The 2014 Annual Meeting of the American Academy of Otolaryngology–Head and Neck Surgery was just held in Orlando from September 21-24. It is always enjoyable and interesting to share experiences and findings with colleagues in several sessions and courses related to the surgical evaluation and treatment of snoring and obstructive sleep apnea. This year, I spoke on a number of topics, including hypoglossal nerve stimulation, surgical treatment of the Tongue Region, and evaluation of patients to select procedure with drug-induced sleep endoscopy.
There were a number of interesting research studies that were presented. Chris Ayers and Boyd Gillespie, from the Medical University of South Carolina, presented research evaluating the review of drug-induced sleep endoscopy videos to determine whether patients would be candidates for Upper Airway Stimulation. I was one of the surgeons who reviewed videos for the research study, and I was happy to hear that we all had a relatively high rate of agreement on the key question: whether there was a pattern that is called complete concentric collapse related to the soft palate (roof of the mouth). This finding excludes patients from receiving this treatment, and our agreement was approximately 80%.
Jonathon Russell and Alan Kominsky from the Cleveland Clinic evaluated over 1000 patients who underwent sleep studies at their institution, of which over 500 received a diagnosis of obstructive sleep apnea for the first time. They showed that, while over half of them tolerated positive airway pressure therapy, there were many that did not and went untreated. The fact that many of them were not referred for consideration of other treatment, whether to a surgeon or sleep dentist, is a pattern that is all too common. As readers of this blog and website can attest, I know well the limitati0ns of surgery and oral appliances, but patients with sleep apnea who do not tolerate positive airway pressure therapy should at least consider these options.
Jingying Ye, a Chinese surgeon, performed research to show that specific findings on drug-induced sleep endoscopy related to the soft palate were associated with results of soft palate surgery. For blockage of breathing behind the soft palate, both a long segment (>1.4 cm in the vertical direction) and a blockage that was relatively close (<3.2 cm) to the back of the hard palate (hard part of the roof of your mouth) were associated with worse outcomes, with no patients who had both of those findings responding to soft palate surgery. This supports the proposed soft palate classification system of Tucker Woodson of the Medical College of Wisconsin, being the first study to look at surgical outcomes based on shape and the type of palatal obstruction that can occur with different shapes.
Hsin-Ching (Philip) Lin from the Department of Otorhinolaryngology at Chang Gung Memorial Hospital in Kaohsiung City, Taiwan presented his experience with taste disturbance followinga combination of surgery on the soft palate and removal of a part of the back of the tongue. He showed that, 3 months following surgery, 15% (12/80) of patients undergoing surgery of had some change in their sense of taste (sweet, sour, salty, or bitter). There were no changes in swallowing. My experience is that patients can experience changes in their sense of taste, but fortunately these have a gradual recovery period over the course of several months, meaning that the share of patients with changes in taste should only decrease over time (as they do in my patients). This well-done study provides a better sense of the changes that can occur after surgery, and we use these studies to add to our own experience in discussing the surgical recovery with patients. Taste disturbance is something that can occur, especially on a short-term basis, with surgery of the soft palate and tongue, as taste buds have been shown to exist on both the tongue and the soft palate.