Audiology Lesson 2 - OSAS

Question 1

Describe what Obstructive Sleep Apnea Syndrome is and its effects on the pt

Answer 1

OSAS is the most common type of sleep apnea - caused by complete or partial obstructions of the upper airway.

• characterized by repetitive episodes of shallow or paused breathing during sleep, despite the effort to breathe.
• It is usually associated with a reduction in blood oxygen saturation.
• Apneas typically last 20 to 40 seconds.
• Individuals with OSA are rarely aware of difficulty breathing, even upon awakening. It is often recognized as a problem by others who observe the individual during episodes or is suspected because of its effects on the body.
• OSA is commonly accompanied with snoring.

Patients experience:
Excessive daytime sleepiness
Pediatric patients are nervous and irritable with attention problems

Consequences of OSAS are:

1. Arterial hypertension
2. Excessive daytime sleepiness
3. Uvula and palate oedema

Question 2

Describe what can be observed on Pharyngo-Laryngeal inspection and endoscopic investigation in OSAS

Answer 2

Pharyngo-Laryngeal Inspection (Endoscopic investigation) - Nose and sinonasal inspection and pharyngo-Laryngeal inspection by means of Mueller maneuver.
o After a forced expiration, an attempt at inspiration is made with closed mouth and nose, whereby the negative pressure in the chest and lungs is made very sub-atmospheric; the reverse of Valsalva maneuver.
o This technique is designed to look for collapsed sections of airways such as the trachea and upper airways.
o In this maneuver, the patient attempts to inhale with his mouth closed and his nostrils plugged, which leads to a collapse of the airway.
o Introducing a flexible fiberoptic scope into the hypopharynx to obtain a view, the examiner may witness the collapse and identify weakened sections of the airway. Müller’s maneuver is used to help determine the cause of sleep apnea.

Question 3

How is OSAS diagnosed?

Answer 3

Polysomnography - sleep study

Question 4

Describe the cause of Apnea in OSAS

Answer 4

It is characterized by complete collapse of the soft tissues of the upper airways and epiglottis with consequent desaturation.

So an apneic event can be caused by epiglottis collapse.

Question 5

What is seen on Oral cavity / oropharynx inspection?

Answer 5

Tonsil hypertrophy - kissing tonsils. Palate position and uvula types

Question 6

What is the role of ENT in OSAS?

Answer 6

To understand where the sites of obstruction are and surgical treatment (to increase the space of the upper airway - therefore reducing the collapse.

Question 7

Describe Ronchosurgery targets

Answer 7

Upper airways shunt
o long term tracheostomy.
o If our patient suffers of a periheperal obstruction.

Removal of obstructing tissues

Stiffening soft tissues
For example repositioning the hyoid anteriorly; this results in a significant reduction in resistance.
Hyoid bone surgery can be done by means of
• Hyoido-plasty (in which you achieve a transversal gain)
• Hyoido-pexy that can be a mandibulo-hyoidoplexy or a thyro-hyoidoplexy to reduce upper airway resistance suspending the hyoid bone

Question 8

Describe how Robotic surgery is used for the removal of obstructing tissues

Answer 8

Surgeries can be performed transorally to remove obstructing tissues - e.g large tongue base