Injection Snoreplasty: A Treatment Option for Snoring
Injection snoreplasty is a minimally invasive procedure for treating primary snoring that involves injecting a sclerosing agent into the soft palate to reduce palatal flutter, but it cannot be recommended for simple snoring due to lack of evidence in clinical guidelines. 1
What is Injection Snoreplasty?
- Injection snoreplasty is a procedure that involves injecting a sclerosing agent (typically sodium tetradecyl sulfate) into the soft palate to create stiffening and scarring, which reduces the three-dimensional flutter of the soft palate that causes snoring 2
- The procedure aims to decrease inspiratory airway resistance by reducing palatal vibration during sleep 1
- It is performed as an office-based procedure under topical anesthesia, making it less invasive than surgical alternatives 2
Efficacy and Evidence
- Short-term studies show 92% of patients report significant decrease in snoring immediately after treatment, but this success rate drops to 75% at 19-month follow-up with a snoring relapse rate of 18% 3
- Objective analysis confirms statistically significant decreases in palatal flutter snoring and palatal loudness after injection 3
- Multiple treatment sessions (average 1.8) are typically required to achieve optimal palatal stiffening 2
- European Respiratory Society guidelines do not recommend palatal procedures like injection snoreplasty for simple snoring due to lack of sufficient evidence 1
Advantages and Disadvantages
Advantages:
- Minimally invasive procedure with low cost compared to surgical alternatives 2, 4
- Minimal post-procedure pain and discomfort (confirmed by visual analog pain scales) 2
- Little to no recovery time or convalescence period 2
- Can be performed in an office setting without general anesthesia 4
Disadvantages:
- Limited long-term efficacy data compared to other snoring treatments 3
- May require multiple treatment sessions for optimal results 2
- Potential complications include transient palatal fistula (especially with ethanol as the sclerosing agent) 5
- Not recommended by clinical guidelines for simple snoring due to insufficient evidence 1
Alternative Sclerosing Agents
- While sodium tetradecyl sulfate (STS) was the original agent used, other alternatives have been studied:
Diagnostic Value
- Injection snoreplasty can serve as both a diagnostic tool and treatment:
- A positive response to injection snoreplasty (reduced snoring) indicates that palatal flutter is the primary cause of snoring 6
- This information can help identify patients who might benefit from more definitive palatal procedures like uvulopalatopharyngoplasty (UPPP) or laser-assisted uvuloplasty 6
- In a study of 60 patients, 40 (67%) showed improvement after a single injection, suggesting palatal flutter as their snoring cause 6
Comparison to Other Snoring Treatments
- Success and relapse rates of injection snoreplasty are similar to those of other current treatments for snoring 3
- Surgical options like radiofrequency thermal ablation and palatal implants appear to have relatively good outcomes with minimal postoperative pain 4
- The European Respiratory Society guidelines recommend mandibular advancement devices (MADs) for mild to moderate obstructive sleep apnea (OSA) with the highest level of evidence (A) 1
Clinical Considerations
- Patient selection is crucial - injection snoreplasty is only appropriate for primary snoring (respiratory disturbance index less than 10) caused by palatal flutter 2, 6
- Pre-procedure snoring analysis may predict patient response to palatal stiffening treatments 3
- Patients should be evaluated for obstructive sleep apnea before considering this procedure, as it is not indicated for OSA treatment 2
- Weight reduction should be considered as a first-line approach for snoring associated with excess weight 1