[Role of ENT surgery in the assessment and treatment of snoring and of obstructive sleep apnea syndrome in adults and children]. / Beitrag der HNO-Heilkunde zur Abklärung und Behandlung der Rhonchopathie und des obstruktiven Schlafapnoesyndroms bei Erwachsenen und Kindern.

ABSTRACT

The otolaryngologist is increasingly involved in the evaluation and management of sleep-related respiratory disorders. Main symptoms of intermittent obstruction in adults and children are snoring and stridulous breathing. Important factors causing pharyngeal obstruction are functional and structural narrowings in the upper airways leading to increased upstream resistance. The ENT's examination has two principal aims: 1. habitual snoring must be separated from an obstructive sleep-apnea syndrome (OSAS), as the later is associated with cardiovascular diseases and an increased mortality; 2. a functional or structural cause of the obstruction must be sought. Flexible nasopharyngoscopy is a valuable diagnostic tool to determine the nature of obstruction. OSAS patients need a differentiated evaluation in a sleep laboratory, and an attempt of therapy with continuous positive airway pressure (CPAP) should be undertaken in most of these cases. Today the otolaryngologist is equipped with a whole range of conservative and surgical therapeutic possibilities. The introduction of compact lasers as well as the endoscopic/microscopic endonasal surgery have revolutionized surgical treatment in patients with habitual snoring and OSAS. In contrast to adults, OSAS in children has still received poor attention and leads often to impaired thriving. Most frequently, hypertrophied tonsils are present, and tonsillectomy eliminates obstruction in nearly all of these cases.