I'm Going For A Second "ENT" Opinion Tomorrow

[SleepyNoMore]

Hi Everyone, I am going tomorrow for a Second Opinion as I had my 1st. ENT appt. last month on Sept. 6 and I still have got nothing done, I had already posted trouble I was having with the Nurse's Aid after my 1st. ENT"s office, I called and left her a voice message and she basically called me a liar right in front of the Office Manager! Well, I finally got the CT SCAN after I stormed in their office after waiting for 6 weeks for the phone to ring, for an authorization to get the CT Scan and the NURSE"S AID never did get me one until she got in trouble and I got it the very same day. I had the CT Scan the very next day which was last tuesday.. Again, I called and left a voice message for her to please call me and let me knoe if they got the results, NO CALL TODAY EITHER SO, Today, I decided to get the he#!! out and away from that Doctor's office as i've had enough.. My surgery could of been over a month ago. I called The 1st. ENT"s office, asked for Medical Records, told them I needed a copy of my records with this doctor as I was getting a second opinion so she faxed them to me along with a copy of my CT Scan results WOW! Great, so I go tomorrow to another Doctor that likes to take care of his patients, he's also considered a Sleep Doctor, yes I needed one, I THINK, lol This is the 1st. time seeing the 1st. ENT"s report, got to read the CT Scan results to but don't know anything about it, I will post another one so I can type the results/finding's in Sorry this is soooooo long. So what do you think? Did I do the right thing or should I have stuck with the 1st. doctor????

[SleepyNoMore]

I forgot to add that we will more than likely talk about the surgeries tomorrow, any thing I should ask the Doctor about that, the 1st. ENT Doc said I need UPPP, Tonsils, & Deviated Septum Surgery! Thank You

[GumbyCT]

Did I do the right thing or should I have stuck with the 1st. doctor????

Well I think it is a little late to be asking that question, no?

That said, I wouldn't want to have anyone who I don't/can't trust or like put me under much less cut me open.

Gumby says "Never trust a man with a mask on his face and a knife in his hand".

I say if you can live with, live with it. They can easily make it worse.

Good Luck,
GumbyCT

[wabmorgan]

HI Again Stevie

I had Rhinoplasty with Septoplasty last year. I think that one is worth the trouble.

As for UPP..... I had ENT says it would help.

The pulmonologist said.... "I think you should stop for a second...Think for a moment

This could be a whole lotta trouble
Whole lotta trouble
Whole lotta trouble for you
Well this could be a whole lotta trouble
Whole lotta trouble
Whole lotta trouble for you"

Actually.... he did say he thought it would reduce my presure... but I would still need to be on CPAP. So.... I thought.... what's the point. In my case I'm only on 10 anyway.

You might want to discuss with your ENT and make sure there is some kind of reasonable degree of success.

Also.... there are some on that have had UPP, it work for a short time., only to have to return to CPAP later. I have also read of some here that had UPP done and then were STUCK with a full face mask from that point on.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

[ozij]

Redefining Success in Airway Surgery for Obstructive Sleep Apnea: A Meta Analysis and Synthesis of the Evidence Volume : 30
Issue : 04
Pages : 461-467

--------------------------------------------------------------------------------

Adam G Elshaug, BSc(Hons), MPH1; John R Moss, MSocSci, BEc, MBBS, FCHSE1; Anne Marie Southcott, MBBS(Hons), FRACP2; Janet E Hiller, MPH, PhD1

1Discipline of Public Health, The University of Adelaide, Australia; 2Respiratory Medicine Unit, Queen Elizabeth Hospital, Woodville, Australia




Study Objectives:

The role of upper airway surgery as a treatment for adult obstructive sleep apnea (OSA) remains controversial, with perspectives on treatment efficacy varying considerably. Though debate may occur in the clinical sphere, it is necessary to appreciate the ever-increasing funding and policy focus on cost effectiveness and “efficacy” in health care.

Design:

In this review, we examine contemporary evidence that highlights the importance of “highly effective treatment” over “sub-therapeutic treatment” as a necessity to confer improved health outcomes in OSA. We highlight that assumptions of surgical success inherent in most articles fail to assimilate contemporary, clinically significant indicators of success. We performed a literature search and present interpolated meta-analyses data from 18 surgical articles. Statistical meta-analyses highlight how surgical success decreases when new evidence-based criteria of success are applied.

Measurements and Results:

Specifically, when the traditional definition is applied (50% reduction in apnea-hypopnea index [AHI] and/or ≤ 20) the pooled success rate for Phase I procedures is 55% (45% fail). However, at AHI ≤ 10, success reduces to 31.5% (68.5% fail) and, at AHI ≤ 5, success is reduced to 13% (87% fail). According to these definitions, Phase II success (fail) rates decrease from 86% (14%) to 45% (55%) and 43% (57%), respectively.

Conclusions:

The evidence for clinical efficacy must define treatment “success”. We propose all future surgical audits report “objective cure” rates with success based on AHI outcomes of ≤ 5 and/or ≤ 10. We hope this paper serves as a catalyst for debate and consensus.

From the full article:

http://www.journalsleep.org/Articles/300411.pdf

Traditionally, claims of treatment “response,” “effectiveness,” “success,” and even “cure” of OSA have been defined in the literature as a reduction in the Apnea/Hypopnea Index (AHI) of equal to, or greater than, 50%. Some go on to specify this criterion plus a reduction in AHI to 20 or less.9-11 Yet, based on these conservative and variable criteria, there is a notable
interpretative quandary. That is, such reporting of surgical “success” bears only a limited relationship to the evidence-based criteria of what is “effective” treatment.

My added emphasis.

The pressure of the cpap can take care of soft tissue uvula and palate. In can't take care of bony obstructions. If it were me, I would do all I can to clear my nasal pathway (deviated septum etc.) I would not have any surgery on my palate and uvula.

Not only is the "success rate" defined by the surgeons absurd, in the long run, having UPPP surgery can interfere with successful cpap treatment.

O.

[Snoredog]

the nasal surgery is the only thing I would show any interest in, it is not a major deal, recovery is fairly easy and goes fast. I don't recall any pain associated with mine except when my 18 month old daughter bonged me in the head trying to give me a kiss about 3 days after the surgery.

if the ENT is promoting UPPP as a solution to OSA, run!! they are a quack and I wouldn't let them do the nasal surgery (if you need it) either. I could see removing the tonsils if they are overly large and you have a small mouth. But I wouldn't let them touch my palate or Uvula, you need those for Peanut butter sandwiches and so are not left using a Full Face mask the rest of your days.

The CT scan should clearly show the septum and or if it is contributing to congestion along with the internal turbinate bony structure. if you need a turbinate reduction, they will go in cut the membrane chisel away some of the excess bone and stitch the membrane back over it.

[SleepyNoMore]

Did I do the right thing or should I have stuck with the 1st. doctor????

Well I think it is a little late to be asking that question, no?

That said, I wouldn't want to have anyone who I don't/can't trust or like put me under much less cut me open.

Gumby says "Never trust a man with a mask on his face and a knife in his hand".

I say if you can live with, live with it. They can easily make it worse.

Good Luck,
GumbyCT

GumbyGT, you are 100% correct, thank you!

[SleepyNoMore]

[quote="wabmorgan"]HI Again Stevie

I had Rhinoplasty with Septoplasty last year. I think that one is worth the trouble.

As for UPP..... I had ENT says it would help.

The pulmonologist said.... "I think you should stop for a second...Think for a moment

This could be a whole lotta trouble
Whole lotta trouble
Whole lotta trouble for you
Well this could be a whole lotta trouble
Whole lotta trouble
Whole lotta trouble for you"

Actually.... he did say he thought it would reduce my presure... but I would still need to be on CPAP. So.... I thought.... what's the point. In my case I'm only on 10 anyway.

You might want to discuss with your ENT and make sure there is some kind of reasonable degree of success.

Also.... there are some on that have had UPP, it work for a short time., only to have to return to CPAP later. I have also read of some here that had UPP done and then were STUCK with a full face mask from that point on.

[SleepyNoMore]

Redefining Success in Airway Surgery for Obstructive Sleep Apnea: A Meta Analysis and Synthesis of the Evidence Volume : 30
Issue : 04
Pages : 461-467

--------------------------------------------------------------------------------

Adam G Elshaug, BSc(Hons), MPH1; John R Moss, MSocSci, BEc, MBBS, FCHSE1; Anne Marie Southcott, MBBS(Hons), FRACP2; Janet E Hiller, MPH, PhD1

1Discipline of Public Health, The University of Adelaide, Australia; 2Respiratory Medicine Unit, Queen Elizabeth Hospital, Woodville, Australia




Study Objectives:

The role of upper airway surgery as a treatment for adult obstructive sleep apnea (OSA) remains controversial, with perspectives on treatment efficacy varying considerably. Though debate may occur in the clinical sphere, it is necessary to appreciate the ever-increasing funding and policy focus on cost effectiveness and “efficacy” in health care.

Design:

In this review, we examine contemporary evidence that highlights the importance of “highly effective treatment” over “sub-therapeutic treatment” as a necessity to confer improved health outcomes in OSA. We highlight that assumptions of surgical success inherent in most articles fail to assimilate contemporary, clinically significant indicators of success. We performed a literature search and present interpolated meta-analyses data from 18 surgical articles. Statistical meta-analyses highlight how surgical success decreases when new evidence-based criteria of success are applied.

Measurements and Results:

Specifically, when the traditional definition is applied (50% reduction in apnea-hypopnea index [AHI] and/or ≤ 20) the pooled success rate for Phase I procedures is 55% (45% fail). However, at AHI ≤ 10, success reduces to 31.5% (68.5% fail) and, at AHI ≤ 5, success is reduced to 13% (87% fail). According to these definitions, Phase II success (fail) rates decrease from 86% (14%) to 45% (55%) and 43% (57%), respectively.

Conclusions:

The evidence for clinical efficacy must define treatment “success”. We propose all future surgical audits report “objective cure” rates with success based on AHI outcomes of ≤ 5 and/or ≤ 10. We hope this paper serves as a catalyst for debate and consensus.

From the full article:

http://www.journalsleep.org/Articles/300411.pdf

Traditionally, claims of treatment “response,” “effectiveness,” “success,” and even “cure” of OSA have been defined in the literature as a reduction in the Apnea/Hypopnea Index (AHI) of equal to, or greater than, 50%. Some go on to specify this criterion plus a reduction in AHI to 20 or less.9-11 Yet, based on these conservative and variable criteria, there is a notable
interpretative quandary. That is, such reporting of surgical “success” bears only a limited relationship to the evidence-based criteria of what is “effective” treatment.

My added emphasis.

The pressure of the cpap can take care of soft tissue uvula and palate. In can't take care of bony obstructions. If it were me, I would do all I can to clear my nasal pathway (deviated septum etc.) I would not have any surgery on my palate and uvula.

Not only is the "success rate" defined by the surgeons absurd, in the long run, having UPPP surgery can interfere with successful cpap treatment.

O.

[wabmorgan]

I wouldn't let them touch my palate or Uvula, you need those for Peanut butter sandwiches.

I guess I can add that to my list, I LOVE PEANUT BUTTER!!!!!!!

[SleepyNoMore]

the nasal surgery is the only thing I would show any interest in, it is not a major deal, recovery is fairly easy and goes fast. I don't recall any pain associated with mine except when my 18 month old daughter bonged me in the head trying to give me a kiss about 3 days after the surgery.

if the ENT is promoting UPPP as a solution to OSA, run!! they are a quack and I wouldn't let them do the nasal surgery (if you need it) either. I could see removing the tonsils if they are overly large and you have a small mouth. But I wouldn't let them touch my palate or Uvula, you need those for Peanut butter sandwiches and so are not left using a Full Face mask the rest of your days.

The CT scan should clearly show the septum and or if it is contributing to congestion along with the internal turbinate bony structure. if you need a turbinate reduction, they will go in cut the membrane chisel away some of the excess bone and stitch the membrane back over it.

Hey SnoreDog, I am glad I ran from the 1st. ENT doctor after my 1st. visit and decided to get a 2nd. opinion because the 1st. one wanted to do all that stuff, the uppp, tonsils, and the septum, I told him my tonsils we're very very small and he didn't comment, i'm telling you these money hungry dr's will do anything for the love of a buck. I also told him about the scar tissue that grows and again, no commit from him so we really didn't talk at all so YES, i'm so happy and thankful that , to RestedGal or RoseMaryB that suggested I get a second opinion~ THANK YOU, THANK YOU, THANK ALL OF YOU! THIS IS SO LONG BUT HERE GOES! Here are the findings from the CT Scan: There is moderate mucosal thickening in the echmoid sinuses bilaterally with the left side slightly worse than the right. There is mucosal thickening in the floor of each frontal sinus. Mucosal thickening is seen in the floorof the left maxillary sinus. There is mucosal thickening in the anterior portion of the left sphenoid sinus. The right sphenoid sinus is clear. The nasal septum is bowed to the right. There is a right sided septul spur inferiorly. The upper portion of the nasal septum is bowed to the left. There isconcha bullosa of the anterior portion of the left middle turbinate. The vertical lamella of the right middle turbinate is pheumatized. The right-sided septal spur narrows of the right nasal airway. The right osteomeatal unit is narrowed by mucosal thickening. There is no frank obstruction. The biatus semilunaris is clear. The uncinate process has normal oblique orientation. No Haller cell is seen. The left osteomeatal unit is patent. There is slightly narrowing by mucosal thickening at the infundibulum. The hiarus semilunaris is clear. THe uncinate process has normal oblique orientation. The nasofrontal recesses are narrowed bilaterally by mucosal thickening. The visualized anterior portions of the mastoids and middle ear are well pneumatized. The pteryggopalatine fossa are clear bilaterally. Theskull base deep cervical facial planes are symmetric and normal. Conclusion: Sinusitis with an OMU pattern of narrowing. No frank obstruction is seen ! Whewww, finally done.. I really don't know what this means but I really hope you guys are still up to read this and post a reply back about it so I can know a little about what this report is saying before my ENT appt. tomorrow. I want to be able to tell him I do not want the UPPP and Tonsill removal and i'm hoping this report will prove I don't need all of that surgery!!!! All I want is the septum surgery, am I right ? After reading this report??? Thanks

[SleepyNoMore]

I wouldn't let them touch my palate or Uvula, you need those for Peanut butter sandwiches.

I guess I can add that to my list, I LOVE PEANUT BUTTER!!!!!!!

That sure was a cute remark from snoredog wasn't it? Cracked me up, I love those peanut butter & jelley sandwiches myself and I sure wouldn't want to drown on my milk that goes with it you know, how you drown after getting the uvula surgery,

[SleeplessInOhio]

...helps direct fluid down your throat. After U3P, the juicy stuff can come out your nose when you drink. And the tissue tends to grow back after 4 or 5 years. It rarely helps obstructive sleep apnea. Sures gives snoring a kick in the head though!

[Slinky]

Sleepy, I don't think it is ever a mistake to get a second opinion when your instincts say you aren't comfortable with a doctor, a doctor's office or a treatment option presented to you. Yes, we all get nervous about any surgery, but when we just don't feel confidence in the doctor by all means one should get another opinion. Even when we feel confident in the doctor a second opinion can be warranted, especially the more drastic the surgery.

That being said (and I am NOT a medical professional, nor do I pretend to understand the entire report) but I get the impression that mucosal thickening (from sinusitis ??) is a major issue. Has a 30 day regimen of an antibiotic been tried? Often the usual 10 day dosage of antibiotics doesn't quite cut the mustard even when repeated. Obviously there is some deviation of the septum, whether enough to warrant surgery before trying a 30 day dosage of an antibiotic is not clear to this non-medical person, but given there is mention of a spur as well, surgery might well warrant consideration for the deviation alone. I haven't take the time to read up on the terminology used in the two mentions of the turbinates so I would really want that explained in detail to me before I would consider letting them do anything to the turbinates. I sure wouldn't consider any more "drastic" surgery than the deviated septum and MAYBE (a big MAYBE) the turbinates at this point in time w/o a really good, thorough explanation that made sense to me by at least one specialty surgeon I REALLY felt comfortable with and had confidence in.

Just my opinion and I confess to being someone who is against surgery unless I'm just about dead and dying. What they take out they can't put back in and any surgery creates some scar tissue.

[GumbyCT]

I would think that if the deviation was of ANY significance you wouldn't need a CT Scan. Meaning you would notice some difficulty everyday, no?

I know when my sis tries to breath thru her deviated nose, you can hear the congestion. But she is allergic to lots of things, too. She has apnea (knows it) but refuses therapy, go figure.

I know my sinuses seem to clear after a few mins. w/mask on. I can smell the dust in the air as soon as I take the mask off. Then my nose sometimes runs for a couple hours. Pollen, irritation,allergies?? who knows.

On initial exam, my 2nd sleep doc (Dr.) mentioned I have a deviation. hmmm, I never knew that, my 1st sleep doc (PA) NEVER mentioned it but he only examined my nose from 2ft away. When I questioned the 2nd doc she said "everyone has it", and didn't think it was a big deal I guess.

Shirley it sounds to me like yours does NOT bother you either? Is this a CA thingy? oh, hopefully you are NOT affected by the wild fires plaguing the state.

"Life consist of a series of choices". Gumby said it.

I like to play the hand I've been dealt.

Good Luck with whatever you choose,
GumbyCT