title: Clinically small tonsils are typically not obstructive in children during drug-induced sleep endoscopy.
abstract: To determine whether the degree of lateral pharyngeal wall (LPW) obstruction on pediatric drug-induced sleep endoscopy (DISE) correlates with preprocedure tonsillar hypertrophy score on physical examination, and to determine if clinically small tonsils are obstructive.
  
  
  
  Retrospective review of 154 patients who underwent DISE at a single pediatric tertiary care center over a 4-year period. Inclusion criteria were documentation of Brodsky tonsil score on preoperative physical examination. Exclusion criteria were previous tonsillectomy, adenoidectomy, or adenotonsillectomy. Lateral pharyngeal wall obstruction was graded for each patient from 0 (no obstruction) to 3 (severe obstruction) using a validated pediatric DISE scoring system known as the Chan-Parikh scoring system (C-P). Data were analyzed using multivariate linear regression controlling for age at time of DISE and presence of comorbid conditions.
  
  
  
  One hundred fifteen patients met criteria for analysis. Median age at DISE was 5.1 years. A moderate positive correlation was calculated between Brodsky score and DISE score, Spearman correlation coefficient 0.55, P = < 0.001. Linear regression modeling determined that for every 1-point increase in tonsil score, there was a 0.7-point increase in C-P LPW score (95% confidence interval [0.45, 0.92]). Sensitivity analysis did not detect a difference in correlation between children with comorbid conditions and children who were otherwise in good health. Of the 65 children with a pre-DISE Brodsky tonsil score of 1, 39 (60%) had a LPW score of 0 (no obstruction); nine (14%) had a score of 1 (< 50% obstruction); 11 (17%) had a score of 2 (> 50% obstruction); and six (9%) had a score of 3 (100% obstruction).
  
  
  
  There is a positive correlation between Brodsky Score and DISE LPW score. The majority of children with sleep-disordered breathing with a Brodsky score of 1 did not demonstrate LPW obstruction. These children may benefit from DISE for identification of alternative sites of upper airway obstruction.
  
  
  
  4. Laryngoscope, 127:1943-1949, 2017.
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, Seattle, Washington, U.S.A.|Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: Craig
authors.initials: C
authors.lastname: Miller
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, Seattle, Washington, U.S.A.|Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Purcell
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, U.S.A.|Riley Hospital for Children, Indianapolis, Indiana, U.S.A.
authors.forename: John P
authors.initials: JP
authors.lastname: Dahl
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, Seattle, Washington, U.S.A.|Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: Kaalan
authors.initials: K
authors.lastname: Johnson
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, Seattle, Washington, U.S.A.|Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: David L
authors.initials: DL
authors.lastname: Horn
authors.affiliation: Department of Pediatrics, Division of Pulmonary and Sleep Medicine, the University of Washington School of Medicine, Seattle, Washington, U.S.A.
authors.forename: Maida L
authors.initials: ML
authors.lastname: Chen
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, the University of California, San Francisco, San Francisco, California, U.S.A.|Benioff Children's Hospital, San Francisco, California, U.S.A.
authors.forename: Dylan K
authors.initials: DK
authors.lastname: Chan
authors.affiliation: Department of Otolaryngology: Head and Neck Surgery, Seattle, Washington, U.S.A.|Seattle Children's Hospital, Seattle, Washington, U.S.A.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
mesh_terms: D000234:Adenoids / Q000473:pathology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy; D006801:Humans; D007223:Infant; D009929:Organ Size; D017286:Polysomnography / Q000379:methods; D011300:Preoperative Care; D012189:Retrospective Studies; D012890:Sleep; D020181:Sleep Apnea, Obstructive / Q000209:etiology* / Q000601:surgery*
keywords: Obstructive sleep apnea; drug-induced sleep endoscopy; pediatrics; polysomnogram; sleep-disordered breathing