Government recommends RF procedure to Stop Snoring

Extract from National Institute Clinical Excellence (NICE), part of NHS that advise Governement on clinical recommendations.

Issue date: May 2005
Radiofrequency ablation of
the soft palate for snoring
Understanding NICE guidance – information
for people considering the procedure,
and for the public

www.nice.org.uk

About this information
The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. One of NICE’s roles is to produce guidance (recommendations) on the use of medicines, medical equipment, diagnostic tests and clinical and surgical procedures within the NHS in England and Wales.
This information describes the guidance that NICE has issued on a procedure called radiofrequency ablation of the soft palate for snoring. It is not a complete description of what is involved in the procedure – the patient’s healthcare team at Stop Snoring -Manchester will describe it in detail.
NICE has looked at whether radiofrequency ablation of the soft palate is safe enough and works well enough for it to be used routinely for the treatment of snoring.
To produce this guidance, NICE has: 

 looked at the results of studies on the safety of radiofrequency ablation of the soft palate and how well it works

asked experts for their opinions

asked the views of the organisations that speak for the healthcare professionals and the patients and carers who will be affected by this guidance.

This guidance is part of NICE’s work on interventional procedures’ Radiofrequency ablation of the soft palate for snoring.

About radiofrequency ablation of the soft palate for snoring.

The sound of snoring is the sound of the soft palate and other parts of a person’s mouth, nose and throat vibrating (the soft palate is the soft upper part of the back of the mouth). Snoring happens because of turbulence in the person’s airways when they breathe in. And the turbulence happens because there’s a partial blockage somewhere between the nose and the bottom of the throat. In the procedure NICE has looked at, which is called radiofrequency ablation of the soft palate, the soft palate is made smaller and its texture is improved. This is done using radiofrequency energy, which is produced using an electrode device. The aim is to reduce the amount of vibration.
The procedure is usually done in a clinic environment, and the patient usually has a local anaesthetic applied to the area before the electrode device is used.

Alternatives available:

The standard treatment for snoring is lifestyle change (for example, losing weight, stopping smoking). However this is sometimes a long term solution. Sometimes aids can be worn during sleep to help stop the turbulence and vibrations. Hopwever, patient normally grow tired of wearing such devises on going to bed. There are also surgical procedures that aim to help reduce the blockage that’s causing the turbulence. This normally involves the removal of the uvula and considerable long lasting pain for the patient. The loss of the uvula leaves the patient with a strange sensation in mouth and susceptable to regurgitation of foods and liquides from their nose.

How well the procedure works.

 What the studies said 'For the patients who had the radiofrequency ablation, the partners’ scores showed that the snoring had significantly improved after the procedure. On a scale of 1 to 10, the average score went from 7.5 before the surgery to 2.8 at 8 weeks after it. Subsequent improvement were noted after this period but not recordfed.

In another study, partners thought patients snored more quietly after having radiofrequency ablation of the soft palate. These checks were made 16 weeks after the surgery. NICE also looked at several other studies that followed what happened in people who had  radio frequency ablation of the soft palate.

In one study that ‘scored’ snoring before the laser surgery and again 1 year later, the snoring score went down from 9 before the surgery to 3.5 afterwards, indicating that patients’ snoring had improved.

 In another study, which checked on patients around 9 months after the procedure, 12 out of 19 patients had an improvement in their snoring.

Finally, in another study, patients’ snoring was thought (by the partners) to cause less of a disturbance to sleep and patients were less tired during the daytime after they’d had the procedure. These assessments were made in the 12 weeks after the surgery.

What the experts (ENT Consultants) said.

The experts said that it was important that the procedure was offered only to the specific patients who might be helped by it. Therefore careful screening by consultant and medical assessment is essential prior to any procedure. One expert also pointed out that sometimes people need to have the additional procedure trimming the uvula for the optimum results.

What the studies said.

One study compared patients who had radiofrequency ablation with patients who had laaser surgery for snoring. The pain lasted for a shorter length of time in the patients who had radiofrequency ablation (2.5 days compared with 14 days for the other types of
surgery).

 The extent of patients had pain was said to be mild or an average of 7 days
after radiofrequency ablation, compared with 15 days of excessive pain after the laser surgery called laser-assisted uvulopalatoplasty.

Radiofrequency ablation of the soft palate for snoring and risks and possible problems where minimal compare to the risks using laser surgery.
What has NICE decided?

In a study of 60 people who had radiofrequency ablation, 6 people said their pain had lasted for longer than they expected after the laser surgery. 

in another study that included 117 radiofrequency ablation procedures, there were small sores or ulcers in the area on 11 occasions. These got better, without treatment, after 1 to 3 weeks.

There weren’t any serious side effects from the procedure in two other studies NICE looked at.

What the experts said
The experts had no specific concerns about the safety of radiofrequency ablation for snoring. But they said haemorrhage (bleeding), infection and ulceration at the back of the mouth were possible problems.

What has NICE decided?
NICE has decided that, if a ENT Consultant doctor wants to carry out radiofrequency ablation of the soft palate for snoring, he or she should make sure that the patient understands what is involved and that there are still uncertainties over how well the procedure works in the long term should the patient gain significant weight or change their life style habits.
They should also be told about the alternatives, including lifestyle changes. There should be special arrangements in place so that the patient only agrees (consents) to the procedure after this discussion has taken place.

Radiofrequency ablation of the soft palate
for snoring.

 What the decision means for you the patient.
The ENT Consultant  offering you radiofrequency ablation of the soft palate for snoring will be able to advise you of the risks and possible outcomes from the procedure.  NICE has considered this procedure as being the most suitable option available to Stop Snoring because it has the lower risk and discomfort to patient whilst providing the best outcome to the patient and their partner in terms of reduced or total noise reduction.