What is a Clinical Evaluation for Snoring?

by Dr Kenny Pang

Clinical evaluation is the most important step in managing a patient with snoring and/or sleep apnea.

Dr Kenny Pang

In diagnosing sleep apnea, clinical evaluation is crucial. In fact, clinical evaluation is the most important step in managing a patient with snoring and/or sleep apnea.

An ear, nose and throat endoscopic examination of the upper airway should be done. The patient should also have his weight and height recorded, body mass index (BMI) calculated, blood pressure taken, and neck circumference measured.

The upper airway assessment is key in evaluating snoring and sleep apnea in a person. It is also fundamental in assessing and deciding the modality of treatment in all cases of snoring and/or sleep apnea.

The anatomy and features to be observed during the clinical evaluation are:

  • Nose / Sinus swelling — The nose is physiologically essential in breathing, so any swelling within the nose or a deviated nose wall needs to be corrected for normal breathing to be restored.
  • Tonsil size — The patient’s tonsils are assessed with regard to how big and obstructive they are. They are graded based on their size in relation to the oral cavity.
  • Tongue size — The tongue is essential in the evaluation, as the tongue is the final “gatekeeper” to the opening of the airway and lungs. If it is obstructive, treatment is necessary.
  • Palate thickness — Loud snoring can happen if a person’s palate is too thick or “redundant”, which can lead to obstruction of the airway and hence, sleep apnea.
  • Lateral (side) throat wall thickening — Many patients with obstructive sleep apnea (OSA) have very thick and bulky lateral walls in the throat. These side walls can collapse and obstruct the upper airway, resulting in breathing cessation and low oxygen intake during sleep.

Based on the patient’s body mass index, neck circumference, oral cavity adequacy, tonsil size, palate size/length, tongue size, upper airway assessment, and the size of his nasal passage, treatment options are selected and decided upon in consultation with the patient.

People with snoring/sleep apnea can be divided into 3 main groups:

  1. Those with a GLOBAL problem, who are grossly obese and have a thick, fat neck
  2. Those with a LOCAL problem, who are not obese, but have big tonsils, a big tongue, and/or a thick, “redundant” palate
  3. Those with an OVERLAP problem, who are obese and who also have a local problem, such as big tonsils and/or a thick redundant palate.

Snoring and sleep apnea treatments may be conservative and/or surgical.