Does Sinus and/or Nasal Surgery Help with Sleep Apnea?

Bluntly, the answer is not really... Although it may make sense that improving nasal airflow should help with obstructive sleep apnea, the reality is that it does not make a profound difference. Indeed, there was a study in 2014 that looked into this question.

In this study, 3 groups of patients were looked at divided into patients with mild, moderate, or severe obstructive sleep apnea (OSA). These patients underwent sinus surgery, septoplasty, and turbinate reduction.

What was found was that patients with severe OSA with a mean AHI of 52 would go down to 43 (normal being less than 5) after surgery. Moderate OSA with a mean AHI of 22 down to 20. Patients with mild OSA did not have any significant changes to AHI at all.

In other words, for patients with moderate or severe OSA, although the AHI does decrease somewhat, it does not decrease enough that it really makes any clinical difference. Patients with moderate or severe OSA still had OSA... and still would need to use a CPAP or equivalent machine after surgery to correct their sleep apnea.

Although at first blush, these results may not make sense, it actually does make sense when you consider sleep apnea to be a multi-level disorder affecting not just the nose, but the throat as well.

For example, the back of the tongue may fall backwards obstructing the airway causing sleep apnea. Correcting nasal factors would have absolutely ZERO impact on tongue factors of OSA.

In order to determine where these other anatomic factors may be that may contribute to OSA, a sedated or sleep endoscopy is often performed. Watch the video below.

Granted, patients may STILL wish to pursue sino-nasal surgery due to discomfort with their sinuses and nasal breathing... but patients need to be aware that their OSA may still remain essentially unchanged!

Sino-nasal surgery may also help with CPAP compliance as lower pressures may be required to address OSA compared to before surgery. Why? Because the nasal passages are more open after surgery so it is easier to push air into lungs when using CPAP.

Reference:
Effects of Endoscopic Sinus Surgery and Nasal Surgery in Patients with Obstructive Sleep Apnea. Otolaryngol Head Neck Surg. 2014 Mar 31;151(1):171-175. [Epub ahead of print]

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Normal Appearance After Turbinate Reduction

Normal mucosal blistering (turbinate reduction
done only on right side)

Often, patients become disturbed with the way the inside of their nose looks after a turbinate reduction to improve nasal breathing. However, many of the concerns are unfounded and the appearance though disturbing, is actually normal. It usually takes a FULL 2 weeks for the turbinate mucosa to heal to a more normal (and reduced) appearance. It is around 2 weeks that nasal breathing also markedly improves.

In any case, during the first week, white plaques that may appear on the turbinates (picture below) are actually scabs which when wet turn white. It should be wet (and white) due to the regular use of saline nasal spray and/or flushes along with normal nasal secretions.  The turbinate mucosa may also occasionally even blister (picture above/right) producing a pale appearance like the inside of a grape. These are pictures of what the inside of the nose may look like about 5-8 days after a coblation turbinate reduction.

Be assured that such appearances are NORMAL and will typically resolve to a more normal appearance 2 weeks after the procedure. At that time any residual scabbing is typically removed.

White eschar/plaques (normal).

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How Can Nasal Obstruction CAUSE Clogged Ears?

It is not uncommon that patients who suffer from a clogged nose also develop clogged ears.

Why??? There are 2 major and 1 minor reasons.

First a little anatomy lesson.

In the back of the nose, there is an opening that leads into a tunnel (eustachian tube) that goes up into the ear. When the ears get clogged, a person can get the pressure out by "popping the ears." This can be accomplished by yawn, swallow, or trying to blow out the nose that is pinched shut. When the ear pops, what happens is that the tunnel opens up allowing pressure to come out the ear. Watch video:



Mucosal Swelling

Now when the patient's nose gets obstructed, it may mean the nasal lining has become swollen making it difficult to breath. It also means the tunnel that goes up into the ear may be swollen shut as well. As such, it may become difficult if not impossible to pop the ears. This is known as eustachian tube dysfunction.

Negative Pressure Inside the Nose

However, there is a more active process that may lead to ear clogging beyond just mucosal swelling of the eustachian tube.

When the nose is obstructed, every time the patient tries to breath in thru the nose, negative pressure is built up in the back of the nose where the eustachian tube opening is located. As such, this negative pressure inside the nose can get transmitted up into the ear resulting in negative pressure to slowly build up in the ear as well which can ultimately cause a clogged ear sensation. This is just like sucking on a straw to draw fluid out of a cup, though in this case, the straw is analogous to the eustachian tube, the fluid is air, cup is the ear, and the mouth is the nose.

Bernoulli's Principle

In fluid dynamics, Bernoulli's principle states that for an inviscid flow, an increase in the speed of the fluid occurs simultaneously with a decrease in pressure.

To use an example, if you are driving a car with the window down, the fast-moving air outside the car creates a negative pressure inside the car causing things to not just blow around, but does cause some suction effect to things within the car (paper inside the car potentially getting "sucked" to the outside).

When the nose becomes clogged, airflow increases in the back of the nose (think garden hose where you have the same amount of water flow, but by changing the nozzle diameter, flow can be increased by making diameter smaller or decreased by making diameter larger). Due to Bernoulli's principle, negative pressure builds up inside the ear due to this increased nasal airflow.

This negative pressure can be transmitted into the ear causing it to become clogged.

So there you have it... 3 reasons why a clogged nose can lead to clogged ears!

That also means that often, if you just treat the clogged nose... the clogged ears will get better as well!

Reference:
Upper airway obstructions and chronic otitis media: A clinical study. American Journal of Otolaryngology - Head and Neck Medicine and Surgery. Volume 35, Issue 3 , Pages 329-331, May 2014

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Stabbing Headache Around Eye or Cheek

Do you suffer from a stabbing headache in the areas denoted in red? Do these headaches seemingly come out of nowhere one day? Perhaps started after a viral upper respiratory infection?

You may be suffering from a condition known as contact point headache. This type of headache is also known as:

• Sluder's neuralgia
• Anterior ethmoid neuralgia
• Sphenopalatine ganglion neuralgia
• Pterygopalatine ganglion neuralgia

This type of headache has often been confused with cluster headache, migraine without aura, sinusitis, or other undefinable pathology especially since CT scans and MRI scans that are obtained often do not reveal any tumor or presence of infection.

Click here for more information.

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