I keep having headaches after nasal somnoplasty, but my ENT dismisses my complaints. He says my headaches aren't related to my sinuses. What do you know about this operation? I'm starting to think I made a mistake in having the procedure.

Sue

First, "nasal somnoplasty" requires an explanation. "Somnoplasty" is a proprietary name coined by one of the manufacturers of the equipment used to perform this procedure. (The company's name is Somnus.) "Plasty," merely means "to change the shape, appearance or position of" some structure. Thus, rhinoplasty is an operation designed to change the appearance of the nose, and septoplasty is an operation designed to alter the position and shape of the nasal septum (the "divider" of the nasal cavity).

"Somnoplasty" is the name of a procedure used to stiffen the soft palate in order to treat snoring. In this procedure, a doctor numbs the soft palate with a local anesthetic, and then embeds a small electrode into the muscle of the soft palate. A brief pulse of radiofrequency energy is applied through the electrode. This is repeated in three to six locations along the soft palate. The radiofrequency energy injures the muscle of the palate, not so badly as to affect its function, but enough to cause stiffening through scar-tissue formation. The preferred name for this procedure is "radiofrequency palatoplasty" -- "radiofrequency" for the type of energy used, and "palatoplasty" for the fact that the palate is being altered by the procedure.

"Nasal somnoplasty" is really terrible terminology. It is essentially medical shorthand for saying, "You know that somnoplasty thing? I'm going to do that in your nose." The appropriate term is "radiofrequency turbinate reduction." The inferior turbinates are thin shelves of bone covered by mucus membrane (mucosa). The turbinates arise from the sides of the nasal cavity. Turbinate mucosa is erectile tissue -- it can engorge with blood, leading to the classic problem of "stuffy nose." Occasionally, the turbinates will enlarge and STAY large. This is known as turbinate hypertrophy. Patients with turbinate hypertrophy have chronically stuffy noses. There are many potential treatments for this, one of which is radiofrequency turbinate reduction.

In a radiofrequency turbinate reduction, the doctor sprays your nasal cavity with a decongestant and anesthetic, and then injects a small amount of local anesthetic into the turbinate. An electrode is embedded into the turbinate, a pulse of radiofrequency energy is applied to the interior of the turbinate, and the electrode is removed. The goal is to cause enough scarring that the turbinate will shrink and cease to cause nasal airway obstruction.

To my knowledge, the main reason (perhaps the only reason) to perform a radiofrequency turbinate reduction is to treat turbinate hypertrophy. Your comment, "I keep having headaches after nasal somnoplasty," thus makes me wonder several things:

• Was the procedure performed to treat the headaches, or did the headaches occur after the procedure?
  
• Did you in fact have turbinate hypertrophy? Your doctor may not have explained this to you, but it should be documented in his chart notes. One simple question may settle the matter: Did you have the procedure because of chronic nasal congestion?
  
• If you did have chronic nasal congestion, did your ENT try any other treatments before suggesting radiofrequency turbinate reduction?
  

Answer the questions and, if necessary, read between the lines. If I might be allowed to dole out some general advice, here it is. Your doctor needs you more than you need him. Let him know that your needs are not being addressed. If you still think you are receiving inadequate care, find another doctor.