New Treatment for Tonsils

A new federally approved method for reducing tonsil size by zapping them with radio waves may make traditional surgery, overnight hospital stays and bowls of ice cream a thing of the past.

The Food and Drug Administration in May approved the technique, dubbed somnoplasty, but some doctors remain skeptical that the technology is better than traditional methods of removing tonsils that have repeated infections.

Somnoplasty has been performed on more than 20,000 patients with oversized soft palates or nasal tissue who suffer from heavy snoring, chronic nasal obstruction or sleep apnea, according to the manufacturer, Somnus Medical Technologies of Sunnyvale, Calif. The new approval extends the use to patients with enlarged tonsils.

A Quick Recovery

Somnoplasty advocates say patients recover rapidly after the procedure.

“One of my patients was eating a sandwich two hours after the procedure and went back to work the next morning,” says Dr. Lionel Nelson, an associate clinical professor in the surgery department at Stanford University in Palo Alto. Nelson’s industry-funded study reporting on the new technique was published in the June issue of the Archives of Otolaryngology.

Nelson says somnoplasty can be performed in under five minutes while the patient is wide awake in a doctor’s office. Using a needle probe, doctors shoot the area with radiofrequency waves, which act like a microwave oven, heating and vibrating the overgrown tissues and causing the cells to dissolve and the tissue to eventually shrink over a period of time.

Traditional Tonsillectomies

Doctors traditionally perform tonsillectomies surgically or with a laser. But the method involves general anesthesia, a painful, weeklong recovery, and carries a remote chance of bleeding and dehydration, Nelson says.

Tonsillectomies are usually recommended for children or adults who have either repeated infections of the tonsils, characterized by sore throats and painful swallowing, or have enlarged tonsils that constrict airways and cause snoring or noisy breathing.

Nelson performed the new procedure on nine adults who suffered from enlarged tonsils. He reported a gradual 70 percent, on average, shrinking of the tonsil size during the next eight to 12 weeks, as the tissue dissolves and contracts.

It remains unclear whether radiofrequency tissue reduction is permanent or could require additional visits.

Proponents say the tissue reduction is maintained. Somnoplasty procedures for sleep apnea and snoring have been on the market for three years, and have seemed to sustained themselves, says Dr. Marshall Strome, chairman of the ear, nose and throat department at the Cleveland Clinic, who has already performed several somnoplasties on patients with snoring problems.

Even if the tissue did become enlarged again, patients would be more likely to return for another procedure because it is painless, he says.

Not For Kids, Yet

A drawback of the technique, doctors say, is that it is probably better suited for adults rather than young children, who would probably not cooperate with having a needle pressed down their throat.

”You would still require general anesthesia for kids,” says Dr. Nina Shapiro, a pediatric ear, nose and throat surgeon at the University of California Los Angeles Medical Center who performs traditional tonsillectomies. “That may negate some of the benefit.”

But Strome says the procedure is a clear boon for adults with snoring, bad breath or other airway problems fixable by a tonsillectomy.

“For the adult, the pain [of a tonsillectomy] really is far more significant than for a child,” Strome says. “If you can reduce that and get people back to work quickly, that’s an advantage.”

All agree that it remains to be seen whether the technique can also be used on patients with infected, rather than enlarged, tonsils.

Dr. Neil Ward, a former president of the Academy of Otolaryngology, points out that there is no evidence that reducing the size of the tonsil, rather than surgically removing it, will necessarily protect against further infections.