Summary
Objective
Transnasal flexible laryngoscopy (TFL) is a simple, safe, and cost-effective procedure.
TFL is routinely performed to awake patients in a sitting position but there is no
a definite data about ideal head and neck position to be applied. The aim of this
study is to determine which position is most appropriate to obtain the best laryngeal
view during the TFL.
Methods
The TFL videos of 132 randomized patients were evaluated by three blind observers
experienced with laryngology. Three basic head positions; simple head extension (SHE),
sniffing position (SP), and neutral position (NP) were performed during the TFL-Interobserver
agreements for the grading system scores were assessed by using the kappa (k) statistic.
Results
For the SHE and SP, the numbers of patients constituting grade 1 were 127 (96.2%)
and 126 (95.5%), respectively, while grade 2a were 5 (3.8%) and 6 (4.5%), respectively.
In NP, the number of patients constituting grade 1 was 5 (3.8%), while grade 2a was
83 (62.9%), grade 2b was 37 (28%), and grade 3 was 7 (5.3%). The k score of the SHE was 0.826 (P < 0.001) between the ratings of observer 1 and observer 2, 0.905 (P < 0.001) between observer 1 and observer 3, and 0.919 (P < 0.001) between observer 2 and observer 3. These values denote nearly perfect agreement.
A complete agreement was seen in 130 of the 132 (98.48%) videos.
Conclusion
SHE and SP both provide a better glottic view than the NP and demonstrate the same
success.
Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of VoiceAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Can transnasal flexible fiberoptic laryngoscopy contribute to airway management decisions?.Anesth Analg. 2011; 112: 519-520
- Reliability of a transnasal flexible fiberoptic in-office laryngeal biopsy.JAMA Otolaryngol Head Neck Surg. 2013; 139: 341-345
- Advances in office-based diagnosis and treatment in laryngology.Laryngoscope. 2015; 125: 2630
- Head and neck position for direct laryngoscopy.Anesth Analg. 2011; 113: 103-109
- Management of the difficult adult airway. With special emphasis on awake tracheal intubation.Anesthesiology. 1991; 75: 1087-1110
- A grading system for transnasal flexible laryngoscopy.J Voice. 2018; (pii: S0892-1997(17)30617-3)
- Clinical grading of Reinke's edema.Laryngoscope. 2017; 127: 2310-2313
- A standardized lingual tonsil grading system: interexaminer agreement.Otolaryngol Head Neck Surg. 2015; 152: 667-672
- Endotracheal anesthesia.Am J Surg. 1936; 34: 450-455
- Comparison of the rate of successful endotracheal intubation between the "sniffing" and "ramped" positions in patients with an expected difficult intubation: a prospective randomized study.Korean J Anesthesiol. 2015; 68: 116-121
- Age and gender are important considerations in choosing the sniffing position for laryngoscopic view.Int J Med Sci. 2014; 11: 1258-1261
- Airway management by US and Canadian emergency medicine residents: a multicenter analysis of more than 6,000 endotracheal intubation attempts.Ann Emerg Med. 2005; 46: 328-336
- In-office laryngeal surgery with the 585 nm pulsed dye laser (PDL).Otolaryngol Head Neck Surg. 2007; 137: 477-481
- A randomized study comparing the sniffing position with simple head extension for glottis visualization and difficulty in intubation during direct laryngoscopy.Anesth Essays Res. 2017; 11: 762-766
- Office-based laryngology: technical and visual optimization by patient-positioning maneuvers.Laryngoscope. 2018; https://doi.org/10.1002/lary.27506
Article info
Publication history
Published online: December 20, 2018
Accepted:
November 13,
2018
Footnotes
This work was prepared in Gulhane Medical School and Birecik State Hospital, Departments of Otolaryngology, Head and Neck Surgery, Ankara and Sanliurfa, Turkey.
Funding source: No funding was received for this work from any organizations.
Identification
Copyright
© 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
