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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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