5.23.17 in General
Healthy Mouth Sounds- Signs of Airway Insufficiency
It is paramount to remember that sifting through clues in an attempt to uncover and solve a patient’s medical problems, is a lot like detective work. One must follow the trail of “knowns”, yet always have a suspicion about “what else could this be?” I will certainly not propose that when we become aware of a potential sign of a problem, we have made the diagnosis. No, that is almost never the case. It is the accumulation of many signs, symptoms, and tests results that leads us to a diagnosis. With that in mind I would like to talk about some of the signs we may see, that can lead us to question, “could this be an airway problem?”
Let’s start with the obvious. The patient or their representative says, “I can’t breathe.” I know this sounds elementary, but don’t dismiss that statement. You definitely should ask on this one, “could this be an airway problem?”
But that finding may be more subtle. It often takes the form of a spouse reporting that there partner stops breathing while asleep, then gasp for air. Better investigate that one. Or maybe it’s just a report of how loudly one snores. “could this be an airway problem?”
Signs of airway insufficiency that may manifest in sleep time include, awakening often, awakening unrefreshed, restless sleep, disheveled bed sheets/ blankets, daytime sleepiness or difficulty concentrating. This is just to mention a few, and none of these findings alone equates to an airway problem, however…better ask!
There are often physical features that fit with a compromised airway. Things like, long vertically grown face, forward head posture, receding chin/neck, narrow maxilla, signs of bruxism (teeth grinding), malocclusion(especially crowded teeth), enlarged tonsils, a deviated nasal septum and mouth breathing. Again, the presence of one of these features does not mean that an airway is compromised, but when we get use to spotting these outward signs, it should naturally take us that ever important question. “could this be an airway problem?”
So, good history taking combined with astute physical examination is of utmost importance. As we continue in our next blog, we will discuss just how important these skills are when we turn our attention to airway compromise in children. So, stay tuned in and keep smiling. Dr. W.