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Physical Exam: The Dangly Thingy
October 15, 2007
In my most recent physical exam post, I dealt with the mouth from outside in. We made it as far as the tongue, and so now carry on with our voyage toward the back of the throat. The last post was fairly long, so I will break it down into smaller parts.
So, as intrepid explorers, we grab our binoculars and look ahead of us and we see this funny looking thing hanging down in front of us. That funny thing is the called Uvula, which is at the very end of the Soft Palate.
What the heck is the uvula for? It lets you make funny noises with your throat. That’s cool. But what else?
The uvula has its own little muscle, the musculus uvuae, to help it stiffen and change shape, so it helps fill in the space at the back of the throat. It helps keep food from going down the wrong way down the breathing passage when one swallows. Singers credit the uvula with letting them produce a vibrato, a wavy up-and-down sound.
From MedicineNet
Some languages depend a lot of the uvula. The famous “clicking” sounds made by South African tribesmen are made with the soft palate and uvula. Germanic languages also use the uvula a lot in their speech. So, here is the German take on the uvula (vrom ze vikipedia):
Auch ein Ödem des Gaumenzäpfchens, das Uvulaödem, ist möglich. Ursache ist ein, z. B. durch Schnarchen verursachtes “Rumschleudern” des Gaumenzäpfchens, deshalb tritt dieses Phänomen auch insbesondere morgens auf, was zu einer starken und bisweilen sehr unangenehmen Anschwellung führt. Es besteht jedoch in der Regel keine Erstickungsgefahr und die Schwellung geht im Laufe des Tages von selbst zurück
I hope that clears things up.
The main disease of the soft palate and uvula is sleep apnea. Sleep apnea happens when a person snores to an extent that they cut off their airway and cause apnea, or a cessation of breathing. Several things make snoring happen (which may or may not be present):
- Blockage of the nose - from nasal congestion or deviated nasal septum. This is why some people use the nasal strips that open up those passages.
- A low-hanging soft-palate/uvula. You can see this on exam sometimes.
- Soft tissue swelling around the airway - obesity is the primary cause of this.
Most of my patients worry about sleep apnea causing a person to stop breathing and die in their sleep. But it just doesn’t happen that way; people don’t just stop breathing.
There are several reasons why sleep apnea can be dangerous. The first is that people with sleep apnea drop their oxygen levels down while they sleep. This can cause elevation of the blood pressure in the lungs (pulmonary hypertension) and right-sided heart failure. It can also possibly lead to elevation of the systemic blood pressure.
The other danger of sleep apnea (and possibly the most significant) is that it interferes with sleep. A person will have multiple night-time awakenings when they have apnea, leading to a significant decrease in the amount of the deeper stages of sleep. This results in excessive daytime sleepiness, causing the person to fall asleep throughout the day. This can happen in expected times, such as committee meetings, presidential debates, at a Kenny G concert, and after lunch; but it also can happen at very dangerous times, such as while driving.
Another danger of sleep apnea is the relationship stress it causes. The sleep partner of a person with sleep apnea is not only disturbed by the sound of heavy construction equipment emanating from the mouth a few inches from their ear, it is also the anxiety of hearing a loved one stop breathing periodically through the night. This results in frequent blows to the head and shoves to promote the lateral decubitus position.
Continuous Positive Airway Pressure (CPAP) is the device commonly used to treat sleep apnea. While it looks like the person is being put through some sort of Medieval punishment, it is often dearly cherished by those who use it. CPAP allows a person to sleep so much better and have so much more energy, they will put up with the relative confinement of the device.
The other treatment for sleep apnea is surgical. The uvulopalatopharyngoplasty, or UPPP (sometimes called the oral Roto-Rooter procedure) removes the uvula along with part of the soft palate and perhaps the tonsils. This is generally effective and is especially good for those who don’t want to feel that they are being attacked by a squid every night.
What about the exam of the palate and uvula? It involves looking at that dangly thingy at the back of the throat.
You can even say, “hey look! There’s that dangly thingy at the back of your throat!”
It will really impress your patients.
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October 15th, 2007 at 7:00 am
My husband accidently burned his uvula several years ago with a bite of really hot fish. It resulted in a uvuloplasty, tightening his soft palate attachment (the sling). He doesn’t snore like he used to do. Wouldn’t recommend it, as he says it was painful. I thought he was joking and laughed at him (uncaring wife, huh?).
October 15th, 2007 at 8:59 am
Oy. Does it make me a bad person that I still tell my husband that he’s going to die if he doesn’t get his sleep apnea looked at?
Our nights consist of *Snore…silence, silence, silence, long silence, POKE POKE, “BREATHE ALREADY!!!” Gasp, Snore, snore, snore.* and repeat until I’m ready to put a pillow over his head and finish the job myself.
October 16th, 2007 at 11:39 am
from the National Uvula Association.
October 16th, 2007 at 12:35 pm
Frankly, I don’t much care, as long as it’s uvula and not mevula.
October 16th, 2007 at 12:39 pm
Here is what Ed’s Comment went to:
Babs’ Uvula
Sister…..Laraine Newman
Babs…..Gilda Radner
Doctor…..Chvy Chase
[ open on National Uvula association flash card ]
Announcer: And now, a public service dramatization from the National Uvula Association.
[ dissolve to Babs and her sister sitting in their living room ]
Sister: Gee, Babs, you look like something the cat just dragged in.
Babs: I know. I feel crummy. But I just can’t seem to put my finger on what’s wrong.
Sister: That’s too bad, Babs. Has it ever dawned on you that it just may be your uvula?
Babs: Gee, no, Sis.. I must have stupidly glossed right over my uvula.
Sister: I had a hunch you might’ve. That’s why I made an appointment for you with a top uvula specialist. [ doorbell rings ] Who makes house calls! Right now!
[ Doctor enters the living room ]
Doctor: Hello, I’m the doctor.
Sister: Hi.
Babs: That must be him! [ coughs ]
[ Doctor sits next to Babs on the couch ]
Doctor: I won’t beat around the bush, Babs.
Babs: Is it bad?
Doctor: In a nutshell, your uvula is on the fritz. Which reminds me of a little joke. Knock knock!
Babs: Who’s there?
Doctor: Babs’ uvula.
Babs: Babs’ uvula who?
Doctor: I don’t know, Babs. But I do know this - you’ve really let your uvula go to the dogs.
Babs: Yes.. I have..
Sister: I’d like to share this with you, Sis. [ opens a greeting card ] “To Babs: It’ll behoove ya’, to care for your uvula! Love, Sis.”
Babs: Boy, do I hear ya’, Sis! From now on, it’s strictly good, clean fun. For me and my uvula!
Doctor: That reminds me of a little joke. Knock knock!
Announcer: Who’s there?
[ Doctor, Babs and her sister laugh at the surprise interruption ]
Announcer: The preceding dramatization was brought to you by the National Uvula Association.
Thanks, Ed!
Sid - just wait for my next post!
October 16th, 2007 at 6:57 pm
Dr. Rob, Thanks for your ongoing “trip through the body” series. I will have to take exception to your contention that a UPP is “generally effective” for treatment of Obstructive Sleep Apnea. It may be generally effective for managing the snoring (though even there it will not help in severe sleep apneics), but it is decidedly NOT a generally effective alternative to CPAP. The real danger is that in essence one has “turned off ” the fire alarm in a sleep apneic by stopping the noxious snoring. I regularly see patients who either insisted upon or were aggressively offered this operation, only to find that it had done little or nothing to help with the sleep apnea per se. There are also some significant potential downsides to this surgery, with the tendency among surgeons to under-report the complications. Since this blog is read by lay people, they might walk away form this with the distinct impression that a UPP is an equivalent alternative to CPAP. It is not.