Hearing Test Administered Over the Phone

I was just made aware of this service in a Washington Post article 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.

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."

Here's how to take the test by phone:

1. Find a quiet place to take the test that is free from distractions. 
2. If you hang up in the middle of your test, you will have to start from the beginning. 
3. Use a telephone that plugs into a wall-mounted jack. Please do not use a cell phone. 
4. Dial our toll-free number: 1-866-223-7575 
5. Listen to the recorded instructions. 
6. At the end of the test, write down your test results for each ear and the date. The categories are: 

Within the Normal Range

Slightly Below the Normal Range

Poor

Further details of this test can be found here, 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.

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.

If hearing is assessed to be abnormal, you can contact our office to undergo a more sophisticated hearing test for confirmation and next steps.

Source: 
Take this hearing test right now. I did, and the results were disturbing. Washington Post 5/16/14.

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Cure Hiccups by Pulling on the Tongue

There are many different ways to treat hiccups (otherwise known as singultus). Some of the more bizarre ways of treating hiccups include rectal massage and tongue pulling.

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).

It is hypothesized to work by stimulating the vagus nerve thereby easing the diaphragmatic spasms.

Reference:
Treatment of singultus by traction on the tongue: an eponym revised. J Hist Neurosci. 2013;22(2):183-90. doi: 10.1080/0964704X.2012.728389.

[Stimulation of the root of the tongue can cure hiccup. 20 years of "unscientific" experience supports the thesis]. Lakartidningen. 1998 Oct 7;95(41):4477-9.

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How Common is Hoarseness?

At some point, we all have suffered from a hoarse voice 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"...

According to a study 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 health care professional for their hoarseness and 40% were given a diagnosis.

Infectious laryngitis was the most common diagnosis mentioned (685±86 thousand cases, 17.8±2.0%). Gastroesophageal reflux disease was mentioned in 308±54 thousand cases (8.0±1.4%).

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.

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.

Another general rule of thumb is to minimize using your voice if it becomes unexpectedly hoarse.

Reference:
The prevalence of voice problems among adults in the United States. Laryngoscope. 2014 Apr 29. doi: 10.1002/lary.24740.

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How Ears Tune In and Out Certain Sounds

Ever wonder how humans with normal hearing are able to "hear" what one person is saying in a crowded room where many people are talking? How is it that the ear is able to tune in and out of conversations going around, especially when everybody in a room is talking equally loud?

To understand this ear "tuning" ability, one needs to first understand that the ear incorporates two "aspects" that allow for good hearing: a volume knob and an antenna. Should the volume knob not work, hearing aids boost the frequencies where hearing loss is present. However, if the antenna does not work, simply increasing the volume does not necessarily make sounds/speech more understandable. This situation is analogous to an old radio where turning the volume up on a station with a lot of static does not make sounds more understandable (fiddling with the antenna to get a clear signal is better).

We have a very good understanding the volume knob of the human ear. What we do NOT have a good understanding (nor how to fix) is the antenna.

However, researchers have begun to clarify how the human ear "fiddles" the antenna to make certain sounds more understandable relative to others providing humans the ability to tune into what one person is saying in a loud restaurant.

Apparently, part of the answer is the tectorial membrane found within the cochlea (membrana tectoria in the Gray's illustration below).

Note that this membrane found inside the cochlea rests on the inner and outer hair cells which allow for hearing (the volume knob). When the ear hears a sound, "waves" are created within the cochlea stimulating the hair cells which allow us to hear. Depending on which hair cells are stimulated, a specific sound frequency is heard.

Using mutant mice, MIT researchers have determined that the viscosity of tectorial membrane depends on the size and distribution of tiny pores. This viscosity provides mechanical filtering that helps to sort out specific sounds by influencing the speed and decay of tectorial membrane waves when a sound is heard.

Although the precise way how the tectorial membrane allows for such exquisite frequency selectivity is still not fully understood, this may be the first step towards that comprehension.

Because once we firmly understand how the ear's antenna works, we hopefully can make better hearing aids that not only act as a volume knob, but can also fiddle the antenna as well.

Reference:
Porosity Controls Spread of Excitation in Tectorial Membrane Traveling Waves. Biophysical Journal, Volume 106, Issue 6, 1406-1413, 18 March 2014 doi:10.1016/j.bpj.2014.02.012

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Flushing Ears with Cold Water Can Treat Somatoparaphrenia

Somatoparaphrenia is a condition whereby a person denies that a limb or an entire side of the body belongs to them, even if provided with irrefutable proof. This condition usually is accompanied by left-sided paralysis and anosognosia (denial or lack of awareness) of the paralysis often due to a parietal stroke.

What is interesting is that flushing the left ear with cold water (caloric vestibular stimulation) can temporarily treat/resolve somatoparaphrenia. Specifically, the protocol is flushing into the left ear canal 60cc of cold water (20 degrees Celsius) for one minute. During the stimulation, the patient is laid down and head tilted forward 30 degrees. If properly done, clear horizontal nystagmus with leftward slow phase can be seen for about 3 minutes.

Normally, flushing the ear in this manner is routinely performed as part of balance testing (ENG) to determine whether a person's dizziness is due to an inner ear problem or not.

In any case, how does vestibular stimulation help with somatoparaphrenia? I don't quite understand it myself, but according to one reference:

"vestibular input takes part in building up and updating the representation of egocentric space." [link]

Whatever that means...

References:
Can vestibular caloric stimulation be used to treat apotemnophilia? Med Hypotheses. 2007;69(2):250-2. Epub 2007 Feb 9.

Partial Remission of Hemiplegia and Somatoparaphrenia Through Vestibular Stimulation in a Case of Unilateral Neglect. Cortex Volume 28, Issue 2, June 1992, Pages 203–208

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Chin Strap May Help with Snoring

There is a relatively simple (and cheap) device that may help some people who snore called a chin strap. This lowly, humble, and low-tech device may benefit patients who typically snore when:

1) Lays on back, but not on side
2) Mouth-breathes when sleeping (but suffers no nasal obstruction)
3) Does not suffer from severe obstructive sleep apnea
4) Appears to be "slack-jawed" when sleeping (chin pushed back relative to upper jaw creating a pseudo-overjet dental appearance)

How (or more importantly why) does this device work?

When a person sleeps who also mouth-breathes AND has a chin that falls backwards, it also causes the tongue to fall back against the back wall of the throat causing a partial narrowing. It also causes the overall throat diameter to decrease causing the throat mucosa to loosen creating the perfect environment for snore production: a partially narrow airway resulting in negative pressure due to increased respiratory effort which triggers any loose mucosa to vibrate causing a snore sound.

A chin strap can be used to force the mouth closed into a more normal position (chin in normal forward position with teeth in normal occlusion). By preventing the chin from falling backward, it would prevent the tongue from falling backward. By preventing the tongue from falling backward, the partial airway narrowing could be avoided. By preventing the airway from narrowing, the throat mucosa would be more taught and less prone to vibrate as well as prevent increased respiratory effort and a "negative" pressure environment.

Where can you get one? There's a whole bunch that can be purchased on Amazon.com.

So there you have it... Of course, keep in mind that the chin-strap will NOT work for everybody as the snore production could be due to other factors unrelated to the chin, tongue, mouth position.

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Surgeon's Point-of-View (POV) Video Recording

Learning how to video record vivid, stable, high-def, and focussed shots from my (surgeon's) point-of-view has not been an easy endeavor due to technology limitations, though things do appear to be slowly improving. There have been pros and cons with most video-recording systems to date which I have summarized below. The "perfect" video-recording system has yet to be developed which must include all these elements:

• Wearable on headlight or glasses
• Camera located between the eyes that is maneuverable to adjust recording angle
• Head-up view to see what is being recorded real-time
• Manual white balance adjustment

• Manual exposure adjustment (bright lights used in surgery often confuse auto-exposure settings which result in washed-out pictures)

• Auto-focussing with adjustable zoom

• VERY good image stabilization

• HD video-recording

General Problems with Head-Mounted Video Recordings

The problem with current head mounted video-recording systems including Google Glass are several-fold. First of all, no matter how good you think you are staying still, there are constant micro-motions/tremors which produce unusable erratic videos. This annoying camera movement becomes even more pronounced when using cameras with longer focal lengths which is why most head-mounted camera systems come with a fixed, wide-angle lens which unfortunately takes away from the narrow-angle, focussed shot a surgeon would like recorded.

Also, the smaller and lighter the camera, the more inferior the optics resulting in poor video quality (compared to high-resolution, 3CCD, HD recordings which is what the surgeon's want).

These short-comings are common with all head-mounted video-recording systems. Unfortunately, there are even more problems depending the camera.

Google Glass (or any eyeglass side-mounted camera)

Typically, when a surgeon operates, the surgical field (green) is a certain distance from the his/her face. When in a comfortable position, wearing any type of head-mounted camera system located on the side like Google Glass unfortunately ends up video-recording a point that is above and to the side (purple) of what is actually desired.

In order to compensate the vertical offset, either the surgeon has to flex the head more or move the eyeglass down towards the lip.

To adjust the horizontal offset, the surgeon would have to turn and move the head to one side such that the camera has a more direct line shot into the surgical field... but that would mean the surgeon would be operating off-centered, almost looking over one shoulder.

Although doable, this is far from perfect or comfortable.

Central Head-Mounted Video Camera Systems

There ARE video-recording cameras that contain a camera that can be placed centrally over the forehead or between the eyes including Luxtec and SurgeonCam which are mounted on the headlight and PivotHead glasses (among others) where the camera is built into the frame between the eyes.

The headlight mounted systems'  camera angle can be adjusted to provide a more precise POV recording, but the general disadvantages of body-worn cameras still apply with constant erratic motion and wide-angle shots that do not specifically focus in on the surgical field.

The PivotHead glasses do provide perfect central shots, but still suffer from a vertical offset (orange) which cannot be adjusted like the headlight mounted systems.

Overhead Mounted Camera Systems

For the same reason the best photos are obtained by cameras fixed to a tripod, the best videos are often obtained by cameras fixed into position by a stationary object.

One object cameras can be attached to are overhead fixtures.. specifically the operating room lights.

Such cameras are attached typically to the light-handle of such overhead operating room lights which are directed down into the surgical field. Such systems provide excellent focussed, stable, high-quality video-recordings with one BIG disadvantage. The surgeon's head keeps getting in the way.

Also, the light-handle is positioned for optimal lighting of the surgical field... not optimal framing for capturing good videos.

Bed-Mounted Camera Systems

Using a Thompson Laparoscopic Retractor System, the video camera can be attached to one of the articulating arms and adjusted sterilely as needed. Using this retractor system can allow the camera to be positioned independently of the overhead operating room lights and to be as close to the surgical field as necessary.

The video is limited by how good the camera is that is attached. The best one I've been able to find is the Sony HXR-MC1 which incorporates a large-sized lipstick camera that is attached to a controller where manual controls for focus, zoom, white balance, exposure, etc can be made. Other than the built-in LCD screen, there are included plugs (Component, RCA, and with adapter S-Video) that allow what the camera is recording to be thrown up onto a large screen.

Other wireless video lipstick cameras are now being produced, but lack manual controls to adjust zoom, white balance, and exposure. Some offer real-time video display so it may be just a matter of time before all other manual controls found with the Sony HXR-MC1 become more widely available.

The main disadvantage with this setup is that the setup itself can get in the way of the surgeon.

Conclusion

So there you have it... No perfect surgical POV video system yet... Maybe in the next few years if technology keeps moving the way it is.

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How Long Do Swallowing and Voice Problems Last After C-Spine Surgery ACDF?

I often see patients for swallowing and/or voice difficulties after cervical spine surgery (ACDF). In the vast majority of cases, reassurance that such "side effects" are not uncommon is the only thing I need to provide after a complete exam.

After all, both the voice box and swallowing tube are manipulated and pushed over to one side in order to perform cervical spine surgery from an anterior approach. Check out the video below that illustrates how this happens.

Beyond reassurance, the next question patients have is how long before things go back to normal. Until now, that was a hard question to answer.

A recent report was able to provide some numbers I can now use to help explain to patients. After anterior approaches to cervical spine surgery:

• 60% had a postoperative issue, including 27% with postoperative voice complaint and 48% with postoperative swallowing complaint
• Swallowing complaints that lasted beyond 1 year occurred in 28%
• Voice complaints that lasted over 1 year occurred in 9%
• Approaching spinal levels above C4 and exposing more than 3 spinal levels were 2 factors that significantly resulted in voice and swallowing problems

In certain patients with more extreme swallowing difficulties, barium swallow studies may be ordered. Swallow therapy can be helpful as well.

Should vocal cord paralysis be seen on endoscopy, voice therapy and even vocal cord medialization injections can be performed to alleviate voice problems.

Reference:
Factors Predictive of Voice and Swallowing Outcomes after Anterior Approaches to the Cervical Spine. Otolaryngol Head Neck Surg. 2013 Dec 23. [Epub ahead of print]

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At-Home Rapid Strep Testing

Rapid strep test kits can be purchased by anybody to be done at home which may save parents/patients a lot of money in doctor visits for those prone to strep infections. Indeed, should a rapid strep test be positive, than you know that a doctor's visit is definitely worthwhile. (A doctor visit may still be worthwhile since a sore throat may be due to something else like cancer, aphthous ulcer, sinus infection, reflux, etc).

Such home kits (which in fact are the same kits used in medical offices) can be purchased online through Amazon. The price is surprisingly affordable at around the cost of a single copay $30 to do 25 tests.

However, with the purchase of such DIY kits, there are some pitfalls patients should be aware of if they decide to proceed.

1) Perform the internal controls that come with the kit!!! The kit may be a dud and needs to be tested against itself to ensure accurate results whether negative or positive. If the controls do not work, throw the whole test kit out and buy another.
2) You must follow the directions precisely, otherwise the test results will be unreliable. In other words, if the directions call for 4 drops, than it MUST be 4 drops (not 3 drops or 5). If directions state to wait 4 minutes... you must wait exactly 4 minutes. This literally is like precision baking.
3) The test strips need to be kept in protected, sealed bag and used immediately after taking one out, otherwise the test results will be unreliable.
4) When swabbing the throat, you MUST get the cotton tip on the tonsil and/or back wall of the mouth which than must be rubbed around a couple times. Getting the tongue or cheek will increase the risk of a false negative. As such, it may be worthwhile to invest in some tongue blades to help push the tongue down in order to perform this test properly.

Should patients elect to start performing home strep tests, please be aware that physicians will be obligated to not only REPEAT the testing but also examine the patient to ensure antibiotics are appropriate. An actual throat culture may be performed as well which is the gold standard test.

1) Repeat testing is required because the patient may not have followed the instructions precisely. For example, the test strips must be read at 5 minutes (variable depending on the kit). If test results are read past 5 minutes, it may incorrectly show a positive result.
2) Some patients unfortunately fabricate test results just so they can get an antibiotic without an office visit.
3) Some patients unfortunately also fabricate test results in order to skip work or school for personal reasons not related to an actual medical condition.
4) There are situations that even though the strep test is positive, no treatment may be recommended. The patient may be a strep carrier for which treatment of any kind is not recommended.

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Aspirin Allergy and Desensitization Protocols

For patients who suffer from terrible allergies, asthma, nasal polyps, and also suffer an allergy to aspirin, desensitization to aspirin can profoundly improve overall allergies and airway hyper-reactivity through an as yet unknown mechanism. It is hypothesized that aspirin desensitization works by decreasing leukotriene production and downregulating cystienyl leukotriene receptors resulting in a decrease in histamine and tryptase release from mast cells which causes allergy symptoms.

However, there are two problems regarding patients who wish to pursue aspirin desensitization: not many physicians perform it due to risk of life-threatening anaphylaxis and lack of standardized protocols.

Here are some sample published protocols for aspirin desensitization. Keep in mind that regardless of which protocol is administered, the aspirin desensitized state only exists as long as regular aspirin continues to be taken. If the patient forgets to take aspirin for a few days (typically 48 hours), the protocol has to be repeated.

Protocol #1:
Aspirin dissolved in water at 1mg/cc concentration. On day 1, patient is given 10mg, 30mg, 60mg, and 100mg of aspirin spaced 6 hours apart. On day 2, an additional 100mg, 150mg, and 300mg is given spaced 8 hours apart. The patient is discharged home on 300mg or 350mg of aspirin to be taken twice a day as well as zantac 150mg twice a day for GI prophylaxis. If needed, proton pump inhibitors can also be taken.

Protocol #2:
Aspirin is administered at intervals of 10–30 min in the following dosages: 0.1 mg, 0.3 mg, 1 mg, 3 mg, 10 mg, 30 mg, 40 mg, 81 mg, 162 mg, and 325mg. The dilution and dosing may be altered depending on the patient's clinical situation.

Protocol #3:
Aspirin is administered starting at 1 mg and doubling each dose every 30 min up to a final dose of 100 mg (therefore lasting 3.5 hours).

Protocol #4:
Aspirin given in 5 sequential doses of 5, 10, 20, 40, and 75 mg given every 30 minutes (the protocol lasting 2.5 hours).

Depending on the physician, patient's clinical characteristics, and comfort level of all concerned, these protocols may be performed in an office-setting to even in the intensive care unit of a hospital.

Pre-treatment with anti-histamines, singulair, or systemic steroids may or may not be administered. Beta-blockers typically is stopped 24 hours prior to protocol initiation. Monitoring during the protocol include blood pressure, pulse, and peak expiratory flow measurements every 30 min as well as checking for any reactions involving the skin, nose, eye, or breathing. Once the protocol is completed, monitoring is continued for an additional 3-6 hours.

Keep in mind that our office does not perform aspirin desensitization and provides this information for educational purposes. Please contact your local allergist to determine if they perform aspirin desensitization. Your best bet is your closest tertiary care academic medical center as locations where such protocols are performed.

Trivia: When a patient suffers from asthma, nasal polyps, and aspirin allergy, it is known as Samter's triad.

References:
Hypersensitivity to ASA in patients with coronary artery disease: rapid desensitisation is feasible. European Society of Cardiology Council. E-journal of Cardiology Practice 3.

Selection of patients for ASA desensitization treatment. J Allergy Clin Immunol 118: 801–804.

Rapid oral challenge-desensitisation for patients with ASA-related urticariaangioedema. J Allergy Clin Immunol 105: 997–1001.

Rational approach to aspirin dosing during oral challenges and desensitization of patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2009 Feb;123(2):406-10. doi: 10.1016/j.jaci.2008.09.048. Epub 2008 Dec 3.

Selection of aspirin dosages for aspirin desensitization treatment in patients with aspirin-exacerbated respiratory disease. J Allergy Clin Immunol. 2007 Jan;119(1):157-64. Epub 2006 Nov 13.

ASA sensitivity: the role for ASA challenge and desensitisation in postmyocardial infarction patients. Cardiology 91: 8–13.

Rapid desensitisation procedure for patients with ASA hypersensitivity undergoing coronary stenting. Am J Cardiol 95: 509–510.

Aspirin Hypersensitivity and Desensitization Protocols. Ther Adv in Drug Safe. 2011;2(6):263-270.

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New Video on Tongue Tie Release Procedure

Tongue tie is a common problem whereby a flap of tissue anchors the tongue tip to the bottom of the mouth. With tongue tie, it is impossible for a patient to stick the tongue straight out (licking an ice cream is impossible) and may potentially lead to problems with feeding in a newborn baby, speech articulation in a young school-age child, and french kissing in teenagers and older.

Due to the frequency at which tongue tie release is performed and the questions parents often have about how this procedure is exactly performed, a video has been created to show the steps on a newborn baby. With the gracious permission of one mom... check out this video.

Tongue tie may not be the only problem that may cause breast-feeding difficulty in an infant. Upper lip tie and posterior tongue tie may also be present.

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Woman Drinks Beer Through Her Ear

Now I am not sure if this woman is actually drinking beer through her right ear at a Czech beer festival as reported by Huffington Post, but is it anatomically even possible?

Well the answer is that it IS theoretically possible though highly improbable.

In order for this to occur, there must first be a hole in the eardrum. Given an eardrum hole, beer can be sucked up into the ear canal (1), through the hole in the eardrum (2), into the middle ear space (3), through the eustachian tube (4), and down into the throat.

Now why would it be highly unlikely that the women is drinking beer through her ear?

1) The eustachian tube opening is VERY small (< 2mm). Trying to suck beer through the eustachian tube would be even harder than trying to suck beer into the mouth through a coffee stirrer.

2) The video would have been more believable if she pinched her nose up when drinking beer into the ear.  The fact that she is not makes it unlikely adequate negative pressure can build up in the back of the nose to the point that it would suck beer up into the ear. Not pinching the nose is equivalent to trying to drink something up into the mouth WITHOUT making a tight lip seal around the straw.

Even if you could drink beer through the ear, you really shouldn't because...

1) Beer contains alcohol and if this touches the middle ear region which is very sensitive, there would be quite a bit of pain akin to alcohol touching an open skin wound.

2) Alcohol can also potentially lead to permanent hearing loss if drawn into the middle ear. It's the same reason why earwax removal drops specifically caution against using it whenever there's a hole in the eardrum.

3) Beer in the ear could lead to an ear infection.

4) Lastly, if the beer is not at body temperature, it could lead to severe dizziness due to a phenomenon known as caloric vestibular stimulation.

So... don't do it... even if you could!

Source:
Woman Drinks Beer Though Her Ear? Czech Clip Appears To Show Crazy, Dangerous Stunt (VIDEO). Huffington Post 5/14/13

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How is a Pollen Forecast Made?

Pollen Trap from Burkard

Unlike weather forecasting which utilizes high technology, satellites, complex computer models, etc, pollen forecasting seems downright archaic, though just can be just as complex and unpredictable.

So, here's what happens...

The main "equipment" to enable pollen forecasting is a simple air trap in order to capture and ultimately count what pollen is currently circulating in the environment. This equipment known as a "Volumetric Spore Trap" is placed in an open area and sucks in a specific volume of air through a narrow slit. Within the spore trap is a rotating drum covered with sticky tape upon which pollen gets stuck on.

Spore Trap. Image from Burkard

Every morning, an aerobiologist removes the sticky tape and places it on a glass slide to look at it under 400x magnification.

Pollen spores are identified and counted by the aerobiologist.

Based on this pollen count information in combination with the weather forecast, precipitation, wind direction, etc a pollen forecast can be provided for a region.

However, a pollen forecast may not accurately reflect local conditions. For example, grass counts may be very elevated all year round where timothy grass is present as feed for horses whereas regional pollen forecast may show elevated grass pollen only during the summer.

More obviously, mold spores would be elevated inside a damp old home all year round that is not reflected in a regional pollen forecast.

In any case, allergies can be treated with medications.

   

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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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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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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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Why Do Biopsy Results Take So Long? [video]

One of the most common questions I get after a surgical procedure is how long it takes before biopsy results are back... especially when a mass was removed and there is a cancer concern.

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

Disappointingly, it can take up to 7 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 mass is removed... in this particular case, a neck mass though the same steps apply to any mass removed from anywhere else in the body.

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

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Just How Contagious is the Flu (and Other Viral Infections)?

Everybody knows the flu and other viral infections are contagious, but did you wonder just how contagious???

Well, here are some facts gleaned from a few studies:

• In just 4 hours, one sick worker can contaminate 50% of surfaces in a typical office
• After 8 hours, one sick worker can contaminate 70%+ of surfaces
• Non-sick workers have a 40-90% chance of getting infected after spending one day with a sick worker
• A sneeze or cough can hurl virus 6 feet away from the mouth
• A sick person literally "emanates" virus up to 6 feet away... even if they are NOT sneezing or coughing.
• Some sick individuals are super-carriers spreading the virus around them 32 times more than others

The good news is that viruses can not survive on surfaces for long... They usually die off within a day (type of surface, temperature, and humidity affecting duration).

Source:
Flu Virus Can Travel Up to 6 Feet, Infect Up to 90 Percent of People Just from Contaminated Surfaces. Medical Daily News 2/1/13

References:
Exposure to Influenza Virus Aerosols During Routine Patient Care. J Infect Dis. 2013 Jan 30. [Epub ahead of print]

InfluenzaVirus: Here, There, Especially Air? J Infect Dis. (2013) doi: 10.1093/infdis/jis774

Germs Spread Fast at Work, Study Finds. AHSC 1/30/13

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Speech Impediment to Great Singing on American Idol

During January 2013 auditions of Season 12 of American Idol, there was Lazaro Arbos who has a terrible stutter when he talks, but sings beautifully. A week later, we encountered Micah Johnson who also suffers from a speech impediment, but rather than a stutter, it was due to "nerve damage" sustained during a tonsillectomy. (Watch videos below)

With stuttering, the problem mainly lies at the brain level. The brain coordinates how a person uses all of their throat muscles to create speech. Talking and language is mainly a LEFT-brain activity (or more precisely, the dominant hemisphere). Singing is mainly a RIGHT-brain activity and as such, uses different pathways than talking. It's also the same reason why patients who have suffered from a stroke may not be able to talk at all, but can sing their words out.

Now, in the case for Micah Johnson, it is reported that his speech impediment was due to "nerve damage" from tonsil removal surgery. As such, his speech impediment is NOT at the brain level (also known as central), but peripheral. Peripheral nerve injury is much more difficult to correct and requires extensive practice (speech therapy) in order to create brand new pathways at the brain level to help it "adapt" and compensate for the loss of function from the nerve injury. The analogy would be walking with a limp to compensate for a leg injury.

However, in Micah's case, it is a bit difficult to explain why he talks with an impediment, but sings wonderfully. It is not a matter of activating previously established brain pathways as what happens with stuttering.

With a tonsillectomy, there is a mouth gag placed to move the tongue out of the way. Typically, this surgery takes about 15 minutes to perform on average. Per Micah, his tonsillectomy took 90 minutes or almost 6 times longer than normal.

I hypothesize that the mouth gag over that time duration slowly crushed the nerve innervating the tongue (cranial nerve 12) causing it to not move as well leading to his speech difficulties. This complication is EXTREMELY rare and if it occurs, almost always temporary. This situation is analogous to a "dead" arm when sleeping on it for too long... but recovering normal function after a few minutes.

Unfortunately in Micah's case, it seems to never have recovered fully.

The puzzling issue for me is how is it that he is able to sing, but not talk well? Peripheral nerve injuries would affect ANY activity involving the affected muscle. For example, if the nerve to a leg muscle is cut, that muscle will not work well whether running or walking. The ability to sing, but not talk well due to a peripheral nerve injury is akin to stating that one can only limp when walking, but can run fantastic.

Anyone have any ideas what may be going on with Micah's amazing singing?

Just as an FYI, another rare complication of tonsillectomy that may lead to speech problems is velopharyngeal insufficiency leading to a hyper-nasal sounding speech. In this situation, there is no nerve damage present. Rather, it is an anatomic problem whereby the soft palate does not 'lift" completely to close off the nasal passage from the mouth. This problem can be surgically fixed.

In any case, best of luck to both men!

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