Böttcher Arne, Schmitz Lisa, Voß Linda J, Betz Christian S, Clausen Jacob F
Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
Klinik für Audiologie und Phoniatrie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
HNO. 2025 Aug 28. doi: 10.1007/s00106-025-01655-8.
The implantation of breathing-dependent unilateral hypoglossal nerve stimulation (HNS) has traditionally required the preoperative exclusion of complete concentric velopharyngeal collapse (CCC) through drug-induced sleep endoscopy (DISE). This prerequisite poses logistical and operational challenges for implantation teams. To address these issues the Eppendorf DISE concept was developed to streamline the process, making it more patient-friendly, cost-effective, and time-efficient.
We retrospectively examined HNS patients who were preoperatively examined for CCC using the Müller maneuver and simulated snoring in a supine position using transnasal flexible endoscopy. If the findings were unremarkable, with no evidence of CCC, the DISE was performed directly before the implantation in the same procedure.
We examined 28 patients of whom 7.9% presented remarkable findings during the Müller maneuver or simulated snoring. These patients also showed a CCC during DISE. If the Müller maneuver was unremarkable no CCC was observed in DISE either, resulting in 100% sensitivity, specificity, positive and negative predictive values. Thus, there is a significant direct relationship between Müller maneuver results and velopharyngeal findings during DISE as confirmed by Fisher's exact test (p = 0.0026, p < 0.05).
The Eppendorf DISE concept has shown to be a reliable method for predicting a low likelihood of CCC in a patient-oriented, cost-effective and time-efficient manner. It is yet to be determined how long the CCC will remain as an exclusion criterion for breathing-dependent unilateral HNS implantation.
传统上，植入依赖呼吸的单侧舌下神经刺激（HNS）术前需要通过药物诱导睡眠内镜检查（DISE）排除完全同心性腭咽闭合不全（CCC）。这一前提给植入团队带来了后勤和操作方面的挑战。为了解决这些问题，开发了Eppendorf DISE概念以简化流程，使其对患者更友好、更具成本效益且更高效。
我们回顾性研究了使用Müller动作进行术前CCC检查并在仰卧位使用经鼻柔性内镜模拟打鼾的HNS患者。如果结果不明显，没有CCC的证据，则在植入前的同一程序中直接进行DISE。
我们检查了28例患者，其中7.9%在Müller动作或模拟打鼾期间有明显发现。这些患者在DISE期间也显示出CCC。如果Müller动作不明显，DISE中也未观察到CCC，敏感性、特异性、阳性和阴性预测值均为100%。因此，经Fisher精确检验证实，Müller动作结果与DISE期间的腭咽结果之间存在显著的直接关系（p = 0.0026，p < 0.05）。
Eppendorf DISE概念已被证明是以患者为导向、具有成本效益且高效的预测CCC可能性较低的可靠方法。作为依赖呼吸的单侧HNS植入的排除标准，CCC还将作为排除标准持续多久尚待确定。
