Radiofrequency Treatment

Enlarged soft tissues of nose, tongue and palate in sleep apnea patients at times are implicated as one of the causes of airway resistance and obstruction. In order to reduce the volume of the tissues and expand the airway without any surgical intervention, radiofrequency technique is applied. This technique uses the high frequency waves carried by a probe under the tissues.

The procedure is performed under local anesthesia in an office setting with minimal discomfort. Once the probe is in place, the targeted tissues are heated to 60-90 degrees of Celsius which as a result starts the process of scar formation and eventual reduction in tissue volume. The process of shrinking of the tissues and scar formation takes several weeks (one to three weeks usually) to complete so the results are not immediate. An advantage of this over conventional cautery is that, radiofrequency is able to deliver energy to specific area with less damage to surrounding tissues and excessive heat dissipation. There is no major recovery with this procedure and virtually no bleeding.

Radiofrequency Nasal tissue (Turbinate) treatment

Turbinate Reduction can provide a fast return to normal breathing for pediatric or adult patients with enlarged nasal airway passages. Enlarged nasal tissue could obstruct normal breathing and use of CPAP. This therapy creates a quick reduction in nasal obstruction with a greater reduction during healing.

In this outpatient procedure, the patient receives a local anesthetic. Using direct vision, the electrode is inserted into the inferior turbinate. The control unit delivers radiofrequency energy beneath the tissue (mucosa). Tissue is heated in a limited area around the electrode, creating a submucosal (below the surface) coagulative lesion. The patient does not feel discomfort during the procedure, and the mucosa is protected from thermal damage. The lesion is naturally resorbed by the body, leading to tissue volume reduction and relief of nasal obstruction. This can be an effective treatment for patients who suffer from chronic turbinate hypertrophy or obstruction. Procedure time is about two or four minutes. This makes radiofrequency turbinate reduction an ideal procedure for the office. There is no specific restrictions post treatment, although some nasal stuffiness for less than a week is expected.

Radiofrequency Soft Palate Treatment

Soft Palate Treatment can reduce the incidence of snoring and sleep apnea without surgery. Radiofrequency Soft Palate Treatment is performed in an outpatient setting under local anesthesia (or IV sedation upon patient preference). The procedure typically takes less than ten minutes and there is a reduction in snoring within six weeks usually. Over a period of 6 to 8 weeks, the lesions are naturally resorbed, reducing tissue volume and stiffening remaining tissue in the desired area.

In addition, studies published in peer-reviewed journals have shown radiofrequency soft palate treatment to have numerous clinical advantages:

• Significant improvement in Eppworth Sleepiness Scales (screening tool for sleep apnea) at both the 3 and 9.5 month postoperative visits
• Significant reduction in snoring reported by both patient and bed partner at 3 and 9.5 month postoperative visits
• Minimal patient discomfort
• Immediate reduction in palatal tissue volume
• Continual symptomatic improvement over time due to tissue shrinkage and stiffening as a result of the deep scar tissue being formed

The patient is fully awake throughout the treatment. The local anesthetic is applied to the uvula and palate, similar to that used in a dental procedure. A few minutes later the probe, which is connected to a radiofrequency control unit, is placed into the soft palate. Radiofrequency is applied through the electrode. Part of the electrode is insulated to protect the delicate surface of the tissue. Through controlled delivery of radiofrequency energy, the tissue is heated in a limited area around the electrode. There is no discomfort during the procedure. The procedure creates a submucosal lesion in the soft palate. Patients typically experience some swelling and have a mild sore throat. Following the procedure, most patients take an over-the-counter analgesic for one to three days. Over a period of three to six weeks the lesion is naturally resorbed by the body, leading to tissue volume reduction. In addition, the collagen in the treated area tends to contract, lifting the uvula, stiffening the tissue and reducing its propensity to vibrate. With the reduction and tightening of the obstructive tissue, snoring and sleep apnea is reduced in many patients. This procedure is not indicated as a sole treatment for sleep apnea. It is usually performed in combination with other procedures depending on the severity of the symptoms.

Radiofrequency treatment of tongue

Tongue is the largest muscle in the oral cavity, as a result, has a propensity for being the most frequent cause of obstruction of airway in sleep apnea patients. In this case goal is to reduce the volume of the tongue and increase the airway volume as a consequent.

Radiofrequency is a non-invasive way to reduce the tongue volume and improve the airway. Similar to other Radiofrequency procedures, this is done in an office setting under local anesthesia or IV sedation if desired. The radiofrequency probe is inserted in the base of the tongue near back of the throat and activated. The resultant heat production would stimulate the tissues and over three to six weeks would shrink and tighten the base of tongue. This reduction would contribute to opening of airway in the back.

The procedure duration is about 15-20 minutes depending on the amount of tissue to be treated. The potential complications with this procedure includes infection (rare) and swelling. The amount of swelling depends on the size of the tissue to be treated. Because of tongue’s large size and limited energy that could be applied at a time, the treatment needs to be repeated in multiple sessions in order to achieve desired results.