Replies to This Discussion

Permalink Reply by Steven Y. Park, MD on October 30, 2009 at 4:55pm

I wrote this on my blog to go out on Tuesday, but here it is for SleepGuide members only:

Snoreplasty Procedure Rediscovered to Cure Snoring

It seems like snoring and sleep apnea treatments are rediscovered and proclaimed by the media as a new "cure," when in fact, it's been described years before. A British doctor reports that by injecting a scarring agent into the soft palate, snoring is eliminated. The material he used was sodium tetradecyl sulfate, which is the same material that's been used for varicose veins for 50 years.

This procedure was originally described by Dr. Eric Mair in 2001. He reported a 92% initial success rate, which dropped to 75% at 19 months on average. Most people will need 2 to 3 injections for optimal results. I performed this procedure quite a lot with good results until other, more sophisticated options became available.

It literally takes less than 5 minutes to perform in the office. Topical anesthesia is used in the mouth and a very tiny needle is used to create a bleb underneath the mucous membrane of the central soft palate. After a few weeks of healing, scarring and tightening occurs, which stiffens the palate, lessening snoring vibrations. It can take a few weeks and up to 2-3 months before results are seen. Repeat injections are given as necessary.

There will be some mild throat discomfort, but most people don't need to take any pain medications. However, a prescription pain medication is usually given.

One important point to remember is that all this does is to stiffen the soft palate. It's not designed to treat any underlying obstructive sleep apnea. Typically, it's much less expensive than the more high-tech, sophisticated precedes such as Pillar implants or laser procedures. Because snoring treatments are considered "cosmetic," they're usually not covered by insurance carriers.

It seems like medicine has a way of forgetting about simpler, more cost effective methods of treatment.

• ▶ Reply

Permalink Reply by RockRpsgt on October 30, 2009 at 7:31pm

What parameters are they using to determine the 'success rate"? Is it a complete cessation of snoring or a moderate decline? I see that on average the success rate drops 15% in less than 2years. Could we expect to see a continued decline in the process over say 5-6 years?

Dr. Park have they seen any success in using this treatment in children?

• ▶ Reply

Permalink Reply by gordon on October 30, 2009 at 8:59pm

I wouldn't let any quack doctor get within 100 ft of me to perform this procedure! Nobody knows the long term ramifications
of this.

• ▶ Reply

Permalink Reply by Judy on October 30, 2009 at 10:26pm

Thank you, Dr Park. Bless you, is there ANYTHING you've missed when it comes to treating sleep breeathing disorders??? Were that there were more sleep doctors of your calibre!

• ▶ Reply

Permalink Reply by Jackie S. on October 30, 2009 at 11:32pm

If u just have a snoring problem this is an option. It is also done in new york with some kind of radio frequency thing that actually shrinks the tissue. It may help with snoring but if u have sleep apnea as well it will not help with that problem at all. But it is interesting.

• ▶ Reply

Permalink Reply by Tanina Agosto on October 31, 2009 at 10:13am

Very interesting Dr. Park. Is this a procedure currently available in the United States? How long has this procedure been researched? What are the medical requirements for a patient to be a candidate for the injection?

Steven Y. Park, MD said:

I wrote this on my blog to go out on Tuesday, but here it is for SleepGuide members only:

Snoreplasty Procedure Rediscovered to Cure Snoring

It seems like snoring and sleep apnea treatments are rediscovered and proclaimed by the media as a new "cure," when in fact, it's been described years before. A British doctor reports that by injecting a scarring agent into the soft palate, snoring is eliminated. The material he used was sodium tetradecyl sulfate, which is the same material that's been used for varicose veins for 50 years.

This procedure was originally described by Dr. Eric Mair in 2001. He reported a 92% initial success rate, which dropped to 75% at 19 months on average. Most people will need 2 to 3 injections for optimal results. I performed this procedure quite a lot with good results until other, more sophisticated options became available.

It literally takes less than 5 minutes to perform in the office. Topical anesthesia is used in the mouth and a very tiny needle is used to create a bleb underneath the mucous membrane of the central soft palate. After a few weeks of healing, scarring and tightening occurs, which stiffens the palate, lessening snoring vibrations. It can take a few weeks and up to 2-3 months before results are seen. Repeat injections are given as necessary.

There will be some mild throat discomfort, but most people don't need to take any pain medications. However, a prescription pain medication is usually given.

One important point to remember is that all this does is to stiffen the soft palate. It's not designed to treat any underlying obstructive sleep apnea. Typically, it's much less expensive than the more high-tech, sophisticated precedes such as Pillar implants or laser procedures. Because snoring treatments are considered "cosmetic," they're usually not covered by insurance carriers.

It seems like medicine has a way of forgetting about simpler, more cost effective methods of treatment.

• ▶ Reply

Permalink Reply by Steven Y. Park, MD on October 31, 2009 at 10:59am

The recent British newspaper results don't report how success was defined. In the original Mair article, 92% of patients reported that snoring is gone or is no longer a problem.

Rock, just like every other palatal stiffening procedure, there is a small relapse rate, since tissues are expected to soften and become more pliable (especially if any underlying sleep apnea goes untreated). I don't have any experience with children, and I don't know any studies reported in children. I don't do this procedure as often as I once did, but in certain carefully selected patients who don't have obstructive sleep apnea, it's a good option.

Other options include using radiofrequency energy to shrink soft tissues inside the soft palate, or using a laser (LAUP) or radiofrequency equipment to trim the soft palate. I've done all of these in the past, but the two that I now perform are either the PIllar implant or the injection snoreplasty procedure. These two have the best success rates with the least amount of pain or discomfort. It's important to realize that some people need 2-3 treatments, even with the Pillar. Some doctors are placing 4-5 implants, rather than the recommended 3.

Having said all this, you have to be very selective in to whom you offer these procedures. In general, these procedures are not designed to help with sleep apnea (with exceptions). The better your selection, the better your success rates. These treatments have to be part of a comprehensive plan to treat the snoring, rather than looking at it as a simple shot or a cure. You also have to address any nasal congestion, dietary, exercise and nutritional issues, allergies, etc.

• ▶ Reply

Permalink Reply by susan mccord on October 31, 2009 at 12:24pm

Steve, it's awesome to have a sleep doc, with the wide range of experience you have, interacting with us here on SleepGuide........

Thank you so much for lending us your time and thoughts.

Susan McCord :-)

• ▶ Reply

Permalink Reply by RockRpsgt on October 31, 2009 at 3:26pm

Thank you Dr. Park.

• ▶ Reply

Permalink Reply by Henning on October 31, 2009 at 3:37pm

As I read it, this is an alternative to radio frequency energy or Coblation.

If this is true, this treatment can also be used to reduce the turbinate’s, to minimize the back of the tongue and to reduce the uvula.

In this case, it is also an effective and easier option in the treatment of OSA.

Henning

• ▶ Reply

▶ Reply to Discussion