Pharyngeal Mucosal Conditioning to Prevent Postoperative Sore Throat in Septoplasty Patients With Severe Nasal Obstruction: A Double-Blind RCT

Postoperative sore throat (POST) affects 21-65% of patients after endotracheal intubation and is among the most common complaints after general anesthesia. Patients presenting for septoplasty with severe nasal obstruction (NOSE score ≥55) are habitual chronic mouth-breathers, having bypassed nasal air conditioning for months to years preoperatively. This produces a documented state of pharyngeal mucosal dehydration and inflammation that precedes any surgical event - making these patients a distinct high-risk subgroup for POST that has never been identified or studied. This double-blind RCT will test whether a simple, low-cost multimodal pharyngeal mucosal conditioning strategy - nebulized 0.9% normal saline (5 mL over 15 minutes, 30 minutes before induction) combined with a water-soluble lubricant gel applied to the endotracheal tube - reduces POST incidence and severity compared to standard care (sham nebulization plus plain water on the ETT). 105 adults aged 18-60 years with NOSE score ≥55 scheduled for elective septoplasty under general anesthesia will be randomized 1:1. The primary outcome is POST incidence at 1 hour post-extubation assessed by a blinded PACU nurse. Secondary outcomes include POST severity (VAS 0-10) at 1h, 6h, and 24h; hoarseness; dysphagia; PONV; time to first analgesic; and preoperative pharyngeal mucosal hydration measured by the Modified Schirmer Test.

Inclusion Criteria: * Age 18 to 60 years * ASA physical status I or II * NOSE score ≥55 (severe or extreme nasal obstruction category) at preoperative assessment * Duration of nasal obstruction symptoms ≥6 months * Scheduled for elective septoplasty ± turbinoplasty under general anesthesia with endotracheal intubation * Mallampati class I or II * BMI ≤35 kg/m² * Written informed consent obtained Exclusion Criteria: * Current or past smoker (any amount) * Gastroesophageal reflux disease (GERD) or laryngopharyngeal reflux (LPR) * Known pharyngeal or laryngeal pathology * Active upper respiratory tract infection within 2 weeks of scheduled surgery * Preoperative sore throat or baseline pharyngeal pain at time of assessment * Anticipated difficult airway (Mallampati class III-IV, mouth opening less than 3 cm) * ACE inhibitor use (causes dry cough, confounds POST assessment) * Concurrent tonsillectomy, adenoidectomy, or rhinoplasty extending operative time beyond 90 minutes * Known allergy to lubricant gel components * Severe systemic disease affecting mucosal hydration (Sjögren's syndrome, uncontrolled diabetes mellitus, end-stage renal disease) * Pregnancy or breastfeeding * Previous participation in this study