A videographic analysis of laryngeal exposure comparing the articulating laryngoscope and external laryngeal manipulation

Activation of the articulating laryngoscope and external laryngeal manipula tion (ELM) improve laryngeal exposure during direct laryngoscopy. We used a head-mounted direct laryngoscopy imaging system and a previously validated scoring system for assessing laryngeal view (the percentage of glottic ope ning or POGO score) on 33 adult patients undergoing laryngoscopy. On each p atient, we videotaped the initial laryngeal exposure (blade not activated), the view with activation of the blade, and the view with operator-directed external laryngeal manipulation. The video recordings were reviewed and th e laryngeal view assessed with POGO scores. POGO scores improved with blade activation in 9/33 (27%) of patients vs 28/33 (85%) of patients with ELM. In nearly half of patients studied (16/ 33, 48%) POGO scores decreased with blade activation. We conclude that ELM is superior to articulating laryngo scope blade activation in improving POGO scores during laryngoscopy on adul t patients in standard sniffing position.