Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Patients and Study Design

The study population consisted of 40 consecutive men who had been referred to the ENT Hospital at Helsinki University Central Hospital because of a snoring problem or suspicion of sleep apnea and were scheduled for surgical treatment of nasal ob-struction. Only one patient had undergone septoplasty earlier, but other upper airway surgery for SDB had not been performed. The evaluation for nasal surgery had been based on symptoms, and anterior rhinoscopy and anterior rhinomanometry (RMM) findings without strict criteria for nasal resistance. The mean age of the patients was 44.2 years (SD, 9.5 years; age range, 26 to 62 years), and the mean body mass index (BMI) was 27.9 kg/m2 (SD, 3.4 kg/m2; range, 22 to 37 kg/m2). The mean total nasal resistance (TNR) was 0.574 Pa/cm/s (SD, 0.597 Pa/cm/s) without decongestion and 0.355 Pa/cm/s (SD, 0.339 Pa/cm/s) after decongestion of the nasal mucosa. All patients were of Finnish origin. None of the patients used sedatives regularly.

Thirty-two percent of the patients reported daytime sleepiness every day or almost every day. The mean Epworth sleepiness scale (ESS) score was 6.3 (SD, 3.7). All patients complained of nasal obstruction, and five patients had a history of allergic rhinitis (13%). Two patients used corticosteroid sprays, and one patient used an antihistamine regularly. Twenty patients (50%) were smokers.
Most of the patients underwent septoplasty with or without partial resection of the inferior turbinates. Septoplasty was performed in all patients using the same technique of mobilization, straightening, and reinserting the straightened cartilage. Septorhinoplasty was performed in two patients, and partial resection of the inferior turbinates was carried out in the other two subjects. The patients underwent preoperative and postoperative active anterior RMM and polysomnography (PSG). Ceph-alometric radiographs were obtained before surgery. Postoperative RMM was performed, at the earliest, 2 months after the operation (mean time to RMM, 125 days; range, 76 to 247 days). The patients underwent a second sleep study 63 to 176 days after surgery (mean time to sleep study, 113 days).
The Ethical Committee of the Department of Otorhinolaryngology of Helsinki University Central Hospital has approved the study. Informed consent was obtained from the study subjects.

Category: Pulmonary Function | Tags: nasal obstruction, polysomnography, rhinomanometry, sleep apnea, snoring, surgery, treatment outcome