what was the final diagnosis on the nasal passage where you were to have surgery that got post-poned back in May?
What was diagnosed? and what procedure were you to undertake in surgery to address it?
Was a turbinate reduction one of the procedures?
If one ENT thought you needed that and maybe your nasal valve fixed and you went to another ENT for their opinion and they said the same thing and they could explain to me the reasons why then I would have gone ahead with the surgery.
I've had nasal surgery before including a partial reduction in turbinate bony structure, it wasn't that bad to deal with.
But if the ENT is pushing a somnoplasty as a cure to OSA, then I see that as pure quackery. My ENT is very conservative, if he doesn't think a procedure will help me he won't waste my time for a buck.
As for tissue health, the only thing I would ever use is a saline rhino rinse.
Looking at those Pulse Oximeters, looks like the software is the deciding factor, they want upwards of $370 US for that, the SPO 7500 includes it for $479, looks to be the better deal from that aspect, but NONE seem to run on Vista so you may be screwed there again. I think I'd keep an old laptop laying around with XP so you can still run some software on it.
Some progress - Dental Device
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jskinner
- Posts: 1475
- Joined: Sat Aug 26, 2006 9:21 pm
- Location: Greenwich, Nova Scotia, Canada
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In the end I saw the surgon a week before the rescheduled date in June and he thought that after being off CPAP for two months the swelling had gone down enough that surgery no longer made sense. He said the risk wasn't worth the benefit at that point.Snoredog wrote:what was the final diagnosis on the nasal passage where you were to have surgery that got post-poned back in May?
That was part of the problem in my opinion there was never really any definitive diagnoses. While there has been improvement during day I still get regular single nostril blockages and when lye down congestion gets bad quite quickly. Staying elevated helps some but I can't turn to either side or that nostril quickly blocks up. He said maybe it was caused by Vasomotor Rhinitis but once he saw the day time improvement he wasn't to interested in the continuing night time problemsSnoredog wrote:what was diagnosed?
Yes septoplasty and turbinate reduction. I have seen 4 ENT now and they all said that the deviated septum is very slight and probably not worth fixing.Snoredog wrote:what procedure were you to undertake in surgery to address it? Was a turbinate reduction one of the procedures?
I agree if I could have got two ENT to agree I would have done it. Sadly they all disagreed The first ENT could not seen any problem. He recommended a LUAP and said that the CPAP was probably causing the irritation. The second ENT said not to get the LUAP and saw no problem. The third ENT was the one that could see the swelling and was recommending the surgery until I went off CPAP and things started looking better. The forth ENT was crazy and questioned that I had sleep apena at all since I wasn't fat!Snoredog wrote:If one ENT thought you needed that and maybe your nasal valve fixed and you went to another ENT for their opinion and they said the same thing and they could explain to me the reasons why then I would have gone ahead with the surgery.
Snoredog wrote:As for tissue health, the only thing I would ever use is a saline rhino rinse.
I've been using a saline rince for six months now. What ever is going on in there is fixed by any of these normal remedies. That the thing its never seemed like an allergy or inflammation.
Profox works on Vista. I had a nice phone chat with the developer the other day because I wanted to find out for sure.Snoredog wrote:Looking at those Pulse Oximeters, looks like the software is the deciding factor, they want upwards of $370 US for that, the SPO 7500 includes it for $479, looks to be the better deal from that aspect, but NONE seem to run on Vista so you may be screwed there again.
-James
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Jskin...is the flapping anything like this?
-Bev
The Epiglottis: A Little-Known Source of Sleep Apnea
by Regina Patrick, RPSGT
Laryngomalacia may be a cause of OSA-like symptoms when CPAP treatment fails because of difficulty breathing during physical exertion, shortness of breath when talking, and stridor.
Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA). In this disorder, the upper airway collapses and blocks airflow during sleep. The collapse can occur at various points. At the upper oropharyngeal level, the soft palate can be drawn downward into the throat during sleep and block the airway. At the lower oropharyngeal level, the base of the tongue can fall back into the airway. At the hypopharyngeal level (beneath the base of the tongue), weak pharyngeal muscles cannot withstand inspiratory pressure, which allows them to be drawn inward and block the airway. CPAP treatment counteracts this collapse by blowing pressurized air through a nose mask to keep the airway open. When the source of upper airway obstruction is the epiglottis, however, the very treatment used to prevent obstruction can actually cause it.
The epiglottis is a cartilaginous flap at the top of the larynx just above the glottis—the opening into the larynx. It is normally in an upright position to allow passage of air. In people with laryngomalacia, the epiglottis does not maintain this upright position during inspiration but instead falls backward and covers the glottis, thereby blocking airflow. During CPAP treatment in such people, the positive pressure forces the epiglottis backward over the glottis, making it difficult for the person to inhale.
Laryngomalacia, which means “weak larynx” in Greek, is most commonly seen in infants and children up to 2 years old. When laryngomalacia occurs in adults, it can be the result of changes that occur in the epiglottis with aging, but it is often secondary to other problems such as head or neck surgery, radiation treatment for cancer in the head or neck area, and neurological disorders such as strokes.
The epiglottis is held in place at its base by a ligament that connects it to the thyroid cartilage and near its top by another ligament that connects it to the hyoid bone. It is covered by a mucous membrane, which connects it to the base of the tongue and to the arytenoid cartilages. The arytenoid cartilages—one for each side—are situated in the rear portion of the larynx opposite the epiglottis. The portion of the membrane that connects each side of the epiglottis to an arytenoid cartilage is called the aryepiglottic fold. During swallowing, the epiglottis would normally lie over the aryepiglottic folds as it covers the glottis. In a person with laryngomalacia, it does this during inspirations.
Laryngomalacia occurs in one of four basic ways: the epiglottis is abnormally long and flaccid, which allows it to fall back and cover the opening of the larynx during inspiration; abnormally short aryepiglottic folds allow the epiglottis to curl in on itself and block the airway during inspiration; structures surrounding the epiglottis such as the arytenoid cartilages are unusually large and block the airway as they fall forward during inspiration; or the epiglottis, which is normally in an upright position during respiration, is instead angled toward the back of the throat and is easily closed from the pressure of the air during inspiration.
Surgery Options
Since most children no longer suffer symptoms by the time they are 2 years old, a physician may try to wait for a child to outgrow the condition if symptoms are mild. Surgery is performed if symptoms are severe enough to be life-threatening or if symptoms give a poor quality to life. Since adults do not have the ability to outgrow laryngomalacia, surgery is often the only treatment that will relieve their symptoms.
Surgery is considered when a child has difficulty eating because he can not breathe well or is failing to thrive because of this difficulty, a child has cyanosis (blue-tinged skin) or has a chronically low blood oxygen saturation (below 92%), or when people are excessively sleepy because their sleep is frequently interrupted by apneic episodes. If laryngomalacia is untreated for a long time, a child can potentially develop cor pulmonale (right-sided heart failure resulting from chronic hypoxia). Advances in surgery have made cor pulmonale a rare consequence of laryngomalacia.
In the past, a tracheostomy—a surgical opening in the trachea created through the front of the neck—provided the only relief for symptoms. Currently, there are three basic surgeries that avoid tracheotomy by targeting the epiglottis and its supporting structures; they include epiglottidectomy, epiglottopexy, and epiglottoplasty.
Epiglottidectomy involves trimming excess issue from the epiglottis so that it will not cover the glottis during inspiration. This technique was first described by Samuel Iglauer in 1922.1 He had an infant patient with severe cyanosis and apnea. In an effort to provide relief, he trimmed away part of the child’s epiglottis, which immediately decreased symptoms.
Epiglottopexy was first reported in a 1971 study by Fearon and Ellis,2 who sutured the epiglottis to the base of the tongue. In this position, the epiglottis can no longer fall back against the glottis during inspiration and the base of the tongue sufficiently covers the glottis during swallowing to prevent aspiration of food.
Epiglottoplasty was first described by Lane et al in 1984.3 This surgery reshapes the hypopharynx by trimming away excessive tissue from the arytenoid cartilages, arytenoid folds, and lateral edges of the epiglottis. In 1985, Seid3 performed a simpler but effective epiglottoplasty by cutting the aryepiglottic folds. Cutting the aryepiglottic folds lengthens the distance between the epiglottis and arytenoid cartilages. When this distance is too short, inspiratory pressure forces the epiglottis to curl in on itself and block airflow.
Another epiglottic problem that can obstruct the airway is a bifid epiglottis (an epiglottis that is split in two). In this condition, airflow is obstructed by two flaps fluttering across the glottis. A bifid epiglottis is a very rare condition; approximately 11 cases have been reported in medical literature.4
Symptoms of bifid epiglottis are the same as for laryngomalacia. A tracheostomy is often performed to relieve symptoms of a bifid epiglottis. This solution may not need to be long term. In 1976, Healy et al4 reported that when the epiglottis matured in two patients, they no longer needed a tracheostomy. Another surgical treatment involves cutting away part of the epiglottis. In 1949, Montreuil4 was the first to report successful symptom relief when he cut away part of the bifid epiglottis in one patient.
Laryngomalacia
Laryngomalacia is the cause of stridor (a harsh high-pitched sound occurring during inspiration) in 60% to 75%2 of children who have this symptom. Of these children, a small percentage (10% to 15%)5 require surgery. The incidence of laryngomalacia in adults is more difficult to determine. Since a child outgrows the condition, laryngomalacia in adults is often secondary to other problems.
An adult with undiagnosed laryngomalacia may go to a physician complaining of symptoms that sound like OSA such as choking episodes during sleep. Based on symptoms, the person may be misdiagnosed as having OSA and prescribed a CPAP machine. If people with undiagnosed laryngomalacia are being monitored by polysomnography while on CPAP therapy, they may appear to be having apneas while awake. This is because the epiglottis is pushed back over the glottis and covers the airway. Their oxygen saturation may drop since there is no airflow. They may complain of sensations of being choked or suffocated with the CPAP mask on.
-Bev
The Epiglottis: A Little-Known Source of Sleep Apnea
by Regina Patrick, RPSGT
Laryngomalacia may be a cause of OSA-like symptoms when CPAP treatment fails because of difficulty breathing during physical exertion, shortness of breath when talking, and stridor.
Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA). In this disorder, the upper airway collapses and blocks airflow during sleep. The collapse can occur at various points. At the upper oropharyngeal level, the soft palate can be drawn downward into the throat during sleep and block the airway. At the lower oropharyngeal level, the base of the tongue can fall back into the airway. At the hypopharyngeal level (beneath the base of the tongue), weak pharyngeal muscles cannot withstand inspiratory pressure, which allows them to be drawn inward and block the airway. CPAP treatment counteracts this collapse by blowing pressurized air through a nose mask to keep the airway open. When the source of upper airway obstruction is the epiglottis, however, the very treatment used to prevent obstruction can actually cause it.
The epiglottis is a cartilaginous flap at the top of the larynx just above the glottis—the opening into the larynx. It is normally in an upright position to allow passage of air. In people with laryngomalacia, the epiglottis does not maintain this upright position during inspiration but instead falls backward and covers the glottis, thereby blocking airflow. During CPAP treatment in such people, the positive pressure forces the epiglottis backward over the glottis, making it difficult for the person to inhale.
Laryngomalacia, which means “weak larynx” in Greek, is most commonly seen in infants and children up to 2 years old. When laryngomalacia occurs in adults, it can be the result of changes that occur in the epiglottis with aging, but it is often secondary to other problems such as head or neck surgery, radiation treatment for cancer in the head or neck area, and neurological disorders such as strokes.
The epiglottis is held in place at its base by a ligament that connects it to the thyroid cartilage and near its top by another ligament that connects it to the hyoid bone. It is covered by a mucous membrane, which connects it to the base of the tongue and to the arytenoid cartilages. The arytenoid cartilages—one for each side—are situated in the rear portion of the larynx opposite the epiglottis. The portion of the membrane that connects each side of the epiglottis to an arytenoid cartilage is called the aryepiglottic fold. During swallowing, the epiglottis would normally lie over the aryepiglottic folds as it covers the glottis. In a person with laryngomalacia, it does this during inspirations.
Laryngomalacia occurs in one of four basic ways: the epiglottis is abnormally long and flaccid, which allows it to fall back and cover the opening of the larynx during inspiration; abnormally short aryepiglottic folds allow the epiglottis to curl in on itself and block the airway during inspiration; structures surrounding the epiglottis such as the arytenoid cartilages are unusually large and block the airway as they fall forward during inspiration; or the epiglottis, which is normally in an upright position during respiration, is instead angled toward the back of the throat and is easily closed from the pressure of the air during inspiration.
Surgery Options
Since most children no longer suffer symptoms by the time they are 2 years old, a physician may try to wait for a child to outgrow the condition if symptoms are mild. Surgery is performed if symptoms are severe enough to be life-threatening or if symptoms give a poor quality to life. Since adults do not have the ability to outgrow laryngomalacia, surgery is often the only treatment that will relieve their symptoms.
Surgery is considered when a child has difficulty eating because he can not breathe well or is failing to thrive because of this difficulty, a child has cyanosis (blue-tinged skin) or has a chronically low blood oxygen saturation (below 92%), or when people are excessively sleepy because their sleep is frequently interrupted by apneic episodes. If laryngomalacia is untreated for a long time, a child can potentially develop cor pulmonale (right-sided heart failure resulting from chronic hypoxia). Advances in surgery have made cor pulmonale a rare consequence of laryngomalacia.
In the past, a tracheostomy—a surgical opening in the trachea created through the front of the neck—provided the only relief for symptoms. Currently, there are three basic surgeries that avoid tracheotomy by targeting the epiglottis and its supporting structures; they include epiglottidectomy, epiglottopexy, and epiglottoplasty.
Epiglottidectomy involves trimming excess issue from the epiglottis so that it will not cover the glottis during inspiration. This technique was first described by Samuel Iglauer in 1922.1 He had an infant patient with severe cyanosis and apnea. In an effort to provide relief, he trimmed away part of the child’s epiglottis, which immediately decreased symptoms.
Epiglottopexy was first reported in a 1971 study by Fearon and Ellis,2 who sutured the epiglottis to the base of the tongue. In this position, the epiglottis can no longer fall back against the glottis during inspiration and the base of the tongue sufficiently covers the glottis during swallowing to prevent aspiration of food.
Epiglottoplasty was first described by Lane et al in 1984.3 This surgery reshapes the hypopharynx by trimming away excessive tissue from the arytenoid cartilages, arytenoid folds, and lateral edges of the epiglottis. In 1985, Seid3 performed a simpler but effective epiglottoplasty by cutting the aryepiglottic folds. Cutting the aryepiglottic folds lengthens the distance between the epiglottis and arytenoid cartilages. When this distance is too short, inspiratory pressure forces the epiglottis to curl in on itself and block airflow.
Another epiglottic problem that can obstruct the airway is a bifid epiglottis (an epiglottis that is split in two). In this condition, airflow is obstructed by two flaps fluttering across the glottis. A bifid epiglottis is a very rare condition; approximately 11 cases have been reported in medical literature.4
Symptoms of bifid epiglottis are the same as for laryngomalacia. A tracheostomy is often performed to relieve symptoms of a bifid epiglottis. This solution may not need to be long term. In 1976, Healy et al4 reported that when the epiglottis matured in two patients, they no longer needed a tracheostomy. Another surgical treatment involves cutting away part of the epiglottis. In 1949, Montreuil4 was the first to report successful symptom relief when he cut away part of the bifid epiglottis in one patient.
Laryngomalacia
Laryngomalacia is the cause of stridor (a harsh high-pitched sound occurring during inspiration) in 60% to 75%2 of children who have this symptom. Of these children, a small percentage (10% to 15%)5 require surgery. The incidence of laryngomalacia in adults is more difficult to determine. Since a child outgrows the condition, laryngomalacia in adults is often secondary to other problems.
An adult with undiagnosed laryngomalacia may go to a physician complaining of symptoms that sound like OSA such as choking episodes during sleep. Based on symptoms, the person may be misdiagnosed as having OSA and prescribed a CPAP machine. If people with undiagnosed laryngomalacia are being monitored by polysomnography while on CPAP therapy, they may appear to be having apneas while awake. This is because the epiglottis is pushed back over the glottis and covers the airway. Their oxygen saturation may drop since there is no airflow. They may complain of sensations of being choked or suffocated with the CPAP mask on.
Today I bent the truth to be kind, and I have no regrets; for I am far surer of what is kind, than I am of what is true.
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Shadowatcher
- Posts: 39
- Joined: Mon May 14, 2007 5:17 pm
- Location: California
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jskinner
- Posts: 1475
- Joined: Sat Aug 26, 2006 9:21 pm
- Location: Greenwich, Nova Scotia, Canada
- Contact:
Mine is the Klearway device.Shadowatcher wrote:James - What dental device are you using? I have been screwing around with a mouth guard, trying to control leaks
http://www.klearway.com/
Encore Pro Analyzer Author
Facebook Apnea Group
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