AAO-HNSF Primary Care Otolaryngology Handbook

INTRODUCTION TO CLINICAL ROTATION AND PHYSICAL EXAM OBSTRUCTIVE LEEP APNEA

Medical Treatment CPAP is first-line treatment for OSA in adults. This device transmits air into the patient’s upper airway and stents open areas of collapse. This allows movement of air during sleep and reverses the airway narrowing. Ideally, CPAP should be titrated to optimize flow for each patient. This can be done with a titration PSG or in an automated fashion by certain auto CPAP machines. Not everyone can tolerate CPAP. About 50 percent of adults and children are intolerant or noncompliant. Alternative therapies are available to these patients. If patients’ OSA is in the mild-to-moderate range and they have permanent teeth, they could be candidates for an oral appliance. These dental devices cover the upper and lower teeth and force the mandible forward while sleeping. This in turn pulls the tongue and palate forward and opens the airway. Close dental supervision is needed as this therapy causes shifting of the teeth over time and may alter the bite. Surgical Treatment Surgical treatment of OSA has evolved over the last four decades. Tracheostomy is the surgery most curative for OSA. It is typically recom- mended for only the most medically ill patients with severe comorbid disease, or infants, especially those with hypotonia, craniofacial issues, or significant comorbidities. Upper Airway Modification Surgery (Nasal, Tonsil, Palate, and Tongue Base Surgery) Modifications of the upper airway can involve any or all levels. Multilevel surgery has become increasingly more common and is seen as generally more effective for the surgical treatment of OSA. Nasal airway surgery is well established as an effective treatment for nasal airway obstruction. Furthermore, it has been demonstrated to improve the subjective quality of sleep. It can be a useful adjunct in combination with other upper airway procedures for the treatment of OSA. As a stand-alone procedure, nasal surgery can produce partial improvements in a patient’s OSA, but does not typically result in a complete cure. Tonsillectomy continues to be a very effective method of treating OSA. It is recognized as first-line therapy in children and can also be of great utility to treat adults with OSA. Important factors to consider are the tonsil size and the modified Mallampati stage. Thought about generally, patients with large tonsils and a low-positioned tongue base (i.e., some of the pharynx is visible) will most likely respond well to a tonsillectomy,

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