Talk me into or out of surgery

[Sleeprider]

There are definitely benefits to certain surgeries. Tonsillectomy is pretty high on the list, as well as the nasal surgeries for deviated septum, turbinate correction, polyps and adenoids. I am very much against more radical UPPP surgery that seems to have more adverse side-effects. It's always a personal decision and trusting your doctor has your interests in mind rather than his wallet, but I have seen quite a few people benefit form these procedures. I have a deviated septum, but the ENT I visited 18 years ago did not recommend surgery and I went to CPAP.

[Jay51]

I think mine was a moderately deviated septum also.  From the research I have done, I concluded that the greater the deviation, the greater the benefit from surgery.  ENT said reducing the inferior turbinates would increase space also.  

When I woke up from anesthesia immediately after the surgery, I could tell I was breathing better.  I have looked up my nostrils with a mirror and flashlight before the surgery.  After the surgery, the hole in my left nostril seemed at least 100% bigger (twice the size as before surgery).  Apparently the turbinate reduction helped also, because it seems I can breathe a little better out of my right nostril also.  

I presented with the same symptoms you have:  lower than normal tidal volume for my size.  Arousals during the night disrupting my sleep continuity, and a very large proportion of mouth breathing.  I can go all nasal breathing now I think.  I had a lower minute vent also, but had a lower than normal respiratory rate at times too though.  

It is certainly easier for me to tolerate therapy during the night now.  I use a full face mask, but fall asleep only nasal breathing and wake up doing the same.  Just the opposite pre-surgery.  

The one major risk my ENT said was a hematoma (and very rare).  He said if that occured, he could go back in and fix it.  My ENT was close to my age I guess (I am 54), and had lots of surgeries under his belt he said.  He explained the postitives and negatives to me, and I decided to have the surgery.  My thinking was this is a once in a lifetime opportunity now (insurance paying) and relatively low risk, so I decided to do it.  I had the time to recover also.  I was out about 3 to 5 days (ENT recommended not working that long after surgery) also, but in hindsight a small price to pay for the improved nasal breathing.  

I can't decide for you, Pete, but seem like an intelligent guy and I hope you make the right decision here.  You have done a lot of independent research (like I did) so good for you.  I have contemplated other surgeries before related to sleep apnea, but concluded they were too high risk and too little reward for me personally.

[BoxcarPete]

Thanks for adding all that detail. I'm feeling better and better about this as time goes on. The ENT I am going through is closer to my dad's age, he's been practicing since before I was born and has done procedures like this thousands of times. The tenor section leader in our choir apparently knows one of the top ENT doctors in the country from when he lived in New York and offered to do a little sleuthing to confirm that he's the real deal, but I'm pretty confident that he is.

I never considered any other surgery, in fact I wasn't even looking for surgery going into the appointment, I was looking for advice on how to make CPAP easier to work with. In less than a minute the doc concluded that there was enough structurally wrong with my nose that it wasn't even worth getting into the weeds on any of the questions I had prepared until it was corrected.

I'm settling into the idea as the days go by, but it was some mental whiplash to go from "how do I improve my apnea treatment using this here CPAP machine" to "so what do we need to to to get surgery scheduled before the end of the year which in less than three weeks" in a matter of minutes, if not seconds. Most everything I'm reading here has helped me firm up my decision to go for it.

Thanks, all!

[BoxcarPete]

Quick update, I talked to my parents last night hoping to figure out what the ENT had looked at prior to my first surgery to see if there was any correlation to now.

What I found out was that they didn't look too far beyond the tonsils once they saw how huge they were, and once the tonsils and adenoids were gone I made such improvement that they looked no further. My father also had a deviated septum, both sides like mine, which he had surgically corrected when he was a teenager.

I take this as largely good news because although he ended up on a CPAP machine eventually, his diagnosis came 20 years later in his life than mine. He was also 3 inches shorter and 30-40 lbs heavier than I am at the time of his diagnosis. It's mostly still good news though, because he has tolerated CPAP since day 1 without any trouble to speak of, which is not my experience so far.

I'm going to go for it. The septoplasty and adenoidectomy are both really low risk and should each give me quite a benefit. I'm leaning no for the turbinate reduction because I had been sick with a cold about a week prior to getting scoped, so I'm not 100% convinced that they're a real problem and the risk of messing with them is a little higher than the other stuff.

[paulag1955]

You can always get another opinion on the turbinate reduction before surgery and decide then. How long will you have to wait for surgery?

[robbob2112]

My 2 cents, and worth that.

I had my badly deviated septum (both sides) corrected about 20 years ago because it was causing constant congestion issues and I would get a sinus infection at least once a year. A quote from the doctor is "crooked like a snake".

It made a night and day difference for the reason I got it done.

I am also of the opinion that I have had undagnosed apnea all my life. I've always snored like a freight train at night to the point that my wife was about to give me the ultimatum that one of us had to sleep in another room.

About a year and a half ago I was first diagnosed with apnea (sever complex apnea) and it took 8 months to finally get a machine. I don't snore at all anymore and I feel a million times better.

So, my point is if you have congenstion issues at all the septum surgery is a winner, but don't count on it curing the apnea. It will have it's own benifits, and I wish I had it fixed 20 years earlier.

[BoxcarPete]

Well, had my follow-up today to confirm, and I'm going to go for all three. Doc acknowledged empty nose syndrome as more of a problem with the old-school method of turbinate reduction where they go in and cut out flesh and bone then pack the nose full of cotton so you don't bleed out. He said he's got a better way now, done endoscopically, where the excess flesh is sucked up similar to lyposuction, and the bone is adjusted with a combination of small fractures and ultrasonic shaving if needed. He told me he's done thousands of these, and never had a full blown "empty nose" in any of his patients, nor even any lesser complaints along those lines with the new method. Then he said, "you never know, you could be the first!"

Another thing he mentioned regarding the turbinates is that he has noticed in OSA patients they tend to go back farther than normal folks, so he recommended that I have it done for that reason. It's not just a feeling of congestion, it's a legitimate obstruction where the nasal passage meets the pharynx which can be removed.

What's also funny is that the patient informational sheet they gave me for the adenoidectomy was a little comic book about a boy named Billy who wants to play soccer but he can't do his best because he snores at night, is tired, and has a sore throat all the time. I have been there, done that, need it done again!

Operation should be all set to go on the 29th, keep your fingers crossed for me.

[SaminDenver]

At some point in my apnea slog I had surgery for deviated septum and turbinates. The surgeries weren't bad. They did make it much easier to breathe during the day not just at night. You can always get a second opinion. For me, anything that increased airflow was going to be for the better. I have two children with apneas, and they had to have adenoids and tonsils too. Their surgeries increased their airflow which was good.

[punkrockcholo]

When I was 8, I was sick all the time, scrawny, snored badly at night, etc. Had my tonsils and adenoids out and BOOM everything changed. I started eating better, gained a bunch of weight (which was needed, but I overdid it a bit...), and started sleeping soundly at night. 

Interesting.

I was sick all the time, scrawny and snored bad as a kid, too! But I didn't have my tonsils and adenoids removed until I was 18. Now, it did change my life in the same way as you but eventually I started snoring again in my mid 20s. My girlfriends in my 20s and 30s would tell me I would stop breathing in my sleep, in addition to.. you know, snoring like a chainsaw.. and it wasn't until 2019 that I was diagnosed with sleep apnea after taking a sleep study test through Kaiser.

41 now, didn't really give CPAP a try (left the ResMed bag with all supplies in my closet for a rainy day) until two months ago, and it's made a world of difference. Of course, this is the reason I'm on this wonderful forum with all you beautiful people!

I recently interacted with Jay on his therapy thread as I had questions about my apparent nasal valve collapse, but it doesn't APPEAR to be too bad. It's just on the LEFT outside wall collapsing in (think where your glasses' nose pads, or nose arms rest on your nose) but not my nostrils. Well.. they DO flare a bit and research tells me that's not exactly normal.

I am seeing an ENT on January 12th for my eustachian tube dysfunction and I'll be sure to ask about my newfound nasal issues. Perhaps I have a deviated septum. This is causing anxiety now since after beginning PAP therapy my body's been struggling to alternate between mouth breathing and nose breathing. Anyone else experience something similar?

[ejbpesca]

Out of three people I've known to have similar surgery, none were pleased with the outcome and all returned to having blockages after tissues grew back. Three doctors have advised me not to have nasal/sinus surgery even though I qualify, the last advice being over 15 years ago. I have not drawn a clear breath through my nasal passages since early childhood.

For over 20 years I have relied upon nasal sprays to keep my damaged nasal airways clear with adequate success. Both sprays are prescription and expensive but my insurance takes care of the cost. One is available over the counter (Flonase) yet I get it by prescription (less cost by copay) and the other is prescription only.

One is a common allergy relief spray (Flonase) and the other is for clearing out nasal passages. I use both upon waking and before sleeping. I sometimes use the Azelastine HCI a third time when I clog up. Azelelastine application is followed by a coughing-like session to remove mucus. If you have seen the movie Beetlejuice, he acts out the cough process to remove what was in there.

By using the sprays at night I can get through sleep okay with my full face mask. I have had over 16,000 doses of the sprays with no apparent side effects. Had I not found them long ago, I would have gone for surgery due to repeated sinus infections and breathing problems. Once the sprays were used the sinus infections stopped and my allergies to many things airborne are not cured but symptoms are at least diminished.