Skip to main content
SpringerLink
Log in

Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing

  • Miscellaneous
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

There is currently no standardized ear, nose, and throat (ENT) clinical examination for patients with sleep-disordered breathing (SDB). As a result, there are large inter-individual differences in the examinations due to an inadequate estimation of the relevance of certain anatomic sites. We aimed to identify which examinations/dynamic tests are considered most relevant by German ENT physicians. A questionnaire was designed, evaluating 23 anatomic sites/dynamic tests of the upper aero-digestive tract. The questionnaire was sent to all German ENT departments (n = 153), including universities and other tertiary or secondary referral centers, by postal mail. In addition, almost all private ENT specialists registered with the German professional association (n = 2496) were contacted via e-mail. Participants assessed how often they examined the sites/dynamic tests, subjective importance, and the impact on the therapeutic procedure. A mean score of relevance (mSOR) was generated (minimum score 1; maximum score 75) from these three items. The response rate for hospitals was 58.8 %; while, it was 4.1 % for ENT specialists in private practice. Therefore, the total response rate was 7.3 %. Of the 23 assessed items, some showed a high overall relevance, such as the tonsils (mSOR 64.75), webbing (mSOR 58.14), uvula (mSOR 55.12), or tongue base (mSOR 53.99). Other examinations, such as simulated snoring (mSOR 19.34) or the Mueller maneuver (mSOR 18.98), were estimated as less relevant. Our data reflect the assessment of German otorhinolaryngologists on the clinical examination of SDB patients. The results should be considered as a basis for compiling a standardized procedure.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Rombaux P, Bertrand B, Boudewyns A, Deron P, Goffart Y, Hassid S, Leysen J, Liistro G, Marien S, Moerman M, Remacle M (2002) Standard ENT clinical evaluation of the sleep-disordered breathing patient; a consensus report. Acta Otorhinolaryngol Belg 56(2):127–137

    PubMed  Google Scholar 

  2. Zonato AI, Bittencourt LR, Martinho FL, Junior JF, Gregorio LC, Tufik S (2003) Association of systematic head and neck physical examination with severity of obstructive sleep apnea-hypopnea syndrome. Laryngoscope 113(6):973–980

    Article  PubMed  Google Scholar 

  3. Acar B, Babademez MA, Karabulut H, Ciftci B, Gunbey E, Karasen RM (2009) Otorhinolaryngologic examination in obstructive sleep apnea syndrome: the correlation between the severity of sleep disorder and physical examination. Kulak Burun Bogaz Ihtis Derg 19(5):246–252

    PubMed  Google Scholar 

  4. Rodrigues MM, Dibbern RS, Goulart CW (2010) Nasal obstruction and high Mallampati score as risk factors for Obstructive Sleep Apnea. Braz J Otorhinolaryngo 76(5):596–599

    Article  Google Scholar 

  5. Croft CB, Pringle M (1991) Sleep nasendoscopy: a technique of assessment in snoring and obstructive sleep apnoea. Clin Otolaryngol Allied Sci 16(5):504–509

    Article  CAS  PubMed  Google Scholar 

  6. Marais J (1998) The value of sedation nasendoscopy: a comparison between snoring and non-snoring patients. Clin Otolaryngol Allied Sci 23(1):74–76

    Article  CAS  PubMed  Google Scholar 

  7. Quinn SJ, Daly N, Ellis PD (1995) Observation of the mechanism of snoring using sleep nasendoscopy. Clin Otolaryngol Allied Sci 20(4):360–364

    Article  CAS  PubMed  Google Scholar 

  8. Pringle MB, Croft CB (1993) A grading system for patients with obstructive sleep apnoea–based on sleep nasendoscopy. Clin Otolaryngol Allied Sci 18(6):480–484

    Article  CAS  PubMed  Google Scholar 

  9. De Vito A, Carrasco Llatas M, Vanni A, Bosi M, Braghiroli A, Campanini A, de Vries N, Hamans E, Hohenhorst W, Kotecha BT, Maurer J, Montevecchi F, Piccin O, Sorrenti G, Vanderveken OM, Vicini C (2014) European position paper on drug-induced sedation endoscopy (DISE). Sleep Breath Schlaf Atm 18(3):453–465. doi:10.1007/s11325-014-0989-6

    Article  Google Scholar 

  10. Dahlqvist J, Dahlqvist A, Marklund M, Berggren D, Stenlund H, Franklin KA (2007) Physical findings in the upper airways related to obstructive sleep apnea in men and women. Acta Otolaryngol 127(6):623–630

    Article  PubMed  Google Scholar 

  11. Zonato AI, Martinho FL, Bittencourt LR, de Oliveira Campones Brasil O, Gregorio LC, Tufik S (2005) Head and neck physical examination: comparison between nonapneic and obstructive sleep apnea patients. Laryngoscope 115(6):1030–1034. doi:10.1097/01.MLG.0000163494.19965.DC

    Article  PubMed  Google Scholar 

  12. Friedman M, Ibrahim H, Bass L (2002) Clinical staging for sleep-disordered breathing. Otolaryngol Head Neck Surg 127(1):13–21

    Article  PubMed  Google Scholar 

  13. Schellenberg JB, Maislin G, Schwab RJ (2000) Physical findings and the risk for obstructive sleep apnea. The importance of oropharyngeal structures. Am J Respir Crit Care Med 162 (2 Pt 1):740–748. doi:10.1164/ajrccm.162.2.9908123

    Article  Google Scholar 

  14. Mallampati SR, Gatt SP, Gugino LD, Desai SP, Waraksa B, Freiberger D, Liu PL (1985) A clinical sign to predict difficult tracheal intubation: a prospective study. Can Anaesth Soc J 32(4):429–434

    Article  CAS  PubMed  Google Scholar 

  15. Friedman M, Hamilton C, Samuelson CG, Lundgren ME, Pott T (2013) Diagnostic value of the Friedman tongue position and Mallampati classification for obstructive sleep apnea: a meta-analysis. Otolaryngol Head Neck Surg 148(4):540–547. doi:10.1177/0194599812473413

    Article  PubMed  Google Scholar 

  16. Karakoc O, Akcam T, Gerek M, Genc H, Ozgen F (2012) The upper airway evaluation of habitual snorers and obstructive sleep apnea patients. ORL J Oto Rhino Laryngol Relat Spec 74(3):136–140. doi:10.1159/000337134

    Article  Google Scholar 

  17. den Herder C, van Tinteren H, de Vries N (2005) Sleep endoscopy versus modified Mallampati score in sleep apnea and snoring. Laryngoscope 115(4):735–739

    Article  Google Scholar 

  18. Barcelo X, Mirapeix RM, Buges J, Cobos A, Domingo C (2011) Oropharyngeal examination to predict sleep apnea severity. Arch Otolaryngol Head Neck Surg 137(10):990–996. doi:10.1001/archoto.2011.176

    Article  PubMed  Google Scholar 

  19. Vroegop AV, Vanderveken OM, Dieltjens M, Wouters K, Saldien V, Braem MJ, Van de Heyning PH (2013) Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome. J Sleep Res 22(3):348–355. doi:10.1111/jsr.12008

    Article  PubMed  Google Scholar 

  20. Dieltjens M, Vanderveken OM, Heyning PH, Braem MJ (2012) Current opinions and clinical practice in the titration of oral appliances in the treatment of sleep-disordered breathing. Sleep Med Rev 16(2):177–185. doi:10.1016/j.smrv.2011.06.002

    Article  PubMed  Google Scholar 

  21. Sher AE, Thorpy MJ, Shprintzen RJ, Spielman AJ, Burack B, McGregor PA (1985) Predictive value of Muller maneuver in selection of patients for uvulopalatopharyngoplasty. Laryngoscope 95(12):1483–1487

    Article  CAS  PubMed  Google Scholar 

  22. Naya M, Vicente E, Llorente E, Marin C, Damborenea J (2000) Predictive value of the Muller maneuver in obstructive sleep apnea syndrome. Acta Otorrinolaringol Esp 51(1):40–45

    CAS  PubMed  Google Scholar 

  23. Suslu AE, Ogretmenoglu O, Onerci TM, Yucel OT (2006) Comparison of two endoscopic examination methods, the Muller maneuver and fiberoptic pharyngoscopy during sleep, in patients with obstructive sleep apnea. Kulak Burun Bogaz Ihtis Derg 16(5):200–204

    PubMed  Google Scholar 

  24. Stuck BA, Maurer JT (2008) Airway evaluation in obstructive sleep apnea. Sleep Med Rev 12(6):411–436

    Article  PubMed  Google Scholar 

  25. Petri N, Suadicani P, Wildschiodtz G, Bjorn-Jorgensen J (1994) Predictive value of Muller maneuver, cephalometry and clinical features for the outcome of uvulopalatopharyngoplasty. Evaluation of predictive factors using discriminant analysis in 30 sleep apnea patients. Acta Otolaryngol 114(5):565–571

    Article  CAS  PubMed  Google Scholar 

  26. Herzog M, Kuhnel T, Bremert T, Herzog B, Hosemann W, Kaftan H (2009) The upper airway in sleep-disordered breathing: a clinical prediction model. Laryngoscope 119(4):765–773

    Article  PubMed  Google Scholar 

  27. Herzog M, Metz T, Schmidt A, Bremert T, Venohr B, Hosemann W, Kaftan H (2006) The prognostic value of simulated snoring in awake patients with suspected sleep-disordered breathing: introduction of a new technique of examination. Sleep 29(11):1456–1462

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, Martin-Luther-University Halle Wittenberg, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany

    Sebastian Plößl, Alexander Glien, Stefan Plontke & Michael Herzog

  2. Institute of Medical Epidemiology, Biometry and Informatics, Martin-Luther-University Halle Wittenberg, Magdeburger Straße 8, 06112, Halle (Saale), Germany

    Beatrice Herzog

Authors
  1. Sebastian Plößl
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Beatrice Herzog
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alexander Glien
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Plontke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Herzog
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sebastian Plößl.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Plößl, S., Herzog, B., Glien, A. et al. Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing. Eur Arch Otorhinolaryngol 273, 1045–1053 (2016). https://doi.org/10.1007/s00405-015-3748-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-015-3748-9

Keywords

Search

Navigation