Table 2 Responses with consensus for OSA and DISE practice survey

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