Characterizing the Landscape of Otolaryngology Trained Hypoglossal Nerve Stimulator Surgeons

Hypoglossal nerve stimulator (HNS) implantation has become increasingly common to treat obstructive sleep apnea (OSA) among patients unable to tolerate positive pressure therapy. Given the novelty of this surgery, there is variability in the training backgrounds of implanting surgeons. The objective of this study is to characterize the surgical training backgrounds and geographic locations of implanting surgeons in the United States.

A list of physicians certified to perform HNS implantations as of March 2024, their geographic location, and fellowship training background was provided by Inspire Medical Systems along with the total number of HNS devices implanted from 2019 to 2022. General demographic information and surgeon practice type (academic versus non-academic) were recorded.

A total of 1345 implanting physicians were identified. A total of 210 (16%) providers were not otolaryngologists and therefore excluded. Among those included, 1058 (93%) had an MD degree, 948 (84%) were male, 248 (22%) were in academic practice, and 325 (29%) were fellowship trained. The most common subspecialty training backgrounds included head and neck surgical oncology (39%), facial plastic and reconstructive surgery (15%), and sleep surgery (12%). Wyoming (1.2) and the District of Columbia (0.88) had the highest density of HNS surgeons per 100,000 persons, while Hawaii (0.07) and New Mexico (0.09) had the lowest density.

There is wide variability of HNS-implanting otolaryngologists in the United States. Most surgeons are general otolaryngologists in private practice. Given the increased demand for HNS implantation compared to other treatments for OSA, there may be an expanding role for sleep surgery training.

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