Automatic scoring of drug-induced sleep endoscopy for obstructive sleep apnea using deep learning.

BACKGROUND: Treatment of obstructive sleep apnea is crucial for long term health and reduced economic burden. For those considered for surgery, drug-induced sleep endoscopy (DISE) is a method to characterize location and pattern of sleep-related upper airway collapse. According to the VOTE classification system, four upper airway sites of collapse are characterized: velum (V), oropharynx (O), tongue (T), and epiglottis (E). The degree of obstruction per site is classified as 0 (no obstruction), 1 (partial obstruction), or 2 (complete obstruction). Here we propose a deep learning approach for automatic scoring of VOTE obstruction degrees from DISE videos. METHODS: We included 281 DISE videos with varying durations (6 s-16 min) from two sleep clinics: Copenhagen University Hospital and Stanford University Hospital. Examinations were split into 5-s clips, each receiving annotations of 0, 1, 2, or X (site not visible) for each site (V, O, T, and E), which was used to train a deep learning model. Predicted VOTE obstruction degrees per examination was obtained by taking the highest predicted degree per site across 5-s clips, which was evaluated against VOTE degrees annotated by surgeons. RESULTS: Mean F1 score of 70% was obtained across all DISE examinations (V: 85%, O: 72%, T: 57%, E: 65%). For each site, sensitivity was highest for degree 2 and lowest for degree 0. No bias in performance was observed between videos from different clinicians/hospitals. CONCLUSIONS: This study demonstrates that automating scoring of DISE examinations show high validity and feasibility in degree of upper airway collapse.

[Transoral robotic surgery for the head and neck].

Transoral robotic surgery (TORS) has been utilized in the head and neck field for more than a decade. It is a minimally invasive technique which ensures flexible instrumentation and 3D visualization of the oropharynx. This has led to a paradigm shift in the treatment of early-stage oropharyngeal cancer and in the diagnostic management of unknown primary of the head and neck. Over time, the indications for TORS have broadened. This review discusses the development, current indications, and future perspectives of TORS within head and neck surgery.

[Chronic rhinosinusitisand type 2 disease].

Diseases of the upper and lower airways are commonly described as global airway disease, which shares basic inflammatory mechanisms, and airway comobidity is frequently found. The prevalence of chronic rhinosinusitis (CRS) is 5-12%, characterised as CRS with nasal polyps (CRSwNP) or CRS without nasal polyps (CRSsNP). Inflammation in CRSwNP is often type 2, whereas CRSsNP often involves non-type 2. New monoclonal antibodies towards type-2 inflammation have been launched internationally to treat refractory severe CRSwNP, with effect on polyps, congestions and smell, as well as quality of life. This review gives a summary of the current treatment modalities.