Snoring results from the vibration of soft tissues in the throat, though the source of the airflow problem often originates higher in the airway. Sinus surgery and other nasal procedures can be effective, but only when a structural blockage in the nose is the primary cause of snoring. A comprehensive evaluation is necessary to determine if the obstruction is nasal-based or if the issue lies further down in the throat.
Nasal Obstruction and Snoring
Restricted nasal airflow forces mouth breathing during sleep, which contributes to snoring. This change in breathing causes the head to tilt back and the jaw to drop, destabilizing the soft tissues in the back of the throat. Increased airflow velocity past these relaxed tissues creates negative pressure, causing them to vibrate and produce the characteristic snoring sound.
Nasal obstruction often stems from anatomical issues that narrow the passages. Common causes include a deviated nasal septum, which is a displacement of the wall separating the nasal cavities. Another frequent structural issue is the enlargement of the turbinates, bony structures inside the nose that humidify and filter air.
When these blockages force mouth breathing, upper airway resistance increases significantly. Addressing the nasal obstruction restores the natural, lower-resistance nasal breathing pathway, reducing the negative pressure that causes throat vibration.
Surgical Procedures Addressing Nasal Airflow
Nasal surgery aims to physically open the airway for quieter and more efficient breathing. Septoplasty straightens the nasal septum, reducing mechanical blockage and improving airflow. Turbinate reduction is often performed alongside septoplasty to shrink enlarged turbinates, frequently using techniques like radiofrequency ablation.
When chronic sinusitis with associated polyps causes obstruction, Functional Endoscopic Sinus Surgery (FESS) may be necessary to clear inflamed sinus passages.
For patients whose snoring is due purely to nasal resistance, these procedures can provide relief and improve subjective sleep quality. While they improve nasal breathing, they do not guarantee the elimination of snoring, especially if other factors are involved. Studies show these procedures improve the patient’s perception of their breathing and sleep.
Why Sinus Surgery May Not Resolve Snoring
The primary limitation of nasal and sinus surgery is that they treat the nose, while the most severe forms of snoring and all Obstructive Sleep Apnea (OSA) occur lower down in the throat. OSA is defined by the repetitive collapse of soft tissues in the pharynx, including the soft palate, uvula, and the base of the tongue.
This collapse is caused by the muscles in the throat relaxing excessively during sleep, leading to a partial or complete blockage of the airway and pauses in breathing. A successful nasal surgery improves breathing comfort but may offer only marginal relief for this throat-based collapse.
The severity of the obstruction and the resulting snoring sound is often dictated by the collapsibility of the pharyngeal tissues, which is unaffected by nasal procedures. Therefore, for patients with moderate to severe snoring or confirmed OSA, addressing the nose alone typically fails to resolve the core issue.
Nasal surgery can still play a supportive role by making other treatments more effective, even if it does not cure the snoring itself. Better nasal airflow can significantly improve a patient’s ability to tolerate Continuous Positive Airway Pressure (CPAP) therapy. However, if the snoring is loud and characterized by gasping or choking, the solution lies beyond the sinus cavity.
Non-Surgical and Advanced Treatments
For throat-based snoring or OSA, the most common and effective non-surgical treatment is CPAP therapy. CPAP uses pressurized air to act as a pneumatic splint, keeping the airway open during sleep. Many patients who find CPAP difficult to use often benefit from nasal surgery first, as it makes breathing against the pressurized air easier.
Alternative non-surgical options include oral appliance therapy. This involves a custom-fitted mandibular advancement device worn at night to move the jaw forward and keep the throat airway patent.
Lifestyle adjustments, such as maintaining a healthy weight and avoiding alcohol or sedatives near bedtime, can also reduce the collapsibility of the throat tissues. When non-surgical methods fail, advanced surgical options may be considered. Uvulopalatopharyngoplasty (UPPP) is a traditional procedure that removes excess tissue from the soft palate and uvula to widen the throat airway.
A more modern option is Hypoglossal Nerve Stimulation (HNS). This involves implanting a small device that monitors breathing and delivers a mild electrical impulse to the hypoglossal nerve. This impulse gently moves the tongue forward during inhalation, preventing it from collapsing and blocking the airway.
HNS is typically reserved for patients with moderate to severe OSA who cannot tolerate CPAP. Patients must also meet specific criteria, such as having a body mass index (BMI) below 35 kg/m2.