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Patient Services
The Institute For Better Breathing has the collective experience, the staff, and the modern equipment to test and diagnose pulmonary dysfunction, allergies, sleep apnea, snoring and nasal obstructions. In particular, The Institute For Better Breathing has special equipment for in office state-of-the-art Laryngoscopy and Somnoplasty. Additionally, The Institute has special equipment for the diagnosis and treatment of osteoporosis. The following sections summarize major tests the physicians at The Institute For Better Breathing perform at their Burbank and Glendale, California facilities:
Allergy Testing - Doctors at the institute use skin tests to determine whether a patient has IgE antibodies in the skin that react to a specific allergen. The doctor uses diluted extracts from allergens such as dust mites, pollens, or molds commonly found in the local area. The extract of each kind of allergen is injected under the patient's skin or is applied to a tiny scratch or puncture made on the patient's arm or back. With a positive reaction, a small, raised, reddened area (called a wheal) with a surrounding flush (called a flare) appears at the test site. There are also diagnostic tests that use a blood sample from the patient to detect levels of IgE antibody to a particular allergen. One such blood test is called the RAST (radioallergosorbent test), which can be performed when eczema is present or if a patient has taken medications that interfere with skin testing.
Chest X-Rays
The physician uses the chest x-ray to reveal the structure of the chest and lung areas. This procedure may exposes a large number of pulmonary diseases such as pulmonary fibrosis and cancer. The procedure is common and painless. The patient stands in front of the machine and holds his breath for a moment while the x-ray exposes the x-ray film. The photograph is developed and analyzed within a short period.
CT Scan
A CT scan (computed tomography) of the chest uses x-rays to scan the chest from many angles. The detected x-rays are analyzed by the computer. The computer generates an image of the area of the chest being scanned and displays the image on a computer video monitor. The images can also be reproduced as photographs. You will lie flat on a table that is guided into the CT scanner. The scanner emits x-rays from a complete circle around you. This non-invasive procedure is used to examine the structures inside the chest. Common indications for thoracic CT include chest injury, a suspected tumor or to search for bleeding or fluid collections in the lungs and adjacent areas.
Laryngoscopy - via Flexible Endoscopes - This is an optical instrument that assists the doctor during the examination of the larynx. This device has a flexible fiber optic cable that the doctor passes through the nose and the pharynx until he sees the vocal folds. Because of the flexibility of the scope, the patient does not gag and is comfortable. With this device, the doctor can examine the larynx during normal speech.
Endoscopic Examinations
Using endoscopes, the doctor also examines the nose and throat, the vocal chords and the back of the tongue.
The doctor performs somnoplasty to treat upper-airway obstructions. The doctor uses local anesthesia and the procedure is essentially painless. Somnolasty uses controlled, low-power microwave energy to create submucosal lesions. Over a period of 6 to 8 weeks, the lesions are naturally resorbed, reducing tissue volume and stiffening the remaining tissue in the desired area. Somnoplasty is a safer, less invasive solution for the treatment of upper-airway disorders than traditional surgical therapies. The procedure takes less than 2 minutes per turbinate. Somnoplasty reduces surgical risks without postoperative pain and moreover is office-based. To avoid traditional surgical pain, patients with various nasal conditions resulting from enlarged turbinates often endure prolonged use of intranasal sprays and systemic medications, which have minimum long term effectiveness and moreover carry harmful side effects. Somnoplasty is proven effective for the following conditions: obstructive sleep apnea, habitual snoring and chronic nasal obstruction.
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Play the short video on the left indicating how Somnoplasty provides a relatively painless solution for patients who seek treatment for habitual snoring. Somnoplasty reduces soft-palate tissue volume in a precise, minimally invasive manner. The older alternate method, Laser Assisted Uvulopalatoplasty (LAUP), is a multiphase procedure so invasive and painful that many patients fail to return for treatment even after their first visit!
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Chronic enlargement of turbinates is irreversible except through surgical intervention. Somnoplasty reduces turbinate tissue with minimal, if any, crusting or bleeding and cures chronic nasal stuffiness. Play the short video on the left that depicts how Somnoplasty reduces chronic nasal obstruction.
Sleep Disordered Breathing (SDB)
Patients undergoing Somnoplasty experience decreased daytime sleepiness, no infections, no airway compromises, and limited, short-term postoperative pain. Also, as discussed above, they snore less.
Bronchoscopy
Fiber optic bronchoscopy examines the main airways for the presence of cancer or a foreign body. In this hospital procedure, the doctor suppresses the patient's gag reflex by spraying anesthetic into the throat. After light sedation, the doctor inserts the fiber optic bronchoscope into either the nose or the mouth and passes it down the throat into the trachea and then into each lung. There are no pain fibers in the tracheobronchial tree, so the procedure is painless.
Endobronchial Biopsy
This hospital procedure is called an endobronchial biopsy, because it is done inside the bronchus. If an abnormality seen in the airways suggests a tumor, the doctor takes a biopsy. The doctor passes a small wire with biopsy forceps through the bronchoscope removing small samples of tissue. In most cases, these biopsies identify the abnormality.
Transbronchial Biopsy
The doctor performs this procedure in the hospital to obtain tissue samples farther from the main divisions of the bronchii. The doctor advances the bronchoscope as far as possible using fluoroscopy and takes specimens from the peripheral part of the lungs.
Pulmonary Function Tests (PFTs)
Spirometry
Spirometry measures the amount of air entering and leaving the lungs. The technician performs this simple test using a computerized instrument. This machine measures airflow that passes through the machine. The patient inhales deeply and then completely exhales through the machine. This is a valuable screening test that can identify obstructive diseases (asthma, emphysema, PEFR (see below), or restrictive diseases (fibrosis).
PEFR
The spirometer also measures peak expiratory flow rate (PEFR). The doctor compares these readings with readings the patient obtains at home with their own portable peak flow meter.
Postbronchodilator Spirometry
If the doctor suspects an obstruction, he may repeat spirometry with the administration of a bronchodilator. This procedure provides some information on the potential responsiveness of the airways to medication as can be seen in asthma.
Lung Volumes
The doctor measures lung volumes using the gas dilution method whereby the patient inhales an inert gas, such as nitrogen or helium. The doctor determines the lung volume from the volume of gas the patient inhales. The most important measurements are residual volume and total lung capacity (TLC). A high TLC demonstrates hyperinflation; that is, there is more air in the lungs than there should be, which is consistent with emphysema. Increased residual volume signifies air trapping, meaning the patient cannot exhale as much air as he should. This demonstrates an obstruction to exhalation. A low TLC suggests a restrictive ventilatory defect whereby the doctor may perform additional pulmonary procedures.
Diffusion Capacity
Diffusion capacity is a measurement of gases that transfer from the alveoli to the capillary. The patient inhales a very small amount of carbon monoxide. The doctor measures the amount of carbon monoxide absorbed by the blood. A reduced diffusion capacity is consistent with emphysema, although it occurs in other lung diseases as well.
Exercise Testing and Oximetry
In exercise testing, the physician connects the patient to a small oxygen utilization and measurement machine. The machine records these measurements while the doctor walks the patient. The physician can obtain consistent and accurate assessment of arterial oxygen saturation when using pulse oximetry machines. The physicians at the Institute use oximetry with particular usefulness in predicting those with acute asthma who will require more aggressive treatment. Arterial oxygen saturation has also been well utilized to demonstrate the lack of efficacy of many drugs used to treat acute viral bronchiolitis.
PET Scan
PET scanning or Positron Emission Tomography, is a procedure that produces a 3D image indicating where the body is using oxygen to burn glucose. In PET, the physician injects a small amount of a radioactive drug into the patient and places the patient in the PET scanner. The PET scanner consists of thousands of small radiation detectors that measure the radiation that is being emitted by the radioactive drug within the patient. Thus, the PET scanner makes 3D images that show where the radioactive drug went in the body. A PET scan shows how the body is working as opposed to how it looks in other forms of medical imaging, such as CAT scanning and MRI. The physicians at the Institute use PET scanning to discover how extensive a disease is within a patient.
Thoracentesis
The doctor performs this procedure to drain large amounts of fluid for therapeutic purposes and to obtain a sample of pleural fluid. The patient sits at a table, leaning against it with his arms resting on the tabletop. The doctor locates the pleural fluid by ultrasound or through percussion. In percussion, the doctor places one finger on the patient's back and taps against this finger with a finger from the other hand. Lungs that are filled with air sound hollow, while lungs surrounded by fluid sound dull. The doctor, after administering an anesthetic, advances a needle until the pleural space is entered, and then, using another slightly larger needle, drains the fluid. The doctor usually takes a chest x-ray after the procedure to detect a possible pneumothorax.
Closed pleural biopsy
Sometimes the doctor requires a sample of the pleural membrane. The doctor performs a closed pleural biopsy to obtain the sample in the same manner as thoracentesis, except that the doctor uses a different needle to obtain a sample of the pleural membrane.
Bone Density
The Institute For Better Breathing uses the Lunar Bone Densitometer, the state-of-the-art instrument to detect osteoporosis. The system provides for a comfortable, safe, and accurate examination. It typically takes only a few minutes of resting, fully dressed, on the densitometer. The test results are available immediately.
The machine measures bone density in various sites of the body. With this test, the doctors can detect osteoporosis before a fracture occurs; predict your chances of fracturing in the future, determine your rate of bone loss and/or monitor the effects of treatment if the test is conducted at intervals of a year or more.
Institute for Better Breathing: (818) 842-1327 - Burbank and Glendale, CA