Ep. 284 Optimizing Nasal Airway for CPAP Compliance with Dr. Michael Hutz and Dr. Atul Malhotra

Is nasal obstruction the overlooked culprit behind CPAP intolerance? On this episode of BackTable ENT & Allergy, Dr. Gopi Shah interviews Dr. Atul Malhotra and Dr. Michael Hutz to examine the critical but often underappreciated role of the nose in obstructive sleep apnea management. They discuss how nasal obstruction can undermine CPAP adherence, why relying solely on AHI may miss key issues, and how identifying the true cause of intolerance can lead to more personalized and effective therapy.

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This podcast is supported by

Aerin Medical
https://vivaer.com/

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Timestamps

00:00 - Introduction
04:05 - OSA Presentation and AHI Limitations
08:13 - Understanding CPAP Intolerance and Nasal Obstruction
15:24 - Evaluating Nasal Obstruction
20:32 - Nasal Anatomy and Workup
27:47 - DICE Technique and Assessing Dynamic Nasal Collapse
32:51 - Medical and Non-Surgical Management
37:29 - Surgical Options and VivAer
43:39 - Nasal Procedures and CPAP Success
51:57 - Nasal Surgery and Heart Outcomes
55:23 - Beyond CPAP: Nasal Breathing, Myofunctional Therapy, and Collaborative Care
01:04:51 - Wrap Up

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More about this episode

The physicians review practical strategies for evaluating nasal obstruction, from targeted patient questionnaires, physical exams, nasal endoscopy, and selective imaging. The doctors also detail medical and surgical treatment options, from allergy management and nasal sprays to septoplasty, turbinate reduction, functional rhinoplasty, and temperature-controlled radiofrequency (VivAer). Throughout the episode, they highlight how comprehensive nasal evaluation and intervention can significantly improve CPAP comfort and adherence.

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Resources

Dr. Atul Malhotra - https://providers.ucsd.edu/details/22362/sleep-medicine-pulmonology-(lung)

Dr. Michael Hutz- https://doctors.rush.edu/details/19100

CPAP treatment persistence following nasal procedures in obstructive sleep apnea - https://www.tandfonline.com/doi/pdf/10.1080/13696998.2026.2671550

Design and rationale for treating Obstructive Sleep Apnea using Targeted Hypoglossal Nerve Stimulation trial - https://www.sciencedirect.com/science/article/pii/S1551714422001306

The Impact of Mouth-Taping in Mouth-Breathers with Mild Obstructive Sleep Apnea - https://pmc.ncbi.nlm.nih.gov/articles/PMC9498537/

VATRAC Trial of VivAer - https://aerinmedical.com/company/news-and-media/aerin-medical-announces-positive-two-year-outcomes-from-the-vatrac-trial-of-vivaer/

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