Yesterday, the New York Times podcast “The Daily” focused on tongue tie surgery in children with “The Booming Business of Cutting Babies’ Tongues”. The podcast pointed to the explosive growth in aggressive tongue tie surgery for children. Simple snipping of tissue under the tongue has been done for centuries, with proven benefits for some children with certain types of feeding or speech issues. This podcast highlighted the fact that different, aggressive surgeries are now promoted without any proof that they are needed or beneficial. They argued that this is fueled by a combination of:

• Financial incentives that can motivate providers to increase procedures
• Medical device companies that want to increase sales
• Information void for solid medical advice, with providers and companies taking advantage of patients

I encourage you to listen to the podcast or read the transcript that is available online. Frankly, I was shocked that this New York Times podcast with a huge audience had focused on something relatively close to my own field.

Why Does This Matter for Sleep Apnea in Adults?

The podcast contains lessons for all of us, extending to tongue tie surgery in adults (a more striking example of the problems they reference). The growth in the use of tongue tie surgery and oral myofunctional therapy in adults for treatment of obstructive sleep apnea is disturbing, as it continues despite calls from many (not just me but including me) for some scientific evidence to support it. Hopefully this podcast will add another voice to calls for science instead of just marketing.

Over the past 6 years, I have written previously on this blog about the complete lack of scientific evidence supporting myofunctional therapy and tongue tie surgery in the treatment of adults with obstructive sleep apnea. I encourage you to read my previous blog posts presenting the real story about myofunctional therapy and adults with obstructive sleep apnea:

• Oral myofunctional therapy and frenuloplasty are not proven treatments for obstructive sleep apnea
• ISSS 2018 Munich and OMT frenuloplasty blog post reaction
• Oral Myofunctional Therapy and Frenuloplasty: not proven for adults with obstructive sleep apnea
• Can we stop publishing “systematic reviews” of myofunctional therapy for obstructive sleep apnea?

This is just one – albeit glaring – example of the numerous interventions that are being marketed to patients without any real scientific foundation. This is not just my random idea, as a number of international experts wrote about this and had our article published in the premiere lung disease medical journal in the world. I will point out that many providers – sleep medicine providers, surgeons, dentists, and speech language pathologists – have expressed their support for my being vocal on this topic.

I really just want all health care interventions, including surgery, subject to the same criteria where providers and patients can evaluate risks and benefits of interventions fully, openly, and honestly. As a surgeon, I understand that procedures are especially expensive and strive to avoid influence from these financial incentives and medical device companies. At the same time, my goal is to provide full, open discussion of the best scientific evidence to make decisions with patients about the choice that is right for them. The process of health care decision making is far from perfect, as patients can be overwhelmed and often ask me, “What should I do?” when faced with difficult choices. I view that question as asking for guidance (I do want to provide it), but at the same time I never want to make decisions for patients. In my work with medical device companies (whether in the development of new technologies), I am often a critical voice questioning the value of a procedure or technology, and I am reassured in being told that my opinions are valuable because asking these questions is important.