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    Frequently Asked Questions
    SomnoplastyTM/SM FAQ
    What should I expect prior to the procedure?
    Prior to the procedure, you will have an opportunity to review and discuss your medical and social history with the doctor. You will then be examined and advised of the degree of your problem. The options and alternatives will be discussed. If you are a candidate for SomnoplastyTM/SM, the procedure could be scheduled close to the day of your consultation.
    What should I expect during the procedure?
    The entire procedure takes 45 minutes. You will be asleep during the procedure but completely numb in the roof of your mouth when you wake up. An insulated probe delivering 85o Celsius, generated from radiofrequency energy, is placed through a hollow needle against the uvula and soft palate. This heat is sufficient enough to create a small coagulative lesion, which is absorbed naturally by the body within three to six weeks. It's quick, painless and best of all, involves no cutting or burning. Most patients find this procedure easier than having their teeth cleaned. You can rest assured that your surgeon has the greatest knowledge and expertise needed for treating individuals who suffer from snoring and sleep apnea.
    What should I expect after the procedure?
    Snoring can be expected to be worse immediately after the procedure for up to 10 days due to swelling of the tissues. Improvement is variable and continues to progress for up to three months. A second procedure may be needed 12 weeks following the initial treatment for further resolution of the problem. For alleviation of post-operative discomfort, over-the-counter pain medication is, generally sufficient.
    Does this procedure affect the voice in any way?
    There has not been any report of voice change with our patients.
    Are the taste buds affected in anyway?
    No. The taste buds are not affected in any way.
    Has this procedure been approved by the FDA?
    Yes. In July of 1997, the FDA approved a new out-patient treatment for habitual snoring, using radiofrequency. Better known as SomnoplastyTM/SM, it is a quick, painless procedure that seems promising to help significantly reduce snoring. Radiofrequency is a device that literally coagulates enlarged tissues such as the uvula and soft palate, reducing their size while relieving snoring. In January 1998, the FDA approved the use of SomnoplastyTM/SM for the volumetric reduction of the nasal turbinates. The radiofrequency treatment to reduce the tongue size and position for the treatment of sleep apnea has recently been approved by the FDA.
    Where can I go to have the SomnoplastyTM/SM procedure?
    Experience is the key factor when searching for a qualified surgeon. Dr. Anderson has performed hundreds of these procedures. To find out if you are a candidate for radiofrequency surgery, contact Dr. Anderson's office at 1-503-226-1688.
    What is the price range for somnoplasty?
    The fees vary depending on the necessary procedures required to accomplish the results you seek. Fees will be discussed after an examination and diagnosis has been reviewed with you.
    Are the insurance companies willing to pay for the procedure?
    All insurance companies have different policies for procedure coverage. Some companies have been covering this procedure while others have denied it. Some insurance companies require a sleep study before any payment can be determined while other companies will pay regardless of any diagnosis. Since we are technically treating snoring, this procedure is considered elective and therefore payment infull must be made at the time of service. We will be happy as a courtesy, to bill your insurance and whatever amount they cover would be your refund.
    How long does it take to perform the treatment?
    The procedure takes approximately 45 minutes, done right in our office and requires general anesthesia.
    How many visits are required?
    Generally one visit, plus two follow-up visits. Occasionally, because of the variability in anatomy and the response to treatment, it may be necessary to repeat the surgery for optimal results.
    What side effects are involved?
    Following the procedure, patients can expect to have a moderate sore throat for 3-4 days. Pain medication is generally not necessary but may be prescribed to help alleviate the discomfort. For the first day and a half, patients should be on a soft food diet. Recommended: (fish, oatmeal, potatoes, pasta, eggs, etc.). When patients feel ready, they can slowly resume eating regular meals.
    Is there pain involved, and time off work?
    The procedure is generally done at the end of the week, patients normally return to work the following Monday.
    How do I know if I have sleep apnea?
    Normally, patients with sleep apnea may have certain signs and symptoms such as: day time sleepiness, loud snoring, stop breathing at night, restless sleep, morning headache, memory loss and nighttime disturbances. However, patients may not be aware of their apnea disorder, so a sleep study may confirm the presence or absence of apnea. Most sleep studies are done in a sleep center and patients spend the night in a private room.. Many large area hospitals are equipped with sleep centers. During the study, special sensors record the activity of your heart, lungs and brain; the movements of your muscles; air flow from your nose and mouth; and the oxygen level in your blood. In addition, your body movements may be videotaped while snoring. A technician watches the recording on the monitors all night to observe you and make sure there are no problems with the equipment. If you have severe sleep apnea, the technician may provide a device called CPAP that keeps your air passage open and helps you breathe.
    Do I need a sleep study prior to the procedure?
    Not everyone is required to have a sleep study prior to the procedure. However, a post-operative sleep study is recommended for sleep apnea patients to evaluate their progress. During your consultation, in addition to a detailed review of your medical history, a head, neck and oral examination will be done and all of your options will be discussed.
    Tonsils and Adenoids FAQ
    What are adenoids?
    Adenoids are the name given to a third lump of lymphoid tissue that sits between the tonsils, higher up in the back of the mouth in an area called the nasopharynx. Adenoids are high in the throat behind the nose and the roof of the mouth. They are not visible through the mouth without special instruments or x-rays. When they are large enough, they can block air from flowing through the nose.
    What affects tonsils and adenoids?
    The most common problems affecting the tonsils and adenoids are:
    • Recurrent infection
    • Sore throat
    • Ear infection
    • Breathing problems
    • Sleeping problem, sleep apnea
    • Difficulty chewing
    • Chronic tonsillitis
    • Foul-smelling because of infections of small pockets within the tonsils (cheese-like formations can also affect the tonsils and adenoids, making them sore and swollen)
    • Tumors (they are rare, but can grow on the tonsils)
    • Childhood snoring is often the result of enlargement of the tonsils and adenoids.
    Don't I need my tonsils?
    Since the tonsils are immune tissues, it would seem logical to think that removing them would somehow reduce the body's ability to fight infection and tumors. Many studies have been done over the years to look at rates of lymphoma, polio, and other infections with and without tonsils. There have not been any consistent findings of decreased immune function or increased rates of these diseases following tonsillectomies. It seems that the tonsils are the "tip of the iceberg" with regard to the immune system, and that removing them does not significantly reduce the overall amount of immune tissue in the body.
    Can enlarged tonsils affect my sleep?
    Enlarged tonsils can cause narrowing of the air passage in the back of the throat. While you sleep, the muscles of the throat relax. Air flowing through the narrowed space results in a drop in air pressure. The combination of relaxed muscles, enlarged tonsils and low pressure while sleeping causes collapse of the throat and the individual will not be unable to breathe (sleep apnea).

    When the apneic individual is partially aroused from sleep (although he or she will not completely wake up), the muscle tone returns, and the throat opens - often with a gasp. This condition is known as Obstructive Sleep Apnea (OSA).
    What is the difference between a sore throat, tonsillitis, strep throat?, bacterial and viral infections?
    Tonsillitis: When tonsils are infected with bacteria, they will usually get large, turn somewhat red, and may have some yellowish-white debris of the surface. This will causes sore throat.

    There are some viruses, which can cause tonsillitis (as in infectious mononucleosis). The only way to be sure whether you have a bacterial or a viral infection is by doing a throat culture, although there are other tests, which may suggest a bacterial infection.

    Obstruction of the airway by enlarged tonsils can lead to difficulties in breathing, snoring and disturbed sleep that leads to daytime sleepiness in adults and behavioral problems in children. Some orthodontists believe chronic mouth breathing from large tonsils and adenoids causes malformations of the face and improper alignment of the teeth.

    Sore Throat: It can be caused by a number of problems. A sore throat is usually the result of a virus infecting the upper respiratory tract (mouth, nose and throat) viruses such as the flu, the common cold or mononucleosis.

    Less commonly, it can be caused by a bacterial infection such as strep, mycoplasma, or hemophilus.

    Bacterial infection responds very well to antibiotic treatment. However, viruses do not respond to antibiotic treatments.

    Infections cause the majority of sore throats and are contagious. Canker sores and fever blisters in the throat also can be very painful. Infections in the nose and sinuses also can cause sore throats, because mucus from the nose drains down into the throat and carries the infection with it.

    The most dangerous throat infection is epiglottitis, caused by bacteria that infects a portion of the larynx (voice box) and cause swelling that closes the airway. This infection is an emergency condition that requires prompt medical attention. Symptoms include extreme pain when swallowing (causing drooling), muffled speech and difficulty breathing.

    Strep Throat: It is an infection by one particular type of bacteria - Streptococcus pyogenes. Although other bacteria can cause throat infections, most doctors will try to specifically diagnose the "strep" bacteria so that antibiotic treatment can be given.

    In rare cases, strep infections can also damage the heart valves (rheumatic fever) and kidneys (nephritis), cause scarlet fever, tonsillitis, pneumonia, sinusitis, and ear infections. Because of these possible complications, a strep throat should be treated with an antibiotic.

    Strep throat is not always easy to detect by examination, and a throat culture may be needed. These tests, when positive, may help us to give you appropriate antibiotics. However, strep tests might not detect other bacteria that also can cause severe sore throats that deserve antibiotic treatment.

    Severe and chronic cases of tonsillitis or tonsillar abscess may be culture negative. Negative cultures are seen with diphtheria, and infections from oral sexual contacts will escape detection by strep culture tests.

    Viral Infections: Most viral sore throats accompany flu or colds. Usually patients have a stuffy, runny nose, sneezing, and generalized aches and pains. They are highly contagious and spread quickly, especially in winter. The body builds antibodies that destroy the virus, a process that takes about a week.

    Sore throats accompany other viral infections such as:
    • Measles
    • Chicken pox
    • Whooping cough
    • Croup
    Infectious mononucleosis, or "mono?: Mono is a viral infection that takes much longer than a week to be cured. This virus lodges in the lymph system, causing massive enlargement of the tonsils with white patches on their surface and swollen glands in the neck, armpits, and groin.

    It has been nicknamed the "kissing disease," but it can also be transmitted from mouth-to-hand to hand-to-mouth or by sharing of food and even your towels. It creates a severely sore throat and, sometimes, serious breathing difficulties. It can affect the liver, leading to jaundice- yellow skin and eyes.  It also causes extreme fatigue that can last six weeks or more.

    "Mono," a severe illness in teenagers but less severe in children, can he transmitted by saliva. In some patients, treatment with steroids (e.g. cortisone) is sometimes helpful.
    What are the other causes of sore throat?
    • Pollens and molds
    • Cat and dog dander
    • House dust
    Dry heat, during the cold winter months, may create a recurring, mild sore throat with a parched feeling, especially in the mornings. This often responds to humidification of bedroom air and increased liquid intake.

    Patients with a chronic stuffy nose, causing mouth breathing, also suffer with a dry throat. They need an examination and treatment of the nose.

    Pollutants and chemicals in the air can irritate the nose and throat. The most common air pollutant is tobacco smoke. Other irritants include smokeless tobacco, alcoholic beverages and spicy foods.

    A person who strains his or her voice (yelling at a sports event, for example) gets a sore throat not only from muscle strain but also from the rough treatment of his or her throat membranes.

    An occasional cause of a morning sore throat is regurgitation of stomach acids up into the back of the throat. To avoid reflux, Place extra pillows under your head or tilt your bed frame so that the head is elevated four-to-six- inches higher than the foot of the bed.

    Antacids can be helpful and avoid eating within three hours of bedtime, and eliminate caffeine and alcohol. An evaluation by a physician is recommended if these tips failed.

    Tumors of the throat, tongue, and larynx (voice box) are usually (but not always) associated with long-time use of tobacco and alcohol. Sore throat and difficulty swallowing-sometimes with pain radiating to the ear-may be symptoms of such a tumor. More often the sore throat is so mild or so chronic that it is hardly noticed. Important symptoms include:
    • Hoarseness
    • Lump in the neck
    • Unexplained weight loss
    • Spitting up blood in the saliva or phlegm
    When Should I See a Doctor?
    The following signs and symptoms should alert you to seek medical treatment:
    • Severe and prolonged sore throat
    • Difficulty breathing
    • Difficulty swallowing
    • Difficulty opening the mouth
    • Joint pain
    • Earache
    • Rash
    • Fever (over 101°)
    • Blood in saliva or phlegm
    • Frequently recurring sore throat
    • Lump in neck
    • Hoarseness lasting over two weeks
    How Can I Treat My Sore Throat?
    A mild sore throat associated with cold or flu symptoms can be made more comfortable with the following remedies:
    • Increase your liquid intake
    • Warm tea with honey is a favorite home remedy
    • Use a steamer or humidifier in your bedroom
    • Gargle with warm salt water several times daily: ¼ tsp. salt to ½ cup water.
    • Take over-the-counter pain relievers such as acetaminophen (Tylenol Sore Throat®) or ibuprofen (Motrin IB®, Advil®).
    How are tonsil and adenoid diseases treated?
    Bacterial throat infections can be treated with antibiotics. There is no benefit to treating a virus with antibiotics. Sometimes, removal of the tonsils and/or adenoids may be recommended.

    The two primary reasons for tonsil and/or adenoid removal are:
    • Recurrent infection despite antibiotic therapy
    • Difficulty breathing due to enlarged tonsils and/or adenoids
    If an individual is severely affected with recurrent sore throats, particularly if they involve tonsillitis, a T&A may be recommend (tonsillectomy and adenoidectomy). This is the removal of the tonsils and adenoids (the adenoids generally get infected along with the tonsils).

    A recurrent infection is a less common reason for surgery today, and most tonsillectomies are now done for sleep disorder breathing.

    Studies conducted at the Center for Corrective Surgery shows that use of radiofrequency might be an alternative to more invasive type of surgery. Tonsillar Radiofrequency is performed in an office setting and under light sedation or local anesthesia. A radiofrequency probe is introduced in the enlarged tonsils and the energy delivered causes the volumetric reduction of the tonsils within a 12 week period. The advantages of this technique are minimal discomfort, ease of operation and immediate return to work and/or school.
    What are the risks of traditional tonsillectomy?
    The surgery is done under general anesthesia, and this is could be frightening for some patients (Modern anesthesia however is extremely safe). The most common significant risk of tonsillectomy is bleeding after surgery. It usually takes about two weeks for the throat to heal completely, and bleeding can be seen at any time before then.

    This usually happens about five to ten days after the operation when the "scab" in the back of the throat separates from the wall of the throat. Bleeding that is enough to be noticed happens in about 2-4% of patients, and will be seen as blood in the mouth.

    Postoperative bleeding from the tonsillectomy site is usually managed in children by returning them to the operating room for a brief procedure under anesthesia, in which the open blood vessel is found and cauterized. Some adolescents and adults may allow this to be done without anesthesia, but most children will not permit a thorough examination and cautery while awake.

    The soft palate (roof of the mouth) keeps air from flowing backward from the mouth to the nose during speech and swallowing. Sometimes, removing the adenoids and/or tonsils can result in an improper seal by the palate with "escape" of air or liquid around the back of the nose.

    These patients have a high, nasal voice, different from the "clogged up" sound that they had before surgery. Usually, this does not last long, but sometimes it takes a few weeks or even months before the palate can stretch enough to make a good seal again.

    Occasionally, the pain after surgery is so severe that patients will not be able to drink enough liquid and will become dehydrated. In case of dehydration, the patient may need to be remitted to the hospital overnight for stronger pain medication and intravenous fluids.
    What are the benefits of the new tonsillar ablation with radiofrequency (Coblation) procedures?
    • It is easy
    • Done in the office
    • Generally there is no bleeding
    • Minimal post operative pain
    How is tonsillar ablation done?
    The procedure is done in the office. General anesthesia is used in all cases. A radiofrequency probe is placed in 3-4 locations in the tonsils. The probe is kept in position for only 10-15 seconds.

    Patients are discharged with a prescription for antibiotics. Patients can return to work the next day.
    Do I need to stay overnight in the hospital after a tonsillar ablation?
    No! One of the greatest features of this new procedure is that you can go home immediately after the procedure.
    What can I eat after tonsillar ablation?
    Following tonsillar ablation, a soft food diet is recommended for few days after surgery then you can return to normal food.
    What should I expect after tonsillar ablation?
    You should expect a mild to moderate sore throat for a few days. Antibiotics will be given to you to prevent infection. Please make sure to take the whole prescription.

    Healing will be completed within 12 weeks. A second procedure may be needed depending to the size of your tonsils. Any questions or concerns you have should be discussed openly with us. We are here to assist you.
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    Copyright © 1999-2000, Dr. Scott P. Anderson, All Rights Reserved.
    SomnoplastyTM/SM is a registered trademark of Somnus Medical Technologies.
    CoblationTM is a registered trademark of ArthroCare Corporation.
    Portland Medical Center, Suite 1214
    511 SW Tenth
    Portland, OR 97205
    Phone:(503) 226-1688