Surgery for snoring

UPPP usually involves removing the uvula and pharyngeal arches, partial removal of the soft palate and sometimes the tonsils. This procedure is performed under general anaesthetic. Research indicates that UPPP is often complicated by severe post-operative pain. Additionally there may be some long-term complications such as nasopharyngeal regurgitation, persistent palatal dryness, long-term voice changes and a partial loss of taste. UPPP is the only procedure that increases the width of the oropharynx. It has been shown that this could be useful in patients who palatal obstruction is caused by the side walls collapsing against each other.

LAUP is performed under local or general anaesthetic and is considered to be a safer, more economical and a more comfortable alternative to UPPP. It involves vaporising the free edge of the soft palate and uvula using a laser. Unlike UPPP, LAUP can be repeated in order to obtain the desired effect. The number of procedures needed varies with some patients requiring up to four sessions. The tonsils are not removed with this procedure. Although laser surgery is associated with fewer complications than UPPP, post-operative pain is still reported as being severe.

In clinical trials that compared UPPP with LAUP, there was no significant difference in post-operative pain between the two. Postoperative pain peaked anywhere from 3 to 9 days after surgery and usually resolved within 2 weeks. Because of the severe postoperative pain LAUP negatively affects the patient compliance and unlike UPPP patients who undergo the procedure only once, LAUP patients often have to undergo the post-operative severe pain several times. As with UPPP the success rate from this type of surgery is not high and research indicates that 2 years after the surgery only 55% if patients report that their bed partner is satisfied with the outcome. One disadvantage of LAUP is that it is difficult to perform on patients who have a strong gag reflex.

CAPSO or electrical cautery, burns the palate causing fibrosis and consequent stiffening of the soft palate. It is also used a means to remove a longitudinal strip of mucosa along the soft palate or uvula. This procedure is performed during a single out-patient visit under local anaesthetic. Because this procedure is less invasive than UPPP or LAUP there are generally fewer complications, however post-operative pain is similar to the other surgical methods. Data now available shows that the short-term efficacy is also similar to that of UPPP and LAUP. As with LAUP, CAPSO can be repeated until the desired effect on the snoring is gained.

Radio-frequency ablation is designed to shrink redundant tissue of the soft palate. The treatment involves heating the inner tissue to 85ºC which results in the tissue beneath the skin being scarred. Somnoplasty is minimally invasive and creates controlled lesions that have little effect on surrounding tissues. The procedure takes about 20 minutes, can be performed in an outpatient clinic and does not carry the same complications as the other procedures. However, this is still a relatively new procedure and some surgeons prefer to perform the procedure under general anaesthetic. Somnoplasty generally requires the patient to undergo several treatment sessions but unlike the other procedures is much less painful. The applications of Somnoplasty are expanding and to date it is useful for turbinate and palate-based snoring.

Interestingly, one study reported that the chance of success from somnoplasty was considerably less in subjects with a Body Mass Index (BMI) in excess of 30, i.e., obese patients. Another study reported that 7 of 11 patients who underwent somnoplasty was dissatisfied with the procedure, stating that although there had been a moderate benefit it was not as good as expected.

In Germany, trials have recently been undertaken to reduce the tongue as a treatment for tongue-base snoring and obstructive sleep apnoea. Results however were not encouraging. These trials were conducted on a very small number of patients. Despite improvement in daytime sleepiness and subjective snoring levels after an average of 3.4 treatment sessions per patient, only 33% reported success.

The method of injecting a chemical into the soft palate known as ‘Snoreplasty’ is not well recognised in the UK as an effective method of treating snoring. This method has been used in the past and was found to be unsuccessful and ineffective. The chemicals used to inject the soft palate are similar to those used for removing varicose veins and they work by destroying the injected tissue. However, the exact amount of chemical needed for effectiveness has not yet been established. If too much chemical is used it will destroy surrounding tissue unnecessarily. If too little chemical is used the treatment will be unsuccessful. The research to date is unconvincing as this method has been tried on just 27 patients whose snoring levels were only 11 decibels at the outset. Many of the patients relapsed after 1 year as the scar tissue softened.

Septoplasty is a surgical procedure that straightens a deviated nasal septum. The nasal septum is the wall of bone and cartilage that separates the nostrils.

A minimally invasive surgery where a doctor inserts three small, woven polyester implants into the soft palate to stiffen the tissue, reducing vibrations that cause snoring by providing structural support.