Obstructive Sleep Apnea Syndrome Caused by The "Kissing" Tonsils and Seen During Müller's Manoeuvre

In this video we can see the changes in the airway lumen dimensions of the velopharynx and oropharyngeal areas during Müller's manoeuvre. It is routinely performed as an office evaluation of obstructive sleep apnea syndrome. When the patient is asked to breathe deeply with the nose and mouth closed tightly the negative pressure is induced. Then we can see the collapsible segment which is approximating particularly at the velopharyngeal isthmus region. If the base of tongue collapses, the prominent lingual tonsils will be assessed. The tongue base collapse is not seen in this video but the most prominent findings were situated near to the total closure of the velopharyngeal isthmus, contributed by the "kissing" enlarged tonsils. A combination surgery is usually needed, if the adenoids, nasal septal deviation and turbinates hypertrophy are present but first they need to be evaluated. [L-larynx, T- tonsil, BOT- base of tongue, SP- soft palate, PW- posterior pharyngeal wall]