In a 2011 study of patients who had undergone uvolopalatopharyngoplasty (UPPP) but still had persistent sleep apnea, assessment with DISE found that half of these patients still had residual palate obstruction, and almost all had prominent hypopharyngeal obstruction (Laryngoscope. 2011;121:1320-1326). Furthermore, a more recent study found that DISE led to changes in surgical plans in half of cases, compared with plans made after the awake exam (Laryngoscope. 2016;126:768-774).
Cost Versus Outcomes
But David Steward, MD, professor of otolaryngology at the University of Cincinnati, Ohio, said the literature shows that DISE tends to lead to more procedures and more cost, without better results.
In a Level 1, randomized controlled trial, 39 patients selected for primarily palatal surgery by way of preoperative nasal pharyngoscopy were randomized to receive DISE and possibly additional procedures as a result. Both groups saw significant improvement in apnea-hypopnea index (AHI) and Epworth Sleepiness Scale (ESS) scores, but there were no significant differences between the groups. The DISE group was more likely to undergo additional procedures (Laryngoscope. 2015;125:2220-2225). “About 60% of patients had an additional procedure added, based on the sleep endoscopy, with no improvement in their outcomes,” Dr. Steward said.