• K Venkata Nageswara Rao, D Dhatchinamoorthi, Amar Nandhakumar, N Selvarajan, Hani Rajesh Akula, and Venkatesan Thiruvenkatarajan.
• Department of Anaesthesia, Lokamanya Hospitals Pune, Maharshtra, India.
• Indian J Anaesth. 2018 Aug 1; 62 (8): 603-608.

Background And AimsThyromental 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.MethodsThis 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.ResultsTMHT 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.ConclusionTMHT 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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