Hypoglossal Nerve Stimulator Placement
Medically reviewed by Drugs.com. Last updated on Jun 2, 2025.
AMBULATORY CARE:
What you need to know about hypoglossal nerve stimulation (HNS) placement:
A HNS is a device used to help manage obstructive sleep apnea. The hypoglossal nerve controls the tongue muscles. HNS helps improve breathing during sleep.
How HNS works:
The HNS is placed under your skin in your upper right chest during surgery. The device sends a small amount of electrical current to the hypoglossal nerve. This causes the tongue to move forward to keep your airway open. The device is turned on 4 weeks after surgery to give the surgery areas time to heal. The device has the following parts:
- A stimulation electrode cuff is placed around the hypoglossal nerve and connected to the generator.
- A breathing sensor is implanted near your ribs. The sensor is also connected to the generator.
- A pulse generator is implanted on the upper chest under your collarbone. It is about the size of a large watch face and produces electrical signals. The pulse generator is powered by a battery that usually lasts about 11 years.
- A remote control is used to control how strong the electrical impulses are.
How to prepare for HNS placement:
- Your surgeon will tell you how to prepare. Your surgeon may tell you not to eat or drink anything after midnight on the day of your surgery. Arrange to have someone drive you home when you are discharged.
- Tell your surgeon about all medicines you currently take. Your surgeon will tell you if you need to stop any medicine for the surgery, and when to stop. Your surgeon will tell you which medicines to take or not take on the day of the surgery. Tell your surgeon if you have a blood disorder or ever had a bleeding problem.
What will happen during HNS placement:
- You will be given general anesthesia to keep you asleep and free from pain during your surgery. Your surgeon will make 2 small incisions:
- The first will be made in the skin under your jaw. An electrical stimulation cuff will be placed around the hypoglossal nerve. Stitches will hold the electrodes in place.
- The second will be made on the chest wall under your right collarbone. Your surgeon will create a pocket under your skin. The pulse generator device will be placed in the pocket.
- A tunnel will be created under your skin to connect the 2 parts with wires. Your surgeon will do an electrical test to make sure the device triggers the correct tongue movements. An x-ray will be used to check that all the parts are in the correct place.
- All incisions will be closed with stitches and covered with bandages.
What to expect after HNS placement:
You will be taken to a room to rest until you are fully awake. Healthcare providers will monitor your heartbeat, blood pressure, and incision sites. Do not get out of bed until your healthcare provider says it is okay. Your provider will tell you when you can go home.
- Medicines may be given for pain or to prevent a bacterial infection.
- The HNS device will be turned on when you see your surgeon for a follow-up visit. The impulses can be set to cycle at different levels, times, and strengths. The impulses usually start at a low level and can be increased gradually, if needed. You may have symptoms when the impulses are happening. These may include tingling or discomfort in your neck, upper chest, head, or tongue. You will receive a hand-held remote control. This can be used to start or increase the impulse and turn the device on and off. Your provider will show you how to use the remote.
Risks of HNS placement:
The HNS may not work correctly, and you may need to have a part of the device replaced. You may get an infection or have pain, bruising, or swelling at any of the incision sites. You may have tongue weakness or problems moving your tongue. You may have discomfort, pain, or feel a shock during stimulation. On rare occasions you may have a collapsed lung.
Call your local emergency number (911 in the US), or have someone call if:
- You have sudden chest pain, shortness of breath, and a rapid heart rate.
- Your lips, skin, or nails turn blue or gray.
Seek care immediately if:
- You have a fever.
- Blood soaks through your bandage.
- Your incision sites become swollen, red, more painful, or have pus coming from them.
- You have severe bruising close to an incision site.
- You develop a lump filled with fluid under your skin at an incision site.
- Your stitches come apart.
- You become confused or feel faint.
Call your doctor or surgeon if:
- You have pain at an incision site.
- Your symptoms return or get worse.
- You have new pain or new symptoms with stimulation.
- You feel like you are being shocked with the stimulator on or off.
- You have questions or concerns about your condition or care.
Medicines:
You may need any of the following:
- Antibiotics help prevent a bacterial infection.
- Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely. Some prescription pain medicines contain acetaminophen. Do not take other medicines that contain acetaminophen without talking to your healthcare provider. Too much acetaminophen may cause liver damage. Prescription pain medicine may cause constipation. Ask your healthcare provider how to prevent or treat constipation.
- NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
- Take your medicine as directed. Contact your healthcare provider if you think your medicine is not helping or if you have side effects. Tell your provider if you are allergic to any medicine. Keep a list of the medicines, vitamins, and herbs you take. Include the amounts, and when and why you take them. Bring the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency.
Self-care:
- Apply ice as directed. Ice helps decrease swelling and pain. Ice may also help prevent tissue damage. Use an ice pack, or put crushed ice in a plastic bag. Cover the bag with a towel and place it on your incision sites for 15 to 20 minutes every hour, or as directed.
- Care for your incision sites. Ask when you can remove your bandages. Gently clean the incision sites with soap and water. Do not rub the sites. Do not take a bath, swim, or get in a hot tub until your healthcare provider says these are okay. Keep the areas clean and dry. Gently dry the areas dry and put on new, clean bandages, if directed. Check for signs of infection, such as redness, swelling, or pus.
- Limit upper body activities as directed. You may need to limit neck, arm, and shoulder movement until your incision sites heal. This may take up to 2 weeks. Ask your provider about exercises you can do safely while you have the HNS.
Care for your device:
- Your healthcare provider will give you an identification card with information about your device. Keep this with you at all times. Show the card to all your healthcare providers. Tell them you have an implanted HNS. Some tests and procedures may damage the HNS.
- Limit activities that may cause damage to the device area, such as contact sports. Ask your healthcare provider before you scuba dive or enter a hyperbaric chamber.
Follow up with your doctor or surgeon as directed:
You will need to return to have your stitches removed and the device checked. You will also need a sleep test 1 to 2 months after your HNS was turned on. Healthcare providers will test how the HNS is working, check for problems, and adjust device settings, if needed. Write down your questions so you remember to ask them during your visits.
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