Technological Advancements

Recent technological advancements and trends have made the diagnosis and treatment of sleep apnea more achievable for patients. Sleep studies used to be a lot more onerous, requiring spending the night at a medical center, sleeping in a hospital bed in an unfamiliar environment with cold/sterile equipment attached to your body and head. Today, at-home sleep studies are becoming the norm, accelerated by pandemic precautions and patient demand. As doctors, we often appreciate, like our patients, the more realistic snapshot of a patient’s at home sleep habits.

Wearables

In 2022, “wearables” or real time health monitors in the form of watches and rings are becoming more commonplace and the information they are providing patients and their doctors is exponentially growing. Smart phone apps have for some time attempted to delve into sleep disturbances, but the recent explosion of wearables, typically Bluetooth connected to a mobile device, have really changed patients’ immediate appreciation of sleep physiology and diagnostic acumen. The most common devices include the Oura ring, Fitbit watch, Motiv ring, THIM smart ring, and GO2SLEEP ring. The expense and now subscriptions associated with these wearables is seen by many as the leading barrier to more broad use. Patients able to afford this technology are typically excited about these innovative developments in personal wellness.

Inspire Sleep Apnea Innovation

The Inspire implant is easily one the most exciting advancements in bioengineering and sleep medicine in the last decade. Since the development of the Inspire device, FDA cleared since 2014, sleep medicine has experienced a true paradigm shift in how surgeons approach a significant group of patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP). CPAP is the primary initial treatment for OSA.

While over 20 million Americans suffer from moderate to severe OSA, researchers estimate less than 40% compliantly continue to wear their prescribed CPAP according to long term studies. These untreated patients frequently cite mask leakage, facial pain/irritation with mask use and hygiene, nasal congestion, throat pain/dryness, sleep position preference and sleep partner irritability with CPAP use as reasons they stop using CPAP. This leaves a significant number of patients emotionally and physically in the lurch, untreated yet fully aware of the problems they face. For these millions of patients, the Inspire implant has offered tremendous hope, and a chance to sleep in peace without a hose or a mask. The Inspire implant is a small pacemaker-type device placed during a same-day, outpatient procedure. The device works by gently stimulating the muscles of the tongue and palate when you want to inspire while asleep, allowing you to comfortably breathe and sleep peacefully. Patients return to work in less than a week, many patients taking over-the-counter pain medicine for just 3-4 days following their procedure.

In two sentinel studies looking at the success of Inspire implants, researchers found the following:

0 %
reduction in sleep apnea events
Many patients show no apnea episodes with Inspire.
0 %
of bed partners
report no snoring or soft snoring
0 %
of Inspire patients
say Inspire is better than CPAP and would recommend Inspire to others.

The Mayo Clinic and the American Academy of Otolaryngology has listed the Inspire device as one of the most innovative medical technology devices in the last decade. Put simply, the Inspire device has been a game changer for many patients with obstructive sleep apnea and probably the most exciting and innovative technological advancement in sleep medicine with a proven track record for more restful sleep.

Find a Proliance ENT location today

Proliance Surgeons has partnered with Hall of Fame Health to provide healthcare to former NFL players, team employees, and their families.

“This network of world-class health systems, physician groups and provider organizations is committed to helping the Pro Football Hall of Fame serve former football players and their families as they look to gain access to the very best care,” said Jeremy Hogue, CEO of Hall of Fame Health. “It’s consistent with the Hall’s mission ‘to honor the heroes of the game.’”

0 %
of former NFL players

are not covered under employer-sponsored medical plans

It’s estimated that 80% of the National Football League’s more than 18,000 former players are not covered under employer-sponsored medical plans.  Hall of Fame Health and Proliance are working together to fill gaps in coverage, offering services complementary to services the NFL provides.

The partnership with Proliance is the latest development to provide services and solutions to address the health and wellness needs of former players and their families.  “When we talk about ‘honoring the heroes of the game,’ it’s more than documenting their accomplishments on the field. It’s about caring about them off the field as well,” said David Baker, President and CEO of the Pro Football Hall of Fame.

Caring for our heroes and their families on and off the field

“And that care is not limited to members of the Hall of Fame; it’s for everyone associated with the great game of football. Hall of Fame Health and Proliance will improve quality of life by providing world-class health care to the thousands of men and women who have been associated with the National Football League and its clubs,” said Baker.

Read more about our surgeons who are dedicated to providing exceptional outcomes, personally delivered:

Though it can be a tough subject to talk about, it’s an important one. Your colon and rectal health are essential. Taking the time to put your health first and complete routine screenings can save your life.

  • Risks increase after age 50, but polyps may begin several years earlier
  • Manage risk factors like diet, exercise, tobacco use, and alcohol consumption
  • Make a routine appointment for a colonoscopy to catch it early

Diet & Nutrition

Exercise

Routine Screenings

March is colorectal cancer awareness month, so there’s no better time to start screening

Colon cancer is almost entirely preventable! But here’s the thing, colorectal cancer can strike without any symptoms at all. Get screened, catch it early, and outcomes are often positive.

Risk factors

There are risk factors you can modify, like:

  • Diet
  • Exercise
  • Tobacco use
  • Alcohol consumption

All of these are great places to start in terms of proactive management of your health. However, without proper screening, there’s no way to know the true state of your colorectal health.

Then, there are non-modifiable risk factors. You can’t choose your parents or family genetics, and you can’t do anything about getting older. Each of these risk factors can contribute to your vulnerability to colon cancer.

So, what can you do to advocate for your own health and future? Make a routine appointment for colorectal screening.

Screening methods

There are a few different screening methods approved by the American Cancer Society and the U.S. Preventative Services Taskforce:

  • Colonoscopy
  • Flexible sigmoidoscopy
  • CT scan colonography

The preferred screening method is a colonoscopy. It’s considered the gold standard for screening, the best testing method, the most accurate at providing reliable results, and it’s the most comfortable for patients.

During the colonoscopy your physician will examine your entire large intestine for abnormalities, including growths or inflammation. The test is performed in a specialized endoscopy suite with nurses and monitors, and usually intravenous sedation, and the exam usually takes around 30 minutes.

There are other tests, including flexible sigmoidoscopy, and double contrast barium enema, which is an x-ray study. A CT scan colonography, which is a CAT scan study. And there are even some stool tests where the samples of stool are sent off to look for hidden blood or some genetic abnormalities. All of these methods are ‘get your foot in the door’ tests that provide basic screening.

According to the American Cancer Society, colorectal cancer is the leading cause of cancer deaths in the US for men and women.

When to get screened

To detect colon cancers and colon polyps early, the American Cancer Society recommends performing certain screening examinations at regular intervals.

While the risk of colon and rectal cancer starts to increase after age 50, the risk of colon polyps may begin to rise several years earlier. Patients are often divided into risk groups which help to define what screening they need.

Medicare has been covering screening colonoscopies for all Medicare beneficiaries since 2000. So, in Washington State, there is virtually no reason why someone shouldn’t make an appointment for a routine screening.

Set up an appointment. Be empowered to play an important role in your health. We’re here to help you along the way.

In response to the Covid-19 crisis, with the safety of our patients and people top of mind, along with many healthcare clinics, we’re minimizing in-person clinic visits. In order to meet our community’s surgical needs, we are pleased to introduce Telemedicine Virtual Visits.

At the virtual visit, if your reason for consultation is not resolved, you will be referred based on your need for:

  • Subsequent face-to-face visit at a later date or
  • Referral to the ER for acute care

During these unprecedented times, we would like to support our community hospitals as emergency rooms focus resources to manage the COVID-19 crisis. 

More About Our Response to COVID-19

SEATTLE, WASH. – March 18, 2020 – Proliance Surgeons, Inc., one of the nation’s largest surgical practices, announced that it would postpone all elective surgeries in Proliance-controlled Ambulatory Surgery Centers (ASC) and temporarily suspend non-urgent patient care at each of its clinics and other facilities during the Coronavirus outbreak in the region. Urgent care will continue by Proliance surgeons in our locations and in partnership with area hospitals.

“We have made the necessary decision to postpone all elective procedures as well as patient appointments at each of our clinics within Proliance,” said Charles Peterson II, M.D., President and Chairman of the Board of Directors of Proliance Surgeons. “It has become clear that the most critical key to successfully overcoming the COVID-19 epidemic involves drastically limiting the number of close contacts between people.”

Proliance Care Centers are limiting care to urgent and emergent encounters only until Friday, March 27, 2020. The organization made this decision on March 15, 2020 and instituted it widely on Tuesday, March 17, 2020 at each of its facilities. This includes all ambulatory service center procedures, clinic visits, MRI’s, PT, and other general patient care programs. Obstetrical care will continue to be provided uninterrupted.

“We will continue to monitor the situation with our healthcare community and government, and will update the community if and when this changes,” he added.

Proliance is also instituting telemedicine services to provide an additional layer of protection for patients, staff and providers.

Assisting Local Hospitals & Surgeons

Proliance Surgeons’ administrative leaders are in contact with Washington hospital systems to offer assistance in delivering acute care for patients with fractures, trauma, or urgent surgical care in seven different surgical specialties.

“As a specialty-care surgical organization, we can offer our surgical teams to provide urgent and appropriate emergent surgical care in our carefully-screened ASC’s as a critical backup to Puget Sound area hospitals. Offering those hospitals the unique option of providing surgical services at our ASC’s ensures our hospital colleagues can focus on COVID-19 patients. This maintains social distancing standards, preserves personal protective equipment and lowers the potential for COVID-19 exposures for patients, families and staff.”

Patients with urgent injuries or urgent care needs in specialties (orthopedics, sports medicine, ear nose & throat, general surgery, ophthalmology, pain management and urology) treated by Proliance Surgeons should first call their Proliance Surgeons’ office for further information. Then, if necessary, can visit the Proliance website at ProlianceSurgeons.com to identify available ASC and clinic locations that are remaining open during this time period.

In addition to providing urgent surgical services to ease the burden on local hospitals, Proliance is in contact with local surgeons to offer availability of its ASC operating rooms and staff to help them provide urgent surgical care for patients.

“All King County healthcare professionals are dedicated to providing the highest quality medical care to patients in acute and emergency situations,” said Dr. Peterson. “By partnering with each other, we are better able to serve to the healthcare needs of our community, flatten the curve of COVID-19 disease spread, and come through this crisis more safely and quickly.”

###

More About Our Response to COVID-19

Synopsis: The number and frequency of global infectious pandemics is increasing. While the current SARS-CoV-2 virus and COVID-19 disease pandemic has been the most widespread and crippling in recent history, it will certainly not be the last in many of our lifetimes.

COVID-19 has exposed serious inadequacies in the ability of world society, the medical community, and the medical supply industry to robustly and flexibly respond and adapt to a rapidly-spreading respiratory disease, especially when a large (and even currently, unknown) proportion of disease carriers remain asymptomatic.

Traditional social distancing, testing and quarantining, and waiting for both herd immunity and vaccination capabilities to develop are effective over a 3 to 18-month period. However, in their current iterations, they are far too slow, challenging to implement, socially-disruptive, and fraught with the peril of resurgent disease when lifted to be used solely as long-term management strategy.

A more proactive, adaptable, and universal strategy is required to prevent recurrent, massive human suffering, death, and social and economic disruption. Rapid, accurate, home-based testing, coupled with advanced technological contact tracing via cell phone data have been proposed, but still face developmental, validation, and privacy-rights hurdles.

Our healthcare system’s ability to address and adapt quickly and flexibly to novel infectious disease has also been sorely tested. To keep patients and providers safe and healthy, and preserve a weakened personal protective equipment (PPE) supply chain, a radical, unprecedented, and widespread shutdown of all elective patient care in Washington State and elsewhere was undertaken. This placed many patients in situations of severe, unrelieved pain, untreated disease states, undiagnosed conditions that might prove severe or even fatal, or diagnosed conditions that might prove harder to treat when left to an unknown future date. In addition, the financial ramifications of such a shutdown on the US healthcare sector, which accounts for 18% of US GDP (2016), are staggering.

In such a crisis, there is an understandable desire to look immediately for rapid testing, effective medical treatment, development of herd immunity, and an eventual vaccine as the ultimate (and historically effective) solution to allow a return to more normal patient care. We would propose that while these measures are indeed essential and should be aggressively pursued, they do not address the basic challenge that we are seemingly entering a “new normal:” the “era of pandemics.” Unless a proactive, effective, and permanent change in our healthcare delivery system is undertaken, global society and the healthcare community will recurrently need to undertake the same draconian and crippling measures.

We propose that there exist (relatively) simple, scientifically-validated measures that can be undertaken to alter our care delivery process, which can both address easing of restrictions for elective care in the current crisis, but also proactively allow for prevention of disease spread during the next crisis. These include:

  • Defining tiered levels respiratory infectious disease threat (RIDT);
  • Correlated levels of universal precautions, and PPE use;
  • Social distancing practices in healthcare facilities based on RIDT levels;
  • Ongoing promotion of widespread personal and facility sanitization practices;
  • Eventual use of patient and provider disease testing as a qualifying factor in treatment algorithms
    • ONLY when an effective test is available that can accurately prove the recipient either capable or incapable of transmitting disease.

These straightforward measures, if properly implemented, will allow for safe, progressive increases in elective patient care in both current and future crises.

Furthermore, using a “tiered-threat-level” system allows for adaptability of care process based upon existing pandemic/epidemic characteristics, and thus can operate at a less stringent level in times of epidemiological calm.

By not relying heavily on imperfect and evolving testing regimens, or time-consuming development of treatments and vaccines, these measures also allow for much more rapid initial response to future infectious disease hazards.

More About Our Response to COVID-19

These past few months have taught us that living a healthy lifestyle may be our best defense in tough circumstances.  But why is it so hard to maintain healthy habits? Let’s break down the simple truth about the core components to living healthier and how simple it actually is to do them.

Exercise

Diet & Nutrition

Stress & Sleep

Exercise: Just 15 minutes a day makes a difference

The outward benefits of exercise are obvious – trimmer figure, stronger muscles, improved cardiovascular fitness. However, recent research has shown the benefits of exercise extend far beyond what we can see physically:

  • Improved brain function, sharpening memory, speeding up learning, and improving mood
  • Delaying Alzheimer’s onset, even in older adults
  • Lessening depression, often as well as or better than drug-based therapies without the side effects

The mechanisms of how this happens are still being worked out, but exercise improves blood flow to the brain and triggers the formation of substances like BDNF (brain derived neurotrophic factor) a protein that helps stimulate the growth of new neurons and repair and protect brain cells from degeneration, all of which help with brain function.  It also has been shown to increase the size of a part of the brain called the hippocampus (also called “the gateway to memory”), an area that typically shrinks with age. Interestingly, both aerobic exercise and resistance training seem to help improve symptoms of depression equally.

Aside from the brain, exercise also:

  • Channels blood flow to the skin which promotes wound healing and skin health
  • Increases muscle endurance and strength
  • Lessens perceived pain in those with chronic pain
  • Causes bones to become denser and stronger with weight-bearing activity causes bones, lessening fracture risk
  • Protects against many diseases including diabetes, heart disease, hypertension and cancer
  • Slows the aging process and lengthens life spans by as much as 5 years by producing a molecule that protects the telomeres (the protective DNA sequences on the ends of our chromosomes that get shorter and shorter as we age, ultimately resulting in cell death)

As many have postulated, if the benefits of exercise could ever be synthesized in pill form, it would be the most valuable drug ever invented.

So, how much exercise is enough?

The World Health Organization (WHO) has recommended at least 150 minutes of moderate or 75 minutes of vigorous physical activity per week for healthy adults age 18-64.

Aerobic exercise should be performed for at least 10 minutes at a time. In addition, 2 episodes of resistance training for 30 minutes each is also recommended. This, of course, is a guideline. For people with specific health conditions that preclude this level of activity, adjustments can be made to these recommendations to accommodate their limitations.

Let’s dive into some specifics.

What constitutes moderate versus vigorous exercise? The great thing here is that much of what we do a part of our daily life counts as moderate exercise – activities like cleaning the house, gardening, raking leaves. Simple choices like taking the stairs rather than the elevator or walking rather than driving short distances add up over time. More vigorous exercise might include brisk walking, cycling, swimming, dancing, hiking or playing sports.

What about resistance training, do I have to join a gym? Health clubs do offer benefits over working out at home, including a larger selection of exercise equipment as well as a social network to make working out more fun. However, resistance training can be performed using just body weight, through movements such as squats, lunges or push-ups. Activities such as yoga and tai-chi combine body weight resistance training with movements that improve flexibility and balance and have been shown in orthopedic literature to prevent falls. There is a term called “sarcopenia” which is used to describe the age-related loss of muscle mass over time. We lose 3-8% of our muscle mass per decade after age 30 and about 1% per year after age 40. Sarcopenia is reversible through resistance training.

Key Takeaway: Exercise has far reaching value, even small steps add up, and finding time is easier than you think

Exercise has value far beyond the benefits we traditionally have attributed to it and that virtually any effort we make to increase our fitness through exercise will have far-reaching benefits to us. The goal of improved fitness is achievable. The WHO guidelines are a good place to start but each of us has unique needs and abilities. Resources exist to help you to figure out the best way to begin your exercise program including your family doctor or friendly orthopedic surgeon. Physical therapists can also help to turn a negative situation, such as a musculoskeletal injury, into a positive by helping to create a customized home exercise and fitness program for you. Personal trainers are also a valuable way to begin to exercise by providing structure, knowledge and accountability.

Once you have identified your preferred workout and created your regimen, you then have to figure out how to fit it into your schedule. Many of us take care of others – parents, children, spouses – before taking care of ourselves. It’s easy to set aside our own needs in order to serve others. I think you have to take care of yourself first, in order to be able to care for others effectively. There are many ways to fit exercise into your life – do it first thing in the morning, create time during your work day, walk the dog in the evening, find an exercise buddy – whatever gets you out there moving regularly that is not subject to the capricious demands of a busy life. Also, remember the little things count too. It doesn’t all have to be gym shoes and spandex. Clean out that garage, wash your car (or better yet, wash my car), weed the garden, give the dog a bath … it’s all exercise and it’s all good.

 

Diet and Nutrition: Eating a rainbow a day, keeps the doctor away

The dreaded “D” word. I don’t need to go into all the things that are wrong with the typical American diet. Our obesity statistics speak for themselves. In orthopedics, it has long been recognized that obese patients are more prone to complications following surgery, with increased rates of surgical wound infections, blood clots and other adverse surgical outcomes. There is a general measure of obesity called “body mass index”, which is a simple formula incorporating height and weight (weight in kg divided by height squared in cm). A BMI north of 35 has been shown to lead to higher surgical risk.

There have been as many diets described as there are dogs in Seattle. Grapefruit diets, Twinkie diets, McDonald’s diets …you name it, it’s been described and all of these diets seem to have one thing in common – they’re unsustainable. Still, even if they aren’t sustainable, diets can serve a purpose. Embarking on a diet can jump-start weight loss or a fitness program, even if you eventually go off the diet.

There are a couple of diets with some scientific support: the Slow Carb diet and the Ketogenic diet.

The Slow Carb diet consists of eating primarily protein, vegetables and legumes in roughly equal portions 6 days a week, in whatever portion sizes the dieter desires and avoiding “white foods” like sugars, potatoes, and grains. Then one day a week, often Saturday or “Faturday” as Slow Carb dieters lovingly call it, you can eat whatever you want.

The Ketogenic diet consists of eating primarily fat and protein and some studies suggest may prevent diseases such as cancer and diabetes. There are many resources on the internet about both of these diets if you are interested in learning more.

Improving your nutrition and eating habits doesn’t require a specific diet, and small changes can be more sustainable

You can make a measureable difference with simple measures:

  • Eating dinner off a salad plate in order to control portion size
  • Reducing intake of sugary drinks
  • Eating more colorful foods

It’s generally accepted that we are exposed to toxins and pathogens on a daily basis. Our food can contain pesticides, additives, chemicals, pollutants – some of which is unavoidable. However, certain types of foods can help to protect us against these pathogens. A study from Johns Hopkins showed that cruciferous vegetables (broccoli, cauliflower, brussels sprouts) and foods such as onions and mushrooms contain a compound called sulforaphane that helps protect our cellular DNA against these toxic chemicals and escort them out of our cells.

Brightly colored fruits and vegetables contain anti-oxidants and other compounds that scavenge free radicals and may help protect against cancer and other diseases. Along those lines, a study from Harvard suggests certain foods help reduce chronic inflammation, which has been linked to cancer, heart disease, Alzheimer’s, diabetes and depression. “Anti-inflammatory” foods include tomatoes, fruits, nuts, olive oil, leafy greens and wild caught fatty fish like salmon, tuna and sardines. B vitamins and omega 3 fatty acids are critical for neurologic and cardiovascular health. Grass fed meats appear to have health benefits over corn or grain fed meats.

What are foods to avoid?

Clearly sugar and other refined carbohydrates are over-represented in the American diet with profound health consequences. In addition to a genetic component, Alzheimer’s disease is associated with diets containing large amounts of saturated (meat and dairy) and trans fats (baked goods). Iron and copper have also been found to be part of the amyloid deposits found in brains of people with Alzheimer’s. We typically get plenty of iron and copper in our diets already from dietary sources and from environmental sources such as copper pipes, so avoiding vitamins and other supplements containing these minerals is probably advisable for most of us without some form of iron deficiency.

In the previously mentioned Harvard study, certain foods have been linked to causing chronic inflammation such as fried foods, sodas, refined carbohydrates, lards and processed meats. All of these foods are probably best avoided or at least minimized.

Key takeaway: Eat good foods, fad diets are not required, and plants are good for you.

It can all seem a bit overwhelming. However, there are resources to help you here as well. Your family doctor is a reliable source of information, as is a nutritionist. Websites from institutions such as the Mayo Clinic are generally full of useful information. When it comes down to it, though, I think author Michael Pollan may have said it best: “Eat food, not too much, mostly plants.”

 

Stress and Sleep: Reduce one by increasing the other

Chronic stress has been associated with many of the same diseases that are connected with chronic inflammation. Therefore, reducing stress has direct health benefits.

There are many strategies for reducing stress:

  • Mindfulness exercises, like meditation
  • Learning how to say “no” when necessary
  • Exerting control over the chaos by controlling what can be controlled and making healthy choices, like finding time to exercise
  • Getting enough sleep, which recent studies suggest is 7 hours

The best solution combines mindfulness with physical activity, like simply going for a walk.

Life seems to move more quickly with every passing year. I’m convinced one major reason for this is that we spend too much time in front of screens, working or being entertained. Finding opportunities to turn off our electronics is well worth it.

The ability to communicate face-to-face is rapidly becoming a lost art, yet is critical in order to build relationships. A longitudinal study performed at Harvard looked at a group of subjects over a period of 75 years and found that the happiest and healthiest participants were the ones who maintained loving, fulfilling and intimate relationships. Dr. Robert Waldinger, a Harvard psychiatrist who took over the Grant study in 2003, has a TED talk describing the study findings – screen time that’s worth it.

 

In Summary

In order to live longer, healthier and happier lives, we need to get out and move. An effective exercise program doesn’t require fancy clothes or expensive gym memberships. Eating right doesn’t require suffering or drastic measures, but instead simple choices for healthier alternatives. Reflecting on your life and investing your time developing your close relationships may be the secret to long-term happiness.

So, turn off your cell phone, grab an apple, take the dog for a walk and say hello to someone new. It might be the best thing you do today.

Inspire therapy is an innovative new obstructive sleep apnea treatment for patients who are unable to obtain consistent improvement with the use of CPAP.

The Inspire System is fully implanted, and does not require wearing any external devices during sleep. Minute electrical impulses are delivered to selected nerve branches innervating the tongue musculature with each inspiration. The stimulation activates the extensor muscles of the tongue to move the tongue forward and open the pharyngeal airway. Through the process of entrainment, the soft palate is also moved forward providing further airway opening.

Inspire therapy is specifically indicated in patients with:

A BMI of 32 or less
An AHI between 15 and 65
Moderate to severe obstructive sleep apnea
Those who are unable to achieve consistent improvement with CPAP

In addition, each patient must have a sleep endoscopy exam to evaluate the pattern and location of airway collapse to ensure that they are a good candidate for Inspire therapy.

The Inspire system was approved by the FDA in 2014. At this point in time over 1600 patients have been implanted in the United States.

The device is implanted in an outpatient procedure. There are three components to the system:

  • A sensing lead
  • The IPG (stimulus generator) unit
  • A stimulating lead

The sensing lead is placed in the right lateral chest wall, between the external and internal intercostal muscles, ideally in the 5th intercostal space. This lead is a pressure sensor able to detect the intrathoracic pressure drop indicating inspiration is beginning. The IPG unit is placed in the right anterior chest wall, superficial to the pectoralis fascia. The stimulating lead is placed around the branches of the hypoglossal nerve which have been determined through intraoperative observation and EMG recording to supply the extensor and stiffener muscles of the tongue.

The patient may resume light activity on post op day one and full activity as tolerated 10- 14 days post op.

A one month healing period is allowed for healing prior to device activation. The patient is provided with a remote control so the device can be activated for sleep and deactivated during waking hours.

Postoperative complications have been rare, but have included postoperative infection necessitating device removal, pneumothorax, device migration requiring revision surgery, and tongue abrasion with device utilization. Tongue abrasion has been successfully managed with the use of a dental protector.

Several studies with 1 and 3 year follow up are available for review. Overall these studies show an average reduction of the AHI of >70%, cessation of snoring reported by >80% of bed partners, and >80% consistent usage by implanted patients. These findings remain stable at 3-year follow-up. There is no indication that increasing levels of electrical stimulation are required to maintain these results.

Find a Proliance ENT location today