{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T11:11:05Z","timestamp":1760958665816,"version":"build-2065373602"},"reference-count":9,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Determine if a flexed\u2010neck posture during flexible nasolaryngoscopy (FNL) improves visualization of the subglottis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective review of children undergoing FNL in the neutral (FNL) and flexed\u2010neck (FN\u2010FNL) positions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Tertiary children's hospital.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>FNL was performed with each child's head in neutral and flexed\u2010neck 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\u2010Lehane grade.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u20106.8, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001; 2.3 vs 1.5, IQR: 1.0\u20102.0, <jats:italic>P<\/jats:italic>\u2009&lt;\u2009.001; 3.4 vs 1.7, IQR: 2.3\u20103.8, <jats:italic>P<\/jats:italic>\u2009=\u2009.001). There was no difference in the modified Cormack\u2010Lehane grade between positions. Interrater reliability was excellent or strong (0.93\u20100.94, confidence interval: 0.91\u20100.93).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>FN\u2010FNL is a simple maneuver performed in children undergoing FNL that partially improves the subjective visualization of the subglottis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.1132","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T09:15:51Z","timestamp":1736500551000},"page":"1735-1740","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flexed\u2010Neck Flexible Nasolaryngoscopy for Evaluation of the Subglottis and Trachea in Children"],"prefix":"10.1002","volume":"172","author":[{"given":"Jennifer M.","family":"Siu","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikolaus E.","family":"Wolter","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meghan E.","family":"Tepsich","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander M.","family":"Treble","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Goh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alex J.","family":"Osborn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evan J.","family":"Propst","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Hospital for Sick Children, University of Toronto Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31371"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/coa.12423"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2018.11.006"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvoice.2020.01.019"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/ohn.419"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25169"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11165-016-9602-2"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2013.12.026"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijporl.2024.112084"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.1132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T10:31:15Z","timestamp":1760956275000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.1132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,10]]},"references-count":9,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5]]}},"alternative-id":["10.1002\/ohn.1132"],"URL":"https:\/\/doi.org\/10.1002\/ohn.1132","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"type":"print","value":"0194-5998"},{"type":"electronic","value":"1097-6817"}],"subject":[],"published":{"date-parts":[[2025,1,10]]},"assertion":[{"value":"2024-08-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-27","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-01-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}