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

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.