In our previous post we discussed about the home remedies for snoring. In this, we shall see- what are the surgical options for treating sleep apnea. Sleep surgery is a highly evolved branch of sleep medicine under the purview of otolaryngologists (ENT specialists). It includes a variety of skillful surgeries addressing the airway, neck, throat and nose tailored to the patient’s needs.
Who needs Sleep Surgery?
Usually we recommend surgery when other modes of treatment fail. In patients of sleep apnea, when behavioral changes and CPAP fail, we explore if surgery will be beneficial. In others CPAP may produce a lot of discomfort that the patient prefers to go for sleep surgery. Some individuals suffer from anatomical problems in their aupper airways, which may not be amenable to conservative methods of treatment. For instance, take the case of a 30 year old young man, fit and having a normal BMI, but complains of snoring. Clinical evaluation reveals completely blocked nose due to septal deviation and enlarged tonsils. He clearly needs sleep surgery to address the problems in anatomy. Talk to your sleep physician if you are unsure about what’s the best treatment option for you. Or if you are not satisfied with the current treatment.
I would like to tell the readers that, sleep surgery is not a substitute to regular exercise, weight loss and other conservative methods. You must maintain a healthy lifestyle incorporating lot of cardio exercises and a well balanced nutritious diet so that you succeed. You must understand that the fight against snoring and sleep apnea is multifaceted.
What tests are done before going for surgery?
Before your surgeons considers surgery, he will want to check a few things. Two tests are of special interest here. One is MRI scan of tongue base and neck. The next is Drug Induced Sleep Endoscopy (DISE).
MRI
This test doesn’t involve any radiation (unlike a CT scan or X-Ray). It helps the surgeon understand the girth of tissues in the area concerned. The scans can reveal the volume and diameter of tongue base. Additionally, MRI lets us calculate various distances inside our airway and assess where there could be obstruction. The disadvantage of this test is that, it is an external assessment. During the test, the patient is awake and hence doesn’t simulate the actual scenario.
DISE
This is a simple test. We inject an intravenous sedatives, like propofol or dexmed, and the patient sleeps. We wait for him to start snoring. Next, we insert a thin flexible tube having camera and light at one end into his nose. We visualize the nose, back of nose, palate, tonsils, back of mouth, tongue base, epiglottis till the vocal cords. Because the patient is actually snoring we are able to see the exact level of obstruction. Additionally, we get details about the severity of obstruction. Accordingly we tailor the surgery as per the needs of the particular patient. The test is done in the presence of an anesthetist.
Types of Surgeries Done for Snoring
Once we ascertain the level and severity of obstruction, we chalk out the surgery and discuss with the patient. Based on the level we have the following options.
Nasal Surgeries
Correction of deviated nasal septum and reduction of the size of the turbinates are two important surgeries to relieve nasal obstruction. ENT specialists perform septoplasty and turbinoplasty in the same sitting under general anesthesia. It will involve an overnight stay in hospital. Your doctor may place a nasal pack to arrest bleeding. He will remove the pack on day 2 of surgery usually. In our practice, we put a self absorbing nasal pack which doesn’t have to be removed. Such a pack prevents infection as well.
Palate Surgeries
Surgeries which reduce the size of palate and increase oropharyngeal airway are the mainstay in the surgical treatment of snoring. Tonsil removal (Tonsillectomy) along with reduction of uvula, palate and sidewalls of pharynx (uvulo-palato-pharyngoplasty) remove obstruction at mid level of throat. The surgery can be accomplished using coblation, radiofrequency and laser. Alternatively, you can try palatal implants which reduce the vibration of palate. Talk to one of our experts to know the relative advantages and disadvantages of each. These surgeries involve some amount of post operative pain.
Base of Tongue Surgeries
To find out if you are a tongue base snorer click here. While sleeping the tongue falls backward obstructing the airway and causes snoring. We have many techniques to prevent snoring due to tongue base. Removal of lymphoid tissue in the back of tongue (lingual tonsillectomy) and removal of a part of mid part of tongue (partial midline glossectomy) have proved very helpful. Genioglossal muscle advancement and hyoid suspension are two other methods to reduce the tongue base volume.
Others
In some complex cases, where other methods fail, we have done maxillo-mandibular advancement (jaw advancement). It is a successful procedure. Alternately, we provide custom made oral appliances to prevent snoring. In very severe cases, we can make an opening in the trachea so that air doesn’t have to pass through the nose and throat at all (Tracheostomy).
Recent Advances
Office surgeries
With the advent of radiofrequency probes we perform some of the above in the out patient clinic itself. After numbing the tongue and palate we pass radiofrequency by dipping the RF probe into the tissues. This brings in fibrosis of the lax tissues.
Robotics
Approaching the tongue base from outside through the neck is tedious and results in scar. However, in robotic surgery, there is no cut outside. We do the same procedure endoscopically with robotic hands through the mouth. Find out more about robotic tongue base surgery by talking to an expert.
Conclusion
Though, we have a plethora of options to address snoring surgically, we carefully choose your treatment plan. It is important to customize the surgery as per the requirements of your anatomy. There are multiple surgical tools, like RF, Coblation, Robotics and Laser to achieve the same result in surgery. But please maintain a healthy lifestyle taking care of your weight and diet, even after your surgery. For comments and feedback, please write to us at feedback@worldENTcare.com.