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Updated: Jan 30, 2026
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Palatine Tonsil Stenting of the Airway as Determined by Drug-Induced Sleep Endoscopy
Habib G Zalzal1, Steven Coutras1
1Department of Otolaryngology-Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
Insights
In some children, tonsillectomy for obstructive sleep apnea can worsen symptoms due to lateral pharyngeal wall collapse. Drug-induced sleep endoscopy (DISE) can help identify this risk before surgery.
Area of Science:
- Otolaryngology
- Sleep Medicine
- Pediatric Surgery
Background:
- Obstructive sleep apnea (OSA) is common in children.
- Tonsillectomy is a primary treatment for pediatric OSA.
- Some children experience worsening OSA after tonsillectomy.
Observation:
- A 7-year-old boy with OSA underwent drug-induced sleep endoscopy (DISE).
- Initial DISE showed an open airway with tonsillar hypertrophy.
- Post-adenotonsillectomy and lingual tonsillectomy, symptoms and polysomnogram results worsened.
Findings:
- Postoperative DISE revealed significant lateral pharyngeal wall collapse.
- Oropharyngeal airway space narrowed more after surgery compared to pre-surgery.
- Apnea-hypopnea index increased postoperatively.
Implications:
- Palatine tonsillar tissue may act as a splint, preventing airway collapse in some children.
- DISE can identify patients at risk for worsening OSA post-tonsillectomy.
- Further research is needed to identify predictive factors for this phenomenon.
Objective:
To demonstrate lateral pharyngeal wall collapse and increased apnea-hypopnea index in a child posttonsillectomy.
Background:
Some children have worsening of their sleep symptoms after tonsillectomy for obstructive sleep apnea. This case report demonstrates an open airway on drug-induced sleep endoscopy (DISE) in a child with tonsillar hypertrophy followed by more pronounced airway obstruction related to lateral pharyngeal wall collapse after tonsillectomy.
Case Presentation:
A 7-year-old boy presented with obstructive sleep apnea and underwent workup with DISE. Following adenotonsillectomy and subsequent lingual tonsillectomy with epiglottopexy, the patient's sleep apnea symptoms and polysomnogram results worsened. Subsequent DISE showed a more narrowed oropharyngeal airway space as compared to his preoperative DISE.
Discussion:
Palatine tonsillar tissue may splint open the airway and prevent airway obstruction in a subset of pediatric patients. Further clinical studies are necessary to determine which children experience this phenomenon. Clinical examination using DISE can be useful in making clinical decisions prior to tonsillectomy.
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