At 42, Robert’s loud snoring caused his wife to insist that he sleep in their guest room, and it was her prompting that made him seek treatment. During his initial visit, Robert denied that he had daytime fatigue, sleepiness or frequent headaches. When asked about a recent weight gain or the regular use of alcohol, Robert claimed neither pertained to him. Although Robert’s past medical history was negative, he reported that he had his tonsils and adenoids removed as a child. He also admitted to a long history of non-seasonal nasal obstruction.
Robert’s Deviated Nasal Septum
Physically, Robert is a tall, thin man. An examination of his nose revealed a severely deviated septum with no polyps or sign of infection. In addition, his throat showed that his tonsils had been removed, and there was no evidence of crowding of soft tissue in the back of his throat. His remaining airway passages were also normal. When Robert’s history and physical findings were reviewed it was suggested that his snoring was due to a deviated nasal septum and that treatment be aimed at his nasal obstruction. As a conservative first step, a nasal steroid pray was prescribed, and Robert was asked to purchase nasal breathing strips to use while sleeping.
The Need for Surgery
Three weeks later, Robert returned for a consultation and reported that his wife had not noticed any change in his snoring and that his nasal obstruction had only minimally improved. Because Robert did not respond to the nasal spray and breathing strips, a turbinectomy and surgery to repair his deviated nasal septum were recommended.
The nasal septum is a structure that ordinarily divides the nasal cavity in half. In Robert’s case, a deviated or crooked septum blocked his air passageways. A deviated septum may be present from birth or it may be caused by damage to the nose from a fight or fall. Repairing a deviated septum involves moving or repositioning cartilage and bone.
The nasal turbinates are bulky structures that occupy a large space within the nasal cavity. Covered by mucous membranes that protrude into the nasal airway, they can become chronically enlarged, producing symptoms of nasal obstruction or a stuffy nose. Turbinectomy refers to a procedure in which a portion of the turbinates is removed to enlarge the airway.
Both surgeries were easily accomplished on an outpatient basis. However, six weeks following the surgery, Robert reported that although his nasal obstruction had significantly improved, his wife still heard snoring and continued her request that he sleep in a different room. A sleep study to exclude the possibility of significant sleep apnea was selected as the next course of action, and portable monitoring equipment was arranged at Robert’s home.
Sleep Study Results
Robert’s sleep study results revealed a respiratory disturbance index of 5, which confirmed that he did not have sleep apnea. During his visit to review the sleep study results, various other treatment options were discussed, including uvulopalatopharyngoplasty, laser-assisted uvulopalatoplasty, radio-frequency palatoplasty, and snoreplasty. After discussing the various treatment options with his wife, Robert decided to schedule a snoreplasty.
Robert’s Injection Snoreplasty
Robert’s injection snoreplasty was performed in the office, and he was able to work the following day. During a follow-up visit two weeks later, he described a mild sore throat immediately following the snoreplasty that had lasted a few days. A throat exam revealed a shallow healing ulcer of the soft palate. One month after the snoreplasty, Robert reported that while his snoring had not completely disappeared, its volume was lower and the improvement made it possible for his wife to sleep in the same bed. A throat exam revealed a small midline dimple in the soft palate.