CHAPEL HILL -- An ear, nose and throat doctor at the University of North Carolina-Chapel Hill is using a new technology that has already proven successful in treating snoring to provide a less expensive, relatively pain-free alternative to traditional nasal obstruction surgery.
"This nonsurgical procedure, called somnoplasty, could change how we're doing things," said Dr. Wendell Yarbrough, assistant professor of otolaryngology at the UNC-CH School of Medicine, who divides his time between head and neck cancer research and clinical duties.
"The technology was first approved for treating snoring, which is treatment of the palate," he said. "It's exciting that now another innovative use of the technology has been approved."
Somnoplasty delivers radio frequency energy through a needle, which, in the treatment for snoring, is put underneath the lining of the mouth.
"It creates a scar that, as it forms, tightens up the palate and decreases the volume and intensity of snoring," Yarbrough said. "The procedure is relatively pain-free - patients might need to take some Motrin or Tylenol immediately but narcotics for seven to 10 days are unnecessary. It's also more convenient and less expensive because it can be done in a physician's office and the patient can be back at work the next day."
In dealing with a nasal obstruction, the procedure works like this: the doctor introduces the needle into the turbinate, the thin, membrane-covered bony plates on the walls of the nasal chambers. The front part of the turbinate is treated first. If the patient is still obstructed a few weeks later, a second treatment focuses on the back part of the turbinate.
"The turbinate is what swells up when you have allergies or colds," Yarbrough said. "You can be stopped up within minutes because that tissue fills up so readily with blood. When the needle is stuck into the turbinate, it creates a scar and shrinks it down, so that it can't swell up like before."
The surgeon has performed the procedure for snoring for two years and for nasal obstruction for the past year and said both work well. The nasal obstruction treatment has helped several of his patients get off allergy medicines and decongestants. However, he said, the procedure doesn't work for a patient with major problems with the septum, the dividing wall or membrane between nasal cavities.
Somnoplasty to reduce the severity of snoring - a procedure increasingly popular with those who live with snorers - is not covered by medical insurance. While costs vary around the country, the first treatment at UNC is $1,400, Yarbrough said. Subsequent treatments are $500, and the average number of treatments for his patients has been two. "We say a patient is cured when the snoring is reduced to a level the patient's bed partner can live with," he said. There are many different treatments for snoring, "which means nothing's perfect," the physician said. The LAUP - laser-assisted uvulo palatoplasty - is popular but can require multiple treatments and mild anesthesia and can be painful. Uvulo palatoplasty - but done with electrocautery rather than lasers - is less expensive.
Medical insurance generally covers somnoplasty to treat nasal obstruction; because the procedure is new, Yarbrough gets pre-approval from insurance companies.
Somnoplasty - for the treatment of both snoring and nasal obstruction - is the way of the future, he said. "Obviously, people like the decreased pain of the procedure - that there's no nasal packing -- and also the fact that the procedure doesn't disrupt their lives for very long," Yarbrough said. "The nasal procedure, I believe, is changing the way a lot of ear, nose and throat doctors address nasal obstruction. The only option before was the operating room.
"Some are even doing the procedure on people whose septums aren't great. It's worth a try - it may save a trip to the operating room and there's no nose packing and no hospital stay. If necessary, the patient can have a septoplasty afterwards."
Yarbrough, whose 1998 paper on the study of tumor suppressors -- gene therapy that prevents tumor formation) was the 12th most referenced paper in English literature last year -- says a third use for somnoplasty was recently approved by the Federal Drug Administration. The procedure can now be used to treat patients who have obstructive sleep apnea (OSA) - a sleep disorder in which the muscles of sleeping patients relax and occlude their airways, making it difficult to breathe. The needle in the tongue can cause tissue reduction, prevent swelling of the tongue and help keep airways clear; preliminary studies indicate seven to eight treatments are needed.
Note: Yarbrough can be reached at (919) 966-3341.
Contact: David Williamson, 962-8596.