Injection snoreplasty is a well proven and innovative technique for the treatment of snoring. It involves a submucosal injection into the soft palate of a sclerosant (scarring agent), which leads to stiffening of the soft palate. The procedure is done here in the rooms under local anaesthetic and we use a gargle and injection into the hard palate to numb your throat. The procedure takes 20 minutes or so and we typically perform these injections on a Thursday, with the patient back at work on the Monday. There is some discomfort with the injection and simple pain relief medications are prescribed. Some pain is common for up to 2 weeks after injection.
During the procedure, 2mls of Fibrovein are injected into the area above the patient’s uvula. Often people complain of a “golf ball” sensation at the back of the throat, but typically this lasts for less than 24 hours. The injected area can form a painless ulcer or change colour but then heals back to normal after 4 weeks. The palate is stiffer and less floppy, and the full effect on snoring is usually present by 8 weeks, which is when the patient is reviewed.
Depending on the change in snoring achieved, some patients require a second injection, which involves two separate sites slightly higher up from the first injection. Snoreplasty is the cheapest surgical option for the right patient.
RF treatment is a new technology using radio waves to induce a thermal injury below the surface of the lining tissue in the soft palate, nose, and the base of tongue. This thermal injury to the tissue leads to shrinking and scarring, which creates a smaller stiffer site. In the throat this leads to less collapse during sleep (snoring, OSA) and in the nose it leads to a more open nasal airway. We now are using the Celon System by Olympus (http://www.celon.com/eng/index.php). I have this in my rooms as well as in the private hospitals for use under either local or general anaesthesia. I was the first surgeon to be able to use this technology in ENT in New Zealand, and have spoken at several international and domestic meetings on OSA and snoring surgery about the technology, as well as choosing the right techniques for the specific situations of different patients.
RF treatment is often done to the soft palate and nose and occasionally the tongue base here in our minor procedures room at Specialists at NINE. It costs more than snoreplasty and the initial cost includes the handpiece, which you get to keep and can be used again if needed. “Top up” treatments may be necessary but are inexpensive. The pain is usually less than snoreplasty and the procedure can be repeated more times as necessary.
Surgery to the soft palate such as uvulopalatopharyngoplasty (U3P) and tonsillectomy have very high success rates for control of snoring, often quoted as greater than 80% for the right patient. The effect lasts longer than snoreplasty or RF, but there can be a drop in effectiveness over 10-20 years. I use a modified Z-plasty technique for most surgeries, but also palatal expansion techniques which have a higher success rate than classical U3P and create less pain.
Tongue base RF can be done at the same time using Coblation or Celon techniques to further improve the chances for success. Surgery involves usually 1-2 days in hospital and 1-2 weeks off work. This procedure is expensive, although if you have Obstructive Sleep Apnoea (OSA) then the surgery may be covered under your health insurance. Snoreplasty and RF are designed for the control of simple snoring, and these are usually not covered by medical insurance, but are certainly cheaper than surgery. These treatments are also performed out of hospital and have a minimal impact on your work.
Snoreplasty and RF are only effective if the bulk of your snoring is caused by palatal flutter. 80% of simple snoring is caused by palatal flutter, with other causes such as large tongue base and floppy laryngeal cartilages being less common and much harder to treat surgically. Snoreplasty and RF are not very effective in moderate or severe OSA, and should be used with caution in these situations. I recommend that every person with loud snoring and daytime tiredness undergo overnight airflow studies (level IVA or Level III) to help determine what spectrum of sleep disordered breathing they are in before commencing a treatment protocol, as overnight oximetry (basic level IV studies) are usually not enough for me to decide what treatment may suit you. Airflow studies can be coordinated through my rooms before or after your initial consultation to see whether you are a candidate for the procedure, or contact CANSLEEP on 03 3795060.