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Swelling, swelling, inflamed tongue in the throat (uvulitis): causes, treatment

Uvulitis is an acute inflammatory pathology of the uvula of infectious-allergic etiology, occurring suddenly and manifested by painful sensations, the feeling of a foreign object in the throat, and respiratory dysfunction.

Table of contents:

Cough does not bring relief, but only worsens the well-being of patients. They develop dysphonia, dysphagia, and severe pain when moving the tongue.

With this pathology, the uvula swells, increases in size, hurts, swells, becomes red or bluish, and becomes covered with a film. Often light spots or plaque appear on its surface. It hangs down to the root of the tongue, interferes and causes vomiting.

The uvula is a fairly small organ that cannot become a source of serious problems. In severe cases, inflammation develops so severely that patients have difficulty breathing.

The uvula is the final part of the soft palate, located in the basal part of the tongue. It is a smooth muscle organ, covered on top with a mucous membrane and penetrated by many capillaries, arterioles and venules. Swelling of the uvula in the throat and its redness develops with infectious tonsillitis, pharyngitis, and stomatitis.

The uvula performs a number of specific functions:

  • Participates in sound production
  • Prevents pieces of food from entering the larynx,
  • Provides redistribution of air flows,
  • Participates in the process of vomiting and coughing,
  • Warms the atmospheric air.

Inflammation of the uvula in the throat can lead to disruption of any of these functions.

Etiology

The most common cause of uvulitis is infection. Bacteria, viruses, fungi, protozoa, penetrating into the body from the external environment or from chronic foci present in the body, lead to the development of a pathological process, manifested by 5 signs: pain, swelling, hyperemia, hyperthermia, dysfunction.

Diseases in which uvulitis often occurs:

  1. Infectious diseases of the oral cavity and nasopharynx,
  2. Dental diseases,
  3. Acute or chronic tonsillitis, pharyngitis,
  4. Purulent inflammation of the subcutaneous fatty tissue of the neck,
  5. Injuries and burns of the oral cavity,
  6. Allergy,
  7. Benign and malignant tumors of the soft palate.

The uvula becomes inflamed due to the following provoking factors: excessive alcohol consumption, long-term use of certain medications, local hypothermia, snoring, rupture of blood vessels in the uvula, smoking.

Symptoms

At the initial stage of the disease, swelling and other signs of inflammation are insignificant. Respiratory dysfunction does not develop in patients. Clinically, uvulitis is manifested by a feeling of a foreign object in the throat, a change in voice, and discomfort when swallowing and speaking. The tongue in the throat enlarges and swells slightly. The general condition of the patients remains satisfactory.

Moderate and severe uvulitis manifests itself with more pronounced clinical symptoms. The patient experiences:

  • Hyperemia and swelling of the uvula,
  • Hanging it to the root of the tongue,
  • Swelling and tenderness of the soft palate,
  • Fever,
  • Weakness, myalgia, arthralgia,
  • Dysphonia,
  • Hypersalivation,
  • The urge to vomit
  • Rhinitis.

photo of an inflamed tongue in the throat

Symptoms of uvulitis occur when eating food, coughing or sneezing. Persons who have undergone adenoidectomy and tonsillectomy are most susceptible to developing the disease.

The inflamed uvula swells in the throat, becomes red and increases significantly in size. The uvula appears white when coated. In the absence of timely medical care, it can block the airways, which will lead to the development of asphyxia.

Diagnosis of uvulitis involves conducting a pharyngoscopy examination. In patients, the uvula is enlarged, swollen, and hyperemic. If it reaches the root of the tongue, a gag reflex occurs. In severe cases, the tip of the tongue becomes bluish, becomes covered with a false film, or becomes ulcerated.

Treatment

Treatment of uvulitis consists of eliminating the underlying disease, which directly caused it. Complex therapy of pathology will help get rid of the main clinical signs and restore the condition of patients.

General recommendations from specialists that should be followed when treating uvulitis:

  1. Sufficient drinking regimen, restoring water and electrolyte balance,
  2. Maintaining personal hygiene rules
  3. Airing the room
  4. Wet cleaning,
  5. Air humidification,
  6. Using separate utensils
  7. Eliminating foods that irritate the throat from the diet
  8. Rejection of bad habits.

Traditional medicine

Uvulitis is usually treated by otolaryngologists. The infectious form of the pathology requires a course of antibiotic therapy, as well as local exposure - rinsing the mouth with a decoction of chamomile and sage, and using an antiseptic spray.

Antibiotics are prescribed after analyzing the oral fluid for microflora, determining the type of pathogen and its sensitivity. Broad-spectrum drugs from the group of fluoroquinolones, cephalosporins, macrolides - Ciprofloxacin, Azithromycin, Ceftazidime - have a positive therapeutic effect.

Treatment of allergic uvulitis involves the use of:

  • Antihistamines - “Diazolin”, “Suprastin”, “Cetrin”.
  • Diuretics - Furosemide, Veroshpiron, Hypothiazide.
  • Glucocorticosteroids for difficulty breathing - Prednisolone, Hydrocortisone, Betamethasone.

Swelling of the uvula and soft palate in advanced cases requires tracheostomy.

Among the most effective physiotherapeutic procedures used to treat uveitis are: UHF therapy, phototherapy, electrophoresis, acupuncture, magnetic therapy, galvanotherapy, ultraviolet irradiation, quartz.

ethnoscience

To treat uvulitis, mouth rinses with decoctions of medicinal herbs, inhalations, and infusions for oral administration are used.

The following products are used to rinse your mouth:

  1. Viburnum decoction is obtained from dried fruits, which are boiled in a water bath for half an hour.
  2. Garlic infusion is prepared by chopping garlic and adding boiled water to the resulting mass. Leave the product for 5 hours and use it as directed.
  3. Raspberry leaves and stems are brewed for half an hour in a glass of boiling water.
  4. St. John's wort, sage and thyme are infused in vodka for 7 days and taken forty drops orally.
  5. Pour boiling water over the onion peel and leave for 4 hours, then gargle.

Inhalations are made using essential oils of eucalyptus, cedar, and fir. A decoction of pine buds and thyme infusion are combined, eucalyptus oil is added and inhalation is carried out with the resulting product.

Rosehip infusion has a pronounced diuretic effect. Anise infusion and linden tea are suitable for oral use for uvulitis.

Source: http://uhonos.ru/gorlo/bolezni-gorla/uvulit/

Uvuloplasty or surgery for snoring: methods of surgical treatment of the disease and the cost of the procedure

Weak muscle tone of the tongue and larynx can lead to unpleasant “night serenades”, known to everyone as snoring.

If this uninvited guest has come into your life, you need to urgently take measures to remove snoring.

Its sound power can reach 65 decibels or more - an indicator characteristic of the sound of a jackhammer.

For comparison: according to sanitary standards, the permissible noise level in the daytime is 55, at night – 40 dB. From this article you will learn when surgical intervention is prescribed for this disease, about possible contraindications and how much does snoring surgery cost?

What is anti-snoring surgery?

In men, this process begins after 40, but recently the age marker has begun to rapidly decrease.

Fun fact: Snoring astronauts in space sleep silently because gravity magically cancels out the night's sleep. Not everyone can navigate outer space, but anyone can solve this problem in a clinic!

Surgical treatment of snoring currently involves the following surgical interventions:

  • on the nasal septum;
  • on the nasal turbinates;
  • removal of nasal polyps;
  • adenoidectomy;
  • removal of tumors from the nasopharynx;
  • tonsillectomy;
  • plastic surgery of the posterior pharynx: uvulopalatopharyngoplasty (UPPP) and punctate diathermy of the soft palate;
  • laryngopharynx surgery;
  • tracheostomy.

Benefits of uvuloplasty

Uvuloplasty is a safe manipulation using a laser, in which the soft palate is subjected to plastic surgery. This manipulation allows you to restore normal airway patency.

There are several varieties aimed at correcting the structure of the palatine arches, tonsils and soft palate. For example, it is possible to cut the tongue in the throat to prevent snoring. The main action is focused on increasing tissue density and expanding the lumen of the pharynx.

Low muscle tone causes the uvula to sag, and these anatomical disorders are the reason for uvuloplasty. It is especially effective in the presence of mild signs of breathing obstruction during sleep.

Whereas a severe form will be more of a contraindication: after the manipulation, scars remain, which in turn will become a source of new complications.

  1. Healthy lifestyle.
  2. Good physical shape, excluding obesity.

For what causes and manifestations of the disease is UPFP used?

It can be triggered by a variety of factors:

  • rhinitis;
  • individual features of the body structure: large tongue or elongated tongue;
  • deviated nasal septum;
  • polyps;
  • taking sedative medications;
  • age-related changes;
  • enlarged adenoids;
  • tonsillitis.

Serious blockages in various parts of the respiratory tract can lead to cessation of breathing during sleep - obstructive apnea syndrome, a fairly common pathology. It is fraught with hypoxia, which provokes negative changes in the cerebral cortex.

Attacks of depression and arrhythmias, including heart block, may occur. Its most common manifestations during the day are drowsiness, chronic fatigue and increased blood pressure.

The primary recommendations of doctors before surgery to eliminate snoring are:

  • weight loss;
  • sleep in a comfortable position;
  • quitting smoking and drinking alcohol;
  • normalization of the thyroid gland.

If, after eliminating all of the above factors, the client’s problem does not go away, doctors recommend uvuloplasty. UPFP is used in advanced cases, when the airways are blocked by overgrown tissues and other methods of therapy have not worked.

Techniques used

Among the most common, palatal implants are widely used. They are installed in the soft palate. This helps strengthen it and prevent nighttime vibration.

Mouthguards for snoring are no less popular. They are made of plastic and fix the lower jaw in a slightly protruded position, thereby increasing the elasticity of the pharynx and preventing it from “collapsing”.

The CPAP method is also used, which involves the use of a special compressor.

If we consider the surgical treatment of snoring, the most “working” one is uvulopalatopharyngoplasty. There are several types of UPFP: traditional, laser, cryotherapy and radio wave.

The following video describes the UPFP cryotherapy method:

Traditional is an operation to expand the pharynx, which effectively solves the problems.

During this intervention, the following tissues or organs are subject to cutting:

  • uvula;
  • tonsils and adenoids;
  • fragment of the soft palate.

Such an “invasion” is used extremely rarely: there is a danger of injury to adjacent tissues and blood vessels.

There are also a number of possible complications that are a serious psychological obstacle to deciding on such measures:

  • swelling and narrowing of the airways;
  • bleeding;
  • risk of infection;
  • insomnia;
  • apnea attacks that occur after anesthesia;
  • difficulty swallowing;
  • speech complications.

Indications and contraindications

Such combined operations are called “revision of the upper paths.” Contraindications include: myocardial infarction, chronic diseases of internal organs in the decompensation phase, poor blood clotting.

It has a number of side effects. Due to the fact that the swallowing function changes, some of the ingested liquids may enter the nasal cavity, which in some situations leads to the appearance of nasal sounds. As a rule, it is temporary, but sometimes these processes become permanent.

Cost of surgical treatment

From a financial point of view, there is one significant disadvantage: this procedure is not included in insurance coverage, because from an official point of view it is not a disease.

Therefore, to get rid of snoring surgically, the price you will need to pay is within rubles.

This price for snoring surgery includes examination, anesthesia, hospital stay and initial consultation.

Progress of the procedure

Before anti-snoring surgery, you should undergo a series of standard blood and urine tests, and also be tested for syphilis and HIV. The main point of the examination is polysomnography, which consists of assessing the frequency and depth of breathing of a sleeping person. Also ECG, pulsometry, electroencephalography.

During anti-snoring surgery, the doctor removes the tonsil glands, if the patient has them, along with any excess tissue around them. Then the required volume of tissue is cut off from the edge of the soft palate in order to expand the airways. At the final stage, sutures are placed along the edges of the incisions to stretch the back wall of the pharynx.

In some cases, before carrying out such a manipulation, patients suffering from excess weight or severe apnea must undergo a temporary tracheostomy. If you have dental problems, such as tooth decay, you should visit a dentist.

Rehabilitation period

Immediately after completion, the patient is under therapeutic observation; often he is even placed in an intensive care ward, and then in a hospital for several days.

The recovery period takes about 3 weeks: it is accompanied by unpleasant sensations when swallowing, sometimes the pain radiates to the ear area.

But a general improvement in the condition is observed almost immediately. According to statistics, up to 73% of operations produce results.

During the recovery period, you should avoid spicy and acidic foods. You may also need to use a CPAP machine for some time.

The patient's head should be elevated throughout the entire rehabilitation period. To relieve throat swelling, you should constantly apply ice compresses, as well as intravenous injections of antibiotics and cortisone.

Is a relapse possible?

In most cases, UPVF gives a positive result. But the assessment of its benefits for patients suffering from apnea is still questionable. Other criteria apply to them: an operation to remove snoring is considered successful, after which the symptoms of this disease disappear.

It was noted that even with the disappearance of snoring, during the study of sleep processes, signs of nocturnal breath holding were detected. Recurrence of the disease is possible: over time, there is a risk of tissue sagging, and postoperative scars can create additional complications.

If you care about your health and the safe sleep of your beloved, be sure to consult your doctor. In many cases, the problem can be solved without surgery! But if you still have to undergo surgery for snoring, you know the price. Good luck!

Source: http://samec.guru/anatomiya/hrap/lechenie-h/hirurgicheskie-metody.html

Uvulotomy (resection or removal of the uvula)

Indications for uvulotomy

  • moderate to severe obstructive sleep apnea syndrome (without snoring);
  • Mild SAS with snoring;
  • snoring without SAS.

Contraindications

Preparing for surgery

How is surgical treatment for snoring performed?

There are several uvulotomy techniques:

  1. Traditional uvulotomy. The operation is performed using a scalpel, which is used to excise the uvula, after which sutures are placed on the mucous membrane.
  2. Laser treatment for snoring. Using a laser beam, completely bloodless, incisions are made, which then scar and change the configuration of the soft palate.
  3. Radio wave surgery. Instead of a conventional scalpel, radio waves are used.
  4. Cryotherapy. The uvula is frozen with liquid nitrogen and then removed.

Complications

Additional Information

Non-invasive treatments for snoring and SAS include:

  • CPAP therapy is a method of respiratory (breathing) support of external respiration using assisted ventilation;
  • oral devices for the treatment of snoring (Somnolis, Snorban and the like).

Literature:

  1. Buzunov R.V., Eroshina V.A., Gasilin V.S. Snoring and obstructive sleep apnea syndrome - M., 2007. - 100 p.
  2. Gorbachevsky V.N., Minin Yu.V. Rationale for the tactics of surgical treatment of patients with snoring and obstructive sleep apnea // Journal. ear, nose and throat diseases.

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Source: http://medoblako.ru/uslugi/uvulotomiya-rezektsiya-ili-udalenie-nebnogo-yazychka/

Treatment of snoring with laser and radio waves: myths and reality. Dedicated to patients without uvulas

Authors: Doctor of Medical Sciences Buzunov R.V., Legeyda I.V., Department of Sleep Medicine, Clinical Sanatorium "Barvikha"

Dedicated to patients without uvulas

"Seven times measure cut once"

Call to the hospital: “Doctor, my stomach hurts!” Answer: “Come to us, we will remove your appendix, and everything will be fine.” Strange dialogue, isn't it? How can a doctor make a diagnosis over the phone using one phrase and immediately offer treatment without examining the patient? If only the appendix could hurt in the stomach, then there would be no need to ask further questions. What if it is cholecystitis or pancreatitis? Unfortunately, with the treatment of snoring, exactly this situation often occurs when the patient is offered laser or radiofrequency treatment for snoring on the website or by phone and is practically guaranteed to get rid of snoring quickly and painlessly in 1 session. But snoring is not a diagnosis, it is a symptom of narrowing of the airways and their walls beating against each other. There are about a dozen reasons for this narrowing. Moreover, the choice of optimal treatment tactics depends not only on the causes, but also on the severity of breathing disorders during sleep. Surgery on the palate is just one of the methods of treating snoring, which has its own specific indications and contraindications.

In October 2010, the American Academy of Sleep Medicine published Clinical Practice Guidelines for Upper Airway Surgery for Obstructive Sleep Apnea in Adults [Aurora RN et al. Practice parameters for the surgical modifications of the upper airway for obstructive sleep apnea in adults. // Sleep.- 2010.0 Vol. 33.- N. 10.- P.]. You can read the full text of the recommendations in English and a brief translation into Russian.

These recommendations at the standard level (standard - the highest level of evidence) determine that laser uvulopalatoplasty* (LUPP) is not recommended for patients with obstructive sleep apnea syndrome. This is justified by the following phrase: “LUPP usually does not lead to normalization of the apnea/hypopnea index** and does not provide a significant improvement in other parameters. Since there is no significant improvement with LUPP, there is a potential for worsening of the condition, and there are potential problems associated with perioperative pain and complications, routine use of this procedure is not in the best interests of the patient.” It is interesting to note that, compared with the recommendations for the use of laser treatment for snoring, published in 2001, this item has been moved from the “Guideline” recommendation category to the “Standard” mandatory category. The 2010 Recommendations also at the standard level indicate the need for all patients to undergo an objective examination to diagnose obstructive sleep apnea syndrome before surgery for snoring on the palate. And after healing, perform a control study to assess the dynamics of the condition after snoring surgery.

Thus, in patients with obstructive sleep apnea, laser treatment of snoring is contraindicated; accordingly, before surgery, all patients must be examined to exclude sleep apnea.

In Moscow, there are more than 50 otorhinolaryngological centers or departments that perform operations against snoring on the palate (snoring treatment with laser or radio frequency). However, only a few centers perform polysomnography, cardiorespiratory monitoring, or other tests to diagnose obstructive sleep apnea. Thus, most surgeries for palate snoring are performed without any objective examination of the patient's breathing during sleep. At the same time, a number of centers directly state that they treat sleep apnea using laser interventions on the palate, which is completely contrary to all international standards. The current practice in Russia of performing surgeries for snoring on the palate without taking into account the severity of sleep apnea leads in some cases to the ineffectiveness of the intervention and the development of serious and sometimes tragic complications.

Several times a month, in the sleep medicine department of the Barvikha clinical sanatorium, a serious deontological problem arises associated with the consequences of laser treatment for snoring or other operations for snoring on the palate. We examine the patient, identify severe obstructive sleep apnea syndrome and inform him about it. And the patient asks the question: “Doctor, some time ago I had laser treatment for snoring, they removed the uvula and promised that I would stop snoring. I haven’t stopped snoring, and you also say that I have severe sleep apnea. Maybe you shouldn't have removed the tongue? Could laser treatment for snoring have worsened my condition? What should we answer to patients in this situation, especially if there are signs of pharyngostenosis (scar narrowing of the pharynx after surgery)?

Here we would like to share a story told by my colleague from Israel. Several years ago there was a lawsuit involving laser treatment for snoring. The patient filed a lawsuit demanding compensation for moral damages due to the fact that the operation did not eliminate snoring. A forensic medical examination was ordered and polysomnography was performed, which established that the patient had a severe form of obstructive sleep apnea syndrome. At the same time, the operating surgeon made a note in the medical history that the intervention was carried out for snoring. There was no history of sleep apnea. No specific night sleep study was performed before surgery, so the diagnosis was made only on the basis of history and examination. Of course, it can be assumed that the patient had sleep apnea before the operation, but it was not diagnosed. The legal conflict was that before the operation the diagnosis sounded like normal snoring, and after laser treatment of snoring, the patient was diagnosed with a severe form of obstructive sleep apnea syndrome. That is, purely formally, the patient’s condition has sharply worsened. And what do you think the court decided? The million-dollar claim against the clinic was satisfied, the doctor was deprived of his license... and now all ENT centers in Israel perform night sleep studies before and after laser treatment for snoring.

Of course, a radical improvement in the situation in Russia is only possible if standards for laser treatment of snoring and other surgical interventions in patients with snoring and obstructive sleep apnea syndrome, based on advanced domestic and foreign experience, are adopted at the level of the Ministry of Health and Social Development. But until this issue is resolved at the state level, each otorhinolaryngologist himself must decide on the advisability of treating snoring and sleep apnea with laser or radio frequency, based on his knowledge, clinical experience and the well-known expression “Do no harm!”

We do not have the right to tell otorhinolaryngologists what and how to do with their patients, but we consider it possible to express our point of view on possible approaches to the diagnosis and effective comprehensive treatment of snoring and obstructive sleep apnea syndrome.

First of all, let's define the terminology. By selective surgical interventions on the palate we will understand such techniques as classical surgery with a scalpel, laser plastic surgery, radiofrequency intervention (somnoplasty), cryoplasty and injection methods. All these techniques are based on the principle of applying dosed trauma to the palate of varying intensity (surgical, thermal, cold, radiofrequency or chemical). Depending on the intensity of the impact, local inflammation, necrosis, or partial tissue rejection (cutting off) may occur, for example, when exposed to a laser or scalpel. During healing, there is a decrease in volume and thickening of the soft palate. The uvula can be partially or completely removed. As a result, the mobility of the structures of the soft palate decreases and decreases, or the phenomenon of snoring is eliminated: the beating of the soft palate against the walls of the respiratory tract.

Currently, in domestic popular medical literature and advertisements, laser or radiofrequency treatment of snoring is presented as practically the only and most effective method of eliminating snoring. Here are some quotes:

“The developed and patented method of laser treatment for snoring allows you to cope with this phenomenon in just 1 session.”

- “Treatment of snoring with a laser: on an outpatient basis, within a few minutes, with virtually no cases of bleeding in the tissue, in most patients there is absolute relief from snoring, in others the condition will improve significantly, only a tiny percentage of patients do not respond to treatment.”

“Laser treatment for snoring has a number of important advantages over others: the operation is performed on an outpatient basis, absolutely painless, bloodless, in just a few minutes, without subsequent disability, eliminating a serious problem for many years.”

— “CO2 laser (carbon dioxide) is an excellent tool for treating snoring. Treatment requires one session, and the effectiveness is 95%.”

— “Treatment of snoring in 1 session! Radio wave method. Effective and safe."

“Treating snoring with radio waves will also help get rid of sleep apnea.”

When reading these advertisements, one gets the impression that modern medicine has completely solved the problem of snoring and sleep apnea, and, so to speak, with “little loss.”

Unfortunately, the solution to the problem of snoring is not as obvious as it seems in the above sources. We routinely counsel and treat patients with persistent snoring and obstructive sleep apnea who, prior to presentation to us, had undergone laser and radiofrequency treatment for snoring without significant benefit (Figure 1).

Rice. 1. Photographs of the pharynx of patients with persistent severe OSA who had previously undergone laser or radiofrequency interventions on the soft palate (own data).

Serious foreign studies are also very critical of the use of selective pharyngeal interventions in patients with snoring and sleep apnea:

— Low or no effectiveness of laser uvulopalatoplasty (LUPP) for obstructive sleep apnea syndrome has been noted [Arch. Otolaryngol. Head Neck Surgery, 1997].

— LUPP is often accompanied by severe pain. There are no significant differences in the severity of postoperative pain between LUPP and uvulopalatopharyngoplasty [J. Otolaryngol., 1997].

— LUPP can lead to serious complications (scar stenosis of the pharynx, loss of the obturator function of the soft palate, nasal voice). In some cases, LUPP can provoke the development of OSA in patients with uncomplicated snoring or aggravate existing OSA [Am. J. Resp. Crit. Care Med., 1997].

Why does laser treatment for snoring, actively used by domestic ENT surgeons, not give the expected effect in a number of patients? From our point of view, the problem is caused by two factors:

1. Incorrect assessment of the leading causative factor of snoring. The fact is that excess soft tissue is far from the only cause of snoring. The most common cause of snoring and sleep-disordered breathing is obesity, which leads to a narrowing of the airways themselves (Fig. 2). In addition, snoring can be caused and intensified by smoking, micro- and retrognathia (small and backward-biased lower jaw), difficulty in nasal breathing, enlarged tonsils, decreased thyroid function, neurodystrophic processes, myopathies, etc. Moreover, the same patient may have 2-3 or more causes of snoring. For example, in a patient with severe obesity, retrognathia and an excessive soft palate, the latter cause may contribute 10-15% to the overall severity of the condition. Accordingly, intervention in the palate will improve the situation by a maximum of 10-15%, which from a clinical and social point of view can be considered as a lack of effect.

Rice. 2. A — the lumen of the respiratory tract is normal; B - narrowing of the airway in an obese patient (Schwab RJ Airway imaging // Clinics in Chest Medicine, 1998; 19: 33-54).

2. Underestimation of the severity of obstructive breathing disorders during sleep. With uncomplicated snoring, the airways remain open, and the soft palate vibrates as the air stream passes, hits the walls of the airways and creates the sound phenomenon of snoring (Fig. 3B). In this situation, palate plastic surgery can give a good effect. But as the obstruction progresses, obstructive sleep apnea syndrome develops. With this disease, a complete collapse of the respiratory tract itself, which is a hollow muscular tube, occurs cyclically. In moderate forms of OSA, especially in obese patients, obstruction occurs not only at the level of the palate, but also at the level of the root of the tongue and even the epiglottis (Fig. 3B).

Rice. 3. A - free breathing; B - narrowing of the airways and beating of the soft palate against their walls, manifested by snoring; B - complete collapse of the airways at the level of the palate, root of the tongue and epiglottis (indicated by arrows) (National Primary Oral Health Care Conference, 2005, Atlanta, Georgia).

In this situation, radiofrequency and laser treatment for snoring may not have any effect, since it does not eliminate the collapse of the underlying sections of the airways. Moreover, after exposure to laser or radio frequency on the soft palate, a burn develops, after which the tissue becomes scarred and thickened. If the patient's pharynx is initially wide, then some narrowing of it will not cause serious consequences. If the pharynx is initially narrow and its walls collapse during sleep, then additional narrowing of the lumen can even worsen obstructive sleep apnea syndrome.

Below we give an example of one of the letters that we periodically receive from patients after unsuccessful laser or radiofrequency treatment for snoring:

I am 37 years old and live in Ukraine. I, a man, had 4 (four) operations over 6 (six) months in the sky, and it did not bring results, i.e. again everything returned to its previous state. My attending physician, “F.I.O. doctor,” who performed all four operations on me at the “Clinic Name” clinic, recommended that I contact you. Please, I respectfully ask for your recommendation, since in this case neither my family nor my doctor know how to live with this further? Everything that is possible has already been cut out; there is nothing left to cut out. The hole size was 30%, the hole was cut four times to 100%. At the moment the hole is again 30%.

The doctor made the following diagnosis - hypertrophy of the soft palate, ronchonatia (snoring - author's note).

The operation of uvulopalatopharyngoplasty (excision of tissues of the soft palate and lateral arches - author's note) caused a complication: pharyngostenosis (scar narrowing of the pharynx - author's note) - excision of scars followed by repeated pharyngostenosis.

The radiosurgical method used was surgetron.

Thank you in advance for your assistance! I will definitely show all your recommendations in medical slang to the doctor “Full name.” doctor” to understand what our next steps should be.

With sincere respect, “F.I.O. patient"

PS. According to my specialty, I have to talk a lot. It is desirable for me to have an opening of 100%, not so much for the sake of my good in life (and with 30% you can exist), but for the sake of the good and benefit of many other people.

(Full names of the doctor and patient, as well as the name of the clinic are omitted for ethical reasons)

When talking with the patient, it was found out that he has grade 2 obesity. Even before the operation, others noted that he stopped breathing during sleep (a sign of obstructive sleep apnea syndrome). After treatment, the snoring intensified and breathing pauses became more frequent.

It should be noted that operations on the soft palate are considered one of the most irreversible in ENT surgery. Those. If the intervention is unsuccessful, it is almost impossible to correct or redo anything, especially in the case of the development of pharyngostenosis.

Most centers that treat snoring with laser or radiofrequency do not have the expensive diagnostic equipment needed to perform polysomnography or cardiorespiratory monitoring. The high cost of diagnostic equipment and the labor intensity of sleep breathing studies determine their high cost (from 6 to 12 thousand rubles), which is comparable to the cost of surgical interventions on the palate themselves. In the current situation, medical centers are taking a certain risk by not purchasing diagnostic equipment and not conducting polysomnography in order to minimize the cost of treatment and increase competitiveness. Doctors are deprived of the opportunity to objectify the severity of breathing disorders during sleep and must rely only on the story of the patient himself (what can he say if he sleeps at night?) or his relatives, as well as the results of a clinical examination (this also occurs during the daytime). Accordingly, without a special study of night sleep, the possibility of a diagnostic error cannot be excluded.

Patients themselves may also refuse a polysomnographic study, relying on advertisements about the almost 100% effectiveness of the intervention (why then are any additional expensive studies needed?). Unfortunately, miraculous healings only happen in fairy tales; in reality, this is far from the case. According to large and credible foreign studies, it has been shown that the effectiveness of laser and radiofrequency palate plastic surgery is about 80% for uncomplicated snoring, about 50% for mild forms of sleep apnea and less than 20% for moderate forms of sleep apnea. How can one not recall the good Russian proverb “Measure twice, cut once.”

In this situation, we believe that the patient must be informed about the possibility of performing polysomnography or cardiorespiratory monitoring in order to clarify the diagnosis before surgical treatment. And then the patient himself must decide whether to incur additional costs for a diagnostic study or immediately agree to surgical intervention in the palate, but without clear guarantees of success. Unfortunately, in our experience, the vast majority of patients presenting to our sleep medicine department after unsuccessful treatment of snoring with laser or radio wave palatal surgery for snoring and sleep apnea were not previously informed about the possibility of polysomnography to clarify the diagnosis and determine the optimal treatment tactics depending on the combination of causes and severity of sleep disturbances. But useless and sometimes quite dangerous surgical interventions could have been avoided if the patient had immediately been accurately diagnosed with obstructive sleep apnea syndrome. Yes, with this diagnosis it is impossible to cure a patient “on an outpatient basis, once, bloodlessly, painlessly and 100%.” In this situation, it is better to honestly tell the patient that he requires more difficult and serious treatment methods (significant weight loss or assisted ventilation during night sleep - CPAP therapy). We often hear from patients that if surgical treatment was unsuccessful, they were again and again asked to come for repeated sessions of laser or radiofrequency intervention (sometimes up to 5-6 times!). In this case, usually the patient himself at some stage stops visiting the doctor, and in response to the legitimate question “Why didn’t it help?” The answer usually follows: “You haven’t completed the full course of treatment, so it’s your own fault.” At the same time, promises to do everything in one session with 100% success are usually quickly forgotten.

We conducted a study that included 15 consecutive patients with severe obstructive sleep apnea (OSA) who had undergone laser uvulopalatoplasty (from 2 to 6 sessions) at different times (up to 2 years) before admission to our sleep medicine department. ). The following data was received:

— Before laser intervention, not a single patient had a polysomnographic study or cardiorespiratory monitoring performed to clarify the severity of sleep-disordered breathing.

— Only 3 patients were clinically diagnosed with OSA, although all patients had the classic clinical picture of severe OSA.

— None of the patients were offered alternative treatments for OSA before laser uvulopalatoplasty (LUPP).

— Only 3 patients were referred for examination to the sleep laboratory by ENT surgeons after LUPP. The remaining patients did not receive any recommendations for further examination and treatment, despite the ineffectiveness of LUPP.

Particularly noteworthy is the fact that after unsuccessful LUPP, patients were not informed about the possibility of CPAP therapy, an effective method of treating severe OSA. They were simply told that nothing would help you now.

In conclusion, we do not advocate laser or radiofrequency intervention on the soft palate in patients with uncomplicated snoring in whom the primary cause of snoring is an excessive soft palate or uvula. Of more than 5,000 patients examined in our sleep center for snoring and sleep apnea, about 15% were subsequently referred to ENT surgeons and underwent laser or radiofrequency treatment for snoring, most with good results. This suggests that these techniques are also in our arsenal of treatment methods. We only urge, no matter how trivial it may sound in medical circles, to conduct a thorough history taking, provide adequate instrumental examination and use the most optimal treatment methods depending on the combination of causes and severity of snoring and sleep apnea. This may include laser or radiofrequency interventions on the palate, surgical or conservative methods of restoring nasal breathing, CPAP therapy, the use of intraoral applicators, smoking cessation, treatment of hypothyroidism and a number of other therapeutic measures. Weight loss should also be considered as one of the main treatments for snoring and sleep apnea in overweight patients. Sometimes losing 5-7 kg of weight is enough to stop snoring.

Snoring is just a symptom. Snoring can be uncomplicated and represent only a social problem, or it can accompany a severe form of obstructive sleep apnea syndrome. There are also more than a dozen causes of snoring. In this situation, treating snoring with laser or radiofrequency indiscriminately in all patients is like removing the appendix in all patients with abdominal pain. Maybe it will help someone...

Below is a clinical case from our practice.

Patient K., 43 years old, in 2003, applied to the sleep medicine department of the Barvikha clinical sanatorium with complaints of snoring, sweating at night, restless and unrefreshing sleep, waking up with a feeling of lack of air, frequent urination at night (3-5 times) , fatigue and headache in the morning, daytime sleepiness, irritability, decreased potency, deterioration in performance.

Anamnesis. Snoring appeared about 10 years ago and increased in parallel with a gradual gain in body weight. For snoring, cryoplasty of the palate (exposure to liquid nitrogen) was performed in 1996. The intervention was quite difficult. For 2 weeks, my throat was very sore and my body temperature was rising. I did not notice any improvement in the loudness of snoring. Over the years, he gained about 6-7 kg, against the background of which his snoring intensified, and those around him noted the appearance of respiratory arrests during sleep. In 1999, I went to a laser center, where laser treatment for snoring was carried out twice, which also did not produce a positive effect. Polysomnographic studies were not conducted either in 1996 or 1999 (the patient was not even informed about this possibility). Over the years I gained about 10 more kg. During this period of time, other complaints (besides snoring) appeared and increased. After about 3 years, there is an increase in blood pressure to 170/110 mmHg. Art. mainly in the morning hours. He has been smoking 20 cigarettes a day for more than 10 years.

Inspection. Obesity 2 tbsp. (height 197, body weight 116 kg). Significant fat deposits at the neck level. Breathing through the nose is not difficult. Moderate retro- and micrognathia. The pharyngeal ring is narrowed due to general obesity. Condition after cryo- and laser palate plastic surgery (Fig. 4).

Rice. 4. Photograph of the pharynx of patient K., 43 years old, with a persistent severe form of OSA. Condition after repeated cryo- and laser interventions on the palate: the lateral arches are scarred, subtotal resection of the uvula (own data).

The patient underwent a polysomnographic study (Fig. 5 and 6). During 7.5 hours of sleep, 327 apneas and 120 hypopneas of obstructive origin were recorded. Apnea/hypopnea index = 60 per hour. The total duration of apnea and hypopnea was 195 minutes or 60% of sleep time. The maximum duration of apnea is 63 seconds. Minimum blood oxygen saturation 74%. A sharp disturbance in the structure of sleep was noted: an increase in the duration of stage 1 of sleep, an almost complete absence of deep stages of sleep (3-4), the index of brain micro-awakenings was 64 per hour.

Diagnosis: obstructive sleep apnea syndrome, severe form.

Rice. 5. On a 5-minute polysomnogram scan, cyclic stops of breathing are noted (the “Breathing” channel), accompanied by a significant drop in blood oxygen saturation (the “SaO2” channel) and micro-awakenings of the brain on the electroencephalogram (the “EEG” channel).

Rice. 6. Initial somnogram (sleep structure) within 7.5 hours. There is a sharp disturbance in the macrostructure of sleep, a significant redundancy of the first stage of sleep (yellow in the lower graph), and a complete absence of deep stages of sleep (3-4).

Rice. 7. Somnogram during the first session of CPAP therapy. There is a normalization of the sleep structure, a predominance of deep stages of sleep (blue in the lower graph) and REM sleep (red).

Non-invasive continuous positive pressure ventilation during night sleep (CPAP therapy) was started. On the first night of treatment, obstructive breathing disorders were almost completely eliminated. The apnea/hypopnea index decreased from 60 to 2 per hour, normalization of blood oxygen saturation indicators, and normalization of the macro- and microstructure of sleep were noted (Fig. 7). The patient noted a significant improvement in the quality of sleep and daytime activity after the first night of treatment. Subsequently, continuous CPAP therapy at home was continued.

A comment. The patient had congenital predisposing factors in the form of retro- and micrognathia. Additional factors that provoked the occurrence of snoring, apparently, were smoking and weight gain. It cannot be ruled out that there was also an excess soft palate or an elongated uvula. Thus, there was a set of factors that could contribute to the occurrence of snoring. The patient underwent cryoplasty of the palate, which was unsuccessful, apparently due to the fact that the contribution of other causative factors to the occurrence of snoring was more significant. In addition, the patient was not told anything about the need to lose weight! At our consultation, he learned for the first time that obesity can be a major factor in the development and severity of snoring. Thus, from our point of view, a diagnostic error was made due to an incorrect assessment of the leading causative factor of snoring.

Further weight gain probably led, already in 1999, to the development of obstructive sleep apnea syndrome (those around her noted that they stopped breathing during sleep). In this situation, the feasibility of performing laser palate surgery in 1999 was even more questionable, since interventions on the palate for OSA are not indicated. Moreover, scarring of pharyngeal tissue could even worsen OSA by further narrowing the pharyngeal lumen.

Accordingly, in this situation the severity of obstructive sleep disordered breathing was also underestimated.

Analysis of the given clinical example allows us to draw three obvious conclusions:

— Surgical interventions on the palate are not effective in patients with obesity and severe sleep apnea.

— In this category of patients it is necessary to use CPAP therapy.

— The choice of treatment tactics depends not only on the causes of snoring, but also on the severity of breathing disorders during sleep. The severity of the disturbance can only be determined on the basis of a polysomnographic or cardiorespiratory sleep study. Accordingly, instrumental diagnosis of sleep breathing disorders should be an integral part of a comprehensive examination of a patient with snoring and suspected obstructive sleep apnea syndrome.

In conclusion, I would like to express the hope that this article will allow both doctors and patients to make more informed decisions when choosing a treatment method for snoring and obstructive sleep apnea syndrome.

* — Laser uvulopalatoplasty is a laser treatment for snoring, which involves exposure of the soft palate, uvula and palatine arches to laser radiation.

** — Apnea/hypopnea index — frequency of episodes of complete and partial stops per hour, reflecting the severity of obstructive sleep apnea syndrome.

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The uvula interferes

People who are bothered by the uvula may experience snoring, a feeling of a lump in the throat, a feeling of discomfort, difficulty breathing, especially at night, and sometimes nausea due to pressure on the root of the tongue.

The appearance of this symptom is most often associated with either an anatomically low location of the soft palate or an enlargement of the uvula. A number of factors can lead to its occurrence. When snoring, the beating of the tongue against the walls of the pharynx causes mechanical damage, when smoking, tar has a negative chemical effect on its mucous membrane, and infections of the tonsils or allergic reactions lead to severe swelling. All these processes lead to chronic inflammation of the mucous membrane, and against this background, the muscles of the uvula are replaced by connective tissue and lose their tone. As a result, the uvula can no longer be pulled up and hangs down, sometimes even touching the root of the tongue.

Is the uvula getting in the way? Contact our Center and we will help you effectively! Make an appointment by phone: -69-07, -69-08.

Fortunately, the uvula has minimal impact on the lumen of the pharynx and does not make a significant contribution to the occurrence of sleep apnea. At the same time, its changes cause snoring, because the uvula is the most mobile part of the pharynx, which vibrates when air passes and produces a characteristic sound.

Patients with this problem are often recommended surgical treatment, for example, partial or complete removal of the tongue using the radio wave method. As a result, the vibration of the palate decreases and snoring disappears. This is possible if the uvula was the only cause of snoring, but we must remember that one person may have several factors that cause an unpleasant sound during sleep. This may be weight gain, a deviated nasal septum, polyps, adenoids and other changes in the walls and lumen of the pharynx. With this “set” there are often pauses in breathing during sleep - obstructive apnea syndrome.

In this case, soft palate surgery may not be the right choice. This is due to scarring of the walls of the pharynx and narrowing of the airway, which is unacceptable during apnea. It is much more effective to eliminate snoring in combination with apnea CPAP therapy, which prevents vibration and collapse of the pharyngeal walls, protecting your sleep and health at night.

Therefore, before removing the interfering tongue, you should consult a somnologist. If sleep apnea is present, the doctor will diagnose it, determine the severity of the disease, determine the causes and risk factors and, based on all this, recommend the optimal treatment regimen.

Patients with sleep apnea should begin treatment as quickly as possible. The disease is dangerous, it several times increases the risk of heart attack and stroke, accelerates the development of cardiovascular and other diseases, contributes to the appearance of endocrine disorders, and daytime sleepiness with OSA greatly increases the likelihood of injury or getting into an accident.

Is the uvula getting in the way? Contact our Center and we will help you effectively! Make an appointment by phone: -69-07, -69-08.

Calls are accepted from 8 to 20.00 Moscow time

Source: http://www.sleepnet.ru/rasstroystva-sna/simptomyi-bolezney-sna/meshaet-yazyichok/