{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T14:06:45Z","timestamp":1792678005112,"version":"4.5.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aims:<\/jats:title>\n                    <jats:p>Effective airway assessment prevents intubation failure. Despite the limited sensitivity of standard tools, ultrasonography (USG) offers promise, especially in predicting difficult laryngoscopies. Our study aims to evaluate tongue-to-oral height ratio (TTOHR) and anterior neck soft tissue measurements on airway USG to predict difficult laryngoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This prospective observational study enroled 120 patients posted for elective surgery under general anaesthesia, without anticipated difficult airways. The skin to hyoid bone distance (SHBD), skin to epiglottis distance (SED), skin to thyrohyoid membrane distance (STHMD), and TTOHR were measured on USG. Modified Cormack-Lehane (CL) grading at laryngoscopy was the primary outcome. Statistical analysis included ROC curve analysis, multivariable logistic regression, and evaluation of predictive models combining multiple USG parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The incidence of difficult laryngoscopy and intubation was 11.6% and 6.6%, respectively. The highest diagnostic performance was observed for SED, with an area under the curve (AUC) of 0.95 [95% confidence interval (CI): 0.91, 0.98], a cut-off value of 1.87 cm, a sensitivity of 100%, a specificity of 89%, and a diagnostic accuracy of 90%. STHMD followed with an AUC of 0.94 (95% CI: 0.88, 0.99), a cut-off of 1.58 cm, a sensitivity of 90%, a specificity of 86%, and a diagnostic accuracy of 84%. TTOHR showed an AUC of 0.92 (95% CI: 0.78, 1.00), with a cut-off value of 0.80, a sensitivity of 92%, a specificity of 98%, and the highest diagnostic accuracy of 97% (95% CI: 0.96, 1.00). Various models, tested using three or four parameters, showed AUC values ranging from 0.96 to 0.97. A model containing TTOHR, SHBD, and STHMD was identified as a best-fit model for predicting difficult laryngoscopy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>SED, STHMD, and TTOHR individually showed substantial diagnostic accuracy, with AUCs ranging from 0.92 to 0.95. Analysis of models combining parameters outperformed individual measurements, with statistically significant contributions from TTOHR and SHBD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ija.ija_1360_24","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T15:02:56Z","timestamp":1754924576000},"page":"918-925","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":2,"title":["Evaluation of the predictive value of tongue height to oral cavity height ratio and anterior neck soft tissue measurements for difficult laryngoscopy in patients with unanticipated difficult airway: A prospective observational study"],"prefix":"10.4103","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9767-7939","authenticated-orcid":false,"given":"Sambit","family":"Nandi","sequence":"first","affiliation":[{"name":"Department of Onco-Anaesthesia and Palliative Medicine, Dr BRA-IRCH, AIIMS, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6707-4627","authenticated-orcid":false,"given":"Aparajita","family":"Panda","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-2755","authenticated-orcid":false,"given":"Nitasha","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2731-5657","authenticated-orcid":false,"given":"Parnandi Bhaskar","family":"Rao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Critical Care, AIIMS, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0663-0922","authenticated-orcid":false,"given":"Anand","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, AIIMS, Bhubaneswar, Odisha, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"R1-20260421","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/ALN.0b013e31827773b2","article-title":"Practice guidelines for management of the difficult airway: An updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway","volume":"118","author":"Apfelbaum","year":"2013","journal-title":"Anesthesiology"},{"key":"R2-20260421","first-page":"CD008874","article-title":"Airway physical examination tests for detection of difficult airway management in apparently normal adult patients","volume":"5","author":"Roth","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"R4-20260421","doi-asserted-by":"crossref","first-page":"671658","DOI":"10.3389\/fmed.2021.671658","article-title":"Useful ultrasonographic parameters to predict difficult laryngoscopy and difficult tracheal intubation-A systematic review and meta-analysis","volume":"28","author":"Gomes","year":"2021","journal-title":"Front Med (Lausanne)"},{"key":"R5-20260421","doi-asserted-by":"crossref","first-page":"6327","DOI":"10.3390\/jcm11216327","article-title":"Airway ultrasound for anesthesia and in intensive care patients-A narrative review of the literature","volume":"11","author":"Lazar","year":"2022","journal-title":"J Clin Med"},{"key":"R6-20260421","doi-asserted-by":"crossref","first-page":"83","DOI":"10.11152\/mu-1764","article-title":"Preoperative difficult airway prediction using suprahyoid and infrahyoid ultrasonography derived measurements in anesthesiology","volume":"21","author":"Petrisor","year":"2019","journal-title":"J Med Ultrason"},{"key":"R7-20260421","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1213\/ANE.0000000000005839","article-title":"Airway ultrasound as predictor of difficult direct laryngoscopy: A systematic review and meta-analysis","volume":"134","author":"Carsetti","year":"2022","journal-title":"Anesth Analg"},{"key":"R8-20260421","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/CCM.0000000000005711","article-title":"Prediction of difficult laryngoscopy using ultrasound: A systematic review and meta-analysis","volume":"51","author":"Bhargava","year":"2023","journal-title":"Crit Care Med"},{"key":"R9-20260421","doi-asserted-by":"crossref","first-page":"456","DOI":"10.4103\/0019-5049.89868","article-title":"Ultrasound of the airway","volume":"55","author":"Kundra","year":"2011","journal-title":"Indian J Anaesth"},{"key":"R10-20260421","doi-asserted-by":"crossref","first-page":"629","DOI":"10.4103\/ija.IJA_270_19","article-title":"Ultrasound measurement of anterior neck soft tissue and tongue thickness to predict difficult laryngoscopy - An observational analytical study","volume":"63","author":"Yadav","year":"2019","journal-title":"Indian J Anaesth"},{"key":"R11-20260421","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1186\/1471-2105-12-77","article-title":"pROC: An open-source package for R and S+to analyze and compare ROC curves","volume":"12","author":"Robin","year":"2011","journal-title":"BMC Bioinformatics"},{"key":"R12-20260421","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.3390\/diagnostics13091541","article-title":"Point-of-care ultrasound in airway evaluation and management: A comprehensive review","volume":"13","author":"Lin","year":"2023","journal-title":"Diagnostics (Basel)"},{"key":"R13-20260421","doi-asserted-by":"crossref","first-page":"S193","DOI":"10.4103\/ija.IJA_843_19","article-title":"Different 2D ultrasound calculation methods to evaluate tongue volume for prediction of difficult laryngoscopy","volume":"64","author":"Ohri","year":"2020","journal-title":"Indian J Anaesth"},{"key":"R14-20260421","doi-asserted-by":"crossref","first-page":"353","DOI":"10.4103\/joacp.JOACP_166_17","article-title":"Correlation between preoperative ultrasonographic airway assessment and laryngoscopic view in adult patients: A prospective study","volume":"33","author":"Parameswari","year":"2017","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"R15-20260421","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1016\/j.cjtee.2023.09.005","article-title":"A quantitative study of airway ultrasound in predicting difficult laryngoscopy: A prospective study","volume":"26","author":"Ning","year":"2023","journal-title":"Chin J Traumatol"},{"key":"R16-20260421","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1093\/bja\/aex051","article-title":"Can tongue thickness measured by ultrasonography predict difficult tracheal intubation?","volume":"118","author":"Yao","year":"2017","journal-title":"Br J Anaesth"},{"key":"R17-20260421","doi-asserted-by":"crossref","first-page":"134","DOI":"10.4097\/kja.20114","article-title":"Effectiveness of four ultrasonographic parameters as predictors of difficult intubation in patients without anticipated difficult airway","volume":"74","author":"Agarwal","year":"2021","journal-title":"Korean J Anesthesiol"},{"key":"R18-20260421","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.7863\/ultra.15.11098","article-title":"Effectiveness and validity of sonographic upper airway evaluation to predict difficult laryngoscopy","volume":"35","author":"Andruszkiewicz","year":"2016","journal-title":"J Ultrasound Med"},{"key":"R19-20260421","first-page":"21","article-title":"Validation of clinical versus ultrasound parameters in assessment of airway","volume":"35","author":"Shetty","year":"2020","journal-title":"Trends in Anaesth and Crit Care"},{"key":"R20-20260421","doi-asserted-by":"crossref","first-page":"380","DOI":"10.4103\/ija.ija_896_24","article-title":"Comparison between El-Ganzouri risk index and sonologically measured skin-to-epiglottis distance for predicting difficult laryngoscopy: A prospective observational study","volume":"69","author":"Karimbanakkal","year":"2025","journal-title":"Indian J Anaesth"},{"key":"R21-20260421","doi-asserted-by":"crossref","first-page":"1334595","DOI":"10.3389\/fmed.2024.1334595","article-title":"A new score for airway assessment using clinical and ultrasound parameters","volume":"11","author":"De Luis-Cabez\u00f3n","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"R22-20260421","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/EJA.0000000000000832","article-title":"Evaluation of two neck ultrasound measurements as predictors of difficult direct laryngoscopy: A prospective observational study","volume":"35","author":"Falcetta","year":"2018","journal-title":"Eur J Anaesth"},{"key":"R23-20260421","doi-asserted-by":"crossref","first-page":"182","DOI":"10.4103\/aam.aam_33_23","article-title":"Ultrasound evaluation of anterior neck soft-tissue thickness to predict difficult intubation in overweight adult patients posted for surgery under general endotracheal anesthesia \u2013 An observational study","volume":"23","author":"Archana","year":"2024","journal-title":"Ann Afr Med"}],"container-title":["Indian Journal of Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_1360_24","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:01:30Z","timestamp":1786647690000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ija.ija_1360_24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,12]]},"references-count":22,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.4103\/ija.ija_1360_24","relation":{},"ISSN":["0019-5049","0976-2817"],"issn-type":[{"value":"0019-5049","type":"print"},{"value":"0976-2817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,12]]},"assertion":[{"value":"2024-12-27","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-27","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}