Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France.
Pediatr Pulmonol. 2023 Jul;58(7):1889-1895. doi: 10.1002/ppul.26408. Epub 2023 Apr 10.
Pediatric drug-induced sleep endoscopy (DISE) lacks a universal and easy-to-use scoring system. The velum, oropharynx, tongue, epiglottis (VOTE) scoring system is widely used but needs to be completed in pediatrics. The main objective of this study was to investigate the distribution of obstructive sites in DISE and to propose an appropriate pediatric scoring system. The secondary objective was to evaluate the changes in surgical management induced by the proposed scoring system.
A single-center prospective 5-year study was conducted from March 2016 to December 2021, including 99 children with a mean age of 7.2 years (±3.7), with pathological preoperative sleep recordings and undergoing DISE. The distribution of all upper airway obstructive sites was studied.
Adenoids (A) were the most frequent obstructive site (63% of patients), and the nasal cavities (N) and the larynx (L) were other frequent obstructive sites. These sites are not explored by the VOTE scoring system, leading to the creation of the nose, adenoids, velum, oropharynx, tongue, epiglottis, larynx (NAVOTEL) scoring system. NAVOTEL was significantly correlated with the severity of obstructive sleep apnea-hypopnea syndrome (OSAS) (ρ = 0.2; p = 0.04) and highlighted obstructive sites in 6/9 patients with VOTE = 0. Of these patients, 4 had a complete obstructive site, and 3 had a multisite obstruction. VOTE indicated 8 additional surgical actions; NAVOTEL indicated 50 other actions compared to clinical examination. The NAVOTEL scoring system was exhaustive regarding surgical indications for OSAS.
The NAVOTEL scoring system is exhaustive in pediatric DISE and correlated to OSAS severity. It should be preferred in pediatric DISE.
儿科药物诱导睡眠内镜检查（DISE）缺乏通用且易于使用的评分系统。软腭、口咽、舌、会厌（VOTE）评分系统虽然被广泛应用，但需要在儿科中完成。本研究的主要目的是研究 DISE 中阻塞部位的分布，并提出一个合适的儿科评分系统。次要目的是评估所提出的评分系统对手术管理的改变。
本研究为单中心前瞻性 5 年研究，于 2016 年 3 月至 2021 年 12 月进行，纳入 99 例平均年龄 7.2 岁（±3.7）的患儿，所有患儿均有术前病理性睡眠记录，并接受 DISE。研究分析了所有上气道阻塞部位的分布。
腺样体（A）是最常见的阻塞部位（63%的患者），鼻腔（N）和喉部（L）也是常见的阻塞部位。这些部位不在 VOTE 评分系统中得到评估，因此创建了鼻腔、腺样体、软腭、口咽、舌、会厌、喉（NAVOTEL）评分系统。NAVOTEL 与阻塞性睡眠呼吸暂停低通气综合征（OSAS）的严重程度显著相关（ρ=0.2；p=0.04），并突出了 VOTE=0 的 6/9 例患者中的阻塞部位。这些患者中，4 例存在完全阻塞部位，3 例存在多部位阻塞。与临床检查相比，VOTE 提示了 8 例额外的手术操作；而 NAVOTEL 提示了 50 例其他手术操作。NAVOTEL 评分系统全面涵盖了 OSAS 的手术适应证。
NAVOTEL 评分系统在儿科 DISE 中全面，与 OSAS 严重程度相关。它应该在儿科 DISE 中得到优先应用。
