Ultrasonographic Airway Measurements and Difficult Laryngoscopy in Children Undergoing Adenotonsillectomy: A Prospective Observational Study

Objectives: This study aimed to evaluate the diagnostic performance of preoperative ultrasonographic airway measurements for predicting difficult laryngoscopy in pediatric patients undergoing adenotonsillectomy. Methods: A total of 153 pediatric patients aged 3–8 years who were scheduled for elective otorhinolaryngologic surgery were included in this prospective observational study. Patients were divided into two groups: the adenotonsillectomy group (n = 74) and the non-adenotonsillectomy ENT surgery group (n = 79). Skin-to-epiglottis distance (SED), hyomental distance (HMD) and tongue thickness (TT) were measured using ultrasonography before anesthesia induction. Laryngoscopic view was graded according to the Cormack–Lehane classification, with grades III and IV considered indicative of difficult laryngoscopy. The diagnostic performance of ultrasonographic measurements in predicting difficult laryngoscopy was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The incidence of difficult laryngoscopy was 14.9% in the adenotonsillectomy group and 6.3% in the non-adenotonsillectomy group; however, this difference did not reach statistical significance (p = 0.085). In the adenotonsillectomy group, patients with difficult laryngoscopy had significantly greater skin-to-epiglottis distance and tongue thickness values (p = 0.002 and p = 0.015, respectively). No significant association was observed between hyomental distance and difficult laryngoscopy (p = 0.319). ROC analysis demonstrated that skin-to-epiglottis distance had the highest discriminatory performance in the adenotonsillectomy group (AUC = 0.795; 95% CI: 0.685–0.880; p = 0.004). Conclusions: Skin-to-epiglottis distance and tongue thickness were associated with difficult laryngoscopy in pediatric patients undergoing adenotonsillectomy. Among the evaluated ultrasonographic parameters, skin-to-epiglottis distance demonstrated the highest diagnostic performance. Preoperative ultrasonographic airway assessment may provide valuable information for identifying children at increased risk of difficult laryngoscopy. These findings should be confirmed in larger multicenter studies.