Int J Med Sci 2022; 19(3):425-433. doi:10.7150/ijms.69425 This issue

Research Paper

Quantitative Measurement of Adult Human Larynx post General Anesthesia with Intubation

Chung Feng Jeffrey Kuo1, Jagadish Barman1, Shao-Cheng Liu2✉

1. Department of Materials Science & Engineering, National Taiwan University of Science and Technology, Taipei, Taiwan, Republic of China.
2. Department of Otolaryngology-Head and Neck Surgery Tri-Service General Hospital, National Defense Medical Center Taipei, Taiwan, Republic of China.

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Kuo CFJ, Barman J, Liu SC. Quantitative Measurement of Adult Human Larynx post General Anesthesia with Intubation. Int J Med Sci 2022; 19(3):425-433. doi:10.7150/ijms.69425. Available from

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Graphic abstract

Introduction: Post-anaesthetic sore throat (PAST) is a well-recognized consequence of tracheal intubation; however, quantitative morphometric measurements remain challenging. This study aimed to introduce a special laser projection device that can facilitate computer-assisted, digitalized analysis and provide important information on laryngeal mucosa change, pre and post-surgery under general anesthesia with intubation.

Materials and methods: The laryngeal images were captured and divided into the control group and the intubation group. Image processing techniques were used to quantify the post-extubation laryngeal variation, with its distinct color space and texture features. Meanwhile, the maximum length of the vocal fold, vocal width at the midpoint, and maximum cross-sectional area of the glottic space were determined and calculated. These parameters were analyzed and compared pre and post-surgery.

Results: A total of 69 subjects were enrolled in this study, comprising 32 subjects in the healthy group and 37 subjects in the intubation group. The color space and texture analysis with contrast and correlation profiles all shows trend toward higher measures in the intubation group than in the healthy group, with statistical significance and outstanding discrimination ability, especially in the interarytenoid region. The incidence of PAST was approximately 46% (17 patients). The gender difference, type of surgery, and the fixation position of the tube were not significantly related to the PAST occurrence. All the eigenvalues showed significant differences pre and post-surgery in the interarytenoid region and a significant trend toward red and increased contrast texture profiles was revealed. Furthermore, the glottic area showed a significant decrease of 25.29%, while the vocal width showed a significant increase post extubation.

Conclusion: Our equipment and processing can measure subtle laryngeal changes that would allow a clinician to diagnose postoperative laryngeal inflammation in a simpler and less invasive way. The trend toward red, the increased contrast texture and vocal width, and the reduced glottic space were all compatible with post-intubation inflammatory response, especially in the interarytenoid region. This is important to know so that one can take appropriate steps to alleviate PAST in the future.

Keywords: quantitative laryngoscopy, computer-aided diagnostic system, voice, general anesthesia, intubation, sore throat