Emerg Med J 22:394-396 doi:10.1136/emj.2004.021402
  • Review

The nasopharyngeal airway: dispelling myths and establishing the facts

  1. K Roberts1,
  2. H Whalley2,
  3. A Bleetman3
  1. 1Specialist Registrar in General Surgery, Walsall Manor Hospital
  2. 2Senior house officer in Intensive Care Medicine, Birmingham Heartlands Hospital, UK
  3. 3Consultant in Accident and Emergency Medicine, Birmingham Heartlands Hospital, UK
  1. Correspondence to:
 Keith Roberts
  • Accepted 13 March 2005


The nasopharyngeal airway (NPA) is a simple airway adjunct used by various healthcare professionals. It has some advantages over the oropharyngeal airway (OPA) but despite this it appears to be used less frequently. This may be due to fears over intracranial placement in cases of possible basal skull fracture. This fear, promulgated by training, is based solely on two single case reports and relative risk needs to be put into clinical context.

Widely taught methods of sizing NPAs are based upon the width of the patient’s nostril or little finger, MRI data demonstrate that these methods are inaccurate. Ideal NPA length measured at nasal endoscopy correlates with subject height, this is independent of subject sex, and is a far more accurate determinant and easy to use in the clinical setting. Average height females require a Portex size 6 NPA and average height males a size 7 Portex NPA. This knowledge provides a rapid method of NPA selection.


  • Competing interests: none declared

  • KR and AB are both HEMS doctors, Warwickshire and Northamptonshire Air Ambulance

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