Guest: David Mcintosh
Guest Bio: David McIntosh is a paediatric Ears, Nose and Throat Specialist. David’s particular areas of interest are airway obstruction, facial and dental development and its relationship to ENT, airway problems and middle ear disease. He specialises in sinus disease.
Health Professional Radio – Kids snoring and treats
Katherine: Thank you for listening to this segment on Health Professional Radio. Let me ask you a question: Do you snore? Have you always snored? Or could snoring be an indication of something more serious, a more serious health issue?
To help us answer the last question, today we have David McIntosh. He is a paediatric Ears, Nose and Throat Specialist. David’s particular areas of interest are airway obstruction, facial and dental development and its relationship to ENT, airway problems and middle ear disease. He specialises in sinus disease. Welcome to our show, David.
Dr. David McIntosh: Thank you very much. Thank you for having me.
Katherine: With snoring, what causes snoring exactly?
Dr. McIntosh: Sure. Well, snoring obviously is a noise. That’s what everyone notices. But the noise is generated because of one of two reasons, and sometimes both. It’s a disturbance of the airflow because there’s a blockage to the air flowing through correctly, or there is something within the nose or the throat that’s shaking and vibrating that’s been generating the noise that people hear.
It is disturbance of the airflow, it’s just a matter of whether it’s because of blockage or because of something being there that’s flapping around.
Katherine: Yeah, and for adults, sometimes we snore, sometimes we don’t. Sometimes, something like a cold might bring on a short amount of snoring and when the cold clears, so does the snoring. But what about people that are chronic snorers? Is this an indication … yeah?
Dr. McIntosh: That’s a good point, because I think they would be pretty much everyone that gets to snore at some stage in their lifetime.
Dr. McIntosh: What we do need to differentiate is between different groups. So, the groups that do it just on occasion, so the perfect example you described is when someone gets a cold, or gets really tired and run down. But the other example then is when they do it all the time. We know that it’s actually more common than what people want to confess to. It’s probably around about a third of adults actually do snore a fair bit of the time.
Dr. McIntosh: What it comes down to really for adults, is whether during that snoring associated with it, they have episodes where their breathing is actually compromised to the point they have something called obstruction.
Dr. McIntosh: When it happens in sleep, we call it obstructive sleep apnoea. That’s actually quite a significant health issue, which has a range of effects on adults, and affects their sleep quality which then flows on to their concentration and so forth during the day, but also has issues with regards to their heart and increases chances of things such as heart disease, stroke.
It’s also tied in with people that are overweight, and [inaudible 02:46] for example, some diabetes in the background, if that’s the case, and that also adds to the risk factors. It’s actually quite a complicated little beast with respect to if they have the sleep apnoeapart associated with the snoring.
Katherine: Right, and how would people seek help with this? Would they go to their general GP?
Dr. McIntosh: Yeah. Absolutely, the GPs are always the first port of call with regards to these things. The first thing to do isrecognise that there is a big difference between something that’s a bit of a joke amongst the family about uncle this or grandpa thator dad that snores. And incidentally, it’s not just men, it is women as well that have these problems.
Dr. McIntosh: Differentiating it between that being a bit of family joke and actually coming to the realisation that it actually is a healthissue which needs to be assessed. First thing the GP would do with regards to that is obviously taking a good history, just checking out things, looking for obvious things such as a person being overweight, have they got a blocked nose, big tonsils, for example.
Dr. McIntosh: Then doing some basic investigations, looking at some blood tests and so forth, to see if there’s any medical reasons why this might be going on. Then proceeding through a referral to something called a sleep study, which is an overnight assessment of someone’s sleep patterns, looking at things such as their breathing, their oxygen levels, brain patterns – all these things that give us a lot of information which, when we put it altogether, can basically identify these people that have got the sleepapnoea aspect.
Then from there, it really comes down to how bad it is with regards to the results of the study as to what, if anything, needs to be done. Not everyone with sleep apnoea needs to be treated from a medical point of view. Then the management options, there are quite a few different options depending on what’s appropriate. Usually it’s best managed with a team approach with regards to sorting everything out.
Katherine: Right. Sleep apnoea, it affects people of all ages, is this correct?
Dr. McIntosh: Oh, absolutely, yeah. You can get it from the day you were born to the day you pass away. It certainly doesn’t discriminate. We see it in children, [indecipherable 04:56] talk about children, because it’s a little bit more of a complicated beast with regards to the sleep issues.
Dr. McIntosh: But if we just talk about adults, yeah, look, absolutely. They can have it at any age for a whole range of reasons. I did mention that the one important thing is that it’s not necessarily just the obese people that do get sleep apnoea. You can be tall, trim and terrific, and an Olympic athlete, and still have sleep apnoea. You shouldn’t think that you’re immune because of any other health factors that you may have going in your favour.
Katherine: Exactly, and I’m glad you brought up the children affected, because not many people may know this, but children aren’t actually meant to snore.
Dr. McIntosh: No, absolutely not, and again, we’ll just differentiate that as we did with the adults. The every now and then with the cold or flu, tired, run down, sniffles and snuffles, sure, absolutely normal. It’s when they’re doing it what we call habitually. The more we’ve investigated this, the more we’ve found out more and more how much of a problem this is.
We have children with obstructive sleep apnoea, which is where they do actually stop breathing with their snoring. They’re in the worst part of the category. But there’s other people who … on a range of, so [indecipherable 06:08] call this sleep disorder breathing. And what it includes is not just the kids that are stopping breathing, but we have kids that are really noisy and are struggling with their breathing. They’re not quite so bad that they’re blocking off completely. But they’re really fighting hard to prevent that from happening.
Then we have the kids that snore. What we now know is kids that snore habitually, which means four nights of the week or more, actually, we can pick up that there are a whole range of issues with regards to their brain function, their brain development, their growth pattern, their heart function.
Also, there’s a lot of research being done at the moment which suggests [indecipherable 06:46] that kids that are snoring are the ones down the track that are getting sleep apnoea and they also are the ones that have increased issues with things like high blood pressure.
It’s possible that snoring as a kid can mean that you’re going to be on medication for high blood pressure when you’re older unless we get into the intervention early, and that really is the take home message, is that the earlier something is identified and properly assessed and properly managed, the better the outcome. That applies to anything you want to nominate in health.
Dr. McIntosh: If the children [indecipherable 07:18] snoring, that really is something that is significantly overlooked, not only by the family, but to be honest, even by the GP. A lot of GPs don’t seem to ask about these sort of things, but it really is quite important that, one, it is discussed, and, two, that the parents are proactive in proceeding to get specialist advice, because sometimes it’s all too easy to have things like this dismissed at times, but it certainly shouldn’t be ignored.
Katherine: Right, exactly. With some parents that are concerned about their children, what treatments are available?
Dr. McIntosh: Yeah, the whole process really is two steps back from that, is to form an assessment as to the cause, and the severity, much the same as the adults. But to be honest, in the mainstay, for children, they’re a lot easier to fix than adults, because for the mainstay in children it is a physical issue with regards to something in their nose or throat that’s causing blockage, most commonly it’s the things called the tonsils, which are in the throat, or the adenoids which are at the back of the nose.
But they’re not the only things, but they’re certainly, by far, the most common. We know that for 70 to 80% of kids with snoring where that’s the issue, managing nose is all you need to do. You don’t need to have any other invasive treatments done, and so forth. It’s always a bit disconcerting for parents thinking about having their kids have operations. I think they need to balance it out with the kids having lifelong health issues potentially otherwise.
That’s something obviously a specialist would go through in great detail, to make sure that they fully understand what’s involved, and go from there. Then there’s a small group where the kids, they don’t need surgery or they need other things done. Sometimes that involves working with a dentist or an orthodontist, looking at their jaw and facial growth in terms of how that’s progressed, and doing things to improve upon that in contributing to issues there.
Dr. McIntosh: Then the other thing, sometimes, is that they actually need treatments much like the adults need. They may need to wear a mask at night. Certainly not the mainstay for children at the moment, but it’s certainly something that it is considered in certain cases.
Dr. McIntosh: But it’s [inaudible 09:34] again, all being managed by specialists and making sure that the appropriate test investigations are done and making progress from there.
Katherine: Right, and getting back to some of the adults, for those quiet snorers out there …
Dr. McIntosh: Sure.
Katherine: … there is help for them, isn’t there? You’re actually trained in advanced sinus surgery.
Dr. McIntosh: Yes, look …
Katherine: Can you tell us about that?
Dr. McIntosh: Sure. The nose and sinuses are just one aspect of the whole sleep issue. But for adults, it’s actually one of the areas that we target very early on in the test. If they have problems with blocked nose which can be just from the nose itself or from the sinuses themselves contributing to that, that’s part of their breathing passage that is actually compromised. There’s some evidence that shows that breathing through the nose is actually a better way of breathing than breathing through the mouth in terms of oxygen delivery and utilisation.
The other important thing though, is for someone that has got sleep apnoea, if they do have a blocked nose and they come to needing certain treatment such as wearing a mask at night, which we call CPAP, that mask works by pushing air through the nose. If the nose is blocked to start with, it’s fighting a bit of a losing battle in the sense of the treatment being effective.
Some patients, we will see them, they’ve definitely got sleep apnoea with the snoring, we manage their nose and sinuses. That’snot necessarily give them a cure. It might reduce their problems to some degree, but, it would certainly then facilitate other treatments so that they can get the best of what they need with respect to managing that.
But then, having said that, looking away from the sleep apnoea, just talking about nose and sinuses in general, look, it’s a big part of an ear, nose and throat surgeon’s workload, is managing people’s sinuses. We know that allergies are on the rise. We know that the air is not as clean as it used to be, maybe some dietary issues feed into it as well at times and infection certainly plays a role.
With regards to people with sinuses, then, yeah, there’s a whole range of really great advances that have come online over the past few years, where certainly, operations of the past which had variable success and certainly weren’t necessarily well-liked by patients, have been quite changed and overhauled, such that we can do these brilliant operations as day surgery and get really good results in the patients that need them.
Katherine: Yeah. Well, thank you so much for your time today, David. It’s been a very enlightening interview. Thank you.
Dr. McIntosh: It’s been my pleasure. I hope that helps a lot of parents and the families out there with the kids, and obviously everyone else that’s sleeping next to the snorers.
Katherine: Yes. For those of you that want to know more, please visit entspecialists.com.au. Thank you, David.
Dr. McIntosh: Thank you.