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Updated: May 20, 2026
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Drug-Induced Sleep Endoscopy (DISE) with Target Controlled Infusion (TCI) and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Hypopharyngeal surgery in obstructive sleep apnea: practice patterns, perceptions, and attitudes.
Eric J Kezirian1, Heather M Hussey, Scott E Brietzke
1Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA. ekezirian@ohns.ucsf.edu
Summary
Surgeons performing hypopharyngeal obstruction surgery for obstructive sleep apnea (OSA) cite training and evidence concerns. Better education and research are needed for procedure selection.
Area of Science:
- Otolaryngology
- Sleep Medicine
- Surgical Procedures
Background:
- Obstructive sleep apnea (OSA) significantly impacts adult health.
- Hypopharyngeal obstruction is a key factor in OSA.
- Surgical interventions for hypopharyngeal obstruction vary, necessitating clear selection criteria.
Purpose of the Study:
- To identify surgeon-perceived factors influencing the selection of hypopharyngeal procedures for OSA.
- To compare these factors between sleep medicine and general otolaryngology surgeons.
Main Methods:
- A cross-sectional online survey was distributed to American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) members.
- Respondents rated education quality and factors influencing procedure selection on a 5-point Likert scale.
- Data were analyzed for the overall group and specific subgroups based on subspecialty interest.
Main Results:
- Continuing medical education (CME) courses received higher quality ratings for OSA surgical training than residency/fellowship or medical school.
- Over 40% of surgeons reported limited training in individual hypopharyngeal procedures, with concerns about scientific evidence and reimbursement.
- Patient reluctance and surgeon personal experience also influenced procedure choice, with the sleep medicine subgroup reporting higher satisfaction with training and evidence.
Conclusions:
- Procedure selection for hypopharyngeal obstruction in OSA is multifactorial.
- Surgeons express significant concerns regarding the adequacy of education, training, and the quality of research evidence.
- Addressing these concerns is crucial for optimizing surgical treatment selection.
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