Category Archives: Unique Content

Sleep Apnea and the Hazards of Driving

The NTSB recently finished up their review of a fatal train derailment in New York.  What they found is that the driver actually fell asleep behind the wheel while driving the train.  He reached speeds of 82mph in a 30mph section of track.  As a result the trail derailed and four passengers lost their lives.

After the accident the driver was diagnosed with obstructive sleep apnea syndrome (OSA) and treated.

Sleep apnea has many causes but a common end point of causing physical blockages in the throat and upper airway in the deepest phases of sleep.  This causes (sometimes drastic) fluctuations in blood oxygen levels, blood pressure, and heart rate.  These fluctuations eventually cause the brain to “snap you out of it” causing a slight awakening, usually just to a lighter phase of sleep and allow the patient to take a breath and temporarily restore breathing.

When this happens over and over through the night many symptoms develop.  Usually among the first is being extra sleepy, or hypersomnolence, through the day.  While this may be no more serious than an afternoon nap, it also causes hundreds of thousands of automobile accidents a year.

The body also responds very poorly to fluctuations and chronic dips in oxygen levels.  This leads to elevated risks of sudden heart attack, fatal arrhythmia, or even stroke.  Blood pressure will start to creep upwards (hypertension), and the patient may begin to suffer from depression.  Rising levels of adrenaline at night may also cause enuresis, or the need to urinate often through the night.

Treatment options for OSA are varied.  The best studied and “most reliable most of the time” treatment option is positive airway pressure (PAP, CPAP or BiPAP).  Other options such as oral appliance therapy and surgery also have proven benefits are typically considered when PAP therapy fails.  Mild snoring is at times effectively treated with cauterization type procedures that may be done in the office.  Recently however these cauterization or ablation procedures have been taken far out of context and I now hear them advertised on the radio to treat all kinds of true sleep apnea.  Beware!  Usually these procedures are not covered by insurance and basically are useless moneymakers!

If you are concerned about severe snoring or sleep apnea, we can help you arrange testing either from an Atlanta-area sleep lab or even from home most of the time.

Sleep Well!

Sinus Infections: Is Balloon Sinuplasty Right For Me?

Chronic sinusitis affects tens of millions of patients annually (including my own household). Over the years we have continued to refine treatment options, both medical and surgical. The latest incarnation of surgical treatment is the use of small balloon catheters (taken from the cardiac angioplasty world) to more gently stretch the sinus openings, usually done in the office. I did my first balloon procedure in 2006 in the operating room and in 2010 in the office. Now I do them exclusively in the office.

This technique has two distinct advantages: a) improved safety from “surgical misadventure” or anesthesia complications and b) almost zero downtime from work and school.

The big disadvantages are that in many cases the balloons simply “aren’t enough” to adequately solve the problem. A badly deviated septum, ethmoid sinus infection, nasal polyps, and allergies are problems not treated with balloons.

Personally I use balloons for treatment often in the office, citing the advantages above. For certain localized infections, milder infections, and frail patients this is an awesome tool.

However our busy practice sees lots of “second opinion” consults after unsuccessful treatment elsewhere. Many of these patients simply need a more aggressive surgical option. And unfortunately many of these patients were “sold” on balloon treatment for purely economic reasons.

There is an unfortunate trend in my community for certain ENT’s to buy tv/radio advertising to market their balloon treatments. Why? This procedure pays well and only takes a few minutes. Some doctors have built an entire practice around doing this.

The problem is abuse and mismanagement. Just this past week I have seen: a)a patient who got 7 procedures in six months for what turns out to be migraines not even infections, b) another patient with three procedures in 1 year, and c) a patient who got a balloon procedure after a 5 minute initial consultation with never having tried antibiotics or having gotten a CT scan – she actually suffered from allergies without any sign of infection (she stated the procedure only took about 10 minutes altogether which means she probably even had a sham operation).

So yes, I am a fan of balloon dilation for many of my patients. I only hope that the technology does not get crushed by the misuse and overuse that is becoming rampant. I have had some great successes with balloons, even for severe infections, but like any other surgical tool it must be used properly.

Good luck with your sinuses and beware of ANYBODY pitching a medical procedure on the radio :)

The latest in high tech digitial hearing aids

Last month my practice partners and audiology staff went up to Minnesota to tour the Starkey headquarters.  Starkey is the leading manufacturer of fully custom and programmable off-the-shelf digital hearing aids.  Their worldwide headquarters is just outside of Minneapolis.  What an impressive facility!

It is amazing to see exactly how their 24 hour operation can receive orders and construct a 100% customized hearing device in less than 4 days.

Key technology that allows this is the massive computing and hardware power allowing for fully customized 3D digital modeling and rapid stereo lithography (“3D printing”).  Furthermore, round-the-clock engineers and technicians are manually placing the tiny microprocessors and components into your custom aid before going through a final round of quality testing.

Equally impressive are two separate wings of the campus: a truly high-tech troubleshooting and quality control lab that is charged with making aids more durable and determining causes for failure.  An array of photomicrography and cross sectioning instruments allows the lab to pinpoint potential microchip failures, while several micro environments have been created to artificially “age” devices to ensure they remain salt, water, and wax resistant.

Their second remarkable facility is full-on R&D.  Starkey spends almost $100M annually on research and development, the majority of which happens in Minnesota and California.  The labs work on tweaking current projects as well as developing the devices that won’t be ready for another 5 years or so.  This includes everything from industrial design of the shells, to microcircuitry, to microphone/receiver research, to Bluetooth wireless, to iPhone apps.

For Starkey’s robustness in quality, design, and service we see them as a strategic partner for ensuring a truly optimal experience for our patients.

The days of lousy poorly-fitting noisy hearing aids are numbered!