Background: In otolaryngology, a nasal endoscopy is a crucial and frequent diagnostic procedure that examines the nasal cavity and nasopharynx.The present study was conducted to compare 4% lidocaine with 3% ephedrine used on nasal packs or as a nasal spray. Materials & Methods: 80 patients with nasal, paranasal sinus or nasopharyngeal diseases who needed to be examined by rigid nasal endoscopy were divided into 2 groups of 40 each. In group I, nasal cavity was packed by cotton sized 1x1 cm which was soaked with mixed solution of 4% lidocaine and 3% ephedrine (1:1). In group II, the other nasal cavity was sprayed at the upper and lower parts with a solution of 4% lidocaine and 3% ephedrine (1:1) via an atomizer (three puffs per each surface). After 10 minutes, nasal endoscopy was done. Parameters such as pain, discomfort, clarify of nasal anatomy during nasal endoscopic procedures were recorded. Results: The mean patient pain score was 3.8 in group I and 2.4 in group II. The difference was significant (P< 0.05). The mean discomfort score was 2.9 in group I and 2.7 in group II. The difference was non- significant (P> 0.05). Clarify of view during nasal endoscopy in middle meatus was 60.4% in group I and 39.6% in group II, in superior meatus was 51.2% in group I and 49.8% in group II, sphenoethmoidal recess was 55.8% in group I and 44.2% in group II and in nasopharynx was 57% in group I and 43% in group II. The difference was non- significant (P> 0.05). Conclusion: In contrast to nasal spray with an atomizer, nasal packing with cotton soaked in topical anesthetic and decongestant should be done before to endoscopy.