Is VOTE enough to guide therapy? A prospective study on phenotypic characterization

Objective: To demonstrate the heterogeneity within the VOTE classification through an extended phenotypic assessment based on iconographic documentation obtained during DISE. Study Design: Prospective observational study. Material and Methods: DISE was evaluated using the VOTE classification, along with palatal morphology, subjective pharyngeal airway dimensions, collapse patterns at the palatal genu, velum, upper and lower tongue base, and epiglottis, and lingual tonsil grading (Friedman). Results: Fifty patients were included (mean age 47.2 ± 8.4 years; 68% male), 35 of whom had confirmed OSA. Significant phenotypic heterogeneity was observed among patients with similar VOTE classification. Conclusions: The VOTE classification alone may underestimate the anatomical and functional complexity observed in DISE. Detailed phenotypic characterization is essential for individualized therapeutic planning in cases of snoring and OSA.