Upon completing the OneWelbeck Sleep study there are a variety of treatments available. These will be advised by the consultant based on the feedback from the diagnostics.
In certain cases, nasal and throat issues can be solved by surgery which can play one of two roles:
- Relieving obstruction of the nasal and throat airway may improve the delivery of pressurised air, thereby improving the efficacy of and your compliance with CPAP.
- For some carefully selected patients, surgery may reverse the need to use CPAP altogether.
The surgical strategy at OneWelbeck involves the DISE procedure. Any additional information on the size and nature of any obstructive tissue may be gained from performing an MRI or CT of the neck. This will identify the culprit areas that need to be addressed and demonstrate individual variation in blood supply to them to help us minimise complications. The surgical strategy offered to you will also be influenced by whether you have moderate to severe obstructive sleep apnoea (OSA).
If you have an obvious nasal deformity such as a deviated nasal septum or inferior turbinate enlargement you may be offered surgery to correct these. This often involves a septoplasty procedure to straighten the septum and/or reduction of inferior turbinate tissue. The latter can be done in different ways ranging from laser vaporisation to endoscope mediated turbinate bone removal. If the adenoids are enlarged, they should also be removed at the same time.
As sleep does not affect nasal anatomy in the same way as that of the throat and tongue musculature, such defects can be diagnosed in the clinic and could subsequently be managed at the same time as DISE.
Other targets identified on DISE will be discussed with you later, in concert with the video recording of your airway anatomy. A second stage operation may then be offered, tailored to your unique anatomical problem(s). Examples of procedures you may be offered include: a palate shortening and/ or stiffening procedure (for example laser palatoplasty, barbed expansion sphincter-pharyngoplasty), tonsillectomy and targeted surgery to the tongue base.
Very rarely a blockage may exist at the level of the voice box entrance and a procedure such as epiglottis reduction may be helpful.