Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: Recommendation

Snoring Is Not Relieved by Nasal Surgery Despite Improvement in Nasal Resistance: RecommendationVariable treatment outcomes can be hypothesized to reflect differences in other obstructive sites. Strifes and coworkers reported better outcomes after nasal surgery in patients with normal cephalometry in 14 patients who were matched for SDB and BMI. In six of seven patients with a wide ph1-ph2 and a short H/MP as criteria for normal cephalometry findings, the AHI returned to < 10 and the number of arousals decreased. In the group of patients with abnormal cephalometry findings, none of the patients were cured by nasal surgery. In consecutive patients taken from our waiting list of patients for nasal surgery, these results could not be confirmed.

RMM is a physiologic noninvasive method for the evaluation of nasal patency. Nasal resistance increases when the patient is in the supine position, and it is influenced by arterial CO2, pain and fear, tactile stimuli, temperature, and humidity. Alternating congestion of the capacitance vessels of the nasal mucosa is the most important factor modulating unilateral nasal resistance. A decongested nasal mucosa is less dependent on these physical and physiologic factors, and decongestion is recommended for the evaluation of structural nasal obstruction. The fact that patients with more severe nasal obstruction preoperatively obtained a greater decrease in nasal resistance seems natural. The relationship between nasal resistance and BMI is unknown.
There is no agreement about how to measure snoring. However, repeated measurements before and after intervention will show changes reliably, assuming that snoring characteristics recorded during the study are those that are essential for the human ear too. In this study, snoring time was measured when snoring intensity exceeded a level that had been preset at calibration. The recorded snoring intensity was compared with perceived snoring sounds during the calibration process.

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