Published in Medical News 2006

Sleeping with the enemy? A simpler, faster remedy

medical-news-immunotherapy_thumbnailFor patients and their partners vexed by habitual snoring and obstructive sleep apnea (OSA), a minimally invasive outpatient procedure may be the way to a night of restful slumber.

Employing bipolar radiofrequency-induced thermotherapy (RFITT), the CelonENT method (Olympus) is a simple thermoablative clinic option performed under local anesthesia, with minimal pain during and after the procedure. Furthermore, it can be performed in under 15 minutes.

Excessive snoring and OSA – caused by constriction of the upper respiratory tract or a slack soft palate – can be treated with the Celon method by thermally coagulating excess palate tissue in a few seconds. Consequently, the body gradually breaks down the necrosed tissue, resulting in scarring and stiffening of the treated region.

Likewise, the procedure is also indicated for the shrinkage of nasal turbinates in the treatment of nasal congestion.

According to Dr. Pang Yoke Teen, senior consultant ENT surgeon at Centre of ENT Allergy & Snoring, HealthSense Specialist Clinic, Paragon Medical Suites, Singapore, “the bipolar electrode configuration of the RFITT applicator allows surgeons to be in better control of how much energy to deliver for precisely defined treatment.”

In addition, automatic dosimetry control by the CelonLab ENT power control unit “ensures that coagulation auto-stops to avoid excessive tissue burning and carbonization.”

Often under-diagnosed, OSA affects one to 10 percent of the population. Risk factors are obesity, male gender, age over 40 years and menopause in women. Cardinal night-time symptoms include loud snoring, witnessed apnea, restless sleep, frequent toilet visits and awakenings due to gasping or choking, or with a sense of anxiety.

In the day, individuals may awake with a sore throat or dry mouth, fatigue, headaches and excessive daytime sleepiness. Over time, this may give rise to difficulty concentrating, impaired memory, personality changes and diminished libido.

More importantly, unmanaged OSA poses serious health risks including hypertension, heart disease, stroke, myocardial infarction, sudden death and polycythemia, and is associated with increased mortality.

“Obese patients who present with a history of snoring, enlarged tonsils, swollen soft palate or a receding jaw should alert doctors to the possibility of excessive snoring and OSA,” advised Pang.

Initial management of OSA includes weight reduction in overweight persons and medication to relieve nasal congestion in those with nasal blockages. Failure to improve may warrant invasive surgical interventions.

Increasingly, RF reduction of the turbinates, soft palate, tonsils and tongue – such as the Celon method — is being employed for the management of mild-to-moderate OSA. Other options include laser treatment and palate implants, although the former has now been superceded by less costly and painful methods.

In Singapore, Tan Tock Seng Hospital, Singapore General Hospital, Alexandra Hospital and some of the private ENT practitioners at HealthSense and Mount Elizabeth Medical Center are offering the RFITT Celon service.

The Celon probes used are semi-disposable; in most practices, they are sterilized and given to patients for safe-keeping should they require repeat procedures – particularly for mild OSA. Hence, patients pay a one-time probe charge regardless of the number of treatments required.

To date, Pang has been using the Celon method in his ENT practice for the past 12 months, with success rates of between 80 and 90 percent.

“Having performed about 50 procedures with it, I’ve seen the most benefit in mild-to-moderate OSA involving tissues of the soft palate and nose. It also works well for hyperplasia of the nasal concha.”

Book an appointment with HealthSense Specialist Dr. YT Pang to look at your ENT problems and get cured.