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Medical Subspecialties

doctor treating childOtolaryngologists (also known as ENT - “Ear, Nose, and Throat” doctors) play an important role in identifying and treating problems with nasal blockage, mouth breathing, snoring, and sleep apnea. As specialists of the complex soft tissue anatomy of the head and neck, an otolaryngologist has the training to examine the nose, mouth, and throat for potential issues that may limit the comfortable and easy flow of air through the nose and into the chest.

Comfortable nasal breathing requires that lips be pressed together, the tongue rests high on the roof of the mouth, and the nasal passage is open. The most common cause of blockage in the nose is inflammation of the lining of the nose due to environmental allergies, food allergies, weather conditions, air pollution, smoking, nutritional factors, or exposure to certain chemicals. Other causes of nose blockage may include deviated septum, large turbinates, nasal polyps, or large tonsils and/or adenoids. Issues of nasal blockage are addressed using saline rinses, nasal sprays, allergy medicines, breathing therapy or surgery.

An underdeveloped upper jaw, identified by a high arched narrow palate, may also lead to nasal restrictions since the roof of the mouth is the floor of the nose. This can be addressed by a dentist or orthodontist expanding the roof of the mouth.

Tongue-tie or ankyloglossia refers to the condition where connective tissue under the tongue limits the mobility of the tongue. The tongue plays an important role in speech, swallowing, sleep and breathing, and adequate tongue mobility is essential for optimal growth and development of the upper and lower jaws. Patients with very severe tongue-tie often present with swallow or speech issues that are hopefully identified and addressed early. On the other hand, patients with mild to moderate tongue-tie often present in a less obvious fashion and so may have the tongue-tie go unrecognized for a long time. If the mobility of the tongue is restricted, the back of the tongue stays low and back in the mouth which can block the airway and cause problems with sleep. These individuals often complain of difficulty sleeping on the back, snoring, or restless or unrefreshing sleep. Compensation patterns during sleep may develop, including open mouth breathing, teeth clenching, or predominant side-sleeping. These behaviors can then lead to unfavorable facial development, temporomandibular (TMJ) pain, and posture issues such as forward head posture or anteriorly rolled shoulders to offset the limitations of a restricted upper airway. Effective release of a tongue-tie with the restoration of tongue mobility and proper tongue placement can have a profound impact on many areas of the person's life.
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