Original Research Article
Year: 2016 | Month: March | Volume: 3 | Issue: 3 | Pages: 37-44
Coblation Palatoplasty, A Treatment for Snoring: Our Experience
SK Singh1, Manoj Kumar K2, Suresh Mokamati3, Nikhil Kumar3
1Professor, 2Asst Professor,3Junior Resident,
Dept of ENT, AFMC, Pune, India.
Corresponding Author: SK Singh
ABSTRACT
Background: Snoring is the sound produced during sleep by vibration of respiratory structures due to obstructed air movement during breathing. It may be a sign or first warning of obstructive sleep apnea (OSA). Usually the commonly involved structures are uvula and soft palate. The suspicion of Obstructive Sleep Apnoea Hypopnoea Syndrome (OSAHS) is required to be confirmed along with location of obstruction and grade severity. Sleep study is done to determine this and guide the therapeutic choices available for these patients. Surgical procedures like Uvulopalatopharyngoplasty (UPPP), Coblation Palatoplasty and Uvulectomy have been tried for treatment. Coblation Palatoplasty is performed and preferred nowadays to reduce snoring and alleviate sleep apnoea. This operation involves trimming of tissues causing airway obstruction at the back of soft palate, resulting in improvement of the airflow and thus reduction in snoring. The minimally invasive nature of the procedure is its biggest advantage. The main objective of this study was to assess and evaluate the efficacy of plasma-mediated radiofrequency based ablation (Coblation) palatoplasty(PRAP) in the treatment of snoring.
Material & Methods: This prospective study included 32 cases between 30 and 60 years of age with no gender bias reporting to a tertiary care ENT centre with history of snoring and probable sleep disorders. Study was for two years including a one year follow up period. Clinical evaluation, drug induced sleep evaluation and Polysomnography was done for all subjects. A Perceptual Score for Snoring (PSS), Epworth Sleepiness Scale and Snoring Outcome Survey was done for snoring, daytime somnolence and quality of life index prior to and after intervention respectively.
Results: Plasma Mediated Radiofrequency Based Ablation (Coblation) Palatoplasty (PRAP) is a safe procedure having minimal morbidity and adverse symptoms. Efficacy of the procedure was established as evidenced by the improvement in outcome scores of Apnoea-Hypopnea Index, Snoring Outcome Survey and Epworth Sleepiness Scale in the initial phase and lasting for 06 months after the procedure. Long term efficacy of the procedure is doubtful as assessed after 06 weeks till 06 months.
Conclusion: The results of this study indicate that patients who undergo PRAP for treatment of snoring obtain a satisfactory response when assessed subjectively and objectively by pre intervention and post intervention. While perceptual scores significantly improved in the immediate post intervention period lasting till 06 months, there was a reversal of the status by twelve months. All these point to the fact that volumetric reduction of palate has a temporary influence on snoring. Despite this poor subjective efficacy, significant improvements were noted in indices of quality of life and sleepiness. This raises a significant question whether it is rational to repeat the procedure at intervals of six months. It is likely that the outcome results will be much longer lasting if the procedure is repeated. These results raise several concerns about the continued use of PRAP as a treatment for snoring and mild sleep apnoea.
Keywords: Snoring, Coblation, Apnoea-Hypopnea Index, Palatoplasty.