• C Torre, S Zaghi, M Camacho, R Capasso, and S Y Liu.
• Division of Sleep Surgery, Department of Otolaryngology-Head & Neck Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA.
• Clin Otolaryngol. 2018 Jun 1; 43 (3): 823-827.

ObjectiveTo validate the use of Cormack-Lehane and Modified Cormack-Lehane scoring systems to classify patterns of hypopharyngeal airway visualization seen during awake flexible laryngoscopy among patients with obstructive sleep apnoea.Study DesignValidation study using samples collected from a prospective database.SettingUniversity Medical Center.ParticipantsData were obtained from a retrospective review of a prospective database of flexible fiberoptic examination recordings in 274 consecutive OSA subjects (Stanford Sleep Medicine/Surgery Clinic).Main Outcome MeasuresSingle still images from awake fiberoptic laryngoscopy examinations of the vocal cords from 90 different patients were presented to 2 experts and 4 novice raters. Raters used two grading systems (Cormack-Lehane scale and Modified Cormack-Lehane) to rate vocal cord visualization. Percent agreement and Cohen's kappa statistical analysis were used to evaluate inter-rater reliability and intrarater reliability for each grading system. Feedback from the participants was then used to propose updates to further improve upon the existing grading scales for their applicability to awake flexible endoscopy.ResultsThe Cormack-Lehane and Modified Cormack-Lehane scale both communicate unobstructed and restricted views of the vocal cords reliably. Compared to the 4-grade scale, however, a modified 5-grade Vocal Cord Grading System allows for better objective communication of common variations in hypopharyngeal airway visualization.ConclusionWe propose a 5-Grade Vocal Cord Grading System that builds upon existing grading systems to allow for efficient and reliable communication of hypopharyngeal airway examination during awake fiberoptic laryngoscopy.© 2017 John Wiley & Sons Ltd.

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