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New Treatment for Snoring Avoids Postoperative Pain

By William Allstetter

Radio frequency waves applied to the soft palate destroy cells by “cooking” them at approximately 85 degrees Celsius (185 F). Once the body absorbs the dead cells, the soft palate shrinks, which can clear airways and reduce snoring. The procedure can be done in the office and requires no cutting of tissue.
Surgery to reduce or remove tissue that blocks airways can successfully treat many of the most serious cases of snoring. Dr. Jeffrey Ahn, associate professor of otolaryngology/

head and neck surgery, has begun using a new procedure, which uses radio frequency waves to accomplish the same goal. The procedure, known as somnoplasty, can be done in the physician’s office, involves no cutting of tissue, and avoids the postoperative pain that accompanies traditional surgical procedures. Dr. Ahn was one of the first physicians to perform somnoplasty, beginning in the fall of 1997.

Nightly snoring by an estimated 40 million Americans usually upsets bed partners and others within earshot more than it does the snorer. Dr. Ahn has even seen reports of neighbors paying a snorer to move. But the snorer can suffer as well.

“It can be very disturbing to the quality of the sleep,” says Dr. Ahn. As a result, the habitual snorer doesn’t get a good night’s rest and is often drowsy during the day. “It is a significant cause of motor vehicle accidents.”

Snoring also can be a sign of obstructive sleep apnea, in which a person briefly stops breathing many times an hour. Obstructive sleep apnea can have significant health consequences, such as pulmonary hypertension and cardiovascular disease.

A person snores when muscles in the nose, mouth, and throat relax during sleep and tissue blocks the airway. The sound of snoring arises from the flapping of tissue as air is sucked past the blockage, which can occur anywhere from the nasal passages down to the base of the tongue and the tonsil.

There are many treatments for habitual snoring, ranging from mouthpieces designed to keep the airways open to forced-air ventilation through a mask worn during sleep. But many patients consider those appliances a nuisance and often quit using them after a short trial. Many severe snorers end up choosing surgical removal of excess or abnormal tissue causing the blockage.

A procedure known as uvulopalato-pharyngoplasty, or UPPP, is the most versatile kind of surgical treatment that can address the widest variety of problems, says Dr. Ahn. But this traditional form of surgery requires general anesthesia and a night in the hospital. Laser surgery cannot address as many problems but can be done as an outpatient procedure. Both of these methods involve cutting of tissue, bleeding, and significant postoperative pain for seven to 10 days.

Somnoplasty avoids cutting, bleeding, and postoperative pain through the use of radio frequency waves. The waves are applied to a small area through a needle-like instrument inserted into the target tissue. The waves heat tissue to approximately 85 degrees Celsius (185 F), which destroys the cells by “cooking” them. The body absorbs the damaged tissue over the course of three to four weeks. As a result, the tissue shrinks and becomes more rigid as remaining collagen contracts. The procedure can be performed in a physician’s office in about half an hour.

Although somnoplasty has distinct advantages over surgical techniques, Dr. Ahn says it is effective in a limited number of cases. He estimates that less than a third of his patients have problems that can be solved by somnoplasty. Dr. Ahn uses it only for reduction of the soft palate, which is the most common cause of snoring. He has found that somnoplasty is good at thinning the soft palate or uvula, but laser surgery is more effective at shortening it. He sometimes uses both somnoplasty and laser surgery on one patient. By using the combination of treatments, he can often solve a problem with one procedure rather than the two or three procedures often necessary with laser surgery alone.

“Somnoplasty definitely has a role in the treatment of snoring. But it is not for everybody,” says Dr. Ahn. “I am very selective in choosing the patients who are eligible for this procedure.”

Dr. Ahn performs about 40 to 50 somnoplasties per year. He plans to apply for a grant to study how the procedure can be applied most successfully.

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