Introduction : Correct positioning of the patient appears to be the crucial determining factor for obtaining a good glottic visualization. The “sniffing position” is widely recommended for direct laryngoscopy. However, the anatomic explanation of the advantage of this maneuver has been called into question. The neutral head position has been commonly used by nurse anesthetists in routine anesthesia procedures. No any other studies have claimed that the sniffing position superior to the neutral head position. The purpose of this study was to evaluate the head position was obtained by manipulation of patient’s occiput resting on the operating table. The patients were randomized as follows : Group A the sniffing position during the first laryngoscopy and the neutral head position during the second performance ; group B the neutral head position during the first laryngoscopy and the sniffing position during the second maneuver. Glottic exposure was assessed glottic visualization of sniffing position compared with that of neutral head position for tracheal intubation in normal practice. Methods : A prospective, randomized study with a cross-over design, included 500 patients scheduled for elective surgery under general anesthesia. The anesthetic procedure included two laryngoscopies with muscle paralysis performed by nurse anesthetists. During the second direct laryngoscopy, intubation of the trachea was completed. The sniffing position was obtained by placement of a 10 cm cushion under the patient’s head. The neutral by nurse anesthetists using the modified Cormack and Lehane classification. Results : The sniffing position improved glottic visualization (decreased the Cormack and Lehane grade) in 36.4% of patients and worsened it (increased the Cormack and Lehane grade) in 6.2% of patients, as compared to the other group. Conclusions : The sniffing position improved the laryngoscopic view.