Voice Disorders (see section above)
Snoring and Obstructive Sleep Apnoea
Snoring and Sleep Apnoea
Snoring is a common condition that affects up to 50 % of the population. It is a common cause of relationship difficulties and social embarrassment.
Snoring is caused by obstruction of the upper airway which consists of the nose, mouth and throat.
Obstruction at any point along the airway can cause snoring. Nasal obstruction can therefore be implicated. Often snoring is caused by vibration of the soft tissues at the back of the mouth and large tonsils may contribute to obstruction at this site. The size and shape of the jaw are also important as they control the back of the tongue which can collapse backwards when the patient is asleep causing obstruction and thus snoring.
Snoring is often made worse by muscle relaxants such as alcohol or sleeping tablets. Being overweight is also a significant factor as this causes obstruction to the airway by fat deposition around the airway in the neck.
Sleep apnoea is associated with loud snoring. It is caused by severe obstruction of the airway and is characterized by pauses in the patients breathing while asleep. The obstruction leads to poor oxygen uptake while the patient is asleep. The patient does not feel refreshed when waking and may fall asleep during the day. Chronic obstructive sleep apnoea may cause high blood pressure and heart disease and is a potentially life threatening condition. It is also associated with poor concentration and loss of libido.
Treatment for snoring and sleep apnoea
This will depend on the cause in the individual patient. Treatment includes;
- Lifestyle changes, for example, weight loss. Patients can be referred to a dietician if required.
- Medical treatment, for example treating rhinitis (see causes of nasal obstruction)
- Mandibular splint. This is a device like a gum shield that maintains the position of the jaw while the patient is asleep and prevents the tongue from falling backwards.
- Surgery. This may involve surgery to unblock the nose or tonsillectomy to remove large tonsils. There are a range of procedures specifically designed to combat snoring caused by vibration of the soft tissues at the back of the mouth. These can be done using a laser.
- CPAP (Continuous positive airway pressure). This is a treatment for sleep apnoea and consists of delivering air, under pressure, using a mask in order to keep the patient’s airway open whilsed they are sleeping.
Tonsils are aggregates of lymphoid tissue located in the throat. There are two at the back of the mouth at the junction with the throat known simply as ‘tonsils’ or more accurately ‘palatine tonsils’, one at the back of the nose, the ‘adenoid’ and one at the back of the tongue, the ‘lingual tonsil’. They are important in very young children in ‘processing’ bacteria and viruses in order to build up the immune system.
Tonsillitis refers to an infection of the palatine tonsils and can be caused by a virus or bacteria. Acute tonsillitis can be an extremely unpleasant condition causing sore throat, fever and a feeling of being generally unwell and sometimes causes abdominal pain and vomiting in children. Bacterial infections of the tonsils are usually more severe than viral infections. Recurrent tonsillitis can lead to significant absence from school or work and it has been estimated that 350 million work and school days are lost in the UK each year due to tonsillitis.
Acute tonsillitis can be complicated by abscess formation, ear infection (otitis media)and rarely rheumatic fever and acute glomerulonephritis. It can also be associated with ‘flare ups’ of skin conditions. Glandular fever can present with severe tonsillitis (Mr Eynon-Lewis had this when he was 17!)
Treatment for Tonsillitis
In adults, Mr Eynon-Lewis offers CO2 LASER and bi-polar dissection tonsillectomy. There is evidence that LASER is less painful although has a slightly higher revision rate (that is when a second operation is required at some stage, although this is only around 1-2 %). In children, bipolar, non laser dissection is used as the operation is usually straightforward as there is less scar tissue fixing the tonsil to the surrounding tissue. Local anaesthetic is used after the operation before the child has awoken, in order to minimize postoperative pain.
Quinsy (peri-tonsillar abscess)
Even more painful than tonsillitis, this is an abscess on the inside of the tonsil. This causes spasm of the jaw muscles, ear pain and almost a complete inability to swallow. It is usually on one side only and is caused by tonsillitis. Treatment consists of draining the abscess and giving antibiotics. The patient may require admission to hospital.
These are also known as ‘tonsil stones’ and form in the cracks and crevices in the tonsils. They are usually unpleasant fragments of debris and have an unpleasant smell. They can be associated with bad breath, recurrent sore throat or a persistently sore throat – chronic tonsillitis.
Treatment consists of tonsillectomy or re-surfacing the tonsil with the CO2 LASER. The objective of this is to smooth the surface of the tonsil so that the tonsilloliths can no longer form.
A tonsil which is enlarged on one side might be cancerous and needs to be looked at urgently. Initially, a biopsy and a CT scan may be required. Tonsil cancer is treated with chemo-radiotherapy, surgery or photodynamic therapy.