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Snoring is an obscure phenomenon, and many authors have tried to highlight the numerous facets in the past. Remarkable knowledge has been elaborated about obstructive snoring but not about primary snoring with its many epithets such as harmless, simple, habitual, benign, non-apnoeic, continuous, rhythmic etc. In 2010, the German Society of Otorhinolaryngology, Head and Neck Surgery published the S1 guideline: Diagnosis and Treatment of Snoring in Adults in ‘Sleep and Breathing’ 14: 317–321. The guideline has been revised and updated by the group of 10 German authors under the leadership of Boris Stuck in the present S2k guideline. It was initially published in the German journal ‘HNO’ 2013; 61: 944–57. The review of the literature was performed in June 2012 usingMedLine with the following search criteria: {‘snoring’ NOT ‘apnea’ NOT ‘apnoea’}, limited to the terms ‘English’, ‘German’, ‘adults’ and ‘humans’. I think it is very worthy of merit that the author group continued to follow the new developments of the difficult to explain phenomenon of snoring which is not a disease with a medical hazard. The authors wisely interpreted snoring in the sense of this guideline as a diagnosis of exclusion. To date, there is no satisfactory definition of snoring available and no validated questionnaire that aims to differentiate the snoring addressed by this guideline from snoring associated with obstructive sleep apnea. The numerous aspects of snoring are described in detail as to definition, nosology, aetiology, pathophysiology, epidemiology, health effects, clinical presentation, diagnostic measures (very widely discussed), therapeutic principles (conservative approaches—surgical treatments), and inclusive recommendations if possible. As studies about objectively assessing snoring and wellcontrolled clinical trials concerning the treatments and their outcome are lacking, it is not surprising that the words ‘may be’ and ‘could be’ are often to be found in the statements and recommendations. The guideline ends with a list of 93 references and a report of how this guideline was created. The process of compiling it is meticulously described including how all the German Societies were addressed which are engaged in sleep medicine. A detailed description of the commercial interests of the author group completes the guideline. This guideline has not only clarified the understanding of primary snoring but also left open questions. Snoring reminds me of the Lernean Hydra, the fearsome dragon-like monster with nine serpents’ heads. Hercules undertook to slay the beast by clubbing it on its multiple heads. But as soon as one head was crushed, two new ones sprang up in its place. Help came by his faithful companion Iolaus who burnt the wound of the cutoff heads. Thus, Hercules and Iolaus step by step overcame the monster. For the moment, there is no Hercules amongst us and only many companions like Iolaus who may perhaps be able to tame the monster ‘snoring’ in the long run.

Diagnosis and treatment of snoring in adults—S2k guideline of the German Society of Otorhinolaryngology, Head and Neck Surgery