ENT consult *scratches head*

[RicaLynn]

First of all, I'm NOT looking for a way around CPAP therapy. I'm well aware that with my family hx apnea is all but inevitable, and the surgeries mentioned have less than stellar odds of improving the condition.

That said, I like to make informed decisions after exploring all options, so I consulted an ENT about my recent diagnosis to see what his recommendations were. I'm left with nearly as many questions as answers...

The goods news: I do not have a deviated septum, nor do my turbinates seem intrusive. My nasal passages look "pretty clear" despite the exam occurring on a day when I *felt* congested.

The not as good news: I still have all my original parts and my tonsils, though not inflamed, are rather large and do constrict my airway, so there is a possibility that tonsillectomy could improve things. I suspect, however, that insurance would see this as an elective procedure. And the doctor seems to think that a UP3 would go hand in hand, and possibly some work on my turbinates, since he'd be in the neighborhood. IF insurance would cover the procedure, and IF I could be reasonably sure of a noticeably positive outcome, I would consider it, but those are a couple pretty big ifs.

The take away: Doc was at least forthright about the painful recovery to be expected should I elect to do the tonsillectomy, and left the ball in my court. He also prescribed an inhaled steroid to aid in opening my nasal passages, as I do suffer from mild to moderate seasonal allergies.

My only question is, is the steroid really necessary? I prefer holistic preventative measures whenever possible but I know there is better living through chemistry. I already take Loratadine daily during hay fever season and I feel it's doing the trick to keep my sinuses in check, but what if anything will the Flonase do for me and/or my CPAP therapy? Is this just another unnecessary chemical additive?

[JDS74]

Did he say anything about the size of your thyroid gland? If it is enlarged, that could interfere with breathing.

Removal of the tonsils is not without risk in adults. Its good to be cautious.

[RicaLynn]

JDS I don't recall any mention of thyroid, and very little palpation of my throat. I am also dx as hypo-T, managed with a low dose of synthroid.

[Wulfman...]

First of all, I'm NOT looking for a way around CPAP therapy. I'm well aware that with my family hx apnea is all but inevitable, and the surgeries mentioned have less than stellar odds of improving the condition.

That said, I like to make informed decisions after exploring all options, so I consulted an ENT about my recent diagnosis to see what his recommendations were. I'm left with nearly as many questions as answers...

The goods news: I do not have a deviated septum, nor do my turbinates seem intrusive. My nasal passages look "pretty clear" despite the exam occurring on a day when I *felt* congested.

The not as good news: I still have all my original parts and my tonsils, though not inflamed, are rather large and do constrict my airway, so there is a possibility that tonsillectomy could improve things. I suspect, however, that insurance would see this as an elective procedure. And the doctor seems to think that a UP3 would go hand in hand, and possibly some work on my turbinates, since he'd be in the neighborhood. IF insurance would cover the procedure, and IF I could be reasonably sure of a noticeably positive outcome, I would consider it, but those are a couple pretty big ifs.

The take away: Doc was at least forthright about the painful recovery to be expected should I elect to do the tonsillectomy, and left the ball in my court. He also prescribed an inhaled steroid to aid in opening my nasal passages, as I do suffer from mild to moderate seasonal allergies.

My only question is, is the steroid really necessary? I prefer holistic preventative measures whenever possible but I know there is better living through chemistry. I already take Loratadine daily during hay fever season and I feel it's doing the trick to keep my sinuses in check, but what if anything will the Flonase do for me and/or my CPAP therapy? Is this just another unnecessary chemical additive?

Do NOT let him do the U3P!

Can't comment on the rest, but many, many posts on the forum have led me to believe that the U3P is a very bad thing to have done.


Den

.

[archangle]

Steroids are true miracle drugs in many cases. Sometimes they have major side effects, especially with long term use. My gut feel is that many of the current inhaled nasal steroids have a lot less risk of serious side effects than injectable or oral steroids. The idea of using them for the rest of my life is a bit worrisome.

I'm not sure whether the risk of long term Flonase is worse than long term Loratadine.

Have you considered allergy shots? I took them for several years and they made a big improvement and I don't need shots any more. It was a BIG success for me. Giving myself shots was no big deal after a while.

Don't do the UPPP. I think in general, the downside is more than the upside, and they might come up with better procedures in the future that UPPP might prevent you from using.

I don't think the tonsillectomy has that much in the way of drawbacks other than a few weeks of pain.

[JDS74]

JDS I don't recall any mention of thyroid, and very little palpation of my throat. I am also dx as hypo-T, managed with a low dose of synthroid.

Me too until my Dx ended with a thyroidectomy. Most people with enlarged thyroid show as an enlargement of the neck called goiter. Even with three different docs doing a palpation exam, they didn't find it until an ultrasound. My thyroid was three times a normal size. The first thing I noticed after wakening after the surgery was "I can breathe!"

[RicaLynn]

Me too until my Dx ended with a thyroidectomy. Most people with enlarged thyroid show as an enlargement of the neck called goiter. Even with three different docs doing a palpation exam, they didn't find it until an ultrasound. My thyroid was three times a normal size. The first thing I noticed after wakening after the surgery was "I can breathe!"

Duly noted!!! Will keep this in mind...

[Nick Danger]

Having been through the surgery, I do not recommend it. It lowered the pressure I need for CPAP, but had no other noticeable effect. They are not exaggerating when they talk to you about the post-surgery pain.

I used Flonase for a couple of years and it seemed to help nasal congestion a bit - about as much as loratadine. I dropped the Flonase and take one loratadine each day and that keeps my nasal congestion under control.

[Wulfman...]

What humidifier setting are you using on your machine?
If you're experiencing nasal congestion at night, try turning your HH down of OFF (using "passover" humidification).
I've been using it since I started and it's been a huge help for me to breathe during the night. I've never been to an ENT, but I've long suspected my problems are enlarged turbinates and deviated septum......and maybe a mild allergy. In any case, the cool air at night keeps things open for better breathing.


Den

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[49er]

Hi RicaLynn,

Have you considered nasal irrigation? Unfortunately, in spite of several tries, it has made things worse for me but for most people, it seems to greatly help.

Additionally, I have never used this product but bookmarked it because it sounded interesting. And there is a 30 day money back guarantee. Might be an alternative to nasal steroids or nasal irrigation.

http://www.amazon.com/Snoot-Nasal-Clean ... B009TEWQTG

Best of luck.

49er

First of all, I'm NOT looking for a way around CPAP therapy. I'm well aware that with my family hx apnea is all but inevitable, and the surgeries mentioned have less than stellar odds of improving the condition.

That said, I like to make informed decisions after exploring all options, so I consulted an ENT about my recent diagnosis to see what his recommendations were. I'm left with nearly as many questions as answers...

The goods news: I do not have a deviated septum, nor do my turbinates seem intrusive. My nasal passages look "pretty clear" despite the exam occurring on a day when I *felt* congested.

The not as good news: I still have all my original parts and my tonsils, though not inflamed, are rather large and do constrict my airway, so there is a possibility that tonsillectomy could improve things. I suspect, however, that insurance would see this as an elective procedure. And the doctor seems to think that a UP3 would go hand in hand, and possibly some work on my turbinates, since he'd be in the neighborhood. IF insurance would cover the procedure, and IF I could be reasonably sure of a noticeably positive outcome, I would consider it, but those are a couple pretty big ifs.

The take away: Doc was at least forthright about the painful recovery to be expected should I elect to do the tonsillectomy, and left the ball in my court. He also prescribed an inhaled steroid to aid in opening my nasal passages, as I do suffer from mild to moderate seasonal allergies.

My only question is, is the steroid really necessary? I prefer holistic preventative measures whenever possible but I know there is better living through chemistry. I already take Loratadine daily during hay fever season and I feel it's doing the trick to keep my sinuses in check, but what if anything will the Flonase do for me and/or my CPAP therapy? Is this just another unnecessary chemical additive?

[RicaLynn]

49er, I have noticed that on the nights I do remember to rinse, I do better, I use the NeilMed squeeze bottle. I suspect this will need to be added to my bedtime beauty ritual...

(There is a wildfire in my area, that may be contributing to the congestion I'm feeling since I have my window open with the fan exhausting the hot air in my room out.)

[Sleep2Die4]

And the doctor seems to think that a UP3 would go hand in hand, and possibly some work on my turbinates, since he'd be in the neighborhood.

"We will be in your neighborhood tomorrow repaving several of your neighbors' driveways. There will be some leftover asphalt and we can make you an unbelievable, one-time deal on repaving your driveway."

[RicaLynn]

And the doctor seems to think that a UP3 would go hand in hand, and possibly some work on my turbinates, since he'd be in the neighborhood.

"We will be in your neighborhood tomorrow repaving several of your neighbors' driveways. There will be some leftover asphalt and we can make you an unbelievable, one-time deal on repaving your driveway."

Precisely my line of thinking when he mentioned adding turbinate reduction. BIG red flag for me...

[ChicagoGranny]

And the doctor seems to think that a UP3 would go hand in hand

For you or for him?

What is your history with CPAP? Is it working well? What does your efficacy data show? What is your subjective estimate of how well it works, how well you sleep and how energetic you are the next day? (Did the ENT ask you these questions? He should before recommending a panoply of surgeries.)

UP3 is irreversible and always leaves some undesirable side effects and sometime leaves some disastrous side effects.

A tonsillectomy might possibly cure your sleep apnea. So why would the doctor do a nasty UP3 at the same time?
I think your ENT is an idiot or someone who cares more about his immediate income than this patients.

[RicaLynn]

ChicagoGranny, that's kinda my gut feeling as well, but as I said in the OP, informed decisions are best. Truthfully, my OSA is mild to moderate, and even three weeks in CPAP therapy is managing it quite nicely. I haven't had an AHI over 4 and that was the night my nares were torn up with acne. I agree the tonsillectomy would likely do me some good (and eliminate the issue I've had with tonsil stones, there's a Google nightmare if you're interested) but as it stands it's not medically necessary and I can't afford the recovery time. So I'll stick with my hose, quite happily.