Comparative Assessment of Difficult Intubation: Role of Modified Mallampati Test Versus Thyromental Height Test

Abstract

Background: Challenging intubation presents a frequent and significant obstacle for anesthesiologists, frequently playing a role in anesthesia-related mortality. The Modified Mallampati test (MMT) assesses oropharyngeal structures and provides a simple approach for anticipating possible airway challenges during endotracheal intubation. Recently, the thyromental height test (TMHT) has emerged as a dependable indicator of challenging intubation.
Objective: The goal of this study was to find out which of these preoperative airway assessment techniques TMHT or MMT is better at finding patients who are likely to have trouble with intubation.
Methods: This observational study was carried out in the Medical College for Women & Hospital, Uttara, Dhaka from July 2024 to June 2025, spanning a duration of 12 months. A total of 148 patients with various surgical issues were selected for the study, all undergoing different procedures under general anaesthesia in various operating theatres at Medical College for Women & Hospital, Uttara, Dhaka. Following the acquisition of written consent from each patient or their attendant, a detailed history of the illness was gathered, thorough clinical examinations were conducted, and pertinent laboratory investigations were carried out. MMT and TMHT was done for all patients. All data was meticulously documented in a structured data sheet, and statistical analysis was conducted using SPSS version 22.0.
Results: For the purpose of predicting intubation difficulty, TMHT showed a sensitivity of 94.9%, specificity of 93.3%, positive predictive value of 90.3%, negative predictive value of 96.5%, and accuracy of 93.9%. On the other hand, MMT got a sensitivity of 74.6%, specificity of 88.8%, PPV of 81.5%, NPV of 84.0%, and accuracy of 93.1%.
Conclusion: With higher sensitivity, specificity, positive predictive value, negative predictive value, and accuracy than MMT, this study demonstrates that TMHT is the most pertinent predictive test for difficult intubation.

J  Dhaka National Med. Coll. Hos. 2025; 31 (02): 28-33