Do you feel tired during the day despite sleeping 7-8 hours per night? Does your spouse complain about your snoring, or note that you “stop breathing” while sleeping? It is possible that you may suffer from obstructive sleep apnea (OSA).
OSA, considered one of the most common sleep disorders in the US, is caused by complete or partial obstruction of the upper airway. After falling asleep, the muscles in the roof of the mouth (palate), tongue, and throat begin to relax and collapse. This can result in repetitive episodes of shallow or paused breathing while sleeping. Such episodes are called “apneas”, and can cause a patient’s oxygen levels to decrease. Common symptoms of OSA include heavy snoring, excessive daytime sleepiness, gasping while asleep, frequent awakening, and/or trouble sleeping. OSA is an important condition to recognize and diagnose; if untreated, OSA can increase the risk for cardiac and pulmonary-related disease (hypertension and heart disease).
The first step in getting evaluated for OSA is to see an otolaryngologist, who can perform a complete head and neck examination to identify anatomical risk factors for OSA. In many cases, the next appropriate test would be a sleep study, or polysomnogram. A sleep study typically consists of spending a night in the hospital while the patient’s sleep habits are recorded. In some situations, it is also possible to have an at-home sleep study, although the results underestimate the degree of sleep disturbance. Pending the results, some patients may be considered candidates for continuous positive airway pressure, or CPAP. CPAP is a small device that has a mask attached to it which improves patient breathing at night. If no OSA is present, conservative measures are usually recommended. This includes exercise and weight loss, avoid sleeping in the supine position (laying on back), and avoid sedatives and stimulants (alcohol and coffee) before bedtime.
If you or family members have concerns regarding obstructive sleep apnea, please do not hesitate to contact Colden and Seymour Ear, Nose, Throat, and Allergy to set up an appointment. Opinions expressed here are those of Daryl Colden, MD, FACS, and Christopher Jayne, BA. These opinions are not a substitute for a medical evaluation performed by a medical provider.
The ear is made up of three major parts: the outer, middle, and inner ear. All of these various areas are essential for hearing, and when there is an abnormality in one area, it can affect hearing adversely. The outer ear consists of the pinna (the rigid cartilage covered by bone that we can see) and the auditory canal (a short tube from the pinna to the eardrum, or tympanic membrane). The middle ear contains the eardrum (tympanic membrane), and a small air-filled cavity behind it which contains three tiny bones, known as ossicles. These ossicles transmit sound to the inner ear, or the organ of hearing (cochlea), which will then transmit impulses via a major nerve (acoustic nerve) to the brain, which completes the hearing loop.
The middle ear periodically becomes swollen (inflamed) and fluid accumulates in the air-filled region behind the eardrum. This condition is called otitis media with effusion (or middle ear fluid). Viral and bacterial infections are the most common cause of middle ear infections and the subsequent middle ear fluid that may accumulate. Children are more prone to infections and fluid buildup due to a variety of factors, including frequent exposure to others with illness, poor Eustachian tube function, or an immature immune system.
Often, this middle ear fluid will result in a “blocked ear” feeling with decreased hearing. Under acute and more severe circumstances, patients will experience a localized ear pain, fever, irritability, and upper respiratory symptoms. Children with chronic middle ear fluid or recurrent ear infections may present with hearing deficits, poor attention, and even speech and language delays.
Middle ear fluid can be diagnosed through a variety of methods. This includes use of a pneumatic otoscope (a small device that visualizes the ear canal and blows air towards the eardrum), a tympanogram (a test to evaluate eardrum mobility), and a specialized hearing test.
Treatment options depend on the duration or frequency of ear symptoms. For patients experiencing their first ear infection, antibiotics and ibuprofen are usually the treatment of choice. If there are nasal or allergy symptoms occurring with the ear issues, it would be helpful to evaluate and treat these potential triggers. If a patient experiences recurrent ear infections or chronic middle ear fluid, ventilation ear tube insertion may be considered (ear tubes). These microscopic tubes are placed to remove ear fluid, reduce or eliminate ear infections, and restore the ability to equalize pressure between the middle ear and outside atmosphere (for example: no ear pressure when flying). Placing ear tubes is a short and painless procedure which can sometimes be done in the office setting but other times may require anesthesia in the hospital.
The nasal septum is a structure partially composed of bone and cartilage which divides the right and left nasal passages. When the septum is shifted or “deviated,” it can lead to a variety of symptoms including nasal blockage, congestion, bloody noses (epistaxis), snoring and also be a trigger for sinus problems.
Deviated nasal septum’s can occur for many reasons, the most common being related to trauma. Many times people are born with a deviated septum and may not notice the symptoms until later in life.
A deviated nasal septum may be seen in conjunction with deformities of the nasal bones (nasal fracture), but many times a deviated septum is not visible to the naked eye. A deviated septum may be detected on imaging such as an Xray or CAT scan, but it may be best evaluated by a simple painless in office examination called a nasal endoscopy ,usually done by an Ear Nose Throat Specialist.
Although there is no specific medical treatment for a nasal septum deviation, many specialists will use various medications to treat co-existing conditions that can cause similar symptoms, such as environmental allergies and chronic sinusitis (inflammation). If symptoms are significant enough, a routine surgical procedure may be considered , which is known as a septoplasty. When performing a septoplasty, the crooked cartilage and bony is straightened to improve nasal breathing and reduce other symptoms. This outpatient surgical procedure has a high success rate with minimal recovery and discomfort. A septoplasty may be performed in conjunction with other surgical procedures, such as sinus surgery, balloon sinus dilation, nasal fracture repair and also rhinoplasty (cosmetic refinement of the external nasal structures).
Opinions expressed here are those of myself, Dr. Daryl Colden. They are not intended as medical advice and cannot substitute for the advice of your personal physician.