Clinical Services Stanley Ear Nose Throat & Sinus Centre

  • Snoring / Sleep Apnea Management

    Consultation & Investigation

    Flexible Endoscopic examination done in the Clinic
    Collapsing Velopharyngeal Airway
    • Snoring and sleep apnea are common conditions seen in 25 – 40% of the adult population. After a thorough consultation, a video naso-endoscopy of the upper airway is done to look for upper airway obstruction. The site and degree if obstruction is assessed by visual examination.
    • An evaluation of the velopharyngeal airway and extent and nature of collapse is necessary.
    • The position of the tongue base and site of upper airway collapse is important in the initial clinical assessment.
    Collapsed Velopharyngeal
  • Overnight Sleep Study or Polysomnography at the Gleneagles Sleep Laboratory
    Obstructive Sleep Apnea Episode on PSG
    • A complete overnight polysomnograhpy (PSG) can be done at home, hotel or hospital.
    • The sleep data is downloaded and analysed.
    • The extent and degree of OSA including central or obstructive sleep apnea can be diagnosed. The degree of arousals and any periodic (PLB) leg movements are noted.
    Central Sleep Apnea Episode on PSG
  • Principles of Obstructive Sleep Apnea (OSA) Management

    • All patients are advised to lose weight with a weight loss management programme. A change in lifestyle and attitude towards weight control is essential.
    • A regular exercise regime is also advised to tone up the head and neck muscles.
    • Consumption of alcohol related beverages are to be avoided.
    • All regular sleeping pills and tranquillizers are to be stopped permanently.
    • All patients, upon PSG diagnosis of OSA, are advised to undergo a therapeutic trial of Nasal CPAP first. No patients are offered surgery unless there is gross tonsillar obstructive lesions or nasal polyps or chronic sinusitis with gross turbinate hypertrophy.
    • Surgery is only offered after failure of Nasal CPAP Therapy or severe snoring with normal PSG or mild OSA.
    • MULTILEVEL surgery is the gold standard in surgery of nose, velopharynx and tongue base.
    • All patients are offered a trial nasal CPAP therapy which is non-surgical. Surgical management is for nasal CPAP failure or non-compliance of the patient.
    • Surgery is initially aimed at the soft tissues of the upper airway. The aim is to stiffen and widen the airway.
    • Surgery of the oromandibular skeleton is reserved for severe sleep apnea where soft tissue surgery has failed.
  • Non-Surgical Option

    Nasal CPAP

    CPAP Therapy with Breeze Sleep Gear and Nasal Pillow
    Easylife Mask
    • One non-surgical treatment in addition to weight loss and exercise is that of nasal CPAP.
    • Atmospheric air is compressed and forced through the upper airway, opening and splinting the collapsed airway and restoring non-obstructed sleep and alleviation of OSA. This is an effective, non-surgical procedure, provided the patient can tolerate the nasal mask. Patient compliance is important. The type of mask used is important as it is the interface between patient and machine.
    Optilife Mask
  • CPAP masks with Headgear
    (Photo credits: Medworx International)
    • CPAP Therapy with Breeze Sleep Gear and Nasal Pillow One. Atmospheric air is compressed and forced through the upper airway, opening and splinting the collapsed airway and restoring non-obstructed sleep and alleviation of OSA. This is an effective, non-surgical procedure provided the patient can tolerate the nasal mask and pressure of air.
  • Oro-Mandibular Splints

    Dental Splint to widen the Oropharyngeal Airway. To be worn when patient is asleep
    • Dental Splints can also be used to pull the mandible and base of tongue forward to open the oropharyngeal airway. These are effective for mild OSA and must be fitted by an appropriate specialist. The risk of these dental splints are that of injury to the Temporo-Mandibular Joints which may be compromised.
  • Surgical Option

    Uvulo-Palato-Pharyngoplasty (UPPP)

    Results after Tonsillectomy and Uvulo-Palato-Pharyngoplasty for Snoring/Sleep Apnea view through mouth. The oropharygeal airway is widened and stiffened
    • A surgical option is generally offered after failure of nasal CPAP therapy unless there are obvious areas of obstruction with enlarged tonsils, polyps turbinate hypertrophy or rhinosinusitis.
    • The aim of surgery is to widen and stiffen the oro-naso hypopharyngeal airway.
    • It can be soft tissue surgery of the palate, tonsil and tongue base, or nasal cavity.
    • It is essential that the nasal airway be clear also either medically or surgically.
    • Today, we know that single level surgery alone is not as effective as multi-level surgery i.e. surgery of the nose, palate, and base of tongue at the same time.
  • CoblationAssistedUvulo-Palato-Pharyngoplasty (CAUP)

    • Soft Tissue Surgery of the Upper Airway
      • a. Oropharyngeal / Palatal Surgery
        • Besides traditional surgery with radiofrequency diathermy which causes collateral damage, edema and swelling, new technology like the Coblatior has become a major advance as a surgical tool.
        • Coblation works at about 100°C as compared to electrocautery at 400°C Hence there is precise tissue coagulation with little colateral damage.
        • Coblation can be applied to the soft palate as CAUP or tongue base application to reduce the size of the tongue base.
        • The fundamental principle today is multi-level surgery at the nose, velopharynx or oropharynx and base of tongue. In soft tissue surgery of the upper airway, these 3 levels are dealt with with the coblator to widen and stiffen the upper airway. Major obstructive lesions like enlarged tonsils or adenoids or nasal polyps are removed.
        • The Coblator is applied to the soft palate via channeling to scar the soft palate.
      • b. Tongue Base - Surgery of the tongue base is the most difficult. The tongue can be coagulated and reduced in size by COBLATION, or Partially excised or repositioned by slings to the anterior arch of the mandible.
    • Bony Framework Surgery
        • In the extreme situation, if soft tissue surgery fails, then the Bi-Maxillary Mandibular advancement operation whereby the upper and lower jaws are mobilised and pushed forward to open up the upper airway. This is very extensive surgery and surgery of the last resort.

    The most difficult part of surgical therapy is that of choice of site of obstruction and method of surgery. To date most patients are evaluated by eye-balling the upper air way on endoscopy to determine the site or sites of obstruction. There are research tools to determine the site of obstruction, but these have not been proven to be reliable and reproducible to be a gold standard in the evaluation of OSA.

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