pillar procedure

[waker]

I was thinking of having the pillar procedure done I have an RDI of 29 and wanted to try to have this done instead of the UP3 done. I'm scheduled to have up3/tonsilectomy/septoplasty and turbinate reduction next month. ENT says the pillar wont replace up3. My question is can pillar be done after up3

[Guest]

I guess not. Because your uvula and soft palate will be gone and no plance to insert those fibres. correct me if I am wrong.

Deleted guest name 05/06/05 if you have any questions email me.
tasmichael@talkaboutsleep.com

[waker]

So could the upp be performed around the pillar post

[Billinseattle]

Hmmm.

I'd definitely try most anything except the UP3 (see previous posts). However, tonsillectomy may help. The turbinates and septoplasty may help with the CPAP, but likely won't eliminate your OSA.

The pillar procedure was designed to work in a similar fashion as the UP3. Some of the UP3 involves removing or flapping structures...another part involves "pexing" or tacking up the lateral posterior pharynx. This is also, I believe, what the pillar does. It supports the tissue in a similar manner to the way the UP3 surgeon tries to with pexing sutures and removal of tissue. So it makes sense that you might want to try the pillar first. If you fail that then try the UP3 (if you must). Not the other way around. The uvula,by the way, is irrelevant in this scenerio (it can come, go, or stay).

Will the same surgeon do the pillar and the operation...or are you consulting with two different surgeons ? Are they willing to do the nose, tonsils, and pillar instead of the UP3 ? Once you've done the UP3, you've undergone the pain and been exposed to the morbidity...the pillar procedure is somewhat redundant (and may be anatomically unnecessary).

Bill

[Sleepy Stoboy]

You'll find many ENTs to be uninformed about the pillar procedure, and will recommend the UPPP because that is all they know. Trust me as I had two consultations from ENTs before having the pillar procedure done last November.

The outpatient procedure in my mind, was very successful, and I don't see how a UPPP would have given me any greater reduction in RDI. I started at 36 and dropped it down to 18 after the pillar procedure.

Here is what most of us who have had the pillar procedure believe: that in most people, the palate isn't the only obstruction. Since a UPPP and the pillar procedure ONLY address the palate, most people will not be "cured" by this surgery alone. You will most likely be able to combine it with some treatment that removes the rear of tongue as the other obstruction. In my case I chose a dental device as I wasn't sold on the existing tongue surgeries (GA, hyoid, somnoplasty). There was a small percentage of people in Restore's clinical study that brought their RDI under 5 with the pillar procedure alone, but they were all under 20 RDI to begin with. Most likely, their sole obstruction was their palate.

You can do the research and review many posts from other UPPP survivors, but if you do, I think you'll see that what the ENTs call "success" is the same reduction that could be achieved with a far less invasive, and reversible procedure in the pillar implants.

If you want one stop shopping to treat your apnea, best bet is CPAP. If you don't mind creating a "combo platter" of treatments, consider pillar + a dental device. It's worked for me, and I still leave myself open to emerging surgeries that may develop for the rear of tongue obstruction.

[Billinseattle]

I concur with Stoboy.

Except for those trained in doing specialized procedures or operations...the ENT surgeon will commonly suggest the UPPP. That is what they were trained to do...that is their bread & butter. You go to a barber, you'll get a haircut...

Unfortunately, most people have OSA because of base of tongue obstruction. As Stoboy mentioned, there are other causes, but they aren't as frequent...and therefore throat procedures (UP3 or the Pillar) are not commonly curative

Unfortunately, the UP3 is not that effective. Only poorly done subjective post-op surveys were cited in a medical paper that reported 30-50% of people had subjective "improvement" after UPPP. This wasn't citing sleep lab data. This wasn't a chart review . And, it certainly wasn't a prospective randomized trial (very difficult with operations anyway). In other words, what the ENT is recommending to you wasn't based on science. Mostly, they don't get into that unless you ask.

After my UPPP and tonsillectomy, my sleep data wasn't improved by much. My O2 sats improved...but my apnea was still there. Pre-op I had a nice informed consent discussion with my ENT surgeon, who conceded that there was low likelihood that it would eliminate my apnea. Facing the spectre of jaw and tongue advancement surgery, I thought it was worth a try (the Pillar was not yet FDA released and had a paucity of data). In retrospect, the UP3 was not worth the time & effort.

Go with what Stoboy said and give the Pillar and/or dental appliance a shot.

Bill

[waker]

thanks for your feedback that is what I had actually read on another board and tried to explain this to my ent and he kept talking about the "gold standard for treatment" UPP. He did tell me he hated to do OSA surgery and that he wouldn't work on most cases, but since I had tonsil tissue and wasn't overweight that he thought he could make some progress. Does insurance cover the pillar yet?

[dizzy]

I really "good" ENT won't do a UPPP to cure OSA, they know it doesn't work.

My ENT offered to refer me on to Stanford Medical Center where they do them all day long, but he said he wouldn't do them any longer because it simply wasn't that successful.

[Sleepy Stoboy]

From what I understand, most pillar procedures are not being covered by insurance. I negotiated a price at cost with my doctor, and he then submitted the bill to insurance. The insurance company paid him at his retail, but his office staff was very surprised, saying mine was the first payment they had seen.

This should get better in time, due to the FDA approval, and as more clinical studies show it to be an effective procedure in reducing RDI, and at a fraction of the cost to do a UPPP.

[Keleih]

I paid my doctor up front for my pillar procedure. He then gave me all of the information that I needed to go ahead and submit a claim to my insurance company on my own.
My health insurance provider says in their manual that they will cover surgeries and treatments for sleep apnea but not for snoring, but since the pillar procedure was first used to treat snoring, I'm trying to give them all the information I have to prove that is was to treat my apnea. I just submitted everything a few days ago.... I'd say I've got about a 50/50 chance of them covering it. I'll post back on here whether or not they decided to reimburse me for it or not.

[Billinseattle]

Keleih,

Appeal, appeal, appeal. Don't give up. Get those guys to pony-up.

Point out the alternatives. How much it would cost to get a UPPP/ and the PACU and hospital observation, etc...

Good luck,

Bill

[billyji]

My insurance has just said it is a covered item. I am waiting to see how much it will cover and what. They did say it will cover and assisant surgeon for the procedure.

What are the results from the Pillar compared to Cpap or has this been covered somewhere

Mike

[Less Sleepy]

You should read the dental medicine board:
www.talkaboutsleep.com/message-boards/viewforum.php?f=10

The pillar procedure is probably about as effective as UPPP for treating sleep apnea, which means that it's not very effective. There are no good studies on the effectiveness of UPPP, although many people say (without statistical back-up) that 50% of people experience improvement. Improvement doesn't necessarily mean that you are cured, or get to go without CPAP. The other 50% of people who have UPPP are either unchanged, or worse off than before. At least that palatal pillar procedure doesn't involve the painful recovery and possible side effects of UPPP. Unlike UPPP, at least you are unlikely to end up worse off, and it is reversable if you have difficulties. Many people have had good results combining the pillar procedure with dental devices. As always, insist on a follow-up sleep study 9 months or so after the procedure before assuming any effectiveness of the procedure.

CPAP, imperfect though it is, is still considered the gold standard for treating sleep apnea and is still the most effective method available at this time.

[billyji]