Obstructive Sleep Apnea with Paradoxical Vocal Cord Movement in Children during Sleep Endoscopy: Case Series

Table 1

DISE findings for each case.

	Case 1	Case 2	Case 3
Nasal airway
Bilateral nasal airway	Airway narrowed <2 mm at anterior inferior turbinate	Airway narrowed <2 mm at anterior inferior turbinate	Airway narrowed <2 mm at anterior inferior turbinate
Septum	Midline	Midline	Midline
Retropalatal airway
Adenoid	>75% choanae obstructed	>75% choanae obstructed	<25% choanae obstructed
Soft palate	No movement in respiratory cycle or obstruction	Partially closes airway in anterior-posterior direction	No movement in respiratory cycle or obstruction
Tonsils/lateral pharyngeal walls	Absent, lateral pharyngeal walls medialize during respiration	<25% collapse, no obstruction of airway	<25% collapse without obstruction of airway
Retropalatal airway
Retrolingual airway patency	Patent	Narrowed, yet patent	Patent
Tongue base	Well positioned, wide open retro-lingual airway, no movement during respiration	Pushes epiglottis posteriorly	Patent vallecula
Epiglottis	Vertical; true vocal cords easily visualized	2-point contact on posterior pharyngeal wall, airway is narrowed, yet patent	Vertical
Lingual tonsil	Normal size	Partially fills vallecula	Normal size
Endolarynx
Arytenoid and postarytenoid mucosa	No edema, well positioned, no collapse	Vertical without collapse	Vertical without collapse
Collapse of laryngeal mucosa obstructing endolarynx	No obstruction	No obstruction	No obstruction
Vocal cords	Bilateral paradoxical vocal cord motion noted	Bilateral paradoxical vocal cord motion noted	Bilateral paradoxical vocal cord motion noted
Aryepiglottic folds	True and false vocal cords easily visualized	True and false vocal cords easily visualized	True and false vocal cords easily visualized