title: Laryngeal injuries following endotracheal intubation in ENT surgery: predictive value of anatomical scores.
abstract: Endotracheal intubation has been associated with a threefold higher incidence of laryngopharyngeal complaints following anesthesia in comparison to laryngeal mask airway. Such complaints, including hoarseness and sore throat, have been reported in up to 90% of patients within 24 h of extubation. The purpose of this study was to determine which preoperatively documented clinical and anatomic parameters are predictive of laryngo-pharyngeal trauma resulting from elective endotracheal intubation. Fifty-three patients undergoing ENT procedures requiring general anesthesia with endotracheal intubation were recruited. Pre and postoperative laryngostroboscopic examination was performed and findings correlated to preoperative clinical and anatomic parameters. Readily assessed anatomic parameters including height (>180 cm) and weight (>80 kg) correlated significantly to the Eckerbom grade of intubation-associated acute laryngeal injury (rs = 0.374; p = 0.006 and rs = 0.278; p = 0.044, respectively). The mandibular protrusion test also correlated significantly to the Eckerbom grade (rs = 0.462, p = 0.001) while the upper-lip-bite test showed significant correlation to impaired vocal fold oscillation (rs = 0.288, p = 0.036), with injury prediction sensitivities of 37.5 and 39.4%, respectively. No parameters correlated to subjective complaints (n = 5, 9.2%). This study provides suggestions on how to improve the classification of intubation-associated laryngeal injuries as well as providing the basis for larger clinical trials in other surgical subspecialties.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany, ar.boettcher@uke.de.
authors.forename: Arne
authors.initials: A
authors.lastname: Böttcher
authors.forename: Thomas
authors.initials: T
authors.lastname: Mencke
authors.forename: Amelie
authors.initials: A
authors.lastname: Zitzmann
authors.forename: Rainald
authors.initials: R
authors.lastname: Knecht
authors.forename: Nathan
authors.initials: N
authors.lastname: Jowett
authors.forename: Gabriele
authors.initials: G
authors.lastname: Nöldge-Schomburg
authors.forename: Hans Wilhelm
authors.initials: HW
authors.lastname: Pau
authors.forename: Steffen
authors.initials: S
authors.lastname: Dommerich
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods; D005260:Female; D006685:Hoarseness / Q000209:etiology*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D007830:Larynx / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures; D010612:Pharyngitis / Q000209:etiology*; D010614:Pharynx / Q000293:injuries*; D011300:Preoperative Care / Q000379:methods*; D049489:Stroboscopy / Q000379:methods*; D055815:Young Adult