Sex-Based Differences in Force Metrics During Suspension Micolaryngoscopy

Introduction: Despite anatomic differences between men and women, surgical techniques and instruments are generally not tailored based on sex. Our objective was to compare gender differences in suspension microlaryngoscopy (SML) force metrics and correlate them with post-op symptoms.

Methods: Force metrics were collected on 176 patients (92 female, 84 male) undergoing SML using the laryngeal force sensor. The sensor records the force of the laryngoscope blade against the oral cavity. Values include maximum force, average force, and impulse (force and time). Sex, procedure type, BMI/weight, post-operative pain scores, and EAT-10 scores were collected.

Results: Males experienced higher average force (95.2 Newtons vs. 68.0 N, P = 0.0002), maximum force (191.0 N vs. 137.9 N, P < 0.0001), and impulse (P=0.004). Tissue creep (difference between maximum force and average force) was lower in women (P = 0.002). Women reported more post-operative dysphagia (EAT-10 score 5.9 vs. 4.3). Linear regression showed a strong correlation between BMI and impulse in females when controlling for procedure type (R2 = 0.3). In men there were higher variations across force metrics, and lower correlation with weight.

Conclusions: Women experienced higher extra-laryngeal complications after SML despite lower force values. One potential reason may be related to smaller amounts of soft tissue in the oral cavity, as recorded by lower tissue creep values. There was a stronger correlation between force metrics and BMI in females than in men. The results reflect fundamental differences in tissue effects and force measures in sexes and suggest a need to develop methods and instruments that are gender specific.