Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P306

P306		
Otolaryngology-Head and Neck Surgery 163(1S)
Presentation schedule is subject to change. The Official Program Abstracts supplement does not reflect changes made after August 10, 2020.
Comparative Study of the VOTE
Classification System in Sleep Endoscopy
Among Different Racial/Ethnic Groups
Prachi Patel (Presenter); Kealan C. Hobelmann, MD;
Maurits Boon, MD; Colin T. Huntley, MD
Objectives: The VOTE classification is a method for characterizing drug-induced sleep endoscopy (DISE) findings by analyzing the severity and configuration of upper airway obstruction
at 4 positions (velum, oropharynx, tongue base, epiglottis).
Literature on the effectiveness of the VOTE scoring system has
primarily involved Caucasian men. This study aimed to evaluate VOTE scores among different racial/ethnic groups.
Methods: This is a single-center retrospective review from
August to December 2019 of patients undergoing DISE.
Baseline demographic data, sleep study data, and VOTE
scores were collected. Statistical analysis was accomplished
by conducting analysis of variance and t tests.
Results: A total of 133 patients undergoing DISE were
included in this review; 107 (80.5%) patients were white/
Caucasian, 14 (10.5%) were black/African American, 7
(5.3%) were Hispanic/Latino, and 5 (3.7%) were Asian.
Average preoperative Epworth Sleepiness scores, apneahypopnea index, oxygen desaturation index, operative
American Society of Anesthesiologists score, Mallampati
score, and VOTE scores were comparable across all groups (P
> .05). The average VOTE score was significantly higher in
whites (5.44) than in Hispanics (4.29; P = .04). The individual
O score was significantly different between whites (1.05) and
blacks (1.46), and between Hispanics (0.75) and blacks (P <
.05). The overall V scores were not significantly different for
V configurations: anteroposterior, significant difference
between whites (60.7%) and blacks (14.2%) and between
blacks (14.2%) and Hispanics (57.1%; P = .02); concentric,
significant difference between whites (23.3%) and blacks
(71.4%; P = .05); and lateral, no significant differences.
Conclusions: The average VOTE score across all 4 racial/
ethnic groups was comparable. The O score and the VP configuration were found to be different between ethnic groups
and thus may help in treatment planning.

Sleep Medicine

Correlation Among Maxillary Transverse
Deficiency, Upper Airway Obstructive Site,
and Obstructive Sleep Apnea Severity
Eric Rodrigues Thuler, MD (Presenter)
Objectives: Maxillary transverse deficiency has been des-
cribed in individuals with obstructive sleep apnea (OSA), but its
role in disease pathophysiology has not been well established.
Therefore, a better understanding of the relationship between
this anatomic feature and OSA pathophysiology may contribute
to improve its treatment. The purpose of this study was to correlate the maxillary transverse deficiency with upper airway
(UA) obstructive site and OSA severity.
Methods: We conducted a retrospective study of patients
with moderate/severe OSA who underwent drug-induced
sleep endoscopy (DISE) and computed tomography (CT) to

investigate continuous positive airway pressure low adherence. DISE was classified according to the VOTE (velum,
oropharynx, tongue base, and epiglottis) system. Measures of
maxillary deficiency (interpremolar distance [IPMD], intermolar distance [IMD], sella-nasion-point A angle [SNA])were
obtained in CT scan and correlated with DISE findings and
polysomnography data. Mann-Whitney and Pearson tests
were used for the statistical analysis.
Results: We included 69 subjects (57 men [82.6%] and 12
women [17.4%]), with an average age of 41 years, body mass
index 26, apnea-hypopnea index 18.8, and O2 nadir 93%. The
average maxillary measurements were IPMD = 26.9 mm,
IMD = 28.50 mm, and SNA = 83.63°. There was an association between the complete circumferential collapse at the
velopharynx and the complete tongue base obstruction and
maxillary transverse deficiency (IMD). We also found a statistical correlation between the maxillary deficiency and OSA
severity.
Conclusions: The maxillary transverse deficiency, measured
by the IMD, could predict the occurrence of complete circumferential collapse of the velopharynx and tongue collapse, in
correlation with OSA severity. This measure can be used to
aid the detection of UA collapse patterns that do not respond
to most surgical procedures proposed to treat OSA, potentially
improving patient selection.
The Cost of the Surgeon's Learning Curve:
Experience With Upper Airway Stimulation
for Obstructive Sleep Apnea
Pratyusha Yalamanchi, MD, MBA (Presenter);
Kevin J. Kovatch, MD; S. Ahmed Ali, MD;
Nithin S. Peddireddy, MD; Paul T. Hoff, MD
Objectives: The well-established phenomenon of the medical device "learning curve," or time taken/procedure number
required to achieve desired clinical outcomes, has yet to be
studied with the hypoglossal nerve upper airway stimulation
(UAS) device. Here, we report the structured, long-term data
collected from 50 patients who underwent UAS to elucidate
the UAS learning curve, device-related concerns, and preoperative counseling.
Methods: Patients who underwent UAS implantation
(Inspire) from 2016 to 2019 by a single surgeon were included
in the institutional review board-approved study. Authors
independently coded patient interviews; descriptive statistics
for demographics, operative variables, and outcomes/complications are reported with t test comparison of the first 25 cases
performed with latter 25 cases.
Results: The study population consists of 50 adults, with a
mean age of 64 years, preprocedure body mass index (BMI)
29.3, American Society of Anesthesiologists (ASA) 2.6, baseline apnea-hypopnea index (AHI) 39.6/h with postprocedure
mean AHI 11.3/h, and average time to activation of 37 days.
There was no significant difference in terms of demographics,
ASA, BMI, preprocedure and postprocedure AHI, treatment
adherence, or patient satisfaction (mean, 7.69 on a 10-point
Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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