Derek Lam, MD, MPH

Aerodigestive Disorders
Derek J. Lam MD, MPH joined the faculty of the Department of Otolaryngology-Head and Neck Surgery at Oregon Health and Science University in 2012. He completed his medical school, residency, and Masters of Public Health at the University of Washington in Seattle and a Pediatric Otolaryngology fellowship at Cincinnati Children’s Hospital Medical Center. He is the Surgical Director of the Doernbecher Aerodigestive Clinic, a multidisciplinary clinic managing complex aerodigestive disorders in children.

Dr. Lam is certified by the American Board of Otolaryngology and is a member of the American Academy of Otolaryngology-Head and Neck Surgery, the American Society of Pediatric Otolaryngology, the American Academy of Sleep Medicine, the International Surgical Sleep Society, the European Society of Pediatric Otorhinolaryngology, and is an Associate Fellow of the American College of Surgeons. He is actively involved in administrative and academic committees at the institutional and national levels and is a peer reviewer for multiple national and international journals. Dr. Lam is a clinician-scientist with an active research program in the diagnosis and surgical management of pediatric obstructive sleep apnea, supported by a K23 grant through the National Heart, Lung, and Blood Institute. Besides pediatric sleep apnea, his clinical interests include dysphagia management, airway reconstruction, and surgical management of adult obstructive sleep apnea, including upper airway stimulation.

Read Dr. Lam's latest abstract on "Predictors of Obtaining Polysomnography Among Otolaryngologists Prior to Adenotonsillectomy for Childhood Sleep Disordered Breathing."


Pediatric Obstructive Sleep Apnea: An ENT Perspective

Tonsil surgery with or without adenoidectomy is the recognized first line treatment for pediatric obstructive sleep apnea (OSA) based on multiple guidelines across different countries. But it is also well recognized that at least 20-30% of children will have persistent OSA after adenotonsillectomy (AT). Children with comorbidities such obesity, Down syndrome, severe baseline OSA, craniofacial anomalies, and neuromuscular disease are at particular risk for persistent OSA. However, the reasons for failure, and the optimal management of children with persistent OSA after AT remains a significant clinical challenge without clear guidelines.

In an effort to help guide decision-making in the treatment of OSA in children, pediatric drug-induced sleep endoscopy (DISE) has become increasingly popular in recent years. DISE offers direct visualization of the upper airway and characterization of the dynamic patterns of obstruction that occur during sleep.

Despite its increasing popularity, there remains significant variation and controversy regarding the appropriate indications, sedation regimen, endoscopy protocol, and interpretation of findings. In addition, though evidence is improving, it remains unclear whether DISE actually offers improved outcomes compared to other approaches.

Specific topics to be discussed include a review of the outcomes of AT for OSA, risk factors for post-AT OSA, DISE in children, and outcomes of DISE-directed surgery for persistent post-AT OSA in children. In addition, case discussions will illustrate common clinical scenarios and treatment strategies.

Upon completion of this CME activity, participants should be able to:
  1. Discuss outcomes of adenotonsillectomy and risk factors for persistent OSA
  2. Understand the indications, practice variations, and areas of controversy in pediatric DISE
  3. Be familiar with the advanced surgical techniques for management of persistent pediatric OSA

Saturday, November 14, 2020