European Archives of Oto-Rhino-Laryngology

, Volume 268, Issue 8, pp 1233–1236 | Cite as

Drug-induced sleep endoscopy: the VOTE classification

  • Eric J. Kezirian
  • Winfried Hohenhorst
  • Nico de Vries
Short Communication


The surgical evaluation of obstructive sleep apnea is designed to characterize the pattern of upper airway obstruction in order to develop an effective treatment plan for an individual patient. Drug-induced sleep endoscopy (DISE) is one evaluation technique that involves assessment of individuals under pharmacologic sedation designed to simulate natural sleep, utilizing fiberoptic endoscopy to examine the upper airway. Developed in multiple centers throughout Europe, DISE was first described in 1991 and is performed widely around the world. Although multiple studies support a potential role for DISE in evaluation for treatment with surgery and mandibular repositioning appliances, important clinical questions remain unanswered. A major limitation in advancing our understanding of drug-induced sleep endoscopy has been the multiplicity and, in many cases, the complexity of classification systems that prevent the comparison of results across the studies and centers. We present the VOTE classification, a method for characterizing DISE findings that focuses on its core feature, the specific structures that contribute to obstruction.


Sleep apnea Obstructive Surgery Endoscopy Drug-induced sleep endoscopy 



Dr. Kezirian is currently supported by a career development award from the National Center for Research Resources (NCRR) of the National Institutes of Health and a Triological Society Research Career Development Award of the American Laryngological, Rhinological, and Otological Society. The project was supported by NIH/NCRR/OD UCSF-CTSI Grant Number KL2 RR024130. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.

Conflict of interest



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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Eric J. Kezirian
    • 1
  • Winfried Hohenhorst
    • 2
  • Nico de Vries
    • 3
  1. 1.Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoUSA
  2. 2.ENT DepartmentFacial Plastic and Interventional Sleep MedicineWuppertalGermany
  3. 3.Department of Otolaryngology/Head and Neck SurgerySint Lucas Andreas ZiekenhuisAmsterdamThe Netherlands

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