Research Article| Volume 33, ISSUE 5, P712-715, September 2019

A Grading System for Transnasal Flexible Laryngoscopy



      Transnasal flexible laryngoscopy (TFL) is becoming more popular in laryngology clinical practice. There has not been any grading system for TFL to help the physician document and communicate the laryngeal view yet. In this study, we aimed to classify the laryngeal view based on the visualization of the glottic aperture with TFL performed on conscious patients.


      The TFL videos of 920 randomized patients were evaluated by three blind observers experienced with laryngology. The laryngeal view, consisting of the basic anatomic landmarks of the glottis, arytenoids, and epiglottis, was examined, and the glottic aperture was classified with a five-point grading system. Interobserver agreements for the grading system scores were assessed by using the kappa (k) statistic.


      Nine hundred and twenty subjects were enrolled in the study. Six hundred and thirty-eight (69.3%) were men, and 282 (30.6%) were women, and the mean age was 40.13 ± 15.08 (18–89 years). The number of patients constituting grade 1 was 737 (80.1%), while grade 2a was 122 (13.2%), grade 2b was 32 (3.4%), grade 3 was 24 (2.6%), and finally, grade 4 was only 5 (0.5%). The k score was 0.945 (P < 0.001) between the ratings of observer 1 and observer 2, 0.933 (P < 0.001) between observer 1 and observer 3, and 0.91 (P < 0.001) between observer 2 and observer 3.


      This new grading system for the laryngeal view can help physicians assess the upper airways, and it can also help visualize how much of a glottic opening there is.

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