History and Examination

• Nasal obstruction
• Co­morbidity e.g. obesity, hypothyroidism, ischaemic heart disease, cerebrovascular disease, diabetes, hypertension
• Smoking history
• Alcohol consumption
• Medication history
• Consider psycho­social impact
• Assess
  • BMI
  • Nasal airway patency
  • Tonsil and tongue base

Symptoms or signs suggestive of oropharyngeal neoplasm e.g.: unilateral tonsil and tongue enlargement.

Referral is not indicated for simple snoring unless there are features that raise concern of more serious pathology.

Occasionally enlarged tonsils can cause snoring, and surgery may help.

Nasal pathology needs to be excluded. Look for:

• Nasal Polyps
• Allergic Rhinitis
• Deviated Nasal Septum

If allergic rhinitis or nasal polyps are suspected, a topical nasal steroid spray for 3 months should be tried.

Nasal alar collapse may be treated with nasal paper strips.

• Weight reduction if above recommended BMI
• To stop smoking (offer to refer the patient to smoking cessation services)
• Reduce or stop evening alcohol intake
• Keeping the nose clear (including therapies such as nasal sprays or strips)
• Partners using ear plugs whilst asleep to minimise sleep disruption
• Self-training to alter their sleep position to avoid lying on back (e.g. sewing lump into back of pyjamas/nightdress as temporary training method).
• Obtaining a mandibular advancement device to be worn at night from their dentist. The patient must be advised that this device is not funded by the NHS.

Referral Criteria

Referral is not indicated for simple snoring unless there are features that raise concern of more serious pathology when a referral to ENT could be considered:

• Enlarged tonsils – see tonsillectomy commissioning policy
• Nasal pathology:
  • Nasal Polyps resistant to treatment
  • Allergic Rhinitis resistant to treatment
  • Deviated Nasal Septum

Hypersomnolence with no OSA – consider referral to neurology

Referral Instructions

Refer to Neurology

e-Referral Service Selection

• Specialty: Neurology
• Clinic Type: Not Otherwise Specified
• Service: DRSS-South Devon & Torbay-Neurology- Devon ICB - 15N

Refer to ENT

e-Referral Service Selection

• Speciality: Ear, Nose & Throat
• Clinic Type: Not Otherwise Specified
• Service: DRSS-South Devon & Torbay-Ear Nose and Throat- Devon ICB -15N

Referral Form

DRSS referral form

Evidence

Adult Snoring Surgery (in the absence of OSA) commissioning policy

Pathway Group

This guideline has been signed off on behalf of NHS Devon.

Publication date: March 2019