Pharyngeal Collapsibility Outperforms VOTE in Association with Pharyngoplasty Outcomes

Sunday, October 18, 2026

11:48 AM - 11:54 AM PT

Location: 403B

Presenting Author(s)

Tice R. Harkins, MD

Resident Physician
University of Pittsburgh Department of Otolaryngology
Pittsburgh, PA, United States

Senior Author(s)

Thomas M. Kaffenberger, MD

Physician
University of Pittsburgh Department of Otolaryngology
Pittsburgh, Pennsylvania, United States

Co-Author(s)

BS

Brandon Smith, MD

Resident Physician
University of Pittsburgh Department of Otolaryngology
Pittsburgh, Pennsylvania, United States
Ryan J. Soose, MD

Physician
University of Pittsburgh Department of Otolaryngology
Pittsburgh, Pennsylvania, United States

Disclosure(s):

Tice R. Harkins, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Drug-induced sleep endoscopy (DISE) is used in patients with obstructive sleep apnea (OSA) to characterize upper airway collapse and guide surgical decision-making. The VOTE (velum, oropharyngeal lateral walls, tongue base, epiglottis) score is the most common grading system but is subjective and has limited ability to predict outcomes. We evaluated if VOTE score was associated with response to pharyngoplasty and, in an exploratory analysis, whether pharyngeal opening pressure (PhOP) was associated with response.

Methods: We conducted a retrospective study of adults undergoing pharyngoplasty for OSA between 2023 and 2025 at a single academic hospital. All patients underwent DISE with VOTE score and post-op sleep testing; a subset underwent positive airway pressure titration to obtain PhOP. Surgical response was defined as a ≥50% reduction in apnea–hypopnea index (AHI) with post-operative AHI ≤15 events/hour. Independent variables included collapse severity at each VOTE subsite, velum collapse pattern (AP vs CCC), and PhOP.

Results: Seventeen patients met inclusion criteria (mean age 53.7 ± 9.5 years, 82.5% male) with mean BMI 31.9 ± 4.6 kg/m² and pre-operative AHI 44.5 ± 13.2 events/hr; 11 met responder criteria and 6 did not. Neither VOTE subsite collapse severity nor velum collapse pattern differed significantly between responders and non-responders (all p>0.14). In the subgroup with PhOP data, responders (n=5) had lower PhOP than non-responders (n=6) (mean ± SD: 9.1 ± 3.4 vs 14.8 ± 3.9 cmH₂O; p=0.016). Increased PhOP demonstrated a trend toward lower odds of response (OR 0.47 per 1cmH₂O increase, p=0.075).

Conclusions: VOTE score was not associated with response to pharyngoplasty in this cohort, whereas PhOP demonstrated an association with surgical response in an exploratory analysis. These findings suggest that physiologic assessment during DISE may improve surgical selection for patients with OSA beyond anatomic grading alone and warrant validation in larger cohorts.