Radiofrequency Ablation of the Tongue Base

Has anyone here had these treatments?

They are explained by one medical group at this site - http://curemysleepapnea.com/radiofrequency-ablation/

I never paid much attention because it seems they used to do the entire ablation at once in a hospital setting (ouch!).

But at least this one group is doing it in small amounts over five to eight treatments spread over some months. This sounds much more tolerable.

Please, if you have personal experience with ablation, I would like to hear your comments.

Thank you.

If you are thinking of this as an alternative to CPAP therapy, I have to wonder whether the remedy will be short-lived in the same way UUUP seems to be short-lived for many of those who have tried it on the forum.

I'm curious what the risks will be. How will it affect your ability to swallow? Sense of taste? Tongue flexibility (ability to speak)?

Dr. Li is not a fan of this procedure anymore--he says it is short-lived. He talks about it briefly in this MMA interview.

http://www.sleepapneasurgery.com/maxill ... ement.html

I have been researching and treating sleep apnea for several years. Until tongue base radio frequency treatments, the treatment options have been disappointing. 60% of patients can not or will not tolerate CPAP, and of those that are able to tolerate it short term, many stop. I have seen a great improvement in patients, many able to drop below 5 AHI (apneas per hour). UPPP combined with Tongue Base treatments have been shown to have an 82% success rate. Because Tongue base treatments are minimally invasive, I suggest to my patients to undergo this first. We then repeat a sleep study and if warranted, we then proceed to UPPP. Prior to TB treatments, the treatment protocol many times has been "you have sleep apnea, here's your CPAP, God Bless you, go home", the alternative with the CPAP failures was "God bless you, go home". I have been able to help countless patients. Those of you who have sleep apnea know how it effects your health. Unfortunately, many physicians are yet to understand the gravity of untreated sleep apnea.

ENT Doc wrote:I have been researching and treating sleep apnea for several years. Until tongue base radio frequency treatments, the treatment options have been disappointing. 60% of patients can not or will not tolerate CPAP, and of those that are able to tolerate it short term, many stop. I have seen a great improvement in patients, many able to drop below 5 AHI (apneas per hour). UPPP combined with Tongue Base treatments have been shown to have an 82% success rate. Because Tongue base treatments are minimally invasive, I suggest to my patients to undergo this first. We then repeat a sleep study and if warranted, we then proceed to UPPP. Prior to TB treatments, the treatment protocol many times has been "you have sleep apnea, here's your CPAP, God Bless you, go home", the alternative with the CPAP failures was "God bless you, go home". I have been able to help countless patients. Those of you who have sleep apnea know how it effects your health. Unfortunately, many physicians are yet to understand the gravity of untreated sleep apnea.

Please provide us with YOUR definition of success. And what ahi did patients have before you got them to below 5?

We have found that surgeons consider success to be a 50% reduction of ahi. To anybody over 10 ahi, that is NOT success in the real world. Actually, many of us find that even an ahi of 3 or 4 is still too high, and that under 1 or 2 is what makes us feel better.

zoocrewphoto wrote:

ENT Doc wrote:I have been researching and treating sleep apnea for several years. Until tongue base radio frequency treatments, the treatment options have been disappointing. 60% of patients can not or will not tolerate CPAP, and of those that are able to tolerate it short term, many stop. I have seen a great improvement in patients, many able to drop below 5 AHI (apneas per hour). UPPP combined with Tongue Base treatments have been shown to have an 82% success rate. Because Tongue base treatments are minimally invasive, I suggest to my patients to undergo this first. We then repeat a sleep study and if warranted, we then proceed to UPPP. Prior to TB treatments, the treatment protocol many times has been "you have sleep apnea, here's your CPAP, God Bless you, go home", the alternative with the CPAP failures was "God bless you, go home". I have been able to help countless patients. Those of you who have sleep apnea know how it effects your health. Unfortunately, many physicians are yet to understand the gravity of untreated sleep apnea.

Please provide us with YOUR definition of success. And what ahi did patients have before you got them to below 5?

We have found that surgeons consider success to be a 50% reduction of ahi. To anybody over 10 ahi, that is NOT success in the real world. Actually, many of us find that even an ahi of 3 or 4 is still too high, and that under 1 or 2 is what makes us feel better.

What I would like to know is what percentage of his patients achieve an AHI of 5 or below with radiofrequency ablation of the tongue base and what percentage receive an AHI of 10 or below.

And if the patients need to go on to having a UPPP, are you saying that 82% of them have an AHI of 5 or less after both procedures?

As one who has struggled big time with pap therapy, I am always interested in hearing about alternative approaches. If someone gets their AHI below 10 but is sleeping through the night vs. having extremely fragmented sleep on the pap machine, that would be a definite improvement in their health even though they haven't reached the ideal number. But exact percentages are needed so that people can make informed decisions.

49er

Patients don't adapt to CPAP therapy, so let's find another solution...

What a short-sighted view! How about instead determining WHY patients have trouble and addressing that!

MOST patients that don't adapt are having some trouble with the mask they were forced to try. The process for finding a good fit is completely flawed in that a patient is expected to eyeball a few or get a suggestion from the DME, who honestly has little more than their own experience with other patients to rely on. Well, just like clothes, there is no "one size fits all" in CPAP interfaces. And you can't find a good fit in a single appointment! You have to try it SLEEPING to know if it works.

It takes many people (most?) far more than even 5 tries to find a mask THEY TOLERATE let alone like. If each try is 3-6 months between, it's YEARS before they find a mask.

Surgery is presented as a quick fix. You do it, you recover, and done! But so far surgery isn't lasting. Funny, we do the same thing for being overweight. I was SO tempted by the various surgeries for obesity, but guess what? Most patients eventually DO gain it back! I could go in to why's etc, but that's not the point (here). The point is that treating xPAP, obsesity, diabetes, and so many other diseases is NOT a quick thing ... it takes time and effort.

Do I LIKE having to invest my time to find a good treatment? Of course not! But that's what has to happen.

Hi Kevin,

As someone who has struggled big time to adapt to pap therapy, I have a different take and applaud this ENT for trying to find other solutions as long as he is honest about the success and apnea re-occurrence rates. Personally, I think people should try dental appliances if they quit pap therapy before resorting to surgery but I don't want to get off of the topic.

I agree that you should work through all the usual pitfalls such as finding the right mask before you think of alternatives. Hopefully, the ENT is helping patients do that or is referring them to providers who do.

But I am convinced that there is an unknown percentage of people who can't adapt to pap therapy no matter what they do or try. It has nothing to with effort or wanting a quick fix solution. Dr. Park has theorized that people who have UARS issues have a very hyperarousable system that causes them to have arousals when wearing the mask which impacts sleep. I suspect I may be one of those folks and only time will tell as to what course my treatment takes.

49er

khauser wrote:Patients don't adapt to CPAP therapy, so let's find another solution...

What a short-sighted view! How about instead determining WHY patients have trouble and addressing that!

MOST patients that don't adapt are having some trouble with the mask they were forced to try. The process for finding a good fit is completely flawed in that a patient is expected to eyeball a few or get a suggestion from the DME, who honestly has little more than their own experience with other patients to rely on. Well, just like clothes, there is no "one size fits all" in CPAP interfaces. And you can't find a good fit in a single appointment! You have to try it SLEEPING to know if it works.

It takes many people (most?) far more than even 5 tries to find a mask THEY TOLERATE let alone like. If each try is 3-6 months between, it's YEARS before they find a mask.

Surgery is presented as a quick fix. You do it, you recover, and done! But so far surgery isn't lasting. Funny, we do the same thing for being overweight. I was SO tempted by the various surgeries for obesity, but guess what? Most patients eventually DO gain it back! I could go in to why's etc, but that's not the point (here). The point is that treating xPAP, obsesity, diabetes, and so many other diseases is NOT a quick thing ... it takes time and effort.

Do I LIKE having to invest my time to find a good treatment? Of course not! But that's what has to happen.

Hi 49er,
Point taken, and I didn't really mean to come off sounding like xPAP is the ONLY therapy. My knee-jerk response is from years of dealing with myself and others finding xPAP to be difficult to adapt to for various reasons and finding that the only real support is places like here. And by "support" I don't just mean empathy ... I mean solutions (I'm a guy, so I am solution oriented ... it's in one of my genes. Unless I threw that pair out)

I think the field needs a re-adjustment. I sense Molette has similar views, but from a different perspective ... that of someone having to work within the current establishment and seeing how it is failing to help some patients.

ENT surgeons including Dr Steve Park will promise you a lot to get their scalpels into your flesh.
Reducing the AHI is just one more promise.

But, check this about it:

THE APNEA-HYPOPNEA INDEX: USEFUL OR USELESS?
http://www.respiratoryreviews.com/sep02 ... Index.html

Notice this paragraph there: Dr David Rapoport (one amongst the top U.S. sleep disorders docs) defines severe cases as those with an AHI of 30 to 50 events per hour or greater. “This is definitely bad … and I want to treat it,” he stressed. Obstructive sleep apnea symptoms are also likely to be severe enough to warrant treatment in patients with an AHI of about 20 per hour; SDB can probably be ruled out at an AHI of about 10 per hour. You can see here immediately ENT Doc's trap. You don't need ablation to drop the AHI below 10.

In this website there are reports by about a dozen posters who went thru surgeries of the mouth and nose and regret it.

ENT Doc wrote: Because Tongue base treatments are minimally invasive, I suggest to my patients to undergo this first.

I have used CPAP for many years and, sleep apnea being a progressive condition, my case seems to be getting worse. My pressure is running as high as 18 to 20 cm several times during the night and it seems to be when I hit REM. This high pressure pumps up my stomach and even blows out the tear duct of my right eye. I had punctal plugs installed some months ago and this helps my dry eyes but did not solve the problem of CPAP blowing air through the tear ducts.

Next week I have an appointment with a top-notch ENT surgeon to do an evaluation of my airway. My primary objective for the session is to discuss RF tongue base treatment.

I have no hopes of a "cure". The goal for me would be enough tongue base size reduction to be able to treat effectively with CPAP at a moderate pressure even during REM. Maximum pressure of 8 would be wonderful and 12 I would consider successful.

I am glad you posted here. Please don't mind the negative comments from members with hundreds of posts. Their minds are "locked into" CPAP and will not consider anything else. This is not a bad thing for them because it does take a heavy commitment to be a longtime CPAP user. (That is for most people as there are some for whom it seems to be a piece of cake.)

Again, thanks for posting!

Christine L wrote:Has anyone here had these treatments?

They are explained by one medical group at this site - http://curemysleepapnea.com/radiofrequency-ablation/

I never paid much attention because it seems they used to do the entire ablation at once in a hospital setting (ouch!).

But at least this one group is doing it in small amounts over five to eight treatments spread over some months. This sounds much more tolerable.

Please, if you have personal experience with ablation, I would like to hear your comments.

Thank you.

Thank you for posting this. I read it just a few days after you posted it and it spurred me to make the appointment mentioned above.

avi123 wrote:ENT surgeons including Dr Steve Park will promise you a lot to get their scalpels into your flesh.

Avi, babe, this is just wrong. If you listen to the link I posted, Dr. Park concurs (he's giving the interview!) with Dr. Li that he also finds tongue ablation benefits short-lived. Dr. Park is on the front line trying to help sleep apnea people--he's one of the saints.

http://www.sleepapneasurgery.com/maxill ... ement.html


Sheffey: I feel for you. I'm interested in hearing your opinion of the procedure if you get the tongue ablation. You do what you gotta do--I know this well.

@Sheffey:
I confess, after a moderate adjustment period, I can have my cake all night, every night.
Sometimes, I need to adjust the icing, sometimes I'm lucky enough to have fondant.
So, for me, cutting the cake is not an option; but good luck with whatever you're having.

Loreena wrote: Dr. Park concurs (he's giving the interview!) with Dr. Li that he also finds tongue ablation benefits short-lived.

I will not take time to listen to the interviews, but since you have maybe you can answer a question. Why would tongue ablation be short-lived and how many years is "short-lived"?

What I understand about ablation is that muscle tissue is destroyed and will not "grow back"?

Or maybe it is short-lived because OSA is a progressive condition?

I will also ask my surgeon about this next week.

BTW, the thought is appreciated but no need to "feel" for me. I am doing quite well and feel privileged to have been born in a time and place where CPAP was available to extend my life and vitality.