{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T14:48:42Z","timestamp":1788274122990,"version":"build-2803163510"},"reference-count":19,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,12,21]],"date-time":"2018-12-21T00:00:00Z","timestamp":1545350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:sec><jats:title>Objectives\/Hypothesis<\/jats:title><jats:p>The optimal surgical treatment to improve sleep apnea in children with small tonsils is not known. Drug\u2010induced sleep endoscopy (DISE) may be useful in selecting effective surgical procedures for this patient population. This study compared polysomnography (PSG) measures before and after DISE\u2010directed surgery in children with small tonsils. We hypothesize that DISE\u2010directed surgery improves PSG measures in children with small tonsils. We also aimed to identify the most common surgery performed in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Retrospective chart review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review was performed of subjects who underwent DISE at a single pediatric tertiary care center over a 6\u2010year period. Inclusion criteria were 1+ tonsils and PSG performed before and after DISE\u2010directed surgery. Exclusion criteria were previous tonsillectomy and tonsils score 2+ or greater. Pre\u2010 and postoperative PSG parameters were compared using paired <jats:italic>t<\/jats:italic> tests.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Average age was 7 \u00b1 4 years old at the time of surgery. The most common DISE\u2010directed intervention was supraglottoplasty (n = 23). DISE\u2010directed surgery significantly improved mean apnea\u2010hypopnea index (AHI) from 14.4 to 8.0 (<jats:italic>P<\/jats:italic> = .02). Although improvements were seen in mean obstructive AHI (12.5 to 5.5), O<jats:sub>2<\/jats:sub> nadir (87.0 to 88.3), and ODI (10.6 to 5.8), these measures did not reach statistical significance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>DISE\u2010directed surgery significantly improves AHI in children with small tonsils. The most common intervention performed on these children was supraglottoplasty. Interestingly, adenotonsillectomy was rarely performed in this cohort. Additionally, supraglottic collapse, prompting supraglottoplasty, is difficult to accurately assess in an awake child, supporting use of a DISE\u2010directed approach in this patient population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Level of Evidence<\/jats:title><jats:p>4 <jats:italic>Laryngoscope<\/jats:italic>, 129:2771\u20132774, 2019<\/jats:p><\/jats:sec>","DOI":"10.1002\/lary.27759","type":"journal-article","created":{"date-parts":[[2018,12,21]],"date-time":"2018-12-21T17:55:45Z","timestamp":1545414945000},"page":"2771-2774","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Polysomnography outcomes in children with small tonsils undergoing drug\u2010induced sleep endoscopy\u2013directed surgery"],"prefix":"10.1002","volume":"129","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7908-1776","authenticated-orcid":false,"given":"Craig","family":"Miller","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery  Seattle, Washington"},{"name":"Department of Pediatrics Pulmonary and Sleep Medicine, University of Washington School of Medicine  Seattle, Washington"},{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Kirkham","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery  Seattle, Washington"},{"name":"Department of Pediatrics Pulmonary and Sleep Medicine, University of Washington School of Medicine  Seattle, Washington"},{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng\u2010Cheng","family":"Ma","sequence":"additional","affiliation":[{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalia","family":"Filipek","sequence":"additional","affiliation":[{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Horn","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery  Seattle, Washington"},{"name":"Department of Pediatrics Pulmonary and Sleep Medicine, University of Washington School of Medicine  Seattle, Washington"},{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaalan","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery  Seattle, Washington"},{"name":"Department of Pediatrics Pulmonary and Sleep Medicine, University of Washington School of Medicine  Seattle, Washington"},{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maida L.","family":"Chen","sequence":"additional","affiliation":[{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington U.S.A"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay R.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery  Seattle, Washington"},{"name":"Department of Pediatrics Pulmonary and Sleep Medicine, University of Washington School of Medicine  Seattle, Washington"},{"name":"Seattle Children's Hospital  Seattle, Washington"},{"name":"Department of Pediatrics, Pulmonary and Sleep Medicine University of Washington School of Medicine  Seattle, Washington 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