Background: Before nasal endoscopy, topical intranasal anesthetics and decongestant are usually used torelieve patients’pain and discomfort. Two methods of drug administration are usually performed, nasal packingvs.nasal spray. Objective: We compared the efficacy of nasal packing vs. nasal spray with 4% lidocaine and 3% ephedrine inpatients undergoing rigid nasal endoscopy in terms of pain, discomfort, clarity of view of lateral nasal anatomyand overall patient and examiner preference. Methods: A single-blinded randomized controlled clinical trial was conducted in 86 adult patients undergoingrigid nasal endoscopy at the Outpatient Department of Otorhinolaryngology, Faculty of Medicine, Khon KaenUniversity, Thailand. Nasal cavities were randomly selected to receive nasal packing or nasal spraying beforenasal endoscopic procedure. Outcomes were assessed for differences in pain, discomfort, clarify of nasalanatomy during nasak endoscopic procedures as well as patient and examiner preference. Results: There were statistically and clinically significant differences between the nasal spray groups and nasalpacking groups during drug administration in the number of patients who had less pain, 46 (56.1%) vs. 17(20.7%), patients’ pain score 2.36 vs. 3.20 and patient preference, 63.4% vs. 30.5%, respectively. During nasalendoscopic procedure, there were no clinically and statistically significant difference in the number of patientswho had less pain, less discomfort, pain score and discomfort score. There was also no statistically andclinically significant difference for the choice of method of drug administrations for nasal endoscopic examinationin the future. During nasal endoscopy, the endoscopist could see the middle meatus and superior meatus moreclearly when nasal packing group had been performed and the endoscopist expressed a clear preference fornasal packing. Conclusions: Nasal packing provided a clearer view of lateral nasal wall anatomy. This method of drug administrationwas preferred by the endoscopist. There were no clinically and statistically significance differences betweenboth methods in terms of patients’ overall preference.