Sleep Endoscopy for Obstructive Sleep Apnea and Snoring

A new webpage has been created describing a procedure called "sleep endoscopy" or "sedated endoscopy."

This procedure is performed on patients with obstructive sleep apnea (OSA) or severe snoring in order to determine where the source of their problem is anatomically located.

This special exam is needed in patients where such anatomic determination is not able to be made in the clinic while they are awake. As such, an anesthesiologist would put the patient to sleep using IV medications and when snoring or obstructive events happen, endoscopy is performed.

Areas that will be specifically examined during sleep endoscopy include:

• Behind the palate
• Uvula
• Back of Tongue
• Walls of the Throat
• Epiglottis
• Voicebox

Each of these areas may experience collapse during sleep causing obstructive or snoring symptoms.

Why is this information helpful? Well... once it is apparent where and what is the culprit causing a given patient's problems, surgical treatment can be geared more specifically and directly to the area of concern seen during sedated endoscopy.

Read more here!

Miley Cyrus "I Cut My Uvula"! ...NOT!

I was recently made aware of this video Miley Cyrus made in January 2009 when she reported that she cut her uvula (according to a nurse) after swallowing a slippery piece of chicken causing her voice to sound quite hoarse. Watch the video here:



However, based on how her voice sounds, I seriously doubt that her hoarseness is due to a cut uvula. When the uvula gets cut, or swollen, or gets injured one way or another, it would cause her voice to sound muffled... NOT raspy like her voice sounds. Though it is possible that her uvula may have been injured, it certainly is not the cause of her poor vocal quality.

Rather, I suspect that her voice sounds bad the way it does due to a vocal cord injury. Often, when people swallow a piece of food (like a chicken) that either gets stuck or goes the wrong way, the person automatically coughs severely in order to expel it.

If the cough is severe enough, it'll cause traumatic injury to the vocal cord resulting in a hoarse voice. The injury itself may not be that bad (usually a mild vocal cord submucosal hemorrhage), but the voice does sound bad. Here are two mild examples of laryngitis due to blood accumulation here and here. A more severe example of traumatic laryngitis can be found here.

In this situation, if the person persists and tries (forces) to talk and sound normal in a setting where the vocal cord is injured, compensatory behavior sets in whereby the vocal quality will fluctuate and go in and out as Miley's voice does in the video (listen to an audio of another patient with this problem here). This condition is called "compensatory muscle tension dysphonia," and in her case, secondary to acute traumatic laryngitis.

This diagnosis can be confirmed on fiberoptic laryngoscopy. Treatment is high dose steroids that will bring the swelling down as well as strict voice rest for a few days (depending on severity of the injury). Resolution of her voice would be expected within 1 week with this treatment. Voice therapy may be required, though usually not.

Read more about traumatic laryngitis here.

Read more about muscle tension dysphonia here.

New Video on Uvula Excision for Snoring (and Other Problems)

Our office has created a new video on how a uvulectomy (or uvula excision) is performed to treat not only snoring, but chronic cough, throat-clearing, and even gagging due to an extremely long uvula.

Though the procedure can be performed awake without sedation in adult patients without a severe gag reflex, for those with a bad gag reflex, it must be performed under general anesthesia as shown in this video.

For more info on this procedure, click here.

Check it out here!