Discussion
This study evaluated the epiglotticthickness measured by US in healthy
Chinese adults. The results showed that male gender and higher BMI were
positively related to the thicker epiglottis. Also, Chinese adults had
thinner epiglottisthan Americans15.
US is a real-time, noninvasive, non-radiated, readily accessible imaging
modality. With such characteristics, US can play an important role in
screening and diagnosis in the EDs.It has a wide range of applications
such as cardiopulmonary resuscitation, shock evaluation, and airway
management20-22. This study demonstrates the
feasibility of US for evaluation of the epiglottis. It could be a
supplementary examination for patients with suspected acute
epiglottitis, in addition to conventional radiography. Also, it would be
more suitable than laryngoscopy during the COVID-19 pandemic. Moreover,
US had a greater value for patients having hemodynamic instability or
severe dyspnea in difficulties to obtain optimal radiographs18.
Evidence regarding US evaluation of epiglottis for healthy adults is
still limited. Werner et al reported thickness among the normal
American subjects and patients15. Koet al have
reported the sonographic thickness of the epiglottis among Korean
adults18. Comparing with their results, this
studyshowed the epiglottisin healthy Chinese adults was thinner than
that in Americans.
The current study provides comparability between genders that the
numbers of men and women were approximately equal.Also, it not only
included obese volunteers but also stratified them according to their
BMI. The results showed male gender and higher BMI were independent
predictors for the epiglotticthickness, although gender had a greater
impact.Reviewing the literature, menhave been reported to have a thicker
epiglottis than women15,23. Male gender and
BMI>25.0 kg/m2were significantly associated with severe
epiglottitis24. Whether thicker epiglottis related to
a higher incidence of epiglottitis in men5,9,25 is
uncertain. Moreover, whether thicker epiglottis in men and subjects with
higher BMI has more chances to develop severe epiglottitis needs further
investigation.
To the best of our knowledge, this is the first study to investigate the
epiglottic thickness in healthy Chinese adults. Independent predictors
such as gender and BMI were identified. Race ethnicity would exist in
the epiglottic thickness.
Despite these contributions, this study has several limitations. First,
the results were obtained from one single institution. However, the
sample size and the power of the study were statistically sufficient.
Second, US is an operator-dependent imaging modality. The bias could be
eliminated through supervision by a senior instructor. Additionally,
Cohen’s kappa in the current study was 0.87, which implied good
consistency between operators for the epiglottic measurements. Third,
data regarding race-ethnicity were obtained from previous studies.
Future multicenteror international studieswould be conducted for
validation or investigation for race differences.