Dr.K.O.Paulose FRCS DLO, Consultant ENT Surgeon, Jubilee Hospital, Trivandrum, Kerala, India.
Snoring can be dangerous and is no longer a laughing matter. In addition to posing a strain on relationships, it can also indicate a possibly dangerous and life-threatening disease. Snoring means obstructive breathing and its most exaggerated form in obstructive sleep apnea. This disorder is in itself very serious, but, if you snore, it can cause high blood pressure, diabetes, and even stroke.
The sound of snoring originates in the collapsible part of the air passage where there is no rigid support. It involves the back of the nose, palate, tonsils and the tongue. Some factors that cause snoring are obesity, sedation and space occupying masses like enlarged tonsils and adenoids.
Surgical treatments for snoring
Surgery to treat snoring is designed to reduce obstruction or narrowing in the anatomic area that is causing the snoring. Frequently, there is more than one involved area, so surgery on only one of the narrow areas may decrease snoring but not eliminate it entirely. Surgical treatment of snoring is generally focused on the nasal passages, palate and uvula, and tongue.
Nasal surgery for snoring
Nasal surgery to treat snoring is generally focused on improving a narrow nasal passage. Laser can be used to shrink the turbinates by creating scar tissue in them, resulting in a more open nasal passage (LAPT).
Several other anatomic problems can cause or worsen snoring. The nasal septum is in the center of the nose that separates the right and left nasal passages. After trauma including during birth, the septum can be deviated to one side or may curve to both side. The septum deviation can be corrected by removing the crooked cartilage-Septoplasty. It can be done in traditional method or with Laser.
Nasal polyps are usually caused by allergies. As they continue to enlarge over time, they can cause nasal obstruction. If the polyps are large enough, they will require surgery to remove them. It is easier to perform to perform the surgery in the operating room under general anesthesia. Removing the polyps reduces nasal obstruction, which may also improve snoring.
Laser Assisted uvulopalatoplasty (LAUP) involves trimming the palate with a laser. Small cuts are made in the palate on each side of the uvula with a laser. The scarring caused by the procedure stiffens the palate, decreasing the ability of the palate to vibrate and pulls the palate sideways to tighten it. This procedure results in mild to moderate pain for one to two weeks that is generally controlled with oral pain medications.
Snoring due to a long, floppy palate can be treated with office procedures that stiffen the palate. The palate can be stiffened by creating scar tissue by Coblator channeling or with palate implants.
Coblator ablation of the palate: Usually, three tunnels in the tissue are made with a radiofrequency wand. The radiofrequency energy is applied for approximately ten seconds with the wand in the palate muscle tissue. The tissue heals as scar tissue, and the palate becomes stiffer and vibrates less. Generally, scar tissue in the palate continues to form for up to three months. Up to 80% of people report reduced snoring after this procedure, however, as the tissue continues to heal over time, the palate may soften and re-obstruct.
Palate implants are now being used to treat snoring. They are made from Dacron, which is a non-reactive material that has been used for many years for heart valve surgery and hernia repair. Dacron also encourages the normal tissue to grow into it. Small Dacron implants are placed into the palate under local anesthesia. The implants stiffen the palate like scar tissue after radiofrequency treatments. The implants stay in the tissue, so recurrence of snoring should be reduced. There is a small increased risk of infection after insertion of foreign material in the palate tissue. If this occurs, the implant should be removed and replaced with another implant. Although this sounds like a negative consequence, infection actually leads to scarring, which helps decrease the vibrations of the palate.
How effective surgical Treatment for Snoring
Surgeries are generally successful in reducing snoring. The success of a procedure depends on the problem area causing the snoring. For example, someone with nasal congestion will not have much improvement with a palate procedure and vice versa. The other factor that makes success hard to measure is the definition of success.
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