Surgery for Snoring

Surgery for snoring – is it available in Medicine Hat?

Yes, it is done by Dr. Neil Harris, ear, nose and throat surgeon (Otolaryngologist). I asked him about his approach to patients who snore. This is his response:

Hi Noorali:

My approach to the management of sleep apnea and snoring is to first get a detailed history of the patient’s problem. This includes general health, daytime activity, daytime nasal obstruction, hours of sleep, frequency and severity of snoring, and frequency and duration of any witnessed breath-holding spells.

General health considerations include fatigue, excessive drowsiness, hypertension, obesity, any respiratory or cardiac illness and smoking.

It is also important to assess how disruptive the patient’s problem is on family members. Severe snorers tend to become hypertensive so treatment is not only for the benefit of the spouse or family.

Medications, alcohol consumption, and dietary considerations are important. If weight is contributing to snoring and apnea, weight management is discussed.

If true obstructive or central sleep apnea is suspected on the basis of the history, then the patient should be referred for sleep lab testing. If the results confirm sleep apnea then the patient should try CPAP. Surgical treatment for sleep apnea is also an option but surgery works better for snoring without significant apnea.

Most patients with poor sleep, fatigue, and daytime drowsiness are simple snorers and these patients generally do very well with surgical treatment.

Patients are advised before surgery that swallowing will be different for a short while after surgery and few patients have temporary nasopharyngeal reflux, or regurgitation of fluids into the back of the nose if they drink too fast. This has never been a permanent problem for anyone.

Most patients have no trouble at all. Also it is explained that the procedure is not a guarantee that the patient will not make any more noise when sleeping or that snoring will be eliminated forever.

Snoring can return as aging causes further laxity of throat tissues.

The operation is called uvulopalatopharyngoplasty or just pharyngoplasty, and takes about fifteen minutes. It can be done by laser with only local anaesthesia or under general anaesthetic in the operating room using electrocautery. The actual technique is similar with either method. I prefer to do the surgery with the patient asleep to ensure careful trimming of lax tissue and placement of dissolving sutures.

The rim of the soft palate is injected with local anaesthesia and steroid to prevent post-operative pain and swelling. The mucosal rim of the soft palate, the uvula and the part of the posterior tonsillar pillars are trimmed, and sutures are placed, leaving a smooth arch at the back of the throat.

The patient is routinely discharged from hospital on the day of surgery, with a prescription for a liquid antibiotic to prevent infection and a liquid analgesic.

When patients return for follow-up in about three weeks most are pleased with the results. They generally have longer periods of deep, restful and quiet sleep. They wake easier and have greater daytime energy and stamina.

Many have told me that their mood has improved. Some have been able to discontinue blood pressure medicine. Spouses sleep better, too. The results are not quite as good in true obstructive apnea but surgery can still be done in addition to the use of CPAP or if CPAP cannot be tolerated. Central apnea should be managed medically.

Pharyngoplasty is an easy, safe and effective operation. In properly selected patients it significantly improves the quality of life.

Noorali, I hope this information will be useful to readers of your column.

Neil Harris

This is the third column dedicated to the subject of snoring and sleep apnea. I hope after this people will get help and sleep in silence and keep their spouses happy. Good luck and sweet dreams!

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