Dr. Soroush Zaghi on the impact of Tongue-ties on Sleep Disordered Breathing in Kids
12.2 هزار بار بازدید -
6 سال پیش
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On May 18th 2018, the
On May 18th 2018, the Australian Society for Tongue and Lip Ties (ASTLiT) invited Dr. Soroush Zaghi, a highly specialized otolaryngologist and sleep surgeon, to give a lecture on pediatric sleep disordered breathing and maxillofacial development, while paying special attention to tongue-tie. Dr. Zaghi began the lecture by briefly explaining that snoring is not a normal behavior. Specifically, he emphasized that healthy nighttime sleep breathing consists of quiet nasal breathing, in contrast to mouth breathing, with the lips closed and the tongue suctioned to the hard palate (a horizontal plate located in the roof of the mouth). Furthermore, although SDR, sleep disordered breathing, is a multi-factor issue, Dr. Zaghi focused his lecture on the impact of tongue-tie and how it fits into the overall picture. To further explain, Dr. Zaghi introduced a case study of one his patients, Austin. Austin presented a background of ADHD, progressive snoring, and was determined to have mild to moderately severe sleep apnea. Using DISE, drug induced sleep endoscopy, Dr. Zaghi and his colleagues put Austin into a deep sleep in which clear compensation patterns and airway obstructions were observed. The airway obstruction was caused by maxillofacial structures and a tongue-tie. In order to treat his condition, an MMA (Maxillary Mandibular Advancement Surgery) was performed to open up his airway and bring forward his jaws. The surgery was a success and cleared a lot of other issues that Austin faced, thereby giving him a normal life. Austin’s case raises the importance for early diagnosis and treatment. Dr. Zaghi explained that effortful breathing is one of the early signs of sleep-disordered breathing and eventually sleep apnea; therefore, early intervention is key in order to prevent sleep apnea. Furthermore, Dr. Zaghi discussed the many potential consequences of untreated pediatric sleep disordered breathing including behavioral and learning issues as well as overall health and wellness decline. Therefore, asking and observing how a child sleeps can be important for early diagnosis. Furthermore, Dr. Zaghi then described the series of tests that are available in order to study sleep apnea such as the In-Lab Polysomnography, NOX T3 (Home Test), and KNIT: a video monitor sleep study. However, these tests are either limited because they work well for patients with severe sleep apnea or because they don’t provide all the information needed. Also, an important point made by was that Pediatric Sleep Disordered Breathing is on a spectrum with patients either presenting mouth breathing/noisy breathing, suffering from Upper Airway Resistance Syndrome or Obstructive Sleep Apnea.
Dr. Zaghi described the five tier treatment option for Pediatric Sleep-Disordered Breathing: therapy, medication, surgery, dental orthopedic treatment, and CPAP, and stated that this is the ranking for treatment used in his Institute. He emphasized the effectiveness of myofunctional therapy in treating Obstructive Sleep Apnea and displayed results found by Camacho et.al (2015) to support this. Specifically, Camacho et al. (2015) found that myofunctional therapy improved sleeping and snoring in both children and adults ranging between 3 and 79 years of age. However, the key and ultimate treatment as research shows is restoration of nasal breathing. Furthermore, Dr. Zaghi then described the major facts regarding tongue-ties including tongue posture and open mouth posture as they effect breathing. He also presented two techniques to determine whether patients are breathing using their nose: Mirror Flow Test and Rosenthal Test. After dealing with breathing using medication, surgery may then be considered to deal with maxillofacial structures. Dr. Zaghi then introduced the Kotlow’s Free Tongue Measurement, used to numerically classify a tongue-tie, as well as the Tongue Range of Motion Ratio to allow communication for the grade of the tongue-tie.
Following this, Dr. Zaghi presented a summary of the literature on Tongue Tie and Sleep Disordered Breathing, while simultaneously displaying the levels of evidence for these results. Although the literature review presents evidence that falls in levels 3, 4, and 5, this is an optimal position to be for a field that only found in 1972. In order to build onto level one research, we as professionals and scientists should familiarize ourselves with the research that has been conducted onto this point. Therefore, in order to gain a better understanding of Sleep Disordered Breathing, my next step is to study the previous literature on this topic including but not limited to those alluded to in Dr. Zaghi’s lecture.
Learn more about ASTLiT at: http://astlit.org/
Learn More about all we do at The Breathe Institute at: www.TheBreatheInstitute.com
Dr. Zaghi described the five tier treatment option for Pediatric Sleep-Disordered Breathing: therapy, medication, surgery, dental orthopedic treatment, and CPAP, and stated that this is the ranking for treatment used in his Institute. He emphasized the effectiveness of myofunctional therapy in treating Obstructive Sleep Apnea and displayed results found by Camacho et.al (2015) to support this. Specifically, Camacho et al. (2015) found that myofunctional therapy improved sleeping and snoring in both children and adults ranging between 3 and 79 years of age. However, the key and ultimate treatment as research shows is restoration of nasal breathing. Furthermore, Dr. Zaghi then described the major facts regarding tongue-ties including tongue posture and open mouth posture as they effect breathing. He also presented two techniques to determine whether patients are breathing using their nose: Mirror Flow Test and Rosenthal Test. After dealing with breathing using medication, surgery may then be considered to deal with maxillofacial structures. Dr. Zaghi then introduced the Kotlow’s Free Tongue Measurement, used to numerically classify a tongue-tie, as well as the Tongue Range of Motion Ratio to allow communication for the grade of the tongue-tie.
Following this, Dr. Zaghi presented a summary of the literature on Tongue Tie and Sleep Disordered Breathing, while simultaneously displaying the levels of evidence for these results. Although the literature review presents evidence that falls in levels 3, 4, and 5, this is an optimal position to be for a field that only found in 1972. In order to build onto level one research, we as professionals and scientists should familiarize ourselves with the research that has been conducted onto this point. Therefore, in order to gain a better understanding of Sleep Disordered Breathing, my next step is to study the previous literature on this topic including but not limited to those alluded to in Dr. Zaghi’s lecture.
Learn more about ASTLiT at: http://astlit.org/
Learn More about all we do at The Breathe Institute at: www.TheBreatheInstitute.com
6 سال پیش
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