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Evaluation and Treatment

Dr. Dedhia consults with a patient.

Figure 1: "X" marks obstruction behind the soft palate, and "O" marks obstruction behind the tongue base.

Evaluation

Several days prior to an incoming patient's initial appointment and comprehensive evaluation, Raj C. Dedhia, MD, Director of the Emory Sleep Surgery Center, will thoroughly review the patient's previous sleep studies to understand their particular obstructive sleep apnea (OSA). During the actual appointment and evaluation, he will discuss general sleep issues and the patient's experiences with CPAP and any other therapies. If symptoms of nasal obstruction are present, he may prescribe a CPAP trial after treatment of nasal blockage.

Upper airway surgery to treat OSA is not "one size fits all," making it crucial to choose the most appropriate procedure for correcting the particular patient's source(s) of obstruction. Studies have shown that determining the location of the obstruction site can significantly increase success rates.

In most cases, there are two primary sources of obstruction: the soft palate and/or the tongue (Figure 1). Dr. Dedhia will perform a fiberoptic telescope exam through one of the nostrils to identify whether there is single or double-site obstruction. The exam can be done in the clinic with the patient awake, or in the endoscopy suite or operating room with the patient sedated. The sedation is intended to recreate natural sleep, and the exam is called drug-induced sleep endoscopy (DISE).

The Four Surgeries for Improving Throat Blockage

The four surgery types for treating obstructive sleep apnea.

Each of the methods above can address both soft palate and tongue-based obstruction. Choosing the most appropriate procedure requires consideration of each patient's OSA severity, throat anatomy, body weight, medical problems, and personal preference. Since it may take more than one procedure to satisfactorily address OSA, the above procedures may be performed in a staged manner.

Watch a video of Dr. Dedhia performing the soft tissue procedure known as expansion sphincter pharyngoplasty.