Injection Treatment for Snoring

March 2002 Sleep Surgery Centre Newsletter

The Sleep Surgery Centre has been looking at the feasibility of offering injection surgery (Injection Palatoplasty, or IP) for snoring over the last few months. This is a treatment that the otolarygologists (Ear, Nose and Throat surgeons) of the Walter Reed Army Medical Centre in Washington, DC, have been performing on their soldiers and others for a few years, and is in fact being done widely elsewhere in the States now. It involves a simple injection of a chemical soap, Sodium Tetradecyl Sulphate, long used for varicose veins and other disease, into the palate to create scarring. The procedure, as it has been developed, is needed only once in most (80%) patients, and seems to involve very little pain; indeed it can be done comfortably without even injecting local anaesthetic. Afterwards there may be marginally more pain than following RPM, but still Tylenol #3 was used by only 52%. The scarring, as with RPM, begins to have its anti-snoring effect within a few weeks. Because the procedure is "low tech", requiring minimal equipment, it is relatively cheap.

But .... new procedures always raise some questions:

Is it safe? The chemical has been used for varicose vein injection for 60 years, and in the head and neck area, including the mouth, for about 20 years. Cancer has not occurred. Still there remains a very small possibility that a serious untoward effect could become apparent in the future. This is however true for many forms of medical treatment, even such common substances as locally injected anaesthetic (which incidentally is avoided in this treatment). Also similar to local anaesthetic is the risk of anaphylaxis, a dangerous form of shock following the injection. Overall, however, these risks are small. A few cases of palatal fistula (hole developing right through the palate) are reported, but they healed without any treatment within a week or so. The possibility of a fistula developing which requires surgical repair is certainly real, and until we have many more cases to report upon, the probability of this complication is undetermined; at this point however it seems to be remote.
The FDA in the USA has not approved this chemical for use in the palate for snoring. Such "off label" use of drugs is however commonplace: even antibiotic usage for chronic sinusitis is "off label". It takes many years for a new usage to become FDA approved. Still, the drug is investigational in this procedure, and will remain so until we have at least 10 good studies on it.

Is it effective? In their peer-reviewed article,"Injection Snoreplasty: how to treat snoring without all the the pain and expense", (Otol-H&N Surgery, Vol.124,#5), the 2 physicians have reported on 27 treated patients of whom 25 (92%) were effectively treated...ie, snoring was reported by the partner as no longer a problem. More studies are needed to confirm these results. A further study from the Walter Reed institution is awaiting publication and a prospective trial of IP for Obstructive Sleep Apnea is in progress. The Sleep Surgery Center hopes to publish its own figures in due course, and any patient choosing to undergo this procedure will be asked to take part in a simple questionaire study of before-and-after symptoms.

At what point in its development should a patient consider having this treatment? No procedure is without any risk. The procedure is not recommended for sleep apnea at this time. For snoring, however, the Sleep Surgery Centre believes that a well informed patient, fully conversant with the risks of this relatively new procedure, may want to consider having this treatment rather than RPM or LAUP either if medical contraindications to those other procedures exist, or if time and/or expense are a significant factor to him or her. The patient would be well advised to find an experienced otolaryngologist to perform the surgery, and one who has learned the technique directly from either an author of the article, or another surgeon with that training who has been doing the procedure on a regular basis for at least 6 months. All those who perform the surgery at the Sleep Surgery Centre have had such training.

From the information lab of the Sleep Surgery Centre, Inc.

All rights reserved. March 23, 2002.

Sleep Surgery Centre Inc. 303 - 2963 Glen Drive, Coquitlam, Vancouver, B.C. Canada V3B 2P7
Tel: 604-941-2344 Fax: 604-941-2455 E-mail: info@sleepsurgerycentre.com