ASPO065 - DISE: Efficient and Effective Documentation
Sunday, May 1, 2022
8:55 AM – 9:55 AM CT
Location: Landmark C
Matthew C. Gropler, MD1, Sanjay R. Parikh, MD2, Norman R. Friedman, MD3;
1Pediatric Otolaryngology, Univ. Hosp. and Case Western Reserve Univ. Sch. of Med., Cleveland, OH, 2Pediatric Otolaryngology, Univ. of Washington and Seattle Children’s Hosp., Seattle, WA, 3Pediatric Otolaryngology, Univ. of Colorado Sch. of Med. and Children’s Hosp. Colorado, Aurora, CO.
Assistant Professor University Hospital/Rainbow Babies and Children's Hospital Case Western Reserve University School of Medicine Cleveland, Ohio
Introduction: Utilization of drug induced sleep endoscopy (DISE) in the treatment pediatric obstructive sleep apnea (OSA) has rapidly increased. However, there has been a fragmented approach with variation in technique, documentation, and interpretation. DISE can be an effective tool for guiding decision making for further surgical treatment of pediatric patients with OSA. For this to occur, a system that offers a standardized approach is required for an efficient and reproducible exam with consistent documentation that allows for easy review. This protocol provides an efficient and standardized approach to the recordings of DISE in children with standardized points of examination. This allows for reproducible viewpoints across multiple exams. The standardization of the viewpoints with associated photos and short videos provides the ability for reproducible results and facilitation of multi-institutional collaboration and research investigations.
Description of Video: This video demonstrates the technique and documentation of DISE exam. Exam beings with bilateral nasal passages while inhalation anesthetic onboard. Next upper airway is examined with scope in Muller position and video starts at first signs of obstruction. At least 5 respiratory cycles or 15 seconds are observed at each exam point (nasopharynx, oropharynx, and supraglottis) until representative video of obstruction pattern are observed. Adjunctive measures include retraction of scope to free edge of soft palate and perform additional maneuvers in the following sequence: chin lift, jaw thrust and then proceed with tracheobronchoscopy if suspicion for lower airway pathology. Positional exams can be done as well based on polysomnography findings.