American Medical Association Family Medical Guide - American Medical Association [385]
Treatment
People whose sleep apnea is mild often benefit from lifestyle changes, such as losing weight and avoiding alcohol and sleeping pills. Some people with mild sleep apnea have breathing pauses only when they lie on their back. Learning to sleep on their side often improves the condition. Devices, fitted by a dentist, help some people with mild to moderate sleep apnea by repositioning the jaw or tongue.
The most effective treatment for people with severe sleep apnea is called nasal continuous positive airway pressure (CPAP). In CPAP, a person with sleep apnea wears a mask over his or her nose during sleep. Pressure from an air blower forces air through the nasal passages, holding the airway open and preventing tissue in the throat from sagging. If it is used properly, CPAP is very effective in reversing sleep apnea (and therefore sleep apnea’s detrimental effects on the heart). Possible side effects of CPAP include drying and irritation of the nose, facial discomfort, abdominal bloating, sore eyes, and headaches. These side effects sometimes make CPAP uncomfortable to use, but adjustments in pressure and the use of a humidifier may help lessen the discomfort.
Some people with sleep apnea need to have surgery to increase the size of the airway. In children, the most common corrective surgical procedures include removal of the adenoids (lymph glands at the back of the nose), tonsils (lymph tissue at the back of the throat), or, rarely, nasal polyps (small growths in the lining of the nose). In adults, surgeons perform a surgical procedure called uvulopalatoplasty to remove excess tissue from the tonsils, uvula, or soft palate. People who have sleep apnea resulting from a deformity of the jaw may be helped with reconstructive jaw surgery. In severe, life-threatening cases of sleep apnea, surgeons sometimes perform a tracheostomy, in which they make a small hole in the windpipe and insert a tube in the hole for air. The tube stays closed during waking hours but is opened during sleep to allow air to flow directly into the lungs.
Tumors of the Larynx
Both cancerous (malignant) and noncancerous (benign) growths can develop in the larynx (voice box). Papillomas and vocal cord polyps or nodules are the two most common types of benign tumors that develop in the larynx. Papillomas, which are caused by a virus, are usually multiple and occur more often in children than in adults. Nodules are hard, calluslike growths that frequently develop in pairs on both sides of the larynx. Polyps are softer than nodules and usually develop on only one side of the larynx. Both polyps and nodules usually result from overuse of the voice.
Cancerous tumors of the larynx occur most often in smokers. Cancer of the larynx can almost always be cured if it is diagnosed at an early stage. If cancer is not detected until a later stage, it can spread to other parts of the throat or elsewhere in the body.
Examining the larynx
To examine your larynx, an otolaryngologist (a doctor who specializes in disorders of the ears, nose, and throat) uses a system of mirrors in a procedure called laryngoscopy. A mirror attached to a band on his or her head reflects light down your throat (the mirror has a hole in it for the otolaryngologist to look through). He or she holds a smaller mirror at the back of your throat to reflect light and enable him or her to view the larynx. If the otolaryngologist cannot see your larynx well using the mirrors, he or she will numb your nose with an anesthetic spray and pass a small, flexible viewing tube down your nose to the larynx.
Symptoms
Because growths on the larynx are painless and develop slowly, they often go undetected during the early stages. Hoarseness is usually the only symptom, although