Injection Snoreplasty

1

Introduction

A vast array of choices is available to the otolaryngologist to treat simple snoring. The majority of these procedures function via the principle of palatal stiffening in which the vibrating floppy soft palate of the snoring patient is stiffened by creating scar tissue in or on the palate. Injection snoreplasty (IS) was originally developed as a modification of a solitary, indistinct case series published in the 1940s in which fish oil was injected into the pharynx of three patients to “alter the ‘flutter ratio’ of these tissues as to reduce or eliminate snoring.” IS serves well as an alternative to the currently available snoring treatments that are either painful and/or expensive. IS is highly effective in the majority of patients, is easily performed in the office with inexpensive materials, and typically results in mild pain only that does not prevent the patient from returning to the majority of their daily activities.

2

Patient Selection

IS is most effective in patients who suffer from socially bothersome palatal flutter snoring. IS has not been found to be effective in managing obstructive sleep apnea syndrome (OSAS) (authors’ unpublished data), and therefore it is strongly recommended that OSAS be objectively excluded before implementing snoring treatment. This is best accomplished with polysomnography, as the history and physical examination are limited in their accuracy in diagnosing and excluding OSAS. Other published preliminary studies have demonstrated an improvement in objective measurements such as Apnea/Hypopnea Index scores and mean oxygen saturation after IS for mild OSAS. However, these results were obtained in patients deemed to have obstruction exclusively at the site of the soft palate.

IS (and most currently available snoring treatments) targets only the soft palate. Fortunately, it appears the majority (estimated to be approximately 85%) of snoring patients suffer from palatal flutter snoring. Ascertaining that the patient does indeed suffer from palatal flutter snoring, as opposed to other sites of snoring noise production, can translate to increased success with IS and other palatal snoring procedures. Commercially available “take-home” polysomnographic technology does exist that appears to reliably identify palatal flutter snoring that translates into improved treatment success rates. However, one must be careful in relying on objective snoring analysis to the point where the ultimate goal of improving the patient's subjective, social problem of snoring is overlooked.

As with any palatal procedure, patients should be screened carefully for any systemic conditions that may adversely affect wound healing. Examples include vascular disease, poorly controlled diabetes, and chronic steroid use. In addition, patients with a strong gag reflex that is not abated with topical anesthesia may be difficult to treat with IS or any office-based snoring procedure. Lastly, any preexisting allergies to the injected agents should be excluded.