Patient Overview

Patient Overview

Throat Disorders (Tonsillitis, Laryngitis, Sleep Apnea) Treated by Prof. Dr. Ashequr Rahman Bhuiyan

Patient Profile:

• Name: Mrs. jubaida
• Age: 42
• Gender: Female
• Medical History: No significant past medical history, non-smoker, occasional alcohol consumption.

Presentation:

• The patient presented with persistent sore throat, hoarseness of voice, and difficulty swallowing for the past 1 week. She also reported waking up feeling fatigued and unrefreshed, despite sleeping for 7-8 hours.
• The patient also complained of loud snoring and sometimes feeling as though she stopped breathing during sleep, leading to a restless sleep cycle.

Clinical Examination & Diagnostics:

• Physical Examination:

  • On oral examination, the tonsils were enlarged, erythematous, and covered with white exudates, suggesting tonsillitis.
  • Laryngeal examination showed swelling and inflammation of the vocal cords, indicating laryngitis.
  • The patient appeared fatigued and showed signs of poor sleep with some dark circles under the eyes.

• Investigations:

  • Throat culture revealed the presence of Group A Streptococcus, confirming bacterial tonsillitis.
  • Polysomnography (sleep study) was performed, diagnosing the patient with Obstructive Sleep Apnea (OSA), as the results indicated recurrent episodes of airway obstruction during sleep.

Diagnosis:

• Acute Tonsillitis caused by bacterial infection (Group A Streptococcus).
• Laryngitis associated with the inflammation of the vocal cords.
• Obstructive Sleep Apnea due to upper airway obstruction during sleep.

Treatment Plan:

1. Medical Management:

   • The patient was prescribed a course of antibiotics (Penicillin) to treat the bacterial tonsillitis.
   • Anti-inflammatory medications (Ibuprofen) were given to reduce swelling in the tonsils and vocal cords.
   • Throat lozenges and gargles with warm salt water were recommended to soothe the throat and reduce irritation.
   • The patient was advised to stay hydrated and rest her voice to aid the recovery from laryngitis.

2. Management of Sleep Apnea:

   • The patient was referred to a sleep specialist for CPAP therapy (Continuous Positive Airway Pressure) to treat the Obstructive Sleep Apnea.
   • Lifestyle modifications were recommended, including weight loss, sleeping on the side, and avoiding alcohol or sedatives before bedtime, which can worsen sleep apnea.
   • The patient was also advised to monitor sleep hygiene practices, including maintaining a regular sleep schedule and creating a quiet and dark sleep environment.

3. Surgical Intervention (if needed):

   • If the tonsillitis became recurrent or chronic, a tonsillectomy (removal of the tonsils) might be considered.
   • In cases where the sleep apnea persisted or worsened despite CPAP therapy, an upper airway surgery such as uvulopalatopharyngoplasty (UPPP) might be explored to widen the airway and improve airflow during sleep.

4. Follow-up and Rehabilitation:

   • The patient was scheduled for a follow-up in 2 weeks to assess the response to antibiotic therapy and the resolution of tonsillitis.
   • A follow-up sleep study was planned to assess the effectiveness of CPAP therapy and evaluate the improvement in sleep apnea symptoms.
   • Vocal rest and therapy were advised for the recovery from laryngitis.

Outcome:

• After completing the course of antibiotics and anti-inflammatory medications, the patient reported significant improvement in throat pain and swelling. The sore throat resolved, and the hoarseness of voice improved after 10 days.
• With consistent use of CPAP therapy and lifestyle changes, the patient noticed a significant reduction in snoring and felt more rested upon waking up.
• A follow-up sleep study showed a marked improvement in airway obstruction, and the patient’s sleep quality improved drastically.
• The patient was advised to continue CPAP therapy for long-term management of sleep apnea.

Conclusion:

Prof. Dr. Ashequr Rahman Bhuiyan’s comprehensive approach to managing tonsillitis, laryngitis, and sleep apnea allowed for effective treatment of multiple conditions. The bacterial tonsillitis was resolved with antibiotics, laryngitis was managed with rest and anti-inflammatories, and sleep apnea was treated with CPAP therapy and lifestyle modifications. The patient experienced significant improvement in both throat health and sleep quality, demonstrating the effectiveness of timely intervention and holistic treatment.