Jennifer M Siu, Nikolaus E Wolter, Meghan E Tepsich, Alexander M Treble, Samantha Goh, Alex J Osborn, Evan J Propst
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The most distal view of the subglottis in each position was evaluated with 4 rating scales: (1) subjective view (SV); of the subglottis and trachea, (2) airway grade (AG); most distal anatomical structure visualized, (3) airway area (AA); percentage of the subglottis visualized; and (4) modified Cormack-Lehane grade.</p><p><strong>Results: </strong>Twenty children had 80 FNL views blindly evaluated by 5 pediatric otolaryngologists. The SV, AG, and AA were all significantly better with the neck flexed compared to a neutral position (7.3 vs 3.0, interquartile range [IQR]: 2.0-6.8, P < .001; 2.3 vs 1.5, IQR: 1.0-2.0, P < .001; 3.4 vs 1.7, IQR: 2.3-3.8, P = .001). There was no difference in the modified Cormack-Lehane grade between positions. Interrater reliability was excellent or strong (0.93-0.94, confidence interval: 0.91-0.93).</p><p><strong>Conclusion: </strong>FN-FNL is a simple maneuver performed in children undergoing FNL that partially improves the subjective visualization of the subglottis.</p>","PeriodicalId":19707,"journal":{"name":"Otolaryngology- Head and Neck Surgery","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Flexed-Neck Flexible Nasolaryngoscopy for Evaluation of the Subglottis and Trachea in Children.\",\"authors\":\"Jennifer M Siu, Nikolaus E Wolter, Meghan E Tepsich, Alexander M Treble, Samantha Goh, Alex J Osborn, Evan J Propst\",\"doi\":\"10.1002/ohn.1132\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Determine if a flexed-neck posture during flexible nasolaryngoscopy (FNL) improves visualization of the subglottis.</p><p><strong>Study design: </strong>Retrospective review of children undergoing FNL in the neutral (FNL) and flexed-neck (FN-FNL) positions.</p><p><strong>Setting: </strong>Tertiary children's hospital.</p><p><strong>Methods: </strong>FNL was performed with each child's head in neutral and flexed-neck positions. Videos in each posture were captured and randomized. The most distal view of the subglottis in each position was evaluated with 4 rating scales: (1) subjective view (SV); of the subglottis and trachea, (2) airway grade (AG); most distal anatomical structure visualized, (3) airway area (AA); percentage of the subglottis visualized; and (4) modified Cormack-Lehane grade.</p><p><strong>Results: </strong>Twenty children had 80 FNL views blindly evaluated by 5 pediatric otolaryngologists. The SV, AG, and AA were all significantly better with the neck flexed compared to a neutral position (7.3 vs 3.0, interquartile range [IQR]: 2.0-6.8, P < .001; 2.3 vs 1.5, IQR: 1.0-2.0, P < .001; 3.4 vs 1.7, IQR: 2.3-3.8, P = .001). There was no difference in the modified Cormack-Lehane grade between positions. Interrater reliability was excellent or strong (0.93-0.94, confidence interval: 0.91-0.93).</p><p><strong>Conclusion: </strong>FN-FNL is a simple maneuver performed in children undergoing FNL that partially improves the subjective visualization of the subglottis.</p>\",\"PeriodicalId\":19707,\"journal\":{\"name\":\"Otolaryngology- Head and Neck Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2025-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Otolaryngology- Head and Neck Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1002/ohn.1132\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"OTORHINOLARYNGOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Otolaryngology- Head and Neck Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ohn.1132","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"OTORHINOLARYNGOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的：确定柔性鼻咽喉镜检查（FNL）时颈部弯曲的姿势是否能改善声门下的可视化。研究设计：回顾性分析在中性体位（FNL）和屈颈体位（FN-FNL）下进行FNL的儿童。单位：三级儿童医院。方法：患儿头部均取中性位和屈颈位进行FNL。每种姿势的视频都被捕获并随机化。采用4种评定量表对声门下各体位的远端视点进行评定：(1)主观视点（SV）；声门下和气管，(2)气道分级（AG）；最远端解剖结构可见，(3)气道区域（AA）；声门下可见的百分率；(4)改性Cormack-Lehane级。结果：20例患儿经5名儿科耳鼻喉科医师盲目评价FNL影像80张。与中立位相比，颈部屈曲时SV、AG和AA均显著改善（7.3 vs 3.0，四分位数间差[IQR]: 2.0-6.8， P）。结论：FNL -FNL是一种简单的手法，可部分改善声门下的主观视觉。
Flexed-Neck Flexible Nasolaryngoscopy for Evaluation of the Subglottis and Trachea in Children.
Objective: Determine if a flexed-neck posture during flexible nasolaryngoscopy (FNL) improves visualization of the subglottis.
Study design: Retrospective review of children undergoing FNL in the neutral (FNL) and flexed-neck (FN-FNL) positions.
Setting: Tertiary children's hospital.
Methods: FNL was performed with each child's head in neutral and flexed-neck positions. Videos in each posture were captured and randomized. The most distal view of the subglottis in each position was evaluated with 4 rating scales: (1) subjective view (SV); of the subglottis and trachea, (2) airway grade (AG); most distal anatomical structure visualized, (3) airway area (AA); percentage of the subglottis visualized; and (4) modified Cormack-Lehane grade.
Results: Twenty children had 80 FNL views blindly evaluated by 5 pediatric otolaryngologists. The SV, AG, and AA were all significantly better with the neck flexed compared to a neutral position (7.3 vs 3.0, interquartile range [IQR]: 2.0-6.8, P < .001; 2.3 vs 1.5, IQR: 1.0-2.0, P < .001; 3.4 vs 1.7, IQR: 2.3-3.8, P = .001). There was no difference in the modified Cormack-Lehane grade between positions. Interrater reliability was excellent or strong (0.93-0.94, confidence interval: 0.91-0.93).
Conclusion: FN-FNL is a simple maneuver performed in children undergoing FNL that partially improves the subjective visualization of the subglottis.
期刊介绍：
Otolaryngology–Head and Neck Surgery (OTO-HNS) is the official peer-reviewed publication of the American Academy of Otolaryngology–Head and Neck Surgery Foundation. The mission of Otolaryngology–Head and Neck Surgery is to publish contemporary, ethical, clinically relevant information in otolaryngology, head and neck surgery (ear, nose, throat, head, and neck disorders) that can be used by otolaryngologists, clinicians, scientists, and specialists to improve patient care and public health.
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