Tuesday, February 24, 2015

Round 2 on the Nose

I have been diagnosed with sleep apnea and have been noticing that I am sleeping with my mouth open.  This had lead to problems adjusting to the cpap machine.  I tried the full face mask to compensate for mouth breathing but it was way too onerous so I fell back on the nasal mask with pillows.  Even with the nasal mask, it took some doing to adjust to it, but now I can tolerate it.

However, the nasal mask has not stopped the mouth breathing.  So, I am not getting the full benefit of the cpap machine.  I feel like I am breathing through a straw.  Additionally, our home humidifier isn't working so my nose is very dry.   Also, I am sensitive to dust in the house so I start getting a runny nose and sneezing.

Mouth breathing also impacts dental issues.  The tongue may not support the upper arch of the mouth.  Also,  mouth breathing can  eventually lead to getting your teeth out of line. Poorly aligned teeth can lead to all kinds of jaw problems.   Finally, mouth breathing changes the PH in your mouth and saliva leading to gingivitis and tooth decay.  I have had a problem continually with periodontal issues all my life and end up going to dentist four times a year for teeth cleaning.  The pockets between my teeth and the gum can be so large that I risk losing a tooth if I don't keep up with cleaning.

Additionally, my gentle reader will remember that I don't have much of a sense of smell.  Opening up my nasal passages has helped somewhat.  Taking a lidocaine mixture as a presurgical prep really did help my sense of smell a lot as it opened up the nasal passages.  However, it was only a temporary effect.

Given all these issues relating to the nose, I went to see an ENT doctor who put me back on a 6 pack of prednisone, nasal washes and Budesonide.  Same routine as my pre surgery routine with Dr P. did with my previous nasal surgery with the same marginal results.  So we have decided to do some turbinate surgery as I have enlarged turbinates.  The turbinates are the long curved bone shelf that produces into the nasal passage.  When the turbinates get too large especially from sinusitis or allergies, it is necessary to shrink them.   Thus, the prednisone and nasal washes.  When these treatments don't work, it is necessary to have turbinate reduction surgery.  I have that scheduled for Friday.

So, at the end of the day, I am hoping to get my nose passages opened up so I can breathe better, sleep better, stop mouth, improve my dental hygiene, and hopefully get my sense of smell back.

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PRESUMED SINUS-RELATED STRABISMUS

Interesting hypothesis about sinusitis related strabismus.   Even though these are just case studies and not a double blind test, Dr. Ludwig is pointing out some interesting observations linking sinusitis and strabismus.   The concept is in its infancy but is intriguing.

I have wondered myself about sinusitis and strabismus.  I had sinus surgery previously (complete ethmoidectomy and deviated septum, basically cleared out all my sinuses ) and had my sense of smell tested ( congenital anosmia, born with decreased sense of smell).  I have always thought that not getting much oxygen in the body would affect a lot of my physical problems, especially  my neurological problems  including the eyes. And I have seen a small improvement in vision with depth depth perception as my sinus problems have gotten better.

Think about it.  Oxygen is key to many metabolic processes.

I have also wondered about having any problems with my facial structure.  I have a long face and I wonder if my orbital bones are out of whack.

dr. Ludwig is hypothesizing that there is a link between strabismus and sinusitis.  Treating sinusitis can avoid eye surgery in some cases. Sinusitis creates infections that weaken eye nerves and muscles. Opthamological complications of sinusitis are well known in the literature: cellulitis, orbital abscesses, etc.  Many strabismuses due to sinusitis have been attributed to cranial nerve involvement, ie palsy.  Vertical diplopia linked with chronic sinusitis has been due to orbital floor collapse.

All this is just a hypothesis but still intriguing.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1280096/