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Mouth breathing
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Mouth breathing

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Often dismissed as a habit, mouth breathing is a health problem due to the presence of nasal obstruction. An experienced ear nose and throat surgeon can help solve this problem for you or your child.

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Mouth breathing

  1. 1. M OUTH BREATHING W HY YOUR LUNGS AND HEART DON’T LIKE IT Associate Professor Dr David McIntosh Ear Nose Throat Specialist
  2. 2. ASSOCIATE PROFESSOR DR DAVID MCINTOSH Ear, nose, and throat specialist Specialising in paediatric ENT, nose and sinus disease, and upper airway obstruction Contact details: Phone 07 5451 0333 Web Facebook ENT Specialists Australia
  3. 3. DISCLAIMER The advice presented here is general in nature and for the purposes of education and information only All health matters should be directly discussed with your qualified health professional
  4. 4. THE AIR WE BREATHE The most important thing we do is breathe The second most important thing we do is pump blood around our bodies If either of these stop happening, we stop living In the air, the most important thing is oxygen Oxygen makes up about 20% of the gas in the air Our lungs are designed to allow oxygen to enter our bloodstream, so it can be transported around our bodies Our bodies need a constant steady stream of oxygen- if the levels drop this is called hypoxia (pronounced high-pox-ee-ah)
  5. 5. HOW THE LUNGS WORK Our lungs need to be inflated to fill up with a fresh lot of air This happens by the action of muscles around the chest wall and most importantly a muscle called the diaphragm, that all work to stretch the lungs open, sucking air in to our bodies Once the air is drawn in, it comes into very close contact with blood that has been pumped into the lungs by the heart The right side of the heart pumps blood in to the lungs, and the left side of the heart pumps blood to the rest of our body So the system is designed such that blood low in oxygen is pumped by the right side of the heart, to the lungs to be recharged with oxygen, and from here it goes to the left side of the heart, and is then pumped to the rest of the body The brain controls all of this to keep everything organised
  6. 6. IT’S ALL ABOUT THE OXYGEN As mentioned, the body needs a steady flow of oxygen to function properly If it starts to miss out on even just a little bit here and there it causes problems There are different types of low oxygen and the one most important to this presentation is the type where there are very brief drops in the oxygen level below normal, with these dips being very regular all be it short lived A drop in oxygen levels is known as hypoxia, and brief dips are known as intermittent hypoxia When intermittent hypoxia has been going on for a while, it is called chronic intermittent hypoxia A dip in the oxygen levels results in a body reaction called inflammation and this can cause damage to the tissues of the body
  7. 7. WHY YOUR NOSE IS IMPORTANT Although there is no difference in the amount of oxygen in the air we breathe through the nose or mouth, there is a big difference as to how much of that oxygen finds its way in to the blood When we breathe through the nose, we use our diaphragm more than our chest wall muscles, and likewise when we breath though our mouth, we use the chest wall muscles more than our diaphragm So called diaphragmatic breathing results in a better distribution of the oxygen through the lungs, which means the blood can recharge itself better Furthermore, there is a chemical made by the nose and sinuses called nitric oxide. This chemical travels from the nose, with air breathed in through the same, down in to the lungs, Nitric oxide opens up the blood vessels, which helps more blood flow to then pick up the oxygen along its journey through the lungs
  8. 8. WHAT LOW OXYGEN DOES TO YOUR BODY Chronic intermittent hypoxia affects every body organ you can think of For example, it makes the heart have to work harder to make up for the reduced oxygen levels in the blood And the brain gets triggered in to a panic mode to be on the alert- and this affects your sleep quality, concentration, behaviour, and emotions, all for the worse And it makes your skin age prematurely, and your blood pressure go high, your eyesight deteriorate, your bones become weaker, your immune system changes, your body hormones become erratic, your appetite increases, you are more likely to end up with diabetes….. And the list goes on
  9. 9. MORE ABOUT INFLAMMATION Inflammation is not a disease but a description of a bodily reaction It can be triggered by infection, trauma, and stress Stress can be physical, emotional, and psychological Inflammation is a process that is mediated by the body’s immune system In people with chronic intermittent hypoxia, we can measure this over- activity It is this inflammatory response at a local tisue level that causes all the problems for the body systems
  10. 10. WHAT CAUSES A BLOCKED NOSE The nose starts at the nostrils, goes through the nasal passages, and into the open space at the back of the nose, and this then leads down the back of the throat to the voice box, wind pipe, and lungs So the nose can be blocked because there is a problem with the nostrils, a problem inside the nasal passages, or a blockage in the space behind the nose Whilst there are lots of things that can cause this, the 3 most common things are: 1. The adenoids in the space behind the nose are too big 2. The middle part of the nose known as the septum is crooked (deviated septum) 3. The swellings inside the nose known as turbinates are too big
  11. 11. HOW TO FIX A BLOCKED NOSE Unblocking the nose is a glorified plumbing job The easiest way to look at it is based on the 3 main causes: 1. Large adenoids- quite simply, the only thing that works is surgical removal; we used to thing nasal sprays would help, but the more recent research on this has cast doubt on that notion 2. Deviated septum- this is a structural problem, and the only thing that fixes it is surgery 3. Large turbinates- these may shrink with nasal steroid sprays or otherwise require surgery to trim them down to size So lets go through the basic details of surgery
  12. 12. REMOVING THE ADENOIDS- ADENOIDECTOMY The adenoids sit at the back of the nose, so the only 2 ways of seeing them are wither with a telescope through the nose or using a telescope or mirror placed inside the mouth at the time of surgery The historical approach of removing adenoids though, is to not even look at them- this is called blind scraping or “curettage” The research on blind scraping shows a high rate of adenoids being left behind, and sometimes so much can be left behind, there is still a blockage present Newer techniques mean that the old style blind curette approach has a limited role in modern surgeon’s hands An adenoidectomy can be performed in isolation or in conjunction with other ENT surgery and can be done for reasons other than airway obstruction The post-op recovery is usually pretty straight forward
  13. 13. STRAIGHTENING A CROOKED SEPTUM- SEPTOPLASTY The middle part of the nose may be crooked in as many as 20% of people When it comes to fixing it, if it is a simple deviation, then this can be done entirely on the inside of the nose, with no cuts on the outside If the septum is severely deformed, or the outside of the nose is also deformed, then an approach that requires an incision to be made on the outside of the nose may be necessary – this is called an open, or external, septorhinoplasty In modern surgeons hands this is a day surgery procedure more often than not, and may be performed in conjunction with other surgery such as on the turbinates or sinuses The post-op recovery is variable, depending on the degree of surgery required and other procedures performed at the same time
  14. 14. SURGERY FOR LARGE TURBINATES In the mainstay, there are 3 types of operations to reduce the size of the nasal turbinates: 1. Cautery- this is simply the application of an electrical burn to the tissue which results in the formation of scar tissue, which shrinks the turbinate down; it tends to only last 6-12 months, so it is useful for little kids where other procedures are harder to perform due to the small size of their nose 2. Coblation turbinate reduction- this is the use of a special instrument that generates a plasma field; this results in tissue melting away and tends to last about 2-5 years, and is well suited again for children where the access is possible 3. Micro-debrider assisted turbinate reduction- this is the gold standard for surgery as it physically removes both soft tissue and the supporting bone, to truly open up the space within the nose; it is the go to operation for adults and kids that are appropriately selected
  15. 15. WHAT NOT TO DO IF THE NOSE IS BLOCKED Sometimes the best of intentions are misplaced As a starting point, it is important to realise that 80% of the time, a person is breathing through their mouth because there is a physical obstruction of some sort to nasal breathing As a result of this, it is important that the cause be identified- remember, mouth breathing is merely an observation, not a diagnosis When it comes to management strategies, there are 2 things to absolutely avoid until an ENT has checked out the breathing: 1. Breathing exercises to force someone to breathe through their nose 2. Taping the lips closed at night (and this should probably never be done ever) If nasal breathing is forced against obstruction, it may result in ever worse inflammation, which is not a good thing for the body
  16. 16. WHEN TO FIX A BLOCKED NOSE People often wonder when they should get their kids or themselves sorted The short answer is as soon as a problem is identified Kids are not supposed to snore, mouth breathe, or for that matter grind their teeth at night; these are all potential symptoms of airway obstruction and this needs to sorted out immediately When it comes to adults, some notice a problem and some have such long standing basal obstruction they have become used to it and do not realise just how bad they truly are; so if you snore, mouth breathe, notice you are not getting good quality sleep, waking up tired, or have limited exercise capability, then you may have an underlying issue with nasal obstruction So in short- if it’s broke, fix it!
  17. 17. WHAT TO DO WHEN MOUTH BREATHING CONTINUES Sometimes once the nose is unblocked, the patient does not transition to using their newly created breathing option Now often with time things will sort themselves out, but where this is not the case, then it may be necessary to engage the services of either a speech therapist or a myofunctional rehabilitation specialist The best analogy is if you break your leg- being stuck in a cast leads to muscle disuse, and then requires a physiotherapist to get things sorted once the cast comes off- well the same applies to breathing Having said that, it is a bit different to breaking your leg as more often than not, nasal breathing will evolve within about 3 months from surgery- nobody is really sure at what time point breathing therapy should be started due to this being the case, so that is something to discuss with your surgeon as to their own experience
  18. 18. ASSOCIATE PROFESSOR DR DAVID MCINTOSH Ear, nose, and throat specialist Specialising in paediatric ENT, nose and sinus disease, and upper airway obstruction Contact details: Phone 07 5451 0333 Web Facebook ENT Specialists Australia
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Often dismissed as a habit, mouth breathing is a health problem due to the presence of nasal obstruction. An experienced ear nose and throat surgeon can help solve this problem for you or your child.


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