Phonation Improves the Correlation Between Mallampati Evaluation and Laryngoscopic View
Philip W Lebowitz1*, Naveen Shetty2,
Singh Nair1
1Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA
2Albert
Einstein College of Medicine,NY, USA
*Corresponding author: Philip W Lebowitz, Montefiore Medical Center, Albert Einstein College of Medicine,144 E. 84 Street, New York NY 10028, USA. Tel: +19177151118; Email: splebow@gmail.com
Received Date: 14 September, 2017; Accepted Date: 18 September, 2017; Published Date: 26 September, 2017
Citation: Lebowitz PW, ShettyN, BA, Nair S (2017) Phonation Improves the Correlation Between Mallampati Evaluation and Laryngoscopic View. Anesth Med Pract J: AMPJ-112. DOI:10.29011/AMPJ-112/100012
1. Abstract
1. Introduction
The mean and standard
deviation of Mallampati scores for all studied patients without phonation and
with phonation were 2.77+/-1.09 and 1.89+/-0.99, respectively. Patients were
classified without phonation into Mallampati class 3 or 4 in 57.7% of cases.
However, when Mallampati with phonation was evaluated in the same cohort, only
26.2% of patients fell within class 3 or 4. The Pearson correlation coefficient
(r) for Mallampati class without phonation and Cormack-Lehane grade was 0.145,
whereas the Pearson correlation coefficient for Mallampati class with phonation
and Cormack-Lehane grade was .177 (p <0.001).
We examined the
correlations of Mallampati classes and Cormack-Lehane grades to establish
concordances with and without phonation. The kappa statistic for Mallampati
without phonation was 0.006 (95%CI -0.02928 to 0.04128) (p=.729), whereas the
kappa statistic for Mallampati with phonation was 0.145 (95%CI = 0.08424 to
0.20576) (p<0.001).
Given these
limitations, our study demonstrates that Mallampati classification with
phonation offers an advantage over Mallampati classification without phonation
in correlating with Cormack-Lehane grades. Although phonation adds concordance
with Cormack-Lehane scores, neither Mallampati evaluation appears to be
sufficiently sensitive or specific to rely upon in assessing preoperatively the
ease or difficulty of tracheal intubation in a given patient.
5. Conclusion
· Mallampati evaluation as a stand-alone test is an insensitive and non-specific indicator of laryngoscopic view and ease of tracheal intubation-without or with phonation.
· Adding
phonation to the Mallampati evaluation significantly improves correlation with
conventional laryngoscopic view. Consequently, inasmuch as the Mallampati
examination has become ubiquitous in anesthetic practice, we recommend that
phonation be incorporated into the Mallampati evaluation to enhance the
efficacy of predicting laryngoscopic view, however slightly.
Mallampati without Phonation |
Cormack-Lehane Grade |
Total |
|||||
1 |
2 |
3 |
4 |
||||
Mallampati Class |
1 |
Count |
54 |
16 |
3 |
3 |
76 |
% of Mallampati |
11% |
3% |
1% |
1% |
15% |
||
2 |
Count |
91 |
34 |
4 |
3 |
132 |
|
% of Mallampati |
19% |
7% |
1% |
1% |
27% |
||
3 |
Count |
76 |
31 |
2 |
4 |
113 |
|
% of Mallampati |
15% |
6% |
0% |
1% |
23% |
||
4 |
Count |
94 |
46 |
22 |
9 |
171 |
|
% of Mallampati |
19% |
9% |
5% |
2% |
35% |
||
Total |
Count % of Total Cormack-Lehane |
315 |
127 |
31 |
19 |
492 |
|
64% |
26% |
6% |
4% |
100% |
Table 1: Mallampati without Phonation, Number and percentage of patients in each Mallampati class (without phonation) and their corresponding Cormack-Lehane grade.
Mallampati with Phonation |
Cormack-Lehane Grade |
Total |
|||||
1 |
2 |
3 |
4 |
||||
Mallampati Class |
1 |
Count |
167 |
47 |
7 |
4 |
225 |
% of Mallampati |
34% |
10% |
1% |
1% |
46% |
||
2 |
Count |
76 |
49 |
6 |
7 |
138 |
|
% of Mallampati |
15% |
10% |
1% |
1% |
28% |
||
3 |
Count |
42 |
24 |
13 |
6 |
85 |
|
% of Mallampati |
9% |
5% |
3% |
1% |
17% |
||
4 |
Count |
30 |
7 |
5 |
2 |
44 |
|
% of Mallampati |
6% |
1% |
1% |
0% |
9% |
||
Total |
Count % of Total Cormack-Lehane |
315 |
127 |
31 |
19 |
492 |
|
64% |
26% |
6% |
4% |
100% |
Table 2: Mallampati with Phonation, Number and percentage of patients in each Mallampati class (with phonation) and their corresponding Cormack-Lehane grade.
Cormack-Lehane without Phonation |
Mallampati Class |
Total |
|||||
1 |
2 |
3 |
4 |
||||
Cormack-Lehane Grade |
1 |
Count % of Cormack-Lehane |
54 |
91 |
76 |
94 |
315 |
11% |
19% |
15% |
19% |
64% |
|||
2 |
Count % of Cormack-Lehane |
16 |
34 |
31 |
46 |
127 |
|
3% |
7% |
6% |
9% |
26% |
|||
3 |
Count % of Cormack-Lehane |
3 |
4 |
2 |
22 |
31 |
|
1% |
1% |
0% |
5% |
6% |
|||
4 |
Count % of Cormack-Lehane |
3 |
3 |
4 |
9 |
19 |
|
1% |
1% |
1% |
2% |
4% |
|||
Total |
Count % of Total Mallampati |
76 |
132 |
113 |
171 |
492 |
|
15% |
27% |
23% |
35% |
100% |
Table 3: Cormack-Lehane without Phonation, Number and percentage of patients in each Cormack-Lehane grade (without phonation) and their corresponding Mallampati class.
Cormack-Lehane with Phonation |
Mallampati Class |
Total |
|||||
1 |
2 |
3 |
4 |
||||
Cormack-Lehane Grade |
1 |
Count % of Cormack-Lehane |
167 |
76 |
42 |
30 |
315 |
34% |
1% |
9% |
6% |
64% |
|||
2 |
Count % of Cormack-Lehane |
47 |
49 |
24 |
7 |
127 |
|
10% |
10% |
5% |
1% |
26% |
|||
3 |
Count % of Cormack-Lehane |
7 |
6 |
13 |
5 |
31 |
|
1% |
1% |
3% |
1% |
6% |
|||
4 |
Count % of Cormack-Lehane |
4 |
7 |
6 |
2 |
19 |
|
1% |
1% |
1% |
0% |
4% |
|||
Total |
Count % of Total Mallampati |
225 |
138 |
85 |
44 |
492 |
|
46% |
28% |
17% |
9% |
100% |
Table 4: Cormack-Lehane with Phonation, Number and percentage of patients in each Cormack-Lehane grade (with phonation) and their corresponding Mallampati class.
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