Advocating for equality for preterm infants.

I enjoyed the CMAJ article by Trottier and colleagues, and wish to suggest a possible addition to the initial management of hoarseness algorithm in Figure 3. Many primary care and emergency physicians are able to perform simple, indirect laryngoscopy with topical anesthesia, a headlamp and a laryngeal mirror. In a cooperative patient, obtaining a decent view of the glottic opening and surrounding area is often possible, and might allow physicians to decide quickly if a patient needs to see an otolaryngologist on an urgent basis. If the physician is unable to obtain a useful view, the algorithm continues as already described. Although many emergency physicians have access to and are trained in the use of a fiberoptic nasopharyngoscope, I think the indirect examination may still have a role in certain settings. We should endeavor to pass this skill on to trainees we mentor.