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Measuring and monitoring vital signs
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
Respirations are normally effortless, and you should therefore observe whether breathing is difficult (termed dyspnoea). People with dyspnoea may use accessory muscles of respiration such as their neck and abdominal muscles. If Ken has a chest infection, he is likely to experience dyspnoea and this should be noted in his health action plan for future reference. People with dyspnoea often mouth breathe because there is less resistance to airflow through the mouth than the nose. Mouth breathing can lead to drying of the oral mucus membrane and so oral hygiene (discussed in Chapter 7) is essential.
Respiratory system
Published in Jagdish M. Gupta, John Beveridge, MCQs in Paediatrics, 2020
Jagdish M. Gupta, John Beveridge
Serious postnasal obstruction due to enlargement of the adenoids is an absolute indication for adenoidectomy. This can be demonstrated by a lateral X-ray of the postnasal space. Mouth-breathing is often due to causes other than enlarged adenoids, e.g. mucosal thickening due to allergy. Nasal escape of air is an absolute contraindication to the removal of adenoid tissue. Unlike expiratory snoring, inspiratory snoring unless related to enlargement of adenoids, is not an indication for adenoidectomy. There is much debate as to whether adenoids should be removed from children who suffer from recurrent middle ear disease; the anatomical linkage of the postnasal space with the middle ear by the Eustachian tube is an enticing argument, but proof by statistical means is lacking.
History Stations
Published in Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox, ENT OSCEs: A Guide to Passing the DO-HNS and MRCS (ENT) OSCE, 2019
Joseph Manjaly, Peter Kullar, Alison Carter, Richard Fox
Common causes include Medication side effects – any drug with effects on the autonomic nervous system can cause xerostomia. Antihypertensives and antidepressants are particularly well known in this regard.Mouth breathing – this may be due to nasal blockage, e.g. from adenoidal hypertrophy.Systemic disease – autoimmune disease such as Sjögren’s syndrome must be ruled out. Other systemic disease such as human immunodeficiency virus (HIV), diabetes and Parkinson’s disease can also cause dry mouth.Radiation therapy – the salivary glands, particularly the parotid glands, are often in the radiation field during treatment of head and neck cancer. A number of new developments including intensity-modulated radiotherapy have been developed to minimise collateral damage to healthy salivary tissue.Pseudoxerostomia – rarely as a manifestation of psychiatric disease.
Obstructive sleep apnea: personalizing CPAP alternative therapies to individual physiology
Published in Expert Review of Respiratory Medicine, 2022
Brandon Nokes, Jessica Cooper, Michelle Cao
The occluded nasopharynx has long been appreciated as a source of CPAP intolerance [37]. Nasal occlusion necessitates mouth breathing, leading to higher nasal CPAP pressures due to device-perceived leak, and thereby, greater patient discomfort [37]. Under normal circumstances, obligate nasal breathing is the rule during sleep and the evolution of nocturnal mouth breathing should prompt concern over compromised nasal patency [37]. Notably, increased nasal resistance is an independent risk factor for OSA development [38]. Additionally, mouth breathing has long been appreciated to make sleep-disordered breathing events more likely, potentially owing to decreases in the caliber of the retropalatal airspace [38,39]. Thus, OSA is more common in the presence of nasal allergies, a deviated nasal septum, prominent nasal valves, etc. [37].
Meta-analysis comparing the efficiency of high-flow nasal cannula versus low-flow nasal cannula in patients undergoing endoscopic retrograde cholangiopancreatography
Published in Baylor University Medical Center Proceedings, 2022
Mohamed Gamal, Manar Ahmed Kamal, Mohamed Abuelazm, Amman Yousaf, Basel Abdelazeem
Patients who underwent endoscopies and were under sedation tended to use mouth breathing. Teng et al reported that 58% who underwent sedated endoscopy presented oral breathing.20 A recent RCT evaluated the efficacy of standard bite block and standard nasal cannula, standard bite block and HFNC, and mandibular advancement bite block on hypoxic events and upper airway obstruction.20 The results showed that HFNC had 18% fewer hypoxic episodes despite having the same airway obstruction episodes as the LFNC group. Meanwhile, the mandibular advancement bite block reduced hypoxic episodes and airway obstructions by 12% and 32%.20 Therefore, HFNC is still an effective system for delivering oxygen regardless of oral breathing. Our results also showed that the incidence of jaw thrusting was lower in the HFNC group than in the LFNC group. The role of HFNC in improving end-tidal carbon dioxide is unclear. Kim et al18 compared the end-tidal carbon dioxide by the end of the procedure, and it was lower in the HFNC group than the LFNC group (30.4 vs 33.9 mm Hg, respectively). Lee et al3 did not report any comparison about end-tidal carbon dioxide. Thiruvenkatarajan et al19 did not calculate it; rather, transcutaneous hypercapnic events were monitored between the two groups, which revealed an increased incidence of hypercapnic events in the HFNC group (42%) compared to the LFNC group (34%).
Association between asthma and dental caries in US (United States) adult population
Published in Journal of Asthma, 2021
Parth D. Shah, Victor M. Badner, Deepa Rastogi, Kevin L. Moss
Similar to dental caries, asthma is also a highly prevalent chronic inflammatory disease in the US which afflicts the health and lifestyle of those who are affected (7). Asthma affects the immune system, and hence may cause a disturbance in oral microbiota. Combined with anti-asthmatic medications, which modulate airway and systemic immune responses, this condition may increase the risk of dental caries (8). Mouth breathing that may be more prevalent in asthmatic patients, particularly with co-existent allergic rhinitis, may lead to dehydration of the oral mucosa. As a result of mouth breathing, and the effects of anti-asthmatics and inhalation therapy, people with asthma are more likely to suffer from xerostomia (9), which may increase their susceptibility to dental caries (10). Because of the one or more of these plausible mechanisms, and perhaps due to any barriers in accessing oral healthcare, we hypothesize a connection between asthma and dental caries in adults living in the US.