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Updated: Oct 20, 2025
Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Sleep Endoscopy Findings in Children With Obstructive Sleep Apnea and Small Tonsils
Adrian Williamson1, Steven W Coutras1, Michele M Carr2
1Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, WV, USA.
Insights
Drug-induced sleep endoscopy (DISE) helps identify airway obstruction causes in children with obstructive sleep apnea (OSA) and small tonsils. DISE guides personalized surgical treatment, often avoiding tonsillectomy.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Surgical Diagnostics
Background:
- Obstructive sleep apnea (OSA) in children is commonly treated with adenotonsillectomy (AT).
- The effectiveness of AT for OSA is uncertain when physical examination reveals small palatine tonsils.
- Accurate identification of airway obstruction is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the utility of drug-induced sleep endoscopy (DISE) in pediatric OSA patients with small tonsils (Brodsky scale 1+).
- To identify specific patterns of airway obstruction in this patient subset.
- To determine the effectiveness of DISE-guided surgical interventions for these patients.
Main Methods:
- Retrospective chart review of pediatric patients undergoing DISE over a two-year period.
- Inclusion criteria: small tonsils (1+) and a confirmed positive sleep study.
- Data collected: DISE findings, BMI, comorbidities, and pre-operative polysomnography (PSG) data.
Main Results:
- Forty children (mean age 5.0 years) with OSA and small tonsils were analyzed.
- The adenoid was the most frequent obstruction site (72.5%), followed by the tongue base (52.5%).
- Multilevel obstruction was common (62.5%), and palatine tonsils were infrequently the primary cause of obstruction (25.0%).
Conclusions:
- Small palatine tonsils are rarely the sole cause of airway obstruction in pediatric OSA.
- Drug-induced sleep endoscopy (DISE) is valuable for personalizing surgical management in children with OSA and small tonsils.
- DISE allows for targeted interventions, often avoiding unnecessary tonsillectomy.
Objective:
Obstructive Sleep Apnea (OSA) in children is treated primarily with adenotonsillectomy (AT). When clinical exam demonstrates small tonsils, the success of AT in resolving OSA is uncertain. The purpose of this study is to determine the utility of Drug induced Sleep Endoscopy (DISE) for children with OSA and small tonsils (Brodsky scale 1+) and to identify what obstructive trends exist in this subset of patients and to determine the utility of DISE-directed surgical intervention in patients with small tonsils.
Methods:
A retrospective chart review was performed for patients who underwent DISE at a tertiary care center over a 2-year period. Inclusion criteria were 1+ tonsils and a positive sleep study. Data collected included DISE findings, BMI, comorbid conditions, and pre-op PSG data.
Results:
Forty children were included with a mean age of 5.0 years (range 8 months-16 years). Mean preoperative AHI was 5.46 and mean oxygen saturation nadir was 87.1%. The most common contributor to airway obstruction was the adenoid (29 patients, 72.5%), followed by the tongue base or lingual tonsil (21 patients, 52.5%). The palatine tonsils (10 patients, 25.0%), epiglottis (10.0%), or obstruction intrinsic to the larynx (10.0%) were significantly less frequently identified as contributors to OSA when compared to the adenoid (P < .001). The majority of patients had multilevel obstruction (25 patients, 62.5%). Adenoidectomy (27 patients, 67.5%) was the most commonly performed procedure, followed by tonsillectomy (10 patients, 25.0%, P < .001) and tongue base surgery (9 patient 22.5%, P < .001).
Conclusion:
In this group, small palatine tonsils were infrequently identified as a contributor to airway obstruction and tonsillectomy was avoided in most cases. This study illustrates the utility of DISE as a tool to personalize the surgical management of pediatric patients with OSA and small tonsils on physical exam.
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