Advice from ENT Steven park : Anybody had inspire device or epiglottis surgery?

[Johnson4]

Hi all,

I'm 38m, low BMI and keep active.

I've been having sleeping problems that have been progressing and getting worse since early thirties.

I'm at my wit's s end now. I have brain fog, hardly ever feel refreshed and now considering inspire or surgery.

I live in Melbourne, Australia and had a virtual meeting with Steven park who suggested I do a DISE.
I was lucky enough to get one done and here's the video : 

https://m.youtube.com/watch?v=1lSPDacxwo...e=youtu.be

Melbourne ENTs advice was significant epiglottis collapse and tongue base collapse, mainly when on my back and the thrust helped so suggested a MAD device. Tried it without much luck and started to get jaw pain. He also discussed epiglottic stabilising surgery however he said there is no significant OSA and results can be unpredictable.

Steven Parks advice:

it looks like you definitely have epiglottis obstruction. Later in the video, with the jaw thrust forward maximally, the airway opens up. However, that’s a very uncomfortable position.  You also have tongue base and palatal collapse as well.


Unfortunately, the only way to address this is with surgery.

There are 3 options: 

1. Some type of epiglottis surgery to stiffen it, attach it to the tongue, or trim it.

2. Double jaw surgery (maxillo-mandibular advancement)

3. Inspire procedure (tongue nerve stimulation/pacemaker). Based on the video, you qualify.


#s 2 & 3 will address both the epiglottis/tongue base and soft palate. Addressing the epiglottis will help (multiple arousals), but not cure you of your obstructive sleep apnea.


I have had sleeps study done. One was 5 AHI and 7 RDI. Other was 4 AHI and 50 RDI!

I've tried apap therapy for 3-6 month's without any luck.

Should I pursue epiglottic surgery and tongue base reduction or Inspire? What is the success rate? Anyone had these procedures in Australia?

Any help or advice would be appreciated.

Thanks

[Sleeprider]

No one here can advise on your questions, but a minimally invasive approach would be to use Inspire before other options. It seems to address the most important mechanisms, and Park does not seem very certain on the surgical approach. We have not seen a lot of success with MAD or jaw surgery, and to be honest, Parks has never seen the throat he would not operate on. These are irreversible and painful surgeries, so in my book, the last resort.