Tube or mask? What happens to the vocal cords

Airway & voice · 2 min read

Anesthesiologists have more than one way to protect your airway during general anesthesia. The endotracheal tube passes between the vocal cords into the windpipe. A laryngeal mask airway (LMA) sits above the cords.

In a randomized study of 14 patients undergoing minor surgery, swelling of the vocal cords and a narrower vocal-cord angle were seen after surgery in the tube group, but not in the LMA group. Laryngeal resistance during mechanical ventilation rose only in the tube group. The authors concluded that the LMA has an advantage for avoiding postoperative laryngeal swelling.

A later meta-analysis of 10 randomized trials found that flexible LMAs had lower hoarseness, coughing and oxygen desaturation than tubes, but more partial upper-airway obstruction.

Takeaway: every airway device trades one thing for another. Which is right depends on the operation, your anatomy and your anesthesiologist’s judgement.

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References

1. Tanaka A, Isono S, Ishikawa T, et al. Laryngeal resistance before and after minor surgery: endotracheal tube versus Laryngeal Mask Airway. Anesthesiology. 2003;252-258. PMID 12883396
2. Xu R, Lian Y, Li WX. Airway complications during and after general anesthesia: a comparison, systematic review and meta-analysis of using flexible laryngeal mask airways and endotracheal tubes. PLoS One. 2016;e0158137. PMID 27414807