Snoring occurs when the upper airway is either too small, and or too floppy. The upper airway starts at the nose and goes to the back of the throat, behind the tongue base and then into the larynx which leads to the windpipe. If the airway collapses or obstructs during sleep- this may mean that you have obstructive sleep apnoea. The only way to find out if you have obstructive sleep apnoea is to do a sleep study.
 
To effectively treat snoring; you need to accurately identify which levels are obstructed and then treat these obstructions accordingly.
The nose is an extremely important passage that needs to be clear. Breathing through the nose stabilises the airway and stable airways are less likely to vibrate or obstruct. Mouth breathing is not good as it destabilises the airway and results in the tongue falling backwards narrowing the airway.
So in terms of surgical treatments for snoring, they can generally be divided into:
  1. Nasal Surgeries- these include surgery to the nasal valve, nasal septum, turbinates, swell bodies, sinuses etc.
  2. Back of the Nose- removing adenoids 
  3. Throat Surgeries- removing or reducing tonsils, advancing/shortening/tightening/stiffening of the soft palate(to improve the space behind the palate), removing part of the hard palate to increase the space behind the palate.
  4. Tongue Surgeries- reducing the size of the tongue, advancing the tongue by using sutures/other devices, innervating the nerve to the tongue, stiffening the cartilage above the voice box(epiglottis) etc
  5. Jaw Surgery- to advance the lower jaw/tongue and sometimes both the upper/lower jaws to increase the space behind the throat and tongue
  6. Very rarely- doing a tracheostomy(opening into the windpipe) in severe cases-eg if the patient has severe heart failure resulting from sleep apnoeasites-of-obstruction-OSA
Many of these surgeries are done as day procedures or even under local anaesthesia. Obviously the bigger the surgery; the more likely it has to be done under general anaesthesia and likely require an inpatient hospital stay.
 
In summary- the surgical treatment of snoring first requires an accurate identification of the levels of obstruction performed by a trained ENT Surgeon and then treating the levels of obstruction in a stepwise manner. One point to note is that there are non-surgical means of treating snoring and these include wearing a positive airway pressure machine to sleep or even wearing an oral appliance to advance the jaw.

Dr Adrian Saurajen
MBBS (U of Sydney, Australia), FRCS (ENT) (RCS, Edinburgh, United Kingdom), FRCS (RCPS, Glasgow, United Kingdom), FAMS (Academy of Medicine, Singapore), M Med (Sleep Medicine) (U of Sydney, Australia)

Nobel Ent Centre

6 Napier Road #10-04,

Gleneagles Medical Centre,

Singapore 258499


238 views 9 Oct 2019
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