The position of a patient’s head during flexible nasendoscopy to visualise the larynx does not usually require much consideration – adequate views are almost always obtained with a patient sitting in a neutral position. Occasionally however, there will be patients in whom it is difficult to obtain a full view of the larynx, particularly with respect to its anterior extent. This paper compared the grade of laryngeal visualisation among 132 patients undergoing transnasal flexible laryngoscopy (TFL) using three different head positions – simple head extension (SHE), sniffing position (SP) and the neutral position (NP). Videos of the procedure were evaluated by three blinded observers and scored according to the Cormack-Lehane classification. Unsurprisingly, better visualisation of the larynx was achieved in the sniffing position relative to the neutral position – grade 1 views were obtained for 96% of patients in SP versus only 4% in NP. Interestingly however, simple head extension performed just as well as the sniffing position with grade 1 views again obtained in 96% of patients in SHE.
The data from this paper would support asking patients simply to bend their heads back to optimise visualisation of their larynx during TFL.
This is certainly easier to do than describing the correct posture to achieve the sniffing position and has worked well in this review author’s clinical practice so far.