Snoring Treatment and Injection Snoreplasty
Why do we snore?
Snoring is noise produced by partial obstruction of airflow during sleep. Partial obstruction at the level of the soft palate is typically responsible for higher pitched snoring, whereas lower pitched snoring may come from the tongue base partially obstructing the throat.
Many factors may contribute to snoring. The length of the uvula and palate and the size of the tongue are factors which may determine how much each of these areas is responsible for snoring. Nasal obstruction cause by septal deviation or nasal congestion from allergies can affect snoring. Weight gain is a major factor in many patients who snore.
How can snoring be treated?
First, it is important to distinguish simple snoring from obstructive sleep apnea (OSA). OSA occurs when the airway is obstructed enough while sleeping to deprive the body of oxygen. In addition to the effects of oxygen deprivation on the brain and heart, OSA causes the brain to ?awaken? to a lighter stage of sleep in order to restore tone to the relaxed throat muscles, and open the airway. These mini-awakenings can occur hundreds of times per night, resulting in chronic fatigue. While snoring can be a significant aggravation for patients and their loved ones, OSA is a serious health condition which can contribute to heart failure and increase one?s risk of fatigue related accidents. It is important to discuss the possibility of OSA with your physician if you snore and have excessive daytime tiredness, or if loved ones have witnessed periods of apnea (breath-holding) during sleep.
There is no ?one size fits all? treatment for snoring. Your physician can help identify factors such as allergies which may contribute to your snoring problem. Weight loss is one of the most important factors in snoring treatment. Avoiding sedatives or alcohol at bedtime can improve snoring., and sleeping on ones side can reduce or eliminate snoring in some patients. Sewing a pocket in the back of a night shirt, and placing a tennis ball in the pocket, can usually train anyone to learn to sleep on their side!
If simple solutions fail to help, there are surgical options which may help improve snoring. Many procedures are available to treat palatal snoring. All of these procedures involve some method of tissue injury or tissue removal from the palate and uvula. Snoring, without OSA, is unfortunately considered a cosmetic condition by insurance providers, and surgical treatment is not covered. The goal in surgical treatment of snoring has been a safe procedure which can be performed in the office and is as painless as possible. Laser assisted uvulopalatoplasty was an initial procedure that, while office based, was complicated by a painful recovery and high cost. Radio-frequency ablation (also known as Somnoplasty) has also been popular, but recovery is still quite painful for many patients, and expense is higher due to need for special equipment. As with most snoring procedures, more than one treatment may be necessary, which can be frustrating for patients who endure a painful recovery from each procedure.
What is Injection Snoreplasty?
Injection Snoreplasty is a minimally invasive procedure in which a chemical scarring agent is injected into the soft palate just above the uvula, producing soft tissue injury. As the injured tissue heals, it stiffens, decreasing the palatal flutter responsible for the sound of snoring. The chemical used is sodium tetradecyl sulfate, which has been used for years to treat varicose veins. Because the procedure requires no special equipment, cost is much less than laser or radiofrequency ablation procedures. While pain may still be an issue in some patients, most patients can recover without need for narcotic pain medication. The procedure itself requires only a topical anesthetic. Like most snoring procedures, more than one treatment may be required.
This procedure was developed at Walter Reed Army Medical Center. Initial study reported a 92% success rate in control of snoring with patients requiring an average of about two treatments. They have recently found the success rate dropped to 75% when patients were interviewed an average of 19 months after treatment. This is probably due to softening of the initial palate scar, but patients can improve again with subsequent procedures, and 95% reported they would be willing to have the procedure performed again.
Complications of injection snoreplasty include painful recovery, transient swelling of the palate, palatal ulceration, and palatal fistula (a hole developing through the palate). Studies of injection snoreplasty report that ulceration and palatal fistula usually heal without any special treatment. Pain scores averaged 3 on a scale of 0 to 10. Recovery was minimal for most patients in these studies, though some patients might require 3-5 days of recovery if swelling or ulceration causes more discomfort.
Pain can usually be controlled with Tylenol, and some find Cepacol lozenges are helpful. We can provide a prescription for Tylenol with codeine in case it is needed for more significant discomfort.
Injection Snoreplasty is available at Alamance ENT, performed by Dr. Scott Bennett, for a cost of $300 per injection. An initial medical evaluation is required, though the initial exam is usually billable to insurance.