Airway Obstruction Calculator

Assess percent airway obstruction based on endotracheal tube size

Calculate Airway Obstruction

Based on Cotton-Myer Grading System for Subglottic Stenosis

Percent Airway Obstruction Reference Table

Age ETT 2.0 ETT 2.5 ETT 3.0 ETT 3.5 ETT 4.0 ETT 4.5 ETT 5.0 ETT 5.5
Pre-term (younger) 40% No obstruction - - -
Pre-term (older) 58% 30% No obstruction - - -
0-3 months 68% 48% 26% No obstruction - - -
3-9 months 75% 59% 41% 22% No obstruction - - -
9 months - 2 years 80% 67% 53% 38% 20% - - -
2 years 84% 74% 62% 50% 35% 19% - -
4 years 86% 78% 68% 57% 45% 32% 17% -
6 years 98% 81% 73% 64% 54% 43% 30% 16%

Cotton-Myer Grading System

Grade I

0-50% obstruction

Mild stenosis - Usually well tolerated

Grade II

51-70% obstruction

Moderate stenosis - May cause respiratory symptoms

Grade III

71-99% obstruction

Severe stenosis - Significant airway compromise

Grade IV

No detectable lumen

Complete obstruction - Critical airway emergency

Clinical Considerations

Assessment Method: The percentage of obstruction is determined by comparing the size of ETT that can pass through the stenotic area with age-appropriate normal ETT sizes

Clinical Application: This grading system is widely used for pediatric subglottic stenosis assessment and treatment planning

Tube Variability: The grading may depend on the style and outer diameter of the specific ETT used

Limitations: This is an estimation tool. Direct visualization via endoscopy and imaging studies are essential for accurate diagnosis

References

  1. Myer CM 3rd, O'Connor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes. Ann Otol Rhinol Laryngol. 1994 Apr;103(4 Pt 1):319-23. doi: 10.1177/000348949410300410. PMID: 8154776.
  2. Propst EJ, Funamura JL, Kawai K, Watters K, Rahbar R. Myer‐Cotton Grade of Subglottic Stenosis Depends on Style of Endotracheal Tube Used. Laryngoscope. 2023 Oct;133(10):2721-2725. doi: 10.1002/lary.30577. PMID: 36688266.