The Pillar Procedure

[Jason S.]

I have moderate OSA. My ENT now performs the Pillar Procedure, 3 pillar inserts surgically placed into the soft palette to support it and keep it from collapsing the airway during sleep.

Any comments on this procedure????

[chunkyfrog]

So, he just started?
All comments about the procedure in general aside,
you aren't really serious having an inexperienced guy cut into you?

[The Choker]

I have moderate OSA. My ENT now performs the Pillar Procedure, 3 pillar inserts surgically placed into the soft palette to support it and keep it from collapsing the airway during sleep.

Any comments on this procedure????

For some it is a cure. For some it helps but does not cure. For others it doesn't even help.

Ask the ENT how he determines who is a good candidate and who is not. If he doesn't have a good answer stay away from him.

[DoriC]

Hi Jason, good to see you again! I'd ask what type of training he received, how he determines who would benefit, how many procedures he's performed and what his followup patient data shows,etc. You don't want to be a guinea pig.

[rocklin]

Any comments on this procedure????

No, but if he gave you a free-face lift he did a hell of a job.

My gosh, you're a handsome man.

[mayondair]

I have no personal experience, but an acquaintance had the procedure, and wound up having more surgery to remove them after they started working their way out of her palate, she reports it was a big mistake for her. She had mild / moderate OSA.

[jamiswolf]

Jason,
I was reading about the procedure recently. It can be done in the office but it does take awhile for the scar tissue to form and that's part of how it works.

One thing to consider, and this reflects on your sleep study results. The procedure will only help with obstructive events. It does nothing for central apneas. So be sure that your apnea is primarily obstructive before expecting relief.
J

[archangle]

I'm not impressed with the success rate. Remember that they may define "success" much differently than you do. They may take a small improvement in AHI score as "success" and you may want to be able to stop CPAP.

I believe it doesn't even treat all obstructive apnea, only apnea that involves certain parts of the throat.

It's a lot less invasive, and has a lot fewer complications than some other procedures.

[NightMonkey]

From their website:

only a doctor can determine if you're a good candidate. Your doctor will examine your upper airway to determine if your palate is causing or contributing to your snoring or OSA, and if you are a good candidate for the Pillar Procedure.

[archangle]

From their website:

only a doctor can determine if you're a good candidate. Your doctor will examine your upper airway to determine if your palate is causing or contributing to your snoring or OSA, and if you are a good candidate for the Pillar Procedure.

Unfortunately, I think a lot of doctors look in your wallet rather than in your throat to see if you're a good candidate for any surgical apnea procedure.

[NachtWürger]

Jeez! A con-artist behind every bush.

Glad I live in a different world.

[NightMonkey]

Jeez! A con-artist behind every bush.

Glad I live in a different world.

archangle is our Resident Skeptic!

[DoriC]

From their website:

only a doctor can determine if you're a good candidate. Your doctor will examine your upper airway to determine if your palate is causing or contributing to your snoring or OSA, and if you are a good candidate for the Pillar Procedure.

Unfortunately, I think a lot of doctors look in your wallet rather than in your throat to see if you're a good candidate for any surgical apnea procedure.

It's unfortunate that you really believe that! How many is "a lot"?

[archangle]

archangle is our Resident Skeptic!

I don't believe you.

[archangle]

It's unfortunate that you really believe that! How many is "a lot"?

I don't believe many of them actually say to themselves, "This guy doesn't really need this procedure, but I'm going to do it anyway."

I think the whole system is biased towards what brings in the most money.

Pharmaceutical firms send them info, free samples, etc. to convince them that their new, hideously expensive drug is better than the cheaper generic drug. So do the equipment manufacturers and promoters of surgical procedures. They hold "information sessions" with fancy lunches or other perks to entice the doctors to use their product. Doctors get big fees from the companies to present at conferences telling how wonderful the new product is. Doctors get expense paid trips to presentations and training sessions on the new product. Often with nice accommodations with golf courses, meals, etc. thrown in.

Doctors who do a lot of fancy procedures get the respect of their peers, and promotions within the ranks of their organizations or group practices. The doctor who does fewer and simpler procedures gets less respect and rewards even if his patients fare better on the average.

Even the patients pitch in. If the doctor tells a patient that procedure X is not really in the patient's best interest, the patient is rarely happy about it. If the doctor tells the patient he should get the surgery, the patients who get better are happy and tell their friends. A lot of the people who don't get worse think "oh well, at least he tried."

There's also a bias for more treatment based on the idea that if they don't do the "newest and best" treatment, they'll get sued. "Dr. Smith, why didn't you give your patient the new and improved XYZ diagnostic test instead of the cheaper and obsolete MNO test?"

Even apart from that, most people in this country tend to believe in what they sell. They believe in what earns them money. The car salesman or computer salesman may really believe he's selling a good product at a fair price. The clueless DME may even believe he's providing good service at a fair price and helping his poor patients.

As for numbers, it's hard to guess. I'm going to say that at least 80% of the doctors are somewhat influenced by the system to spend more money than what is really the best choice from the patients' point of view, even though they may believe they're doing the right thing. Doctors don't get evaluated by well informed patients, they get evaluated by other physicians and medical company bureaucrats.

I'd guess 30% of the surgeons are seriously biased in terms of doing more treatment, but have convinced themselves that they're doing the best thing for the patient. Another 10% don't actively do things they consider unnecessary, but don't really put much thought into whether it's really in the patient's best interest. It's just the "standard treatment for condition X, ring the cash register." Maybe 10% know they're doing something that's probably not really in the patient's best interest, but don't worry as long as it's something that's is not likely to get them successfully sued. Maybe 5% are willing to do something they know is wrong if the cash vs. risk is good.