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Although it is controversial, the Mallampati classification is routinely adopted as an evaluation tool used to predict the presence and severity of Obstructive Sleep Apnea. The Oropharyngoscopy is a simple, minimally invasive examination, but it requires specific knowledge, and training. Given the growth of sleep medicine and the insertion of non-medical professionals in multidisciplinary teams, it is necessary to guarantee a consistency in its assessments.


To verify the concordance of the Mallampati evaluation among professionals of different specialties.


Analytical, observational and cross-sectional study with the participation of 144 individuals, of both sexes with a mean age 33.79 years. Approved N 2,891,458.
The photograph was taken by a student of speech therapy and another of dentistry. Two records were taken for each patient as they and were told to open their mouths and swallow, relaxing the tongue. To select the images that were analysed, luminosity and better tongue relaxation position were considered.
The images were sent separately to three evaluators, (a speech therapist certified in Sleep Medicine, an anaesthetist and an otorhinolaryngologist) along with a spreadsheet of answers. Professionals observed the relationship between the tongue and the oral cavity and classified it according to the Modified Mallampati score in grade I, II, III or IV.
After analysis and completion, the spreadsheet was returned by e-mail and blindly forwarded for statistical analysis.
To verify the degree of coincidence between the pairs of examiners, the weighted Kappa coincidence scores and confidence intervals were obtained for the parameter cited. The values for the three pairs of examiners and their confidence intervals were also obtained.
The statistical program MEDCALC version 14.8.1 was used. The intervals were obtained with a reliability of 95%.


Most assessments corresponded to grade 4 (percentages ranging from 61.8% to 68.1%). The percentages of Grade 1 ranged from 4.2% to 10.4%, grade 2 ranged from 6.9% to 15.3% and grade 3 from 11.1% to 20.8%. The weighted kappa value was higher among examiners 1 and 2 (0.92) indicating excellent concordance and 0.69 to 0.72 in the other two pairs (good concordance). The kappa value for the three pairs of examiners was 0.78 (good concordance).


There was good concordance in the evaluation of Mallampati among speech therapists, anesthesiologists and otorhinolaryngologists.


oropharynx; diagnosis; oral; sleep apnea syndromes


Área Clínica


Eduardo Rodrigues dos Santos, Nádia Maria da Conceição Duarte, Damião Fabrício Mangueira de Sousa, Jamilly Henrique Costa da Silva, Luciana Moraes Studart-Pereira