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Table 2 Responses with consensus for OSA and DISE practice survey

From: Management of obstructive sleep apnea in children: a Canada-wide survey

Question % of yes % of no Response % of response (Likert) Consensus
Evaluation and treatment of OSA
1. What do you use to objectivize OSA in your pediatric patients?   - - -  
c) Clinic only ± video from parents 82.6 (74.27–88.55)     Yes
8. How do you objectivize enlarged adenoids and tonsils?   - - -  
a) Clinically 93.6 (87.33–96.85)     Yes
c) Flexible scope in the office 80.7 (72.34–87.04)     Yes
10. In your practice, how often do children undergo a polysomnography before an adenotonsillectomy? - - Likert Rarely + Sometimes 97.2 (92.22–99.07) Yes
11. Is adenotonsillectomy the first action undertaken to treat obstructive sleep apnea in children? 75.2 (66.36–82.38) - - - Yes
Indications regarding DISE
14. How often do you perform a DISE before an adenotonsillectomy? - - Likert Rarely + Sometimes 100 (75.75–100) Yes
15. Which of the following elements influence your decision to perform a DISE before an adenotonsillectomy?   - - -  
b) Nonhypertrophic tonsils 75.0 (46.77–91.1)     Yes
i) Discordance between clinical findings and severity of apnea 83.3 (55.2–95.3)     Yes
Performing the DISE
19. Which anesthetic(s)/other agent(s) do you use for the DISE? -   - -  
a) Oral premedication   100 (75.75–100)    Yes
b) Intranasal dexmedetomidine   100 (75.75–100)    Yes
c) Nitrogen monoxide (NO) to install an IV line   91.7 (64.61–98.5)    Yes
d) Sevoflurane to install an IV line   75.0 (46.77–91.1)    Yes
g) Fentanyl   83.3 (55.2–95.3)    Yes
h) Ketamine   83.3 (55.2–95.3)    Yes
i) Topical anesthetic   100 (75.75–100)    Yes
j) Local decongestant   91.7 (64.61–98.5)    Yes
k) O2   83.3 (55.2–95.3)    Yes
21. Do you evaluate the following structures during the DISE?    - -  
a) Nasal cavities 91.7 (64.61–98.5)     Yes
b) Adenoids/nasopharynx 100 (75.75–100)     Yes
c) Soft palate/palatine tonsils 100 (75.75–100)     Yes
d) Oropharynx 100 (75.75–100)     Yes
e) Base of the tongue 100 (75.75–100)     Yes
f) Supraglottis 100 (75.75–100)     Yes
g) Glottis 91.7 (64.61–98.5)     Yes
h) Subglottis 75.0 (46.77–91.1)     Yes
j) Bronchus   75.0 (46.77–91.1)    Yes
22. Do you use the DISE findings to perform a surgical procedure during the same general anesthesia session? - - Likert Rarely + Sometimes 81.8 (46.77–91.11) Yes
23. How often do you perform cine-IRM before the DISE? - - Likert Rarely + Sometimes 100 (75.75–100) Yes
Clinical case
25. Patient is 7 years old, in good health and has never been operated. Snoring, daytime sleepiness and persistent difficulty concentrating in spite of a 3-month treatment with intranasal corticosteroids and montelukast. Obstructive AHI with 11 events/hour. Physical nasal exam with a speculum is normal and there is no retrognathism or high-arched palate. The cavum requested by the pediatrician is normal - - - - -
 Considering the same 7-year-old patient, what is your first therapeutic action?      
c) Adenoids < 25% and tonsils grade 3 +  T&A (81.8%)     Yes
d) Adenoids 50–75% and tonsils grade 2 +  T&A (81.8%)     Yes
g) Adenoids 50–75% and tonsils grade 3 +  T&A (100%)     Yes
h) Adenoids 50–75% and tonsils grade 4 +  T&A (100%)     Yes