Severe OSA, have any of you had any kind of ENT Surgery???

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Sat Dec 31, 2005 10:02 pm

Just wondering for those of you who have severe OSA, like I do (67 per hour), who has had any kind of ENT surgery Ii.e., tonsillectomy ect.)

Thanks in advance for responding.

Heidi

Guest · Post by **Guest** » Sat Dec 31, 2005 10:09 pm

For many first-hand accounts with different surgery options, rested gal has compiled a list of threads. You'll see they are broken into categories depending upon the procedure. It is a TON of reading, but if you are considering surgery, you'll want to do a ton of reading!

LINKS to surgery, turbinates, Pillar, TAP experiences

sapphireskye · Post by **sapphireskye** » Sat Dec 31, 2005 10:27 pm

I dont have severe sleep apnea. But whether I need a tonsillectomy or not remains to be seen. In the next 6 months if they keep swelling, I will probably have to get them out. I am praying that is not the case. It sure doesn't help the breathing issues.

Happy New Year
chelle

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Sun Jan 01, 2006 12:04 am

My ENT says my tonsils should come out, they are huge and I get lots of sore throats and uvulitis.

My little boy, 6 years old just had his T&A out on Tuesday and man, it doesn't look fun and HIS BREATH IS NASTY.

He is quite a trooper!

Heidi

ozij · Post by **ozij** » Sun Jan 01, 2006 1:13 am

Back in April 05, VancouverBreeze had his tonsils taken out.

Here's his story:

Diagnonsis

After it was done

Good luck!

O.

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Sun Jan 01, 2006 1:44 pm

Thanks Ozij,

Very encouraging! I know the chances of me getting off APAP are not that great but maybe with the weight loss that goes along with decreased appetite due to the soreness?!?

I'm scared to death, but right now I have a cold (again) and my throat is sore (again).

My tonsils are huge, my uvula is long and it touches my tongue.

Keep the replys coming, I need all of the encouragement that I can get through this....

My brain tumor and recent Lap Nissen Fundoplication are probably nothing compared to what I have in store for me with this tonsillectomy.

Heidi

Colorado Jan · Post by **Colorado Jan** » Sun Jan 01, 2006 2:26 pm

My OSA is severe, AHI of 85 with severe desats, but I am not a candidate for any kind of ENT surgery. There isn't anything wrong with me in that department.....

But yes, from what I have heard, tonsil surgery in adults is pretty painful. But I really doubt that it is going to be any worse than your abdominal surgery was! And the recovery period is nowhere near as long as abdominal surgery!

And hate to burst your bubble about weight loss....I lost 15 pounds or so with a recent hysterectomy, but it made its way back to me with no trouble at all, lol.....it didn't stay "lost" for long!

Good luck!

Jan in Colo.

Sleeping With The Enemy · Post by **Sleeping With The Enemy** » Mon Jan 02, 2006 12:29 pm

I've lost about 12 lbs since 12/14 when I had my Nissen Fundo surgery (kind of like a mini gastric bypass, but for other reasons).

Ent says I'd probably lose 20 after tonsillectomy....

Swordz · Post by **Swordz** » Mon Jan 02, 2006 6:33 pm

I am starting to look into the MMA/GA surgery. I'm not giving up on my Somnomed MAS dental device, but I'm preparing just in case. The problem with MMA surgery, is you want someone who has done PLENTY of them. Oral surgeons perform the surgery, but its hard to find someone experienced in smaller cities (ie: Lexington, KY).

The best place to go by far is the Sleep Medicine Center at Stanford. Unfortunately, I don't have money for flying to CA, let alone insurance. So, if I deem the surgery necessary, I'm looking at prob 15K-25K out of pocket. (Anyone want to donate?)

Weight is not an issue with me, as I'm 6'0 and 175lbs. My throat must just be literally horrible for air passage. Keep us updated if you end up getting any type of surgery.

Swordz · Post by **Swordz** » Mon Jan 02, 2006 7:11 pm

MMA success rate study:

"Dr. Prinsell reported in the Journal CHEST (vol. 116 no 6 pp 1519-1529) a 100% success rate, in a five-year 18-center clinical study, of maxillomandibular advancement (MMA) surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients.

This 100% success rate, highest ever published in a study of this size, suggests that MMA is the most effective acceptable surgical treatment of sleep apnea, with a therapeutic efficacy equal to, but without the compliance problems associated with nasal CPAP"

Taken from Dr. Prinsell of Atlanta website: MMA Surgery

ozij · Post by **ozij** » Tue Jan 03, 2006 12:12 am

http://jada.ada.org/cgi/content/full/133/11/1489

Dr. Prinsell's review of MMA from 2002 in the Journal of the American Dental Association

And look for a rewiew in Thorax - the August 2005 issue. It needs a subsription - your college may have one.

O.

Guest · Post by **Guest** » Tue Jan 03, 2006 1:25 am

Hi-- long time since I last posted. For unknown reasons I don't seem to be able to sign in under my Username "Cameo Ann."

As I understand from my reading, many studies consider surgery for OSA to be successful if it decreases the AHI by 50%. Thus, it could be that surgery for one's moderate or severe OSA could be called "successful" even though afterwards the AHI might still be moderate or severe, which would still require the time-tested standard treatment of XPAP. The kicker here is that sometimes the effects of the surgery can it so that the person can no longer successfully use XPAP because of the alteration of the airways.

Food for thought anyway.

Ann

ozij · Post by **ozij** » Tue Jan 03, 2006 3:20 am

Hi Ann,
Nice to hear from you again!

Here's Prinsell's definition of success:

http://www.chestjournal.org/cgi/content/full/116/6/1519?

All 50 patients were successful responders to MMA based on the criteria of an LSAT > 80%, an AHI < 15, and AI < 5 or a > 60% reduction in AHI and AI, with all patients having an AI < 10, for a success rate of 100%.

However, the PSG results he reports were really good:

Postoperative PSG results (n = 50) showed dramatic improvement over preoperative data (n = 50), with therapeutic values similar to nCPAP (n = 42). Mean values improved from preoperative to postoperative vs nCPAP for apnea index (34.5 to 1.0 vs 2.0, respectively), apnea-hypopnea index (59.2 to 4.7 vs 5.4, respectively), lowest arterial oxyhemoglobin desaturations (72.7% to 88.6% vs 88.6%, respectively), and number of desaturations < 90% (118.8 to 6.6 vs 2.4, respectively).

By the way, tonsilectomy shouldn't be confused with UPPP.
O.

Barb (Seattle) · Post by **Barb (Seattle)** » Tue Jan 03, 2006 10:31 am

Sleeping With The Enemy wrote:Just wondering for those of you who have severe OSA, like I do (67 per hour), who has had any kind of ENT surgery Ii.e., tonsillectomy ect.)

Thanks in advance for responding.

Heidi

Yep. I had UPPP, and GA and it reduced my apneas from 70/hour...
to 64. A glaring failure, and had I known I would have saved myself extreme pain for nuthin' I feel I was deceived. The statistics of someone getting improvement from apnea that is severe from UPPP are dismal. They usually don't recommend it for severe apnea. Tonsillectomy might work if it's the thing causing the apnea, but I don't know if that's the only cause in some people...

Guest · Post by **Guest** » Tue Jan 03, 2006 11:00 am

Hi again,

Please see the quote below. The following quote is taken from the the discussion section of the article cited in the previous posting. Perhaps it does not apply to the current surgical procedure being discussed, but it does illustrate the importance of evaluating critically each study under discussion. I am also a researcher but not in the medical area (part of my job)-- and a 100% success rate should be thoroughly evaluated in my opinion. This success rate could be due to a number of variables, such as the particular selection of patients, the experience of the doctors performing the operation, the overall quality of the hospital, the cooperation and motivation of the patients, the age of the patients, etc. I would also like to segment the patients into different categories of OSA severity to see how one with very severe OSA might fare under this surgery vs someone with mild or moderate OSA. Admitedly, I did not read through the publication-- perhaps this segmentation is there. If not, it should be. I think all of us with OSA want to have accurate, reliable, and comprehensive information to guide us in our journey. If the results of this study can be replicated by others, then so much the better.

Averages hide a lot of information-- for instance, if you have one hand in freezing water and the other held to the fire, on the average your hands would be comfortable. Perhaps that is not the best analogy but it makes the point.

"A comprehensive review of the OSA surgery literature33 showed that UPPP has been one of the most commonly performed, yet one of the least effective, surgeries for OSAS. Using the criteria of postoperative AHI < 20 or AI < 10 or > 50% reduction in either value, 137 of 337 patients from 37 independent case series were successful responders, for a combined success rate of only 41%. "

Severe OSA, have any of you had any kind of ENT Surgery???

Severe OSA, have any of you had any kind of ENT Surgery???

Well

Re: Severe OSA, have any of you had any kind of ENT Surgery?