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Drug-Induced sleep endoscopy in children: NAVOTEL scoring system development.

Jawad Qarbal1, Claire Le Treut-Gay1, Laure Allali1

  • 1Department of Pediatric Otorhinolaryngology-Head & Neck Surgery, La Timone Children's Hospital, Aix-Marseille University, APHM, Marseille, France.

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PubMed
Summary

A new scoring system, NAVOTEL, has been developed for pediatric drug-induced sleep endoscopy (DISE). This system accurately identifies obstructive sites in children with obstructive sleep apnea-hypopnea syndrome (OSAS), improving surgical planning.

Keywords:
VOTE classificationdrug-induced sleep endoscopypediatric obstructive sleep apnea-hypopnea syndromepediatric sleep disordered breathingtonsillectomy

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Area of Science:

  • Otolaryngology
  • Pediatric Sleep Medicine
  • Respiratory Medicine

Background:

  • Pediatric drug-induced sleep endoscopy (DISE) lacks a standardized scoring system.
  • The widely used VOTE scoring system is insufficient for pediatric upper airway anatomy.

Purpose of the Study:

  • To investigate the distribution of obstructive sites in pediatric DISE.
  • To propose a novel, comprehensive scoring system for pediatric DISE.
  • To evaluate the impact of the new scoring system on surgical management decisions.

Main Methods:

  • A prospective, single-center study included 99 children (mean age 7.2 years) undergoing DISE.
  • The distribution of upper airway obstructive sites was analyzed.
  • A new scoring system, NAVOTEL (nose, adenoids, velum, oropharynx, tongue, epiglottis, larynx), was developed and evaluated.

Main Results:

  • Adenoids were the most frequent obstructive site (63%), followed by nasal cavities and larynx.
  • The NAVOTEL system identified obstructive sites missed by the VOTE system in 6/9 patients.
  • NAVOTEL showed a significant correlation with obstructive sleep apnea-hypopnea syndrome (OSAS) severity (ρ=0.2, p=0.04).
  • NAVOTEL indicated significantly more surgical actions compared to VOTE and clinical examination.

Conclusions:

  • The NAVOTEL scoring system is comprehensive for pediatric DISE.
  • NAVOTEL correlates with OSAS severity and guides surgical indications effectively.
  • NAVOTEL is recommended for use in pediatric DISE.