May 21, 2001 -- If you or someone in your household is shaking the timbers at night with snoring, a painless new technique may be the secret to nighttime quiet.
The new medical technique, called injection snoreplasty, involves injecting a scarring agent known as Sotradecol -- commonly used to treat varicose veins -- into the soft palate at the back of the roof of the mouth. The agent stiffens the soft palate.
A loose or floppy palate causes the characteristic "flutter" sound of loud snoring, says Eric Mair, MD, an ear-nose-throat surgeon at Walter Reed Army Medical Center in Washington.
"The treatment is effective, very simple, cost effective, and well tolerated with minimal pain," Mair tells WebMD.
The "minimal pain" part, says Mair, will come as welcome news to snorers who have undergone any of a number of common, painful surgical techniques to correct snoring. One of these techniques -- known as uvulopalatopharyngoplasty, or UPPP -- involves surgically cutting the palate to make it shorter.
Although short-term results with UPPP are good, no one looks back on the procedure with pleasure. "Patients are in pain for a month and require long-term narcotics," Mair says. "It requires a general anesthetic and usually an overnight stay in the hospital."
Other treatments using lasers to shorten the palate, radiotherapy to decrease its thickness, or surgical techniques to peel a piece of skin away from the palate, are similarly painful, Mair says.
And some of those surgical techniques, which are not commonly covered by most health insurance plans, can be expensive. UPPP can cost as much as $10,000, Mair tells WebMD.
Injection snoreplasty, on the other hand, can cost as little as $50. And the procedure can be done repeatedly, whenever snorers need a "tune-up," he says.
In a study of the procedure, appearing in the May edition of Otolaryngology-Head and Neck Surgery, 27 patients with loud snoring received one or more of the injections. Of those, 25 reported a significant decrease in snoring. There were no complications from the treatment, and patients reported minimal discomfort. Patients were followed for approximately one year with no recurrence of snoring, according to the report.
While the procedure is a new one of his own devising, Mair says it may now be in use by other doctors. First reported at a medical meeting last year, injection snoreplasty results prompted a flood of emails from doctors interested in learning the procedure, he says.
Mair says an estimated 40-60 million people have some degree of habitual snoring. Most of those -- perhaps 80% -- are due to palatal flutter. The rest may be due to obstruction caused by a thickening of the back of the tongue or a nasal obstruction. Among those two groups, perhaps 5% will have snoring associated with obstructive sleep apnea, when the obstruction actually causes the sleeper to stop breathing momentarily.
Mair tells WebMD that snoring patients who undergo the procedure are also tested for apnea. And further studies are underway to determine if injection snoreplasty also can treat obstructive apnea, he says.
The lengths to which snorers will go to be relieved of their nighttime noisemaking is liable to be determined by others in their household who can't take it anymore. And sometimes those others -- spouses or children -- can be adamant, though snorers themselves may be reluctant to undergo painful or expensive procedures, Mair says.
It was this that led Mair to find a simpler solution. And the story of how he came across injection snoreplasty using Sotradecol illustrates how there is nothing -- even in medicine -- that is new under the sun.
Mair had earlier developed a procedure to stiffen the palate by peeling off a layer of skin. The resulting scar causes the palate to stiffen -- less painful than UPPP, but still not a procedure snorers were eager to undergo. "You still hurt for about 10 days," Mair says.
Later, while traveling in England with his wife and perusing garden sales, Mair ran across an old medical journal from 1943 describing a small study using scarring agents to stiffen the palate and stop snoring.
Different areas of the palate were treated in that study and much smaller amounts of a substance no longer available were used, but the results were excellent, Mair says. "It remains unclear why the concept of injection [therapy] for the treatment of palatal flutter snoring did not develop further after this intriguing case series presentation," Mair writes in his report.
Mair then decided to search for a scarring agent to use as an injection. He selected Sotradecol because of its excellent safety record and documented effectiveness.
Sleep expert Mark Mahowald, MD, however, cautions that virtually every procedure for snoring has shown good results in the short-term, but disappointing results in the long-term.
"Before I would recommend any procedure to patients for snoring, I would want them to be aware that regardless of the short-term results, snoring is a progressive condition," Mahowald tells WebMD. "Even with the most aggressive surgical treatment, 50% of people are snoring again within four years." Mahowald is director of the Minnesota Regional Sleep Disorder Center at Hannepin County Medical and professor of neurology at the University of Minnesota School of Medicine.
Mahowald says some patients who have received UPPP or other aggressive surgeries have returned extremely angry because they had been told the procedure would cure snoring forever. A scarring procedure cannot be expected to have long-term success when even the most radical surgery is only effective in the short-term, he says.
"Patients should undertake any procedure with the full awareness that the short-term results may not hold up," he says.