To the Editor:—

Adnet et al.  1have produced an article that has enhanced my understanding of our favorite organ. They believed that they had not been able to demonstrate any benefit to the “sniffing position.” However, judging from their figure 1, it seems that there may be something to it. If one draws a line parallel to the line of vision (LV) and tangential to the cephalad surface of the tongue, the distance between these two lines seems to be minimal in the sniffing position. Because this is the amount of forward displacement of the soft tissue by the laryngoscope needed to visualize the larynx, could it be that a smaller distance equates with a better view? The authors almost allude to this in their second to last paragraph.

Clinically, we recognize that the compliance of submandibular soft tissue can be the limiting factor in forward displacement. Decreased compliance (from small size, inflammation, edema, autoimmune disease, burns, or radiation fibrosis) makes it more difficult and thus makes visualizing the larynx more difficult. It is not a stretch to project that ease of laryngoscopy will be compromised if the forward displacement of the soft tissues is less than the distance required to line up the line of vision, or, put another way, a smaller distance could be enabling.

The small scale of figure 1 of Adnet et al.  1makes it hard to tell for sure, so confirmation of this requires measurement of the full-scale images.

Adnet F, Borron SW, Dumas JL, Lapostolle F, Cupa M, Lapandry C: Study of the “sniffing position” by magnetic resonance imaging. A nesthesiology 2001; 94: 83–6