title: Hypopharyngeal surgery in obstructive sleep apnea: practice patterns, perceptions, and attitudes.
abstract: OBJECTIVE
  To characterize factors that surgeons perceive as affecting selection of procedures designed to treat hypopharyngeal obstruction in adults with obstructive sleep apnea (OSA) and to compare those factors among 2 groups of American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) member surgeons.
  
  
  METHODS
  Cross-sectional online survey.
  
  
  METHODS
  AAO-HNS members with a self-identified subspecialty interest either in sleep medicine or general otolaryngology were asked to complete an online survey, each respondent rated (5-point Likert scale) the perceived quality of their education and training and the role of specific factors in selection, both for procedure categories (eg, all hypopharyngeal) and individual procedures. Responses were examined for the entire group and for subgroups.
  
  
  RESULTS
  Response rate was 27% (163/610). Sixty-five percent of respondents rated their surgical OSA education and training during postgraduate continuing medical education (CME) courses as of high quality, compared with 39% for residency/fellowship and 4% for medical school (P < 0.01). For individual hypopharyngeal procedures, over 40% of respondents reported limited training (except for tongue radiofrequency), and over 30% raised concerns about scientific evidence and reimbursement. Surgeon personal experience suggested treatment benefits without clearly favoring individual procedures. Respondents noted that patients were reluctant to undergo procedures, despite treatment recommendations, particularly maxillomandibular advancement. The sleep medicine subgroup reported higher ratings for education and training quality, research evidence, and personal experience with hypopharyngeal procedures. Concerns about adequate education and training, the quality of research evidence, and reimbursement issues were major factors in procedure selection.
  
  
  CONCLUSIONS
  Multiple factors affect procedure selection. Surgeons identify concerns regarding education and training and research evidence.
authors: Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, CA, USA. ekezirian@ohns.ucsf.edu
authors: Eric J
authors: EJ
authors: Kezirian
authors: Heather M
authors: HM
authors: Hussey
authors: Scott E
authors: SE
authors: Brietzke
authors: Seth M
authors: SM
authors: Cohen
authors: Greg E
authors: GE
authors: Davis
authors: Jennifer J
authors: JJ
authors: Shin
authors: Debra G
authors: DG
authors: Weinberger
authors: Michael D
authors: MD
authors: Cabana
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007013:Hypopharynx / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D013043:Specialties, Surgical