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].