Optimization of Subglottic View During Flexible Laryngoscopy With Patient Positioning.

Area of Science:

• Otolaryngology
• Respiratory Medicine
• Medical Imaging

Background:

• Flexible laryngoscopy is crucial for evaluating the subglottic airway.
• Optimizing visualization is essential for accurate diagnosis and treatment planning.
• Current head positioning techniques may not consistently provide optimal views.

Purpose of the Study:

• To determine the ideal head position for maximizing subglottic visualization during flexible laryngoscopy.
• To compare the effectiveness of "sniffing," chin tuck (flexed), and stooping head positions.

Main Methods:

• Prospective cohort study involving 100 patients in a tertiary care airway clinic.
• Nasoendoscopic airway examinations were performed using three distinct head positions.
• Views were assessed by in-office and blinded reviewers using Cormack-Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS).

Main Results:

• Flexed and stooping positions significantly improved AG and VAS scores compared to the "sniffing" position (p < .01).
• No significant difference was found between flexed and stooping positions for AG and VAS.
• Older age correlated inversely with AG and VAS in the flexed position; higher BMI necessitated tracheoscopy for complete evaluation.

Conclusions:

• Both head flexion and stooping postures enhance subglottic visualization in awake, transnasal flexible laryngoscopy.
• These positions are valuable tools for experienced endoscopists.
• Head positioning is a modifiable factor to improve airway assessment accuracy.