The impact of pretreatment assessment of oropharynx on interstitial soft palate radiofrequency surgery outcome--a multi-center study in patients with habitual snoring.

PURPOSE: Interstitial radiofrequency (RF) surgery of the soft palate (SP) is an established option in the treatment of habitual snoring. The decision-making process in the management of habitual snoring would benefit from diagnostic guidelines for oropharyngeal findings. Our aim was to investigate the correlation of systematic clinical pretreatment oropharyngeal examination scores with the efficacy of interstitial RF surgery of SP in a multi-center study. METHODS: Seventy-four patients (58 (78%) males and 16 (22%) females) with the median age of 42 years (range, 23-64), pre-treatment BMI of 25.6 kg/m(2) (range, 20.0-28.0), and preoperative AHI of three events/h (range, 0-10), received a single session of RF surgery. Thirty-two, five, 16, and 21 patients, respectively, were treated at the participating centers with a follow-up time of 13 weeks (range 12-16). The primary outcome measure was the efficacy of the treatment on snoring assessed by the patient and the bed partner with visual analog scale (VAS). RESULTS: The snoring showed a significant change demonstrating decreased snoring (VASpatpre 7 (range, 5-10) ≥VASpatpost 4.25 (range, 1-8), P < 0.001, VASbedppre 8 (range, 4-10) ≥VASbedppost 5 (range, 1-10), P < 0.001). Twenty-one patients (28.4%) experienced a successful treatment outcome. The increased grade of the uvula had a negative impact on the snoring results. CONCLUSION: Systematic clinical pretreatment oropharyngeal examination scores showed that the increasing grade of the uvula correlated significantly with the short-term post-treatment change in snoring. We suggest that patients with habitual snoring and uvula grade III should be initially treated with SP interstitial RF surgery and concomitant uvular surgery. A grading tool is proposed for oropharyngeal examination to help in the most appropriate treatment decision for each individual snoring patient.

Palatal implants: a new method for the treatment of snoring.

OBJECTIVE: To evaluate the safety, feasibility and effectiveness of a treatment for snoring using permanent palatal implants. MATERIAL AND METHODS: This was a prospective, non-randomized study involving 35 healthy patients (26 males, 9 females) referred for treatment of habitual snoring. A baseline medical examination, an evaluation of snoring-related subjective symptoms and an overnight sleep analysis were performed. Three PET implants were placed in the palate of each patient using a new delivery device under local anaesthesia. The patients were followed by means of office visits at 2-3, 14, 30 and 90 days postoperatively, at which discomfort, pain, adverse events and changes in snoring-related parameters were recorded. RESULTS: The average time required for the procedure was 8 min; 23% of the patients required no postoperative analgesia; the average consumption of analgesic was 125 mg of diclofenac and the average duration of analgesia was 1.5 days after the procedure. No bleeding, haematoma or infection were observed. Two of the implants were extruded; both of these patients experienced a satisfactory reduction in snoring intensity and no replacements were necessary. The mean reduction in snoring intensity was 51%, with the visual analogue scale score evaluated by the bed partner falling from 7.3 to 3.6 (p<0.001). The Epworth Sleepiness Score dropped from 9.3 to 4.6 (p<0.001). In total, 86% of the bed partners and 89% of the patients recommended the procedure. CONCLUSION: The new palatal implant system is safe and is associated with low morbidity. It is a fast, simple and effective treatment for snoring.