SHRINKING TONGUE SIZE USEFUL IN TREATMENT FOR SLEEP APNEA

With energy generated by radio frequency waves, a Loyola University Health System physician is reducing the size of patients’ tongues successfully to treat obstructive sleep apnea, a disorder that causes patients to stop breathing temporarily during sleep.

Loyola is one of only about 10 centers in the nation using the technology to shrink the tongue in an effort to reduce or eliminate sleep apnea in patients who have already failed standard surgical procedures, said Dr. Regina Walker, assistant professor of otolaryngology in the Loyola University Chicago Stritch School of Medicine.

Sleep apnea occurs as a result of an obstruction located somewhere between the tip of the nose and the trachea, the passage in the throat that helps transport air to the lungs. The obstruction may be a deviation in the septum, the dividing wall separating the inside of the nose into two passages; nasal polyps; oversized tongue, soft palate, uvula (the fleshy mass that hangs from the soft palate) or tonsils; a tumor; or even a combination of these problems. Patients with sleep apnea are awakened throughout the night because the obstruction impairs their breathing and causes their oxygen levels to fall too low.

The new technique is applied to patients whose tongue size is believed responsible, at least in part, for their sleep apnea. The procedure, which takes only about 20 minutes to perform, but is usually done in an operating room, involves inserting a needle in two or three locations in the base of the tongue. Energy, and thus heat, is generated through the needle to break down cells in a small area of the tongue. The destruction of these cells causes the tissue in the tongue to shrink.

Most patients require several treatments to achieve the desired results, Walker said. “We are able to reduce the volume of the tongue significantly -- by as much as 17 percent,” she said. The reduction allows more oxygen to pass through the patient’s airways.

“The advantage of this technology is that the physician is able to deliver a precise amount of energy that destroys a predictable amount of tissue in a small area,” Walker continued. “Other than experiencing a tongue that is somewhat stiff for a brief time after the procedure, most patients report no pain.”

Patients who undergo the procedure at Loyola currently remain in the hospital overnight so that physicians can monitor the healing of the tongue and prevent swelling and infection. “As we become more comfortable with this technology, patients will likely go home the same day of the procedure,” Walker said.

Walker called the new technology exciting, because it could improve the quality of life for nearly half the people who develop sleep apnea.

“Only about 50 percent of patients with sleep apnea are cured by standard surgical procedures, such as trimming the soft palate and uvula, removing the tonsils or nasal polyps, or straightening the nose,” Walker said. “The other 50 percent either improve somewhat or derive no relief at all from surgery. In these patients, the culprit usually remains the tongue. Until now, we have been reluctant to do surgery on the tongue because of the dangers of infection and swelling.”

The only options for patients not helped by standard surgical procedures are to wear a special mask that provides pressurized room air during sleep, to receive a tracheotomy or to undergo comprehensive surgery that involves breaking the jawbones and maxillary bones and pulling the face forward.

A pilot study published last year in the journal Otolaryngology-Head and Neck Surgery indicated that the application of radio-frequency energy to the tongue is a safe and efficacious method of treating sleep apnea in patients who have failed standard surgery. The study involved 18 patients. Results of a larger national study of the technique are scheduled for presentation in the fall.

The use of radio-frequency energy in patient care is not a new concept. In fact, cardiologists apply similar technology in eliminating abnormal electrical pathways in the heart. Loyola ear, nose and throat specialists like Walker also have used radio-frequency energy to reduce a patient’s soft palate and uvula. In addition, radio-frequency energy has been used to shrink the lining inside the nose in patients with nasal obstruction.