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Editorials |

Why the Upper Airway Is Not Like a Gall Bladder

Mark H. Sanders, MD, FCCP; Patrick J. Strollo, Jr., MD, FCCP; Charles W. Atwood, Jr., FCCP; Thomas Braun, PhD, DMD; Jonas T. Johnson, MD; The Pulmonary Sleep Medicine Group
Author and Funding Information

Affiliations: University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA 
 ,  Dr. Sanders is Professor of Medicine and Drs. Strollo and Atwood are Associate Professors of Medicine, Division of Pulmonary, Allergy & Critical Care Medicine; Dr. Braun is Professor and Chair, Department of Oral Maxillofacial Surgery; and Dr. Johnson is Professor and Vice-Chairman, Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh School of Medicine.

Correspondence to: Mark H. Sanders, MD, FCCP, University of Pittsburgh School of Medicine, 3550 Terrace St, 440 Scaife Hall, Pittsburgh, PA 15261


Affiliations: University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA 
 ,  Dr. Sanders is Professor of Medicine and Drs. Strollo and Atwood are Associate Professors of Medicine, Division of Pulmonary, Allergy & Critical Care Medicine; Dr. Braun is Professor and Chair, Department of Oral Maxillofacial Surgery; and Dr. Johnson is Professor and Vice-Chairman, Department of Otolaryngology Head and Neck Surgery, University of Pittsburgh School of Medicine.


Chest. 1999;116(6):1503-1506. doi:10.1378/chest.116.6.1503
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Extract

A patient has complaints of right-sided abdominal discomfort, fatty-food intolerance, bloating, and nonspecific physical findings. Gallstones are noted on ultrasonography, and the gall bladder is not visualized on a technically adequate cholecystogram. After there has been no response to medical therapy directed toward dyspepsia, the patient’s physician has reasonably localized the problem to the gall bladder. This site has obviously well-defined “margins” (when it is out, it is out), and following cholecystectomy, the surgeon is secure in the knowledge that he/she has addressed problems that are specifically related to this organ. If symptoms persist, one can definitively eliminate the gall bladder as the source, with the patient having undergone an effective operation that was directed at the wrong diagnosis. Unfortunately, the same cannot be said of the upper airway as it relates to patients with obstructive sleep apnea/hypopnea (OSA/H). As has been frequently noted in these pages as well as elsewhere, the upper airway serves many physiologic and functional masters, accommodating to the demands of speech, deglutition, and breathing. We are aware that each of these charges requires unique and potentially competing properties. Inappropriate synchronization of these services may have disastrous outcome (eg, choking), requiring rescue by built-in protective mechanisms.


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