Optimization of Subglottic View During Flexible Laryngoscopy With Patient Positioning.
airway
in-office procedures
laryngoscopy
subglottis
Journal
Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery
ISSN: 1097-6817
Titre abrégé: Otolaryngol Head Neck Surg
Pays: England
ID NLM: 8508176
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
revised:
25
05
2023
received:
13
03
2023
accepted:
03
06
2023
medline:
22
11
2023
pubmed:
31
7
2023
entrez:
31
7
2023
Statut:
ppublish
Résumé
Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy. Prospective cohort study. Outpatient multidisciplinary airway clinic at a tertiary care center. Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: "sniffing," chin tuck, and stooping positions. In-office reviewers and blinded clinician participants evaluated views of the airway based on Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student's t test, analysis of variance, and Tukey's post hoc analysis. One hundred patients participated. No statistical differences existed among in-clinic or blinded reviewers for the CL score in any head position (p = .35, .5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in-clinic and blinded reviewers (p < .01 for all analyses), but there was no statistical difference between these two positions (p = .28, .18, respectively). There was an inverse correlation between age and scores for AG and VAS in the flexed position for both sets of reviewers (p = .02, <.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (p < .01). Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1556-1563Informations de copyright
© 2023 American Academy of Otolaryngology-Head and Neck Surgery Foundation.
Références
Itamura K, Hur K, Kokot NC, Johns MM. Trends in diagnostic flexible laryngoscopy and videolaryngostroboscopy utilization in the US Medicare population. JAMA Otolaryngol Head Neck Surg. 2019;145(8):716-722. doi:10.1001/jamaoto.2019.1190
Marrugo-Pardo G, Villalobos-Aguirre MC. The confusion between asthma and subglottic stenosis can cause an adverse event during intubation. A case report. Colombian J Anesthesiol. 2017;45:82-85. doi:10.1016/j.rcae.2017.09.003
Nunn AC, Nouraei SAR, George PJ, Sandhu GS, Nouraei SAR. Not always asthma: clinical and legal consequences of delayed diagnosis of laryngotracheal stenosis. Case Rep Otolaryngol. 2014;2014:325048. doi:10.1155/2014/325048
Tasli H, Birkent H, Karakoc O, Gokgoz MC. Optimal position for transnasal flexible laryngoscopy. J Voice. 2020;34(3):447-450. doi:10.1016/j.jvoice.2018.11.006
Ghodke A, Farquhar DR, Buckmire RA, Shah RN. Office-based laryngology: technical and visual optimization by patient-positioning maneuvers. Laryngoscope. 2019;129(2):330-334. doi:10.1002/lary.27506
Killian G. The Mouth of the Esophagus (Special Communications). Vol 17. Wiley; 1907.
Nouraei SAR. Chapter 39: intubation-related tracheal stenosis. In: Allen J, Nouraei SR, Sandhu GS, eds. Laryngology: A Case-Based Approach. Plural Publishing; 2020:399-422.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inf. 2009;42(2):377-381. doi:10.1016/j.jbi.2008.08.010
Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inf. 2019;95:103208. doi:10.1016/j.jbi.2019.103208
Yentis SM, Lee DJH. Evaluation of an improved scoring system for the grading of direct laryngoscopy. Anaesthesia. 1998;53(11):1041-1044. doi:10.1046/j.1365-2044.1998.00605.x
Koh LKD, Kong CF, Ip-Yam PC. The modified Cormack-Lehane score for the grading of direct laryngoscopy: evaluation in the Asian population. Anaesth Intensive Care. 2002;30(1):48-51. doi:10.1177/0310057X0203000109
Lin E, Jiang J, Noon SD, Hanson DG. Effects of head extension and tongue protrusion on voice perturbation measures. J Voice. 2000;14(1):8-16. doi:10.1016/s0892-1997(00)80090-9
Purser S, Antippa P. Maneuver to assist examination of the hypopharynx. Head Neck. 1995;17(5):389-393. doi:10.1002/hed.2880170505
Sakai A, Okami K, Sugimoto R, et al. A new technique to expose the hypopharyngeal space: the modified Killian's method. Auris Nasus Larynx. 2014;41(2):207-210. doi:10.1016/j.anl.2013.10.012
Menapace DC, Ekbom DC, Larson DP, Lalich IJ, Edell ES, Kasperbauer JL. Evaluating the association of clinical factors with symptomatic recurrence of idiopathic subglottic stenosis. JAMA Otolaryngol Head Neck Surg. 2019;145(6):524-529. doi:10.1001/jamaoto.2019.0707