Snoring affects a substantially high proportion of the population and can be extremely disruptive for friends and family. The individual who has heavy snoring often has reduced quality sleep and can wake feeling unrefreshed or have significant daytime fatigue.
Snoring comes from a narrowing in the upper airway, which can be in the nose or the throat or in both areas. As such, there is an increase in the negative intrathoracic pressure, which causes narrowing in the upper airway. Subsequent narrowing leads to turbulent airflow, which is what generates the snoring sound. It is usually the walls of the throat and the palate that begin vibrating that create what we hear as snoring.
The approach to management for snoring patients involves a meticulous assessment of the upper airway. This includes a careful video endoscopy of both nasal cavities. It also involves endoscopy of the oral cavity and the throat and larynx. After this assessment is performed Dr Broadhurst can explain to the patient where he feels the level(s) of obstruction are and what techniques can be employed to address those.
The most common finding in Dr Broadhurst’s patients involves multilevel obstruction. Multilevel obstruction usually involves a deviation of the midline partition in the nose, the septum and enlargement of the inferior turbinates. There is also usually a combination of a long and thick soft palate and a large or relatively large tongue base. At times, large tonsils can contribute to snoring.
It is also commonly noted that the oral cavity has a substantial crowding posteriorly which can include tonsil enlargement.
After this assessment is made Dr Broadhurst explains to the patient how to address the different areas of obstruction. In the nasal cavity straightening the septum and reducing the size of the turbinates is a highly effective way to improve nasal airflow and reduce turbulence. In conjunction with that, shortening or stiffening of the palate is done. This typically involves a rectangle of soft tissue removed. When the rectangle is closed the palate is shortened by 5-7 mm and stiffened in the process. The tongue base is then reduced using Coblation tongue channelling. This technology by Olympus is highly effective at reducing the bulk of soft tissue and greatly improving the space in the oral cavity. If tonsils are present, then they are removed, either with formal tonsillectomy or a Coblation tonsillotomy. The tonsillotomy technique is relatively new and involves a subtotal removal of the tonsil. Such a subtotal removal has the same benefit to improving the upper airway obstruction but has a reduced recovery time and pain in the post-operative period.