The Ear, Nose, and Throat (ENT) specialist, or Otolaryngologist, plays a role in treating obstructive sleep apnea (OSA). While a sleep physician diagnoses the condition and manages sleep studies, the ENT focuses on the physical structures of the upper airway—the nose, throat, and larynx—that obstruct breathing during sleep. Their expertise lies in identifying and managing the anatomical sources of collapse leading to apnea events. This approach involves structural analysis and intervention, optimizing non-surgical therapies, or providing targeted surgical solutions to physically open the airway.
Identifying the Anatomical Source of Obstruction
The ENT’s initial assessment involves a physical examination to determine where obstruction is occurring, examining the nasal passages, tonsil size, the soft palate, and the structure of the tongue base and jaw. This evaluation pinpoints the physical blockage causing the upper airway to collapse. Since the airway is a dynamic structure, this initial static evaluation is often followed by specialized diagnostic tools.
Nasal Endoscopy
This involves passing a thin, flexible scope through the nose while the patient is awake. This allows the ENT to visualize the entire upper airway, from the nasal cavity down to the voice box, to see areas of narrowing or structural issues like a deviated septum or enlarged turbinates. This awake assessment cannot fully replicate the collapse that happens during sleep when muscles relax.
Drug-Induced Sleep Endoscopy (DISE)
DISE is reserved for patients considering surgical options. During DISE, the patient is placed under light sedation to simulate natural sleep conditions while the ENT uses the scope to observe the airway in real-time. This dynamic assessment reveals the precise location, pattern, and severity of the collapse, such as whether it is occurring at the palate, the tongue base, or the lateral pharyngeal walls. The information gathered from DISE guides the selection of the most appropriate and targeted treatment, whether non-CPAP therapy or a specific surgical procedure.
Optimizing Non-Surgical Airway Management
The ENT’s structural expertise improves a patient’s ability to tolerate and adhere to non-surgical treatments, particularly continuous positive airway pressure (CPAP) therapy. Many patients struggle with CPAP because nasal obstruction makes comfortable breathing difficult against the machine’s pressure. Addressing nasal obstruction is a primary ENT focus.
The specialist may recommend treating underlying issues like allergies or chronic inflammation with nasal steroids, antihistamines, or decongestants to improve airflow. Reducing swelling and opening the nasal passages improves the ability to use a CPAP mask effectively. Minor in-office procedures may also be performed to improve nasal valve function, which aids CPAP adherence.
The ENT also evaluates patients for Oral Appliances, specifically mandibular advancement devices, which are often managed by a dental sleep specialist. These devices hold the lower jaw and tongue slightly forward to physically enlarge the space behind the tongue base, preventing collapse. The ENT ensures that the patient’s anatomical factors, such as jaw alignment and tonsil size, are suitable for this therapy.
The anatomical information gathered during the ENT assessment informs positional therapy recommendations. For patients whose apnea events are significantly worse when sleeping on their back, the ENT advises on strategies or devices that encourage side-sleeping. This approach is tailored based on how the patient’s unique anatomy changes with body position during sleep.
Targeted Surgical Treatment Pathways
When non-surgical options fail or are not tolerated, the ENT specialist offers targeted interventions to permanently modify the upper airway. These surgical solutions are categorized by the anatomical region they address, moving from the nose down to the jaw structure.
Nasal Surgery
Nasal surgery is often performed as an initial step to improve CPAP tolerance or reduce airflow resistance. Procedures like septoplasty correct a deviated septum, while turbinate reduction shrinks the swollen tissue inside the nose. Nasal valve repair strengthens the narrowest part of the nasal passage to prevent collapse during inhalation.
Palatal Surgery
Palatal surgery targets the soft palate and uvula, which can be a primary site of airway collapse. The most common procedure is Uvulopalatopharyngoplasty (UPPP), which removes excess tissue from the soft palate, uvula, and often the tonsils to widen the airway. Less invasive options, such as palatal implants, stiffen the soft palate tissue to prevent it from collapsing backward.
Tongue Base Surgery
Tongue base surgery is used when the base of the tongue falls backward and obstructs the hypopharynx. Procedures include radiofrequency ablation to shrink the tissue or genioglossus advancement, which surgically moves the attachment point of the main tongue muscle forward. A newer approach is Upper Airway Stimulation (UAS), also known as hypoglossal nerve stimulation. UAS involves an implanted device that monitors breathing and delivers a mild pulse to the nerve controlling the tongue muscle, moving the tongue forward with each breath.
Skeletal/Maxillofacial Surgery
The most comprehensive intervention is Maxillomandibular Advancement (MMA). This procedure is reserved for severe cases or those with specific facial skeletal abnormalities. MMA involves the physical advancement of both the upper jaw (maxilla) and lower jaw (mandible). Moving the bony frame forward simultaneously pulls the attached soft tissues and tongue, resulting in a lasting enlargement of the entire upper airway.