Uvulectomy experiences?

March 9, 2006 10:38 PM

I'm about to have my uvula removed, in hopes of ameliorating my sleep apnea. Will I regret it?

I have moderate obstructive sleep apnea (30 per hour, blood oxygen saturation dropping to 72%). My laryngologist says my uvula is large and may be the major anatomical factor and I have an appointment next week to have it removed. I'm not having the full uvulo-palato-pharyngoplasty - just the uvula will be cut out, with a laser, under local anaesthesia, during an office visit.

Now, my GP has told me anecdotally that his brother had this procedure some years ago and has suffered ever since from reflux - food and drink that he tries to swallow pushes up instead into his nose and sinuses. That sounds nasty. My surgeon has asserted that this is very rare, and I'm going to ask him for real numbers, but in the meantime, do any of you have anecdotal experience or information about complications or bad results from uvulectomies? Thanks.

posted by nicwolff to health & fitness (26 comments total)

I had a truly severe apnea (75 per hour) and went for the whole shebang. Basically they just went in there with a really sharp ice cream scraper and scooped it all out. I now have a merely moderate apnea (20 per hour), which I should be able to bring under control with weight loss.

I have not had any severe side effects, but....

You know when you're drinking water and a little bit goes down the wrong way, leading to a coughing fit? That used to happen to me maybe once or twice a year. Now it's pretty much once a month. Compared to the possibilty of brain damage from falling asleep on the couch, it's not really a big deal. But there it is.
posted by tkolar at 10:53 PM on March 9, 2006

No problems here.

I had my uvula removed when I was five, during a tonsillectomy. No one even noticed that I lacked a uvula until years later, when a doctor pointed it out. Perhaps it helped that it was done when I was so young: I'm 24 now and have never experienced any problems, definitely not anything like food or drink entering my sinuses. Although, my mother does joke that I had a singing voice like an angel before my uvula-less days. While I can't sing, in general, I feel more evolved and streamlined.
posted by Uncle Glendinning at 11:01 PM on March 9, 2006

My father-in-law had his removed in his 40s and suffered no ill effects. (and he spoke some German, too, but not very well)
posted by BitterOldPunk at 11:57 PM on March 9, 2006

If it works, no. That said, a very healthy percentage of sleep apnea operations (nearly 50%, AFAIK) do not really do the trick.

That said, if you can avoid or ameliorate your apneas by having it done, and you're young and don't have to worry about it any more, it will be a great thing. It's a crap shoot, but you have little to lose except your uvula, and a lot of potential upside.
posted by insomnia_lj at 12:40 AM on March 10, 2006

That said, I might consider being very sure that the problem is your uvula, and not other factors like your tongue being too big, sliding backwards when you're sleeping, soft palate tissue, or possible jaw or sinus issues. They actually have ways of nonsurgically shrinking your tongue and sinus tissues, so just be sure the problem is your uvula... or at least be sure the doctor has some very good reasons to suspect your uvula as opposed to other factors.
posted by insomnia_lj at 12:44 AM on March 10, 2006

Will having it removed really change your voice much?
posted by mhuckaba at 12:49 AM on March 10, 2006

These otolaryngologists are the experts. They have their own anatomic grading scales to help determine whether certain procedures would be better for treating sleep apnea than others. I'd go with what he has to say.

Will you regret it? Sure, if it doesn't work, just like insomnia_lj says. But if it _does_ work, you'll be reaping the tremendous benefits associated with fixing up your sleep apnea.
posted by herrdoktor at 12:58 AM on March 10, 2006

I would also say that if you do actually have a punching bag for a uvula, getting it taken care of might increase the chance of the operation working more than many other types of sleep apnea operations with a lower chance of success. Your doctor can tell you more about this, hopefully.

Many of these operations try to address problems with excess "soft palate", which can (but doesn't necessarily) include the uvula. Clearly, if they have an "obvious target", that's a good thing. Excess soft palate can vibrate, obstruct breathing, and expand again after an operation, but if you have your uvula removed and your uvula is, infact, your problem, then you can be pretty sure that puppy ain't gonna grow back.
posted by insomnia_lj at 1:19 AM on March 10, 2006

Are there other factors that can be addressed first before resorting to surgery? Sleep apnea is often a result of obesity, and for those who loose the weight, loosing the sleep disorder is an extra bonus. I have no idea if you are overweight, but if you are, maybe addressing that health issue will take care of this one as well, and allow you to avoid the operation. Obviously this won't make much of a difference if you are not over weight and/or the problem is not obesity related.
posted by RoseovSharon at 1:49 AM on March 10, 2006

I had a similar procedure done about 5 months back and I have no regrets whatsoever.

When compared to the idea of spending the rest of my life sleeping with a CPAP mask, it was a no brainer to go in for the surgery.

I did experience what tkolar mentions; fluids rushing down in larger quantities than I was used to, but I am now accustomed to it.

The only negative was the couple of weeks, post operation, when eating or even drinking anything was almost impossible due to the pain. But small price to pay for the benefits.
posted by sk381 at 2:49 AM on March 10, 2006

Have you considered a CPAP machine?
posted by konolia at 4:48 AM on March 10, 2006

sk381 ain't kidding about the pain. When I went to have it done the surgeon told me, "you're going to have the worst sore throat of your life for 2 weeks". He was not kidding.

After a week of barely being able to take more than a few sips of water I got in to see him and he said, "oh, well if it's that bad, try this" and sprayed my throat with lidocaine and gave me a prescription for some to gargle with. DO NOT have the surgery without some of this stuff!

Apnea wasn't my problem, it was snoring, and it did help some, but not 100%. I've had no reflux problems and no change of voice.
posted by cptnrandy at 5:39 AM on March 10, 2006

I had the Uvulopalatoplasty (UVP) procedure seven years ago to reduce or eliminate apnea. Researched it to death, talked to my ENT, physician friends, etc. and decided to go with it. In my case, it worked well. But, as said elsewhere, it is a crap shoot. Different data on success rates, but it's probably a 50-50 deal. To echo sk381, I couldn't eat well for three weeks after, lost 15 lbs. in the process, and I had an odd feeling from the scar tissue in my throat for a couple of months.

Yet, I would do it again. The Hannibal Lecter nature of the CPAP unit steered me away from that option. If you're single, and intend to stay that way, CPAP is certainly an option. It has a high success rate, but at the price of your nighttime dignity.

The procedure you are considering is less drastic than a full UVP, so YMMV.
posted by flyingrock at 5:51 AM on March 10, 2006

Does anybody have any experience with the pillar procedure, where they insert 3 stiff little rods into your soft palate to give it more support?
posted by scalefree at 6:13 AM on March 10, 2006

I know I wouldn't do it, but that's because I sing quasi-professionally...
posted by fvox13 at 6:14 AM on March 10, 2006

Well, if you're planning on learning French, Inuktitut, Arabic, or a whole host of other languages, you won't be be able to make the uvular consonants. Stick to English, though, and you're good to go.
posted by heatherann at 8:03 AM on March 10, 2006

A relative of mine, in his mid-70's, could only sleep with a CPAP machine. He spent many nights in a sleep lab and none of the myriad techniques permitted even napping.

One of the ENT consultants then suggested he try singing. He started singing in the shower, then, having gained a little confidence, singing around the house. He now sings to himself all over the place, not loud, but audible.

The increased tone of his palate and throat muscles as a result of the singing has completely cured the apnea. A side effect is that the singing keeps his mood up.
posted by RMALCOLM at 8:07 AM on March 10, 2006

Coincidentally I was in to see my PCP yesterday for a physical in preparation of having a tonsilectomy and having my uvula "shortened" for sleep apnea.

My PCP told me to ask my ENT about a new procedure he just read about, where they can insert a small piece of (curved?) plastic INTO your uvula to prevent it from "sagging" while you're sleeping and blocking your airway. The piece of plastic help keeps it in an elevated position, and the procedure is fairly quick.

Wouldn't hurt to ask about it.
posted by robbie01 at 8:15 AM on March 10, 2006

robbie01: that's the pillar procedure I referred to above, I believe. It's 3 little plastic rods inserted side-by-side, vertically into the soft palate. I have sleep apnea but haven't gone in for diagnosis & treatment because of inadequate (read: no) insurance to cover it. I have no connection to the linked company, they just came up on the first page of my websearch.
posted by scalefree at 9:18 AM on March 10, 2006

re: pain

My (Stanford educated) sleep specialist is South African by birth. He's coal black, and if you swapped his white lab coat for a bone necklace he looks like the prototypical African witch doctor.

All this is just to add flavor to the moment that he looked me in the eye and said: "My son, this is the most painful thing you will experience as a man."

Fortunately it wasn't quite that bad, but yes, the recovery period will be memorable.
posted by tkolar at 10:10 AM on March 10, 2006

I've done a ton of research on snoring, and I can tell you that pretty much the majority of people that get just about any surgery done in the throat totally regret it. It's just too much pain and trouble. And it's totally a craps shoot. One of the 'complications' from surgery is....more snoring. Doh!

However, if the alternative is dieing due to low blood oxygen from sleep apnea, I'd do whatever your speciliast recommends, and also ask for a CPAP.
posted by Phynix at 10:12 AM on March 10, 2006

My father is missing his uvula, and hasn't choked to death these past sixty years.

OTOH, having my uvula removed would be one of the last things I'd do in an attempt to stop the apnea. It would be an action of last resort.
posted by five fresh fish at 10:36 AM on March 10, 2006

I've had severe sleep apnea (60 per hour) for five years now. Although I'm basically against surgery unless it's absolutely necessary, I asked my ENT about it when I was first diagnosed. He was against it in general, and totally against it in my case.

Even with a CPAP, I haven't had a good night's sleep in years. If I'm lucky I get 5-6 hours sleep. But some of that may be related to being self-employed. ;-)
posted by wordwhiz at 11:10 AM on March 10, 2006

Thanks very much to all of you - keep them coming! To answer a few questons: I am in good shape otherwise, for a 40-year-old - I'm thin if anything - so weight loss isn't indicated. I snore and choke mostly when on my back but some in all positions. I have rejected CPAP out of hand and over all my doctors' recommendations for reasons of vanity, comfort, and my preferred sleeping position which is spooning either my female or feline bedmate.

I initially was evaluated for the Pillar palatal implants, but that doctor fell down dead walking his dog 2 days before my scheduled surgery! Heart attack, just a couple of years older than I am! Weird. So I went ahead with a septoplasty that was also scheduled that day, which didn't help my apnea perceptibly. Uvulectomy is the next step in the incremental surgical approach that I'm taking - my feeling is that it might help and it doesn't hurt as bad as the full UPPP, and I can still have a palatoplasty or the implants afterwards if my sleep doesn't improve.

I read through the forums at sleepnet.com but they're mostly about more serious surgeries. So thanks for your feedback!
posted by nicwolff at 11:23 AM on March 10, 2006

One more thing I'd want to think about: sleep apnea has an anatomic basis for sure. BUT, even if you are in low weight -- are you in good shape? Your cardiovascular health and the ability of your lungs to make do more with the blood and air it does get might be looked at too.

I'm not implicating anything about you in the bit. If you're at a good weight -- it probably is something anatomical causing your sleep apnea. However, if you want to avoid surgery, I'd want to give a month at the treadmill (and some CPAP just to be safe) and see what happens.....
posted by narebuc at 7:45 PM on March 10, 2006

If a CPAP works, stick with it. My wife told me she was a bit bothered for a couple of days by the strange look of the mask, but she instantly got used to not being awakened by my snoring.

Like fvox13, I'm a musician -- a clarinetist. I was considering the surgery until I talked with my cousin, who had it. He said there are permanent effects, such has having a leak through his nose when he tries to blow up a balloon.
posted by KRS at 9:31 AM on March 11, 2006