AAO-HNSF Primary Care Otolaryngology Handbook

INTRODUCTION TO CLINICAL ROTATION AND PHYSICAL EXAM OBSTRUCTIVE LEEP APNEA

A number of validated questionnaires can help in the screening for OSA. One of the well-known screening tools is the STOP-BANG questionnaire, which has the following elements: • S—Snoring? • T—Tired?

• O—Observed stoppages of breathing? • P—Being treated for high blood pressure? • B—Body mass index (BMI) >35? • A—Age >50? • N—Neck circumference >16 inches? • G—Gender male?

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The number of positive responses is tallied, with the results correlating to the patient’s low risk (0–2), moderate risk (3–4), and high risk (>5) of having OSA. Several other commonly used questionnaires are validated. These include the Epworth Sleepiness Scale (ESS) , which assesses sleepiness, and the Functional Outcomes of Sleep Questionnaire (FOSQ) , which assesses disease-specific quality of life. Both tools are frequently used to screen for and follow treatment outcomes for OSA. Once a thorough history is obtained, a physical exam should be performed. The patient’s vital signs, including BMI and blood pressure, should be noted. The general appearance of the face and jaw should be examined for maxillary insufficiency and retrognathia or micrognathia. Neck circumference is measured. The nasal airway in an important part of the examination. The presence of nasal obstruction from either a deviated septum or turbinate hyper- trophy, or both, should be determined. The state of the patient’s dentition should be noted. The presence of an over- or underbite should be recorded as well. The oral examination is a crucial part of the examination for OSA. Both tonsil size and tongue position should be recorded. Tonsils are graded on a scale from 0 to 4 with 0 being surgically removed tonsils and 4 being tonsils that are touching in the midline (Figure 18.1). The patient’s tongue position is graded relative to visibility of the posterior pharyngeal wall and palate. The modified Malampati scale (also referred to as the Friedman tongue position) is frequently used. This maneuver is performed by having patients open their mouth with their tongue relaxed and not

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