Jake J Lee1,2, Matthew D Ford3, Allison B Tobey4, Noel Jabbour4. 1. 1 University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 2. 2 Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, MO, USA. 3. 3 Cleft-Craniofacial Center, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA. 4. 4 Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
Abstract
OBJECTIVE: To investigate whether awake endoscopy can diagnose base-of-tongue obstruction as reliably as sleep endoscopy in infants with Pierre Robin sequence (PRS). DESIGN: The study was retrospective with the clinicians blinded to patient identity. Endoscopy findings were assessed and measured by the performing pediatric otolaryngologist. SETTING: Tertiary care children's hospital. PATIENTS: All infants with PRS managed between January 2005 and July 2015 were included. There were 141 patients, of which 35 underwent both awake endoscopy (AE) and drug-induced sleep endoscopy (DISE). INTERVENTIONS: Bedside AE and DISE in the operating room. MAIN OUTCOME MEASURES: Presence of moderate or severe base-of-tongue collapse was assessed. Sensitivity, specificity, and positive likelihood ratio of AE findings as well as intertest differences between AE and DISE were calculated. RESULTS: AE had 50.0% sensitivity (95% confidence interval [CI] 27.2%-72.8%) and 86.7% specificity (95% CI 59.5%-98.3%) for detecting base-of-tongue obstruction compared to DISE; false negative rate was 50.0% (n = 10). Positive likelihood ratio was 3.75 (CI 0.96-14.65). Compared to AE, DISE demonstrated significantly more cases of base-of-tongue obstruction ( P = .039). CONCLUSIONS: Bedside AE has low sensitivity for detecting base-of-tongue collapse in infants with PRS. Because of the substantial false negative rate, AE may not be a reliable diagnostic modality for ruling out base-of-tongue obstruction in this susceptible population. DISE may be indicated in high-risk patients to avoid underdiagnosing upper airway obstruction.
OBJECTIVE: To investigate whether awake endoscopy can diagnose base-of-tongue obstruction as reliably as sleep endoscopy in infants with Pierre Robin sequence (PRS). DESIGN: The study was retrospective with the clinicians blinded to patient identity. Endoscopy findings were assessed and measured by the performing pediatric otolaryngologist. SETTING: Tertiary care children's hospital. PATIENTS: All infants with PRS managed between January 2005 and July 2015 were included. There were 141 patients, of which 35 underwent both awake endoscopy (AE) and drug-induced sleep endoscopy (DISE). INTERVENTIONS: Bedside AE and DISE in the operating room. MAIN OUTCOME MEASURES: Presence of moderate or severe base-of-tongue collapse was assessed. Sensitivity, specificity, and positive likelihood ratio of AE findings as well as intertest differences between AE and DISE were calculated. RESULTS: AE had 50.0% sensitivity (95% confidence interval [CI] 27.2%-72.8%) and 86.7% specificity (95% CI 59.5%-98.3%) for detecting base-of-tongue obstruction compared to DISE; false negative rate was 50.0% (n = 10). Positive likelihood ratio was 3.75 (CI 0.96-14.65). Compared to AE, DISE demonstrated significantly more cases of base-of-tongue obstruction ( P = .039). CONCLUSIONS: Bedside AE has low sensitivity for detecting base-of-tongue collapse in infants with PRS. Because of the substantial false negative rate, AE may not be a reliable diagnostic modality for ruling out base-of-tongue obstruction in this susceptible population. DISE may be indicated in high-risk patients to avoid underdiagnosing upper airway obstruction.
Entities:
Keywords:
Pierre Robin sequence; airway obstruction; endoscopy; nasopharyngoscopy; pediatrics; sleep disorders; tongue
Authors: Austin S Lam; Michael D Bindschadler; Kelly N Evans; Seth D Friedman; Matthew S Blessing; Randall Bly; Michael L Cunningham; Mark A Egbert; Russell E Ettinger; Emily R Gallagher; Richard A Hopper; Kaalan Johnson; Jonathan A Perkins; Erin K Romberg; Kathleen C Y Sie; Srinivas M Susarla; Carlton J Zdanski; Xing Wang; Jeffrey P Otjen; Francisco A Perez; John P Dahl Journal: Otolaryngol Head Neck Surg Date: 2021-07-13 Impact factor: 3.497