Snoreplasty: A New Treatment for Primary Snoring

Snoreplasty may be the answer to snoring, which is a big problem for many people all over the world. We have received a number of emails and calls here at TalkAboutSleep.com since we first published an article last fall on a new treatment for snoring called "injection snoreplasty". Because of your interest, we are publishing this update on the snoreplasty procedure.

Snoreplasty - What Is it?

In late September, 2000, Doctors Scott Brietzke and Eric Mair, from the Walter Reed Army Medical Center, presented research findings at the annual meeting of the American Academy of Otolaryngology -- Head and Neck Foundation. Their study was entitled: "Injection Snoreplasty: How to Treat Snoring Without All the Pain and Expense".

The study, involving a small group of patients, demonstrates that it is a low-cost alternative to traditional snoring treatments, is effective, relatively painless, and can be performed in 15 minutes in a physician's office. The average cost per patient for this procedure is approximately $35. The study results found that the procedure has remained effective for at least one year. Traditional surgical treatments are more painful and much more expensive.

In the procedure, the patient's soft palate is injected with a sclerotherapy agent. That simple injection seems to reduce or stop the snoring in patients with primary snoring, with little pain and little expense. Current estimates are that the procedure might have to be done on an annual basis, but at this time there are no long-term studies of this technique.

Snoreplasty Questions

We do caution our readers, however, that this is still an investigational procedure, and not yet a generally accepted treatment. Interest in this procedure seems quite high, though, and the number of persons asking us for referrals to doctors who do this procedure continues to grow.

To respond to your questions, we contacted Dr. Scott Brietzke to get some additional information. An edited version of that interview follows.

Snoreplasty: A New Treatment for Primary Snoring

An Interview with Dr. Scott Brietzke

TalkAboutSleep: Is the technique of injection snoreplasty being done at any other facility, or is this a research protocol being tested only at Walter Reed Army Medical Center?

Dr. Brietzke: Injection Snoreplasty (IS) is only being done by Dr. Mair and myself under a research protocol at our institution. There are other physicians, who have seen our procedure, either at the national meeting at which we recently presented it or on TV, who are performing the IS procedure, but without our endorsement.

TalkAboutSleep: Since this is currently being done only at Walter Reed, my understanding is that only retired or active duty members of the military or their family members are eligible. Is my understanding correct?

Dr. Brietzke: Only patients eligible for care at a military facility, i.e. active duty, retired, dependents, are allowed to receive care of any kind at Walter Reed, research protocol or otherwise.

TalkAboutSleep: The note posted on your web site does seem to indicate that after the results are published in a peer-reviewed journal that any physician would be able to utilize this procedure. Do you anticipate journal publication anytime in the near future? Which journal?

Dr. Brietzke: Our manuscript has been sent to the journal "Otolaryngology - Head and Neck Surgery", the premiere journal in our field. They have, given the interest, agreed to expedite its review, and publication is tentatively expected in the April or May 2001 issue. We are advocating that ENT physicians wait until the article is published and they can read about our technique in detail and benefit from our experience before they attempt the procedure.

TalkAboutSleep: Is there any specialized training that will be needed before a physician uses this procedure?

Dr. Brietzke: ENT surgeons experienced in treating snoring should be able to read the journal article and properly perform the technique.

TalkAboutSleep: Do you envision that this technique would be utilized by ENT specialists, sleep specialists, dentists or any specific group of trained medical personnel?

Dr. Brietzke: Currently, given the limited experience with only a fairly small number of patients, we recommend only ENT Surgeons trained in treating snoring perform the procedure.

TalkAboutSleep: New drugs and new medical devices need approval by the Food and Drug Administration (FDA). Does the injection snoreplasty procedure require such an approval by the FDA? Or is this a procedure that any physician could do using approved drugs and materials readily available?

Dr. Brietzke: Sotradecol has been FDA approved as a sclerotherapy agent for over 25 years. It has an excellent safety record and has been used for various purposes in nearly all parts of the human body, including the mouth and throat. Indeed, after much research, it is because of its safety record that we chose to use it with Injection Snoreplasty, as we could have potentially used one of many different agents. Using it in this manner is considered "off-label usage" at the discretion of a physician. We have no plans to perform a FDA approval trial.

TalkAboutSleep: How does injection snoreplasty work to prevent snoring?

Dr. Brietzke: The typical loud, vibratory snoring noise is caused by the palate (roof of the mouth) fluttering back and forth during sleep. This is called "palatal flutter" snoring. It is the most common source of loud, obnoxious snoring. Injection Snoreplasty is what we call a "palatal stiffening" procedure. It works to reduce or eliminate this snoring noise by stiffening the palate with scar tissue. The injected medicine, Sotradecol, creates mild scar tissue in the palate that increases its inherent stiffness and thereby quiets the snoring. This is the same mechanism by which other snoring procedures, e.g., Somnoplasty, LAUP, also work. Injection Snoreplasty is just a MUCH cheaper, simpler way to do the same thing.

TalkAboutSleep: Does the research protocol (and possible future guidelines for physicians) indicate that a sleep study be undertaken to rule out sleep apnea before treating for snoring? Are there guidelines suggested for the diagnosis of Primary Snoring before the decision to use this procedure?

Dr. Brietzke: We have only treated patients with primary snoring (RDI < 10) using Injection Snoreplasty (IS). We are currently performing a study to look at the effectiveness of Injection Snoreplasty with OSA. Although we expect IS to be effective in some patients with sleep apnea, particularly those with mild apnea, it will certainly not be the final answer to treating sleep apnea. Sleep apnea is a potentially severe medical condition that should be identified and managed. Therefore, we recommend all patients being evaluated for snoring undergo a sleep study. We have performed sleep studies in all patients who have received IS so far.

TalkAboutSleep: How did you and Dr. Mair come up with the idea for this new procedure?

Dr. Brietzke: Dr. Mair could tell the story better than I. There was a doctor from Chicago who published an article in 1943 describing the use of an injected sclerotherapy agent to stiffen vibrating tissues during snoring. He injected 7 patients and had some limited success. The agent he used is no longer around, and he was injecting the sides of the palate and not the middle as we do, which likely limited his results, but in fairness the idea was originally his. Dr. Mair had been doing some research in snoring and was trying to find some new ways to treat it. He came across this journal article at a yard sale, while stationed in England. Shortly afterward he was transferred to the US, and we have been working on it ever since! Injection Snoreplasty is born!

TalkAboutSleep: Thank you, Dr. Brietzke, for taking the time to answer our questions.

Dr. Brietzke: Thanks for your interest!

Final Comments

TalkAboutSleep will continue to follow the development of Injection Snoreplasty in the next few months. Visit us periodically to read any further updates. Meanwhile, if you are interested in this new technique for treating primary snoring, we offer these suggestions:

• Discuss with your physician the possibility of a sleep study (if you haven't had one already) to determine if your snoring is truly primary snoring or if it is associated with sleep apnea that should be treated.
• Be referred to an ENT surgeon who treats snoring, IF PRIMARY SNORING IS YOUR DIAGNOSIS.
• Ask your ENT specialist to read the April or May 2001 issue of Otolaryngology - Head and Neck Surgery and review the journal article on Injection Snoreplasty when it is published.
• Discuss with the ENT the possibility of being treated with Injection Snoreplasty.

If you do have the Injection Snoreplasty procedure, we would like to hear from you! Send us an email and let us know if this new procedure works for you!

Email us at: info@talkaboutsleep.com