorded via a microphone mounted on the endoscope with software processing. Maximum Phonation Time was determined from three stopwatch-timed measurements of sustained /a/ phonation, taken immediately before and after HSDI recording.

Each HSDI recording was independently assessed by two experienced otorhinolaryngologists/phoniatricians (>5 years of experience) using visual-perceptual analysis. Discrepancies in parameter scoring were resolved through joint re-analysis and discussion until consensus was reached before proceeding to the next recording. Assessment was standardized using the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) form and the European Laryngological Society (ELS) form for glottal closure pattern classification, along with a modified classification of glottal insufficiency. The Reflux Finding Score was re-determined from recordings according to the Belafsky et al. classification.

Participants underwent a follow-up examination within three months of study participation, during which the Reflux Finding Score (via fiberendoscopy) and Reflux Symptom Index (via questionnaire) were re-assessed while participants continued regular proton pump inhibitor therapy and hygienic-dietary measures; participants with persistent pathological findings were excluded from final analysis.

Statistical analysis included the Kolmogorov-Smirnov test for normality of distribution. Normally distributed variables were described using means and standard deviations; non-normally distributed variables were described using medians and ranges. Differences between recordings with and without topical anesthesia were tested using the paired t-test (parametric) or Wilcoxon signed-rank test (non-parametric), as appropriate. Spearman correlation and regression analysis were used to explore associations between anatomical structures and measured characteristics. A p-value <0.05 was considered statistically significant.

Being tested
Lidocaine 10% Spray, Placebo
Keywords
High-Speed Digital Imaging, Topical Anesthesia, Lidocaine, Laryngopharyngeal Reflux, Phonation
Medical subject headings
Laryngopharyngeal Reflux

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Lidocaine 10% SprayDrug

    Also called Xylocaine spray

    Lidocaine spray, 100 mg/ml, administered topically as one actuation (0.1 ml) each to the base of the tongue, posterior pharyngeal wall, and soft palate, approximately 5 minutes prior to HSDI laryngoscopy. Administered once per participant, on one of the two study days according to randomized sequence assignment.

  • PlaceboDrug

    Also called Normal saline spray; 0.9% NaCl spray

    Physiological saline (0.9% NaCl) spray, administered topically as one actuation (0.1 ml) each to the base of the tongue, posterior pharyngeal wall, and soft palate, approximately 5 minutes prior to HSDI laryngoscopy. Administered once per participant, on one of the two study days according to randomized sequence assignment, identical in application technique to the lidocaine intervention.

Study groups in NCT07696429
Study groupRoleWhat they receive
Anesthesia-First Sequence (A→B)ExperimentalParticipants received topical anesthesia (lidocaine spray, 100 mg/ml) applied to the base of the tongue, posterior pharyngeal wall, and soft palate on Day 1, followed by HSDI laryngoscopy 5 minutes later. On Day 2, the same participants received placebo (physiological saline), identically applied, followed by HSDI laryngoscopy. Order was determined by randomization.
Receives: Drug: Lidocaine 10% Spray; Drug: Placebo
Placebo-First Sequence (B→A)Placebo comparatorParticipants received placebo (physiological saline) applied to the base of the tongue, posterior pharyngeal wall, and soft palate on Day 1, followed by HSDI laryngoscopy 5 minutes later. On Day 2, the same participants received topical anesthesia (lidocaine spray, 100 mg/ml), identically applied, followed by HSDI laryngoscopy. Order was determined by randomization.
Receives: Drug: Lidocaine 10% Spray; Drug: Placebo

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Change in Phonation Process Parameters Assessed by the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) Form

    Parameters assessed by visual-perceptual analysis of HSDI recordings using the VALI form: glottal sufficiency pattern, mucosal wave amplitude, free edge amplitude, vertical level of the vocal folds, non-vibrating segment of the vocal fold, supraglottic structure activation, free edge contour, open-to-closed phase ratio of the glottal cycle, phase symmetry of the vocal folds, periodicity, and axis shift of the vocal folds. Each recording was independently scored by two blinded raters, with discrepancies resolved by consensus.

    Measured: Assessed once per recording session; each participant recorded on 2 consecutive days (with and without topical anesthesia)

  2. Change in Glottal Closure Pattern (European Laryngological Society Classification)

    Glottal closure pattern during the initial phase of the glottal cycle, classified according to the European Laryngological Society (ELS) form (e.g., concave, convex, straight, complex), assessed by visual-perceptual analysis of HSDI recordings.

    Measured: Assessed once per recording session; each participant recorded on 2 consecutive days (with and without topical anesthesia)

  3. Change in Type of Glottal Insufficiency (European Laryngological Society Classification)

    Type of glottal insufficiency during phonation, classified according to a modified European Laryngological Society (ELS) classification (e.g., complete glottal closure, incomplete closure in the cartilaginous part of the glottis), assessed by visual-perceptual analysis of HSDI recordings.

    Measured: Assessed once per recording session; each participant recorded on 2 consecutive days (with and without topical anesthesia)

  4. Change in Acoustic Voice Parameters (Fundamental Frequency and Phonation Intensity)

    Fundamental frequency (F0, Hz) and phonation intensity (dB) during phonation of the sustained vowel /a/, recorded via a microphone mounted on the endoscope with software processing.

    Measured: Assessed once per recording session; each participant recorded on 2 consecutive days (with and without topical anesthesia)

  5. Change in Maximum Phonation Time (MPT)

    Maximum duration (seconds) of sustained, dynamically stationary phonation of the vowel /a/ following maximal inhalation, determined as the longest of three stopwatch-timed trials performed immediately before and after HSDI recording.

    Measured: Assessed immediately before and after each HSDI recording session; each participant recorded on 2 consecutive days (with and without topical anesthesia)

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted10 Jul 2026
  2. Study start1 Mar 2019
  3. Primary completion5 Jan 2021
  4. Study completion5 Dec 2021

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Diagnosis
Allocation
Randomised
Intervention model
Crossover
Model description
Two-period, two-sequence crossover design. Each participant underwent HSDI laryngoscopy on two consecutive days, receiving topical anesthesia (lidocaine spray) on one day and placebo (physiological saline) on the other. Sequence order was determined by randomization (even-numbered participants: anesthesia first; odd-numbered: placebo first) and could not be altered once assigned.
Masking
Triple blind
Who is masked
Participant, Care provider, Outcomes assessor
Enrolment
70 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07696429
Sponsor's protocol ID
Class No.8.1-19/31-2
Status last verified
Jun 2026
First submitted
6 Jul 2026
Last updated
10 Jul 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No: Individual participant data are not made publicly available due to privacy and confidentiality restrictions related to patient health information. De-identified data underlying the results reported in this publication may be made available by the corresponding author upon reasonable request, subject to institutional and ethics committee approval.

Questions about this trial

What is this clinical trial studying?

A study testing Lidocaine 10% Spray in people with Laryngo-pharyngeal Reflux, run by Mario Bilić at 1 site in Croatia.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 10 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Croatia. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. Some participants in this study may receive a placebo. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Change in Phonation Process Parameters Assessed by the Voice-Vibratory Assessment with Laryngeal Imaging (VALI) Form (time frame: Assessed once per recording session; each participant recorded on 2 consecutive days (with and without topical anesthesia)). The study lists 5 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 10 Jul 2026.

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