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Tonsillectomy and UPPP and Coblation for base of Tongue
#1
41 years, male, 5 feet 8 inch and 163lb. Moderate-Severe OSA, used CPAP machine for 3 months and can tolerate it as well.

loose soft palate, long uvula, about 2.5 cm. tested with sedated endoscopy and found "complete obstruction with soft palate, uvula and both tonsils", near complete obstruction with base tongue.

First ENT doctor said " will 80-90% significantly improve if tonsillectomy, UPPP and coblation of base tongue"

Second ENT doctor said "have at least 60% success rate if tonsillectomy and UPPP. Maybe 65-70% success rate if coblation of base tongue at the same time"

Third ENT doctor don't suggest any surgery.

Don't want to use CPAP next 30 years for the rest of my life and personally prefer very conservative surgeries. plan to delay coblation of base tongue since there is no complete obstruction. many peoples had tonsillectomy before and it should be very safe. For uvula and soft palate, the second doctor said he will cut the entire uvula and stitch up the soft palate (no cut soft palate). The biggest contribution factor is to stitch up soft palate. I disagreed the entire uvula removal (prefer partial uvula removal) after research on website, for example,

hospitals.jefferson.edu/tests-and-treatments/partial-uvulectomy/

finally he agree to left a tiny bit uvula and said he never did partial uvula cut before and nobody complain dry throat, etc. I don't trust him now.

The second ENT doctor said he will do whatever surgery I let him do.

Actually I just want to go with the most conservative surgery and may be tonsillectomy as the first step. However both doctors said tonsillectomy is not medical necessary for sleep apnea and the insurance will not cover it.

Any suggestions?

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#2
IMHO - There is no such thing is minor surgery. Minor surgery is surgery on someone else. There are always side effects and risks with any surgery let alone having the surgery fail to do what's intended and you are left with CPAP anyway. I realize this amounts to personal preference but I would stick with CPAP if its working and head to surgery as a place of last resort.
Coffee

Happy Pappin'
Never Give In, Never Give Up


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#3
I would stick with cpap. Surgery is always risky and most people who have it still need pap anyways. For me, cpap has become a way of life, and I can't imagine going without it.
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#4
Surgery is terrifying! I have been there and have the t-shirt to prove it. I was VERY lucky to survive a recent bout with cancer.

CPAP is non-invasive and not too bad after you get used to it.

YMMV,

Good luck, Jeff
Sleep is worth the effort.
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#5
Hi sleep_apnea,
WELCOME! to the forum.!
I sure wouldn’t be in any hurry for surgery because of the risks involved. Usually, people who have surgery, wind up having to use the CPAP machine in the end anyway.
The CPAP machine is non-invasive and if you can tolerate it, it would be less risky, of course, YMMV..
Hang in there for more responses to your post and much success to you as you continue your CPAP therapy.
trish6hundred
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#6
Your most optimistic scenario with 80-90% improvement could still leave you dependent on CPAP for apnea relief. The pain and difficult recovery, and complications of this surgery are well documented by those that have had it, and the lack of long-term success in terms of eliminating the need for CPAP is poor.

You are apparently a fit, individual of approximately correct weight, and have been dealt the severe apnea card. Please research your options carefully and don't make a decision based solely on your emotional reaction to using a CPAP machine for life. For those of us that have made this a part of our lives, it's no big deal, but I understand your negative feelings towards it. I felt that at one time as well.
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#7
sleep apnea,

I feel if cpap is working for you as it appears to be in your case, that is your best option and work through your feelings of being on it. How is the therapy working for you?
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#8
sleep apnea,

If you're still adamant about having surgery, you need ask your surgeon what he means by his success rate statistics because that can mean different things depending on who is providing them. For example, Dr. Park, in his podcast on alternatives to cpap, defined a success rate as taking the AHI down to less than 20. Can't remember which procedure he mentioned but said this occurred 80% of the time. He went on to say that in 40% of cases, the AHI ends up below 5 which is considered to be cured.

Of course, if pap therapy hasn't been working for you for several months, I would take these odds because obviously not treating the apnea is not an option and doing something is better than nothing. But this is a perfect example of why clarity is needed on the statistics, no matter what the situation is.

I would also ask the surgeon to provide these statistics as they apply to his/her patients and not give generalities as that would give a better idea of your chances. This may be harder to find out because I haven't seen any good research one way or another but I would also want to know the long term success rate of his/her patients who have had the surgery. And if it can't be provided, then I guess settling for generalities would have to suffice.

Good luck with your decision. Again, if you are tolerating the pap therapy, I would stay with that. But I wanted to provide you with more things to consider in case you still wanted to have surgery.

49er
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#9
None of the above options are 100% successful for any patient, and while there is a chance of reduction, unless your initial AHI is relatively low, I would not guarantee complete relief form any of them. Having your tonsils removed will not have a major effect, but admittedly, these days we tend to remove them anyway, because at some point they WILL turn on you, and better younger than older (say, 70) for this very minor op. But again, jerking the tonsils will do practically nothing for your problem. Find out why surgeon 3 says do nothing. I never advocate surgery for this unless it is the best option, and if you cannot get three doctors to agree on it, something isn't right.
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#10
I am too rush for the surgery and will delay it, and think more about it. Thank you for the reply.

In the reports of my sedated endoscopy, ENT Doctor wrote: Jaw thrust did resolve both areas of obstruction completely. As such, candidate for mandibular advancement device.

any comments for long-term using mandibular advancement device? somebody wrote on webpage that doctor let him bite something, then send it to a factory and make the device specifically for his teeth. in order to get such device, should I go to see a dental doctor? will dental insurance cover it?
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