Laryngoscopy

File:Larynx (top view).jpg

Direct laryngoscopy is carried out (usually) with the patient lying on their back; the laryngoscope is inserted into the mouth on the right side and flipped to the left to trap and move the tongue out of the line of sight, and, depending on the type of blade used, inserted either anterior or posterior to the epiglottis and then lifted with an upwards and forward motion ("away from you and towards the roof "). This move makes a view of the glottis possible.

This procedure is done in an operation theatre with full preparation for resuscitative measures to deal with respiratory distress.

There are at least ten different types of laryngoscope used for this procedure, each of which has a specialized use for the otolaryngologist and medical speech pathologist. This procedure is most often employed by anaesthetists for endotracheal intubation under general anaesthesia, but also in direct diagnostic laryngoscopy with biopsy. It is extremely uncomfortable and is not typically performed on conscious patients, or on patients with an intact gag reflex.{{citation needed|date=January 2022}}

Indirect laryngoscopy is performed whenever the provider visualizes the patient's vocal cords by a means other than obtaining a direct line of sight (e.g. a mirror). For the purpose of intubation, this is facilitated by fiberoptic bronchoscopes, video laryngoscopes, fiberoptic stylets and mirror or prism optically enhanced laryngoscopes.{{citation needed|date=January 2022}}

{{See also|Tracheal intubation}}

File:Garcia-Laryngoskop.gif, 1884]]

Some historians (for example, Morell Mackenzie) credit Benjamin Guy Babington (1794–1866), who called his device the "glottiscope", with the invention of the laryngoscope.{{cite book |last=Hunting |first=Penelope |year=2002 |title=The history of the Royal Society of Medicine |publisher=RSM Press |page=79 |isbn=978-1-85315-497-3}} Philipp von Bozzini (1773–1809){{cite journal |vauthors=Koltai PJ, Nixon RE |title=The story of the laryngoscope |journal=Ear, Nose, & Throat Journal |volume=68 |issue=7 |pages=494–502 |year=1989 |pmid=2676465}}{{cite journal |author=Bailey B |title=Laryngoscopy and laryngoscopes--who's first?: the forefathers/four fathers of laryngology |journal=Laryngoscope |volume=106 |issue=8 |pages=939–43 |date=August 1996 |pmid=8699905 |doi=10.1097/00005537-199608000-00005|s2cid=32925553 }} and Garignard de la Tour were other early physicians to use mouth mirrors to inspect the oropharynx and hypopharynx.Stark, James (2003). Bel canto: a history of vocal pedagogy. University of Toronto Press, p. 5. {{ISBN|0-8020-8614-4}}

In 1854, the vocal pedagogist Manuel García (1805–1906) became the first man to view the functioning glottis and larynx in a living human. García developed a tool that used two mirrors for which the Sun served as an external light source.{{cite journal

|doi=10.1098/rspl.1854.0094

|first=Manuel |last=García

|title=Observations on the Human Voice

|journal=Proceedings of the Royal Society of London

|volume=7

|pages=399–410

|year=1855

|issue=60 |jstor=111815

|pmid=30163547 |url=https://books.google.com/books?id=o6PYNM7RNwkC&pg=PA399

|access-date=28 August 2010

|author-link=Manuel Patricio Rodríguez García|pmc=5180321

}}American Otological Society (1905). The Laryngoscope. Volume 15, pp. 402–403 Using this device, he was able to observe the function of his own glottic apparatus and the uppermost portion of his trachea. He presented his findings at the Royal Society of London in 1855.{{cite journal

|first=Teresa |last=Radomski

|title=Manuel García (1805–1906): A bicentenary reflection

|journal=Australian Voice

|volume=11

|pages=25–41

|year=2005

|url=http://www.harmonicorde.com/Radomski%20Australian%20Voice.pdf

|access-date=28 August 2010}}{{Cite web | url=http://www.rtve.es/alacarta/videos/con-ciencia/ciencia-manuel-patricio-garci/2352708/ |title = Con ciencia - Manuel Patricio García|date = 27 January 2014}}

All previous observations of the glottis and larynx had been performed under indirect vision (using mirrors) until 23 April 1895, when Alfred Kirstein (1863–1922) of Germany first described direct visualization of the vocal cords. Kirstein performed the first direct laryngoscopy in Berlin, using an esophagoscope he had modified for this purpose; he called this device an autoscope.{{cite journal |vauthors=Hirsch NP, Smith GB, Hirsch PO |title=Alfred Kirstein. Pioneer of direct laryngoscopy |journal=Anaesthesia |volume=41 |issue=1 |pages=42–5 |date=January 1986 |pmid=3511764 |doi=10.1111/j.1365-2044.1986.tb12702.x|doi-access=free }} It is believed that the death in 1888 of Emperor Frederick III{{cite book

|author=Morell Mackenzie

|title=The case of Emperor Frederick III.: full official reports by the German physicians and by Sir Morell Mackenzie

|publisher=Edgar S. Werner

|location=New York

|year=1888

|page=167

|url=https://books.google.com/books?id=G2DTAAAAMAAJ&pg=PA167

|access-date=27 August 2010|author-link=Morell Mackenzie

}} motivated Kirstein to develop the autoscope.{{cite journal |vauthors=Burkle CM, Zepeda FA, Bacon DR, Rose SH |title=A historical perspective on use of the laryngoscope as a tool in anesthesiology |journal=Anesthesiology |volume=100 |issue=4 |pages=1003–6 |year=2004 | pmid=15087639

|doi=10.1097/00000542-200404000-00034|s2cid=36279277 |doi-access=free }}

In 1913, Chevalier Jackson was the first to report a high rate of success for the use of direct laryngoscopy as a means to intubate the trachea.{{cite journal |doi=10.1111/j.1460-9592.1996.tb00434.x |title=The technique of insertion of intratracheal insufflation tubes |year=1996 |last1=Jackson |first1=Chevalier |journal=Pediatric Anesthesia |volume=6 |issue=3 |pages=230|s2cid=72582327 }} Jackson introduced a new laryngoscope blade that had a light source at the distal tip, rather than the proximal light source used by Kirstein.{{cite journal |author=Zeitels SM |title=Chevalier Jackson's contributions to direct laryngoscopy |journal=J Voice |volume=12 |issue=1 |pages=1–6 |date=March 1998 |pmid=9619973 |doi=10.1016/S0892-1997(98)80069-6}} This new blade incorporated a component that the operator could slide out to allow room for passage of an endoracheal tube or bronchoscope.{{cite book

|author=Chevalier Jackson

|title=A manual of peroral endoscopy and laryngeal surgery

|chapter=I: Instrumentarium

|publisher=W.B. Saunders Company

|location=Philadelphia

|year=1922

|pages=17–52

|chapter-url=http://mybebook.com/download_free_ebook/jackson-chevalier-1865-1958_ebooks/bronchoscopy-and-esophagoscopya-manual-of-peroral-endoscopy-and-laryngeal-surgery/ebook13336.pdf

|access-date=27 August 2010

|isbn=978-1-4326-6305-6|author-link=Chevalier Jackson

}}

That same year, Henry Harrington Janeway (1873–1921) published results he had achieved using another new laryngoscope he had recently developed.{{cite journal |doi=10.1288/00005537-191311000-00009 |title=Intra-Tracheal Anesthesia from the Standpoint of the Nose, Throat and Oral Surgeon with a Description of a New Instrument for Catheterizing the Trachea.* |year=1913 |last1=Janeway |first1=Henry H. |journal=The Laryngoscope |volume=23 |issue=11 |pages=1082–1090|s2cid=71549386 |url=https://zenodo.org/record/1448738 }} An American anesthesiologist practicing at Bellevue Hospital in New York City, Janeway believed that direct intratracheal insufflation of volatile anesthetics would provide improved conditions for surgery of the nose, mouth and throat. With this in mind, he developed a laryngoscope designed for the sole purpose of tracheal intubation. Similar to Jackson's device, Janeway's instrument incorporated a distal light source. Unique however was the inclusion of batteries within the handle, a central notch in the blade for maintaining the tracheal tube in the midline of the oropharynx during intubation, and a slight curve to the distal tip of the blade to help guide the tube through the glottis. The success of this design led to its subsequent use in other types of surgery. Janeway was thus instrumental in popularizing the widespread use of direct laryngoscopy and tracheal intubation in the practice of anesthesiology.

• Helps in intubation during the administration of general anaesthesia or for mechanical ventilation.
• Detects causes of voice problems, such as breathing voice, hoarse voice, weak voice, or no voice.
• Detects causes of throat and ear pain.
• Evaluates difficulty in swallowing : a persistent sensation of lump in the throat, or mucus with blood.
• Detects strictures or injury to the throat, or obstructive masses in the airway.

File:Laryngoscopes-Miller blades.JPG, infant, and neonate)]]

File:Macintosh Blades.jpg blades (large adult, small adult, pediatric, infant, and neonate)]]

The vast majority of tracheal intubations involve the use of a viewing instrument of one type or another. Since its introduction by Kirstein in 1895, the conventional laryngoscope has been the most popular device used for this purpose. Today, the conventional laryngoscope consists of a handle containing batteries with a light source, and a set of interchangeable blades.

Early laryngoscopes used a straight "Magill Blade", and this design is still the standard pattern veterinary laryngoscopes are based upon; however the blade is difficult to control in adult humans and can cause pressure on the vagus nerve, which can cause unexpected cardiac arrhythmias to spontaneously occur in adults.

Two basic styles of laryngoscope blade are currently commercially available: the curved blade and the straight blade. The Macintosh blade is the most widely used of the curved laryngoscope blades,{{cite journal|vauthors=Scott J, Baker PA |title=How did the Macintosh laryngoscope become so popular?|journal=Pediatric Anesthesia|volume=19 | issue= Suppl 1|pages=24–9|year=2009|pmid=19572841|doi=10.1111/j.1460-9592.2009.03026.x|s2cid=6345531|doi-access=free}} while the Miller blade{{cite journal|author=Robert A. Miller|title=A new laryngoscope|journal=Anesthesiology|volume=2|issue=3|pages=317–20|year=1941|doi=10.1097/00000542-194105000-00008|s2cid=72555028|doi-access=free}} is the most popular style of straight blade.{{cite journal|author1=Somchai Amornyotin |author2=Ungkab Prakanrattana |author3=Phongthara Vichitvejpaisal |author4=Thantima Vallisut |author5=Neunghathai Kunanont |author6=Ladda Permpholprasert |title=Comparison of the Clinical Use of Macintosh and Miller Laryngoscopes for Orotracheal Intubation by Second-Month Nurse Students in Anesthesiology|journal=Anesthesiology Research and Practice|volume=2010|pages=1–5|year=2010|doi=10.1155/2010/432846|url=http://downloads.hindawi.com/journals/arp/2010/432846.pdf|pmc=2911595|access-date=27 August 2010|pmid=20700430|doi-access=free }} Both Miller and Macintosh laryngoscope blades are available in sizes 0 (neonatal) through 4 (large adult). There are many other styles of curved and straight blades (e.g., Phillips, Robertshaw, Sykes, Wisconsin, Wis-Hipple, etc.) with accessories such as mirrors for enlarging the field of view and even ports for the administration of oxygen. These specialty blades are primarily designed for use by anesthetists, most commonly in the operating room.{{cite book

|author=James M. Berry

|title=Benumof's airway management: principles and practice

|editor=Benumof JL

|chapter=Chapter 16: Conventional (laryngoscopic) orotracheal and nasotracheal intubation (single-lumen tube)

|publisher=Mosby-Elsevier

|location=Philadelphia

|edition=2nd

|year=2007

|pages=379–392

|isbn=978-0-323-02233-0

|chapter-url=https://books.google.com/books?id=uUVYjVUexKUC&q=Benumof's+airway+management:+principles+and+practice

|access-date=28 August 2010}} Additionally, paramedics are trained to use direct laryngoscopy to assist with intubation in the field.

File:Sagittal cross section view of laryngoscopy intubation with mac 3.png

The Macintosh blade is positioned in the vallecula, anterior to the epiglottis, lifting it out of the visual pathway, while the Miller blade is positioned posterior to the epiglottis, trapping it while exposing the glottis and vocal folds. Incorrect usage can cause trauma to the front incisors; the correct technique is to displace the chin upwards and forward at the same time, not to use the blade as a lever with the teeth serving as the fulcrum.

File:Vie Scope.jpg

The Miller, Wisconsin, Wis-Hipple, and Robertshaw blades are commonly used for infants. It is easier to visualize the glottis using these blades than the Macintosh blade in infants, due to the larger size of the epiglottis relative to that of the glottis.

Besides the conventional laryngoscopes, many other devices have been developed as alternatives to direct laryngoscopy. These include a number of indirect fiberoptic viewing laryngoscopes such as the flexible fiberoptic bronchoscope. The flexible fiberoptic bronchoscope or rhinoscope can be used for office-based diagnostics or for tracheal intubation. The patient can remain conscious during the procedure, so that the vocal folds can be observed during phonation. Surgical instruments passed through the scope can be used for performing procedures such as biopsies of suspicious masses. These instruments have become indispensable within the otolaryngology, pulmonology and anesthesia communities.

Other available fiberoptic devices include the Bullard scope,{{cite journal |author=Gorback MS |title=Management of the challenging airway with the Bullard laryngoscope |journal=Journal of Clinical Anesthesia |volume=3 |issue=6 |pages=473–7 |year=1991 |pmid=1760171

|doi=10.1016/0952-8180(91)90096-6}} UpsherScope,{{cite journal |vauthors=Pearce AC, Shaw S, Macklin S |title=Evaluation of the Upsherscope. A new rigid fibrescope |journal=Anaesthesia |volume=51 |issue=6 |pages=561–4 |year=1996 |pmid=8694210

|doi=10.1111/j.1365-2044.1996.tb12565.x|s2cid=37485173 |doi-access=free }}{{cite journal |vauthors=Fridrich P, Frass M, Krenn CG, Weinstabl C, Benumof JL, Krafft P |title=The UpsherScope in routine and difficult airway management: a randomized, controlled clinical trial |journal=Anesthesia & Analgesia |volume=85 |issue=6 |pages=1377–81 |year=1997 |pmid=9390612 |doi=10.1097/00000539-199712000-00036|s2cid=70552381 |doi-access=free }} and the WuScope.{{cite journal |vauthors=Wu TL, Chou HC |title=A new laryngoscope: the combination intubating device |journal=Anesthesiology |volume=81 |issue=4 |pages=1085–7 |year=1994 |pmid=7943825

|doi=10.1097/00000542-199410000-00044|doi-access=free }} These devices are widely employed for tracheal intubation, especially in the setting of the difficult intubation (see below).

{{unreferenced section|date=October 2017}}

File:Laryngoscope-Glidescope 02.JPG active pixel sensor (CMOS APS) video camera and light source are located at the point of angulation of the blade. An anesthesia machine is visible on the high resolution LCD monitor.]]

The conventional direct laryngoscope uses a line of sight provided by a rigid viewing instrument with a light on the blade or intra-oral portion which requires a direct view of the target larynx; this view is clearly seen in 80-90% of attempts. The frequent failure of direct laryngoscopy to provide an adequate view for tracheal intubation led to the development of alternative devices such as the lighted stylet, and a number of indirect fiberoptic viewing laryngoscopes, such as the fiberscope, Bullard scope, Upsher scope, and the WuScope. Though these devices can be effective alternatives to direct laryngoscopy, they each have certain limitations, and none of them is effective under all circumstances. One important limitation commonly associated with these devices is fogging of the lens.{{cite journal |vauthors=Foley LJ, Ochroch EA |title=Bridges to establish an emergency airway and alternate intubating techniques |journal=Crit Care Clin |volume=16 |issue=3 |pages=429–44, vi |date=July 2000 |pmid=10941582 |doi=10.1016/S0749-0704(05)70121-4}} In an attempt to address some of these limitations, Jon Berall, a New York City internist and emergency medicine physician, designed the camera screen straight video laryngoscope in 1998. The first true video laryngoscope Glidescope was produced in 1999 and a production version with 60 degree angle, an onboard heater, and a custom screen was first sold in dec 2000. The true video laryngoscope has a camera on the blade with no intervening fiberoptic components. The concept is important because it is simpler to produce and handle the resultant images from CMOS cameras. The integrated camera leads to a series of low cost variants that are not possible with the hybrid Fiberoptic units.

File:Glidescope 02.JPG using GlideScope video laryngoscope to intubate the trachea of a patient with challenging airway anatomy]]

In 2001, the GlideScope (designed by vascular and general surgeon John Allen Pacey) became the first commercially available video laryngoscope. It incorporates a high resolution digital camera, connected by a video cable to a high resolution LCD monitor. It can be used for tracheal intubation to provide controlled mechanical ventilation, as well as for removal of foreign bodies from the airway. GlideScope owes its superior results to a combination of five key factors:

1. The steep 60-degree angulation of its blade improves the view of the glottis by reducing the requirement for anterior displacement of the tongue.
2. The CMOS APS digital camera is located at the point of angulation of the blade (rather than at the tip). This placement allows the operator to more effectively view the field in front of the camera.
3. The video camera is recessed for protection from blood and secretions which might otherwise obstruct the view.
4. The video camera has a relatively wide viewing angle of 50 degrees.
5. The heated lens innovation helps to prevent fogging of the lens, which might otherwise obscure the view.

Tracheal intubation with the GlideScope can be facilitated by the use of the Verathon Stylet, a rigid stylet that is curved to follow the 60° angulation of the blade. To achieve a 99% successful rate of intubation with the GlideScope requires the operator to acquire a new skill set with this stylet.

In a 2003 study, the authors noted that the GlideScope provided adequate vision of the glottis (Cormack and Lehane grade I-II) {{cite journal |vauthors=Cormack RS, Lehane J |title=Difficult tracheal intubation in obstetrics |journal=Anaesthesia |volume=39 |issue=11 |pages=1105–11 |date=November 1984 |pmid=6507827 |doi=10.1111/j.1365-2044.1984.tb08932.x|doi-access=free }}{{cite journal

|author=Ernst Zadrobilek

|title=The Cormack-Lehane classification: twenty-fifth anniversary of the first published description

|journal=Internet Journal of Airway Management

|volume=5

|date=28 October 2009

|url=http://www.ijam.at/volume05/historicalnote02/default.htm

|access-date=4 August 2010}} even when the oral, pharyngeal and laryngeal axes could not be optimally aligned due to the presence of a cervical collar. Despite this significant limitation, the average time to intubate the trachea with the GlideScope was only 38 seconds. In 2005, the first major clinical study comparing the Glidescope to the conventional laryngoscope was published. In 133 patients in whom both Glidescope and conventional laryngoscopy were performed, excellent or good laryngeal exposure was obtained in 124/133 (93%) of Glidescope laryngoscopy patients, compared with only 98/133 (74%) of patients in whom conventional laryngoscopy was used. Intubation was successful in 128/133 (96%) of Glidescope laryngoscopy patients.{{cite journal |vauthors=Cooper RM, Pacey JA, Bishop MJ, McCluskey SA |title=Early clinical experience with a new videolaryngoscope (GlideScope) in 728 patients |journal=Can J Anaesth |volume=52 |issue=2 |pages=191–8 |date=February 2005 |pmid=15684262 |doi=10.1007/BF03027728|doi-access=free }} These early results suggest that this device may be a useful alternative in the management of difficult tracheal intubation.

The Verathon design team later produced the Ranger Video Laryngoscope for a United States Air Force requirement that is now rolling forward into EMS and military use. The Cobalt series of GlideScope then introduced a single-use variant that encompasses weights from 1000 grams to morbid obesity and is successful in many airway syndromes as well. The GlideScope Ranger is a variant designed for use in pre-hospital airway management including air, land, and sea applications. This device weighs 1.5 pounds, and is waterproof as well as airworthy to 20,000 feet altitude. The GlideScope Cobalt is a variant that has a reusable video camera with light-emitting core which has a disposable or single use external shell for prevention of cross infection.

In August 2009, the team at Verathon collaborated with Professor John Sakles from the University of Arizona Emergency Department in achieving the world's first tracheal intubation conducted with the assistance of telemedicine technology. During this demonstration, Sakles and the University of Arizona Telemedicine service guided physicians in a rural hospital as they performed a tracheal intubation using the GlideScope.

Several types of video laryngoscopes are also currently available, such as the HEINE visionPRO, Truview PCD-R Manufactured by Truphatek Israel, Glidescope, McGrath laryngoscope,{{cite journal |vauthors=Shippey B, Ray D, McKeown D |title=Use of the McGrath videolaryngoscope in the management of difficult and failed tracheal intubation |journal=British Journal of Anaesthesia |volume=100 |issue=1 |pages=116–9 |year=2008 |pmid=17959584

|doi=10.1093/bja/aem303|doi-access=free }} Daiken Medical Coopdech C-scope VLP-100,{{cite web

|author=Daiken Medical Co., Ltd.

|year=2007

|url=http://www.baobabmedical.com.au/Pdfs/portablecolourvideo.pdf

|title=Coopdech video laryngoscope portable VLP-100

|publisher=Daiken Medical Co., Ltd.

|location=Osaka, Japan

|access-date=27 August 2010

|archive-url=https://web.archive.org/web/20110216044108/http://baobabmedical.com.au/Pdfs/portablecolourvideo.pdf

|archive-date=16 February 2011

|url-status=dead

}} the Storz C-Mac,{{cite journal |vauthors=Boedeker BH, Berg BW, Bernhagen MA, Murray WB |title=Endotracheal intubation comparing a prototype Storz CMAC and a glidescope videolaryngoscope in a medical transport helicopter - a pilot study |journal=Studies in Health Technology and Informatics |volume=142 |pages=37–9 |year=2009 |pmid=19377109 |url=http://booksonline.iospress.nl/Extern/EnterMedLine.aspx?ISSN=0926-9630&Volume=142&SPage=37|access-date=27 August 2010}} Pentax-AWS(or Airway Scope),{{cite web|title=Airway Scope AWS-S100, Rigid Video Laryngoscope for Intubation|url=http://www.pentax.co.jp/english/news/2006/200633.html|author=Pentax Medical Company|date=6 July 2006|publisher=Pentax Medical Company|location=Montvale, New Jersey|url-status=dead|archive-url=https://web.archive.org/web/20100728075509/http://www.pentax.co.jp/english/news/2006/200633.html|archive-date=28 July 2010|access-date=27 August 2010}}{{cite web

|author=Pentax Medical Company

|url=http://www.pentaxmedical.com/brochures/PentaxAWS.pdf

|title=Pentax AWS

|publisher=Pentax Medical Company

|location=Montvale, New Jersey

|access-date=27 August 2010

|archive-url=https://web.archive.org/web/20110715063400/http://www.pentaxmedical.com/brochures/PentaxAWS.pdf

|archive-date=15 July 2011

|url-status=dead

}}{{cite journal |vauthors=Suzuki A, Toyama Y, Katsumi N, Kunisawa T, Sasaki R, Hirota K, Henderson JJ, Iwasaki H |title=The Pentax-AWS((R)) rigid indirect video laryngoscope: clinical assessment of performance in 320 cases |journal=Anaesthesia |volume=63 |issue=6 |pages=641–7|year=2008 |pmid=18477277 |doi=10.1111/j.1365-2044.2008.05452.x|doi-access=free }}{{cite journal |vauthors=Malik MA, O'Donoghue C, Carney J, Maharaj CH, Harte BH, Laffey JG |title=Comparison of the Glidescope, the Pentax AWS, and the Truview EVO2 with the Macintosh laryngoscope in experienced anaesthetists: a manikin study |journal=British Journal of Anaesthesia |volume=102 |issue=1 |pages=128–34 |year=2009 |pmid=19059923

|doi=10.1093/bja/aen342|doi-access=free |hdl=10379/12608 |hdl-access=free }}{{cite journal |vauthors=Asai T, Enomoto Y, Shimizu K, Shingu K, Okuda Y |title=The Pentax-AWS video-laryngoscope: the first experience in one hundred patients |journal=Anesthesia & Analgesia |volume=106 |issue=1 |pages=257–9, table of contents |year=2008 |pmid=18165587

|doi=10.1213/01.ane.0000287647.46165.bc|s2cid=32788869 |doi-access=free }} Video Macintosh Intubating Laryngoscope System (VMS),{{cite journal |vauthors=Kaplan MB, Ward DS, Berci G |title=A new video laryngoscope-an aid to intubation and teaching |journal=Journal of Clinical Anesthesia |volume=14 |issue=8 |pages=620–6 |year=2002 |pmid=12565125

|pmc=4803417 |doi=10.1016/S0952-8180(02)00457-9}} the Berci DCI,{{cite journal |vauthors=Low D, Healy D, Rasburn N |title=The use of the BERCI DCI Video Laryngoscope for teaching novices direct laryngoscopy and tracheal intubation |journal=Anaesthesia |volume=63 |issue=2 |pages=195–201 |year=2008 |pmid=18211452

|doi=10.1111/j.1365-2044.2007.05323.x|doi-access=free }} and the Copilot VL.{{cite web|last=Tydlaska|first=Jay|title=Introducing the CoPilotVL|url=http://copilotvl.com|publisher=Magaw LLC|access-date=5 August 2011}} These laryngoscopes employ a variety of features such as a monitor on the handle and or channels to assist in guiding the endotracheal tube into the trachea. The superior performance of video laryngoscopes in airway management where cervical spine injury is possible has raised the question of whether these scopes should supersede direct laryngoscopy in routine airway management.{{cite journal |vauthors=Agrò F, Barzoi G, Montecchia F |title=Tracheal intubation using a Macintosh laryngoscope or a GlideScope in 15 patients with cervical spine immobilization |journal=Br J Anaesth |volume=90 |issue=5 |pages=705–6 |date=May 2003 |pmid=12697606 |doi=10.1093/bja/aeg560|doi-access=free }} Further evidence in support of videolaryngoscopy has accumulated over the years, indicating a favourable risk profile for video laryngoscopes over direct laryngoscopes.{{cite journal |vauthors= Hansel J, Rogers AM, Lewis SR, Cook TM, Smith AF |title=Videolaryngoscopy versus direct laryngoscopy for adults undergoing tracheal intubation |journal=Cochrane Database Syst Rev |volume=2022 |pages=CD011136 |date=April 2022 |issue=4 |pmid= 35373840 |doi=10.1002/14651858.CD011136.pub3|pmc=8978307 }}

Other "noninvasive" devices which can be employed to assist in tracheal intubation are the laryngeal mask airway{{cite journal |author=Brain AI |title=The laryngeal mask--a new concept in airway management |journal=Br J Anaesth |volume=55 |issue=8 |pages=801–5 |date=August 1983 |pmid=6349667 |doi=10.1093/bja/55.8.801|s2cid=21057581 |doi-access=free }}{{cite journal

|doi=10.1111/j.1365-2044.1985.tb10788.x |author=Brain AI |title=Three cases of difficult intubation overcome by the laryngeal mask airway |journal=Anaesthesia |volume=40 |issue=4 |pages=353–5 |year=1985 | pmid=3890603|doi-access=free }}{{cite journal |author=Benumof JL |title=Use of the laryngeal mask airway to facilitate fiberscope-aided tracheal intubation |journal=Anesth. Analg. |volume=74 |issue=2 |pages=313–5 |date=February 1992 |pmid=1731560 |doi=10.1213/00000539-199202000-00034|doi-access=free }}{{cite journal |vauthors=Lim SL, Tay DH, Thomas E |title=A comparison of three types of tracheal tube for use in laryngeal mask assisted blind orotracheal intubation |journal=Anaesthesia |volume=49 |issue=3 |pages=255–7 |date=March 1994 |pmid=7848398 |doi=10.1111/j.1365-2044.1994.tb03435.x|doi-access=free }}{{cite journal |vauthors=Theroux MC, Kettrick RG, Khine HH |title=Laryngeal mask airway and fiberoptic endoscopy in an infant with Schwartz-Jampel syndrome |journal=Anesthesiology |volume=82 |issue=2 |pages=605 |date=February 1995 |pmid=7856930 |doi=10.1097/00000542-199502000-00044|doi-access=free }}{{cite journal |vauthors=Inada T, Fujise K, Tachibana K, Shingu K |title=Orotracheal intubation through the laryngeal mask airway in paediatric patients with Treacher-Collins syndrome |journal=Paediatr Anaesth |volume=5 |issue=2 |pages=129–32 |year=1995 |pmid=7489423 |doi=10.1111/j.1460-9592.1995.tb00260.x|s2cid=36051869 }}{{cite journal |vauthors=Lee JJ, Lim BG, Lee MK, Kong MH, Kim KJ, Lee JY |title=Fiberoptic intubation through a laryngeal mask airway as a management of difficult airwary due to the fusion of the entire cervical spine - A report of two cases - |journal=Korean J Anesthesiol |volume=62 |issue=3 |pages=272–6 |date=March 2012 |pmid=22474556 |pmc=3315659 |doi=10.4097/kjae.2012.62.3.272}} (Some types of which may be used as a conduit for endotracheal tube placement), the lighted stylet,{{cite journal |vauthors=Zbinden S, Schüpfer G |title=Tube-Stat®: ein nützliches Hilfsmittel bei schwieriger Intubation |trans-title=The Tube-Stat: a useful aid in difficult intubation |language=de |journal=Der Anaesthesist |volume=38 |issue=3 |pages=140–3 |year=1989 |pmid=2719227}}{{cite journal |vauthors=Davis L, Cook-Sather SD, Schreiner MS |title=Lighted stylet tracheal intubation: a review |journal=Anesthesia & Analgesia |volume=90 |issue=3 |pages=745–56 |year=2000 |pmid=10702469 |doi=10.1097/00000539-200003000-00044|s2cid=26644781 |doi-access=free }} and the AirTraq.{{cite journal |vauthors=Maharaj CH, Costello JF, McDonnell JG, Harte BH, Laffey JG |title=The Airtraq as a rescue airway device following failed direct laryngoscopy: a case series |journal=Anaesthesia |volume=62 |issue=6 |pages=598–601 |year=2007 |pmid=17506739 |doi=10.1111/j.1365-2044.2007.05036.x|s2cid=21106547 }} Due to the widespread availability of such devices, the technique of blind digital intubation{{cite journal

|author=Norman R. James

|title=Blind Intubation

|journal=Anaesthesia

|volume=5

|issue=3

|pages=159–160

|year=1950

|doi=10.1111/j.1365-2044.1950.tb12674.x|s2cid=221389855

}} of the trachea is rarely practiced today, though it may still be useful in emergency situations under austere conditions such as natural or man-made disasters.{{cite book

|author1=Chris C. Christodoulou |author2=Michael F. Murphy |author3=Orlando R. Hung |title=Benumof's airway management: principles and practice

|editor=Benumof JL

|chapter=Chapter 17: Blind digital intubation

|publisher=Mosby-Elsevier

|location=Philadelphia

|edition=2nd

|year=2007

|pages=393–398

|isbn=978-0-323-02233-0

|chapter-url=https://books.google.com/books?id=uUVYjVUexKUC&q=Benumof's+airway+management:+principles+and+practice

|access-date=28 August 2010}}

Cases of mild or severe injury caused by rough and inexperienced use of laryngoscopes have been reported. These include minor damage to the soft tissues within the throat which causes a sore throat after the operation to major injuries to the larynx and pharynx causing permanent scarring, ulceration and abscesses if left untreated.{{citation needed|date=January 2012}} Additionally, there is a risk of causing tooth damage.

The word laryngoscopy uses combining forms of laryngo- and -scopy.

{{reflist|30em}}

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