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Department of Otolaryngology
Tonsils and Adenoids
Enlarged tonsils and adenoids can also cause problems even if they do not get infected. Sometimes they are so large that children have problems breathing or, less commonly, eating. Indications of adenotonsillar enlargement that is interfering with normal processes include:
Surgery is the only effective treatment for enlarged tonsils and adenoids that are causing symptoms. Upper Respiratory Tract Infections Viral upper respiratory infections, common colds, are seen very frequently. Adults tend to get 2-4 colds a year and even normal children can get 8-10 colds per year. While the symptoms impart considerable misery, the infections are not serious and are self-limiting in normal people. Much research has been done on the common cold but there is no curative treatment. These infections run their course in 5-10 days. Over the counter cold remedies provide symptomatic relief but do not hasten resolution of the illness. Bacterial upper respiratory infections (either sinusitis or bronchitis) can also develop. It can be very difficult, even for physicians, to distinguish between viral and bacterial URI's. Many factors, including duration and severity of symptoms, as well as underlying respiratory diseases are considered when deciding whether or not to prescribe antibiotics in the treatment of URI. It is also common for a viral infection to weaken a patient's defenses and set the stage for a secondary bacterial infection. In contradistinction to viral URI's, antibiotics do provide effective treatment for bacterial upper respiratory infections. When upper respiratory predictably recurr at certain times of the year, allergies should be suspected. Because the symptoms of for these upper respiratory disorders sometimes overlap, a thorough evaluation by an ear, nose and throat specialist is often required to sort out the problem. Snoring What Causes Snoring? The noisy sounds of snoring occur when there is an obstruction to the free flow of air through the passages at the back of the mouth and nose. This is the collapsible part of the airway where the tongue and upper throat meet the soft palate and uvula (the fleshy structure that dangles from the roof of the mouth back into the throat). When these structures strike against each other and vibrate during breathing, that is snoring. Persons who snore have at least one of the following problems:
Is Snoring Serious? Socially - yes. It is disruptive to family life. It makes the snorer an object of ridicule and causes other household members sleepless nights and resentfulness. Snorers become unwelcome roommates on vacations or business trips. And medically - yes. It disturbs the sleeping patterns of the snorer himself, so that he may not sleep restfully. Furthermore, heavy snorers tend to develop high blood pressure at a younger age than non-snorers. The most exaggerated form of snoring is known as obstructive sleep apnea, when loud snoring is interrupted by frequent episodes of totally obstructed breathing. This is serious if the episodes last over 10 seconds each and occur more than 7 times per hour. Your physician may recommend a laboratory sleep study as a way of evaluating your symptoms. Apnea patients may experience 50 to 500 obstructed events per night, and many spend as much as half their sleep time with blood oxygen levels below normal. During the obstructive episodes, the heart muscle may not receive sufficient oxygen resulting in irregular heartbeats that may be life threatening. Each apnea (obstructed breathing) episode ends when the brain wakes up the person enough so that he begins breathing again. The sleeper is unaware of his frequent awakenings because they only last for a few seconds but the result is that the person never progresses to deeper stages of sleep. Persons with obstructive sleep apnea may spend little of their night-time hours in the deep sleep stages that are essential for a good rest. Therefore, in the morning they awaken unrefreshed and are sleepy much of the day. They may fall asleep while driving to work or while on the job. Since snorers with severe sleep apnea are often unaware of it, a laboratory sleep study may be the only way to discover it. Can Snoring Be Cured? Remember, snoring means obstructed breathing, and obstruction can be serious. It's not funny, and it is definitely not hopeless. Every child who snores should be thoroughly examined by a physician. Medical evidence suggests that a tonsillectomy and adenoidectomy will probably make an important difference in the health and well-being of the child. Snoring adults should be examined to determine the seriousness of the problem. Treatment will depend, of course, on the diagnosis. It may be as simple as managing nasal allergies or infection. In other cases, it may require surgery to correct a nasal deformity or to remove large tonsils or an enlarged uvula. Many snorers respond best to surgery on the throat to remove flabby tissue and expand the airway. In the past, this surgery was somewhat involved. New laser techniques have made it a simple office procedure. A new treatment for snoring, laser-assisted uvulopalatoplasty (LAUP), is providing a high tech answer to an age-old problem. The patient is treated in the physician's office, sitting upright, and fully awake. After local anesthesia is administered, the surgeon uses the laser beam to remove the excess throat tissue that vibrates during sleep to cause snoring. The laser produces a high energy light beam that cuts tissue with precision in an almost bloodless fashion. In order to remove the right amount of tissue, the LAUP procedure is performed in one to four sessions with approximately six weeks between sessions. Patients leave the office fully alert, able to speak, eat, and return to work. Post operative discomfort consists of a moderate sore throat while swallowing and lasts for only a few days versus the prolonged severe postoperative pain that occurs with the conventional in-patient operation for snoring. The LAUP patient is given a prescription for pain medicine that is usually only needed for a few days. The biggest advantage of treatment with the laser is that it works! Reduction in snoring is common, with significant improvement usually occuring after the second session. In 85% of patients the snoring is completely or nearly completely eliminated, while an additional 12% report a reduced level of snoring. The LAUP eliminates the expense of general anesthesia and an expensive hospital stay. The patient must be informed that most insurance carriers do not reimburse for treatment of snoring, as is the case for cosmetic procedures. However, surgery for treatment of obstructive sleep apnea is often a covered benefit. Diagnosis of obstructive sleep apnea must be documented by a sleep study. Many people with severe snoring have mild, moderate, or even severe obstructive sleep apnea. We recommend performing an overnite sleep study to determine if obstructive sleep apnea is present. You should check with your insurance carrier for information about your specific benefits. Overall, the LAUP procedure represents a technologically advanced yet uncomplicated way to remedy a serious social and sometimes dangerous medical, condition. Although snoring surgery in the past had been considered major surgery, LAUP is enabling specially trained physicians to treat your snoring condition with an in-office procedure. Please feel free to ask one of them about this new technique! Cleft Palate Clinic The purpose of this clinic is to provide a comprehensive approach to the care of these children. Babies are typically referred very soon following their birth, so that the Team can make recommendations regarding the early care of the baby, e.g. making sure the baby is eating without difficulty, is gaining weight, and to discuss the timing for surgery. As the baby grows and develops, an evaluation of speech and language skills is completed and any necessary referrals for intervention are discussed with the parents. Primary care physicians, parents, teachers, and any other professionals from the tri-state area can make referrals to the Cleft Palate Clinic by contacting Dr. Mark Armeni's office at 598-4825, which is located on the first floor of the Physician's Office Center. The Team meets following the clinic to review the patient and to discuss recommendations. The timing for return visits to the clinic is determined by the Team depending on the needs of the patient. Transnasal Esophagoscopy For patients with GERD and asthma, symptoms such as chronic cough can be further investigated through TNE. The procedure allows physicians to view the effects of GERD in the throat--effects which are more common than previously recognized and which may increase patients' risks for cancer of the larynx and hypopharynx. The endoscope is inserted through the nose and down the throat to view the vocal folds, larynx, esophagus, and other structures. The new endoscopes are better tolerated by patients, and sedation is not necessary. Therefore, the risk of complications is lower than with conventional endoscopy. The most common complication associated with TNE is nosebleed. TNE is also used to examine patients with swallowing difficulties (dysphagia) caused by mechanical problems or obstructions. In one study, TNE led to correct diagnosis of the cause of dysphagia in 100 percent of patients. |
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