Hypnosis protocol
Prior to the HISE, patients benefited from 3 hypnosis sessions to prepare the patient to the HISE. The hypnosis session was performed in a soundproof room with softened lighting and ambient temperature respecting the recommendations of French hypnosis society. The first, second, and third hypnosis sessions were performed in seated, half-seated and supine positions, respectively. The traditional steps of the conversational hypnosis protocol included induction, dissociation, hypnotic trance, confusion-metaphor relaxation, suggestion and re-association [5]. The following steps were added in the last session after the relaxation: explanation and introduction of the portable nasofiberscope (Xion®, 3.7mm, Xion inc., Germany) into the patient upper aerodigestive tract and an evaluation of the acceptance of the procedure. The otolaryngologist did not use nasal/local anesthesia before the nasofibroscopy in both hypnosis session and HISE. The light of the nasofiberscope was turned on after the introduction of the fiberscope to avoid the light-related wake up of the patient. To proceed with sensitivity, the otolaryngologist stopped the fibroscopy progression in the nasopharynx a few seconds without touching the soft palate. The muscle relaxation was assessed at this time through the observation of the soft palate relaxation or vibration in case of snoring. The next step of the procedure consisted of the assessment of the pharyngeal cavity through the velum oropharynx tongue base epiglottis (VOTE) classification system [6].