Pop Singer Nathan Sykes Undergoes Vocal Cord Surgery

Nathan Sykes, singer for the boy band The Wanted, underwent vocal cord surgery on April 18, 2013 for a "hemorrhaged nodule" according to media reports.

Rather than a nodule, I am suspecting he actually suffered from a hemorrhagic polyp which makes more medical sense. And along with surgery... he is now on voice rest for an indefinite period of time.

This condition is the same reason Adele underwent vocal cord surgery in 2011 which mandated a several month period of voice rest leading to cancelled concerts.

Typically, a hemorrhagic polyp is treated with strict voice rest followed by extensive voice therapy prior to surgical consideration. However, this (safe) course of action takes time and as such, much more aggressive approaches can be pursued in order to recover the voice as quickly as possible.

For professional singers like Nathan Sykes and Adele, the desire to have a restored voice as soon as possible is understandable. However, there are always downsides.

To explain, a lesson in some basic anatomy first...

Normally, the vocal cords are pearly white without any vasculature. Watch a video of how this exam is performed.

However, when a blood vessel is present in the vocal cords, they may look something like this:

When there is a hemorrhagic polyp with a blood vessel as in Nathan's case (presumably), the vocal cords may have looked like this where the blue arrowhead is pointing to a hemorrhagic polyp. The green arrow is pointing towards a feeding blood vessel.

The issue with a blood vessel within the vocal cord itself is that it fluctuates in size due to phono-trauma or even hormones especially in females. When a polyp is present, the vocal changes are even more dramatic. Such fluctuation in size causes the voice to change in pitch and quality on an hour to hour basis depending on how much swelling occurs. For a singer, it makes the voice very unpredictable.

When the blood vessel becomes engorged and traumatized, it may even rupture leading to a vocal cord hemorrhage. Especially in a woman, the blood vessel may be more prone to hemorrhage during her menstrual cycle.

This is a dangerous situation for a singer because of their regular voice use and need to use it forcefully. However with too much force, the blood vessel may suddenly rupture (even in the middle of a performance) resulting in a hemorrhage into the vocal lining itself causing a sudden and complete loss of voice. There may even be mild pain associated with this occurrence.

It is unknown what exactly happened in Nathan Syke's case.

But, in Adele's case, she remembers the very moment this occurred during a radio interview when she "felt a pop" and her vocal pitch suddenly dropped into the bass range.

This makes perfect sense... To use the analogy of a violin string, the thicker the violin string the deeper the pitch. When hemorrhage occurs, the vocal cord becomes thicker due to blood pooling resulting in a deeper voice instantly.

To the right is a picture of a vocal cord hemorrhage. Note the entire vocal cord on one side (which is the patient's right side for those in the know) is brilliant red indicative of the presence of blood throughout the cord.

How is this treated?

Initially, during an acute vocal cord hemorrhage, STRICT VOICE REST is mandatory. With continued voice use, the patient risks abnormal healing that may result in the development or exacerbation of a vocal cord polyp. With repetitive cycles of healing and trauma, vocal cord scarring may even develop. Along with strict voice rest, steroids are often prescribed to help reduce the inflammatory swelling that often occurs as well as minimize risk of scarring.

Unfortunately, though such treatment may resolve the hemorrhage, it will typically not get rid of the culprit blood vessel and associated polyp.

For that, surgical intervention is required.

One option is to precisely cut out the polyp and cauterize the feeding blood vessel at the same time. This approach was the course that Adele pursued and probably what happened with Nathan Sykes as well. Watch a video on this approach (video shows a generic vocal cord mass removal, but the approach is identical).

The other option is use of a laser first to extinguish blood vessels present which may also significantly resolve the polyp followed by excision of the residual polyp at a later date. This latter approach is typically what I recommend. Why? It is relatively non-invasive and I feel the risk of scarring to be less compared with excision and vessel obliteration with a laser at the same time (though not zero). Furthermore, a smaller polyp also means a smaller wound that needs to heal.

Shown at end of this blog article is a video of a vascular polyp being obliterated using a pulsed-dye laser (courtesy of Dr. Chandra Marie-Ivey). Another type of laser that may be used is a KTP laser. Read more about laser treatment of vocal cord pathology here.

Regardless of how or in what order the surgery is performed, strict voice rest is mandatory for a period of time post-operatively. For Adele, that was strict voice rest for nearly two months (Nov and Dec 2011). Why? Because with talking or any other vocal activity, the vocal cords come together. After surgical removal of a polyp, there is a raw surface present which won't heal as well if the other vocal cord is banging against it. Talking after vocal cord surgery is analogous to jogging right after foot surgery.

The vocal cord surgical wound MUST heal prior to talking let alone singing for normal recovery. That means strict voice rest. Strict voice rest means no talking, no singing, no whispering, no mouthing words, no throat-clearing, no humming, etc.

Read more about vocal cord polyps here.

Source:
The Wanted's Nathan Sykes Taking 'Unforeseen Hiatus'. MTV News 4/17/13

The Wanted say they 'fear' for Nathan Sykes' voice. BBC News 4/29/13

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How the Voice Anatomically Reverberates to Produce Speech

Came across this old school animation showing how sound produced in the voicebox reverberates in the upper airway, mouth, and nasal cavity to produce speech that everybody else hears.

To watch what it looks like from the inside, check this video out.

Source:

FFFFound! 5/23/11

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ENT Sued for Wrongful Death from Airway Closure

Media reported on a malpractice case whereby in October 2010, a woman presented to the emergency room at Ochsner Medical Center (Louisiana) with symptoms of sore throat, neck pain, and painful swallowing.

A CT neck performed at that time revealed "swelling in her neck and a narrowing at the top of the throat" [link]. Patient was given a strong pain medication to help with her discomfort (presumably a narcotic), admitted into the hospital, and ENT consulted for further evaluation and management. Unfortunately, the patient's airway completely closed early the next morning resulting in a massive brain injury due to oxygen deprivation with eventual withdrawal of life support four days later.

Lawsuit against the hospital and ENT among others pending.

What could have happened?

Based on the limited information provided, it seems that the airway swelling noted on the CT scan could have been due to a large peritonsillar abscess, throat tumor, or epiglottitis.

A peritonsillar abscess is basically a tonsillitis gone real bad with pus collecting under the tonsil causing it to swell. This condition could have been treated quickly with an incision and drainage.

Epiglottitis is when the "throat flap" becomes infected resulting in massive swelling which can lead to airway closure. Typical management would include IV antibiotics, IV steroids, and close observation. If airway truly becomes critical, an awake tracheostomy should be pursued. However, medical management is most always tried first if airway is still patent (albeit narrowed).

Throat tumor (ie, cancer) is pretty much a large growth in the throat causing airway narrowing. Treatment is an emergent awake tracheostomy followed by biopsies to determine what type of cancer is present so that treatment can be pursued as quickly as possible.

It is unclear from media reports exactly what was causing the airway narrowing and whether ENT had even seen the patient until the airway closed off. Also unclear was whether the ENT was made aware just how critical the airway was.

A tragedy...

Source:
Daughter of woman who died from brain damage after airway swollen shut sues hospital. The Louisiana Record 4/15/13

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Men with Deeper Voices are More Successful

© Dreamstime Agency | Dreamstime Stock Photos

A Duke University study has found that men with deeper voices not only are more successful, but also make significantly more money. How much more money? $187,000 per year more than men with higher-pitched voices.

How much deeper does the voice need to be to make a difference? Apparently 22.1 hertz which is approximately 1/6 the difference between the pitch of James Earl Jones (low-pitch) and Mike Tyson (high-pitch).

Other research (see below) have found that a deeper voice also makes a candidate more likely to win, are more desirable to women, mate more frequently, and father more children.

How can a man with a relatively higher-pitched voice achieve a natural-sounding deeper voice? The first and perhaps best way to accomplish this is through voice therapy. Think of it like singing where a person learns to achieve a greater vocal range through intensive instruction... but in this case, focusing on the lower range.

Of course, there are surgical interventions that may also be helpful should voice therapy be unsuccessful including:

1) Vocal cord bulking through injection
2) Cricothyroid muscle dennervation through botox or lysis
3) Thyroid cartilage framework surgery (Isshiki Thyroplasty Type 3)

I should point out that surgical intervention is NOT recommended as a first step and usually does not achieve the profound improvement that most men desire... in other words, there is no simple, quick, and easy way to deepen the voice.

References:
Voice pitch and the labor market success of male chief executive officers. http://dx.doi.org/10.1016/j.evolhumbehav.2013.03.001, How to Cite or Link Using DOI

"Sounds like a winner: Voice pitch influences perception of leadership capacity," Proc Biol Sci. 2012 Jul 7;279(1738):2698-704. doi: 10.1098/rspb.2012.0311. Epub 2012 Mar 14.

Preferences for very low and very high voice pitch in humans. PLoS One. 2012;7(3):e32719. doi: 10.1371/journal.pone.0032719. Epub 2012 Mar 5.

Sources: 
Voters 'like low-pitched voices'. BBC 11/14/11

Your Voice Could Be Costing You Hundreds Of Thousands Of Dollars, Study Shows. Forbes 4/18/13

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Scam Tracheostomy in Hospital Leading to Arrests

Image from Wikipedia

A Chicago hospital owner and a few doctors were arrested in a horrific scandal involving deliberately over-sedating patients thereby ensuring a patient will not be able to come off the breathing machine leading to the excuse needed to perform a tracheostomy [link]. All done in the name for greater profits.

This scandal is particularly notable given it has come right at the heels of a New York Times story which reported that hospitals often profit from surgical errors, though in this criminal case, it was deliberate rather than unintentional errors.

Tracheostomy is typically performed whenever a patient is on a breathing machine for a prolonged period of time and there is a low likelihood of recovery.

However, prior to tracheostomy consideration, sedation is turned off so that the patient is allowed to wake up and try to breath on their own. If able to breath on their own with machine assistance, the breathing tube may be removed thereby avoiding a tracheostomy.

However, according to the lawsuit, the hospital and physician colluded to over-sedate patients thereby ensuring the patient is "ventilator-dependent" for which a tracheostomy is (erroneously) "justified".

Furthermore, patients who have undergone tracheostomy were intentionally made to stay in the hospital longer than required ("28 days") in order to earn as much money as possible in insurance reimbursements for the hospital.  [link: paragraphs 123-142]

According to media reports, this scam has so far involved 28 patients... 5 who ultimately died within 2 weeks. The most recent unnecessary tracheostomy was performed on March 1, 2013.

Because of the trach and subsequent prolonged hospitalizations, the hospital received up to $160,000 for each patient from Medicare and Medicaid.

There's more... there was a massive kickback scheme whereby the hospital paid doctors to refer cases to the hospital (clear violation of Stark Laws), doctors ordered unnecessary ER visits, and fraudulently referred patients to nursing homes and ambulance services which the hospital had a relationship with.

This awful scam was brought to light by hospital workers (administrators, physicians, and nurses) who secretly worked with the FBI and other federal investigators.

Sources:
Feds raid Sacred Heart Hospital, arrest owner and doctors. Chicago Sun-Times 4/16/13.

United States of America Criminal Case Record. 4/15/13

Hospitals Profit From Surgical Errors, Study Finds. New York Times 4/16/13

Relationship Between Occurrence of Surgical Complications and Hospital Finances. JAMA. 2013;309(15):1599-1606. doi:10.1001/jama.2013.2773.

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Pinterest for the Medical Office

For some time now, I've been struggling to figure out how to use Pinterest social media as it applies to a medical practice.

Pinterest is a pinboard-style photo-sharing website that allows users to create and manage theme-based image collections such as events, interests, and hobbies. Users can browse other pinboards for images, 're-pin' images to their own pinboards, or 'like' photos.

Pinterest is also one of the newest and hottest social media platform, especially among women and 20-40 years old demographic. As such, it behooves physicians and hospitals interested in social media to figure out how to incorporate Pinterest to their social media campaign.

For more interesting Pinterest statistics, check this webpage out.

BUT... given its visual and pictoral nature, it has been problematic when incorporating into something as privacy-ridden as healthcare.

How to use Pinterest for a medical practice and be successful without getting into trouble with HIPAA?

Not sure I have the secret, but I've ultimately decided that relevant medical infographics is the best way to go.

We shall see...

Check out our Pinterest page here!

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Top 3 Reasons Why Your Child Can't Shake that Cough

Guest Blog Post by Dr. Julie Wei

Any parent who has lived with a toddler or preschooler knows the pain of hearing a child’s endless cough, daytime, nighttime, all the time... It seems as if the cough never clears up in a day or two, or after a cold, but may last for weeks. Even if it does clear up, it always seems to return without much warning, and can be more stubborn than your 4 year old about eating vegetables! If you are wondering why cough medications can't stop your child's cough, or for that matter, why inhalers for "asthma", another 10 days of antibiotics, and/or allergy medications are all not working, then continue reading. Have you dragged your child all over town to see yet another specialist to find out why they just keep coughing?

Here is what I explain to all families who come to see me about cough. Cough is an involuntary reflex, or protective mechanism the body has to get unwanted particles or irritants out of our airway. So if dust got into our windpipe, or a droplet of liquid goes into the airway accidentally while your child was drinking and trying to talk at the same time, or the phlegm that he/she gets with a viral illness... all of these things can make our children cough. While most children are thankfully not intermittently or continuously inhaling dust, or running around drinking with their head tilted while talking at the same time, the one frustrating thing about young children is the fact that they get 7-10 viral upper respiratory track illnesses, or colds every year. Each one of these “colds” last 7-10 days, and so pretty quickly, you can have a child with cold symptoms for a third of the year!

So... without further ado... the top 3 reasons why the cough is still hanging on...

NUMBER 3: Post-viral neurogenic cough or habitual throat-clearing. Whatever the reason was, your child started out having a bad cold and coughed due to being sick. Even after the fever and acute illness goes away after 7-10 days, their throat and voice box somehow stays irritated and they continue to cough. At some point, your child may not even realize that he/she is "coughing". Often these are children who are throat-clearing and not really coughing (more often in short annoying bursts, as often as every few minutes). If you no longer hear them "coughing" during sleep, but only when they are awake, then this is likely what your child has. These children often show no other signs of illness or discomfort. It's a difficult diagnosis to make and usually after all other reasons have been rules out. I often offer strategies to families to help break these habits such as creating a game (older than 3 or 4 years of age can do this) whereby a kitchen timer is used to help suppress the urge to "cough" starting from 30 seconds and working up to 5 minute intervals. School aged children who do not appear ill but have a “dry” throat clearing do very well with this exercise. Another option is when they get into a coughing fit, to distract them with chewing gum, having them count backwards from 20, hopefully distracting them from this habit.

NUMBER 2: Chronic Rhinosinusitis (CRS). Your child may have developed true chronic rhinosinusitis which means inflammation from thickening of the lining inside their sinus cavities and their sinus "plumbing" is clogged up. Chronic sinus inflammation is NOT a bacterial infection so antibiotics will not make it go away completely, even if it seems to decrease the cough temporarily. This usually occurs in children older than 4, especially if they have underlying test proven allergies to common aero-allergens like trees, pollen, grass, dust-mites, and other environmental allergens. Sometimes this is bad luck and develops after your child has experienced a terrible viral illness, such that the mucous membranes inside the nasal passages were so swollen that the natural drainage points that lead each sinus cavity into the nasal passage are blocked, which then leads to the inflammation inside the sinus. Since there is a built-in mechanism called the "sinopulmonary reflex", children who have inflamed sinus mucous membrane lining will likely continue to cough until the nasal passage and sinus mucous membranes are no longer swollen and healthy again. The only way to truly know if your child has CRS is for him/her to get a CT scan, a special imaging of their sinus cavities which can involve some radiation exposure. These children tend to complain of a stuffy nose all the time along with the cough, and can't blow anything out of their nose even if they try. Mothers always tell me that their child is stuffy and can’t breathe well, leading to snoring, fatigue, sometimes headaches.

NUMBER 1: The Milk and Cookie Disease (MCD). Your child is coughing because day after day, night after night, their larynx (voicebox) is bombarded with stomach content backwash (gastroesophageal reflux and laryngopharyngeal reflux) coming up to and irritating the voicebox. The voicebox which enables humans to talk is also designed to "cough" as a way to keep unwanted materials from entering our airway. If it did not protect itself by coughing, then we would aspirate and possibly get pneumonia. Find out how your child can live and eat in "A Healthier Wei" and fight the Milk and Cookie Disease, by minimizing dairy and sugar in the evenings and then his/her voicebox can rest and not be in "fighting" mode all the time. I have met thousands of children who have chronic cough not because they are sick, but because they were eating a diet or drinking beverages containing too much dairy and sugar, as well as possibly greasy foods and processed foods. All these items increase likelihood of reflux or backwash and assault on the larynx. If the voicebox is always on “alert” and ready to “fight” and protect the body, then it really can’t relax and rest. I believe that when this happens chronically from MCD, and let’s not forget those 7-10 colds and how they also lead to an irritated overreactive cough, then together, this child has no chance and probably will cough, A LOT! By making changes in diet and dietary habits in children, we can decrease the chance of stomach backwash coming up to irritate the voicebox and cause cough, then hopefully your child only coughs when it is truly because of a cold. Don’t take my word for it, try “A Healthier Wei”. You will likely notice at least much less coughing, and coughing ending much sooner after a cold. I also ask parents to stop dairy/milk for up to 1 week during the time their child is sick. This is when digestion is not at its best, and things get sour and gross in the stomach increasing chance for reflux and more cough.

by Julie Wei, MD, FAAP

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Cicadas Can Cause Permanent Hearing Loss!

Cicadas are pretty darn ugly... But beyond their ugliness and making cars look pretty messed up... the sound they make is not only irritating, but potentially harmful.

Sometime the end of this April 2013, billions of large flying insects called cicadas will make their appearance along with their characteristic stridorous noise. The male cicadas are the ones making this mating noise with "tymbal" soundmakers amplified by large resonance chambers found on body.

Occurring every 17 years, this year's swarm is known as Brood II and has not been seen since 1996. Expected to cover much of the East Coast, the buzz created by these insects can reach 90 decibels... about as loud as a jackhammer. If one is right next to your ear, the sound can reach 120 decibels are equivalent to sandblasting or a loud rock concert. [see noise chart]

At 90 decibels, possible hearing damage may occur if a human ear is exposed to this level noise for more than 8 hours a day. At 120 decibels, less than 15 minutes of exposure can induce possible permanent hearing loss.

So... keep a pair of ear plugs in your purse or pants pocket and use them if the sound starts to get too loud.... or too irritating.

Sources:
17 years in the making, this spring's cicada invasion generates early buzz. NBC News 4/10/13.

Cicada. Wikipedia

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When Your Child Has a Draining Ear

Guest Blog Post by Dr. Julie Wei, MD, FAAP

One of the most common and simple procedures that Otolaryngologists (ear, nose, and throat specialists) perform is that of putting “tubes” in children’s ears. General and pediatric otolaryngologists alike perform thousands of these simple and quick procedures every year, often several times in a single hour! Most children who need and get “tubes” in their ears are toddlers and those in preschool age. What continues to surprise me is how often parents and caretakers are not explained to clearly about what to do once a child has ear tubes in and then develop a wet or draining ear. Yes, I am talking about yellow, green, white, brown, stinky (the smell can fill up a room!), sticky, nasty stuff that not only runs out your child’s ear canal, but then crusts around their ears and worse, perhaps down their cute cheeks!

I have believed it is critical that every ENT surgeon take the time to explain to parents why and how tubes decrease “ear infection”, which is when there is buildup of pus in the middle ear space, pushing on the eardrum from the “inside”. Every time I recommend ear tubes, I make sure that parents understand the simple “plumbing” logic that is involved once there is a small opening created in the eardrum so that oxygen and air can go from the world into that tiny space behind the eardrum (middle ear space), and of course, when there is “infection” or pus which develops from that space now it can drain out through the tube directly out of the ear canal and be seen by parents. The whole point of tubes is that parents and caretakers can tell when a child actually has an ear “infection”. Instead of pain from pus trapped and pushing on eardrum and fever that results from trapped pus, there should be no pain or fever... just nasty stuff coming out the ear. I realized early in my career that unless I explain in detail how a wet ear should be treated once a tube has been placed and is working, parents go first to an urgent care, or their primary doctor’s office, and then are usually prescribed oral antibiotics (almost always unnecessary as well as ineffective), instead of using antibiotics in the form of ear drops which primary and ENT doctors should prescribe.

You see, the beauty of the ear tubes is that now just as air can go through that tiny 1.2 mm round ‘hole” in your child’s ear drum, so can ear drop which contain antibiotics (and steroid, an important component of ear drop therapy in my experience). The strength of the antibiotics in those few drops from that expensive bottle is likely 300 times stronger than what the human body can safely eat. Since the drops are getting absorbed into our blood stream and system which is what happens when we eat/drink it, it works by simply making contact with the infected surfaces of the middle ear space, the mucosal lining with living cells which produce the pus or mucus in the first place (when it is inflamed by viral and bacterial infection along with the irritation that goes with every infection).

A nasty draining ear is easily treatable – the junk is all removed from the canal, tube is checked to ensure it is still in the eardrum and “working” (hole is open), and then topical ear antibiotic and steroid drops are prescribed. I emphasize the importance of aural toileting, that means taking toilet paper or KleenexTM, twirling it into tiny 1-2 cm “wicks”, and putting that gently into the canal for a few seconds so that the nasty drainage is absorbed onto the tissue. Twirl another area of tissue and repeat, and repeat, until not much nasty wet stuff is coming out. THEN, and ONLY THEN, do they start putting the few ear drops into the ear canal. It is also critical to perform the “tragal pump”, meaning to gently push on the little “nubbin” just in front of the opening of the ear canal to make sure that trapped air bubbles come out and drops make it all the way deep into the canal to where the tube and “hole” is to have a chance to get into the middle ear space where the infection is.

Of course, there may be other problems. Sometimes the child is having this issue because it’s been 2 or 3 years since the tubes were put it, but not one knows if it’s still in the ear drum or has “fallen out”. Often the tube is no longer in the drum, the hole has healed itself, but the tube is “stuck” on the drum or ear canal which is lined by skin. The body gets irritated with this “foreign body” that is stuck there and then angry tissue called granulation tissue forms. This angry reddish mass is full of blood vessels and is most likely cause of blood coming out of any child’s ear if that child has had tubes placed. Thankfully, the treatment is the same. As I tell parents every clinic day, it doesn’t matter what is coming out of the ear canal, using the antibiotic and steroid ear drops is the way to go. The steroid component will calm the anger, reduce inflammation, shrink the angry tissue, stop the drainage and pain associated with this, and then the tube can be removed from the canal in the office most likely.

If families are informed of how tubes work, and techniques for good aural toileting, as well as immediate use of ear drops whenever there is draining ear in a child with tubes, then they can be empowered to stop going to urgent care, their primary physicians, save time from work and school missed, save money on oral antibiotics, and most importantly, spare their child from yet another course of oral antibiotics.

I must mention that while perhaps 95% of draining ears should respond to a solid week of using ear drops containing antibiotics and steroid, currently we do have another cause of persistent draining ears in healthy kids. That is the issue of methicillin-resistant staphylococcus aureus (MRSA) infection, even in the ear. I find that many daycare aged toddlers will show up in the office, after using drops as I have intensely preached, and in these children often the culture will prove they have MRSA as the bacteria causing this problem. Thank goodness MRSA in this setting is almost universally susceptible to a class of antibiotics that are “sulfa” based, like “Bactrim” (trimethoprim/sulfamethoxazole), because we the medical professions have not used this drug much in the past decade or two since we have many “newer” antibiotics, it is actually useful to fight MRSA. If your child’s ears are still draining after a week of the antibiotic and steroid ear drops, you should call the surgeon who put the tubes in, ask to be seen, for a culture to be done of the nasty drainage, and if it is MRSA positive, then the best treatment is to switch to a “sulfa” based drop , 10% sulfacetamide, used 3 times daily for next 7 days, as well as put mupirocin ointment in the child’s nostrils twice a day for 10 days, and finally your child should also be given oral Bactrim for 10 days. The idea is to try to eradicate the MRSA living in their nasopharynx which is connected to the middle ear space through the Eustachian tube – details worthy of a separate blog.

If the MRSA drainage does not clear up, I will make the tough but proactive and effective decision to take those tubes out and let the ear drum heal. Thankfully, these children do not necessarily go back to having a bunch of ear infections or trap fluid causing mild hearing loss. Thanks to time, sunshine, love, and nourishment, little heads and bodies grow and they often do well without the tubes.

Sometimes I joke with parents that I am just a glorified plumber. There is a great deal of truth in that. If the plumbing is blocked, much goes wrong in the house. You would certainly contact the plumber, and as such, do contact your child’s ENT sooner rather than later if a draining ear does not stop, AFTER you’ve done what I have described. May you and all parents out there whose children have tubes save money and time live better lives as promised by your child’s ENT.

By the way, stop plugging your child’s ears from bath and swimming, unless they complain of pain every time water gets in. Ten years of a handful of studies show that children whose ears are plugged from water are no better than those who plug and there is no difference….but everyone is much happier without those plugs. Yes, even if your child is swimming in a lake (again, another blog worthy topic). I am a mother first, and believe that your child deserves more than opinions, but information based on science.

by Dr. Julie Wei, MD, FAAP

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Dr. Chang Quoted in Washington Post Regarding Hearing Damage from Noise

The Washington Post on April 8, 2013, published a story about how loud noises can lead to hearing loss, even in young teenagers.

Dr. Chang was liberally quoted throughout this informative article.

"...That’s according to Christopher Chang, an ear, nose and throat doctor at Fauquier ENT Consultants in Warrenton, who sees patients every day with hearing-related issues. “What he’s hearing is way too loud, because it’s concentrated directly into the ear itself,” he says of my son, adding that the anatomy of the ear magnifies sound as it travels through the ear canal." 

"And when someone turns the music up louder? Well, in short spurts, that’s okay. Loudness is only one part of the equation. How long you’re exposed to loud noises also affects your risk. “The biggest concern is that teens and 20-somethings are using music players so regularly,” Chang says. 

"Cheap earplugs that you can buy at the drugstore offer some protection, Chang says. In addition, there are specialized ear plugs, such as ones for hunters that amplify low-level sounds and block out gunshots. Musicians’ earplugs reduce noise with higher fidelity than the muffling effect that regular plugs have: You want to hear the music that you and your orchestra mates are playing, after all."

Read the entire article here.

Source:
Hearing loss may be caused by cities’ noises and music that’s played too loud. Washington Post 4/8/2013.

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Surgical Video Recording: How I Do It

A number of people have asked how I go about video-recording surgeries... Beyond having hospital administration on board as well as obtaining appropriate consents from all involved parties, the technical aspects are actually quite straightforward.

I have tried all sorts of methods in order to obtain the closest and most vivid images possible. I tried cameras mounted on the surgical headlight which did work... but there was too much motion artifact leading to unusable footage. Even though I thought my head was absolutely still, it really was not.

What I found worked best is using the video tower used for sinus surgery in my hospital with the camera-head attached to the overhead light-handle. Thankfully, my hospital uses HD equipment with 3CCD camera-head, so the video footage is spectacular. And because the camera-head is mounted on a light-handle, the footage obtained is absolutely still.

The footage is recorded digitally directly onto a hard drive which I than transfer to a USB thumb drive.

Along with this setup, I have a roaming individual with a hand-held camcorder to obtain different angled shots to add variety to the final movie.

So that's how I now do it!

The specific video equipment I use is a Conmed Linvatec HD System... however any sinus surgery video equipment should work even if analog.

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New Video on Thyroid Surgery and Its Complications

A new video has been created regarding how the thyroid gland is removed along with potential complications that may occur with this surgical procedure.

This video creation was a collaborative effort between myself and Dr. Henson, the general surgeon who performed the actual operation portrayed in the video. Assistance by Robin Earl and the surgical staff at Fauquier Hospital were invaluable as well.

Read more about the surgery here or watch the video!

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Dr. Chang Mentioned on NBC News Regarding Sound of One's Voice

Dr. Chang was mentioned today in a NBC News article on their popular Body Odds section. The article entitled "why you hate the sound of your own voice" describes why people sound and often dislike the way their voice sounds on a recording.

What we hear when we speak, however, is air- and bone-conducted sounds. Vibrations from our vocal cords directly reach the cochlea. Our skulls deceive us by, in fact, lowering the frequency of these vibrations along the way, which is why we often perceive ourselves as higher-pitched when we listen to a recording.  

“When [someone] listens to a recording of their voice speaking, the bone-conducted pathway that they consider part of their ‘normal’ voice is eliminated, and they hear only the air-conducted component in unfamiliar isolation—what everybody else actually hears,” says Dr. Chris Chang, an otolaryngologist at Fauquier Ear, Nose & Throat Consultants in Warrenton, Virginia. [link]

I wrote a more comprehensive blog article on this phenomenon here.

In any case, very cool I got quoted!!!

Source:
Why you hate the sound of your own voice. NBC News 4/2/13

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Why Do Culture Results Take So Long? [video]

One of the most common questions I get after obtaining a culture of pus whether from the ear or the nose is how long it takes before the culture results are back... especially when MRSA is a concern.

Does it take a few hours? 24 hours? Days?

Disappointingly, it can take up to 5+ days if not longer.

You want to know why?

Well, rather than explaining, watch a 6-minute video that explains the numerous steps that goes into providing a diagnosis after a culture has been obtained... in this particular case, ear drainage though the same steps apply to any culture obtained from anywhere else in the body.

Special thanks to Robin Earl who spent hours hanging out in the microbiology lab video-taping all the relevant video clips as well as Fauquier Health for allowing this video to be made!

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