How are the findings of sleep endoscopy graded?

Updated: Aug 21, 2019
  • Author: Philip E Zapanta, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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VOTE is a proposed system of classification that may be used in order to help establish a universal way for otolaryngologists to classify and communicate objective findings of airway obstruction in OSA patients. Based on multiple DISE interventions, four common locations of obstruction were established. These locations can either contribute to OSA individually or in combination. The levels are velum, oropharynx, tongue base, and epiglottis (VOTE). A grade of 0-2 is assigned based on degree of obstruction: 0 = no obstruction; 1 = partial obstruction; 2 = total obstruction. [24, 25] It is also helpful to describe the type of collapse: lateral, anterior-posterior, or concentric.

In a recent study looking at DISE in pediatric patients, authors developed a quantitative way of distinguishing airway obstruction in pediatric DISE. The evaluated locations were adenoids, velum, lateral pharyngeal wall, tongue base, and supraglottis. Obstructions were scored on a specific 4-point grading system. [26]

Both grading schemes provide a reliable and reproducible method of evaluating the upper airway during sleep endoscopy.

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