Diagnostics Flashcards
How does the pharyngometer/rhinometer compare in accuracy to CAT scan and MRI?
Favorably.
It is also very consistent with a standard deviation of 7%
What do studies show about the correlation between awake and upright pharyngometry/rhinometry and AHI?
That there is a strong relationship between nasopharyngeal resistance when awake and AHI during sleep.
How should we handle patients with nasal patency issues?
Any resistance in the nose will cause further collapse further downstream in the pharynx (Bernoulli and Venturi principles). Surgery, nasal strips, etc. The net result is decreased negative intrathoraic pressure on inspiration.
What are the four landmarks that we measure with the rhinometer (in order from external to internal)?
Nasal opening (first dip, not marked)
Nasal valve (first markings)
Anterior border of inferior turbinate (second mark)
Posterior border of inferior turbinate (third mark)
The rhinometer does not get past the inferior turbinate
What is the objective of the “breathing out” phase of measurements with the phaaryngometer?
To promote collapse of the airway. The goal is to have the patient breathe out as much as they can before we see flutter on the readings.
How does Dr. Dean recommend using the pharyngometer?
Window 1 is tidal, 2 is collapse in centric
Window 3 is tidal, 4 is collapse in shim
Compare 1 to 3 and 2 to 4
Where can I go to find the studies about efficacy of the rhinometer/pharyngometer?
Sleep Group Solutions website. They are the distributor.
What is the Muller maneuver?
After forced expiration, close mouth and nose and attempt to inspire. With a scope, areas of collapse may be seen. Typically done by ENT.
What is joint vibration analysis (JVA)?
An instrument measures sound vibration and friction in the TMJ. It’s much more accurate than doppler, auscultation, palpation, etc.
On a panoramic radiograph, we sometimes see gonial notching. What is gonial notching and what it is indicative of?
Gonial notching is a notch on the inferior border of the ramus just anterior to the angle of the ramus. It is indicative of bruxism (overactive masseter causes bone loss at the site of attachment).
How does OSA affect the distance of the hyoid bone from the base of the mandible?
In OSA patients the hyoid is further from the mandible than in patients without OSA (normal is 15mm or less on a ceph).
Where are the adenoids located?
Posterior junction of the nasopharynx – superior to the oral airway on a ceph – on about the same plane as the maxillary sinus/dentition.
Where are the tonsils located?
Back of the throat at the junction of the oral cavity and oropharynx – inferior to the adenoids on a ceph – on about the same plane as the mandibular dentition. Tonsils are visible with visual examination of the throat (say “ah”).
