Eur Arch Otorhinolaryngol (2017) 274:3547 DOI 10.1007/s00405-017-4564-1 LETTE R T O T HE EDI T OR Response to letter to the editor: ‘‘is drug induced sedation endoscopy surgical decision making process objective and systematic?’’ 1,2 Andrea De Vito Received: 29 March 2017 / Accepted: 4 April 2017 / Published online: 20 April 2017 Springer-Verlag Berlin Heidelberg 2017 Dear Editor, the better postoperative AHI outcome is, as a consequence. (3) The candidate’s surgical selection begins before DISE per- The authors thank for the overall positive opinion expressed formance. We should select OSA patients, in whom anatom- about our paper ‘‘The importance of drug-sedation endoscopy ical factors represent the main pathophysiological reason of (DISE) techniques in surgical decision making: conventional obstructive events, by means of the PSG/PM analysis. After versus target controlled infusion techniques—a prospective that, during DISE, we decide the single or combined surgical randomized controlled study and a retrospective surgical techniques to perform, observing the level, grade, and pattern outcomes’’ in the letter to the editor entitled ‘‘Is Drug Induced of upper airways obstruction, taking into account the surgical Sedation Endoscopy surgical decision-making process technology available in our institution (conventional surgical objective and systematic?’’ and we wish brieﬂy reply to the procedures vs radiofrequency vs robotic surgery). (4) We questions raised by the reader. (1) To the best of our knowl- concur with you about the need of make database of sleep edge, at least 16 DISE classiﬁcation’s systems are reported up centers available, including DISE videos. (5) We strongly to now in the literature and each classiﬁcation has positive suggest that the patient referral process for surgical treatment aspects, but also limitation. Currently, there is not a DISE could be systematic and objective across the world if any sleep classiﬁcation system universally accepted. Our NOHL clas- center and/or otorhinolaryngologist approaching a SBD siﬁcation system provides a scoring index for upper airways in patient in daily practice will perform or analyze a correct awake and sleep stage setting, which can support the decision- polysomnography/portable monitoring trace in which will be making process for surgical treatment, as reported in our possible to distinguish OSA patient with anatomical reason of experience. We have introduced the NOHL classiﬁcation obstructive event (phasic desaturation pattern) from SBD system since 1996 in our clinical routine and we believe that patient no-OSA (prolonged desaturation pattern or overlap the experience built in about 20 years represents the main patterns). Moreover, a team of experienced otorhinolaryn- reason for the postoperative AHI outcome obtained (TCI- gologist and anesthesiologist should perform DISE, by means DISE: from 27.5 ± 3.4 to 8.1 ± 4.2; C-DISE: from of the support of the best technology available (at least target 27.1 ± 4.6 to 11.5 ± 4.2). (2) We strongly believe that the controlled infusion pump). We also suggest organizing groups more otorhinolaryngologist and anesthesiologist deeply DISE of study across the world, who could realize DISE analysis and experience is, the better candidate’s surgical selection is, and standardization, providing results consistently comparable. This reply refers to the comment available at Compliance with ethical standards doi:10.1007/s00405-017-4544-5. Conﬂict of interest Author Andrea De Vito declares that he has no & Andrea De Vito conﬂict of interest. firstname.lastname@example.org Ethical approval This article does not contain any studies with Department of Head and Neck Surgery, Otorhinolaryngology human participants or animals performed by any of the author. and Oral Surgery Unit, Morgagni-Pierantoni Hospital, Via Forlanini, 34, 47121 Forlı `, Italy Financial disclosure No ﬁnancial disclosures. Via Dei Gerolimini 12, 47121 Forlı, Italy
European Archives of Oto-Rhino-Laryngology – Springer Journals
Published: Apr 20, 2017
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