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32 SPECIALIST CLINICS


HEALTHCARE INNOVATIONS 25 MARCH 2018 Get help with snoring and sleep apnoea


procedures, ranging from minimally invasive radio frequency surgery to soft palate, tongue and nose, to more aggressive laser or robot- ic surgery. Surgery may also help improve the utilisation of appliances or alleviate the need to use them. An example of how much improvement in the dimensions of the mouth and throat can be attained through surgery is illustrated in the clinical images below, show- ing before and after the operation. Recent innovation utilising techniques to


Snoring is an extremely common problem


that affects up to 40% of the population. It can disrupt the quality of sleep of both the patient and the partner. About 10% of these patients can have a condition known as ob- structive sleep apnoea, whereby they have breath-holding episodes in their sleep which can cause oxygen deprivation. This can re- sult in poor sleep, morning headaches and daytime sleepiness. If sleep apnoea is left un- treated then the chances of developing other disorders, such as ischaemic heart disease, diabetes, memory problems and stroke, can increase. In addition to having higher risks of developing the above problems, intrusive snoring can have a detrimental role on rela- tionships and many of these patients are ex- periencing marital disharmony. Snoring occurs as a result of a turbulent


airflow and can affect both children and adults. The commonest cause in children is due to enlarged tonsils and adenoids, and there’s a plethora of evidence in medical lit- erature to demonstrate that the removal of


tonsils and adenoids dramatically improves these sufferers’ quality of sleep as well as their cognitive function. In adults, the problem could be due to an


obstruction in the nose as a result of a devi- ated nasal septum or nasal polyps, but more commonly it’s the redundant, floppy soft pal- ate in the throat that’s the culprit. Certain life- style factors, such as increased alcohol intake or obesity, could aggravate symptoms. Evaluation of these patients would include


a full assessment of the nose and throat with an endoscope and a sleep study. Treatment options include oral appliances


such as a mandibular advancement device or a nasal CPAP (continuous positive air- way pressure). Medical treatment with nasal sprays and antihistamines may help patients with allergic rhinitis by improving breathing through the nose and thus improve snoring. Patient compliance with medication and ap- pliances can be poor and therefore surgery in carefully selected patients could offer a good alternative. Surgery involves a number of


stimulate the nerve that supplies the tongue has been proposed to improve the upper airway obstruction in patients with sleep apnoea. This is usually suitable for patients where the problem is caused by a very bulky tongue and in patients who’ve already undergone various other surgical procedures which have failed to resolve their problem. Patient selection, however, is crucial and this is achieved by performing a drug-induced sleep endoscopy whereby a hospitalised patient is given sedative agents to mimic sleep, snoring and obstruction, and a fibre optic


endoscope is inserted through the


nose and in to the throat, allowing a three- dimensional evaluation of the upper airway anatomy in the dynamic mode. The above surgical techniques involve soft


tissue but in some patients this may not be enough as they could have a more complex anatomical abnormality involving the bones


Professor Bhik Kotecha MBBCh., M.Phil., FRCS Before surgery After surgery


27 Harley Street, London — 01277 695653 Nuffield Hospital Brentwood, Essex — 01277 695695 Spire Hartswood Hospital, Brentwood, Essex — 01277 232525 snoringmanagement.co.uk


Intrusive snoring can have a detrimental role on relationships and many of these patients are experiencing marital disharmony


of the face. They’d require skeletal frame- work surgery to bring the upper and lower jaw forward in order to overcome the upper airway obstruction. In some severe cases, it may be necessary


for the patient to have combined treatment options involving appliances and surgery.


Limp in, walk out C


hanging the way you walk can dramat- ically reduce your knee pain. Patients with knee pain will often limp as this


reduces the loads on the knee. This is fine for a short period of time but if it becomes ingrained, the thigh muscles waste away and the overworked muscles at the back of the leg cramp painfully, and the patient is forced to walk on a bent knee, which can be extremely painful. Standard physiotherapy won’t cor-


rect the walking pattern. Jamie Flanagan has spent many years teaching patients to change the way they walk at the Chelmsford Knee Clinic and also the Gait Laboratory at Anglia Ruskin University.


ARE YOU LIMPING? You’re almost certainly limping if: • You have generalised pain around the front of your knee


• Your knee is swollen • You have pain in your calf or down the side of your thigh


• Your knee remains slightly bent • You have to use your arms when climbing the stairs


• The circumference of the affected thigh is significantly less than the normal leg, when measured nine inches above the top of your kneecap


PATIENTS WILL LIMP WITH: • An unstable knee • Arthritis while awaiting a knee replacement • Even after a successful knee replacement if they’ve limped for many years


Limping can cause unmanageable pain, yet it can be easily corrected by retraining the way you walk.


Meet the expert


Mr Jamie F l a n a ga n , FRCS, trained at Addenbrooke’s Hospital in C a m b r i d g e and set up the C he lms f or d knee


clinic in


1996. He treats the full spec- trum of knee


problems, from sports injuries to ar- thritis. He has a special interest in gait rehabilitation.


For more info T: 01245 234035 E: tina.williamson2@ramsayhealth.co.uk chelmsfordkneeclinic.co.uk


Limping is fine for a short period of time but if it becomes ingrained, the thigh muscles waste away and the overworked muscles at the back of the leg cramp painfully, and the patient is forced to walk on a bent knee, which can be extremely painful


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