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Letters to the Editor
April 2003

LAUP Reconsidered—Reply

Arch Otolaryngol Head Neck Surg. 2003;129(4):495. doi:10.1001/archotol.129.4.494

In reply

Kern has expressed concerns that publication of articles lacking critical comments may provide third-party payers with ammunition to deny payment for LAUP. Treatments are ultimately judged according to their safety and long-term efficacy. Over the last 5 years our team has published in the ARCHIVES a series of studies dealing with the anatomical,1 histopathologic,2 and clinical aspects of LAUP for snoring3 and OSA. The unavoidable conclusion drawn from these studies was that LAUP is initially associated with favorable results; yet, in a considerable number of patients, the improvement proves short-lived. Laser-assisted uvulopalatoplasty may also cause mild OSA in patients who formerly were nonapneic snorers, or lead to deterioration of existing apnea. These results are attributable to the thermal damage inflicted by the laser beam. The latter may induce progressive palatal fibrosis, accompanied with medial traction of the posterior tonsillar pillars or even of the lateral pharyngeal walls, and thus lead to a narrowing of the velopharyngeal isthmus and the aggravation of objective sleep parameters. Mickelson and Ahuja,4 among other authors, consider LAUP an effective treatment for OSA; yet they show that, after a mean of 112 days after surgery, 27% of their patients experienced an RDI deterioration. Others indicate the limited efficacy of LAUP for OSA and state that the results of LAUP are unpredictable,5 using a choice of words that could not be more appropriate to depict the nature of this procedure. Furthermore, an update for 2000 issued by the board of directors of the American Academy of Sleep Medicine states that LAUP is not recommended for the treatment of OSA.6 All these admonitions paint a grim picture of a once popular and promising therapy. As a result, they may deter potential candidates from undergoing this type of surgery, and change health insurance coverage policies.

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