Surgical Treatment for Snoring Cure (www.SnoreCenter.org)
by Dr. Christopher Chang, last modified on
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People are already inundated with information regarding snoring from TV commercials to internet medical websites. Such advertisement for the snoring cure is exemplified by the ads found even on this webpage (look below).
The purpose of this article is to provide information in hopefully a different and more common sense way approach so that one understands where snoring is coming from and what can be done about it.
Snoring is a noise (obviously!) produced by a person while they sleep. What you may not realize is that the noise production is actually an orchestra of sounds from different regions of a person's airway from the tip of the nose to the windpipe.
SO, for one given snoozing person, their particular snore may be the result of:
- 10% deviated septum
- 20% back of nose vibrating
- 10% sides of throat vibrating
- 20% uvula and palate vibrating
- 40% tongue vibrating
- 100% TOTAL
Whereas another person's snore may be the result of:
- 60% deviated septum
- 20% enlarged turbinates
- 5% cheeks vibrating
- 5% lips vibrating
- 10% uvula and palate vibrating
- 100% TOTAL
For this last individual where 80% of the snore is due to the deviated septum and turbinate hypertrophy, over the counter solutions such as Breathe Right Nasal Strips, nasal dilators, and nasal decongestants may help, but definitely would do little to improve the first person's snoring which is mostly due to tongue vibration which may be helped by a mandibular advancement device (MAD), tongue sleeve (aka tongue suction device or TSD), or eXciteOSA device. Watch a video of how a MAD or TSD device works.
Because of this variability in anatomic sources of snoring, treatment is not easy or straightforward. Many of the surgical procedures performed attempt to alleviate snoring by either removing the problem (ie, UPPP removes the uvula & trims the soft palate; septoplasty corrects the deviated septum) or scarring the tissues so they won't vibrate as easily (somnoplasty, elevoplasty, or pillar procedure). That said, for most people if they do not have any nasal obstruction, most of the snoring originates from the uvula/palate and/or base of tongue region. If you are able to imitate the snore while sticking out the tongue, the snore is most likely from the uvula/palate.
Sample Uvula/Palate Snore #1
Sample Uvula/Palate Snore #2
Sample Tongue Base Snore
Fortunately, surgical treatment to significantly reduce and even cure snoring due to the uvula/soft palate may be accomplished by in-office, outpatient, unsedated procedures (ie, you can drive yourself to the procedure and drive yourself back home immediately afterwards). Such procedures include:
- Uvula Excision (aka, uvulectomy): When the uvula is particularly long, removal does appear to reduce and even eliminate snoring in many people. This procedure is performed under local in the office without any sedation and takes about 5-10 minutes to perform. Click here for more info.
- Injection Snoreplasty: This procedures involves a single injection of a sclerosing agent to the area right above the uvula. A sclerosing agent causes the tissue to scar which shortens and stiffens the palate reducing the snore. This is the least expensive option for snoring. 50% of patients may require a 2nd injection for optimal results. Click here for more info.
- Elevoplasty: Elevoplasty is a procedure to treat primary snoring due to isolated soft palate vibration. This procedure is accomplished by inserting 3 absorbable barbed sutures into the soft palate which allows the soft palate to be both lifted as well as stiffened. The sutures are slowly absorbed by the body over 6 months leaving behind scar tissue to help maintain soft palate position and stiffness. Watch video.
- Soft Palate Adjustment (Our office no longer offers): There are 2 ways to "adjust" the palate to prevent it from vibrating and thereby reduce snoring. If the palatal structure is elongated, we advocate use of coblation palatoplasty which both reduces the size of the palate and uvula as well as promotes scarring which stiffens and therefore minimizes unwanted vibration leading to snoring. The ideal candidate is a patient with a large and thick soft palate. This procedure is performed under local in an office setting. No sedation is required and there is minimal downtime. The downside is that this procedure may need to be repeated up to 3 times. Another procedure which may be helpful is the pillar procedure which involves inserting three tiny woven polyester implants into the soft palate. These Pillar palatal implants, together with the body’s natural fibrotic response, add structural support and stiffens the soft palate, thereby minimizing or eliminating the palatal tissue vibration that can cause snoring. This procedure is also performed under local in an office setting without any sedation.
- eXciteOSA: This device is a FDA approved DAYtime treatment for patients suffering from primary snoring or mild obstructive sleep apnea (OSA). This device is an intra-oral neuromuscular stimulator which is used 20 minutes per day for 6 weeks followed by twice a week resulting in significant reduction in mild OSA and snoring scores. Click here for more information.
However, even with these maneuvers, snoring may not completely go away as snoring is due to many different other levels of the airway (ie, tongue vibration, nose vibration, cheek vibration, throat vibration, etc). Regarding the tongue base snore, the eXciteOSA device as well as an oral mandibular advancement device (MAD) are really the only simple options (second audio clip above). MAD devices can be obtained from a dentist or over-the-counter. Surgical options are high risk and outlined here. Check out our online store on over-the-counter snore products here.
Often, sleep endoscopy will be recommended in order to help determine the source of a person's snore more definitively.
Another issue to keep in mind is that snoring is considered a COSMETIC problem and as such, any procedures used to treat snoring surgically will be an out-of-pocket expense for patients. Cost is variable depending on the treatment but may be anywhere from a few hundred dollars to over $1000.
However, snoring may be due to an underlying medical condition like obstructive sleep apnea (OSA) for which treatment IS covered by insurance. Treatment for OSA often helps snoring as a bonus side effect. In order to determine if a person's snore is due to OSA, a sleep study needs to be performed which can only be prescribed by a physician. Watch the video below to see how a sleep study is performed at a sleep center.
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