By Christopher Clark, MD
As Seen In Birmingham Medical News
Obstructive Sleep Apnea (OSA) is a common problem affecting nearly one-third of the adult population. The long-term health effects of untreated OSA are beginning to become established and are frightening: increased risk of cardiovascular disease, stroke, dementia, pulmonary hypertension.
The etiology of OSA is multifactorial and related to the interplay of anatomic obstruction as well as physiologic relaxation of the upper airway during sleep. The primary goal of treatment for OSA is to relieve anatomic obstruction of the upper airway. This has most commonly and most effectively been achieved by the use of continuous positive airway pressure (CPAP) therapy. There are, however, many difficulties with tolerance of CPAP which may be easily overcome after identifying and treating areas of often overlooked anatomic obstruction.
Otolaryngology (ENT) as a medical and surgical subspecialty has the unique opportunity to directly identify and treat upper airway obstruction as it may relate to nasal, nasopharyngeal, oropharyngeal, oral, or supraglottic anatomy. Specific sites of obstruction that may be identified with in-office flexible laryngoscopy include:
• Nasal obstruction resulting from: External/Internal valve collapse, nasal septal deviation, turbinate hypertrophy, chronic rhinosinusitis/nasal polyps, or adenoid hypertrophy
• Oropharyngeal obstruction, resulting from tonsillar hypertrophy, long/hypotonic soft palate, or retropulsion/collapse of the base of tongue
• Supraglottic obstruction resulting from lingual tonsillar hypertrophy, epiglottic cysts, etc
• Laryngeal or tracheal obstruction from upper airway stenosis
The widespread adoption of Drug Induced Sleep Endoscopy has allowed further qualification and quantification of upper airway obstruction and assists with identifying potential procedures that would most effectively improve CPAP tolerance. This simple, approximately 15 minute long procedure is performed in the operating room with the assistance of Anesthesiologists.
Titration of sedative medication which usually consist of propofol, midazolam and/or dexmedetomidine is administered until the physiological effects of sleep become manifest, namely the demonstration of upper airway obstruction. A flexible laryngoscope is then inserted into the nasal cavities and observation is undertaken at each potential level of obstruction. Any sites of obstruction would be appropriately documented and addressed either during the same anesthetic event, or catalogued and submitted for discussion with the patient to be addressed at another encounter.
Potential surgical treatment options for upper airway obstruction may include:
• Nasal: Nasal Valve Collapse Repair (Functional Rhinoplasty), Septoplasty, Turbinate Submucous Resection, Sinus Surgery for removal of polyps
• Oropharyngeal: Tonsillectomy, Uvulopalatopharyngoplasty (UPPP), Expansion Pharyngoplasty, Base of Tongue Suspension, Lingual Tonsillar Coblation, Hyoid Suspension
• Supraglottic/Glottic: Microsuspension laryngoscopy with removal of any obstructive lesions or masses. Upper airway stenosis is most commonly treated with endoscopic airway dilation.
Perhaps the most promising and unique procedure to treat OSA that is directly performed by ENT doctors involves the principle of hypoglossal nerve stimulation during sleep. Stimulation of the hypoglossal nerve provides tone to the intrinsic tongue musculature and prevents upper airway collapse in the first place.
INSPIRE is the only FDA-approved implantable device for the treatment of moderate to severe OSA. A small power source and sensor is placed during a short, outpatient surgery, and therapy may be initiated without the requirement of CPAP masks or hoses. Recent studies have demonstrated a 79 percent reduction in AHI (Apnea/Hypopnea Index), and five-year study data has maintained that reduction.
There are many variables in the treatment of OSA, including many sites of easily treatable obstruction. Simple ENT procedures may improve CPAP tolerance, or as in the case of Hypoglossal Nerve Stimulation, may free patients from CPAP masks and hoses entirely.
All patients evaluated in sleep clinics would benefit greatly from ENT evaluation as part of their multidisciplinary (Sleep Medicine, ENT, Dentistry/OMFS, Diet & Weight Management) workup for OSA treatment.
At ENT Associates of Alabama we take employee appreciation very seriously. Each year we celebrate our employees and their contributions to the practice. We want to say thanks to all ENT Associates employees for another outstanding year.
Dr. H. Baltzer LeJeune was born and raised in New Orleans, Louisiana. He attended Washington & Lee University where he served on the Executive Committee and was selected for membership in both ODK and AED, the premedical honor society. He also received the Kenneth P. Stevens and Gary H. Dobbs award (Biology), graduating with honors. Dr. LeJeune attended LSU School of Medicine in New Orleans where he was a member of the Aesculapian Society, graduating in 1991.
Dr. LeJeune received the Outstanding Service Award (Touro Infirmary) in his intern year and completed his residency training in Otolaryngology at Tulane University in 1997. He was recruited from residency to join Birmingham Ear Nose & Throat Group, where he practiced for 20 years. He has now joined ENT Associates of Alabama, P.C, and will be seeing patients at the St. Vincent’s Birmingham and Gardendale locations. In his free time, Dr. LeJeune enjoys spending time with his wife and 3 children and enjoys hunting, golf and sailing when time permits.
Dr. Christopher Clark completed his undergraduate training in an early-entry program offered through the school of Veterinary Medicine at Mississippi State University – majoring in Microbiology and Religion. Thereafter, he completed Medical School at the University of Mississippi; and finished postgraduate training through the University of Texas.
Following residency, Dr. Clark sought advanced Fellowship training in NeuroRhinology (diseases of the nose and sinuses) and Allergy through the University of Texas – Southwestern Medical Center. In addition to his Fellowship training in Nasal/Sinus and allergic disease, he welcomes all adult and pediatric patients and has interest in a wide range of surgical and nonsurgical disorders of the head and neck, including: plastic and reconstructive surgery, rhinoplasty (functional nasal reconstruction), head and neck cancer, thyroid/parathyroid disease, salivary gland disease, sleep apnea, airway and voice disorders, chronic ear disease, and hearing loss.
Dr. Clark and his wife, Haley, live in Mountain Brook with their two children, Addison and Elliott. Haley is a Radiologist specializing in Women’s Imaging at several Birmingham area hospitals. Together, they love reading, cooking, hiking/biking/swimming and are actively involved with their local church.
ENT Associates of Alabama is excited to be on the cutting edge of nasal polyp treatment by offering the SINUVA sinus implant, recently approved by the FDA to treat nasal polyps in adults who have had previous ethmoid sinus surgery (ESS). SINUVA is a non-surgical option that is placed during a routine physician office visit. It is clinically proven to reduce nasal congestion and polyps. Patients with a known hypersensitivity to the mometasone furoate drug or any of the ingredients in SINUVA should not use SINUVA. The area around SINUVA should be monitored by a physician for any signs of bleeding, irritation, infection, or perforation. For full safety info, visit www.SINUVA.com.
Is It a Cold or Allergy – Understanding Allergies
When most people think of Spring they think of flowers blooming, birds chirping and sunny days ahead, but for millions… their thoughts turn to congestion, runny noses, itchy eyes or endless sneezes. They have what are known as seasonal allergies.
|General Aches, Pains||Slight||Never|
|Itchy Eyes||Rare or Never||Common|
|Duration||3 to 14 days||Weeks|
Allergy symptoms are caused by a hypersensitive response to an otherwise harmless substance and not all allergies are the same.
Allergies, also known as allergic diseases, are a number of conditions caused by hypersensitivity of the immune system to something in the environment that usually causes little or no problem in most people. These diseases include hay fever, food allergies, atopic dermatitis, allergic asthma, and anaphylaxis. Symptoms may include red eyes, an itchy rash, sneezing, a runny nose, shortness of breath, or swelling. Food intolerances and food poisoning are separate conditions.
Allergies, including allergic rhinitis, affect an estimated 40 million to 50 million people in the United States. Some allergies may interfere with day-to-day activities or lessen the quality of life.
Although there are many types of allergies such as foods, chemicals, metals, medications and insect stings, seasonal allergies by far affect people the most.
Seasonal allergies — also known as hay fever and allergic rhinitis — can make you miserable. But before you decide to stay indoors all spring long, there are solutions and treatments to make your life more tolerable.
Finding out exactly what causes your allergic reactions is half the battle. The other half is knowing how to treat them properly. An ENT visit can be the beginning of a successful resolution.
Many allergens such as dust or pollen are airborne particles. In these cases, symptoms arise in areas in contact with air, such as eyes, nose, and lungs. For instance, allergic rhinitis, also known as hay fever, causes irritation of the nose, sneezing, itching, and redness of the eyes. Inhaled allergens can also lead to increased production of mucus in the lungs, shortness of breath, coughing, and wheezing.
Their development is due to both genetic and environmental factors. The underlying mechanism involves immunoglobulin E antibodies(IgE), part of the body’s immune system, binding to an allergen and then to a receptor on mast cells or basophils where it triggers the release of inflammatory chemicals such as histamine. Diagnosis is typically based on a person’s medical history. Further testing of the skin or blood may be useful in certain cases. Positive tests, however, may not mean there is a significant allergy to the substance in question.
Allergy treatment is based on avoidance of offending allergens through environmental control, medications to control symptoms, and immunotherapy (allergy shots). Treatment is generally begun with avoidance and medications. Dramatic symptomatic improvement may occur by environmental control, such as removing a pet from the household. Should avoidance therapy and medications fail to gain adequate control, immunotherapy is begun.
If immunotherapy is recommended, a solution is mixed specifically based on allergy testing results and will be administered in the arm. The need for allergy medication may decrease or disappear as immunotherapy is advanced. Overwhelming antigen exposure may provoke symptoms even after symptom control with immunotherapy. Allergy injections are usually given three to five years, but some patients require immunotherapy indefinitely.
1. ENT Associates of Alabama
2. American Academy of Allergy, Asthma & Immunology
3. American College of Allergy, Asthma & Immunology
6. NIH Medline Plus
It is with deep sorrow we announce the recent passing of Dr. John Poynor. Dr. Poynor was born in Birmingham, Alabama on October 11, 1940, the son of Wilmer Smith Poynor, Jr. and Helen Worrell Poynor.
Dr. Poynor graduated from Indian Springs School, Washington and Lee University and The University of Alabama School of Medicine in Birmingham. After completing an internship, a surgical residency, a residency in Otolaryngology at The Medical School, as well as a Fellowship at the Armed Forces Institute of Pathology, he joined Dr. Jack Odess and Dr. Morton Goldfarb in July, 1971 at ENT Associates of Alabama and practiced at St. Vincent’s Hospital for forty-seven years, up to one week before his death. Dr. Poynor was committed to education on all levels, he served and supported the institutions that greatly impacted his life.
Dr. Poynor’s outside interests focus on elementary, secondary, college and post-graduate education – from reading to first grade students at Hill School near Legion Field to serving on the board at Highlands School; alumni boards at Indian Springs School and Washington and Lee University, and the Admissions Committee to the University of Alabama School of Medicine. The Mountain Brook Library Foundation and the Birmingham Museum of Art boards also were commitments important to Dr. Poynor as a source of pleasure and a chance of giving back to the community.
Dr. Poynor was a member of The Cathedral Church of the Advent and a past Vestry member and Junior Warden. Dr. Poynor is survived by his wife, Nancy McCall Poynor; his brother, Wilmer Smith Poynor III and his wife, Carol Perkins Poynor; his niece, Helen Poynor Crabtree and her husband, Reaves; and nephews, Wilmer Smith Poynor, IV and his wife, Elizabeth and Hamilton Perkins Bouchelle Poynor and his wife, Kim; and great nephews and nieces.
Dr. Poynor’s wife, Nancy, is especially grateful for the tremendous and generous expressions of friendship and sympathy and wanted all to know how grateful Dr. Poynor was for his ENT Family and his patients, spanning several generations. He truly was interested in each one of you.
Dr. Poynor will be sorely missed by his patients, fellow physicians, audiologist and entire staff at ENT Associates of Alabama.
Congratulations to our Cullman office for being named by The Cullman Times as Cullman’s Best of the Best Hearing Aid Center. We appreciate all of our patients that voted for us to receive this honor, and we are proud of Our Cullman group for receiving this outstanding award. At ENT Associates of Alabama, we always strive to provide “the best of the best” patient service in all our offices.
At ENT Associates of Alabama we take employee appreciation very seriously. Each year we celebrate our employees and their contributions to the practice. This year we had Christmas in July with food, fun and gifts for all. We want to say thanks to all ENT Associates employees for making this another banner year.