Snoring (Rhonchopathy): Surgical Therapy

Depending on the underlying cause of snoring, ENT surgery may be appropriate. For example, malpositioning of the nasal septum (with concomitant obstruction of nasal breathing) or excessively large soft palate can be corrected.

If the soft palate represents the suspected source of snoring, surgical procedures on the soft palate should be offered for therapy if treatment is desired [S3 guideline].

For surgical therapy of snoring, minimally invasive surgical procedures should be preferred [S3 guideline]. The following surgical methods are available for this purpose:

  • Rhinosurgery (operations in the area of the nose, e.g., conchal surgery, surgery of the nasal valve); indications: subjectively disturbing nasal breathing obstruction and presence of a corresponding anatomical abnormality in the noseNote: No statement can be made on the effectiveness of nasal surgery in patients without subjective nasal breathing obstruction due to the lack of evidence (strong consensus) [S3 guideline].
  • Soft palate surgery (snoring surgery aimed at reducing or removing the duration or attenuating the intensity of snoring).
    • Uvulopharyngoplasty with scalpel (UPP) or with laser (LAUP; laser assisted uvulopharyngoplasty).
    • Uvulopalatopharyngoplasty (UPPP) – resection of excess tissue or tightening of the palate and pharyngeal mucosa.
    • Radiofrequency volume reduction (RFA) – stiffening of the soft palate by artificial scarring; narrowing of the pharynx.
    • Soft palate implants (implant small synthetic fibers) – stiffening of the soft palate.

    Note: The indication for the more invasive uvulopalatopharyngoplasty, usually performed with tonsillectomy, should be strict because of its increased morbidity and complication rate (strong consensus) [S3 guideline].

  • Tongue base surgery
    • Radiofrequency therapy aimed at scarring shrinkage and stiffening of the muscles at the base of the tongue with widening of the retrolingual spaceNote: This procedure showed only a mild effect on snoring in the long-term.

Further notes

  • According to a study, a simple test can determine whether a heavy snorer will benefit from nasal palate surgery:
    1. With the mouth slightly open, the patient should try to gently vibrate the palate by breathing in through the mouth (mouth breathing). This should result in a second step.
    2. In the second step, the patient is encouraged to produce the fluttering of the soft palate also by nasal breathing with the mouth closed.

    If the sound succeeds with mouth breathing, but not with nasal breathing, there is a chance of successful surgery.