Exploring speech-language pathologists' training and use of topical nasal anaesthesia during laryngeal endoscopy in the United States

Background: Speech-language pathologists (SLPs) perform nasal laryngoscopy (LE) to assess voice and dysphagia-related disorders. The procedural aspects may include the use of topical nasal anaesthesia.

Aims: To explore the practice patterns of American Speech-Language-Hearing Association (ASHA)-certified SLPs use of anaesthesia during laryngeal endoscopy procedures in the United States METHODS & PROCEDURES: Data were collected via a brief computerized survey. A mixed methodology was employed. National representation across the United States was achieved.

Outcomes & results: Limited pre-licensure training in LE with the majority of educational content embedded in a voice course (64.7%) and post-academic training via live continuing education (CE) (58.8-72.5%). Pharmacology training was notably lacking in pre- and post-licensure groups. A total of 50% of post-licensure training occurred via interprofessional (IP) mentorship with significant correlations (LE confidence and skills r = 0.64, < 0.001, anaesthesia r = 0.74, < 0.001). However, when looking at confidence of knowledge as compared with skills for the procedure, 83% of participants reported high levels of confidence in their knowledge, yet 31.25% reported high levels of confidence in the skills to perform LE. Conversely, when looking at confidence of anaesthesia knowledge (20.83%) as compared with skills, participants were less confident in their knowledge yet more confident in the skills (31.25%) to administer anaesthesia.

Conclusions & implications: Bandura's Social Cognitive Learning Theory of 1986 with standardized use of vicarious and self-regulatory capabilities based on prior experiences and the use of IP mentorship during pre- and post-licensure education for LE may be beneficial in training. Limitations and suggestions for future research are additionally reported.

What this paper adds: What is already known on this subject Laryngeal endoscopy is an advanced competency procedure completed by SLPs used in the evaluation and treatment of voice and swallowing disorders. Standards for competency lack consistency. Simultaneously, topical nasal anaesthesia may be a component of some exams, yet training and, subsequently, competency is inconsistent. Education and training for use of anaesthesia and navigating potential complications is not a required element of graduate training for SLPs. While SLPs may be independent practitioners of the laryngeal endoscopy procedure, it is unclear if they, or others, are administering the anaesthesia within an IP practice model. What this study adds to the existing knowledge Laryngeal endoscopy is comparatively new within the field of SLP. There are no studies investigating the knowledge, skills, and practice patterns of SLPs related to the use of anaesthetic agents during such procedures. This study adds to the literature regarding the practices of a sample of SLPs in the United States regarding use of topical anaesthesia during flexible laryngeal endoscopy, their training in topical anaesthesia and use/barriers of IP teams during flexible laryngeal endoscopy. Initial insight relative to the variability of training and practice is documented with potential learning needs for SLPs related to pharmacology, patient safety and IP practice. What are the practical and clinical implications of this work? This study offers considerations for SLP graduate and postgraduate training in the areas of topical nasal anaesthesia use and laryngeal endoscopy procedures. The results show variability in training for completion of these exams which may contribute to patient safety and outcomes. Promoting an IP approach to care, specifically roles and responsibilities related to use of anaesthesia, may further benefit those we serve.