Today at 3:00 I’ll be sitting in an exam room at the Stanford Sleep Clinic, essentially getting the inside of my nose cooked. Sounds awesome, doesn’t it?
It’s called radiofrequency turbinate reduction. My boyfriend got it done, also, as part of his general sleep apnea surgery four or five years ago (his surgery worked; sadly, I am not a candidate for that same surgery since I do not have the same structural cause).
But back to the procedure itself. To quote obstructednose.com:
All of these methods aim to shrink the underlying turbinate by applying heat to the surface lining of the turbinate and creating a lesion. A probe is inserted into the turbinate tissue between one and six times, while the needle is heated and the underlying tissue is shrunk.
That, my friends, is cooking. When you apply heat to flesh, causing that flesh to shrink, you are cooking. (And this makes me think of something a burn-ward nurse friend of mine said about the burn ward essentially smelling like cooked meat; it is very unsettling, she says. Which reminds me of another tangent from which I will refrain since I don’t completely want to gross people out.)
Here is the why: swollen nasal turbinates can contribute to sleep apnea. Very commonly, people with allergic rhinitis will have this kind of swelling. Here, a picture that kind of shows you what and where the turbinates are:
Nasal Turbinates
The air you breathe in through your nose has to go past the turbinates; their job is to clean that air. If they’re inflamed, though, they create blockage, and it’s a lot harder to get any air in past them. This is why nasal sprays like Afrin (oxymetazoline) are so popular. They’re vasoconstrictors. They constricts the blood vessels, which limits the blood flow, which minimizes the inflammation. Unfortunately, Afrin and its kin also cause rebound inflammation when they wear off, which makes you keep using them, which keeps causing rebound inflammation.
Since I’ve been having trouble with CPAP air pressure going too high at night, the ENT wants to reduce my nasal turbinates. I don’t actually have a lot of inflammation there, but I do have some. And I am constantly on antihistamines and anti-inflammatories to help me breathe.
Today’s procedure is supposed to be pretty minor. Local anesthetic only. I’m supposed to take it easy for the rest of the week, and not go back to work today. But I can go back to work tomorrow. Unlike getting the endoscopy for my celiac biopsy – for that one I was told that I wasn’t to make any important decisions whatsoever that day. And someone else had to do the driving.
We’ll see how this goes.
Twitter
Diana: I tried to write you a note some time ago. I was referred to Dr. Capasso back in December, and while Googling him I found your blog entry on turbinates, etc. Well, fast forward to February. I had three procedures done, including UPPP, adnoid removal and turbinate reduction. I had sleep apnea to overcome, but also physical trauma because my nose and sinues did a full faceplant against the airbags and so on in a high speed head-on accident (wrong way drunk hit me on the freeway).
Anyway, Reading your blog made me feel much better about driving 4.5 hours to go meet Dr. Capasso and get his evaluation. I gave CPAP a real good try, but my pressure was so high it made it difficult to keep a mask on my face without a chin strap, and I couldn’t handle that after the wreck … too much facial pressure.
So, it was painful for about two weeks. He found a whole bunch of hurt up there to repair, and I think I spent about three hours on the table at Stanford Hospital.
I am due to go have my post-op checkup next week, but the turbinate surgery and the other work Doctor Capasso did in my nose alone made a huge difference in how well I can breathe … I have never been able to breathe this well!
I hope you find a way to sleep better. Diana, I just wanted to drop you a note and let you know that reading about your turbinate reduction helped greatly to put me at ease about that part of my surgery:) Eric
I am so glad to hear that, Eric! Will you be using CPAP at a lower pressure now, or completely off?
I’m still congested a lot of the time, thanks to my allergies, but it’s much better now than it ever was before the turbinate reduction.
That’s wonderful that my blog helped you 🙂
I have not tried to use the CPAP since the operations, because the pressure is so high, but I plan to take it with me when I meet with Dr. Capasso next week to see if he wants to prescribe a lower pressure setting. I think I would sleep even better with a new, lower pressure, but I have not talked to the Doc since I have been weened off the post-op drugs and become coherent again:)
I think, after my triple procedure, that he may order another sleep study to document the improvements adn or what a new CPAP pressure should be. To be honest, I took a slightly different research path for my due diligence than you did. I studied up on UPPP and the alternative procedure, and focused on who characteristics these can correct in the limited range of folks who are most likely to benefit. Then I really looked into Capasso, and even slogged thru some of his papers he presented while practicing in Miami. Of course I researched Stanford, and quickly realized how lucky I am to have access to THE pioneer of the sleep medicine field. I wanted a realistic perspective on what surgery could offer long term, and then pursued that alternative. I hope I can do a less aggressive pressure CPAP regime, or possibly not even need the machine. Capasso said it may follow that 10-15 years from now I may gradually come to need CPAP as I age, or not. I have read that in some patients the turbinate reduction may only be beneficial for 10-15 years, and may need to be repeated. I know this, I breather SO MUCH BETTER now, that if I do need CPAP at some point it just has to be more effective with my nasal improvements.
Now the key is to stay away from contact with those inconsiderate drunk drivers that are cruising our highways… If I can keep from having a repeat collision I should be just fine:)
Good luck with your sleep situation. Eric
Cool. I hope you get to go without CPAP *fingers crossed*. I’ve been evaluated for surgery, and I’m not a candidate for anything other than mandibular advancement, and even with that they don’t think it would do me much good. So I’ll be on CPAP for a long time yet. Which is worth it, so long as I’m not so exhausted all the time 🙂
Came across your blog just now when I was looking for info on acupuncture and sleep apnoea. Found it really interesting,especially the piece about turbinate reduction, as I’m working my way through all possible ways to unblock my airways at the moment.
You have some good links on your site. I have another which I have found really useful, which you might want to consider. Doctor Steven Park, an ENT surgeon in New York has lots of useful info on his web site http://doctorstevenpark.com He also does teleseminars in which he interviews experts in various fields,with knowledge of sleep apnoea, as well as hosting his own question and answer sessions. I’ve only been listening to these for the last few months, but have learned loads.
I am getting my turbinates reduced under the burning method as well. I’m curious how yours went?
It went well, and the results have been lasting. How did your procedure go? Did it help?
Philip:
Just read your post, from August! I had my surgery back in February, and I must say, I have never breathed better! Even thought I live in the Central Valley, where fruit trees and pollinators abound, I breathe so much better. No side effects. My Doctor really did me a solid:) Diana, how are you doing? Philip, the best advice I can give you, assuming you have not already had surgery, is to really research your doctor and the procedure to see if your conditions match their suggested therapy. I found Diana’s blog JUST before having my first consult with Dr. Capasso. I felt like my doc was certainly the right fellow for me. I like straight talk, and once I evaluate everything that can go wrong, I can make a good risk assessment.
My outcome was exactly what I hoped for. And Dr. Capasso was very, very up front and good about answering all of my questions. The surgery I had is painful, afterwards. About 6 days of daunting recovery, and then it was all uphill from there. Now I was stubborn, and did not take al the drugs that Capasso perscribed, because while they killed the pain, I did not want to feel like a zombie. Having the adenoids out and the resculpting of the palate was more painful than the turbinates. Frankly, once they take the splints out, it’s no big deal. I was at Stanford right down the hall from Steve Jobs, and I must say, Stanford treated me as if I was Steve Jobs. I’m nobody special, but they sure made me feel like I was a VIP. The standard of care was off the charts.
That’s awesome to hear, Eric. How much do you feel it’s helped? How’s your sleep/energy? I know someone else who had the procedure and was much better after.
I’ve been doing pretty well. I can still feel the difference from reducing the turbinates. I’m much less congested than I’ve ever been. Still on CPAP, but it’s been a lot more effective for me–once I found the right mask.