Sleep Endoscopy for Obstructive Sleep Apnea and Snoring

A new webpage has been created describing a procedure called "sleep endoscopy" or "sedated endoscopy."

This procedure is performed on patients with obstructive sleep apnea (OSA) or severe snoring in order to determine where the source of their problem is anatomically located.

This special exam is needed in patients where such anatomic determination is not able to be made in the clinic while they are awake. As such, an anesthesiologist would put the patient to sleep using IV medications and when snoring or obstructive events happen, endoscopy is performed.

Areas that will be specifically examined during sleep endoscopy include:

• Behind the palate
• Uvula
• Back of Tongue
• Walls of the Throat
• Epiglottis
• Voicebox

Each of these areas may experience collapse during sleep causing obstructive or snoring symptoms.

Why is this information helpful? Well... once it is apparent where and what is the culprit causing a given patient's problems, surgical treatment can be geared more specifically and directly to the area of concern seen during sedated endoscopy.

Read more here!

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Miley Cyrus "I Cut My Uvula"! ...NOT!

I was recently made aware of this video Miley Cyrus made in January 2009 when she reported that she cut her uvula (according to a nurse) after swallowing a slippery piece of chicken causing her voice to sound quite hoarse. Watch the video here:



However, based on how her voice sounds, I seriously doubt that her hoarseness is due to a cut uvula. When the uvula gets cut, or swollen, or gets injured one way or another, it would cause her voice to sound muffled... NOT raspy like her voice sounds. Though it is possible that her uvula may have been injured, it certainly is not the cause of her poor vocal quality.

Rather, I suspect that her voice sounds bad the way it does due to a vocal cord injury. Often, when people swallow a piece of food (like a chicken) that either gets stuck or goes the wrong way, the person automatically coughs severely in order to expel it.

If the cough is severe enough, it'll cause traumatic injury to the vocal cord resulting in a hoarse voice. The injury itself may not be that bad (usually a mild vocal cord submucosal hemorrhage), but the voice does sound bad. Here are two mild examples of laryngitis due to blood accumulation here and here. A more severe example of traumatic laryngitis can be found here.

In this situation, if the person persists and tries (forces) to talk and sound normal in a setting where the vocal cord is injured, compensatory behavior sets in whereby the vocal quality will fluctuate and go in and out as Miley's voice does in the video (listen to an audio of another patient with this problem here). This condition is called "compensatory muscle tension dysphonia," and in her case, secondary to acute traumatic laryngitis.

This diagnosis can be confirmed on fiberoptic laryngoscopy. Treatment is high dose steroids that will bring the swelling down as well as strict voice rest for a few days (depending on severity of the injury). Resolution of her voice would be expected within 1 week with this treatment. Voice therapy may be required, though usually not.

Read more about traumatic laryngitis here.

Read more about muscle tension dysphonia here.

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New Video on Uvula Excision for Snoring (and Other Problems)

Our office has created a new video on how a uvulectomy (or uvula excision) is performed to treat not only snoring, but chronic cough, throat-clearing, and even gagging due to an extremely long uvula.

Though the procedure can be performed awake without sedation in adult patients without a severe gag reflex, for those with a bad gag reflex, it must be performed under general anesthesia as shown in this video.

For more info on this procedure, click here.

Check it out here!

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The Doctors TV Show Does Surgery for Obstructive Sleep Apnea

The Doctors TV show at some point in the past (not sure when), did a segment on surgery used to treat obstructive sleep apnea. The surgery portrayed was UPPP (uvulopalatopharyngoplasty). Dr. Brian Weeks, the featured otolaryngologist, removed the tonsils and uvula followed by suturing the cut mucosa to reposition the soft tissues of the patient's throat.

This operation is a basic surgical method addressing obstructive sleep apnea. However, prior to considering surgical treatment, I typically recommend trial of CPAP for 3 months.

Some things to keep in mind is that obstructive sleep apnea is often due to multiple levels of obstruction. UPPP only addresses mouth-level problems. Other sleep apnea surgery options need to be considered when obstruction exists at other levels including the back of tongue (below the mouth level). Base of tongue reduction helps in this situation.

Watch the video of the TV show here. Watch the video our office produced on this surgery here.

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New Video on UPPP Surgery to Treat Sleep Apnea (Uvulopalatopharyngoplasty)

A new video has been created and uploaded onto our YouTube channel showing how a UPPP (uvulopalatopharyngoplasty) sleep apnea surgery is performed. This surgery is commonly performed to try and improve or even cure obstructive sleep apnea in adults. This surgery rarely is performed in kids.

Read more about UPPP here. More info about obstructive sleep apnea can be found here.

Another operation used to treat obstructive sleep apnea in adults along with UPPP is base of tongue reduction. Read about this operation here as well as watch the video here.

Watch the video here.

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Mucus in Back of Nose/Throat After UPPP or Uvula Removal

I have recently seen a rash of patients who have a presenting symptom of a sense of mucus or phlegm buildup in the back of the mouth/nose right behind the soft palate after surgery involving uvula removal. Such surgery may include the uvula alone or UPPP (uvulopalatopharyngoplasty) for obstructive sleep apnea.

Often in these cases, this problem with mucus and phlegm is due to a very small velopharyngeal insufficiency. This is a rare problem where there is a small opening between the palate and nose when swallowing causing a little bit of saliva to "regurgitate" into the nose. If the opening is very large, liquids and even food will come out the nose when swallowing. If it is very small, mucus/phlegmy sensation will be present localized to the area right behind the soft palate.

This problem, if present, can be corrected by a simple procedure called nasopharyngoplasty.

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