[Monty_girl]

SHRINKING TONGUE SIZE USEFUL IN TREATMENT FOR SLEEP APNEA

With energy generated by radio frequency waves, a Loyola University Health System physician is reducing the size of patients’ tongues successfully to treat obstructive sleep apnea, a disorder that causes patients to stop breathing temporarily during sleep.

Loyola is one of only about 10 centers in the nation using the technology to shrink the tongue in an effort to reduce or eliminate sleep apnea in patients who have already failed standard surgical procedures, said Dr. Regina Walker, assistant professor of otolaryngology in the Loyola University Chicago Stritch School of Medicine.

Sleep apnea occurs as a result of an obstruction located somewhere between the tip of the nose and the trachea, the passage in the throat that helps transport air to the lungs. The obstruction may be a deviation in the septum, the dividing wall separating the inside of the nose into two passages; nasal polyps; oversized tongue, soft palate, uvula (the fleshy mass that hangs from the soft palate) or tonsils; a tumor; or even a combination of these problems. Patients with sleep apnea are awakened throughout the night because the obstruction impairs their breathing and causes their oxygen levels to fall too low.

The new technique is applied to patients whose tongue size is believed responsible, at least in part, for their sleep apnea. The procedure, which takes only about 20 minutes to perform, but is usually done in an operating room, involves inserting a needle in two or three locations in the base of the tongue. Energy, and thus heat, is generated through the needle to break down cells in a small area of the tongue. The destruction of these cells causes the tissue in the tongue to shrink.

Most patients require several treatments to achieve the desired results, Walker said. “We are able to reduce the volume of the tongue significantly -- by as much as 17 percent,” she said. The reduction allows more oxygen to pass through the patient’s airways.

“The advantage of this technology is that the physician is able to deliver a precise amount of energy that destroys a predictable amount of tissue in a small area,” Walker continued. “Other than experiencing a tongue that is somewhat stiff for a brief time after the procedure, most patients report no pain.”

Patients who undergo the procedure at Loyola currently remain in the hospital overnight so that physicians can monitor the healing of the tongue and prevent swelling and infection. “As we become more comfortable with this technology, patients will likely go home the same day of the procedure,” Walker said.

Walker called the new technology exciting, because it could improve the quality of life for nearly half the people who develop sleep apnea.

“Only about 50 percent of patients with sleep apnea are cured by standard surgical procedures, such as trimming the soft palate and uvula, removing the tonsils or nasal polyps, or straightening the nose,” Walker said. “The other 50 percent either improve somewhat or derive no relief at all from surgery. In these patients, the culprit usually remains the tongue. Until now, we have been reluctant to do surgery on the tongue because of the dangers of infection and swelling.”

The only options for patients not helped by standard surgical procedures are to wear a special mask that provides pressurized room air during sleep, to receive a tracheotomy or to undergo comprehensive surgery that involves breaking the jawbones and maxillary bones and pulling the face forward.

A pilot study published last year in the journal Otolaryngology-Head and Neck Surgery indicated that the application of radio-frequency energy to the tongue is a safe and efficacious method of treating sleep apnea in patients who have failed standard surgery. The study involved 18 patients. Results of a larger national study of the technique are scheduled for presentation in the fall.

The use of radio-frequency energy in patient care is not a new concept. In fact, cardiologists apply similar technology in eliminating abnormal electrical pathways in the heart. Loyola ear, nose and throat specialists like Walker also have used radio-frequency energy to reduce a patient’s soft palate and uvula. In addition, radio-frequency energy has been used to shrink the lining inside the nose in patients with nasal obstruction.

[(JD)]

That is interesting to say the least! Radio waves kewl!

[Perna]

That's wild! Can't they just go on a talking spree and "exercise" their tongue more to get it to reduce?

[January]

I go for a sleep test Tues. night. I don't want anyone touching my tongue or doing anything to it!

Jan

[Monty_girl]

Good luck on your sleep study Jan. I go for mine next friday the 8th.

Have you ever had one before?? It's not bad. They have a lot of wires they hook you up too. They put a bunch on your head and around your face. The stuff they hook the ones up to your head with, you get that gel like stuff in your hair. Sometimes it's hard to get out. They have wires even down to your feet so see if you have restless leg. They monitor your heart and lungs, to see if your O2 drops any while you sleep. They vidoe tape and mic you as well to hear and see you sleeping.

During my last sleep study they woke me up and put a cpap mask on me to see if that helped my O2 level when I slept. I couldn't stand to have it on my face and ripped it off. The cpap pushes air into your nose. It didn't help me anyways because I can't breath through my nose.

After your test they send you home and then you met with your doctor for the results of the test and to see if there is anything they can do for you.

Their not going to touch your tongue any during the sleep study. With mine they know that my tongue is falling back into my throat cutting off my airway. I've had a lot of problems in the past with my jaw and my mouth being so narrow. I've had my upper jaw widened and might have to have the lower one done now. But if I can have the tongue shrunk some where I don't have to have major work done. It will be a lot easier.

Good luck tomorrow and let us know how it goes.
Lisa

[jennie]

Sounds interesting.

I'd like to hear what tech gurus say about the safety of this procedure.

Somnoplasty procedure info

What is the maximum permissible exposure of temperature controlled RF energy on the head (tongue area)? What is the time-average of RF exposure?

( . . . the tongue is awfully close to the brain . . . .)

Somnoplasty procedure details:
radiofrequency signal around 456kHz
1 to 10 watts power level
80 volts
generates heat at temperatures between 65 C (149 F) and 95 C (203 F) with tissue temperatures of less than 100°C
5 to 10 minutes of RF energy delivery

I don't know much about this, but I would only do this procedure under 7 watts. I think ANSI guideline for RF safety mentioned something about 7 watts and less not being so dangerous.

[January]

(((((((((((((( Lisa )))))))))))))))

Thank you so very much for explaining the test to me. I'm having some real PTSD issues with going there. I won't be behind a locked, chained door and as far as I know I'll be the only patient there and I think the tech is male. There will not be other staff there from what I understand.

I couldn't sleep last night because I was so worried. Your explaination did help though.

Hugs,

Jan

[January]

Lisa, did you have to answer a long questionaire which contained some very rude questions? I absolutely refuse to answer a couple of them. Some of those questions are way out of line!

Jan

[Monty_girl]

No, I didn't have to answer a questionaire. I had to keep a sleep log for awhile. The only questions I had to answer is the medical ones the doctor asked me. But nothing very personal. I wouldn't answer the questions I wasn't comfortable answering.

I had a lot of PTSD issues as well with the study the first time around. People watching me sleep and all. Had an abuser who would do that.

Only one person there for the sleep study?? I had a male and a female there during mine. The female was the one who put the wires on me.

Let me know how it went.

Take Care, and get some rest when you get home.
Lisa

[January]

I survived it! I knew I would, but my nerves were frayed the whole time even though I took my meds.

There was only one other patient, a female. There was only one tech. We were the only ones in the building. The tech herself was afraid for safety reasons. Boy, that really inspired confidence!

I had a very, very hard time falling asleep. I was freezing, the sheets smelled of some horrible soap, and there was a big red, round light for the camera. It reminded me of the cyborgs' eyes on Battle Star Galactica. I was constantly aware that I was being taped and watched.

I got the giggles when she taped this buck tooth looking thing over my lips to monitor my breathing. It reminded me of Gopher's tooth on Winny the Pooh.

I won't know how it turned out until the end of the month, but I was so glad to get home to my bed and conk out for a while.

Jan