According to an article published in the British Medical Journal, surgery on the upper airway had “…very little impact on symptoms…” of sleep disordered breathing.
The article was based on a study by Dr Adam Elshaug at Adelaide University, who also found that even subjective improvements (i.e., perceived quality of life) rarely lasted more than one or two years.
More worryingly, 62% of the reviewed patients suffered persistent adverse effects, including difficulty swallowing, voice changes, smell and taste disturbances, and dry throat.
This is only partly surprising. The Sleep Therapy Clinics do not provide any type of surgical treatment for sleep disordered breathing conditions -- but if surgical intervention is necessary, we refer the patients to one of the excellent ENT surgeons we’re proud to work with and these specialists routinely produce excellent results.
So, we believe that surgery DOES have a place. (For instance, when the adenoids, tonsils or tongue are enlarged, leading to a crowded upper airway. Or when the patient has chronic nasal congestion as a result of tissue growth or malformation of the nose or septum. And certainly in children, where enlarged tonsils and adenoids frequently cause obstructions or constriction of the upper airway.) We will continue to refer these types of patients to professionals who can alleviate their sleep disordered breathing condition by clearing their airway.
But note that we do this AFTER the patient has been assessed for treatment via constant positive airway pressure (CPAP) or oral appliance therapy (OAT). Referral for surgery occurs only when alternative treatments cannot work, in line with the guidelines laid down by the Academy of Sleep Medicine — the international authority on ‘best practice’ for the treatment of sleep disordered breathing.
So why has the research found such a bad result in its review of surgical interventions? We believe it is almost certainly because surgery is too often promoted as ‘first line’ treatment (in contradiction of the ASM’s guidelines) instead of as a last resort.
Indeed, we have frequently treated patients who have already undergone surgery, without success. They invariably ask “Why wasn’t I told about CPAP / OAT at the time?”