The role of virtual reality in nasal procedures: a randomized controlled trial

Patients undergoing routine office-based otorhinolaryngology procedures, such as nasal endoscopy, often experience distress, pain, and anxiety. Although local anesthesia is typically used, it may not always be suitable due to contraindications. Virtual reality (VR) emerges as a potential solution. Research suggests that VR provides distraction and alters pain perception through visual stimuli, significantly decreasing pain during various medical procedures. The immersive nature of VR could benefit otolaryngology patients by managing pain and reducing discomfort during procedures. This study investigates the impact of VR on pain management, anxiety reduction, and overall patient satisfaction during otolaryngology procedures in our clinic, addressing a gap in adult-focused VR research.

This randomized controlled trial was conducted on 64 patients aged 18-65 who attended the outpatient clinic at our tertiary hospital, for their routine office-based otorhinolaryngology procedures, and consented to participate in this study, from September 2024 to December 2024. Data were gathered on patients' demographics, pain scores using a validated Numerical Rating Scale from 1 to 10, which provides quantifiable continuous data for statistical analysis while capturing patients' subjective pain experience (22), and anxiety levels using a validated Subjective Units of Distress Scale (SUDS), offering numerical distress ratings from 10 to 100 (23). Additionally, we assessed postprocedural patient satisfaction and willingness to undergo VR again using a validated five-point Likert scale (1-5), which provides ordinal qualitative data reflecting patient perceptions of satisfaction (24). Before data collection, we powered a two-sample, two-sided t-test to detect a standardized between-group effect size of Cohen's d = 0.70 with α = 0.05 and 80% power. This yields n =32 per arm (N = 64). Randomization was performed using REDCap software, assigning participants to either the VR intervention group (1) or the control group (2). Blinding was not feasible due to the visible nature of VR. Descriptive statistics summarized demographic data, and mean and standard deviation were calculated for continuous variables. Inferential statistics, including t-tests and χ² tests, compared pain scores, anxiety levels, satisfaction, and willingness between different demographic groups. The work has been reported in line with the consort criteria.

This randomized controlled trial demonstrates the potential of VR as a transformative tool to enhance patient experiences during medical procedures. Pain scores in the VR group were significantly reduced, dropping from an average of 3.81 out of 10 during past procedures without VR to 1.78 out of 10 during current procedures with VR. Patients in the VR group also reported lower pain scores compared to the control group, who had an average pain score of 2.56 out of 10. Anxiety levels showed a trend toward improvement, with the VR group reporting an average score of 15 out of 100 on the SUDS, compared to 18.125 out of 100 in the control group, although this difference was not statistically significant (P = 0.31). Patient satisfaction was markedly higher in the VR group, with an average score of 4.91 out of 5, compared to 4.69 out of 5 in the control group. Nearly all patients in the VR group, accounting for 93%, rated their satisfaction as 5 out of 5 (Very Satisfied). Additionally, 73% of patients in the VR group expressed the highest level of willingness to use VR for future procedures (Very Willing). These findings underscore the ability of VR to significantly reduce pain, enhance satisfaction, and provide meaningful benefits for patients undergoing medical procedures.

Despite limitations including sample size and single-center design, these findings support that VR has the potential to become an additional tool to improve patient comfort and satisfaction, and ultimately enhance the quality of care we deliver for otolaryngology office-based procedures. Further research is warranted.