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Year : 2018  |  Volume : 62  |  Issue : 8  |  Page : 603-608

Validity of thyromental height test as a predictor of difficult laryngoscopy: A prospective evaluation comparing modified Mallampati score, interincisor gap, thyromental distance, neck circumference, and neck extension

1 Department of Anaesthesia, Lokamanya Hospitals Pune, Maharshtra, India
2 Department of Anaesthesia, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
3 Department of Community Medicine, Alluri Sitarama Raju academy of Medical Sciences, Eluru, Andhra Pradesh, India
4 Department of Anaesthesia, The Queen Elizabeth Hospital, Woodville; Discipline of Acute Care Medicine, The University of Adelaide, Adelaide, Australia

Correspondence Address:
Venkatesan Thiruvenkatarajan
The Queen Elizabeth Hospital, Woodville, South Australia - 5011
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ija.IJA_162_18

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Background and Aims: Thyromental height test (TMHT) is a recently described anatomical bedside screening tool in predicting difficult laryngoscopy. It has been shown to be more accurate than the modified Mallampati score, thyromental distance (TMD), and sternomental distance with regard to sensitivity and positive predictive value (PPV). Airway assessment studies based on the anatomic parameters of the upper airway are limited in the subcontinent population. We attempted this study to evaluate and validate the predictive value of TMHT at 50 mm in an Indian population in predicting difficult laryngoscopy. Methods: This prospective observational study was conducted in a tertiary teaching hospital on 340 patients. TMHT along with other bedside predictors of difficult intubation, including modified Mallampati score, interincisor gap (IIG), TMD, neck circumference (NC), and neck extension were assessed. We compared the sensitivity, specificity, PPV, negative predictive value (NPV), and diagnostic accuracy of TMHT with other bedside tests such as the modified Mallampati score, IIG, TMD, NC, and neck extension individually in predicting difficult laryngoscopy. Any Cormack and Lehane's intubation grade II b and above was considered to be difficult laryngoscopy. Results: TMHT had the highest sensitivity (84.62%) and specificity (98.97%), and had the most PPV (88%) and NPV (98.63%) when compared with the modified Mallampati score, IIG, TMD, NC, and neck extension. TMHT was followed by the modified Mallampati score and IIG. Conclusion: TMHT appears promising as a single anatomical measure to predict the risk of difficult laryngoscopy, however, validation will require further studies in more diverse patient populations.

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