Why not surgery?

mxylplik2 · Post by **mxylplik2** » Wed Feb 16, 2005 6:47 am

I know this is a CPAP forum but I haven't seen a lot of discussions about alternatives to CPAP.

I have large tonsils and the ENT has suggested surgery (obviously as he is a surgeon) and the Pulmonologist said that he normally recommends CPAP but he thinks my tonsils are particularly large and has recommended that I have my tonsils removed.

Other than the risk of dying under general anesthesia (low probability as this is a simple, straightforward procedure), why aren't more CPAP users thinking or doing the surgery?

To partially answer my question, I'm sure some surgeries are not effective at curing sleep apnea and that people have to go back to using the CPAP. But if there aren't major risks, why don't people at least try the surgery and then go to CPAP if the surgery fails? That way, if it works, you have to deal with CPAP for the rest of your life (e.g., using it, washing it, traveling with it, etc.)

Any insight on this matter would be appreciated.

Liam1965 · Post by **Liam1965** » Wed Feb 16, 2005 6:52 am

Well, I've been told by several doctors that CPAP (if you can remain compliant) works in 90% of cases. The various operations and dental appliances, significantly less than 50% for the best of them, and down in the range of 10-15% for the worst.

Now, surgery seems to me to be a pretty extreme option for a low possibility of helping, when there is a non-intrusive option which has a much higher rate of success.

If you can't tolerate the CPAP, that's a different story, and if you don't mind surgery, go for it. But for me, I'd just as soon not make permanent and intrusive changes to my body if there's as good or better an option that doesn't involve such modifications.

Liam, who doesn't have any piercings....that show.

Nenetx2004 · Post by **Nenetx2004** » Wed Feb 16, 2005 8:06 am

I also have very large tonsils as well as a fairly large soft palate. What's been said about the surgery is absolutely correct. It's success rate is not as good as some ENT's would like to believe. Plus, as an adult (I'm assuming you're an adult) the recovery time for a tonsillectomy is pretty rotten.

I'm still dealing with fatigue issues at times but I definitely have felt better on CPAP.

Jeanne

gargoyle · Post by **gargoyle** » Wed Feb 16, 2005 9:34 am

I had my tonsils and adeniods (sp?) out when I was 6. That's when I started snoring according to my mom. I can't keep my mouth shut at night and am considering surgery for the palate or what ever else they have to remove to keep me from having such dry nasal passages. I sneeze and have a runny nose all day. Buckets of clear mucus. I was hoping the percentages were higher for successful surgery. I never got tired before the CPAP and don't feel any more rested after a year of use. I just can't smell anything anymore because my nose is so dry. (I use a humidifier almost on max)

johnnygoodman · Post by **johnnygoodman** » Wed Feb 16, 2005 10:00 am

Howdy,

Lets not forget to mention that those who have gotten the surgery report quite a bit of pain after the "post surgery pain pills" have run out.

I've read posts here and on TAS about people who went through all that and didn't get any better.

Poisson · Post by **Poisson** » Wed Feb 16, 2005 11:42 am

Another reason to be careful about surgery is that some repond well to xpap before surgery, but not after surgery!

--Bob

Liam1965 wrote:Well, I've been told by several doctors that CPAP (if you can remain compliant) works in 90% of cases. The various operations and dental appliances, significantly less than 50% for the best of them, and down in the range of 10-15% for the worst.

Now, surgery seems to me to be a pretty extreme option for a low possibility of helping, when there is a non-intrusive option which has a much higher rate of success.

If you can't tolerate the CPAP, that's a different story, and if you don't mind surgery, go for it. But for me, I'd just as soon not make permanent and intrusive changes to my body if there's as good or better an option that doesn't involve such modifications.

Liam, who doesn't have any piercings....that show.

Miko · Post by **Miko** » Thu Feb 17, 2005 1:01 am

Most ENT specialists will tell you that surgery only removes the symptom (snoring) but not the problem. You will likely still have apneas but your partner won't hear them. The success rate is less than 50% and then u have to interpret what they mean by "success rate". I have read and seen that in the best of cases, the surgery only helps temporarily and OSA soon returns.

There are other options like a dental appliance and combination therapy. This is what I will be trying next. A dental appliance with CPAP therapy. The idea is that my pressure will be lower with the appliance than without. The only problem is that I was recently told I have a slightly larger than average tongue so this likely is playing a big role in my OSA.

Bottom line, don't do the surgery. If you do and if you need to use CPAP later (yes, the odds say you will) then treatment will be a lot more difficult.

wading thru the muck! · Post by **wading thru the muck!** » Thu Feb 17, 2005 1:44 am

If you like liquid squirting out of your nose when you swallow, go ahead and have the surgery. Otherwise stick with cpap.

mxylplik2 · Post by **mxylplik2** » Thu Feb 17, 2005 7:17 am

Most ENT specialists will tell you that surgery only removes the symptom (snoring) but not the problem. You will likely still have apneas but your partner won't hear them. The success rate is less than 50% and then u have to interpret what they mean by "success rate". I have read and seen that in the best of cases, the surgery only helps temporarily and OSA soon returns.

If the "O" in OSA stands for obstruction, I'm not clear why removing the obstruction will only address the symptoms.

Liam1965 · Post by **Liam1965** » Thu Feb 17, 2005 7:41 am

mxylplik2 wrote:If the "O" in OSA stands for obstruction, I'm not clear why removing the obstruction will only address the symptoms.

Almost. It stands for "Obstructive". As in your throat closes and causes an obstruction, not that there is a natural obstruction that could be removed.

Besides, it really doesn't matter what the name is, it matters what the results are, and generally the results from the various operations and oral inserts are fairly poor (and in some cases, they are only temporary fixes anyway).

Liam, who doesn't mean to be obstructionist.

cktan · Post by **cktan** » Thu Feb 17, 2005 9:13 am

mxylplik2 wrote: If the "O" in OSA stands for obstruction, I'm not clear why removing the obstruction will only address the symptoms.

"Obstruction" itself can not totally explain what happen in OSAS.
It's a matter of "collapse" of the upper airway in OSAS.

During sleep, OSA patient's "upper airway" are prone to "collapse". That's why your airway is obstructed when you are sleeping BUT not when you are awake.

Narrowing of soft palate, tonsils... are just making the "collapse" more easily to occlude the airway.

Besides, soft palate, tonsils... are just an upper portion of the upper airway. (That means if the most collapsible part of the upper airway is located below the mentioned parts, there is no way to do the surgery.)

The most useful surgery is tracheostomy -- making a hole on the neck into the trachea(which is formed with "C"-shape ring that are less likely to collapse), that means one can "breath" via the hole and bypass the "collapsible" upper airway. However, tracheostomy will definitely cause more problems: cosmetic, phonation, etc...

Above all, surgery will only do helps in some "selected" patients by some "experienced" surgeon.
Who will benefit from the surgery ?
That's yet a big question to the surgeons.

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Why not surgery?

Why not surgery?

Pain!