Sleep Apnea Surgery
People with sleep apnea stop breathing while they sleep, sometimes hundreds of times per night, and sometimes for a minute or longer. With normal breathing, air passes through the nose and past the flexible structures, such as the soft palate, uvula and tongue, in the back of the throat. When awake, the muscles hold this airway open. When asleep, these muscles relax, but the airway should remain open. In those who suffer from sleep apnea, the upper airway is blocked, causing oxygen levels to drop in both the brain and the blood.
Causes of Sleep Apnea
While sleeping, the airway in the throat may become partially or fully blocked, which may be caused by the following:
- Large tongue and tonsils compared to the opening in the windpipe
- Cardiovascular problems
- Throat and tongue muscles that are much more relaxed than normal
- Aging, which may limit the brain's ability to keep throat muscles stiff during sleep
Diagnosis of Sleep Apnea
Sleep apnea may be diagnosed by a physical examination, review of family and medical history, and a sleep study. Patients may be referred to a sleep specialist to perform a sleep study test. A polysomnogram (PSG) is the most common sleep study test for diagnosing sleep apnea. A PSG records brain activity, eye movements, heart rate and blood pressure. It also records the amount of oxygen in the blood and air movement in the lungs during breathing and snoring.
Types of Sleep Apnea
There are three types of sleep apnea:
Obstructive Sleep Apnea
Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the soft tissue at the back of the throat closes, blocking or obstructing the airway.
Central Sleep Apnea
The airway remains open in central sleep apnea, but the brain does not send signals to the muscles involved in breathing.
Mixed Sleep Apnea
Mixed sleep apnea combines aspects of the obstructive and central types of apnea. A common warning sign of sleep apnea is snoring, especially when it is interspersed with gasps or lack of breathing.
Tonsils and Adenoids
The tonsils and the adenoids are lymphatic tissue. The adenoids are located behind the nose and high in the roof of the mouth, while the tonsils are found on the back of the throat. They are an integral part of our immune system that protects the upper respiratory tract and prevents disease. The tonsils and adenoids assist the body in defense against infection by "sampling" entering bacteria and viruses and becoming infected themselves. They then help form antibodies to resist and fight future infections
Conditions of the Tonsils and Adenoids
The tonsils and adenoids often become susceptible to recurrent bacterial infections and obstruction that may lead to breathing, swallowing and sleep problems. Some of these conditions may become serious and require surgery.
Tonsillitis is an inflammation of the tonsils, the fleshy areas at the back of the throat, caused by a virus or bacteria. This condition is common in children and spreads through contact with throat or nasal fluids. The tonsils become swollen, red and painful and may be coated with a yellow or white substance.
Most cases of tonsillitis are caused by a virus, although it can sometimes be caused by the same bacteria that causes strep throat. Tonsillitis symptoms are similar to those of strep throat or a common cold and may include:
- Sore throat
- Red, swollen tonsils
- Difficulty swallowing
- Swollen lymph nodes
Vocal Cord Paralysis
Vocal cord paralysis is a common disorder that involves a malfunction in one or both of the vocal cords, the tissues that allow us to speak. When a vocal cord does not open or close properly, the airway is left open which can allow food or liquids to slip through. This causes difficulty swallowing, coughing and increased breathing, and often occurs after neck or throat surgery.
Treatment of Vocal Cord Paralysis
Treatment for vocal cord paralysis depends on the cause, severity and length of the condition. Some patients recover from this condition with no treatment, while others may require voice therapy or surgery.
Voice therapy works to strengthen the vocal cords, improve breath control during speech and keep the airway protected. Occasionally, voice therapy may be the only treatment needed if the vocal cords were paralyzed in a location that doesn't require repositioning.
Surgical treatment for vocal cord paralysis may be recommended to improve breathing or speaking ability that does not improve on its own. Treatment options may include:
- Bulk injection to the paralyzed vocal cord, which allows the affected cord to make contact in the middle of the voice box
- Repositioning of the vocal cord, using structural implants or repositioning tissue
- Tracheotomy, or inserting a breathing tube into the windpipe
- Reinnervation, or replacement of a damaged nerve
Speech therapy may be recommended after surgery to strengthen the vocal cords and help the patient adapt to the repositioning. Patients usually require at least one month to recuperate from surgery before initiating speech therapy treatments.