Q: I am a 37-year-old woman with a snoring problem since the age of 10. I thought it was because I was overweight. But the snoring has persisted even after I achieved an acceptable Body Mass Index.
Check-ups with an ear, nose and throat (ENT) specialist when I was in my early 30s revealed that my turbinates are unusually large.
(Turbinates are the portion of the nose that warm and moisten the air that is breathed in. The turbinates are filled with warm blood vessels which help to humidify the air.)
Two turbinate reduction procedures did not help. Further checks showed that I have a deviated septum which is blocking my airway.
I was told that the only way to reduce my snoring is to undergo a surgical procedure to remove the deviated septum, but this requires general anaesthesia. Is surgery the only solution?
A: Nasal obstruction may indeed be a cause of snoring. As you still have a deviated septum even after a turbinate reduction, surgery to correct this deviation may be the only option left to resolve the problem.
However, snoring may also be caused by obstruction at various parts of the airway. It is also a potential symptom of a more serious medical issue - obstructive sleep apnoea (OSA), which may have a long-term negative impact on your health.
Severe OSA has been shown to worsen hypertension, diabetes and atherosclerosis (the narrowing of arteries), which increases the risk of heart attacks and strokes over time.
You should examine if you have other symptoms besides snoring, such as excessive daytime sleepiness, headaches in the morning, waking up at night with shortness of breath and a dry or sore throat in the morning.
If anyone has noticed that you stop breathing for short periods during sleep or if you have experienced any of the above symptoms, you should approach an ENT surgeon for a more detailed examination. The surgeon will perform an endoscopy of the upper airway to determine the points of obstruction.
He will also order a sleep study to determine if you have OSA and evaluate its severity. The sleep study is an overnight test which can be performed in a hospital or in your own home. Various parameters are measured, such as your blood oxygen level, brainwave pattern and breathing.
The best way to manage OSA is to wear a continuous positive airway pressure (CPAP) machine to sleep. This is a pump which pushes air into your airway and the lungs through a mask strapped to your head when you sleep. It needs to be used every night for the long term, as it does not remove the obstruction.
The alternative to the CPAP machine is surgery.
As you have residual nasal obstruction, nasal surgery will be necessary. This may involve septoplasty to correct the septal deviation.
If there is an obstruction in the soft palate at the back of the mouth, various operations can be performed to widen the space. These usually involve removing the tonsils, along with trimming and stitching of the soft palate and uvula, which is the lowest part of the soft palate that dangles at the back of the mouth.
For an obstruction that involves the base of the tongue, surgery to fix this traditionally involves sawing off a block of the jaw bone, shifting it forward and fixing it in the new position with plates and screws.
With the availability of the da Vinci surgical robot, we can now remove the tissues blocking the airway at the tongue base by operating through the mouth.
You should have a detailed evaluation of your snoring so that an appropriate treatment plan can be recommended.
DR TAY HIN NGAN
Director of HN Tay ENT, head and neck, thyroid and sleep robotic surgery, Mount Elizabeth Medical Centre
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