Authors (including presenting author) :
Poon CY(1), Leung YH(1), Yan FP(1)
Affiliation :
(1) Physiotherapy Department, Yan Chai Hospital
Introduction :
Obstructive sleep apnea (OSA) is a common problem in children. A medicine study by the Chinese University of Hong Kong in 2010 estimated about 5% of school-aged children in Hong Kong are affected by OSA (Li et. al., 2010). Traditional management of OSA includes Continuous Positive Airway Pressure Therapy (CPAP) and adenotonsillectomy. Recent evidence revealed that OSA may be caused by different orofacial myofunctional disorders such as hypotonic tongue, tongue tie and mouth breathing etc (Cheng et.al., 2017). Several studies indicated that Orofacial Myofunctional Therapy (OMT) can eliminate poor oral habits, improve tongue posture and encourage nose breathing (Cheng et.al., 2017). OMT training program includes various simple exercises such as pushing tongue against a spoon, button pull, tube chew and lip massage etc. Our department has established a pilot structured OMT program including Tele rehabilitation since November 2023. We target both pediatric and adult population with different disorders such as OSA, allergic rhinitis and mouth breather.
Objectives :
The aim of this pilot study is to evaluate the effectiveness of the pilot OMT program in Physiotherapy Department of YCH.
Methodology :
Patients referred for OMT program were assessed individually and taught OMT exercises (including tongue mobility, lips and nose breathing exercises). The program consists of 4 sessions every 1-2 months, in which the first and last sessions are face-to-face session while the second and third session are Tele-consultation. Training materials are given to patients in the first session and they can review the OMT exercise videos through HA Go. The mobile Apps also remind patients to do home exercises. Additional sessions can be arranged if patient could not perform the exercises precisely.
Outcome measures
• Numeric Global Rating of Change Scale (NGRCS)
• Sino-nasal Outcome Test (SNOT-22): a symptom-based rhinosinusitis outcome measure
• Epworth Sleepiness Scale (ESS): measures the general level of daytime sleepiness
• Average tongue pressure (hPa): measured by TPS-100 oral performance instrument
Result & Outcome :
Result
From Jan 2024 to Dec 2024, 30 paediatrics (age range 4-17) and 3 adult (age range 31-57) patients attended the program. Majority of reason for referral was allergic rhinitis (85%). 21 of them were discharged and all of them are able to complete the program within 4 sessions. Average NGRCS was 5.7±2.1. SNOT-22 and ESS showed decreasing trend from 31.6±20.7 to 23.1±9.4 and 8.9±5.9 to 6.0±1.5 respectively, while average tongue pressure showed significant improvement from 199.9±126.4 hPa to 247.0±149.2 hPa (p=0.044, 95%CI -92.7 to -1.6).
Conclusion
This pilot program showed potential benefit to patient with OSA and allergic rhinitis ,and further more cases should be included for analyzing its effectiveness. Positive feedback about Tele- consultation was obtained from patients. Students can attend the program at home which can ease parents’ pressure and reduce the risk of infection. Exercise compliance can also be improved by sending notification from HA Go. For the future development of the program, tongue range of motion ratio (TRMR) and Apnea Hypopnea Index (AHI) measured by Belun Ring would be included in our outcome measures. More patients such as adults with OSA may benefit from the program when additional referral source is available. Thus, there will be a collaboration program with Department of Surgery in YCH to provide OMT for Obese patients with OSA.
