Video on Orotracheal Intubation

To the Editor: In the Video in Clinical Medicine about orotracheal intubation, presented by Kabrhel et al. (April 26 issue), 1 the authors state that the “combination of flexion of the neck and extension of the head [the sniffing position] improves the alignment of the axes of the oral cavity, pharynx, and larynx, facilitating optimal visualization of the vocal cords.” This is an anatomical myth that is not supported by clinical evidence. 2 In a randomized crossover study of 456 consecutive patients, Adnet et al. 3 found no differences in glottic visualization by direct laryngoscopy or in the score on the intubation-difficulty scale . . .