Erik’s CT Scan

Before treating his sleep apnea, ADVENT takes a look inside Erik's nose and sinuses with a state-of-the-art CT scan. What they find may explain why he struggled to make CPAP work.

 

 

If you haven't read the last part of Erik's journey, check it out here.

Transcript:

Hey everybody, Erik here. So a quick update on my sleep apnea ADVENT patient journey. Going in for my CT scan today, the Wauatosa clinic. Pretty excited. Broke my nose when I was in third grade, a fracture right down the middle. I'm really curious to see what the inside of my nose looks like, what my sinuses look like. I've had terrible nasal breathing and problems with headaches for as long as I can remember. Really excited to see what it looks like in there, and get some insight into what's going on with my airway. I have that thing pretty much year round, where one nostril, when I'm trying to go to sleep, will just plugged up 100%. And then, I'll lay down on my side and that nostril will open up and the other one will plug. And then, I flip over. And then, I just repeat that 'til I finally fall asleep. And it kind of sucks. I'm really curious to see if there's a large turbinate or maybe even a polyp or maybe my septum is crazy deviated. I don't know. CT scans, the kind that ADVENT do are the standup kind, they're pretty minimal radiation exposure. Goes pretty quick and since they have one in each clinic, you can actually just go to any of the clinics, schedule wherever it's easiest, and the doctor will go over it with you right there. My only fear I think at this point, would be seeing that there's nothing wrong. That's my greatest fear. I wanna see something wrong because that means we can fix it and things will get better.

[Erik] You see that Simpsons where they found a crayon in Homer's nose, they pulled it out, and he got smart and then, nobody liked him. So they put it back in so he was dumb again.

[Cameraman] The answer is yes, I've probably seen it. It's been a while since I've Simpsons.


[Dr. Kandula] All right, so that's you. Each of these little rectangles is a copy of your face coming straight up and down, and we're just kinda marching our way backwards. So the top of your nose is here. Your septum, which divides your nose into two, is this guy here. And then, the breathing space is in the black areas here and then here. So right side, left side. So at the tip of your nose here, it's not bad. Your septum, we'll see it more as we go further back. It just sort of swings side aside. Probably from some the trauma when you were a kid. Sinuses are these black areas here and here. Black is what we wanna see. So those guys look pretty good, that's good. And so as we go like this, we're going further back into your face.

[Erik] Okay.

[Dr. Kandula] As we do that, your septum, yup, it definitely kicks over. It's really more towards the right hand side that we see. Next to the septum are the turbinates, which are these great guys here and here, which are the humidifiers in those. Your turbinates, right now, they're bigger than ideal, but they're not as big as they get when you're laying down. So the the deal that's happening to you when you lay down on right side or left side, whatever side you're laying on, the turbinate on that side is swelling up and then, taking this breathing room away from you. And then, you flip over and then, the same thing happens to his friend over here. And so right now, you're upright. And so they look in real life like they do here, which is they're a little bigger than ideal, but you've got some room to breathe in there, right now. Sinuses still look pretty good. And as you go, like this same thing, we're still going further back. Septum's still kicked over. Turbinates still a little bit big. Sinuses still look pretty decent. Now, we start seeing the cheek sinuses. And those guys are also looking okay. And then as we go further back in, yet again, as we get further back in, things start getting a little more problematic. So that septum that was sort of, eh okay, swings pretty hard side to side at this point. Again, this structure that's sort of, I don't know what you described it as. That little wiggle side side to side should be just dead down the middle. Turbinates, big on both sides. And so your case, the septum being bent doesn't help you, but the other thing that does is it takes away some of the wiggle room that you might have for the turbinates. Like if the septum was straight, the turbinates might be able to get a little bit big and not bug you. Because the septum has bent, there's just not much wiggle room in there. And so the turbinates getting a little bit big is enough to shut you down. And then, the additional things that we start seeing is up in the sinuses, we start seeing a little bit of grayness up in the sinuses between the eyes, which is here and here. And then, in the cheek sinuses, we see this gray rim around the sinuses. That grayness that we're seeing is swelling in the lining of the sinus is, chronic swelling. It's not an active infection, but that shouldn't be there. So that there's basically an inflammation up in the sinuses that's just sort of hanging out and not leaving you. And then, tightness in the nose. And then, as we go further back in, once again, that septum definitely dances side to side so it's deviated. Turbinates are big on both sides, bigger on the right hand side than the left. Same deal, sinuses inflammation on both sides. And then, it's tight on both sides. So this sinus that's here is trying to exit into your nose here and then, things pinch down for you. This guy is trying to come this way and same story. So tight and tight with inflammation, scattered through. Same deal back here, septum just sort of swinging side to side, turbinate's is still big, still that inflammation that we're seeing. And then now, we're heading more towards the back of your nose and way back there, we see a couple other things, we see that septum that was swinging more towards the right hand side towards the back of your nose actually swings towards the left. Way in the back of your head, there is a pair of sinuses here and here. They're the sphenoid sinuses, it's their name. So on your left hand side, we got a little bit of gray, but mostly black and right hand side, we got a little bit of black, mostly gray. So this guy here isn't draining at all like he's supposed to. So none of that gray should be there. You have that gray kind of scattered throughout, but that's sort of where it's at its most prominent. And then, that's kind of the end of the story. So the long story short with what we're seeing here is that you do have a deviated septum. It impacts you on both sides. So the septum should be straight down the middle. Yours, it's hard to do, but it's kind of going straight, front, and back, it's kind of doing this to you when it comes to the right.

[Erik] Oh, okay.

[Dr. Kandula] And then, comes to the left. That's a constant, so he's always doing that. Next to the septum and the turbinates. Your turbinates are big and then, they'll get bigger when you lay down, whether it's one side or the other, or just any position when you're laying down, they're gonna get bigger. There's not enough room in your nose to handle both of those realities. So symptoms that turbinates are big, that none of that stuff's helping you and then, sinus wise, the sinus passageways are tight in the upper part of the nose. And then, there's chronic inflammation stuff behind the scenes. So to kind of recap, deviated septum, big turbinates, sinuses tight with what we call chronic sinusitis, which is chronic inflammation in the sinuses. And then on top of that, based on your history and based on when I'm looking at your nose too, the lining on the inside of your nose looks a little bit irritated, as well. So we can't say it's allergies without a test, but I'd say it certainly sounds consistent with that, where changing the seasons is irritating that lining a little bit more, and causing a little bit more trouble. So we've got anatomy issues in both fronts, both in the nose itself, and up in the sinuses. And then you've got a lining issue or inflammation issue on both fronts, as well. So inflammation in the nose and then, inflammation in the sinuses. So you kinda get the full gamut of anatomy issues on all fronts, lining issues on all fronts. None of that stuff is helping you. All of it is not isolated, so it all kind of plays together and puts you where you are. When you try to come after it, medication-wise, medications can't do anything to the anatomy. So all that they can do is help the lining and any medication you can take can really only help the lining on the inside of the nose. And only just a little bit. The anatomy issues are significant and the lining issues are significant. Medications can only come after the lining issues, but they can only do so much. And then on the other hand, they can't really get where they need to get to if the anatomy is kind of shot. I would say other than that very, very back sphenoid sinus, there isn't anything that is anywhere near as open as it's supposed to be, but the biggest thing that we are talking about, right now, is really the sleep apnea and its impact on you. And the nose stuff, the nose and the sinus stuff, that is not where your sleep apnea's coming from, but that is a barrier for us to treat that sleep apnea.

 

Tune in next week for the rest of Erik's CT visit!

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