{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T00:36:05Z","timestamp":1761006965712,"version":"build-2065373602"},"reference-count":15,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"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":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Determine the ideal head position to optimize visualization of the subglottis using flexible laryngoscopy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Prospective cohort study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Outpatient multidisciplinary airway clinic at a tertiary care center.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Patients presenting to a multidisciplinary airway clinic undergoing nasoendoscopic airway examination were enrolled. Three head positions were utilized to examine the subglottis during laryngoscopy: \u201csniffing,\u201d\u00a0chin tuck, and stooping positions. In\u2010office reviewers and blinded clinician participants evaluated views of the airway based on Cormack\u2010Lehane (CL) scale, airway grade (AG), and visual analog scale (VAS). Demographic data were obtained. Statistical analysis compared head positions and demographic data using Student's <jats:italic>t<\/jats:italic> test, analysis of variance, and Tukey's post hoc analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred patients participated. No statistical differences existed among\u00a0in\u2010clinic or blinded reviewers for the CL score in any head position (<jats:italic>p<\/jats:italic>\u2009=\u2009.35,\u00a0.5, respectively). For both AG and VAS, flexed and stooping positions were rated higher than the sniffing positions by both in\u2010clinic and blinded reviewers (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01 for all analyses), but there was no statistical difference between these two positions (<jats:italic>p<\/jats:italic>\u2009=\u2009.28,\u00a0.18, respectively). There was an inverse correlation between age and scores for AG\u00a0and VAS in the flexed position for both sets of reviewers (<jats:italic>p<\/jats:italic>\u2009=\u2009.02, &lt;.01 respectively), and a higher body mass index was significantly associated with the need to perform tracheoscopy for full airway evaluation (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Both flexion and stoop postures can be implemented by an experienced endoscopist in awake, transnasal flexible laryngoscopy to enhance visualization of the subglottic airway.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.419","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T05:24:52Z","timestamp":1690781092000},"page":"1556-1563","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Optimization of Subglottic View During Flexible Laryngoscopy With Patient Positioning"],"prefix":"10.1002","volume":"169","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7920-8749","authenticated-orcid":false,"given":"Julie","family":"Highland","sequence":"first","affiliation":[{"name":"Department of Surgery, Department of Otolaryngology University of Utah Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3430-9877","authenticated-orcid":false,"given":"Vanessa","family":"Torrecillas","sequence":"additional","affiliation":[{"name":"Department of Surgery, Department of Otolaryngology University of Utah Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3638-5630","authenticated-orcid":false,"given":"Taylor","family":"Redding","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4912-1925","authenticated-orcid":false,"given":"Billie","family":"Bixby","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonary and Critical Care University of Arizona Tucson Arizona USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aidin","family":"Iravani","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Pulmonology University of Utah Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0123-4138","authenticated-orcid":false,"given":"Travis","family":"Haller","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Firpo","sequence":"additional","affiliation":[{"name":"University of Utah School of Medicine Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reza","family":"Nouraei","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology Nottingham University Hospitals NHS Trust Nottingham UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8818-9287","authenticated-orcid":false,"given":"Marshall","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Surgery, Department of Otolaryngology University of Utah Salt Lake City Utah USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,7,31]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2019.1190"},{"key":"e_1_2_8_3_1","first-page":"82","article-title":"The confusion between asthma and subglottic stenosis can cause an adverse event during intubation. 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