What happens at consultation?

 

1.    History is taken

2.    Basic examination of the mouth, throat, neck and nose

3.    Flexible naso-pharyngo-laryngoscopy. A tiny fibre-optic camerais used to examine the nose (more thoroughly), the back of throat and voicebox. This examination can help to ascertain which anatomical site(s), theproblems lies at and whether there is an option for surgical treatment.

4.    Discussion

 

Possible outcomes

 

  1. Reinforce basic measures, described above.
  2. Sleep study if sleep apnoea is a concern
  3. Mandibular advancement device recommended (if not tried already)
  4. A form of surgical treatment to palate/oropharynx (throat)-under local or general anaesthetic (see below)
  5. Address nasal blockage- with medicines (prescription sprays for rhinitis-chronic nasal congestion) and/or nasal surgery (usually minor).

 

Mandibular Advancement Device or Splint

 

This is a device worn in the mouth at night that keeps thelower jaw forward/stops it slipping back. This stops the base of tongue fallingbackwards and tightens the muscles of the oropharynx. Some patients are nothappy or comfortable with the concept or practicality of going to sleep withthe device in the mouth. It can cause problems, such as  tending to slip out, causing muscleache or temporo-mandibular joint dysfunction. However, for some patients it isa good solution for snoring.

 

I tend to recommend, as an initial trial, a basic fairlycheap “boil and bite” splint available form multiple sources over the internet.If “mandibular advancement device” and “snoring” are put into an internetsearch engine, various examples of this can be found. If this works and isworthy of a more definitive device, I arrange for a “professional” fit deviceto be made, via a specialist dentist.  

 

Surgical throat procedures for snoring

 

In general, surgical procedures for snoring addressanatomical problems in the oropharynx. Some can be carried out under localanaesthetic.

 

My favoured procedure, in suitable patients, is a form ofpalatoplasty using radiofrequency, under local anaesthetic in a clinic setting.Radiofrequency is a from of energy which, in this case, can be manipulated toeither heat tissue (to stiffen it through scarring) or cut tissue. Thisessentially involves stiffening the tissues of the soft palate; and cuttingtissue to make the uvula smaller and free edge of the soft palate higher andthe back of the throat a little wider. Local anaesthesia takes the form of injectionat the back of the mouth (not dissimilar to a dental procedure). The proceduretakes less than 5 minutes to perform after local anaesthetic. There is acertain degree of post-operative pain over the course of a week after. Thisvaries and requires pain relief. Most patients do not have to take time offwork.