Post-intubation laryngeal injuries: incidence, types, and outcomes in a tertiary setup

Endotracheal intubation is a routine yet critical procedure during general anesthesia that can cause a spectrum of laryngeal injuries, potentially affecting vocal function and airway integrity. The route of intubation, oral versus nasal, may influence the incidence and severity of such injuries, but evidence is inconclusive.

This study aims to prospectively compare the incidence, severity, and clinical impact of laryngeal injuries following oral and nasal intubation in adult patients undergoing elective surgeries under general anesthesia.

A prospective observational study was conducted involving 67 patients scheduled for elective surgery with endotracheal intubation. Patients were allocated into oral (n = 35) and nasal (n = 32) intubation groups based on surgical requirements. Flexible fiberoptic laryngoscopy was performed within six hours of extubation to evaluate laryngeal injuries, graded using the Eckerbom classification. Hoarseness severity was assessed and recorded. Statistical analysis including chi-square tests and multivariate logistic regression identified predictors of injury and compared groups, with significance set at p < 0.05.

The incidence and severity of laryngeal injuries did not significantly differ between oral and nasal intubation groups (p = 0.67). Grade 0 injury (no visible abnormality) was predominant (oral 65.7%, nasal 71.9%). Hoarseness severity distribution was also comparable (p = 0.78). Multivariate analysis revealed no significant association between injury occurrence and variables including tube size, duration of intubation, or number of intubation attempts.

Oral and nasal routes of endotracheal intubation demonstrated comparable rates and severity of post-intubation laryngeal injuries in this cohort. Skilled intubation technique remains paramount to minimizing complications regardless of route.