What is the difference between snoring and sleep apnea?

Snoring affects millions of people of all ages. It is estimated that between 24 and 50% of adult males and between 12 and 27% of adult females are habitual snorers. The cause of snoring is the physical obstruction of the smooth airflow through the mouth and nose. The walls of the airway can vibrate during breathing, resulting in the distinctive sounds of snoring. Airflow can be obstructed by a combination of factors, including obstructed nasal cavities (commonly caused by allergies; nasal or sinus infections; or septal deviation), poor muscle tone in the throat and tongue, bulky throat tissue, and long soft palate and/or uvula (the dangling tissue in back of the mouth) – one of the most common causes of snoring. Several outer conditions can further worsen your snoring, such as obesity, alcohol abuse, heavy meal consumption before bedtime, and smoking.

While habitual snoring generally affects the people who are sleeping in the same room with snorer, sometimes may be affected a snorer itself! Obstructive sleep apnea (OSA) is a serious illness that is almost always accompanied by loud snoring, and is characterized by long interruptions of breathing during sleep that are caused by partial or total obstruction or blockage of the airway. If you spend the night with someone suffering from OSA, you may be shocked realizing that this person stops breathing almost every single minute, with breathing interruptions sometimes lasting more than 20 seconds!

About 5 to 10 percent of habitual snorers actually suffer from OSA and they are at increased risk of long-term health problems! Among others, this condition is characterized by lowered blood oxygen levels, which causes the heart to pump harder and blood pressure to rise. The result is a poor night's sleep, which leads to drowsiness during the day and can interfere with the person’s quality of life. Prolonged suffering from obstructed sleep apnea will result in higher blood pressure and may cause enlargement of the heart, with higher risks of heart attack and stroke. 

If your doctor suspects that you might have an obstructive sleep apnea, she/he may decide that you perform so called a “sleep study” – for one night you will be connected to the small apparatus attached to your chest that will monitor your breathing, heart rate, and levels of oxygen during your sleep.

Swimmer's ear

Probably there is no competitive swimmer or professional diver who once during her/his career didn’t experience infection of the ear canal! That’s why this condition is also frequently called a swimmer's ear. In other people, it is more likely to occur during the summer months, when people spend their time at lakes, seaside or at swimming pools. How to suspect that you might have a swimmer’s ear? If you have it and try to gently stick your finger in your ear, it is very likely that you will feel an unpleasant pain!

Swimmer's ear happens when bacteria grow on the skin in the ear canal. Bacteria get a chance to grow when water stays in the ear canal and it washes away the protective coating of earwax. A lot of swimming can wash away earwax protection and lead to these wet conditions in the ear canal.

Even if just small skin area is infected, ear pain may be very strong! You should not pick or scratch your ear because that can make infection worse! Do not even use a Q-tips! The best thing to do is to visit a doctor. If a doctor thinks you have swimmer's ear, she/he will probably prescribe eardrops that contain an antibiotic to kill the bacteria.

Most people will feel better even after a day or two of therapy. However, it is generally recommended to stay out of the water for the next couple of days.

SWIMMER’S EAR – TIPS & TRICKS:

• Ear pain may be similar from both the ear canal infection (swimmer’s ear) and the middle ear infection (otitis media); accurate diagnosis can only be established by otoscopy (examination of the ear)
• Preschool kids are more likely to develop otitis media, while swimmer’s ear is more common in teenagers and adults
• Otitis media usually follows nose or throat infection, while swimmer’s ear usually follows excessive swimming or ear cleaning (even with Q-tips!)
• Although pain may be similar from both ear infections, pain on pressing the ear canal is more typical for swimmer’s ear
• Swimmer's ear may start with itching or ear blockage
• In swimmer’s ear, usually there is no ear drainage
• Do not scratch or clean the ear with a Q-tip because this can worsen the infection and the pain
• Painkillers and eardrops that contain an antibiotic are usually a sufficient therapy. In most of cases, there is no need for per oral antibiotics 
• If you have suffered swimmer's ear, please stay out of the water for the next couple of days

Sinus problems and injuries in divers

What are paranasal sinuses?

Sinuses are air-filled cavities that are located within the bones of the skull and face. They possess various functions - including lightening the weight of the head, humidifying and heating inhaled air, increasing the resonance of speech, and insulating sensitive structures like dental roots and eyes from rapid temperature fluctuations in the nasal cavity. There are four main groups of sinuses: maxillary sinuses – located under the cheek, frontal – in the forehead area, ethmoid sinuses – situated between the eyes; and the sphenoid – the hidden paranasal cavity, located approximately in the middle of the head.

Sinuses are connected to the nasal cavities by narrow channels (called the osteomeatal complex). These channels permit air to flow from the nose into the sinuses and allow drainage of mucous from sinuses into the nose. We are normally not aware of this process because the mucous is thin and watery and these channels are completely permeable.

The osteomeatal complex can in different people substantially vary in its length or width. Sometimes, this difference can impact greatly on the ability of these channels to function properly. They may be very narrow or tortuous and therefore easily become blocked by swollen tissue such as occurs with inflammation or formation of polyps.

Sinuses and diving

As stated by Boyle’s law, there is an inverse relationship between pressure and the volume of gas in gas-filled spaces. In diving, increasing pressure on descent reduces the gas volume and decreasing pressure on ascent increases the gas volume proportionately. Unless the diver equalizes pressure in sinuses on descent or allow the expanding gas on ascent to escape from the sinuses, problems related to barotrauma can occur. The same may happen for the ear, as well as other gas-filled spaces.

Sinus squeeze, facial pain and nose bleeds

Sinus squeeze - also known as sinus barotrauma - commonly occurs when a diver cannot equalize sinus pressure due to nasal congestion. In the case of blocked nose, there is almost always associated blockage of the sinus openings, and there is no gas flow between the nose and sinuses. The bony structure will not collapse under the pressure changes, but the lower pressure in the blocked sinus will draw blood into it. Blood vessels in sinuses will swell and leak. In more severe cases the squeeze results in a blood-filled sinus, which will drain during ascent when the air in the sinus expands. Sinus squeeze can be recognized as pressure or pain in the forehead or around the teeth, cheeks, or eyes. Sometimes, the nosebleed may occur. Pressure and pain regularly increase with depth.

The most common reasons for nasal congestion and sinus squeeze are colds and allergies, and they should be treated by proper medications. Until the congestion and sinus problems heal, divers should not be diving.

What if these problems persist?

If diver is constantly experiencing these symptoms or they get worse over time it is advised to visit a doctor who specialize in chronic nose and sinus problems – the ENT doctor. In some people, the channels that connect sinuses to the nose may become blocked by swollen tissue. The causes of swelling may relate to allergy or different infections. In addition, certain structural conditions (such as a deviated nasal septum) or nasal polyps – may be further responsible for persistent sinus openings blockage and complaints. All of the above factors may eventually cause thickening (hypertrophy) of the nasal and sinus lining tissue, which can be only detected by nasal endoscopy and CT scans – modern diagnostic techniques performed by the ENT specialist. 

Dr. Sasa Janjanin is double European Board-certified in ENT and Facial Plastic Surgery. Besides being experienced surgeon and proficient in curing problems related to thyroid gland; facial cosmetic procedures; nose, sinus and snoring complaints; and kids’ ENT problems, Dr. Janjanin’s particular expertise is in sport and diving-related ENT problems – acting many years as an ENT consultant for several professional and national sport teams and athletes, some of them Olympic medal and European championship winners.  

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