tag:blogger.com,1999:blog-39888086085497026882024-03-05T18:10:53.752-08:00signs and symptoms of throat cancer picturesAnonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.comBlogger500125tag:blogger.com,1999:blog-3988808608549702688.post-7159038399361046192014-07-19T10:56:00.000-07:002014-07-21T22:52:29.794-07:00Ear Injection of AM-101 May Stop Tinnitus<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhclt0Kny7GXBEweTFmkeCbCbLp6IX6HXA7KghcppZelj8GoLG7VFM468na6XXp2Z_EfEUPinSt-tSH5aRD1YZ4F_wthDJhm-Z9X6khIBTThS6nsld3-NGHK6XwDqJJbvJZvEncR4Rpi4s/s1600/earache1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhclt0Kny7GXBEweTFmkeCbCbLp6IX6HXA7KghcppZelj8GoLG7VFM468na6XXp2Z_EfEUPinSt-tSH5aRD1YZ4F_wthDJhm-Z9X6khIBTThS6nsld3-NGHK6XwDqJJbvJZvEncR4Rpi4s/s1600/earache1.jpg" height="213" width="320" /></a></div>Phantom ringing of the ears also known as <a href="http://www.fauquierent.net/audiotin.htm">tinnitus</a> is an extremely frustrating condition that afflicts many people. Often triggered by hearing nerve damage, there's no good treatment to fix this condition once it sets in.<br /><div><br /></div><div>Until possibly now... </div><div><br /></div><div><a href="http://journals.lww.com/otology-neurotology/Fulltext/2014/04000/Efficacy_and_Safety_of_AM_101_in_the_Treatment_of.4.aspx">AM-101</a> made by <a href="http://www.aurismedical.com/">Auris Medical</a> is an experimental drug containing esketamine hydrochloride embedded within a hyaluronic acid gel formulation. It works by blocking the NMDA receptors of the cochlear inner hair cell.</div><div><br /></div><div>Normally, when there is trauma sustained by the cochlea whether it be loud noise or <a href="http://www.fauquierent.net/audiosudden.htm">viral infection</a>, excess amount of a neurotransmitter called glutamate gets release. The problem is that too much glutamate also triggers hearing nerve death due to over-excitation via the NMDA receptor. When these hearing nerves die, it leaves the brain cells responsible for hearing in a permanently switch-on state leading to tinnitus, even if there's no sound present.</div><div><br /></div><div>AM-101 is hypothesized to block the NMDA receptor from being over-stimulated by the glutamate neurotransmitter thereby preventing hearing nerve death.</div><div><br /></div><div>But, does it work?</div><div><br /></div><div>According to <a href="http://journals.lww.com/otology-neurotology/Fulltext/2014/04000/Efficacy_and_Safety_of_AM_101_in_the_Treatment_of.4.aspx">one small prospective, double-blind, randomized, placebo-controlled study</a> involving 248 patients, it DOES work to a significant degree. 42% reported their tinnitus was half as quiet as before compared with 14% in the placebo group. After 90 days, 57% of those taking the active gel said their tinnitus was 'much improved' or 'very much improved'. <br /><br />Of course, the trick is to administer the drug before nerve death has set in after which it would be too late. In the study, only patients with onset of ringing within 3 months were eligible to participate.<br /><br />Patient also need to realize that the drug is administered by injection through the eardrum and into the middle ear space. This injection technique is commonly used in the treatment of sudden nerve hearing loss where steroids are injected. Watch <a href="http://youtu.be/FyZ0OLFEAm8">video</a> of this injection method below.<br /><br />Unfortunately, AM-101 is not available except under research protocols currently and is undergoing FDA clinical trials. The preliminary results are very promising however.<br /><br /><b>Reference:</b><br /><a href="http://journals.lww.com/otology-neurotology/Fulltext/2014/04000/Efficacy_and_Safety_of_AM_101_in_the_Treatment_of.4.aspx">Efficacy and Safety of AM-101 in the Treatment of Acute Inner Ear Tinnitus—A Double-Blind, Randomized, Placebo-Controlled Phase II Study</a>. Otology & Neurotology: April 2014 - Volume 35 - Issue 4 - p 589-597 <br /><br /><br /><iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/FyZ0OLFEAm8" width="420"></iframe></div>Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-10977725823031888902014-07-19T02:52:00.000-07:002014-07-21T22:52:29.810-07:00Dr. Chang Quoted in Slate Magazine Article<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiCvzVdzWTPt5LDmK-SVOqPS7VHjzLcXi6oCNDZaz5AkJEVhTRIbsc-UrF4SHr2NwznAL4-oazxnhqsgFyUdTQn7DNn1kcNimTtSqqY3p1PeD_YUuIzhZ9hUGifIo-spPyKNKkGp7Sas4/s1600/slate_trans2.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiCvzVdzWTPt5LDmK-SVOqPS7VHjzLcXi6oCNDZaz5AkJEVhTRIbsc-UrF4SHr2NwznAL4-oazxnhqsgFyUdTQn7DNn1kcNimTtSqqY3p1PeD_YUuIzhZ9hUGifIo-spPyKNKkGp7Sas4/s1600/slate_trans2.png" height="240" width="320" /></a></div><a href="http://www.fauquierent.net/aboutme.htm">Dr. Chang</a> was quoted several times in a <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2014/07/strange_things_your_body_does_doctors_answer_reddit_questions.html">Slate Magazine article</a> regarding some strange things the body does. The <a href="http://www.slate.com/articles/health_and_science/medical_examiner/2014/07/strange_things_your_body_does_doctors_answer_reddit_questions.html">article</a> organized in a question and answer format, includes several ENT questions for which Dr. Chang provided answers to.<br /><br />Such answered questions by Dr. Chang included:<br /><blockquote class="tr_bq"> Occasionally my hearing will ‘go out’ and everything will go dull.. and then a high pitched frequency screeches for a few minutes. No one else hears it and everything else seems really hushed while it's happening. Maybe it's the aliens.<br /><br /> I can make a loud rumbling sound in my ears at will without moving any muscle in my face. I have no idea what this is called but it kind of sounds like when you put your ear to a seashell at the beach.<br /><br /> Once in a while when I eat something sugary I get a really sharp pain under/around my ears. like really sharp. It sucks. I did some reading on it, I think it has something to do with the salivary glands?<br /><br /> Tonsil stones or “Tonsillolith”. They're small white/yellowish blob that randomly comes out of my mouth sometimes... And they smell extremely bad. </blockquote>Read the magazine article for the answers!<br /><br /><b>Source:</b><br /><a href="http://www.slate.com/articles/health_and_science/medical_examiner/2014/07/strange_things_your_body_does_doctors_answer_reddit_questions.html">Why Does Your Body Do These Strange Things?</a> Slate July 2014. Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-80656987806409213862014-07-13T16:46:00.000-07:002014-07-21T22:52:29.822-07:00Botox Injection Severe Side Effects Treatment<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1Qu0F5M8_DmeOvEUdVi5xyNDPGjxHAKnVT82is7luVy2bN9e53qgzOhoZ0L2Is5MBxfSkkrEPH4UrIzUAe_X_wws2GRoxgepBe3wMuVaIFuS-b-QdqFAbBKNhmytwSWeC4Z9GlrsiBio/s1600/Unknown.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh1Qu0F5M8_DmeOvEUdVi5xyNDPGjxHAKnVT82is7luVy2bN9e53qgzOhoZ0L2Is5MBxfSkkrEPH4UrIzUAe_X_wws2GRoxgepBe3wMuVaIFuS-b-QdqFAbBKNhmytwSWeC4Z9GlrsiBio/s1600/Unknown.jpeg" /></a></div>Side effects from botox injections are not uncommon and even expected to some degree in the region where the injection was performed. For example, when botox is injected into the voicebox for <a href="http://www.fauquierent.net/SD.htm">spasmodic dysphonia</a>, normal and expected side effects include <a href="http://www.fauquierent.net/voice.htm">hoarseness</a> and <a href="http://www.fauquierent.net/swallow.htm">dysphagia</a>.<br /><div><br /></div><div>However, in very rare instances, more severe side effects may occur that may even appear to be life-threathening including <a href="http://www.fauquierent.net/voicebreathing.htm">stridor</a>, shortness of breath, profound difficulty <a href="http://www.fauquierent.net/swallow.htm">swallowing</a>, etc.</div><div><br /></div><div>In such situations, beyond supportive care and ruling out more serious conditions like a heart attack, treatment with <a href="http://en.wikipedia.org/wiki/Pyridostigmine">pyridostigmine</a> can be quite effective in alleviating if not outright reversing the severe botox side effects.<br /><br /><a href="http://en.wikipedia.org/wiki/Pyridostigmine">Pyridostigmine</a> is a drug that prevents the body from breaking down the chemical mediator (<a href="http://en.wikipedia.org/wiki/Acetylcholine">acetylcholine</a>) that causes muscle contraction. Given botox works by preventing the release of acetylcholine, it makes sense that by preventing the body from breaking this hormone down, more of it is around to activate the muscle.<br /><br />Put simply, pyridostigmine increases acetylcholine levels to counteract the botox effect of decreasing acetylcholine leading to a net zero effect theoretically. But does it work that way? According to one <a href="http://www.ncbi.nlm.nih.gov/pubmed/25008379">research paper</a>, it certainly appears to do so!</div><div><br /></div><div>In cases of stridor due to <a href="http://www.fauquierent.net/vocalcordparalysis_bilateral.htm">bilateral vocal cord paralysis</a> or other severe side effect, an initial treatment of 300 mg of pyridostigmine x 2 doses separated by 6 hours followed by 30 mg 3x per day is recommended. Symptom improvement occurs fairly rapidly.<br /><br />In less dire situations, simply starting a patient on pyridostigmine 30 mg 3x per day without an initial loading dose is sufficient.<br /><br />Otherwise, behavioral support alone is recommended for less severe botox side effects.<br /><br /></div><div><br /></div><div><b>Reference:</b></div><div><a href="http://www.ncbi.nlm.nih.gov/pubmed/25008379">Pyridostigmine for Reversal of Severe Sequelae From Botulinum Toxin Injection</a>. Journal of Voice. 2014 Jul 5. pii: S0892-1997(14)00091-5. doi: 10.1016/j.jvoice.2014.04.010. [Epub ahead of print] </div>Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-15513326573762057042014-07-08T05:20:00.000-07:002014-07-21T22:52:29.841-07:00Does Sinus and/or Nasal Surgery Help with Sleep Apnea?<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuNftMfu25Z93c1ZiPU6e3FnDxV_6Ih8M-q5gjqjDsKQc-GYf0WjlZOPO6o5LOT9BGBRNMCDoYydadlXIHd4TKqMaD4GznhM9ACxDfbmwM4DsW_rSjl13rPOdsIbqWapdNY_YASaqJre4/s1600/nasal_congestion.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuNftMfu25Z93c1ZiPU6e3FnDxV_6Ih8M-q5gjqjDsKQc-GYf0WjlZOPO6o5LOT9BGBRNMCDoYydadlXIHd4TKqMaD4GznhM9ACxDfbmwM4DsW_rSjl13rPOdsIbqWapdNY_YASaqJre4/s1600/nasal_congestion.jpg" height="320" width="213" /></a>Bluntly, the answer is not really... Although it may make sense that improving nasal airflow should help with <a href="http://www.fauquierent.net/osa.htm">obstructive sleep apnea</a>, the reality is that it does not make a profound difference. Indeed, there was a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24687940">study in 2014</a> that looked into this question.<br /><br />In this <a href="http://www.ncbi.nlm.nih.gov/pubmed/24687940">study</a>, 3 groups of patients were looked at divided into patients with mild, moderate, or severe obstructive sleep apnea (OSA). These patients underwent <a href="http://www.fauquierent.net/ess.htm">sinus surgery</a>, <a href="http://www.fauquierent.net/septo.htm">septoplasty</a>, and <a href="http://www.fauquierent.net/turbinatereduction.htm">turbinate reduction</a>.<br /><br />What was found was that patients with severe <a href="http://www.fauquierent.net/osa.htm">OSA</a> with a mean AHI of 52 would go down to 43 (normal being less than 5) after surgery. Moderate OSA with a mean AHI of 22 down to 20. Patients with mild OSA did not have any significant changes to AHI at all.<br /><br />In other words, for patients with moderate or severe OSA, although the AHI <i>does</i> decrease somewhat, it does not decrease enough that it really makes any clinical difference. Patients with moderate or severe OSA still had OSA... and still would need to use a CPAP or equivalent machine after surgery to correct their sleep apnea.<br /><br />Although at first blush, these results may not make sense, it actually does make sense when you consider sleep apnea to be a multi-level disorder affecting not just the nose, but the throat as well.<br /><br />For example, the back of the tongue may fall backwards obstructing the airway causing sleep apnea. Correcting nasal factors would have absolutely ZERO impact on tongue factors of OSA.<br /><br />In order to determine where these other anatomic factors may be that may contribute to OSA, a sedated or <a href="http://www.fauquierent.net/sleependoscopy.htm">sleep endoscopy</a> is often performed. Watch the video below.<br /><br />Granted, patients may STILL wish to pursue sino-nasal surgery due to discomfort with their <a href="http://www.fauquierent.net/sinusitis.htm">sinuses</a> and <a href="http://www.fauquierent.net/nasalobstruction.htm">nasal breathing</a>... but patients need to be aware that their OSA may still remain essentially unchanged!<br /><br />Sino-nasal surgery may also help with CPAP compliance as lower pressures may be required to address OSA compared to before surgery. Why? Because the nasal passages are more open after surgery so it is easier to push air into lungs when using CPAP.<br /><br /><b>Reference:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/24687940">Effects of Endoscopic Sinus Surgery and Nasal Surgery in Patients with Obstructive Sleep Apnea</a>. Otolaryngol Head Neck Surg. 2014 Mar 31;151(1):171-175. [Epub ahead of print]<br /><br /><iframe allowfullscreen="" frameborder="0" height="315" src="//www.youtube.com/embed/iNmSexAKTsM" width="560"></iframe>Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-35960254705879914532014-07-02T08:41:00.000-07:002014-07-21T22:52:29.853-07:00CEO of JPMorgan has Throat Cancer<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGSNSrjOF9UcScq3HaTEhiUXbSL0yhIJjg9gF49wZ0CnAiCVGfM9tIKmsSSBTOIcpHaqUcb6uPzmLv5JjU_hJKT12v7X2wRZ_C1ljJ1NHCwld53gGYKTz-R_0rJynRFque7v1Goxtw5Pw/s1600/440px-Jamie_Dimon,_CEO_of_JPMorgan_Chase.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGSNSrjOF9UcScq3HaTEhiUXbSL0yhIJjg9gF49wZ0CnAiCVGfM9tIKmsSSBTOIcpHaqUcb6uPzmLv5JjU_hJKT12v7X2wRZ_C1ljJ1NHCwld53gGYKTz-R_0rJynRFque7v1Goxtw5Pw/s1600/440px-Jamie_Dimon,_CEO_of_JPMorgan_Chase.jpg" height="254" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Image from <a href="http://en.wikipedia.org/wiki/Jamie_Dimon">Wikipedia</a> by <a href="http://commons.wikimedia.org/wiki/Category:Photographs_by_Steve_Jurvetson">Steve Jurvetson</a></td></tr></tbody></table><div style="text-align: left;">The CEO and President of JPMorgan, Jamie Dimon, announced that he has <a href="http://www.usatoday.com/story/money/business/2014/07/01/jamie-dimon-cancer/11933875/?utm_source=dlvr.it&utm_medium=twitter&dlvrit=206567">throat cancer</a> and is currently undergoing treatment at Memorial Sloan Kettering Cancer Center in Manhattan for the next eight weeks. According to a letter he sent to shareholders on July 1, 2014:<br /><blockquote class="tr_bq">"I wanted to let you know that I have just been diagnosed with throat cancer. The good news is that the prognosis from my doctors is excellent, the cancer was caught quickly, and my condition is curable. Following thorough tests that included a CAT scan, PET scan and a biopsy, the cancer is confined to the original site and the adjacent lymph nodes on the right side of my neck. Importantly, there is no evidence of cancer elsewhere in my body." [<a href="http://www.usatoday.com/story/money/2014/07/01/jpmorgan-chase-jamie-dimon-letter-cancer/11943099/">link</a>]</blockquote></div><div style="text-align: left;">Based on this information, he has a Stage 3 or 4 (out of possible 4) throat cancer. Stage 1 is the early and best stage to have. It is less clear exactly where the throat cancer is whether it be tonsil, tongue, oropharynx, or some other location. Based on probabilities, he most likely has squamous cell carcinoma which is the most common type of cancer of the head and neck including the throat.<br /><br />Although he states the prognosis is good, it is not as good compared to patients where no neck mass is present (Stage 1 or 2) where chemotherapy may not even be necessary.<br /><br />He also mentions the word "curable" which I am leary of when he has just started treatment. Even if no cancer is detectable at the end of treatment, throat cancer, especially stage 3 or 4, has the potential to come back.<br /><br />Recall the case of actor Larry Hagman of Dallas fame... He had throat cancer and was declared <a href="http://fauquierent.blogspot.com/2012/08/actor-larry-hagman-treated-for-throat.html">"cured" 8/29/12</a>. Than on <a href="http://fauquierent.blogspot.com/2012/11/actor-larry-hagman-dies-of-throat-cancer.html">11/24/13, he died of cancer recurrence and complications</a>.</div><br />The risk of cancer recurrence is highest within the first 2-3 years after treatment completion, and markedly decreases after 5 years.<br /><br />Typically if cancer has not come back after 5 years, the word "cure" may than be used, but even than, such patients are seen yearly for the rest of their life for cancer monitoring.<br /><br />Because the risk of cancer recurrence is so high in the first few years after treatment completion, patients are seen frequently for the first 2-3 years after treatment.<br /><br />Every 2 months for the first year. Every 3-4 months in the 2nd year. Every 4 months in the 3rd year. Every 6 months in the 4th year. Yearly starting at 5 years after treatment.<br /><br />This type of follow-up applies to all head and neck cancer.<br /><br /><b>Source:</b><br /><a href="http://www.usatoday.com/story/money/business/2014/07/01/jamie-dimon-cancer/11933875/?utm_source=dlvr.it&utm_medium=twitter&dlvrit=206567">JPMorgan CEO Jamie Dimon has cancer</a>. USA Today 7/2/14 <br /><br /><a href="http://www.usatoday.com/story/money/2014/07/01/jpmorgan-chase-jamie-dimon-letter-cancer/11943099/">JPMorgan CEO Jamie Dimon's letter to shareholders</a>. USA Today 7/1/14 Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-33617704627949384992014-06-19T11:14:00.000-07:002014-07-21T22:52:29.872-07:00Why is Allergy Present More Now than in Past? Hygiene vs Hapten Hypothesis<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiS4zGVavtbSjNTDHhIDfk7EqRa6oAsO3bWdcfbrRzXZXIqOArDee_tJSI8Sx2O0NIf7FkYwOTQ0K9RC0-YPpqpaKSjE1TF_OAtpKWyc-yN0OoW12a4lZ5x3M4xXxVabzEV9uOShQIi3PA/s1600/allergy_lady.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiS4zGVavtbSjNTDHhIDfk7EqRa6oAsO3bWdcfbrRzXZXIqOArDee_tJSI8Sx2O0NIf7FkYwOTQ0K9RC0-YPpqpaKSjE1TF_OAtpKWyc-yN0OoW12a4lZ5x3M4xXxVabzEV9uOShQIi3PA/s1600/allergy_lady.jpg" height="213" width="320" /></a></div>It is pretty much well-established fact that there are more people with food and inhalant allergy now than in the past. Two main theories have been proposed to try and explain this unfortunate phenomenon that is affecting more kids with each new generation.<br /><br />Keep in mind the explanations provided below are significantly simplified for lay public understanding. One can go into cytokines, Th1 and Th2 responses, and other techno-jargon, but not here.<br /><br />Perhaps the most popular explanation is the "<b>Hygiene Hypothesis</b>" which mainly states that major improvements in public health and medical technology have led to a cleaner home environment with less infectious and parasitic disease burden, resulting in less stimulation of the immune system and a consequent predisposition to allergic disease. <br /><br />This hypothesis helps to explain why 3rd world nations which have poor sanitation and greater microbial/parasitic diseases do not suffer nearly as much allergic problems as well-developed nations. Basically, the dirtier and more disease ridden people grow up in, the less allergies they have because the immune system is preoccupied with fighting "real" infectious problems. In the absence of such immune stimulation, the immune system essentially gets "bored" and starts treating normal things like pollen as an infection that needs to be eliminated.<br /><br />The alternative explanation is the "<b>Hapten Hypothesis</b>." Before explaining further how this theory works, first a little immunology instruction. Haptens are very small molecules which are able to easily pass through skin and mucus membranes with ease and by themselves cause absolutely no problems whether immune or allergy. However, when such haptens attach to a carrier protein, it may elicit a profound allergic immune response. Keep in mind that the carrier protein itself may also not elicit an immune response. It is the combination of hapten and carrier protein together that causes the problem.<br /><br />According to the Hapten Hypothesis, persistent low-grade exposure to environmental haptens via the skin and oral routes at key times during human development – namely, pregnancy and the first year of life – can lead to allergy development. Dietary hapten intake may interfere with oral immune tolerance mechanisms while repeated skin exposure to haptens may promote elevated allergy responses.<br /><br />What are some of these oral and skin haptens?<br /><br />• Preservatives<br />• Nickel<br />• Cobalt<br />• Vanillin<br />• Pesticides<br />• Drugs (antibiotics and others)<br />• Industrial chemicals<br />• Food emulsifiers<br />• Food colorants<br />• Flavour enhancers<br />• Antioxidants <br />etc etc<br /><br />Arguments promoting the Hapten Hypothesis over the Hygiene Hypothesis goes as follows:<br /><br />#1. The biggest reduction in infections came at the end of the 19th century with improvements in sanitation and nutrition – not in the second half of the 20th century, when the greatest increase in allergic disease began – so why didn't they occur together??? However, significant exposure of haptens to the human population on a recurrent basis occurred on a major scale during the 20th century.<br /><br />#2. The Hygiene Hypothesis states that our immune system does not get stimulated enough by infections. But technically, that's not true... Vaccination programs are the deliberate exposure of our immune system to a whole host of diseases including polio, tetanus, diphtheria, and measles, all by the age of 1 year. Disease burden is not a factor according to the Hapten Hypothesis.<br /><br />#3. Studies have repeatedly shown that respiratory infections are associated with the development of allergic disease... but according to the Hygiene Hypothesis, the opposite should occur. According to the Hapten Hypothesis, drugs like antibiotics are haptens and can actually <i>promote</i> allergy development.<br /><br />So is there a definitive answer here?<br /><br />Unfortunately not, though there are very smart people working on this.<br /><br />My hunch is that the final answer may be a combination of both hypothesis.<br /><br />At the very least, there really may be something to the organic movement which promotes eating/drinking foods that contain no pesticides, preservatives, or chemicals and the use of skin products which also contain only "organic" ingredients.<br /><br />However, keep in mind that the BIGGEST impact towards the prevention of allergy development are actions taken while a woman is pregnant through the infant's first year of life. After that, interventions may be too little, too late according to the Hapten Hypothesis.<br /><br />I personally like the <a href="http://www.ewg.org/" target="_blank">Environmental Working Group</a> website to check if certain products are "organic" or not because I certainly don't have the time to check every consumer product myself.<br /><br />When it comes to food, try to make all baby food from scratch. Next best would be to purchase baby food that is sold refrigerated (avoid baby food sold on regular shelves).<br /><br /><b>References:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Trends+Immunol.%5bJour%5d+AND+30%5bvolume%5d+AND+67%5bpage%5d+AND+2009%5bpdat%5d&cmd=detailssearch">Does hapten exposure predispose to atopic disease? The hapten-atopy hypothesis</a>. Trends Immunol. 2009 Feb;30(2):67-74. doi: 10.1016/j.it.2008.11.006. Epub 2009 Jan 8. <br /><br /><a href="http://www.estetologia.pl/art/emk2011-006en.html">Food-provoked eczema: A hypothesis on the possible role of systemic contact allergy to haptens present in both cosmetics and foods</a>. Estetol Med Kosmetol 2011; 1(1): 35-40. DOI: http://dx.doi.org/10.14320/EMK.2011.006<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/24936850">The importance of hapten-protein complex formation in the development of drug allergy</a>. Current Opinion in Allergy and Clinical Immunology 2014 Jun 17;Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-39489682543283404262014-06-15T18:00:00.000-07:002014-07-21T22:52:29.903-07:00Nexium is Available Over-The-Counter<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqY4uwPGeYjp_qbBYXTcjO6ZMSD5p4lAK_5q8PvFFZxkw_EjYcbkB9Vq6L0nKa4WqLB_FouwRfQOsC9KsaK0ZdGW-iLYbIaSKfBptBim2R1B5lu9JWpi_VOyK06GwutLTDLNCIFN-fGbI/s1600/nexium_otc_598695.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqY4uwPGeYjp_qbBYXTcjO6ZMSD5p4lAK_5q8PvFFZxkw_EjYcbkB9Vq6L0nKa4WqLB_FouwRfQOsC9KsaK0ZdGW-iLYbIaSKfBptBim2R1B5lu9JWpi_VOyK06GwutLTDLNCIFN-fGbI/s1600/nexium_otc_598695.jpg" height="200" width="158" /></a></div><a href="http://www.amazon.com/gp/product/B00I7L4V04/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B00I7L4V04&linkCode=as2&tag=fauentcon-20">Nexium</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=fauentcon-20&l=as2&o=1&a=B00I7L4V04" height="1" style="border: none !important; margin: 0px !important;" width="1" />, a medication to treat acid <a href="http://www.fauquierent.net/lpr.htm" target="_blank">reflux</a>, has gone over-the-counter and joins <a href="http://www.amazon.com/gp/product/B0000AN9L7/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B0000AN9L7&linkCode=as2&tag=fauentcon-20">Prilosec</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=fauentcon-20&l=as2&o=1&a=B0000AN9L7" height="1" style="border: none !important; margin: 0px !important;" width="1" /> and <a href="http://www.amazon.com/gp/product/B002CVUQWC/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B002CVUQWC&linkCode=as2&tag=fauentcon-20">Prevacid</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=fauentcon-20&l=as2&o=1&a=B002CVUQWC" height="1" style="border: none !important; margin: 0px !important;" width="1" /> as ex-prescriptions now OTC.<br /><br />It's available for purchase in most pharmacies and even on <a href="http://www.amazon.com/gp/product/B00I7L4V04/ref=as_li_tl?ie=UTF8&camp=1789&creative=390957&creativeASIN=B00I7L4V04&linkCode=as2&tag=fauentcon-20">Amazon</a><img alt="" border="0" src="http://ir-na.amazon-adsystem.com/e/ir?t=fauentcon-20&l=as2&o=1&a=B00I7L4V04" height="1" style="border: none !important; margin: 0px !important;" width="1" />.<br /><br />Read more about how reflux medications work <a href="http://www.fauquierent.net/refluxmeds.htm" target="_blank">here</a>.<br /><br /><br /><iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ss&ref=ss_til&ad_type=product_link&tracking_id=fauentcon-20&marketplace=amazon&region=US&placement=B00I7L4V04&asins=B00I7L4V04&linkId=&show_border=false&link_opens_in_new_window=true" style="height: 240px; width: 120px;"></iframe><iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ss&ref=ss_til&ad_type=product_link&tracking_id=fauentcon-20&marketplace=amazon&region=US&placement=B0000AN9L7&asins=B0000AN9L7&linkId=&show_border=false&link_opens_in_new_window=true" style="height: 240px; width: 120px;"></iframe><iframe frameborder="0" marginheight="0" marginwidth="0" scrolling="no" src="//ws-na.amazon-adsystem.com/widgets/q?ServiceVersion=20070822&OneJS=1&Operation=GetAdHtml&MarketPlace=US&source=ss&ref=ss_til&ad_type=product_link&tracking_id=fauentcon-20&marketplace=amazon&region=US&placement=B002CVUQWC&asins=B002CVUQWC&linkId=&show_border=false&link_opens_in_new_window=true" style="height: 240px; width: 120px;"></iframe>Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-90144516954334549582014-06-11T17:54:00.000-07:002014-07-21T22:52:29.922-07:00Are Surgeons Dumber than Anesthesiologists?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTLaar9RIrYZcfyPWrdrF0NlFYwA8Dlb1pyILaQkHekAc5rfIPUK8WJ1FmTIEztzlgKbS48HM0h2-ouaIcfs9AZgCjnd3vjnO6xZDENYxxtvEJqewLCmIXxOn1A7mkYErIaQ50K-4mm3s/s1600/surgery.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTLaar9RIrYZcfyPWrdrF0NlFYwA8Dlb1pyILaQkHekAc5rfIPUK8WJ1FmTIEztzlgKbS48HM0h2-ouaIcfs9AZgCjnd3vjnO6xZDENYxxtvEJqewLCmIXxOn1A7mkYErIaQ50K-4mm3s/s1600/surgery.jpg" height="240" width="320" /></a></div>The British Medical Journal in 2011 published a multicenter prospective comparative study comparing the intelligence of orthopedic surgeons and anesthesiologists. Before I give you the answer, a little history...<br /><br />Traditionally, orthopedic surgeons have the unfortunate stereotype in the medical community of being strong but stupid. Although making fun of orthopedic surgeons is a popular past-time among physicians giving rise to a number of jokes including:<br /><blockquote class="tr_bq">What do you call two orthopaedic surgeons looking at a chest X-ray? <b>ANSWER</b>: A double blind study.</blockquote>Anesthesiologists are considered quite the opposite. Although occasionally teased as gas-passers, they are respected as being quite the Einsteins.<br /><br />Check out this <a href="http://fauquierent.blogspot.com/2010/07/random-orthopedics-versus-anesthesia.html" target="_blank">video</a> illustrating just how much smarter anesthesiologists are compared to orthopedic surgeons.<br /><br />BUT... are such stereotypes true?<br /><br />Well... according to the <a href="http://www.bmj.com/content/343/bmj.d7506?tab=full">BMJ study</a> conducted in three United Kingdom hospitals, orthopedic surgeons are significantly more intelligent than anesthesiologists based on IQ scores (the Mensa Brain Test version 1.1.0 was used to measure intelligence). The mean intelligence test score of orthopaedic surgeons was 105.19 compared with 98.38 for anesthetists (the higher the score, the smarter).<br /><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPdSxFeI_2F-7fJ8tTGpgLGZO9za7MSYKIUcAUGnitMMAUXR9f5kuHdzG2eGFIz6iOPKg6So1NdCmXRBwYwc3uXOqzAABdTL6OuMkWQee8a4T8vXm5q4uNyClzv2NPX8R2GVUBrjsuYQY/s1600/F4.medium.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPdSxFeI_2F-7fJ8tTGpgLGZO9za7MSYKIUcAUGnitMMAUXR9f5kuHdzG2eGFIz6iOPKg6So1NdCmXRBwYwc3uXOqzAABdTL6OuMkWQee8a4T8vXm5q4uNyClzv2NPX8R2GVUBrjsuYQY/s1600/F4.medium.gif" height="176" width="320" /></a></div><br />According to the same study, the orthopedic surgeons were not only smarter than anesthesiologists, they were also significantly stronger based on dominant hand grip strength.<br /><br />So orthopedic surgeons are undeservedly viewed as being stupid when they are actually quite smart!!!<br /><br /><b>Reference:</b><br /><a href="http://www.bmj.com/content/343/bmj.d7506?tab=full">Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study</a>. BMJ 2011; 343 doi: http://dx.doi.org/10.1136/bmj.d7506 (Published 15 December 2011) Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-86215148648490078062014-06-06T11:51:00.000-07:002014-07-21T22:52:29.934-07:00Diagnostic Test for Laryngeal Sensory Neuropathy (Chronic Cough)?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj-tozaSfd1_DUCuoED6WfSDUG78EpssG0cc7rQSmVx3B2pm2pxOpSJhnBoXx1N5HuqzqPYRzzZOOXmMpxTcjWP9o4dgKetXwK9WFrBXhknL52a1YKFlFV9CNqXWh5Jt3H1QP5Mi9KAT0/s1600/cough_lady1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhj-tozaSfd1_DUCuoED6WfSDUG78EpssG0cc7rQSmVx3B2pm2pxOpSJhnBoXx1N5HuqzqPYRzzZOOXmMpxTcjWP9o4dgKetXwK9WFrBXhknL52a1YKFlFV9CNqXWh5Jt3H1QP5Mi9KAT0/s1600/cough_lady1.jpg" height="268" width="320" /></a></div>Patients who suffer from a persistent <a href="http://www.fauquierent.net/cough.htm">chronic cough</a> undergo a tremendous amount of testing, trials of medications, and seeing numerous specialists to try and make the cough go away. Ultimately, the cough may be found due to a rare condition called <a href="http://www.fauquierent.net/cough.htm">laryngeal sensory neuropathy</a> which is treated with anti-depressant and even seizure medications. This nerve also may contribute to <a href="http://www.fauquierent.net/swallow.htm" target="_blank">swallowing</a> problems as well.<br /><br />Because laryngeal sensory neuropathy is a diagnosis of exclusion, an extensive workup is required to rule out all other causes of cough including tests for <a href="http://www.fauquierent.net/lpr.htm">reflux</a>, reactive airway disease, <a href="http://www.fauquierent.net/RAST.htm">allergy</a>, etc. Given the time-consuming nature of evaluating a chronic cough, very smart researchers have been trying to develop a test that checks for laryngeal sensory neuropathy (LSN).<br /><br />One such test called SELSAP (<b>S</b>urface <b>E</b>voked <b>L</b>aryngeal <b>S</b>ensory <b>A</b>ction <b>P</b>otential) is a non-invasive, surface evoked, sensory nerve function testing of the superior laryngeal nerve. Why the superior laryngeal nerve? It's because that's the nerve that is responsible for causing the sensation/urge to cough in affected patients. It's also the primary nerve that suffers from the neuropathy. [see references below]<br /><br />The test basically involves placing an electrode to the side of the voicebox and another under the chin. A mild electric stimulus is than performed behind the ear.<br /><br />Because this test is so new, it is unproven and unclear whether this test will ultimately provide valuable assistance in the evaluation of a patient suffering from chronic cough. Normative values have yet to be rigorously determined.<br /><br />BUT... it is something that can be considered especially if the history is consistent with <a href="http://www.fauquierent.net/cough.htm">LSN</a> and the SELSAP is "clearly" abnormal (HYPERfunctional). In such cases, appropriate treatment can be immediately started without going through the entire chronic cough workup first.<br /><br />Of course, even though LSN treatment is started, it still behooves to still do the workup to ensure a person does not have <i>more than one</i> cause for persistent cough that would still need to be addressed for true cough resolution. Read more about <a href="http://fauquierent.blogspot.com/2010/06/laryngeal-sensory-neuropathy-lsn.html">LSN treatment failures here</a>.<br /><br />When it comes to <a href="http://www.fauquierent.net/swallow.htm" target="_blank">swallowing</a> difficulties, if SELSAP does come back abnormal (HYPOfunctional), it may suggest that there is "numbness" of the voicebox region preventing a proper swallow as the body does not "know" where the food is when it passes by leading to aspiration.<br /><br />Be aware that not all places will offer such testing. Contacting a good neurologist is really one's best bet to see if they are willing to learn and perform SELSAP.<br /><br />However, <a href="http://www.fauquierhealth.org/doctors-Kristin-Williams" target="_blank">Dr. Kristin Williams</a> in Warrenton, VA does perform this test.<br />Office Phone: 540-316-5980<br />384 Hospital Drive<br />Warrenton, VA 20186<br /><br /><br /><b>References:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/24880673">Surface-Evoked Laryngeal Sensory Action Potential Evaluation in Neurogenic Chronic Cough</a>. Journal of Voicw, May 28, 2014. <br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/?term=21120827">A new noninvasive method for determination of laryngeal sensory function</a>. Laryngoscope. 2011 Jan;121(1):158-63. doi: 10.1002/lary.21182.Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-15568216508140993222014-05-29T02:39:00.000-07:002014-07-21T22:52:29.954-07:00Vocal Ranges of Famous Singers Past and Present<a href="http://www.huffingtonpost.com/2014/05/20/top-artists-vocal-range_n_5357698.html?utm_hp_ref=tw">Concert Hotels</a> has put together a nifty interactive chart documenting the vocal ranges of famous singers past and present. Check it out!<br /><br />Keep in mind that the chart represents the <i>recorded</i> vocal range of each artist, not necessarily their actual range.<br /><br />For the "interactive" chart, click <a href="http://www.concerthotels.com/worlds-greatest-vocal-ranges">here</a>.<br /><br /><a href="http://www.concerthotels.com/worlds-greatest-vocal-ranges" target="_blank"><img border="0" src="http://www.concerthotels.com/images/creatives/vocalranges/mbd.png" height="1335" width="512" /></a><br /><br />Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-25912519860711129452014-05-26T02:20:00.000-07:002014-07-21T22:52:29.965-07:00Upper Lip Tie and Posterior Tongue Tie Treatment Without Sedation<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHs40TYlXuV1qTsddOrf_WpCGzwUj2OV0x-VrJx91YaUOgefYjAlV5pWCxf-nAEG7VggP9BBdkMej3kqAuUwc2eko9BPmXaN9tjNT8bIOh6R7_pm9719r8joWb9pLN5l5kdqOQBbvpqQo/s1600/step3.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHs40TYlXuV1qTsddOrf_WpCGzwUj2OV0x-VrJx91YaUOgefYjAlV5pWCxf-nAEG7VggP9BBdkMej3kqAuUwc2eko9BPmXaN9tjNT8bIOh6R7_pm9719r8joWb9pLN5l5kdqOQBbvpqQo/s1600/step3.jpg" /></a></div>It seems that in the past few years, <a href="http://www.fauquierent.net/upperliptie.htm">upper lip tie</a> and <a href="http://www.fauquierent.net/posteriortonguetie.htm">posterior "hidden" tongue tie</a> has become increasingly recognized as factors affecting breast-feeding which correspondingly has led to higher numbers of referrals for evaluation and treatment.<br /><br />Prior to 2011, I probably received only one or two consultations a year to evaluate these two conditions. Ever since than, it seems more and more infants are being diagnosed with these two conditions, especially by lactation consultants.<br /><br /><a href="http://www.fauquierent.net/tonguetie.htm">Anterior tongue tie</a> and <a href="http://www.fauquierent.net/upperliptie.htm">upper lip tie</a> have historically been easily treated in the clinic under local anesthesia using common tools any ENT has.<br /><br /><a href="http://www.fauquierent.net/posteriortonguetie.htm">Posterior tongue tie</a>, given its relative rarity (at least from a referral basis), has historically been treated under sedation in the operating room given the need for specialized equipment and more aggressive surgical dissection.<br /><br />However, given the increasing number of referrals for posterior tongue tie evaluation, specialized instruments needed to treat this condition have been purchased in order to address this condition without the need for sedation (assuming an infant). Young children with teeth may still need to be sedated.<br /><br />Although laser is commonly used to treat this condition in the dental world, ENTs rely more on scissors and fine electro-cautery/coblation instruments which is what I use.<br /><br />Read more about these conditions:<br /><br /><a href="http://www.fauquierent.net/tonguetie.htm">Anterior Tongue Tie</a><br /><a href="http://www.fauquierent.net/posteriortonguetie.htm">Posterior Tongue Tie</a><br /><a href="http://www.fauquierent.net/upperliptie.htm">Upper Lip Tie</a>Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-86593538789325964612014-05-18T06:30:00.000-07:002014-07-21T22:52:29.985-07:00Hearing Test Administered Over the Phone<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsVkvtXGuaAOZAUAHYji8rKlfrGm0IPUKTYg1ijc63OgVFO7XYRuIKfSEex47Wy0OEOdB5Iob7tEpi09OZT8am2-KK3EYw1AbBEamoi-TycPWOorQmymaNUBL3pTTPZ-FGDQn5EgsFSdo/s1600/41wUpiuAbYL._SX425_.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgsVkvtXGuaAOZAUAHYji8rKlfrGm0IPUKTYg1ijc63OgVFO7XYRuIKfSEex47Wy0OEOdB5Iob7tEpi09OZT8am2-KK3EYw1AbBEamoi-TycPWOorQmymaNUBL3pTTPZ-FGDQn5EgsFSdo/s1600/41wUpiuAbYL._SX425_.jpg" height="320" width="320" /></a></div>I was just made aware of this service in a <a href="http://www.washingtonpost.com/news/to-your-health/wp/2014/05/16/take-this-hearing-test-right-now-i-did-and-the-results-were-disturbing/?utm_content=buffera68fa&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer">Washington Post article</a> published May 16, 2014. This screening hearing test is taken over the telephone and accomplished by listening to three-digit sequences presented in a background of white noise. The test-taker has to then enter the digits using the telephone keypad. Based on accuracy of the response, the test than adjusts the next query.<br /><br />Normally, the cost to take this telephone hearing test is $8, but at least for the month of May 2014, it is free in celebration of "Better Hearing and Speech Month."<br /><br />Here's how to take the test by phone:<br /><ol><li>Find a quiet place to take the test that is free from distractions. </li><li>If you hang up in the middle of your test, you will have to start from the beginning. </li><li>Use a telephone that plugs into a wall-mounted jack. Please do not use a cell phone. </li><li>Dial our toll-free number: 1-866-223-7575 </li><li>Listen to the recorded instructions. </li><li>At the end of the test, write down your test results for each ear and the date. The categories are: </li></ol><div style="text-align: center;">Within the Normal Range</div><div style="text-align: center;">Slightly Below the Normal Range</div><div style="text-align: center;">Poor</div><div><br /></div>Further details of this test can be found <a href="http://107.170.47.114/wordpress/">here</a>, but the test essentially is based on the speech-to-noise ratio (SNR) that is adjusted using an adaptive procedure seeking a threshold for 50% correct identification of the digit sequences. A set of 25 sequences provides a reliable SNR threshold in about four minutes of testing per ear. This method of testing is different from most hearing tests in that it uses digits in static noise, rather than pure tones. Because the test measures an SNR threshold rather than one based on the absolute level of tones, a reliable screening measure of hearing, despite the differences in sound levels produced by different telephones, can be achieved. <br /><br />Of note, this method of testing was validated in Europe by scientists at VU University Medical Center in the Netherlands in 2004. The U.S. version began in 2008 with funding from the National Institute of Health and was validated in two studies performed at the Indiana University Hearing Clinic and the other in collaboration with clinics administered by the VA Health System.<br /><br />If hearing is assessed to be abnormal, you can <a href="http://www.fauquierent.net/audiology.htm">contact</a> our office to undergo a more sophisticated hearing test for confirmation and next steps.<br /><br /><b>Source: </b><br /><a href="http://www.washingtonpost.com/news/to-your-health/wp/2014/05/16/take-this-hearing-test-right-now-i-did-and-the-results-were-disturbing/?utm_content=buffera68fa&utm_medium=social&utm_source=twitter.com&utm_campaign=buffer">Take this hearing test right now. I did, and the results were disturbing</a>. Washington Post 5/16/14.Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-13616935624321553042014-05-15T04:30:00.000-07:002014-07-21T22:52:29.997-07:00Top 4 Causes of Dizziness (Table)<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0RimQLuej1v_tT1IWYoK7Nj2JW1lChsXSyktY0or3PthjzkidPYn5EKZCpL16HkRXqTmX2d6XCuWH8Gj5sxgrSv5o5fPHxqYOfp7g3H-FTQd0Y-tGjdMnXTdwVdoiHxvPXE_ZxV2Zcuc/s1600/dizzy.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg0RimQLuej1v_tT1IWYoK7Nj2JW1lChsXSyktY0or3PthjzkidPYn5EKZCpL16HkRXqTmX2d6XCuWH8Gj5sxgrSv5o5fPHxqYOfp7g3H-FTQd0Y-tGjdMnXTdwVdoiHxvPXE_ZxV2Zcuc/s1600/dizzy.jpg" height="239" width="320" /></a></div><a href="http://www.fauquierent.net/dizzy.htm">Dizziness</a> is an extremely common disorder that afflicts an estimated 10-20% of individuals older than 70 years old. Even for those younger, dizziness is a not uncommon problem.<br /><br />Several studies have been performed over the years to try and quantitate what are the most common causes of dizziness to help narrow the possibilities given the workup for dizziness can be long, tedious, and time-consuming which often frustrates patients.<br /><br />Also frustrating is the fact that without a diagnosis, treatment can not be reliably pursued resulting in symptom persistence in spite of attempted treatment.<br /><br />In any case, in rank order, the top 4 most common causes of dizziness are:<br /><br /><b>#1: BPPV</b><br /><br />Depending on the study (see table below), accounts for ~25% of all dizziness. The symptoms of <a href="http://www.fauquierent.net/bppv.htm">BPPV (Benign Paroxysmal Positional Vertigo)</a> are spinning attacks that last no more than a few minutes that occur with positional changes, usually turning the head. Diagnosis is achieved by Dix-Hallpike maneuver. Treatment is positional therapy, usually Epley.<br /><br /><b>#2: Anxiety</b><br /><br />Frequency is around 20% depending on the study (see table below). Fairly self-explanatory. Usually the dizziness is described as light-headed imbalance that lasts hours to days.<br /><br /><b>#3: Unknown</b><br /><br />In spite of exhaustive testing and evaluation by multiple specialties, a diagnosis is never reached and treatment is symptomatic. Sadly, the cause of the dizziness can not be found in approximately 20% of patients.<br /><br /><b>#4: Orthostatic Hypotension</b><br /><br /><a href="http://en.wikipedia.org/wiki/Orthostatic_hypotension">Orthostatic hypotension</a> is usually described as light-headedness (vision going dark when severe) when going from a laying to standing position. Due to cardiac or blood pressure issues which when corrected, resolves this particular dizziness. Only around 5% is dizziness attributable to this condition.<br /><br />Below is a table (references at end) that goes over the frequency rates for other causes of dizziness.<br /><br /><table border="1"> <tbody><tr> <th scope="col" width="26%"><div align="left">Variable</div></th> <th scope="col" width="13%">Study #1</th> <th scope="col" width="13%">Study #2</th> <th scope="col" width="13%">Study #3</th> <th scope="col" width="17%">Study #4</th> <th scope="col" width="18%">Study #5</th> </tr><tr> <th scope="row"># of Patients</th> <td><div align="center">1194</div></td> <td><div align="center">117</div></td> <td><div align="center">149</div></td> <td><div align="center">731</div></td> <td><div align="center">2556</div></td> </tr><tr> <th scope="row">Age of Subjects</th> <td><div align="center">over 70</div></td> <td><div align="center">over 50</div></td> <td><div align="center">over 65</div></td> <td><div align="center">over 70</div></td> <td><div align="center">under 70</div></td> </tr><tr> <th scope="row">Examiner</th> <td><div align="center">ENT</div></td> <td><div align="center">Neurology</div></td> <td><div align="center">Geriatrics</div></td> <td><div align="center">ENT/Neurology</div></td> <td><div align="center">ENT/Neurology</div></td> </tr><tr> <th scope="row"><div align="left">Diagnosis</div></th> <td><div align="center"></div></td> <td><div align="center"></div></td> <td><div align="center"></div></td> <td><div align="center"></div></td> <td><div align="center"></div></td> </tr><tr> <th scope="row">BPPV</th> <td><div align="center">47%</div></td> <td><div align="center">26%</div></td> <td><div align="center">4%</div></td> <td><div align="center">27.6%</div></td> <td><div align="center">22.6%</div></td> </tr><tr> <th scope="row">Anxiety</th> <td><div align="center">0%</div></td> <td><div align="center">3%</div></td> <td><div align="center">32%</div></td> <td><div align="center">15.3%</div></td> <td><div align="center">33%</div></td> </tr><tr> <th scope="row">No Diagnosis</th> <td><div align="center">23%</div></td> <td><div align="center">14%</div></td> <td><div align="center">0%</div></td> <td><div align="center">15.2%</div></td> <td><div align="center">11.4%</div></td> </tr><tr> <th scope="row">Orthostatic Hypotension</th> <td><div align="center">2%</div></td> <td><div align="center">3%</div></td> <td><div align="center">1%</div></td> <td><div align="center">7.1%</div></td> <td><div align="center">1.3%</div></td> </tr><tr> <th scope="row">Vascular Disorder</th> <td><div align="center">8%</div></td> <td><div align="center">7%</div></td> <td><div align="center">70%</div></td> <td><div align="center">5.2%</div></td> <td><div align="center">0.2%</div></td> </tr><tr> <th scope="row">Cervical Disorder</th> <td><div align="center">0%</div></td> <td><div align="center">0%</div></td> <td><div align="center">66%</div></td> <td><div align="center">0%</div></td> <td><div align="center">0%</div></td> </tr><tr> <th scope="row">Meniere's Disease</th> <td><div align="center">4.05%</div></td> <td><div align="center">4%</div></td> <td><div align="center">-</div></td> <td><div align="center">5.2%</div></td> <td><div align="center">5.6%</div></td> </tr><tr> <th scope="row">Migraine</th> <td><div align="center">0.08%</div></td> <td><div align="center">-</div></td> <td><div align="center">-</div></td> <td><div align="center">1.1%</div></td> <td><div align="center">3.9%</div></td> </tr><tr> <th scope="row">Labyrinthitis</th> <td><div align="center">1.77%</div></td> <td><div align="center">3%</div></td> <td><div align="center">-</div></td> <td><div align="center">0.96%</div></td> <td><div align="center">0.51%</div></td> </tr><tr> <th scope="row">Brain Tumor</th> <td><div align="center">1.4%</div></td> <td><div align="center">3%</div></td> <td><div align="center">-</div></td> <td><div align="center">0.55%</div></td> <td><div align="center">0.24%</div></td> </tr><tr> <th scope="row">Medication Side Effect</th> <td><div align="center">-</div></td> <td><div align="center">2%</div></td> <td><div align="center">-</div></td> <td><div align="center">1.9%</div></td> <td><div align="center">0.2%</div></td> </tr><tr> <th scope="row">Stroke/TIA</th> <td><div align="center">6.34%</div></td> <td><div align="center">7%</div></td> <td><div align="center">-</div></td> <td><div align="center">5.2%</div></td> <td><div align="center">0.2%</div></td> </tr></tbody></table><br /><b>References:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/24817230">Dizziness in the elderly: Diagnosing its causes in a multidisciplinary dizziness unit</a>. ENT Journal. 93(4-5):162-167.<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/7963205">Dizziness in elderly men</a>. JAGS 42:1184-1188.<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/8842072">Evaluation of investigations to diagnose the cause of dizziness in elderly people</a>: a community based controlled study. BMJ 313<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/8134140">Dizziness in aging: A retrospective study of 1194 cases</a>. Otolaryngol Head Neck Surg. 1994 Mar;110(3):296-301.Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-21412875943830047082014-05-14T04:09:00.000-07:002014-07-21T22:52:30.016-07:00Whooping Cough Without the Whoop - The Bad Lingering Cough<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivzHi7D8a1hNbWRPGPkk5z_jORWHZ1dat83_9P86neYZmEv0L4lE7t-cugCE0zwKfk2nZ_U5XUBFbT92S1xbhXNT3UVyGak_ywmn6EzOhdvns908G4GCQsuCmILaJWf-fJdeABGch97b8/s1600/cough_lady1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEivzHi7D8a1hNbWRPGPkk5z_jORWHZ1dat83_9P86neYZmEv0L4lE7t-cugCE0zwKfk2nZ_U5XUBFbT92S1xbhXNT3UVyGak_ywmn6EzOhdvns908G4GCQsuCmILaJWf-fJdeABGch97b8/s1600/cough_lady1.jpg" height="268" width="320" /></a></div>Although I have been practicing medicine since 2000, the first time I diagnosed whooping cough was in 2011 and ever since, I have been diagnosing more and more cases each year thereafter. However, what makes these cases a little unusual is that for ALL cases of whooping cough I have diagnosed, there was no characteristic whoop for which it is named after.<br /><div><br /></div><div>Rather, the common characteristics for all patients I have diagnosed include:</div><div><br /></div><div>• <a href="http://www.fauquierent.net/cough.htm">"Mystery" cough</a> that has been going on for weeks if not months</div><div>• Cough can occur in severe attacks with in-between periods of relative normalcy. Cough could also be just a "bad, lingering" cough.</div><div>• Cough attacks can be so severe, patient may get short of breath, faint, turn blue, vomit, etc. However, they could be minor attacks as well.</div><div>• Dry cough, though some mucus may be seen<br />• All studies like lung function tests and chest x-rays (save those described below) come back normal.</div><div>• Medications typically do not work except for strong narcotic cough suppressants.</div><div>• No whoop after the cough.<br />• Afflicts ALL ages</div><div><br /></div><div>Should a person been coughing like this only in the past few weeks, I usually obtain a nasopharyngeal swab tested for bordetella pertussis DNA.</div><div><br /></div><div>If it has been for longer than a month and antibiotics have been given, I usually obtain blood titres for bordetella pertussis mainly because the infectious agent may have been cleared and culture may come back falsely negative.</div><div><br /></div><div>My personal observations have also been reported elsewhere.</div><div><br /></div><div>In fact, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/20736473">study</a> in 2010 stated that the "classic" symptoms of whooping cough which historically was considered only a childhood disease, is no longer a reliable way of determining whether a patient has whooping cough or not. It is also no longer a childhood disease.<br /><br />In fact, most teens and adults lack the classic symptoms for whooping cough and their only symptom may be a bad lingering cough. In fact, some estimate that 10% to 30% of prolonged coughs in adults are caused by pertussis.<br /><br />Even if a patient has been vaccinated for whooping cough, you can STILL get it mainly because it is not 100% effective. Furthermore, vaccine protection fades with time. Given incomplete ineffectiveness in combination with more and more parents electing to not vaccinate their kids, it is no surprise there are more cases being diagnosed every year. It's just that physicians may not recognize the cough for what it is.<br /><br />Here's what the <a href="http://www.cdc.gov/pertussis/about/prevention.html">CDC</a> has to say about whooping cough vaccines:</div><blockquote class="tr_bq">Vaccine protection for pertussis, tetanus, and diphtheria can fade with time. Before 2005, the only booster vaccine available contained tetanus and diphtheria (called Td), and was recommended for adolescents and adults every 10 years. Today there are boosters for adolescents and adults that contain tetanus, diphtheria, and pertussis (called Tdap). Pre-teens going to the doctor for their regular check-up at age 11 or 12 years should get a dose of Tdap. Adults who didn’t get Tdap as a pre-teen or teen should get one dose of Tdap instead of the Td booster. Most pregnant women who were not previously vaccinated with Tdap should get one dose of Tdap postpartum before leaving the hospital or birthing center. Getting vaccinated with Tdap is especially important for families with and caregivers of new infants.<br /><br />The easiest thing for adults to do is to get Tdap instead of their next regular tetanus booster—that Td shot that they were supposed to get every 10 years. The dose of Tdap can be given earlier than the 10-year mark, so it’s a good idea for adults to talk to a health care provider about what’s best for their specific situation. [<a href="http://www.cdc.gov/pertussis/about/prevention.html">link</a>]</blockquote><div>Of course, there may be other causes for a <a href="http://www.fauquierent.net/cough.htm">chronic lingering cough</a>, but whooping cough should be in the differential.<br /><br /></div><div><b>References:</b></div><div><a href="http://www.ncbi.nlm.nih.gov/pubmed/20736473">Does this coughing adolescent or adult patient have pertussis?</a> JAMA. 2010 Aug 25;304(8):890-6. doi: 10.1001/jama.2010.1181. <br /><br /><a href="http://www.health.harvard.edu/blog/no-big-whoop-adult-pertussis-may-not-produce-the-whooping-cough-20100913358">No big whoop: Adult pertussis may not produce the whooping cough</a>. Harvard Health Blog 9/13/10 </div>Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-51898522329143758342014-05-11T13:38:00.000-07:002014-07-21T22:52:30.027-07:00Cure Hiccups by Pulling on the Tongue<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSEQ-IxZ8xbv5Xf2NrTMi7V0Br3Byd_Jkic03OPBZgCTKW2oWOe5rxTMrn0GjXcjYmnG3PttxbZiXcod29TSte2j8yl4YX6HK-KwCr34zv7BZoLZg4mHXNThfoiwd9k9ANYoFd_03etog/s1600/tongue.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjSEQ-IxZ8xbv5Xf2NrTMi7V0Br3Byd_Jkic03OPBZgCTKW2oWOe5rxTMrn0GjXcjYmnG3PttxbZiXcod29TSte2j8yl4YX6HK-KwCr34zv7BZoLZg4mHXNThfoiwd9k9ANYoFd_03etog/s1600/tongue.jpg" height="320" width="213" /></a></div>There are many different ways to treat hiccups (otherwise known as singultus). Some of the more bizarre ways of treating hiccups include <a href="http://fauquierent.blogspot.com/2014/05/anal-massage-cures-hiccups.html">rectal massage</a> and tongue pulling. <br /><br />Tongue pulling treatment is most commonly attributed to Sir William Osler (1849-1919). However, origins of tongue pulling can be found in much earlier French references including Jean Laborde (1830-1903), Jean Viaud (1862-1946), and Raphaël Lépine (1840-1919).<br /><br />It is hypothesized to work by stimulating the vagus nerve thereby easing the diaphragmatic spasms. <br /><br /><b>Reference:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/23586546">Treatment of singultus by traction on the tongue: an eponym revised</a>. J Hist Neurosci. 2013;22(2):183-90. doi: 10.1080/0964704X.2012.728389. <br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/9803740">[Stimulation of the root of the tongue can cure hiccup. 20 years of "unscientific" experience supports the thesis]</a>. Lakartidningen. 1998 Oct 7;95(41):4477-9.Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-56291898352636008582014-05-05T09:55:00.000-07:002014-07-21T22:52:30.046-07:00Anal Massage Cures Hiccups?<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiS7GuBLrdTFKMt6WjZEbm-edzlJStuC4SYa5Al3r1h3BIQltw75q0xE-zG6Hq8kwP9om6eEwVI8OJfcitrYWOTWCvR76u7PZKcNu2skTcbhYxtj7wjxKeDpoNPhPzhJZejlMLFlFZ8eeI/s1600/sore_throat_woman.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiS7GuBLrdTFKMt6WjZEbm-edzlJStuC4SYa5Al3r1h3BIQltw75q0xE-zG6Hq8kwP9om6eEwVI8OJfcitrYWOTWCvR76u7PZKcNu2skTcbhYxtj7wjxKeDpoNPhPzhJZejlMLFlFZ8eeI/s1600/sore_throat_woman.jpg" height="320" width="213" /></a></div>So... I came across a few references addressing treatment of hiccups (otherwise known as singultus), but perhaps the most bizarre treatment for hiccups I saw was rectal massage.<br /><br />Digital rectal massage (see references below) has apparently been reported in the literature to help stop hiccups, mainly by disrupting the vagal afferent limb of the hiccup reflex arc. Name says it all. Essentially, you stick a finger up the bungholio and massage the area firmly until the hiccups stop.<br /><br />It apparently stops hiccups fairly quickly.<br /><br /><br /><b>Reference:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/2299306">Termination of intractable hiccups with digital rectal massage.</a> J Intern Med. 1990 Feb;227(2):145-6.<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/3395000">Termination of intractable hiccups with digital rectal massage</a>. Ann Emerg Med. 1988 Aug;17(8):872. Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-69076218047334796382014-05-04T06:00:00.000-07:002014-07-21T22:52:30.058-07:00How Common is Hoarseness?<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdq3vzF6Z-DXXMDEHPWg_ftXf2Uvv5U9KMAasTXl1jm6p1qivnQYUC5KHYQJabLThJ99UHhlIPOWwKm4BAT7zkDDYogfEhIQ7klqQKD9sXUBKi27HUVX_67VVfGbBFsLm4CWXralBljcY/s1600/throat1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhdq3vzF6Z-DXXMDEHPWg_ftXf2Uvv5U9KMAasTXl1jm6p1qivnQYUC5KHYQJabLThJ99UHhlIPOWwKm4BAT7zkDDYogfEhIQ7klqQKD9sXUBKi27HUVX_67VVfGbBFsLm4CWXralBljcY/s1600/throat1.jpg" height="320" width="213" /></a></div>At some point, we all have suffered from a <a href="http://www.fauquierent.net/voiceraspy.htm">hoarse voice</a> whether from illness or from yelling. However, it was unclear exactly how common this malady is until now... and apparently, the answer is "very common"...<br /><br />According to a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24782443">study</a> looking to answer this question, hoarseness affected 17.9 million adults in 2012. The average age was 49 years old and 63% were women. Overall, 10% saw a <a href="http://www.fauquierent.net/voice.htm">health care professional</a> for their hoarseness and 40% were given a diagnosis.<br /><br /><a href="http://www.fauquierent.net/voicelaryngitis.htm">Infectious laryngitis</a> was the most common diagnosis mentioned (685±86 thousand cases, 17.8±2.0%). <a href="http://www.fauquierent.net/lpr.htm">Gastroesophageal reflux disease</a> was mentioned in 308±54 thousand cases (8.0±1.4%).<br /><br />33% reported their voice problem to be a significant problem. Bad enough that the mean number of days the hoarseness lasted was about 56 days. Because of the hoarseness, patients missed work about one week in the past year.<br /><br />A general rule of thumb is to see your local ENT if the hoarseness lasts more than 1 week. Intervention can be performed to minimize the duration of hoarseness as well as to alleviate the morbidity associated with this problem.<br /><br />Another general rule of thumb is to minimize using your voice if it becomes unexpectedly hoarse.<br /><br /><b>Reference:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/24782443">The prevalence of voice problems among adults in the United States</a>. Laryngoscope. 2014 Apr 29. doi: 10.1002/lary.24740. Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-69271685134085533862014-05-03T18:15:00.000-07:002014-07-21T22:52:30.078-07:00Cricoid Pressure May Minimize Symptoms of Reflux (LPR)<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyMTzK3w3RkwE0i4OpMHqLY5-lDD4POEJNX6ly6nH4bmcW4NhuGsB0WgkCmlgUcGuyaieArmAepKCAYrsyGpRgY1pdLUcp3_UMPf_AbveMQEDGfEVUO8Grwlf59OBeXJRJTWmQwjyRj5o/s1600/Gray1194.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyMTzK3w3RkwE0i4OpMHqLY5-lDD4POEJNX6ly6nH4bmcW4NhuGsB0WgkCmlgUcGuyaieArmAepKCAYrsyGpRgY1pdLUcp3_UMPf_AbveMQEDGfEVUO8Grwlf59OBeXJRJTWmQwjyRj5o/s1600/Gray1194.png" height="280" width="320" /></a></div>Specifically throat symptoms attributable to <a href="http://www.fauquierent.net/lpr.htm">reflux</a> such as <a href="http://www.fauquierent.net/globus.htm">globus</a>, <a href="http://www.fauquierent.net/throatclearing.htm">throat-clearing</a>, <a href="http://www.fauquierent.net/phlegmymucusthroat.htm">phlegmy throat</a>, <a href="http://www.fauquierent.net/cough.htm">chronic cough</a>, etc. However, cricoid pressure may not be realistic nor practical even if it does help.<br /><br />In one of the more unusual studies I have seen, <a href="http://www.ncbi.nlm.nih.gov/pubmed/24782387">researchers</a> deliberately infused 60 cc of hydrochloric acid into the esophagus of 14 patients who suffered from <a href="http://www.fauquierent.net/lpr.htm">LPR</a> as well as 12 healthy controls. 9 patients exhibited confirmed LPR (laryngopharyngeal reflux) events, but none in the control group. With moderate sustained <a href="http://en.wikipedia.org/wiki/Cricoid_pressure">cricoid pressure</a> (20-30 mmHg), only one patient had a confirmed LPR event.<br /><br />Theoretically, why would <a href="http://en.wikipedia.org/wiki/Cricoid_pressure">cricoid pressure</a> work?<br /><br />The <a href="http://en.wikipedia.org/wiki/Cricoid_cartilage">cricoid cartilage</a> is located immediately below the voice box. It is a circular cartilage that is right at the level where the throat connects to the esophagus. By putting pressure on the cricoid cartilage, the top part of the esophagus is manually compressed shut which theoretically would prevent reflux from regurgitating up into the throat.<br /><br />It is based on this theory that anesthesiologists often perform cricoid pressure to prevent aspiration during intubation for surgery, especially if a patient is suspected of drinking/eating something prior to surgery.<br /><br />The problem with cricoid pressure is that in order for this to work, it needs to happen <b><i><u>continuously</u></i></b> which may make it unrealistic and impractical for patients who suffer from LPR. Continuously means 24/7/365. Not just when symptoms are present (because it's too late than).<br /><br /><b>Reference:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/24782387">Prevention of esophagopharyngeal reflux by augmenting the upper esophageal sphincter pressure barrier</a>. Laryngoscope. 2014 Apr 29. doi: 10.1002/lary.24735. Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-29304892411645106912014-05-03T17:32:00.000-07:002014-07-21T22:52:30.089-07:00Map of Vaccine-Preventable Outbreaks Over Time<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYgdnfGVhAO0_X7kiXsfT5NfRR0ZDw3BSZblsdp8tTdLUA9yEHEIvof6-2Q_NKZYSlSC6cuztVJaO2ifFGu4EV4aENTT80uCmZfVkRHKqUtcxFfC1Y5bcjRw_2GDVKjOsXozbLdCVqrHc/s1600/65270206c6d8ebd3d1e0b54a141aeea5.png" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYgdnfGVhAO0_X7kiXsfT5NfRR0ZDw3BSZblsdp8tTdLUA9yEHEIvof6-2Q_NKZYSlSC6cuztVJaO2ifFGu4EV4aENTT80uCmZfVkRHKqUtcxFfC1Y5bcjRw_2GDVKjOsXozbLdCVqrHc/s1600/65270206c6d8ebd3d1e0b54a141aeea5.png" height="175" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Image by <a href="http://www.cfr.org/interactives/GH_Vaccine_Map/#map">Council of Foreign Relations</a></td></tr></tbody></table>The council of foreign relations have produced an <a href="http://www.cfr.org/interactives/GH_Vaccine_Map/#map">interactive map</a> the shows the concentration of vaccine-preventable outbreaks throughout the world over time. Such diseases include measles, mumps, rubella, polio, and whooping <a href="http://www.fauquierent.net/cough.htm">cough</a>.<br /><br />The take-home point of the map is that diseases that were once considered "eradicated" due to near-universal vaccinations have now made a tremendous comeback which is felt almost certainly due to the anti-vaccine movement.<br /><br />Vaccinate!!!<br /><br /><b>Reference:</b><br /><a href="http://www.cfr.org/interactives/GH_Vaccine_Map/#map">Vaccine Preventable Outbreaks</a>. Council of Foreign Relations.Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-30568646639534274102014-05-03T03:44:00.000-07:002014-07-21T22:52:30.109-07:00Hearing Loss Over TimeIt is well-known that professional musicians have a higher risk of <a href="http://www.fauquierent.net/audioht.htm">hearing loss</a> and <a href="http://www.fauquierent.net/audiotin.htm">tinnitus</a> compared to non-musicians. According to <a href="http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full">one study</a>, the risk for musicians is 1.5x for hearing loss and nearly 4x for tinnitus.<br /><br />And although people understand that as you get older, hearing loss increases, what is less clear is how quickly hearing loss occurs over time.<br /><br />After <a href="http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full">analyzing over 3 million subjects</a>, here is the graph of hearing loss with age. Intuitively, I thought there would have been a "jump" in hearing loss after a certain age. The graph indicates no such "jump," but rather a continuous increase of hearing loss from the earliest age studied (19-21 years).<br /><br />This gentle slope does suggest that the vast majority of hearing loss is due to the slow accumulation of noise-induced nerve damage over time and that the vast minority of hearing loss is secondary to an acute event whether from <a href="http://www.fauquierent.net/audiosudden.htm">infection</a> or sudden loud noise exposure (i.e., gunshot without hearing plugs).<br /><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC7Bz2BbEgPzT3vj75n4QT7cLF1LZ6LffsTgaD7Kxam4zcLKVVvmYoHa7SmOSenJBXxl7iLUFbSC0hwN7MOwwJY4ogssqSmthg6eWMC-zw9aT7jZtVwqcaDAAc9uVeIsLju3fDBpYs2lM/s1600/F1.large.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjC7Bz2BbEgPzT3vj75n4QT7cLF1LZ6LffsTgaD7Kxam4zcLKVVvmYoHa7SmOSenJBXxl7iLUFbSC0hwN7MOwwJY4ogssqSmthg6eWMC-zw9aT7jZtVwqcaDAAc9uVeIsLju3fDBpYs2lM/s1600/F1.large.jpg" height="500" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Source: <a href="http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full">http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full</a></td></tr></tbody></table><br /><b>Reference:</b><br /><a href="http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full">Incidence and relative risk of hearing disorders in professional musicians.</a> Occup Environ Med doi:10.1136/oemed-2014-102172 Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-91310129944835748242014-05-03T03:26:00.000-07:002014-07-21T22:52:30.121-07:00A Single Sneeze Can Spread Throughout Entire Building<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipK1tdoPDfF-52z0ujTre4YMi3CjQuz5t5qXjE2pS9rxdpSIg0uTj5WngKsDLhUSJ2X514M1DBaTkx7rSShBaCvHYsZXSw1Pae2_Awn__XEKyoEdkmCW-ZDyH6uGAXMsvg9jOjY4wXqSM/s1600/sneezing.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEipK1tdoPDfF-52z0ujTre4YMi3CjQuz5t5qXjE2pS9rxdpSIg0uTj5WngKsDLhUSJ2X514M1DBaTkx7rSShBaCvHYsZXSw1Pae2_Awn__XEKyoEdkmCW-ZDyH6uGAXMsvg9jOjY4wXqSM/s1600/sneezing.jpg" height="200" width="187" /></a></div>MIT researchers using high-speed cameras and applying fluid dynamics have discovered that although ejected droplets from a sneeze typically fall to the ground, the "cloud" of moisture from a single sneeze actually floats and can enter ventilation ducts and can potentially spread throughout an entire building or airplane. Watch video below.<br /><br />These findings have profound implications as to how infections may travel within buildings and other contained structures like cruise ships and airplanes.<br /><br />So although most people cover their mouths when sneezing in public, it also needs to happen in private even when there's nobody around. Of course, more study is needed to see if the sneeze "cloud" is even minimized with mouth-covering.<br /><br /><iframe allowfullscreen="" frameborder="0" height="360" src="//www.youtube.com/embed/wnafrAtfMzE" width="640"></iframe>Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-89805066741643599932014-04-22T04:58:00.000-07:002014-07-21T22:52:30.141-07:00Sleep Apnea Increases Risk of Cancer<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_sdrF_lCVnSxzNcQLTMgdLvNZBKu7D6OxhM1kevrfFmyYd2h56T8lu3Q7YgYEJTAkcLsTWDuA2SFaH7Sl2Tz7Kuo6ayKPtOTrXpa3yyVTBW0vPJefLs9bgVwhoR9O7goi2ZPErH2XexM/s1600/snoring1.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_sdrF_lCVnSxzNcQLTMgdLvNZBKu7D6OxhM1kevrfFmyYd2h56T8lu3Q7YgYEJTAkcLsTWDuA2SFaH7Sl2Tz7Kuo6ayKPtOTrXpa3yyVTBW0vPJefLs9bgVwhoR9O7goi2ZPErH2XexM/s1600/snoring1.jpg" height="213" width="320" /></a></div><a href="http://www.fauquierent.net/osa.htm">Obstructive sleep apnea</a> has been getting accused of causing all sorts of medical problems including hypertension, stroke, heart disease, heart attacks, peripheral vascular disease, etc. We can also add cancer now.<br /><br />According to <a href="http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29425">Australian researchers</a>, moderate to severe sleep apnea increases the risk of cancer by 2.5 times and death from cancer by 3.4 times. They also reported that sleep apnea increases risk of death (any cause) by 4.2x and stroke by 3.7x.<br /><br />This conclusion was reached evaluating 397 subjects with obstructive sleep apnea with 20 years follow-up. Of course, further study is needed to confirm these findings.<br /><br />If sleep apnea is suspected, the first step is to get a <a href="https://www.youtube.com/watch?v=CcqVwlmO2x0">sleep study</a>. Surgical options can also be considered which may encompass <a href="http://www.fauquierent.net/uppp.htm">UPPP</a>, <a href="http://www.fauquierent.net/botcoblation.htm">base of tongue reduction</a>, etc.<br /><br /><b>Source:</b><br /><a href="http://www.aasmnet.org/jcsm/ViewAbstract.aspx?pid=29425">Sleep Apnea and 20-Year Follow-Up for All-Cause Mortality, Stroke, and Cancer Incidence and Mortality in the Busselton Health Study Cohort</a>. Journal of Clinical Sleep Medicine 2014;10(4):355-362. Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-77750897168117784462014-04-18T10:39:00.000-07:002014-07-21T22:52:30.154-07:00FDA Approves Ragwitek... Ragweed Allergy Tablet by Mouth (Instead of Allergy Shots)<div class="separator" style="clear: both; text-align: center;"></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzcVWenjlm4SviEM1HDcUwVFdiQI_cgBjCOq35D-8GCPSmMDIgZBr5SFn9dg-ClikrbQK0lKFl4GABpgQRIPBXzg_vVK34ENjY8KC7gNXITNaF9QnD684u2zQxZu69bI5M8rq_3-FoQo0/s1600/Unknown.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhzcVWenjlm4SviEM1HDcUwVFdiQI_cgBjCOq35D-8GCPSmMDIgZBr5SFn9dg-ClikrbQK0lKFl4GABpgQRIPBXzg_vVK34ENjY8KC7gNXITNaF9QnD684u2zQxZu69bI5M8rq_3-FoQo0/s1600/Unknown.jpeg" height="145" width="320" /></a></div>The FDA formally approved Ragwitek, the third new sublingual allergy tablet to be sold in the United States this year that works the same way <a href="http://www.fauquierent.net/allergyshot.htm">allergy shots</a> do... but instead is dissolved <a href="http://fauquierent.net/SLIT.htm">under the tongue</a> at home instead of a shot in the arm in a medical office. Ragwitek is the first sublingual allergy tablet to treat ragweed. Although <a href="http://fauquierent.blogspot.com/2014/04/fda-approves-oralair-grass-allergy.html">Oralair</a> and <a href="http://fauquierent.blogspot.com/2014/04/fda-approves-grastek-grass-allergy.html">Grastek</a> are two other sublingual tablets that have already been approved by the FDA, they treat grass allergies rather than ragweed.<br /><br />Ragwitek is a tablet made by <a href="http://www.merck.com/index.html">Merck</a> and treats patients aged 18-65 years who are allergic to <i><b>only</b></i> short ragweed. Ragwitek has a simple regimen of 1 sublingual tablet daily starting 12 weeks <i>before</i> the ragweed season and continued until the end of the ragweed pollen season. As with <a href="http://fauquierent.blogspot.com/2014/04/fda-approves-oralair-grass-allergy.html">Oralair</a> and <a href="http://fauquierent.blogspot.com/2014/04/fda-approves-grastek-grass-allergy.html">Grastek</a>, the first dose is given in a medical office to ensure safety with all other doses are taken at home. The tablet dissolves in less than 10 seconds.<br /><br />Although in next few weeks US physicians should be able to start prescribing Ragwitek, treatment needs to actually begin in early summer thru the fall for full effectiveness.<br /><br />As with Oralair and Grastek, epipen needs to be available at home due to possible risk of anaphylaxis. As with allergy shots, patients on beta-blockers for high blood pressure are not eligible to undergo this treatment.<br /><br />The wholesale price of both Grastek and Ragwitek will be $8.25 per pill, or $247.50 for a 30-day supply. The wholesale price of Oralair will be $10 per pill, or $300 for a 30-day supply.<br /><br /><b>Sources:</b><br /><a href="http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm393820.htm">FDA approves Ragwitek for short ragweed pollen allergies</a>. FDA 4/17/14Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-84741423005025435392014-04-17T04:49:00.000-07:002014-07-21T22:52:30.173-07:00Dizziness and Imbalance in Kids<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiITJ8jJJDVgd0lVNorWlxhNdOZgN7661YzIeQfoVZhFGe50aHpAjPLfPSaLRtD2j7zWRSEYYQFOpAYMOpV1KNJL-ZX6lKlLMS-WneJFCwGVhHHwpGj7dqZwaaDL2TEBl3bSZNg8syu6vA/s1600/head_child.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiITJ8jJJDVgd0lVNorWlxhNdOZgN7661YzIeQfoVZhFGe50aHpAjPLfPSaLRtD2j7zWRSEYYQFOpAYMOpV1KNJL-ZX6lKlLMS-WneJFCwGVhHHwpGj7dqZwaaDL2TEBl3bSZNg8syu6vA/s1600/head_child.jpg" height="213" width="320" /></a></div>Dizziness is not the easiest thing to figure out in adults. It is even more difficult to figure out in kids who may not have the vocabulary to explain what they feel. Regardless of adult or child, a good history is required to help narrow down possibilities. A flowchart of questions to help come up with a diagnosis can be found <a href="http://www.fauquierent.net/dizziness/dizzy1.htm">here</a>.<br /><br />Given that, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24612555">review article</a> published in 2014 went over the most likely diagnosis of a child who is dizzy.<br /><br />Based on 724 subjects over 10 studies, benign paroxysmal vertigo of childhood (18.7%) and migraine-associated vertigo (17.6%) were the two main etiologies causing vertigo and dizziness in children. Head trauma (14%) was the third most common cause of vertigo. The mean (95% CI) rate of every vertiginous form was also calculated in relation to the nine studies analyzed with vestibular migraine (27.82%), benign paroxysmal vertigo (15.68%) and vestibular neuritis (9.81%) being the three most common forms. <br /><br />Benign paroxysmal vertigo of childhood is not clearly understood with some researchers feeling it is a form of adult BPPV (<a href="http://www.fauquierent.net/bppv.htm">benign paroxysmal positional vertigo</a>) given similar symptoms whereas others feel it is more related to a neurologic vascular basis. With this particular condition, there is no established treatment protocol.<br /><br />True <a href="http://www.fauquierent.net/bppv.htm">BPPV</a> occurred in 1.8%. Meniere's disease accounted for only 1.5%. Othostatic hypotension only 1.2%. <a href="http://fauquierent.net/etd.htm">Middle ear problems</a> surprisingly only occurred in 3% which was felt by the researchers to be highly under-estimated.<br /><br />Given the top 3 causes of vertigo in children all have a neurologic basis, an evaluation by a good pediatric neurologist is warranted.<br /><br /><b>Reference:</b><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/24612555">Prevalence and diagnosis of vestibular disorders in children: A review</a>. Int J Pediatr Otorhinolaryngol. 2014 May;78(5):718-724. doi: 10.1016/j.ijporl.2014.02.009. Epub 2014 Feb 15.Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0tag:blogger.com,1999:blog-3988808608549702688.post-34497731057593357792014-04-16T02:54:00.000-07:002014-07-21T22:52:30.185-07:00FDA Approves Grastek... Grass Allergy Tablet by Mouth (Instead of Allergy Shots)<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbejEksN-Y0moGnNmrlJywpiGUJizh-zFTl3xf_NBrp9V6rowBAjGd5PK28ZGy6tqqf6nyt9_sda54NvDRk-7Fm03pofioSO6tr6ICHNUkJUEs96SC3UQ_p1Tox2xvvRMz_zM5aTe3NMU/s1600/Unknown.jpeg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbejEksN-Y0moGnNmrlJywpiGUJizh-zFTl3xf_NBrp9V6rowBAjGd5PK28ZGy6tqqf6nyt9_sda54NvDRk-7Fm03pofioSO6tr6ICHNUkJUEs96SC3UQ_p1Tox2xvvRMz_zM5aTe3NMU/s1600/Unknown.jpeg" /></a></div>Today, the FDA formally approved Grastek, the second new sublingual allergy tablet to be sold in the United States that works the same way <a href="http://www.fauquierent.net/allergyshot.htm">allergy shots</a> do... but instead is dissolved <a href="http://fauquierent.net/SLIT.htm">under the tongue</a> at home instead of a shot in the arm in a medical office. Although this tablet has been available in Europe for some time, only now has sale/distribution in the United States been allowed under prescription. <br /><br />Just 2 weeks ago, <a href="http://fauquierent.blogspot.com/2014/04/fda-approves-oralair-grass-allergy.html">FDA approved Oralair</a> which also treats grass allergies.<br /><br />Grastek (aka Grazax in Europe) is a tablet made by <a href="http://www.alk-abello.com/">ALK-Abello</a> and <a href="http://www.merck.com/index.html">Merck</a> and treats patients aged 5-65 years who are allergic to <i><b>only</b></i> Timothy Grass. Grastek has a simple regimen of 1 sublingual tablet daily starting 12 weeks before and continued until the end of the grass pollen season. As with Oralair, the first dose is given in a medical office to ensure safety with all other doses are taken at home. The tablet dissolves in less than 10 seconds.<br /><br />Although in next few weeks US physicians should be able to start prescribing Oralair, it really won't do much good for this year's grass allergies because in order for this tablet to be fully effective in the treatment of grass pollen allergies, treatment needs to actually begin in December but no later than January and continue through August. Grass pollen season begins in April/May, so for at least this year, it may be too late.<br /><br />For both Oralair and Grastek, epipen needs to be available at home due to possible risk of anaphylaxis. As with allergy shots, patients on beta-blockers for high blood pressure are not eligible to undergo this treatment.<br /><br /><b>Sources:</b><br /><a href="http://www.reuters.com/article/2014/04/14/us-merck-co-fda-grastek-idUSBREA3D1UD20140414">Merck's grass pollen allergy drug wins U.S. approval</a>. Reuters 4.14.14 Anonymoushttp://www.blogger.com/profile/15709907610503338746noreply@blogger.com0