Effect of mouthpiece, noseclips, and head position on airway area measured by acoustic reflections

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Abstract
To investigate whether it is possible to simplify the methodology of measuring airway area by acoustic reflections, we measured upper airway area in 10 healthy subjects during tidal breathing according to seven different protocols. Three protocols employed custom-made bulky mouthpiece with or without nose-clips, two protocols used a scuba-diving mouthpiece and cotton balls placed in the nostrils instead of noseclips, and two protocols employed neck flexion and extension. We found no significant difference in average pharyngeal, glottic, and tracheal areas for any of the protocols except for neck flexion, which was associated with a significantly lower mean pharyngeal area. Intraindividual variabilities were comparable for all protocols, except for protocol employing the customary bulky mouthpiece and no noseclips, which consistently resulted in the most variable measurements of area for all three airway segments: pharynx, glottis, and trachea. Furthermore, we found that the protocol employing the scuba-diving mouthpiece with or without cotton balls in the nostrils resulted in the lowest number of unacceptable measurements. We conclude that measurements of airway area by acoustic reflections may be further simplified by using a scuba-diving mouthpiece without noseclips; furthermore, control of head position during measurements is not critical provided there is no obvious neck flexion.