Further Treatment of Sleep Apnea

If left untreated, sleep apnea can lead to high blood pressure, cardiovascular disease, stroke, memory problems, weight gain, impotency, headaches and daytime fatigue leading to job impairment and motor vehicle crashes. Patients can also take certain steps to handle symptoms of sleep apnea and snoring on their own, including losing excess weight and sleeping on their side. For those who experience heavy snoring, and possibly sleep apnea as well, there are several other treatment options available depending on each patient’s individual case, including nasal sprays to keep the nasal passages open at night, mandibular repositioning and tongue-retaining devices, and oral appliance therapy such as the SomnoGuard. The SomnoGuard has been recognized by the FDA and most insurers to be a safe and reliable option for many patients suffering from mild to moderate OSA (AHI <30). It is fitted with a single in-office custom fitting procedure. While treatment often begins with conservative techniques, many patients require surgery in order to effectively treat their condition.


Surgery for snoring and sleep apnea aims to stiffen or remove the excess tissue from the nose or throat that is contributing to these conditions. This can be done through procedures such as:

Injection Snoreplasty is a treatment for snoring

This procedure is not typically used to treat sleep apnea. It is for patients whose snoring comes from vibrations in the upper palate. This procedure injects a hardening agent called sodium tetradecyl sulfate into the upper palate that eventually helps to reduce the volume and frequency of snoring. The agent creates a blister just in front of the uvula, and when the blister hardens a few days later, it pulls the uvula forward to open up the airway and stiffens the palate to reduce snoring vibrations. Injection snoreplasty can be repeated if desired results are not reached with the first injection.


Uvulectomy

This procedure involves removing the uvula, which hangs from the rear of the mouth, to stop vibration and snoring. It can be performed under local or general anesthesia.

Uvulopalatopharyngoplasty (UPPP)

This procedure involves removing tissue from the rear of the mouth, as well as removing the tonsils and adenoids to stop vibration and snoring. UPPP is performed under general anesthesia.


Pillar procedure

The Pillar Procedure places three tiny implants into the soft palate to gradually stiffen it and keep it from constantly vibrating. This is done through a one-time, minimally invasive procedure that takes about 20 minutes in the office. The procedure does not remove any tissue and is typically painless with a very low risk of complication.


Turbinate reduction surgery

This shrinks the turbinates in the nose in order to alleviate chronic nasal congestion and nasal obstruction by reducing resistance to air flow through the nose. The turbinates are small curved bones that extend horizontally along the wall of the nasal passage. There are three sets of turbinates within the nose (inferior, middle and superior), which humidify and filter the air that is inhaled through the nose. The turbinates are useful in protecting the body against infections and irritants within the inhaled air and effectively direct the flow of air.

The inferior turbinate fills the lower portion of the nasal airway and can become very swollen in response to allergies or infections. Enlarged turbinates can cause difficulty breathing, chronic nosebleeds and chronic sinus infections as a result of airway obstruction.

When a patient’s turbinate is abnormally large and does not respond to traditional therapies such as antihistamines, steroids, or antibiotics, surgical intervention may be recommended. Surgery aims to reduce the size of the turbinates while maintaining their function and relieve symptoms such as nasal drainage and post-nasal drip. This procedure may also affect conditions such as headaches, snoring and sleep apnea. During turbinate reduction surgery, an endoscope is inserted through the nostrils to provide visual access to the turbinates, resulting in no visible incisions on the outside of the nose. An incision in the turbinate is then made to remove a small amount of excess bone or mucous membrane. Turbinate reduction is often performed in conjunction with a Septoplasty to also correct a deviated septum.


Septoplasty

A deviated septum is a common condition that involves a displacement of the septum, the wall that separates the nostrils, to one side of the nose. In adults, the septum is made of cartilage and bone, and helps to support the nose and the mucous membranes of the nose. About 80 percent of people have a deviated septum, which can occur as a result of an injury to the nose that knocks the septum out of place (such as after a car accident, direct sports contact or from tripping or falling on an object). Some patients are born with a deviated septum that occurred during fetal development. This condition makes one nasal passage smaller than the other, which can affect breathing if the displacement is great enough.

Patients with a severe deviated septum may experience nasal congestion, nosebleeds and frequent or recurring sinus infections as a result of their uneven nasal passages. Difficulty breathing and other symptoms are usually worse on one side of the nose than the other. This condition can also lead to facial pain, headaches and postnasal drip, which can significantly affect a patient’s quality of life. Those with only minor displacement may not even be aware that they have a deviated septum and experience no symptoms.

A deviated septum can be diagnosed through a simple physical exam in which a speculum and bright light open up the nostrils to allow for a thorough visual evaluation.

Surgery involves a procedure called a septoplasty to reposition the septum in the center of the nose. During the septoplasty procedure, an endoscope is inserted into the nose through the nostril to provide visual access to the septum. A small incision is made in the septum to separate the mucosa and adjust the underlying bone and cartilage to reposition it in the center of the nose. The mucosa is then replaced over the septum. This procedure is performed under local or general anesthesia and usually takes 60 to 90 minutes on an outpatient basis.

The results of the septoplasty procedure are permanent, but may take up to a year to become evident, as the cartilage and bone of the septum tend to heal slowly. Many people experience significant improvements of the symptoms caused by their deviated septum. Results may vary depending on the severity of the deviation. In some cases, the tissue may gradually move again over time and patients may require a second septoplasty procedure in order to once again relieve symptoms.

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