What is the BEST Way to Disinfect a Toothbrush?

In my previous blog article, I discussed the debate over whether a toothbrush becomes "contaminated" leading to the practice of throwing them out after a strep throat infection. Although the answer is still ambiguous whether it helps or not, the fact that even NEW toothbrushes contain harmful bacteria brings even more confusion on what to do.

Going on the assumption that bacteria on a toothbrush is harmful and if a new or old toothbrush contain such bacteria, perhaps the best practice would be to disinfect toothbrushes on a regular basis.

Would toothbrush disinfection work best by...

• Microwave
• Ultraviolet light (examples in this list from Amazon)
• Dishwasher
• Listerine
• Crest Pro-Health
• Air dry
• 3% Hydrogen Peroxide

Although the ultraviolet sanitization method is perhaps getting the most attention due to the high-tech nature, researchers have found that though this method did significantly decrease bacteria load, they also have found this method to be the least effective compared to other measures.

Rather, the best way to disinfect a toothbrush is by rinsing the toothbrush with Crest Pro-Health mouthwash for 20 minutes OR having it go through a normal dishwasher cleaning cycle.  3% Hydrogen Peroxide was also found helpful.

Interestingly, Listerine didn't work much better than air-dry alone and ultraviolet light didn't do much better.

Bottom line?

Don't waste your money on ultraviolet light toothbrush treatments.

Rather, if you already use a dishwasher regularly, stick the toothbrush in there. If you already like gargling with mouthwash, get Crest Pro-Health which can also disinfect toothbrushes effectively.


References:
Disinfection of toothbrushes contaminated with Streptococcus mutans. Am J Dent. 2011 Jun;24(3):155-8.

Germicidal activity of antimicrobials and VIOlight Personal Travel Toothbrush sanitizer: an in vitro study. J Dent. 2010 Aug;38(8):621-5. doi: 10.1016/j.jdent.2009.08.011. Epub 2009 Sep 23.

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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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Some Facts About Q-Tips and Ears

In this week's episode of "Girls" (Season 2; Episode 9 "Girls Gets Dark"), Hannah grappling with OCD, inserted a Q-tip deep into her ear canal and "heard air hiss out the hole" due to perforating her eardrum.

Although this scene came out of a TV show, this scenario is not uncommon and results in many ENT office visits every month for not only eardrum perforations, but bleeding due to trauma to the ear canal skin.

Some facts about Q-tips as it relates to the ear...

It should never be used to clean earwax within the ear canal. In fact, on Unilever's website (the maker of Q-tips), the company explicitly states that Q-tips should only be used to "gently around the outer ear, without entering the ear canal." [link]

In fact, the word "ear" appears less than a dozen times on the entire Q-tip website.

Apparently, Q-tips are meant for many other uses beyond ears which play only a very small role in the world of Q-tips.

• Cleaning tiny spaces in ventilator grates
• Applying polishes to silverware
• Dust picture frames
• Clean keyboards and the computer screen
• Applying wood stain
• Clean tracks and grooves of medicine cabinets
• Clean small compartments of washing machines
etc, etc, etc

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New Video on Treatment of Hyper-Nasal Speech by Injection

Our office has created a new video that we have uploaded that shows how hyper-nasal speech can be corrected via injection of filler agents under endoscopic guidance.

Keep in mind that this procedure ONLY works with small velopharyngeal insufficiency.

Hyper-nasal speech occurs when there is too much nasal airflow during speech as opposed to hypo-nasal speech (ie, nasal obstruction) which occurs when there is little or no nasal airflow during speech. In either case, the voice sounds "nasal".

Check out the video here.

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"Mother's Kiss" to Remove Nasal Foreign Bodies

In 1965, a general practitioner Vladimir Ctibor described the "Mother's Kiss" technique of removing nasal foreign bodies in a child.

Essentially, a trusted adult (like a mother) places her mouth over the child's mouth as if to perform mouth-to-mouth resuscitation. While pinching off the unaffected nostril, the adult than blows gently into the child's mouth until resistance is felt caused by the child closing the glottis. At that moment, the adult gives a sharp explosive exhalation to deliver a strong puff of air that passes up into the nose and out the unblocked nostril. If successful, this air puff will also blow the foreign body out the nose as well.

If the adult blow's air when the child's glottis is open, air will just go into the lungs rather than up the nose.

Prior to the procedure, the child is informed that the mom will give the child a "big kiss," hence the name of this procedure.

Now... does this technique actually work?

According to one meta-analysis, it works about 59.9% of the time.

The way I consider it... it can't hurt to try before using instruments to manually remove the nasal foreign body. A "mother's kiss" is certainly a more comfortable and familiar approach for a child versus the alternative.

However, one warning point... the child should be calmly breathing during this procedure. If the child becomes hysterical during the procedure, the child might strongly inhale through the unblocked nostril and potentially suck the foreign body (if small enough) down into the lungs making an unlucky situation into a medical emergency.

Another point for those uninformed... do NOT use this procedure on ear foreign bodies. It will NOT work. The ear canal is a closed container with no inlet or outlet for any air pressure produced by a "Mother's Kiss." In fact, trying to perform this procedure on the ear may cause a ruptured eardrum and even permanent hearing loss.


Reference:
Removal of Foreign Bodies from the Nose. NEJM 1985; 312:725.

Efficacy and safety of of the "Mother's Kiss" technique: A systematic review of case reports and case series. CMAJ 2012. DOI:10.1503/cmaj.111864 (full length pdf)

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How to "Grow" Clean Air

The New York Times published a story regarding how common houseplants can purify the air of chemicals like benzene and formaldehyde.

This claim is based on NASA research performed in the 1980s when the agency was trying to figure out ways to keep the air quality as clean as possible within enclosed habitats (like a space station).

Of course, you can read the 27 page report... or read a mom-friendly book that summarizes the findings in an easy-to-understand language from Amazon.com.

"How to Grow Fresh Air" by Dr. BC Wolverton


The book reviews 50 common houseplants' ability to clean the air inside the home or office. Depending on the plant, chemicals that can be removed include benzene, formaldehyde, xylene, toulene, trichlorethylene, chloroform, ammonia, acetone, and alcohols. Such chemicals are emitted from electronics, drywall, adhesives, upholstery, carpet, paint, cosmetics, etc.

It is suspected that such chemicals may be the cause of "sick building syndrome" that induces symptoms of upper respiratory irritation, fatigue, headache, and congestion when afflicted individuals enter certain buildings.

My personal favorite plants are the fern and peace lilly, both which have a high rate of chemical vapor removal, easy to grow and maintain, and fairly resistant to insect infestation. Does the job and easy to care for.

BEWARE!!!

Now before running to the nearest greenhouse and buying numerous plants to keep inside the home, consider that though such plants remove chemicals from the air, the plants themselves may exacerbate allergies in sensitive individuals.

Why? Plants can increase dust (accumulated on the leaves) and mold allergens (in the soil).


Source:
Really? Some Plants Can Filter Airborne Chemicals. NYT 9/3/12

Reference:
Interior Landscape Plants Indoor Air Pollution Abatement. NASA 9/15/89

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Dirty Air Filters and Allergies - Don't Forget the Car!!!

Most people with bad allergies know to change their home's air filter at least quarterly with at least a 1000 microparticle performance rating (mpr). Such filters will remove pollen, dust, and other airborne particles that may exacerbate allergies as well as keep the vent system within a home clean.

BUT... allergic patients should also not forget to change their car's air filter as well regularly, especially given the car is moving around outside and people often have the air conditioning or heat turned on blowing into the face. And guess what... there are many different quality car air filters.

As such, do recommend that whenever you have your car for maintenance, request the mechanic to show you your car's air filter.

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Why Does My Voice Sound Different on Recording and Treatment Options

Every so often, I have a patient who presents to my office with a complaint that their voice sounds different on recording than what they themselves hear.

In particular, singers who come in state specifically that their vocal recordings sounds slightly flat when they thought they were singing in perfect pitch.

So why does this happen? Unfortunately, it is physics and fundamentally integrated to how the ear, skull, and sound transmission work. In other words, it can't be "treated" with surgery or medications.

What other people hear when you sing or talk is air conducted sound that gets transmitted through the ear canal, eardrum, middle ear bones, and ultimately to the cochlea hearing organ (pathway A).

Image by Chittka and Brockmann Modified from Wikipedia

The sound the individual singer/talker hears is not only sound transmitted via the air (pathway A) but also by vibration of the skull itself directly to the cochlea hearing organ bypassing the outer and middle ear completely (pathway B). The mechanical properties of the skull enhance the deeper, lower-frequency vibrations.

Therefore, when a talker/singer listens to a recording of their voice speaking/singing, 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).

SO... what is a singer/talker to do if they are disturbed by the way they sound to others? Particularly, what is a singer to do when they always sing a little flat when they truly think they are singing in pitch?

One can wear earplugs in order to hear only bone-conducted vibrations and get used to their alter-voice and undergo speech/voice therapy. OR... accept that their voice IS different.

For singers, I highly recommend using HearFones Headsetwhich is a funny looking head device that allows an individual singer to hear what they really sound like and more importantly what the audience would hear! In addition, while using HearFones, the singer would be able to hear himself more predominantly over the rest of the ensemble thus helping him to improve the quality of his/her individual vocal quality output.

Over time, singers will be able to automatically adjust their singing such that they no longer will need such a device to sing in tune with others when in familiar surroundings. BUT... in new environments (new concert hall, outdoor arena, etc), it is not unusual that their singing may become off again...

This is why professional singers often wear earpieces that convey sounds recorded by microphones placed in the audience... and also why they sometimes sound flat and out-of-tune when they don't!

It's also why it is VERY important to rehearse in a new place before a concert.

On a related note, most individuals state that they do not "like" they way they sound on a recording. However, according to one study, people unconsciously prefer their recorded voice over others.

Of note Dr. Chang was mentioned on NBC news regarding this question in this story.

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