Distraction Therapies for Office-Based Otolaryngology Procedures Performed on the Upper Airway

To assess the effectiveness of auditory and visual distraction interventions on patient discomfort, pain and anxiety during office-based otolaryngologic upper airway procedures.

Literature searches were done through Cochrane Central Register of Controlled Trials, Lilacs, MEDLINE, Embase, PsycINFO and Cumulative Index to Nursing and Allied Health Literature.

The protocol was registered in PROSPERO on August 17th 2022, under Registration number CRD42020204354.

We identified 138 records; two randomised controlled trials using virtual reality as a distraction technique in adults and one in children were included. All studies had some concerns regarding risk of bias. In adults, anxiety was lower in the virtual reality group than in the standard of care, (mean difference -16.72, 95% CI -27.19 to -6.24, p = 0.002, I ² = 0%). There was no difference in procedure related pain between groups, (mean difference -0.28, 95% CI -1.24 to 0.68, p = 0.57, I ² = 10%). There was no difference in satisfaction between groups (standardised mean difference 0.18, 95% CI -0.22 to 0.58, p = 0.37, I ² = 0%). Only one Paediatric study was included hence no meta-analysis was done. Anxiety and pain were lower and satisfaction was higher in the group using virtual reality.

The use of virtual reality distraction in addition to standard analgesia during office-based otolaryngology upper airway procedures reduced anxiety in adults. It did not decrease pain or increase the level of patient satisfaction. In the paediatric population, there is a reported benefit for procedural anxiety, pain and satisfaction.