Airway Management in Singers: A Cross-sectional Survey

Objective: To review and establish current practices regarding airway management in vocal professionals undergoing surgery. Study Design: Cross-sectional survey Setting: The setting included practitioners that treat vocal professionals across international sub-specialty societies. Subjects and Methods: A twenty-one-item survey was sent to practitioners that routinely treat vocal professionals including the American Broncho-Esophagological Association, European Laryngological Society, and 2017 Fall Voice Conference attendees. It included questions regarding the respondents’ demographics, preferences for airway control in non-laryngeal and laryngeal surgery, and peri-operative management. Results: Total respondents (n = 163): 82.8% were Laryngologists, 4.3 % were General Otolaryngologists, 3.1% were Head & Neck Oncologists, and 6.8% were Speech-Language Pathologists. One hundred twenty-five of the participants (76.7%) classified their experience with vocal professionals as ‘extensive’ or ‘often.’ For non-laryngeal surgery, there was a tendency towards laryngeal mask airway (53.1%) over endotracheal intubation (46.9%). For professional singers, a smaller endotracheal tube was recommended. Size varied based on sex. For males, 88.5% recommended a tube ≤7.0 in non-singers; 98.2% recommended a tube ≤7.0 in singers. In females 76.1% recommended a tube ≤6.0 for non-singers; 94.6 % recommended a size ≤6.0 in a female singer. For laryngeal surgery, 14% of providers personally intubated patients over 90% of the time. Of the providers who work with trainees, 60.5% did not allow resident intubation. Conclusion: Objective data regarding precautions in airway management of professional voice users is scarce. This is the largest survey to date on current practices. Survey results indicate that smaller ETTs are preferred for singers, and that more experienced practitioners are preferred for the intubation.