Drug-induced Sleep Endoscopy (DISE)

DISE is a necessary tool nowadays in the armamentarium of the sleep surgeon, allowing thorough and targeted evaluation of dynamic pharyngeal obstruction in the sleeping patient.

As sedation is administered in a supine position, the surgeon places the distal chip-tip scope into the nose identifying the side with least obstruction for minimizing discomfort.

The scope is passed through the nose, above the inferior turbinate, and directly inferior to the middle turbinate and passed posteriorly until the nasopharynx is reached. From this position, the scope is positioned in a rostral view facing toward the larynx (voice box) to best visualize the velum as sedation is infused. After observation at the level of the velum is complete and the degree of obstruction is noted, the scope is passed distally to observe the airway at the level of the oropharynx.

Subsequently, the scope is passed to observe the tongue base and epiglottis. Observed findings are recorded. Additional measures that are annotated include:

A. Lowest O2 saturation

B. Improvement of desaturation with jaw thrust

C. Improvement of desaturation with mouth closure

Care should be taken by the endoscopist (surgeon) to note additional structures of interest, such as mass lesions of the upper aerodigestive tract, enlarged adenoids, or laryngeal pathologies such as subglottic stenosis.