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Age-related changes in the epiglottis causing failure of nasal continuous positive airway pressure therapy

Published online by Cambridge University Press:  29 June 2007

Thomas Verse  and
Wolfgang Pirsig
Thomas Verse*
Affiliation:
Clinic for Otorhinolaryngology, University Clinic, Ulm, Germany.
Wolfgang Pirsig
Affiliation:
Clinic for Otorhinolaryngology, University Clinic, Ulm, Germany.
*
Address for correspondence: Thomas Verse, M.D., Universitatsklinikum Ulm, Klinik und Poliklinik fur HNO-HeilkUnde Prittwitzstr. 43 - 89075 Ulm, Germany. Fax: +49-731-502-6704 e-mail: [email protected]
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Abstract

At 65 years of age, a former coal miner, now 72-years-old, developed a progressive loss of concentration with daytime sleepiness and sleep disturbances. Work-up in pneumological and medical sleep centres resulted in diagnosis of chronic obstructive pulmonary disease (COPD), borderline obstructive sleep apnoea syndrome and, later, upper airway resistance syndrome. In addition, there was evidence of reduced efficiency of sleep. Neither the initial administration of theophylline nor the later use at night of hyperbaric respiration led to improvement in the patient's symptoms. Instead, the patient developed loud snoring, as well as the inability to sleep while in a lying position.

At age 71 years, otorhinolaryngological examination resulted in findings of age-related changes in the epiglottis, that completely blocked the hypopharynx upon inspiration. Polysomnography, which was possible only in a half-seated position, revealed reduction in deep sleep, with a maximum oxygen saturation of 77 per cent at an apnoea-hypopnoea index (AHI) of 4.8.

Partial resection of the epiglottis with laser surgery resulted in complete improvement of diurnal drowsiness and reduced stamina. Sleeping in a supine position again became possible. Polysomnography revealed normalization of sleep architecture, but unchanged, low efficiency of sleep.

This case underscores the importance of an interdisciplinary approach to the treatment of sleep-related breathing disorders.

Keywords

EpiglottisPositive pressure ventilationLaser surgerySleep apnoea syndrome
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 113 , Issue 11 , November 1999 , pp. 1022 - 1025
Copyright
Copyright © JLO (1984) Limited 1999

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References

Andersen, A. P. D., Alving, J., Lildholdt, T., Wulff, C. H. (1987) Obstructive sleep apnea initiated by a lax epiglottis. A contraindication for continuous positive airway pressure. Chest 91: 621–623.CrossRefGoogle ScholarPubMed
Chetty, K. G., Kadifa, F. K., Berry, R. B., Mahutte, C. K. (1994) Acquired laryngomalacia as a cause of obstructive sleep apnea. Chest 106: 1898–1899.CrossRefGoogle ScholarPubMed
Holinger, L. D., Konior, R. J. (1989) Surgical management of severe laryngomalacia. Laryngoscope 99: 136–142.CrossRefGoogle ScholarPubMed
Johns, M. W. (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14: 540–545.CrossRefGoogle ScholarPubMed
Kahle, W., Leonhardt, H., Platzer, W. (1984) Taschenatlas der Anatomie. Nervensystem und Sinnesorgane. 4th Edition, Thieme Verlag, Stuttgart.Google Scholar
Katsantonis, G. P., Schweitzer, P. K., Branham, G. H., Chambers, G., Walsh, J. K. (1988) Management of obstructive sleep apnea: Comparison of various treatment modalities. Laryngosope 98: 304–309.CrossRefGoogle ScholarPubMed
Kelemen, G. (1953)Congenital laryngeal stridor. Archives of Otolaryngology 58: 245–268.CrossRefGoogle ScholarPubMed
Kuhl, S., Hollandt, J. H., Siegert, R. (1997) Therapie mit nasalem CPAP (continuous positive airway pressure) bei Patienten mit Obstruktivem Schlafapnoe Syndrom (OSAS). Teil II Nebenwirkungen auf die nCPAP-Therapie. Einfluβ auf die Langzeitakzeptanz. Laryngo-Rhino-Otologie 76: 608–613.CrossRefGoogle Scholar
Mancuso, R. F., Choi, S. S., Zalzal, G. H., Grundfast, K. M. (1996) Laryngomalacia. The search for the second lesion. Archives of Otolaryngology Head and Neck Surgery 122: 302–306.CrossRefGoogle ScholarPubMed
Pellnitz, D. (1961) Über den durch das Altern bedingten Gestaltswandel der menschlichen Epiglottis. Archiv für Ohren-, Nasen-und Kehlkopfheikunde 178: 350–354.CrossRefGoogle Scholar
Reyes, B. G., Arnold, J. E., Brooks, L. J. (1994) Congenital absence of the epiglottis and its potential role in obstructive sleep apnea. International Journal of Pediatric Otorhinolaryngology 30: 223–226.CrossRefGoogle ScholarPubMed
Woo, P. (1992) Acquired laryngomalacia: epiglottis prolapse as a cause of airway obstruction. Annals of Otology, Rhinology, and Laryngology 101: 314–320.CrossRefGoogle ScholarPubMed