Treatment of snoring: uvuloplasty and radio wave radiation

According to statistics, about 30% of the entire population suffers from snoring. And if you consider that snoring most often bothers people around them who cannot fall asleep to loud “accompaniments” and therefore suffer from insomnia, we can say that this phenomenon is considered a problem for the majority of the population.

But not only does snoring interfere with sleep for both the snorer himself and his loved ones, this phenomenon also indicates that during the night's rest the sleeper's breathing is disrupted as a result of blockage of the airways. And this, as we know, leads to poor health.

We analyzed patient reviews online and compiled complete information about this type of anti-snoring treatment.

The sound of snoring occurs when the tissues of the nasopharynx and respiratory tract vibrate against each other, which is formed as a result of the passage of air flow through them.

If, during night breathing, air is able to flow freely into the lungs, the body does not experience a lack of oxygen supply to its cells.

If the airways are severely blocked during sleep, breathing stops (apnea syndrome).

This syndrome leads to the fact that the body's systems, internal organs and brain begin to suffer from a lack of oxygen. In order to avoid the unpleasant consequences that arise in case of severe snoring, it is necessary to take measures to treat it.

This can be done in different ways, one of which is a surgical method such as radio wave treatment for snoring. Recently, this treatment has earned not only the recognition of doctors, but also of many patients who leave only good reviews about it.

According to numerous patients, this treatment for snoring is the most effective and least painful method.

The history of radio wave treatment

The possibility of using radio waves in surgery was first discovered in 1970 by the then famous scientists Reber and Maness. They tested the effect of different-frequency currents on the tissues of the human body and experimentally established that waves with a frequency of 3.8-4 MHz are best suited for surgical incisions - they are the safest and most therapeutic.

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When such waves come into contact with the tissues of the oral cavity and palate and cut them, excessive heating of the blood vessels does not occur. As a result, the surgeon performs the operation using the “dry” method. Radio wave treatment of the soft palate, intended to get rid of snoring, was one of the first in otorhinolaryngology.

The essence of radio wave treatment

There are many different reasons why snoring occurs. Most often these are weakened muscles of the soft palate, polyps, rhinitis, curvature of the facial part or nasal septum, adenoids, and obesity.

As you can see, snoring is a serious and common problem that significantly threatens the patient’s health, so it must be solved with the help of a specialist.

Since the most common cause of snoring is weakened muscles of the soft palate, which at the slightest sign of vibration begin to emit an unpleasant sound, it is possible to cope with this phenomenon using the radio wave method. This treatment is based on toning and strengthening the tissues of the palate, and if necessary, changing its configuration, which will increase the clearance in the airways.

This surgical method is performed using weakly directed waves with a frequency of 3.8 MHz. The source of this current is a special medical electrode shaped like a “beak”. Thanks to its use, intracellular fluid evaporates, which does not cause any harm to surrounding tissues and muscles.

Treatment of snoring with radio waves is performed on an outpatient basis, using local anesthesia.

Thanks to this, the operation, which lasts only 20 minutes, is virtually painless, and after an hour the patient is allowed to go home.

However, the next day the person will experience slight discomfort, which usually goes away within a few days. Most often it will manifest itself when swallowing food. Complete healing lasts for 10-12 days.

How is the operation performed?

This modern surgical method allows you to cure snoring and alleviate the patient’s condition aggravated by apnea syndrome in just 1 procedure.

After this method, vibration and holding your breath will disappear on the first night, and snoring will disappear completely after about 2 weeks.

In order for the operation to be successful and without various complications, the doctor must strictly follow certain rules.

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In this case, no special research methods will be required; it is enough to consult a doctor for a professional and complete examination, during which the specialist will conduct several tests.

Only after such an examination can a decision be made to perform the operation using radio waves.

Also, the doctor must understand how the soft palate is structured and how it works. The soft palate not only causes snoring, but also facilitates swallowing food, as well as free breathing through the nose. In contrast, the uvula does not have any special functions - it was formed as a result of the formation of the soft palate during the embryonic period.

Inside the uvula there is an artery, the thickness of which can reach 1.5 mm, so when it is cut off, long and heavy bleeding occurs. Therefore, the doctor should take care in advance to prevent bleeding.

When performing surgical treatment with radio waves, the doctor should try to preserve the functions of the palate as much as possible. In addition, the specialist needs to pull its edge up a couple of cm, so as not to create tightening scars, which often harm patients.

If all these conditions are met when performing this method of treating snoring, then the treatment of night vibration will be the most effective, since it will be possible not only to strengthen the tissues and increase their tone, but also to preserve the functions of the respiratory tract and nasopharynx.

Numerous reviews from patients indicate that during this operation there is no bleeding at all, and the scars that have formed on the soft palate do not interfere with swallowing or breathing.

Due to its characteristics, the use of radio waves does not cause any adverse reactions or complications. These operations are very easy to tolerate and in 80-90% of cases give a positive result. Over the next month, patients should be under medical supervision. If necessary, a repeat operation using radio waves may be scheduled after 8 weeks.

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Benefits of treatment

Compared to other treatment methods, the use of radio waves to get rid of snoring has its advantages.

• A gentle incision of soft tissues, as a result of which only the layer of cells that is affected by the radio wave is damaged.
• There are completely no burns or necrosis of the wound.
• The operation is performed on an outpatient basis, under local anesthesia.
• The duration of the operation is approximately 20 minutes.
• The patient is clearly conscious and does not experience any sensations.
• Rapid healing of the surgical site is observed.
• Most often, one session is enough.
• The risk of complications is minimal.
• Well tolerated by patients.
• Antibacterial and anti-inflammatory therapy is not required.
• The patients' ability to work is not impaired.
• Eating most often occurs as usual.

Thanks to all these advantages, radio wave treatment for snoring has become widespread. It is actively and effectively used in many clinics, because such treatment will relieve the patient from snoring much better than other types of surgical intervention.

Source: https://hrapless.ru/vidy-i-sposoby-lecheniya/radiovolnovoe-lechenie-hrapa-otzyvy.html

Surgical treatment of snoring: features of the operation and its effectiveness

Ronchopathy is a serious sleep disorder that can negatively affect well-being and health.

The problem can be eliminated with the help of gymnastic exercises, medications and special devices. Sometimes such methods turn out to be ineffective and anti-snoring surgery is performed.

After the end of the recovery period, as a rule, unpleasant symptoms completely disappear.

Treating snoring with surgery

In cases where non-surgical treatment for snoring does not give the desired result and interference is detected in the respiratory tract, the doctor decides to perform surgical intervention. During this procedure, the uvula is trimmed, the tonsils are removed, and other tissues that create an obstacle to full breathing are excised.

Anti-snoring surgery is performed to widen the pharynx and increase the density of the laryngeal tissue.

Thanks to this, air begins to penetrate into the lungs without any obstacles. Sometimes after removal of the tissues of the tongue of the palate or tonsils, relief does not occur at all or is observed at all. To prevent this from happening, you need to consider several important points. The intervention will give a good result in the following cases:

• the form of the disorder is mild, vibration of the soft palate and slight weakening of muscle tissue are observed;
• no addiction to smoking;
• weight within normal limits;
• no damage or neoplasms were detected in the nasopharynx area;
• There is no mild or severe sleep apnea.

Types of surgery

Surgical treatment of snoring can be performed in several ways. As a rule, palatoplasty is performed under local anesthesia. This reduces the volume of tissue that impedes the flow of air. The choice of treatment method for uncomplicated snoring depends on a number of factors:

• age;
• the presence or absence of a history of chronic pathologies;
• reaction to anesthesia;
• features of the condition of soft tissues.

Uvuloplasty

This is a plastic surgery for snoring, during which excess tissue on the soft palate is removed and the uvula is shortened. Thanks to this, air begins to flow unhindered. Due to the formation of scars, the tissue becomes denser and stops vibrating.

The procedure is performed under local anesthesia and lasts about half an hour. If it is successful, the person can leave the medical facility after just a few hours. The period of complete recovery does not exceed one and a half weeks.

Uvuloplasty using laser

The operation to eliminate snoring using laser beams is performed on the same principle as conventional uvuloplasty.

The advantages of laser therapy include the following:

• minimal blood loss;
• quick execution of all necessary manipulations;
• the risk of the onset of the inflammatory process is significantly reduced;
• short and virtually painless recovery period.

In this case, the tongue is shortened and excess tissue is excised, and the wounds are immediately sealed.

Uvuloplasty using radio wave frequencies

Surgical treatment of snoring is carried out using high-frequency radiation. Elimination of areas that impede normal breathing is performed locally, without damaging adjacent tissues. Among the advantages of the technique are the following:

• no burns;
• there are no signs of necrosis at the edges of the wound;
• minor blood loss;
• rough scars are not formed.

Uvulopalatoplasty

You can get rid of snoring surgically using this method. They are treated with this method if there are indications for excision of not only palatal tissues and shortening of the uvula, but also other areas:

• laryngeal tissues;
• adenoids;
• tonsils;
• part of the tongue.

In uvulopalatoplasty, the operation is performed using a scalpel, radioknife or laser. After its completion, a significant expansion of the lumen is noted. All manipulations are carried out in a hospital setting. Duration – at least an hour. After this, the person is under medical supervision for a certain period.

Recovery period

After surgical treatment of snoring, the recovery period lasts from several days to a couple of weeks. Rehabilitation is much faster if excess tissue is removed using a laser or radio wave frequencies. The healing process of tissues after classical resection and uvulopalatoplasty is much longer.

During the first 24 hours, the person follows a liquid diet to prevent excessive saliva production and bleeding.

In addition, a three-day regimen of anti-inflammatory medications is prescribed.

Contraindications and consequences

Not everyone can get rid of snoring surgically. There are a number of contraindications to performing this procedure:

• heart pathologies;
• a history of acute diseases;
• malignant tumors;
• period of gestation and lactation.

Before performing the procedure, the doctor should tell you about the possible risks. Sometimes the following complications occur after surgery:

• the onset of bleeding;
• purulent and inflammatory process in the wound area;
• pronounced pain syndrome;
• swelling of the affected tissues;
• feeling drowsy;
• development of apnea syndrome.

Treatment of rhonchopathy is often carried out through surgery. This method of therapy involves excision of tissue that prevents air from entering the lungs. Thanks to this, breathing normalizes and unpleasant symptoms disappear. During the recovery period, a person only needs to strictly adhere to medical recommendations.

Source: https://infson.ru/narusheniya-sna/hrap/operatsiya

Radio wave minimally invasive snoring surgery

A fundamentally new and effective method of treating snoring is radio wave surgery. Tissue incision is carried out using high-frequency radio waves with a frequency of 3.8 MHz. Modern radio wave devices allow you to precisely adjust the depth and power of exposure, which makes them completely safe.

Advantages of radio wave surgery:

• minimally invasive – minimal tissue damage, absence of burns and necrosis (compared to laser treatment);
• painlessness – infiltration anesthesia is sufficient for the procedure;
• minimal risk of complications;
• the possibility of additional exposure to the tissues of the soft palate for 5 minutes if the effect is not sufficiently pronounced;
• fast healing.

Indications

Radio wave surgery is used if snoring is caused by vibration of an enlarged uvula, thickening or decreased tone of the velum palatine, and for some other reasons.

Operation technique

The procedure is as gentle as possible and is therefore performed under local anesthesia. In this case, the patient does not experience any pain. Depending on the cause of the disease, the doctor performs manipulations on the uvula or velum. During tissue incision, the vessels are “sealed”, so there is no blood loss. Typically, the entire radio wave intervention does not take more than 20 minutes.

Rehabilitation

Over the next month, the patient is under the dynamic supervision of a doctor. Recovery is faster and easier than with conventional surgery.

Contraindications

Despite the low morbidity and safety, there are some limitations to radio wave intervention. It is contraindicated in patients with a pacemaker, epilepsy and malignant tumors. In the presence of acute inflammatory processes, it is worth postponing surgery until recovery.

The success of minimally invasive surgery for snoring directly depends on the experience and continuous training of the otolaryngologist in this area. The selection of an individual pharyngeal reconstruction scheme, taking into account the anatomical characteristics of each patient, makes the work of the ENT doctor at the Genesis Clinic Sleep Center as effective as possible.

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Source: https://klinikasna.com/lechenie/radiovolnovaya-maloinvazivnaya-hirurgiya-hrapa

Surgical methods for treating snoring: ultrasonic disintegration (USD), laser treatment of snoring and radio wave treatment of snoring

According to the World Health Organization, more than 30% of the adult population suffers from snoring, and after 60 years, about 60% of people snore. Snoring is a sound phenomenon that occurs when the soft structures of the pharynx beat against each other as a stream of air passes through the narrowed airways.

About a third of all snorers also suffer from sleep apnea syndrome - short-term stops in breathing during sleep. And if snoring mainly causes trouble for others, sleep apnea causes oxygen starvation of the brain, disruption of the heart and blood vessels, leads to strokes and can cause sudden death in sleep.

Obstructive sleep apnea syndrome (OSA) is a disease characterized by snoring, intermittent collapse of the upper airway at the throat level and cessation of pulmonary ventilation (see figure), decreased blood oxygen levels, severe sleep fragmentation, and excessive daytime sleepiness.

Often witnesses to this disease are waking loved ones who watch with alarm as the snoring suddenly stops and a frightening cessation of breathing occurs, then the sleeper snores loudly and begins to breathe again.

Sometimes there can be up to 500 respiratory arrests per night for a total duration of up to 4 hours, which leads to both acute and chronic lack of oxygen and significantly increases the risk of developing arterial hypertension, cardiac arrhythmias, myocardial infarction, stroke and sudden death in sleep.

Patients with breathing disorders during sleep experience restless shallow sleep, sweating and frequent urination at night, fatigue and headaches in the morning, severe daytime sleepiness, irritability, decreased memory and attention, and impotence.

Treatment of snoring and OSA in severe cases consists of overcoming the resistance to air flow from the upper respiratory tract (URT) using the method of continuous positive pressure during inspiration (mask with a CPAP compressor ( method of creating continuous positive airway pressure) or reducing this resistance by surgical expansion of the lumen of the upper respiratory tract.

We choose…

The main thing in the successful treatment of snoring is the correct selection of patients according to a certain algorithm. It is known that brachycephalics and hypersthenics with short necks are susceptible to constitutional snoring and OSA, and they will require surgical correction in the area of ​​the soft palate and tonsils, the lateral walls of the pharynx and the root of the tongue.

In asthenics with long necks, OSA is unlikely, and the cause of their snoring is nasal obstruction, defects of the lower jaw (micro- and retrognathia). Specialist of our Center V.V. Filippov developed a computed tomography technique that makes it possible to obtain a reconstructed section of the upper respiratory tract from the vestibule of the nose to the trachea with clearly visible places of narrowing.

We perform the Müller test, which evaluates the percentage of narrowing of the retropalatal space using a flexible nasopharyngoscope. To assess daytime sleepiness, we use the Epworth Scale (ESS) questionnaire. But the main criterion for selecting patients for surgical treatment of snoring is polysomnography - the “gold standard” for diagnosing snoring and OSA.

We can expect complete success in surgical treatment of patients with pure ronchopathy and mild OSA (AHI up to 20).

No surgical method cures severe OSA, but in these cases, snoring decreases by 20-50 dB, AHI decreases by 10-30, that is, the use of a CPAP mask may not be daily.

Are traditions always good?

All methods have the goal of expanding the upper respiratory tract by removing or reducing the volume of tissue along the path of the air stream (hypertrophied inferior turbinates, nasal polyps, adenoid vegetations, hyperplastic soft palate, posterior arches and uvula, palatine tonsils, lateral walls of the pharynx and root of the tongue) .

Classic “acute” methods (conchotomy, tonsillotomy, uvulopalatopharyngoplasty and uvulotomy, excision of a segment of the root of the tongue) are traumatic, associated with large blood loss, require anesthesia, suturing the palate and nasal tamponade. In the postoperative period, severe pain, dysphagia and hypersalivation make the patient unable to work for at least two weeks.

Possible delayed complications include nasal reflux, overt nasality, and nasopharyngeal stenosis.

In this regard, in the last decade, preference has been given to gentle surgical methods using ultrasound, laser and radio wave devices. In this article we will compare these three methods based on literature, observation and our own experience of radio wave treatment of snoring with the Ellman-Surgitron apparatus.

Alternative Treatment

Ultrasonic disintegration (USD) of the inferior conchae was used by us from 1989 to 1998 and was left as a bleeding and ineffective method for eliminating nasal obstruction. Observing ultrasound somnoplasty and uvolopalatopharyngoplasty in the ENT department of M.G.

Leizerman (LORA-Don apparatus) noted the low power of ultrasound, which was reflected in the absence of a hemostatic effect, large bleeding, and difficulty in cutting tissue. There was no reducing effect with ultrasound somnoplasty.

Thus, ultrasound surgery for snoring appears to be ineffective and associated with blood loss.

Laser treatment for snoring.

In October 2003, a conference on modern laser surgery was held in Moscow, where Dr. Remacle from Belgium presented his wealth of experience in successful laser treatment of snoring, consisting of vaporization, that is, evaporation with a laser beam of limited areas of the uvula, posterior arches, edge of the soft palate, anterior ends inferior conchae and tonsils. Patient selection: snoring and mild apnea. Results: AHI reduction by 20, 70% satisfied patients.

But it is precisely his extensive experience working with laser that allows Dr. Remacle to point out problems and determine contraindications to laser treatment: - small mouth; - increased reflexes (you cannot swallow during the session (!)); - the patient’s place of residence is remote from the hospital (outpatient treatment is contraindicated due to the risk of bleeding). The positive here is the possibility of quick outpatient treatment under local anesthesia, which creates a feeling of simplicity of the method. In fact In fact, this apparent technical simplicity at the high cost of the equipment turns into a difficult postoperative period for the patient, associated with excess laser energy (a temperature of 1200 ° C leads to tissue necrosis with severe pain, halitosis, drooling and the inability to eat for up to one month). While providing assistance to such patients, we had to repeatedly observe abundant white-black necrotic deposits on the palate, trismus, and symptoms of intoxication from an overdose of potent painkillers. We have been carrying out radio wave treatment of snoring on an outpatient basis at CELT since April 1998 using the Ellman-Surgitron apparatus. In 2001 year, already having three years of experience with this device, we studied radiosurgery of snoring at the university clinic of Professor W. Mann (Mainz, Germany), where a radiosurgical monopolar Somnus device with a power of 10 watts with a temperature sensor is used for this, and came to the conclusion that Surgitron is superior it according to a number of parameters: - 15 times less exposure is required; — the ability to vary modes (incision, coagulation); — choice of power depending on the purpose and characteristics of the tissue; - greater depth of penetration of the bipolar electrode in the inferior concha (greater efficiency in the treatment of nasal turbine-dependent obstruction). Wolf Mann performs thermal reduction of the soft palate with three injections of 500 - 750 J each, palatine tonsils with 2 - 4 injections each, sometimes the lateral ridges and side walls of the pharynx and 6 - 7 injections of 1000 J in a diamond shape - into the root of the tongue. The total dose to the tongue is 6000 - 8000 J, the total dose is up to 12000 J. Impact on all zones in one session, under anesthesia. When selecting patients, a body mass index of no more than 27-30 and an AHI of up to 40 are taken into account. Results: a decrease in AHI by 19% and a visual decrease in tissue by 50% after one treatment session. In order to “find a common language” with the data of European studies, taking into account the given parameters of Surgitron and the fact that 1 J = 1 W * 1 sec, we present the following tables.

Table 1. Ellman-Surgitron power in various operating modes (W)

Instrument scale value	MODE
I cut	II incision + coagulation	III coagulation
1	8	4	2
2	20	12	6
3	34	22	10
4	50	35	16
5	63	46	21
6	72	54	26
7	78	60	28
8	82	64	32
9	86	68	34
High	88	72	36

The biological effect of a radio wave depends on the amount of heat absorbed by the tissue and the size of the propagation halo. Absorbed heat is proportional not only to power and exposure, but also to the thermal conductivity of the tissue, that is, mainly from the fluid content in it, so a creative clinical assessment of the situation during the operation is necessary here: the degree of edema, blood filling, moisture of the mucous membrane. No two noses and velums are alike, so a one-size-fits-all approach to choosing exposure power seems wrong to us. We must monitor the color of the mucous membrane, preventing it from whitening, but when removing the bipolar electrode from the lower concha in case of excessive blood filling, or the patient’s blood pressure is high, we hold the tip of the electrode for 2-4 seconds or increase the power by half a division until spot whitening of the mucous membrane in place when the electrode leaves the front end (sometimes a click is heard): the mucous membrane seems to be welded and bleeding does not occur. Conducting experiments on animal tissues, we noted that the heating area depends on the waveform. Thus, a partially rectified wave (coagulation) slowly spreads heat over a large area, and a fully rectified wave (cut + coagulation) gives a rapid tissue-reducing effect, as if concentrated heat in a limited area along the electrode line. For 6 years we have been using the “cut + coagulation” mode on the lower shells, in contrast to the “coagulation” mode recommended by Ellman. In accordance with Table 2, choosing a power of 2.5-3 and an exposure of 10-15 seconds, we get the same amount of heat as Ellman, but this heat is not distributed slowly and widely, warming up and “steaming” the entire lower shell, which would give prolonged postoperative edema, less hemostasis and, possibly, affect the contractile function of the remaining vessels. Linearly, along the course of the electrodes, closing part of the capillaries, we leave intact the mucous membrane and bone of the turbine, which decreases in volume literally before our eyes.

Table 2. Radio wave reduction of the inferior shells. Calculation of the amount of heat absorbed by tissues depending on exposure and mode of the Ellman-Surgitron apparatus.

Surgitron mode	Power level (meter scale)	Power, W)	Exposure (sec)	Absorbed heat per shot (J)	Total heat for 1 lower sink4 injections (J)
III coagulation (Ellman)	3	10	10-15	100-150	400-600
4	16	10-15	160-240	640-960
II coagulation + incision (our experience)	2.5	17	10-15	170-255	680-1020
3	22	10-15	220-330	880-1320
4	35	10	350	1400

We performed 862 radio wave thermal reductions of the lower conchae, of which 17 repeated procedures were required during a 5-year follow-up, which significantly exceeds the average statistical indicators. The age of the patients is from 8 to 67 years, including those with cardiovascular pathology (2 patients after coronary artery bypass grafting (CABG), with stage 1-3 obesity, VSD and mentally labile. The operation was well tolerated, there were no bleedings. Patients leave the office after 10 minutes after completing the procedure, breathing through the nose.There was no need for anterior nasal tamponade.

All patients noted normalization of nasal breathing no more than two weeks after surgery (usually after 2-7 days). Within a period of up to one month, mouth breathing stopped at night, the volume of snoring decreased or disappeared completely.

Radio wave for snoring!

The first stage of snoring treatment is radio wave turbine and somnoplasty with 7-8 injections into the sky. After one month, we evaluate the result: simple snoring stops in 30%, in which case we conduct subsequent somnoplasty sessions every 1.5-2 months until the patient is satisfied.

No patients reported any pain after somnoplasty. According to indications, we perform uvulotomy and uvulopalatoplasty. I would like to emphasize the need to follow the technique: make vertical incisions in the palate upwards 0.5-1.5 cm lateral to the base of the uvula 0.2-1.0 cm.

on both sides, then cut off the tongue above its base and form a small “new” tongue.

For uvulotomy, we use an insulated jigsaw electrode in the “cut + coagulation” mode, power 3.5-4.0. With a thin palate, a universal cutting wire electrode is convenient in the same mode, power 2.0-2.5, if necessary, coagulating with a small button electrode, which gives a gentle cut and a smaller whitening strip of no more than 1.5-2.0 mm.

In order not to increase the thickness of the palate and uvula, anesthesia is performed with five injections of 0.5% Marcain or Scandonest solution along the border with the hard palate, at the site of the exit of the palatine nerves. With each repeated session, we take into account the structural features of the palate, uvula and tonsils, gradually reducing their volume.

We reduce palatine tonsils in two ways: - with deep multiple lacunae, we coagulate them with a small button electrode in the “coagulation” mode with a power of 3-3.5, starting from the bottom of the lacunae, which gradually become less and less deep, the surrounding tissue is tightened around them.

You cannot immediately close the mouths of the lacunae to avoid the formation of retention cysts; — with a smooth parenchymatous structure of the tonsils, we coagulate them with 2-4 injections into the thickness with a needle electrode or a “beak” electrode for somnoplasty, selecting the power and exposure individually, avoiding tissue whitening. We have performed somnoplasty - 212, tonsil reduction - 41, uvulopalatoplasty and uvulotomy - 43. We perform somnoplasty with 7 injections, power 4, coagulation mode. The sky receives heat of 1100 - 1700 J, which corresponds to the method of Professor W. Mann (see Table 3).

Table 3. Calculation of the amount of heat absorbed by the tissue depending on the exposure and mode of the Ellman-Surgitron apparatus

Work mode	Methodology	Power level (meter scale)	Power, W)	Exposure(sec)	Absorbed heat per 1 shot (J)	Total heat per sky (J)
Coagulation	Ellman	3.5	13	20	260	2 injections 520
Coagulation	Our experience	4	16	10-15	160-240	7 injections 1120-1680
Coagulation	Option	5	21	10	210	1470

Source: https://www.celt.ru/articles/art/art_72.phtml

Laser and radio wave treatment of snoring: fairy tale and reality

In these recommendations for upper airway surgery for obstructive sleep apnea, it was determined as the standard (standard - the highest level of evidence) that laser uvulopalatoplasty (LUPP), i.e. Treatment of snoring with laser radiation should not be carried out in patients with OSA.

In 2001, this item was advisory in nature, and since 2010 it has become mandatory.

All patients should be evaluated and diagnosed for obstructive sleep apnea (OSA) before undergoing palate surgery.

Laser treatment for snoring is contraindicated in patients with obstructive sleep apnea, so all patients should be tested to exclude the presence of this disease.

That is, if you have problems with snoring, but you do not know whether you have OSA, surgery cannot be performed without preliminary diagnosis !

Reasons for ineffective surgical treatment

The question arises, why does laser treatment for snoring not give the expected results in many patients? Most likely the problem is the following:

1. Incorrect assessment of the cause of snoring . A common cause of snoring and sleep-disordered breathing is obesity, which narrows the airways themselves (Figure 1). Snoring can be caused by smoking, difficulty breathing through the nose, enlarged tonsils, neuro-dystrophic processes, etc. And one person may have two or three reasons for snoring.

                             

Figure 1. A - normal airways; B - airway of an obese patient (Schwab RJ Airway imaging // Clinics in Chest Medicine, 1998; 19: 33-54).

2. The severity level of obstructive sleep disordered breathing may be misdiagnosed.

If the snoring is weak, then the airways remain open and the soft palate vibrates, and because of this the person snores (Figure 2B). In this case, surgery may provide some benefit.

But if OSAS is moderate, then obstruction can occur not only in the palate, but also at the level of the root of the tongue and even the epiglottis (Figure 2B).

                                                          

Figure 2: A - free breathing; B - airways are narrowed; B – the airways have completely subsided (National Primary Oral Health Care Conference, 2005, Atlanta, Georgia).

Do not forget that operations on the soft palate are irreversible . If the intervention is unsuccessful, it is almost impossible to correct or redo something.

Can promises be trusted?

There are medical centers that encourage palate surgery to cure snoring. But at the same time, they do not conduct preliminary diagnostics , for example, polysomnography or other studies that allow diagnosing sleep apnea.

Most operations for snoring on the palate are carried out without a preliminary full examination of the patient’s breathing during sleep.

Sometimes you can hear that they treat sleep apnea, although this is completely contrary to international standards .

Surgery for snoring on the palate without research may at best be simply ineffective, but sometimes it can lead to tragic complications.

In Israel, for example, all ENT centers are required to first fully examine the patient’s nighttime sleep, and only after that decide on the possibility of surgery. Studies are also carried out after laser treatment for snoring.

Unfortunately, in our country, standards of this kind have not yet been adopted at the state level, but every otorhinolaryngologist must treat his patients responsibly He needs to independently decide whether it is advisable to treat snoring and sleep apnea with laser or radiofrequency.

Each specialist must be based on knowledge, clinical experience and remember the main thing - “Do no harm!”

The studies themselves are quite labor-intensive, and therefore many centers take risks and do not conduct the study , but rely only on the story of the patient, his family and on a clinical examination, which is carried out during the day. Therefore, diagnostic errors are often made.

Sometimes patients themselves may refuse polysomnography in order to save money.

Terminology

Selective surgical interventions on the palate include techniques such as surgery, laser plastic surgery, radiofrequency plastic surgery, injection methods and cryoplasty.

The above methods are based on the principle of causing trauma to the palate of varying intensity . During healing, the soft palate usually decreases in volume and thickens. The uvula is partially or completely removed.

Thus, snoring can be eliminated or reduced, because the mobility of the structures of the soft palate is reduced. 

The attitude of specialists towards selective interventions on the pharynx

Sometimes advertisements present laser treatment as the most effective treatment for snoring. And it seems that curing snoring is quite quick and simple.

But in reality, the solution to the problem of snoring is not so obvious.

We are often approached by patients who continue to snore, despite the fact that they previously treated snoring with laser and radiofrequency, which turned out to be ineffective.

Foreign experts are critical of selective interventions on the pharynx in patients with snoring and sleep apnea:

• There is low or no effectiveness of laser treatment for OSA [Arch. Otolaryngol. Head Neck Surgery, 1997]
• LUPP may be accompanied by pain. There are no significant differences in postoperative pain between LUPP and uvulopalatopharyngoplasty [J. Otolaryngol., 1997].
• LUPP can lead to various complications. Sometimes LUPP provokes the development of OSA in patients with uncomplicated snoring or aggravates existing OSA. [Am. J. Resp. Crit. Care Med., 1997].

The effectiveness of laser treatment for OSAS

You can only be healed miraculously in the movies; in life, everything is not so simple.

According to large foreign studies, it has been proven that laser treatment can be effective 80% in less than 50% of cases for mild apnea, and in less than 20% of cases for moderate sleep apnea.

The patient must be warned that polysomnography or cardiorespiratory monitoring will clarify the diagnosis.

And the patient himself must decide whether he needs additional expenses for a diagnostic study or whether he agrees to surgery on the palate, but without a guarantee that this will help .

But often no one informs patients about the additional and necessary research, and they take a certain risk without knowing it. Although useless and sometimes dangerous surgical interventions could have been avoided, with proper examination and if an accurate diagnosis of obstructive sleep apnea syndrome (OSA) . With such a diagnosis, it is impossible to get rid of snoring immediately; this requires time and quite serious treatment methods (you need to lose weight or carry out assisted ventilation during night sleep - CPAP therapy).

Often, after ineffective laser uvulopalatoplasty (LUPP), which did not produce any results, patients are assured that nothing can be done and are not told about the possibility of CPAP therapy, which is the most effective treatment for severe OSA.

It cannot be said unequivocally that laser or radiofrequency treatment is ineffective. In cases of uncomplicated snoring, when its cause is the soft palate or uvula , such treatment gives good results. But before carrying out this type of operation, it is necessary to carefully study the patient’s breathing during sleep, give an accurate diagnosis and select treatment depending on the severity of snoring and sleep apnea.

This may include laser treatment, radiofrequency intervention on the palate, the use of intraoral applicators, surgical or classical techniques for restoring nasal breathing, CPAP therapy, smoking cessation and a number of other techniques. Weight loss is also a possible treatment for snoring and sleep apnea . Sometimes, after losing 5-7 kg of weight, a person no longer snores.

Snoring is a symptom. Snoring may be uncomplicated or may be a symptom of severe OSA. There are more than a dozen causes of snoring. The choice of treatment method depends not only on the causes of snoring, but also on the severity of sleep-disordered breathing.

The severity of the disorders is determined based on the results of a polysomnographic or cardiorespiratory study of the patient’s breathing during sleep. And, of course, instrumental diagnosis of breathing disorders during sleep is necessary for a comprehensive study of a patient with snoring and suspected OSA.

Patient : 40 years old, in 2013 he came to us at the Healthy Sleep Center with complaints of snoring, he also complained that he sweats at night, he had a restless and uninvigorating sleep, he often woke up with a feeling of lack of air, He had frequent urination at night (3-6 times), he felt exhausted and often had a headache in the morning, during the day he almost fell asleep while walking, he was irritable, and his performance left much to be desired.

History: Snoring appeared about 9 years ago and became more severe as the patient's weight increased. Cryoplasty of the palate (exposure to liquid nitrogen) was performed in 2009. The intervention was difficult to bear. I had a sore throat for two weeks and my body temperature rose.

I did not notice any improvement in snoring. In 2010-2011, I gained about 7-9 kg, as a result of which my snoring became stronger, and my family noticed that my breathing stopped during sleep. In 2011, he underwent laser surgery twice, which also did not produce results.

Polysomnographic studies were not performed (the patient was not even informed about this possibility). During 2012-2013, I gained about 10 more kg. During this period, other complaints emerged. For about 2 years, high blood pressure is observed up to 170/110 mm Hg. Art.

most often in the morning. He has been smoking 15 cigarettes a day for more than 12 years.

Examination: Obesity 2 tbsp. (height 195, body weight 115 kg). Significant fat deposits on the neck. Nasal breathing is not difficult. Moderate retro- and micrognathia. The pharyngeal ring is narrow due to general obesity.

The patient underwent a polysomnographic study. During 7 hours of sleep, 326 apneas and 115 hypopneas of obstructive origin were recorded. Apnea/hypopnea index = 50 per hour. The total duration of apnea and hypopnea was 190 minutes or 60% of sleep time. The blood was saturated with oxygen by 73%. A sharp disturbance in the structure of sleep: the duration of the 1st stage of sleep was too long, but the deep stages of sleep were almost absent, the index of brain micro-awakenings was 60 per hour.

Diagnosis: Obstructive sleep apnea syndrome, severe form.

Figure 3. Initial somnogram (sleep structure) for 7 hours. A sharp disturbance in the macrostructure of sleep. Figure 4. Somnogram during the first session of CPAP therapy. Normalization of sleep structure.

Treatment: CPAP therapy was started. In the first treatment session, obstructive breathing disorders were almost eliminated. The apnea/hypopnea index was reduced from 50 to 3 per hour, and blood oxygen saturation levels normalized. The patient noticed an improvement in the quality of his sleep; he became much more active during the day after the first treatment session. In the future, CPAP therapy continues at home.

Analysis of this clinical case allows us to draw three main conclusions:

1. Palate surgery in obese patients with severe sleep apnea is unsuccessful.
2. Such patients need CPAP therapy.
3. Before taking any action, consult with specialists.

Source: https://centrsna.by/articles/eto-vazhno-znat/laser-treatment-of-snoring/