May 24, 2000 -- Snoring is not a laughing matter, especially if you're the person on the other side of the bed. There are hundreds of devices and "cures" for the annoying problem, some surgical, and painful. But there are no promises, outside of divorce, that the problem will go away.
David R. Hillman, MD, and colleagues at Sir Charles Gairdner Hospital in Nedlands, Australia, have done a study of "a simple, minimally invasive treatment that has the potential to reduce snoring," says Hillman.
The procedure is known as radiofrequency tissue volume reduction (RFTVR) of the soft palate, and it's relatively new. It's also known by the name of somnoplasty, because the device used in the procedure is manufactured by a California company called Somnus Technologies, which provided funds for Hillman's study.
Many practitioners are now trained to use the device, and the procedure is gaining popularity in the U.S. The device was cleared for marketing by the FDA in 1997 as an aid for the treatment of habitual snoring. But Hillman writes in the study, which was published in the May issue of the journal Archives of Otolaryngology -- Head & Neck Surgery, that there have been few published studies on it.
Snoring occurs when the throat muscles relax during sleep, causing the soft tissues in the back of the mouth and throat to collapse, partially blocking the airway. RFTVR applies radio frequency to the uvula (the teardrop-shaped piece of flesh at the back of the throat) and the soft palate (the roof of the mouth), through a needle electrode, essentially causing what Hillman describes to WebMD as a lesion "similar to a low-grade burn."
As the lesion heals, the body's resorption of the tissue shrinks and stiffens the uvula or soft palate, reducing the vibration and opening up the airway.
Hillman and colleagues recruited 20 adults who had "socially problematic" snoring, but not the more severe problem of "clinically significant" sleep apnea -- in which people stop breathing for varying amounts of time during sleep. The patients then underwent procedures to the back, the middle, and the front of the soft palate, during three separate outpatient visits.
Hillman tells WebMD that the procedure is "simple and quick." It's usually accomplished in minutes under local anesthesia. "Postoperative side effects are minimal. There is little pain," he says. What pain exists is easily controlled with simple pain relievers, and speech and swallowing "are not affected to any significant degree." The patients were able to return to work the same day.
Eighteen of the 20 patients reported a "subjective improvement" in their snoring after eight weeks of follow-up, Hillman says. Eight of the patients described more than a 50% reduction in their snoring. Mouth ulcers did form after three treatments, but they did not affect the outcome and healed within a few days.
Jeffrey Spiro, MD, has been working with the device for about six months, and says he needs more follow-up for a more "scholarly" opinion on the procedure. Still, Spiro was familiar with the Australian study and says they used single-spot treatment, whereas the manufacturer-recommended treatment involves creating three lesions during each of two different visits. Following this method, some studies in the U.S. have shown better results than those in the Australian study.
"The more general experience would suggest that probably 70% to 80% of people after two treatments will have significant improvement. We're not saying complete elimination, but significant improvement," Spiro tells WebMD. Spiro is a professor of surgery in the division of otolaryngology at the University of Connecticut School of Medicine.
"It's not that hard to do, it's very well tolerated. The issue is, does it really work?" asks Spiro. "And I guess the bottom line is: if you really pick out the right people carefully, then there's no reason why I would expect you can't duplicate some of the earlier results that have been published, at least in this country," Spiro says.
Hillman says the findings in his study justify more study and explains that the procedure may not work the same for everyone. "In most patients, snoring was substantially reduced, rather than eliminated. Persistent snoring despite treatment relates at least in part to the fact that not all snoring results from vibration of the soft palate: vibration of other parts of the throat can contribute to the snoring noise," Hillman tells WebMD.
An added benefit, says Spiro, is many people come in with a snoring problem and find they have severe sleep apnea, a health risk which can be treated.
So, the question remains, how well does it work? Spiro says one California study looked at patients a year later and found about 40% of the people had some return of symptoms.
"But on the flip side, they pointed out that the technique is so easy to re-treat, they were able to do that in some cases and actually restore these people back to a good result," Spiro says. In his experience, "the most uncomfortable part of it is the initial anaesthesia, where you have to inject the palate. You know, I give the people prescriptions for a mild narcotic afterward and nobody fills them. ... [They] use over-the-counter pain medication."
Perhaps the greatest pain for the patient is in the wallet. Insurance companies place the treatment in the same category as cosmetic surgery, so it's an out-of-pocket expense. Spiro says the cost for full treatment can range between $1,500 to $2,000.
- A new treatment called radiofrequency tissue volume reduction (RFTVR) or somnoplasty can reduce snoring.
- The simple, noninvasive procedure involves burning the soft tissue in the back of the throat, causing it to shrink and harden, which reduces vibrations that cause snoring and opens up the airway.
- RFTVR usually reduces snoring, but does not eliminate it, and if the effects wear off, the surgery can be repeated.