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J Anaesthesiol Clin Pharmacol. 2019 Jul-Sep;35(3):390-395. doi: 10.4103/joacp.JOACP_276_18.

Comparison of thyromental height test with ratio of height to thyromental distance, thyromental distance, and modified Mallampati test in predicting difficult laryngoscopy: A prospective study.

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Department of Anesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India.


Background and Aims:

Preoperative airway assessment to predict patients with difficult laryngoscopy is always crucial for anesthesiologists. Several predictive tests have been studied by various authors in quest of finding the best airway predictor. Recently, a new airway predictor, thyromental height test (TMHT) has been reported to have good predictive value in assessing difficult airway. We conducted this study with primary aim to evaluate the diagnostic accuracy of TMHT and to compare it with other established airway predictors, such as ratio of height to thyromental distance (RHTMD), thyromental distance (TMD), and modified Mallampati test (MMT) for predicting difficult laryngoscopy.

Material and Methods:

This prospective, observational study was conducted in 550 patients of either sex aged >18 years scheduled for elective surgery under general anesthesia. The patients' airway was assessed preoperatively by two anesthetists. Standard anesthetic protocol was followed in all the patients. The laryngoscopic view was graded according to Cormack-Lehane scale. The receiver operating characteristic (ROC) curve was used to calculate the ideal cut off values for TMHT and RHTMD. Standard formulae were used to calculate validity indexes.


The incidence of difficult laryngoscopy was 10%. The cut-off value for TMHT and RHTMD were 5.1 cm and 19.5, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of TMHT were 78.18%, 93.94%, 58.90%, and 97.48%, respectively. The highest sensitivity, PPV, and NPV were observed with TMHT as compared with RHTMD, TMD, and MMT (P < 0.0001).


TMHT is the best predictive test with highest accuracy and odds ratio for predicting difficult airway out of all predictive tests evaluated.


Airway; RHTMD; difficult laryngoscopy; thyromental height test

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