Surgical Options for OSA
An alternative for snoring and Obstructive Sleep Apnea.
What is Snoring and OSA Surgery?
If a patient opts for surgery, the upper airway is examined with nasoendoscopy performed by an ENT specialist to look for areas that contribute to upper airway obstruction during sleep. Identification of these areas allows the surgery to be tailored for that particular patient’s problem.
Several options for surgery exist that are directed at obstructions that may occur at the level of the nasal airway, soft palate or base of tongue.
Septoplasty – A procedure to straighten the nasal septum which is the center part of the nose. This procedure can improve nasal breathing in patients with a deviated nasal septum. A septoplasty can improve sleep apnea and snoring. This procedure can help patients use CPAP by lowering the pressure requirements. This procedure can also improve compliance and comfort with oral appliances.
An inferior turbinate reduction is a procedure which can improve nasal breathing by reducing a bone (inferior turbinate) in the nose. This procedure can be performed under local anesthesia in the office.
Treating chronic sinus infections is an important aspect in dealing with patients with obstructive sleep apnea. Patients with healthy sinuses are much better able to tolerate treatment for their obstructive sleep apnea. Balloon sinuplasty is a minimally invasive procedure used to treat chronic sinus infections and is performed in the office under local anesthesia. A balloon is used to widen the openings into the sinuses to allow for better drainage pathways. The more traditional sinus surgery (Endoscopic Sinus Surgery) can also be done by our surgeons, which is done in the operating room.
Drug-induced sleep endoscopy. This is a procedure performed under sedation. Sedation is given to the patient by an anesthesiologist until the patient falls asleep and starts snoring. Then a camera (scope) is placed through the nose and passed into the back of the throat to evaluate the site of snoring. The snoring sites can be the soft palate, the back of the tongue, the side walls of the throat including the tonsils or the portion of the voice box called the epiglottis. This procedure allows the surgeon to focus their surgery on the sites of blockage, which are causing the obstructive sleep apnea.
Tonsillectomy and adenoidectomy. Removing enlarged tonsils and adenoids can be performed on patients as young as 2 years old as well as adults. These procedures can be used to cure OSA by removing obstructing tissue.
Lateral expansion pharyngoplasty – The trend now is to preserve the uvula. This procedure lifts the soft palate and uvula by rotating a muscle behind the tonsil. This procedure is used to cure obstructive sleep apnea.
Hyoid suspension – a more advanced procedure that is used to cure OSA. Suspending the hyoid bone to the jaw bone helps to open the airway. This procedure requires a small incision in the neck.
Tongue procedures – tissue can be removed from the back of the tongue which can open the airway.
Hypoglossal nerve stimulator – A ‘pacemaker-like device’ used to treat OSA. A stimulator is placed on the hypoglossal nerve through an incision in the neck. The stimulator is turned on at night and is timed with breathing. The stimulator causes the tongue to move forward on inspiration to open the airway.
Snoring procedures can be performed under local anesthesia in the office . If it is determined that patients are snoring without obstructive sleep apnea then simple office procedures can be done. The most common is a procedure called the capso (Cautery-assisted palate surgery operation), which involves trying to stiffen the palate to prevent the vibrations which cause snoring.