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Oral appliances for treatment of sleep apnea… a case by case approach.

The FDA has approved the use of “oral appliances” (sometimes known as mandibular advancement devices) as a first line treatment for mild sleep apnea, or as an alternative treatment in moderate to severe sleep apnea if CPAP is not tolerated. The premise is, that by altering the position of the lower jaw in relation to the upper jaw (either by opening or advancing the lower jaw), the soft tissue attached to the jaw will also be shifted, creating more space at the back of the throat and reducing airflow obstruction.

Many types of devices can be used, most of which look somewhat like a sports mouthguard. Essentially there are two main categories: those that must be custom fit by a dentist, or “boil and bite” devices that can be fitted quickly in the ENT office. Both types of devices are offered here at Chicago ENT and both have been shown to be effective. That said, we are always looking to improve our practice and achieve better outcomes, and to that effect we are currently conducting research to determine if there are any particular indications to use one device or another in certain situations. Using advanced assessment techniques including acoustic pharyngometry (where the caliber of the airway is revealed using a technology similar to sonar), we may be able to tell ahead of time whether an individual’s sleep apnea is likely respond to a certain kind of device.

Another extremely important part of our research is quality assessment, where each patient’s feedback is taken into consideration in helping us determine which devices are the best tolerated. A device that works 100% of the time, is worthless if it’s never used!

As newer oral appliance models are brought into production, our clinical research will continue to ensure that each and every one of our patients is matched with their best possible fit.

Visit www.snoringtreatmentchicago.com for more information on what we do here at ChicagoENT- an Advanced Center for Specialty Care

Robots for Better Sleep

Chicago, Ill. — Aug. 24-2011— Robots of varying complexity have been used for years, for everything from manufacturing to space exploration. Now, they can even help you get a better night’s sleep.

Michael Friedman, MD, chief of the Section of Otolaryngology-Head and Neck Surgery at Advocate Illinois Masonic Medical Center, is one of the first surgeons in the nation to utilize the increasingly popular robotic surgical tools for the minimally invasive treatment of severe obstructive sleep apnea (OSA).

“Approved by the Federal Drug Administration (FDA) last year, TransOral Robotic Surgery allows for finely controlled tissue removal within the patient’s throat without the need for external incisions,” Friedman said.

                Initially used to treat cancer of the throat and mouth, Friedman developed a technique that uses the Da Vinci Surgical System® to reduce obstructive tissue of the back of the throat, relieving OSA. The condition affects more than 20 million Americans, leading to critical health issues such as weight gain, hypertension, heart disease and impotence. Although OSA can be treated with noninvasive devices, such as continuous positive airway pressure (CPAP) machines, millions can’t tolerate the cumbersome device that needs to be strapped to the face. Formerly, surgery offered little chance of a cure due to limited access to the back of the throat. With the use of the da Vinci system, however, Friedman says radiofrequency technology can be introduced right through the mouth to create more space in the throat and lessen obstructions to breathing during sleep.

                “I wish this surgery had been around longer, so I could have had it five years ago,” said Phil Grigus, one of the first of Dr. Friedman’s patients to undergo the surgery last April. “I didn’t think I was sleeping badly before, but after the surgery, I’m more alert during the day and I definitely have more energy.”

                Grigus said he underwent the procedure, which he describes as “life changing,” after he tried non-invasive methods, like the CPAP and an oral dental appliance, and felt he had nothing to lose. He said he’s since lost a total of 24 pounds because he’s sleeping more soundly and, in turn, has more energy for exercise.

                “I was recently on vacation with my family and fell asleep by the pool,” he said. “My 27-year-old son said it was the first time I didn’t make a sound.”

                In a study of 60 patients, Friedman said the robotic technique resulted in significant improvement. His study will be presented at the American Academy of Otolaryngology-Head and Neck Surgery’s Annual Meeting and OTO EXPO in San Francisco, September 11 to 14, 2011.

                Michael Friedman, MD is chairman of Otolayrngology/ Head and Neck Surgery at Advocate Illinois Masonic Medical Center. He is also a Professor of Otolaryngology and Chairman Sector of Sleep Surgery at Rush University Medical Center. Dr. Friedman is the author of “ Snoring & Sleep Apnea” published by Elsilver.

 

About Michael Friedman, MD

    Michael Friedman, MD is the chairman of Otolaryngology- Head and Neck Surgery at Advocate Illinois Masonic Medical Center, Chicago IL. He is also a professor of Otolaryngology and chairman sector of Sleep Surgery at Rush University Medical Center, Chicago IL. He is the author of “ Snoring and Sleep Apnea” published by Elsiver.

A solution for sinusitis and allergies without the need for medication

31 million Americans each year are affected by sinusitis and allergies. This disease affects both adults and children, may require multiple visits to the doctor, and can be severe enough to cause patients to miss work or school.

The four most commonly prescribed medical treatments for sinusitis (both by Otolaryngologists and Primary Care Physicians) are antibiotics, antihistamines, nasal steroids and oral steroids. With increased awareness of drug side effects, many patients want to avoid long term steroid use. A new study shows that a natural substitute may allow patients to avoid steroids.

Almost all patients will also be recommended to use irrigations to flush the nose and sinuses. Regular irrigation improves the symptoms in a number of ways:

  • ·         Improves the function of cilia( tiny hair-like structures that move en-mass to clear mucus from the respiratory system including nasal passages)
  • ·         Decreases localized swelling in the nasal passages
  • ·         Helps clear infective and non-infective debris and sources of allergies.
  • ·         Minimizes crusting

 

Typically, irrigation is performed using a saline (salt based) solution. Solutions with a higher salt concentration than the fluids in the body’s cells have been shown to provide the greatest benefits.

 

The Dead Sea lies between Israel to the west, and Jordan to the east. It sits at the lowest elevation of any location on the Earth’s surface.  The Dead Sea has nearly nine times the salt concentration of regular sea water. The altered salt composition gives Dead Sea Salt anti-inflammatory and fluid-retaining properties not shared by normal saline solutions. Dead Sea Salt solutions have been used for decades by dermatologists with great effect in treating a variety of skin conditions such as, psoriasis and severe dermatitis.

 

More recently, the same principles have been applied to the treatment of sinusitis and other inflammatory conditions of the nasal passages.

 

Studies of Dead Sea Salt in the treatment of sinusitis and allergies have been conducted at Chicago ENT. These recent studies have suggested that by virtue of its inherent anti-inflammatory properties, Dead Sea Salt may provide comparable improvement for patients with sinusitis and allergies. In these studies, patients using Dead Sea Salt had improvement in symptoms without the need for medication. This study was presented at the American Academy of Otolaryngology, Head and Neck Surgery.

Overall, Dead Sea Salt solutions could provide a natural alternative for the treatment of sinusitis, and may eventually decrease the need for use of other medications for certain patients, particularly nasal steroids.

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The Acid Test

Sore throat? Hoarse voice? Chronic cough? Lump in the throat? Difficulty swallowing? There are many causes of these types of symptoms, but one that is increasingly coming to the attention of otolaryngologists is a condition called laryngopharyngeal reflux (or LPR). In fact, some estimates suggest that up to 50% of patients coming to see a doctor about hoarse voice may have this condition.
 
In LPR, acid from the stomach flows back up the esophagus into the throat (pharynx and/or larynx) and causes inflammation, occasionally ulceration, and frequently pain. This condition has also been implicated as a cause of laryngeal cancer
It makes sense that reflux can occur when lying flat, but for many patients, this acid backflow is also occurring when awake and upright.
 
The medical treatment for this condition is a proton pump inhibitor (PPI) medication used twice daily, which is very effective at reducing the damage caused by acid reflux. However, as with the use of any medication, we need to ensure we are only treating those who really need it. As the symptoms of LPR can be mimicked by a number of other conditions, accurate diagnosis is crucial.
 
Here at Chicago ENT, we are currently conducting one of the largest clinical studies of LPR ever undertaken, evaluating the multi-faceted approach to the diagnosis and sub-classification of this condition by comparing questionnaire-based scoring systems and endoscopic findings to “gold standard” data obtained using the latest generation pH monitoring equipment. By constantly reviewing our own processes as well as the international standards of care, Chicago ENT aims to remain at the forefront of LPR diagnosis and treatment.