Bronchoscopy: Oral or Nasal Insertion?

Background: Flexible bronchoscopy is a frequently used procedure for the diagnosis and treatment of various lung disorders. As there is no standardized guideline on the insertion of the bronchoscope, and few studies are available on the subject, we conducted a prospective randomized controlled trial to compare nasal and oral insertion.
Methods: In total, 66 patients who underwent bronchoscopy without sedation were randomly assigned to either oral or nasal insertion. Primary and secondary outcome parameters were time to pass the vocal chords (VC) from first insertion and willingness to return (WTR).
Results: Time to pass the VC was significantly shorter with oral insertion compared with nasal insertion (median 24.43 vs. 52.33 s; P<0.001). WTR did not differ between the 2 groups [median score 4 (nasal) vs. 5 (oral); P=0.358 on a 10-point scale]. However, a significant correlation was found between WTR and the patients' experience with the insertion of the bronchoscope in both groups (r=0.639; P=<0.001). This correlation was strongest in the nasal group (r=0.809; P=<0.001). Conversion occurred more often in the nasal group than in the oral group (51.6% vs. 1.5%).
Conclusions: Time to pass the VC is shorter in oral insertion compared with that in nasal insertion. In particular, after nasal insertion, a negative experience of the patient was associated with a lower score on WTR. Therefore, we advise oral insertion for a nonsedated bronchoscopy with a >6.0-mm bronchoscope when there is no indication for inspection of the upper airways.