Surgery questions

[sarahsleeps]

Hi folks! I'm starting a new thread as I'm curious who all out there has gone ahead with surgery in relation to their sleep apnea and what the results were. 

I am currently considering a partial rhinoseptoplasty with turbinate reduction and nasal wall strengthening. My septum deviates to the left as well as a bone spur to the right, with very small nasal passages (small nostrils) and enlarged inferior turbinates. My understanding is the surgeon plans to straighten my septum, remove the bone spur, and remove two small pieces of cartilage that she will then use to strengthen my outer nasal walls to prevent collapse when breathing in. She will also reduce my turbinates.

At the same time as all this she would perform a sleep endoscopy (DISE) to determine if I am also a candidate for tonsillectomy (large tonsils).

I have previously been told by other surgeons that I wasn't the best candidate for septoplasty because of the small size of my nostrils. I am not sure that ever made sense to me, but it was repeated by two separate ENT's over the years. This new one doesn't agree and feels I have a 60% chance of improved nasal breathing by fixing up the nasal issues. For reference, I was referred to her for a tonsillectomy only, and it was her that brought up the nasal issues after examining me with a scope.

For some background, I was diagnosed with severe sleep apnea in January and have been trying my best with cpap with mixed results. My sleep study AHI was 77 and after a rough start with cpap I am now averaging around 1-3, but my sleep is fragmented and I wake up at least 4 or 5 times a night consistently. I average about 6 hours of use on the cpap per night, with some less and some more, but have only hit 8 hours twice. I have a separate thread with some of my oscar data.

Would love to hear anyone's surgery stories and results. Thank you in advance!

Oh, also wondering if there is anyone out there in Ontario, Canada? Would be great to compare notes on ENT's in the GTA area, I am also looking at a specialist in London, ON.

[OpalRose]

If the surgery results in better breathing (and it should), then it would be worth doing,
although probably not an easy recovery.  Do your research.  I'm sure there are some here who have gone through it and will chime in.

Good luck and let us know what you decide and the results.

[BoxcarPete]

Recovery experience can vary greatly, though it's generally mild. I had almost no pain after the anesthetic wore off, and in fact went to see a show at the Opera House the very next day. I just needed a cup to spit blood into, but I was completely able to enjoy the concert. Surgery on Friday, back to work Monday with my trusty cup. Dropped the cup around 2 weeks (but much of the second week was adenoids only), and stopped having excess mucus at all around two months.

Member halfasleep had surgery right around the same time (mid-Jan), and I believe still doesn't feel 100% yet. Ask her for details if you want an example of how things can be rough.

Breathing is noticeably better, sense of smell and taste improved significantly as well. Jury's still out on apnea numbers, but I have my three-month follow-up this Friday with a home sleep study to check numbers without CPAP. On PAP, the overall ventilation numbers went up 15% and spontaneous arousals went down as well. Event clusters that I would normally expect to be mostly OA got transformed into H and RERA, when sleeping on my back. So it's an unquestionable improvement for me. Per my other thread that you've read, tonsils are long gone and adenoids came out again this time, but I had no work done to the sidewalls so it's not a perfect comparison to my procedure.

[Jay51]

Sarah, this is the test my ENT told me about concerning the lateral walls.  

• Cottle's maneuver: The nasal valve area is widened by pulling it in a lateral direction. If breathing improves when the nasal valve area is manually widened, it is an indication of nasal valve collapse.                                                                                                                                                                                                                                                                      Basically, look at the outermost parts of your nose on each side.  Inhale.  Do these lateral walls collapse inward when you inhale and decrease the space?  Mine did when I took a deep breath.  The space inside my nose got smaller.  Put your 2 middle fingers right up against the lowermost part of your nostrils (one finger on each side of your nose).  Now, pull your skin apart as far as you can straight out towards your ears and try to breathe.  If pulling your skin apart opens your nostrils a lot, getting this fixed could help you.         
  

[sarahsleeps]

Hi Jay! When I inhale sharply my nasal walls do visibly collapse, but when I do the cottle test I’d say it helps some but I don’t know if I’d say a lot. The ENT did a similar maneuver with me in the office where she used some instruments to pull my nostrils apart and see if it helps. I think my sensory issue right now is that my turbinate is so swollen I can’t really tell what’s going on otherwise, if that makes any sense. I tried using a nose strip yesterday while I worked out and I felt like it allowed me to nose breathe more than normal. I have some of those dilators still too so I’m going to use those to continue testing whether the wall strengthening might help.
Thank you for all of your input!

[coffee9724]

I had literally the exact same surgery done about a year ago: septorhinoplasty with turbinate reduction, bone spur removal, and cartilage grafts to strengthen nasal wall/support septum. This was actually before I got my apnea diagnosis or started CPAP. 

My breathing has improved so so much - I didn't even know that I couldn't smell things before until I started smelling them after the surgery. I don't think CPAP could ever have worked for me if I hadn't serendipitously had this surgery ~8 months before my apnea diagnosis. I don't regret the surgery at all and am very thankful my surgeon did such a good job. 

That said, recovery absolutely sucked. I was not prepared for how bad it would be. There are splints in your nose that completely block airflow for 3-5 days. This makes talking and swallowing unbelievably uncomfortable, to the point where I just didn't do either until they were out. I basically survived on small sips of water and my ability to sleep 14+ hours of the days away (thanks apnea). Not to mention the effects of anesthesia which had me feeling like a nauseous zombie for 48 hours. The good news is I wasn't really in any pain, just severe discomfort. This is all in addition to the swelling/bruising/etc. So, while I wouldn't let it discourage you especially if you really struggle with breathing, do be prepared for a couple very miserable days. 

Happy to answer any questions about the surgery/recovery if you have any!

[BoxcarPete]

One thing to note - definitely make sure you ask what method your doc intends to use for turbinate reduction. As I understand it, submucosal microdebrider resection with outfracture is the best, radiofrequency ablation is a fairly close second. Some of the old school methods are higher risk and lower reward.

[sarahsleeps]

Hi @coffee9724, thank you so much for sharing your experience with the same surgeries! Nice to hear you are happy with the results! What were your symptoms before surgery? I ask because I have always had issues with nasal breathing and "congestion", but cpap seems to have exasperated it or made me even more aware of it.
The ENT did warn me about the first week with the stents and that it would feel totally blocked, which sounds awful. I have been under anesthesia before so I know what to expect there, but not being able to use my nose at all for a week definitely makes me pretty anxious. But, worth it if it means better breathing moving forward. I noticed you use a nasal pillow mask, which I did try at the beginning and couldn't use - so maybe doing the surgery could mean going back to a smaller lighter mask too!
Did you notice improvement to your breathing right away after the stents came out, or was it more gradual? How long did it take for your swelling to subside?
I'm also curious about the appearance of your nose before and after the surgeries. I don't want to sound superficial at all but this whole thing has made me realize I actually like my nose quite a bit lol. Did yours look different after surgery? My ENT mentioned mine could look a bit fuller at the sides from the cartilage grafts, and possibly my bridge could look a little different.
Thanks again for sharing your experience with me!

Hi Pete! @BoxcarPete Thank you. This is going on my list of questions for the ENT. I'm confused because I've been referred around so much at this point. The original ENT I spoke with sent me to this recent one for tonsillectomy, but also referred me to another ENT for the radiofrequency turbinate reduction only (apparently this can be done in-office?). I meet with him in May. Meanwhile, the one for the tonsillectomy actually recommended I do the nasal surgeries first and have DISE and the same time to determine tonsils. So I think that means she does the submucosal method (Because the referring Dr originally said I have to see the other guy for the radiofrequency procedure). However I forgot to clarify this so I plan to schedule a follow up appointment with all my questions. Thanks again for your input!

Hi Jay! @Jay51 I thought it was worth mentioning I tried the cottle thing this morning but just one nostril at a time, and I think that it did really improve my left nostril, just not so much my right. I'm wondering if that is because of the bone spur or the turbinate just being in the way right now. This is another question going on my list for the ENT, but wanted to throw it in here. Thank you for all of your input!

Thank you everyone!

[coffee9724]

Just DM'd you!