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Published on: February 12, 2015
Sex Differences in Predicting Difficult Laryngeal Exposure: Validation and Modification of Predictive Models
Kiyohito Hosokawa1, Masayuki Nozawa2, Yusuke Otami2
1Department of Otorhinolaryngology and Head & Neck Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Otorhinolaryngology, Japan Community Health Care Organization (JCHO) Osaka Hospital, Suita, Osaka, Japan.
Objectives/Hypothesis:
To determine the presence of sex differences in difficult laryngeal exposure and the Laryngoscore, validate the Laryngoscore, mini-Laryngoscore, and Clarysse's model for predicting difficult laryngeal exposure, and modify the Laryngoscore for improved prediction accuracy.
Study Design:
Retrospective study.
Methods:
This study included 153 patients who underwent laryngeal microsurgery at a tertiary laryngology center and university hospital. Patients were evaluated using the 11 items of the Laryngoscore, mini-Laryngoscore, and Clarysse's model to predict difficult laryngeal exposure. Difficult laryngeal exposure was defined as the inability to view the anterior commissure through a rigid laryngoscope under counterpressure to the anterior neck. Descriptive statistics and receiver-operating characteristic curve analysis were used to assess the diagnostic performance of the predictive models and variables, including sex.
Results:
The prevalence of difficult laryngeal exposure was significantly higher in men than in women, despite higher Laryngoscore values in females. The Laryngoscore, mini-Laryngoscore, and Clarysse's model demonstrated good diagnostic performance with C-indexes of 0.751, 0.727, and 0.783, respectively. Based on these findings, we proposed a modified Laryngoscore, including treatment history, interincisors gap, upper jaw dental status, thyro-mental distance, degree of neck flexion-extension, and sex, achieving a C-index of 0.835.
Conclusions:
Inclusion of sex in the Laryngoscore and related predictive models enhances the accuracy of predicting difficult laryngeal exposure. These findings support the inclusion of sex as a factor in future modifications of these models to improve their predictive performance.
