Posted by seattlebill on April 21, 2005 at 15:32:21:

In Reply to: I am considering surgery, help!!!!! posted by Frank on April 21, 2005 at 11:35:17:

Hi Frank,

Like many of us on this message board, I have had both of those operations as well as others. My OSA was listed as severe. Therefore, my ENT elected to do them (turbinate reduction & UPPP) separately. Others who are operated on for milder OSA can have both done in one sitting with minimal danger, but should be observed overnight in a monitored unit. It depends on your surgeon as to what degree of severity they will operate on in one sitting. I've seen a lot of folks posted on the OR board who have them done all at once.

The nasal surgery alone may improve your ability to use CPAP; but probably won't "cure" your OSA. As per my previous posts, I have doubts as to the efficacy of the UPPP...although some patients report great results with it.

The UPPP seems to me to be high pain; low benefit ratio. The studies on UPPP aren't scientific. They have a 30-40% "success" rate based on post-op subjective patient surveys (not even reviewing further sleep lab data). It seems to be the most painful of the various operations offered for OSA (although with some tricks, the pain is certainly manageable). There can be some minor morbidities following a UPPP. Retrograde liquid regurgitation (fizz up your nose); foreign body sensations in the back of your throat; inability to seal nasal CPAP devices. UPPP takes about 2-3 weeks to recover. Several days early on will be eating liquids with pain on swallowing. Furthermore, there is a fairly high relapse rate over time with the UPPP .My UPPP didn't do much for my OSA, so I moved on to more extensive surgeries.

The turbinate operation is relatively minor. Almost no/ very little pain. A few days of bad congestion and stuffiness. Annoying post-op routines like nasal irrigation, etc...It takes about 7-10 days to recover.

Unfortunately, there is no free lunch. You may have the UPPP, turbinates, or any operation done and have no improvement. What might be reasonable is to get your turbinates done and see if it improves your CPAP tolerance/ use. It is relatively quick to recover from, reasonably well-tolerated and has a low rate of complications. Plus, you stated that you seem to tolerate CPAP ok as of now. Have you tried Autopap, different masks, cflex, etc...? If I were able to tolerate and use my PAP devices, I wouldn't undergo the morbidity of having these operations.

Clearly, we all agree that OSA must be treated as the further health consequences of untreated OSA can be devastating. I choose to pursue my surgeries now because I am younger and healthy; rather than wait until I develop health problems that would make the peri-op risks more substantial. If tolerated, CPAP is annoying, but is clearly less morbid than any procedure. Lots of us have spouses, girl friends (or perhaps both)who are very tolerant of the devices.

See if your ENT will opt to fix your current problem (nasal obstruction) first and see how you feel after that (rather than combining it with the boat payment...UPPP...that doesn't solve any difficulty that you are having today). Or... at least, you should ask your sleep doc for a new sleep study to see if you are in the "severe" catagory before you elect to have both done in one shot. This may assist in risk assessment.

Good luck, Bill

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