During normal breathing, air flow extends from the nasal passages to the pharynx (back of the nose and throat) through the larynx (voice-box) and trachea (wind pipe) and ultimately to the lungs. Under normal circumstances, we tend to breathe through this pathway as it allows for better regulation of air.
In cases of obstruction, particularly of the nasal passages, or when there is need for a greater than normal intake of air, the body will trigger a response for ‘mouth-breathing’. This obstruction may result in a reduction (hypopnea) or a complete cut off (apnea) of airflow; particularly evident during sleep due to the reduction of muscular and neural tone of the pharynx, hence the term “obstructive sleep apnea”.
The cause of obstruction may be at a single or multiple levels and the most common areas of obstruction are usually linked to the patient’s age. In younger individuals, obstruction tends to result from allergy issues. It is usually identified in the back of the nose (nasal pharynx) in the form of adenoids (tonsil-like tissue) and/or at the back of the throat (oral pharynx) in the form of enlarged tonsils. In adults, the obstruction may be:
1. In the nostril (due to congestion from allergies or sinus related issues;
2. At the pharynx (due to enlarged tonsils or redundant uvulae {i.e. the flap of tissue at the back of the throat that moves with swallowing and speaking and assists in sealing off the nasal passages during swallowing});
3. At the back of the tongue (due to enlargement of the back of the tongue usually linked to acid reflux disease);
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