Questions to Ask Your Surgeon-Dr.K.O.Paulose FRCS. Consultant ENT Surgeon
Surgical treatments for snoring and obstructive sleep apnea include several different techniques for removing tissue from the back of the patient’s throat, reshaping the nasal passages or preventing the tongue from blocking the airway during sleep. In children the best surgical treatment is removing enlarged tonsil and adenoid.
Surgery is an effective option for patients with snoring, OSA and mixed apnea .Surgery can provide permanent relief from their symptoms to a great extent. However, any surgery carries some risks, one has to face it.
I have been doing surgery to cure snoring and sleep apnea since 1996.I might have done over 1500 cases so far. Thank God, no major complications till now.
There is no tailor made operation to cure the complex problem of OSA.I usually plan my surgery according to the need of patients.
Tonsillectomy, Adenoidectomy, Nasal surgery-Septoplasty, Turbinate Reduction,LAUP, CAUP, Base of Tongue reduction, even Tracheostomy(in one case), etc are the common surgical procedures done.
Patients suffering from loud snoring and sleep apnea-Mixed or Obstructive have three options-
Just Do Nothing-Live with all its social and medical consequences as follows, (a few of them)
and Marital problems, loss of libido, sleeping in separate bedrooms, divorce at the end(rare)
and Loss of concentration and alertness, poor performance in job
and Car and other accidents in work
and Headaches, poor memory
and Medical-High BP, Heart attacks, Heart failure, Stroke, even sudden death in sleep(rarely)
Use a CPAP
CPAP is widely recommended for sleep apnea. CPAP entails wearing a mask-like device while you sleep, which provides pressurized air to prevent the airway from collapsing. While CPAP works very well in preventing central apnea, many people find the apparatus uncomfortable and difficult to use, very cumbersome.
How useful CPAP
and After sleep study, If diagnosed as Central Sleep Apnea-One should wear a CPAP, life time
and If one cannot undergo surgery due to medical reasons, or old age, one has to wear CPAP
and Those who have obstructive sleep apnea, with loud snoring, CPAP is not something you would like to wear every night, especially younger age group, you wouldn\’t fancy living a “ventilator life”. Unless obstruction is corrected, how on earth it\’s going to work, I don\’t understand.
and Those who have mixed apnea, the obstructive elements should be surgically corrected before wearing CPAP. Otherwise things get worse only.
and Problems with masks, power supply to work the machine, lack of humidification allergic to masks, carrying around inconvenience, are among other draw backs.
and Patient compliance is poor
and Cost of equipment Rs 75,000 and above for a good machine
If you have exhausted all other apnea treatment options, you have no other choice but opt for surgery.
There is lack of awareness among the public and even the medical profession about the recent advances in surgery for snoring and sleep apnea-Laser, Coblator, Pillar procedures, Harmonic scalpel surgery etc. are all at hand these days.
What else you need to know before Surgery
Many people come with lot of questions before undergoing surgery; I will try to answer a few questions, from my experience. Most of the below mentioned side effects are trivial.
1. Is it Painful?
NO PAIN, NO GAIN. There is hardly any surgery without some pain… Pain issue is over exaggerated by those who have other interests in mind. I won\’t say it is not without pain. The pain is like having a tonsillectomy or less than that. Again it depends on patient\’s threshold. Some doesn\’t complain at all. Moderate pain that can be controlled by analgesics is all that is needed. The pain will last around 5-7 days.
I find patient complaints of less pain after Coblator surgery than Laser surgery.
Eating and drinking-Once the anesthesia wear off one can start eating and drinking, but try avoiding spicy and citrus type food for a week. Some ice cream will be a bonus!!!
2. Is sleep lab study necessary before operation?
It is ideal to get a sleep study (PSG), i.e. spending one night sleeping in the sleep lab with all sorts of wires and gadgets attached on the body. This gives lot of information regarding the type of apnea, hypopnea, Oxygen saturation, leg movements etc.
But unless it is done in a very good lab, false results can confuse both patient and surgeon. Patients coming from distant place find it difficult to spend days to get it done since the waiting lists are too long.
So after a good history from spouse, of loud snoring, gasping for breathe, stoppage of breathing, periodic leg movements, physical examination of upper airway, Flexible endoscopy,MRI , Cardiac and Pre-anesthetic evaluation is all that needed before surgery in majority of the cases.
3. Can you guarantee hundred percent result?
No. No one can guarantee one hundred percent result. I would be happy if one gets 80% improvement in snoring and OSA. Some times more sometimes less, depending upon many factors like obesity, nature of obstruction, tongue factor, jaw factor etc,
4. Will there be any nasal regurgitation while drinking after surgery?
I will be happy to hear from the patient saying this which means he or she is cured nearly 100%, as the airway is fully patent. No one had permanent nasal regurgitation in any patients I have done over these years. It may last 2 weeks or up to 6weeks the most..
5. Any change in voice?
I was forced to operate a famous Lebanese singer many years ago who had severe snoring and OSA, (was bit apprehensive myself), but when he met me after one year and gifted me a gold watch, I was so happy, he said his quality of his voice improved, with better nasal resonance. His rating went up five times!!!!
Of course if you speak Hebrew producing the guttural fricative sounds (like in the Hebrew word “L’chaim”),using uvula in certain words can be affected. But no other language will have that problem; it will change your potato and nasal stuffy voice to better voice. English and other language do not use the guttural fricative sounds.
6. Will it affect taste and smell?
No it will make the smell and taste better once the nasal function gets better
7. Dryness in the throat- phlegm in the throat
After laser, there will be period of dryness in the throat for first 2 weeks till the wound heals. Feeling Phlegm in the back of throat also lasts there for 2-3 weeks.
8. I had the surgery once, still snore, why? Repeat surgery needed?
The result of surgery will be after full healing, which will take nearly 6 weeks, until the scar formation takes place. So be patient. Loosing weight also important along with life style changes.
Very few patients need revision surgery under local anesthetic after one year. Mind you I do “one time” laser surgery; unlike surgeons in the west does it in 3-4 sittings. Here many patients cannot afford redo surgery.
9. Any Infections or bleeding after surgery?
Infections, hardly seen. If done under local anesthetic in the office, primary bleeding from uvular artery can occur rarely-only 2cases I had to deal with.
10. Snoring and sleep apnea in children-
Go for Tonsillectomy and adenoidectomy, One hundred percent result is guaranteed.
11. Cost of Laser/Coblator surgery.
If done under local anesthetic less expensive, but if done under general anesthesia, it cost any where between Rs 40000 to 75000 depending upon what all procedures are done and what type of room you select, cross consultation, expensive medications, investigations like MRI.
12. How can I get an appointment, accommodation, travel arrangements, sightseeing (part of medical tourism)?
We have a good Marketing Department; you may get in touch with-
For Appointment-Accommodation-Travel Arrangements-Hospital Services-Site seeing etc. Please contact- Mr.Issac Daniel,Chief Manager â€“ Mktg & PR, Email:Â [email protected] Mobile No.09447144427