title: Multimodality assessment of upper airway obstruction in children with persistent obstructive sleep apnea after adenotonsillectomy.
abstract: Children with obstructive sleep apnea (OSA) may have multiple sites of upper airway obstruction (UAO). A wide variety of techniques has been used to evaluate UAO. Our aim was to compare findings of cine magnetic resonance imaging (MRI) and drug-induced sleep endoscopy (DISE) in identifying UAO sites in children with persistent OSA after adenotonsillectomy (AT).
  
  
  
  Retrospective chart review.
  
  
  
  The medical records of children who underwent DISE and cine MRI were reviewed. Data pertaining to demographics, past medical history, body mass index, polysomnography, findings of DISE, and cine MRI were obtained.
  
  
  
  Fifteen children (11 boys, 4 girls; age range, 7-18 years) were identified. Comorbid conditions were Down syndrome in nine patients, cerebral palsy in one, attention deficit hyperactivity disorder in two, and asthma in three. Severity of OSA was moderate in five, and severe in 10. DISE and cine MRI showed the same UAO site in 10 patients: a single site (tongue) in nine and multiple sites (tongue and oropharynx/lateral walls) in one. DISE showed additional UAO sites undetected by cine MRI in three patients. Cine MRI showed additional UAO sites undetected by DISE in one patient. DISE and cine MRI showed different sites of obstruction in one patient.
  
  
  
  Cine MRI and DISE documented single and multiple sites of UAO in children with persistent OSA after AT. Cine MRI and DISE findings were similar in the majority of the children. Assessment of the sensitivity and specificity of cine MRI and DISE in detecting sites of UAO merits further investigation.
  
  
  
  4. Laryngoscope, 127:1224-1230, 2017.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, U.S.A.|Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, Texas, U.S.A.
authors.forename: Christopher
authors.initials: C
authors.lastname: Clark
authors.affiliation: Division of Pediatric Otolaryngology, Children's Medical Center, Dallas, Texas, U.S.A.
authors.forename: Seckin O
authors.initials: SO
authors.lastname: Ulualp
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000402:Airway Obstruction / Q000175:diagnosis*; D002648:Child; D015897:Comorbidity; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D017286:Polysomnography; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D014068:Tonsillectomy
keywords: Magnetic resonance imaging; children; drug-induced sleep endoscopy; obstructive sleep apnea; tonsillectomy and adenoidectomy