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Anyone had "Drug Induced Sleep Endoscopy" (DISE)
#1
Anyone had "Drug Induced Sleep Endoscopy" (DISE)
Has anyone had "Drug Induced Sleep Endoscopy" (DISE) to help provide more information about their apnea?  If so, can you say where you had it done?  At present I can only find a few medical centers that perform this procedure and most are far away from me.  I live in the southeast United States. 

I'm sleeping better these days but still curious about certain aspects of my apnea.  I have one paralyzed vocal cord which contributes to my obstructive apnea and I'd like to find a doc that can observe it while I'm sleeping to see what's going on.  From what I've read it can be very helpful. My ENT says it appears that the cords may be slowly moving closer together as I get older and even more so when I'm asleep. He couldn't recommend a doc that does DISE procedure. 

Thank you!
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#2
RE: Anyone had "Drug Induced Sleep Endoscopy" (DISE)
sleep endoscopy is done in any clinic that offers sleep apnea surgeries like uppp etc. its not something thats very specialised that needs to be advertised. I'm sure any ent clinic in a major city can do Sleep Endoscopy, you just gotta phone them in your nearest bigger city.
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#3
RE: Anyone had "Drug Induced Sleep Endoscopy" (DISE)
Ron, welcome back. Are you still really using that old M-series?

DISE is normally used ahead of upper airway procedures to resolve obstruction. While the larynx can be visualized, I'm not aware of any procedure that can restore function of a paralyzed vocal cord, and the structures are easily damaged which could leave you without a functioning voice. Most surgery in the larynx is for cancer (tumors), and the risks of cancer outweigh the risks of losing your voice.

It would be far far less expensive, and likely more effective to get your doctor to prescribe a bilevel machine (Resmed Aircurve 10 Vauto) so that you can have lower pressure on exhale and a much more comfortable positive pressure experience. I think you should look for a more cooperative doctor, that will prescribe bilevel to see if that works more comfortably for you than your ancient CPAP. It should not take a sleep study, because your condition is not observable. Worst case, can you afford to buy out of pocket if insurance denies bilevel? Even a used machine would be newer than your M series and would work a lot better.
Sleeprider
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#4
RE: Anyone had "Drug Induced Sleep Endoscopy" (DISE)
Thank you for the replies.  I will update my profile.  I'm using a Resmed  S9 now and sleep quality is really good.  Also got my over active bladder under control which really improved my life.
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#5
RE: Anyone had "Drug Induced Sleep Endoscopy" (DISE)
Stridor is common with patients with partial or full vocal cord paralysis, and is mistaken as snoring, obstructive events.
A half treatment is baloon endoscopy that dilates any narrowing that may be present, another, scaring the tissue to make it more rigid etc. I'd personally sacrifice being able to speak for a night of good sleep without choking.
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#6
RE: Anyone had "Drug Induced Sleep Endoscopy" (DISE)
(05-21-2019, 01:44 PM)crowtor Wrote: Stridor is common with patients with partial or full vocal cord paralysis, and is mistaken as snoring, obstructive events.
A half treatment is baloon endoscopy that dilates any narrowing that may be present, another, scaring the tissue to make it more rigid etc. I'd personally sacrifice being able to speak for a night of good sleep without choking.

Yep, seems that most docs and ENT's have a basic understanding of vocal cord paralysis, but the subtleties sometimes escape them.  My primary care physician simply would not believe that I have a paralyzed vocal cord.  He literally said "I don't believe you have a paralyzed vocal cord.  You voice is perfectly fine!"  I told him it had been confirmed by Wake Forest, Vanderbilt, Mayo, and others as well as several laryngoscopies.  His response was, "I'll need more proof than your opinion of what you think is going on."  So anyway, the paralysis I have effects the abductor (opening the cord) of the left cord.  So when I inhale the flow is less than half a normal person because the cord is not getting out of the way.  This isn't a problem in normal activities or even talking (the right cord moves against the paralyzed left to make normal sounds).  The problems occur with exercises like running where high flow rates are required to maintain levels of activity.  I can run, swim, etc. but my speed needs to be slow because I can't move enough air.  Sleeping is a problem, but CPAP helps and I use that regularly to good effect.

The issue I'm concerned with now (aside from my poor athletic performance) is that with and sometimes without the CPAP I am making vocal sounds (i.e. through the vocal cords).  This has slowly increased over the last year.  If I nod off without CPAP, I am immediately awakened by my own voice.  My ENT says that right (non paralyzed cord) may be weakening or the paralyzed cord may be flopping toward the good one when I'm in a sleep state.  It could be physiologic or neurologic such as a failing autonomic function (nerve signal) not stimulating full abduction when I sleep.  The way to compare wake and sleep vocal fold function is via the DISE procedure.

Either way there are options ranging from cordectomy (cutting a slit in the vocal cords for greater flow) to implanted electro stimulator (like a pacemaker for the cords) to laryngeal reinnervation surgery performed at Mayo (Rochester) and a few other centers.

So the emerging great new options and determination of autonomic function are why I am interested in pursuing DISE.  I would love to have more or restored vocal cord movement.  Here are some explanatory links:

https://www.mayoclinic.org/medical-profe...c-20431242

Caution, this a graphic, real surgical procedure for reinnervation:  https://www.youtube.com/watch?v=_aoUbRXBxDI
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#7
RE: Anyone had "Drug Induced Sleep Endoscopy" (DISE)
Dr Steven Parks mentions this on the UARS page on his website. I don't know where you are in relation to him, but if he is not close, perhaps he can recommed someone in your area.
Sleep-well
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