Infant Sound Machines for Sleep May Cause Hearing Loss

As a father of two young kids who still use a sound machine to help them sleep, I was quite curious about a recent paper that warned that such devices may cause permanent hearing loss. Researchers compared a total of 65 sounds produced by 14 machines and measured the maximum sound level at a distance of 30 cm (crib-rail placement), 100 cm (beside crib placement), and 200 cm (across room placement).

Why is placement important?

When it comes to risk of hearing loss due to loud noise exposure, there are three factors that come into play: 1) how loud is it; 2) how close is it; 3) how long are you exposed to it. Clearly, a person is at a higher risk for permanent hearing loss the louder a sound is, the closer the sound is, and the longer one is exposed to the loud sound.

When it comes to infant sound machines, two of the three risk factors are typically present given such machines are usually placed in or on the crib (close) and is typically played all night (duration).

Alarmingly, 3 machines produced sound levels 85+dBA which exceeds current occupational limits (if exposed for 8+ hours) for adults in the workplace which would mandate use of hearing protection. All 14 machines were capable of producing noise 50+dBA at distances of 30 and 100cm. 13 machines were capable of 50+dBA at 200 cm.

Which machines were tested? Beyond stating "procured from major online and brick-and-mortar infant-accessory stores," the machines were not identified. I wonder if the authors were fearful of lawsuits from sound machine manufacturers and as such, kept it anonymous.

Of course, one can always try contacting the ENT department at University of Toronto where this research was done and get an off-the-record answer.

Given lack of identification, the main steps a parent can take to minimize noise-induced hearing loss is to:

1) place sound machines as far away from infants as possible
2) set volume as low as possible
3) limit duration of sound machine usage


Reference:
Infant Sleep Machines and Hazardous Sound Pressure Levels. Published online March 3, 2014 (doi: 10.1542/peds.2013-3617)

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Why Do Babies Hate Getting Their Nose and Face Wiped???

I have often been asked this question by parents... and even more so by my wife as we try to clean the snot off our little kids' noses as they shriek as if we're torturing them.

Given it seems ALL young kids have this nose-wiping aversion across cultures and racial ethnicities, it would seem that this reflex reaction is hard-wired into human babies. But why would evolution favor this reaction?

I tried to find an answer to this question to see if any bright researchers actually studied this topic, but was unable to find any. So... here are my thoughts on this topic.

To warn other healthy humans

Evolutionarily, it may have been helpful for the human population as a whole if it was obvious to others when an individual was sick. To see a toddler with snot running out the nose, that would have been a pretty clear sign for other children and their parents to stay away lest they also get sick. This isolation of a sick child would have been nature's way of quarantining to prevent spread of illness to the rest of the human group.

To get eaten by predators

Not to be morbid, but predators tend to feed on the sick. It is nature's cruel way of removing the weakest in an animal population which over time will only strengthen the prey animal population as a whole (Darwin's theory of only the fittest survive). Back in the REALLY old days (caveman era), sick humans would have been just such a prey that would have been targeted by wild predator animals. To be not just a young human, but one that also shows signs of illness would be indicators to a predator of who to go after.

Protect the airway

This is my wife's favorite theory who feels the last idea to be horrible and inhuman (never mind that just because evolution is horrible and inhuman does not make it false). This airway idea is based on the fact that breathing is essential to life. Anything that covers the nose or mouth, even briefly, is a potential hazard that may lead to death. Evolutionarily, this reflex would be favored and strengthened over time... even if avoidance involves just a quick wipe. Who knows? Perhaps SIDS (Sudden Infant Death Syndrome) would be much more prevalent if the nose/face wipe aversion was not present.

Any other ideas? Even better, does anybody know of any studies that actually looked into this topic?

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Does Removing the Adenoids Decrease Risk of Ear Infections? Yes...

A recent meta-analysis has determined that risk of recurrent ear infections is significantly reduced if adenoidectomy is performed in combination with ear tube placement as opposed to ear tube placement alone. When stratified by age, removing the adenoids was found particularly helpful in children older than 4 years of age.

Combining results from over 15 studies containing over 71,000 children, the estimated rate of repeat ear tube placement for recurrent ear infections in children who also had adenoidectomy was only 17.2% vs 31.8% for children undergoing ear tubes alone. However this significance faded under the age of 4 years.

Why would adenoid removal influence ear infections?

First a little anatomy lesson...

In the back of the nose, there is an opening called the eustachian tube that goes up into the ear. That's why one is able to pop the ears when blowing into a pinched nose.

Image by Chittka and Brockmann from Wikipedia

The adenoids are located in the back of the nose immediately behind the eustachian tube opening. The adenoids can potentially lead to ear problems via two mechanisms. First, the adenoids could be very enlarged causing physical obstruction of the eustachian tube which can make it impossible to pop the ears. Second, the adenoids could be a reservoir of germs which can lead to ear infections given proximity to the eustachian tube.

As such, removal of the adenoids would allow the eustachian tube to function better as well as eliminate a potential reservoir of infection.

However, recommendation for adenoid removal typically occurs if a child requires a 2nd set of tubes which usually occurs around age 4. Adenoidectomy may be recommended with the initial set of ear tubes (after taking into consideration age) if other symptoms are present including nasal obstruction and a snotty nose.


Reference:
Adenoidectomy as an Adjuvant to Primary Tympanostomy Tube Placement: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. 2013 Nov 28. doi: 10.1001/jamaoto.2013.5842. [Epub ahead of print]

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Pediatric Sinus Development and Sinusitis

There is a tendency for any type of nasal drainage to be attributed to "sinusitis" in children. Especially in young children, "sinusitis" is a relatively rare cause for nasal drainage and congestion which is actually more commonly due to viruses and enlarged adenoids.

The reason why sinuses play a relatively minor role in nasal drainage and congestion is because sinuses are not fully developed in children. It probably is not until around the age of 7 years old that "sinusitis" starts playing a more major role in disease manifestations. And even than, viruses and enlarged adenoids still play a major role in sino-nasal discomfort and as such, antibiotics not typically warranted.

Take a look at sinus development from newborn to adulthood below. In newborns, sinuses are mere indentations in the facial bone (light green). Adult sinuses are denoted by the dark green/peach.

It is for these reasons that sinus x-rays (or radiological imaging in general) are not warranted in children under 2 years. First, there is not much there, and secondly, x-rays are notoriously poor at diagnosing true sinus pathology [more info]. From 2 years to adolescence, sinus x-rays provide some guidance as to the presence of possible sinusitis, but CT Sinus scans are the gold standard to evaluate sinus disease presence or absence.

With persistent sino-nasal symptoms in children in spite of medical management, nasal endoscopy can be performed to evaluate the nasal cavity as well as the adenoids. Initial surgical management include adenoidectomy with or without turbinate reduction. While sedated for surgery, allergy testing can also be performed. If symptoms persist after these interventions, a CT Sinus scan can be obtained and consideration for sinus surgery can be made. The reason why CT Sinus scans are not obtained earlier is because whether it comes back normal or not, management does not change unless there are unusual extenuating circumstances present (significant eye or facial swelling).

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Ear Tube Placement in Kids WITHOUT Sedation (Starting at 12 Months of Age)

A recent report describes how using a relatively old technology, ear tube placement can now be performed in children starting at 12 months of age with chronic ear infections or hearing loss due to fluid buildup without the need for sedation of any kind nor aggressive restraints (ie papoose). Historically, ear tube placement in the office without sedation is typically performed starting at around 12 years of age using standard local anesthesia techniques. Any younger, a child could not be trusted to stay still during the procedure due to presence of some discomfort.

In any case, a Texan ear group reports how they accomplished this simple procedure at such young ages.

First, the ear canal is cleaned as much as possible of all earwax and debris. The ear canal is than filled with an anesthetic liquid (concoction of lidocaine, epinephrine, and sodium bicarbonate). Over 10 minutes, iontophoresis was than used to induce profound local anesthesia to the ear canal and eardrum. The liquid was than suctioned out and ear tube placement was performed with a reported 90% success rate (78 of 86 ears; 17 subjects were 3 years old or younger; 8 were 12 months old).

The key to success required 3 "new" elements.

• Iontophoresis device made by Acclarent. There are other iontophoresis devices in the market (Medtronic and Otomed), but none adapted for simultaneous bilateral ear canal usage that works within 10 minutes. Iontophoresis works by applying a gentle electric current in order to actively move charged drug molecules into the skin. In this particular case, positively charged lidocaine and epinephrine.
• Optimal anesthetic solution for iontophoresis. Dubbed "EMGIM", it contains 1:12,000 epinephrine with 3.3% lidocaine hydrochloride and 0.7% sodium bicarbonate. The solution is prepared fresh prior to use by combining 10 mL of 4% lidocaine hydrochloride with 1 mL of 1:1,000 epinephrine. After mixing the lidocaine and epinephrine, 1 mL of 8.4% sodium bicarbonate is added.
• Ear tube delivery device and placement system. Typically, a competent ENT can place an ear tube in about 10-20 seconds. However, when dealing with kids who may potentially move unexpectedly and operating within a very small ear canal space, a faster and more reliable way of placing a tube was required. Hence, this new device. [link]

Of course, during the actual procedure, age-appropriate distraction was needed to minimize movement, especially given aggressive restraint was not used.

Sounds great as sedation is something to be avoided if at all possible. However, there is one problem... the Acclarent iontophoresis device is NOT yet FDA approved contrary to what the report states (direct communication with Acclarent executives October 1, 2013). Hopefully in 2014. As such, beyond a research setting, this in-office technique is not yet available for use in the United States.

As an aside, there are FDA-approved iontophoresis devices for use in pediatric head and neck surgical procedures mainly for sub-cutaneous mass excisions and abscess incision and drainage. Check out Phoresor for such applications using lidocaine infused electrodes. It's even sold on Amazon.


References:
Otologic Iontophoresis: A No-Papoose Technique. Annals of Otology. Rhinology & Laryngology 122(8):487-491. Aug 2013.

In-Office Tympanostomy Tube Placement Under Local Anesthesia Using a Novel Tube Delivery Device. Triological Meeting Poster. Dec 2012.

Iontophoresis: a needle-free, electrical system of local anesthesia delivery for pediatric surgical office procedures. J Pediatr Surg. 1999 Jun;34(6):946-9.

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Don't Like a Research Paper? Sue the Journal and Authors...

What is a lawyer to do if medical research produces results that make it more difficult to win lawsuits? Why you sue the medical journal and the researchers who authored it.

And you ask the medical journal to retract it.

And than you ask for a court order forbidding the report to be entered as evidence in future litigation.

Sound like a joke?

Wish it was, except it happened... is happening...

A Boston lawyer has sued the American Journal of Obstetrics and Gynecology for a case report published in 2008 regarding an infant delivery in which a brachial plexus injury was sustained via natural forces of labor without any excessive traction provided by the physician.

More info can be found on the lawsuit here which was initially dismissed by a trial court, but is on appeal to the First Circuit.

Given I'm an ENT, I can't necessarily state whether this published medical report has merit or not, but typically if a study is without merit, one criticizes it by publishing additional research studies to either support or refute it.

If lawyers now start influencing what can be published or not, or indirectly influence researchers whether to publish "unpopular" results for fear of lawsuits, it will have a chilling effect on the advancement of science and medical research.

Hopefully, suing medical journals and researchers will not become a popular trend.


Sources:
Publish an article that undermines lawsuits? See you in court. Overlawyered 9/18/13

Maternal forces causing injury. United Brachial Plexus Network 5/16/11

Permanent brachial plexus injury following vaginal delivery without physician traction or shoulder dystocia. American Journal of Obstetrics & Gynecology. Volume 198, Issue 3 , Pages e7-e8, March 2008

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Popular Nasal Decongestants Associated with Birth Defects

Researchers have discovered that there is a very small, but significant association between birth defects and use of nasal decongestants in the first trimester of pregnancy. Unfortunately, decongestants (ie sudafed, afrin, etc) are also one of the most popular medications purchased over-the-counter to treat symptoms of nasal congestion, runny nose, and allergies.

In particular, three strong associations were found:

• Phenylephrine and endocardial cushion defects
• Phenylpropanolamine and ear defects
• Phenylpropanolamine and pyloric stenosis

Although these associations were related to ORAL decongestant use and first trimester intake, it was also found that intra-nasal decongestant use during the first trimester was associated with pyloric stenosis and tracheo-esophageal fistula.

Taken in summary, it is perhaps ideal that women in their first trimester of pregnancy avoid decongestant use due to a possible association between birth defects and medication usage. This association accounts for a VERY small percentage increase in birth defects and as such more study is needed.

For example, the baseline prevalence of endocardial cushion defect is 0.34 per 1,000 live births. Phenylephrine exposure increases this risk 8-fold resulting in 2.7 per 1,000 live births. That's an overall increased risk of only 0.27%.

Keep in mind that all these over-the-counter products contain a decongestant ingredient:

• Afrin
• Sudafed
• Tylenol Cold Multi-Symptom Nighttime
• Alka-Seltzer Plus Cold
• Delsym Night Time Multi-Symptom
• Tylenol Cold Multi-Symptom Severe
• Tylenol Cold & Flu Severe
• Vicks Dayquil Cold & Flu Relief
• Benadryl Allergy Plus Sinus Headache
• Theraflu Warming Relief Nighttime Severe Cold & Cough
• Vicks Nyquil Sinus
• Acutrim
• Dexatrim
• Afrin
• Zicam
etc, etc, etc

So what is a pregnant woman to do if her nose gets all stuffed up and wants to avoid decongestant medications to eliminate any possible risk of birth defects? Click here for some suggestions.

Source:
Use of Decongestants During Pregnancy and the Risk of Birth Defects. Am. J. Epidemiol. (2013) doi: 10.1093/aje/kws427

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What Reflux Meds are Best in Infants and Children?

Once a decision is made to start medications beyond the conservative ways of dealing with reflux, the most common reflux medications used to treat adults are also used to treat reflux in infants and children. They are the same exact medications, albeit at lower dosages.

Although the effectiveness of such drugs are clear in adults suffering from acid reflux, it is less so in children. As is true with so much of medicine, there's no clear answer to the question of what the best reflux med is for infants and children. According to one review of literature, the answer is decidedly mixed and variable depending on what outcome was looked at (subjective symptom improvement or objective test findings).

In fact, symptom improvement (or lack of) did not always correlate with objective test findings (24 hour testing, barium swallow, EGD, etc) of reflux improvement and vice-versa. The most common finding was reduction in reflux based on tests, but no significant improvement in symptoms. Such findings does bring into question whether the diagnosis of reflux was even accurate.

In any case, when looking at SYMPTOMS in infants (less than 12 years of age) use of proton pump inhibitors was decidedly not favorable (one study in support and 4 against). In children (over 1 year of age), proton pump inhibitors were found to be equally effective to alginates and ranitidine.

When looking at OBJECTIVE test findings, proton pump inhibitors were found to be equally effective in both infants and children compared with placebo, alginates, or ranitidine. For reducing histologic aberrations, proton pump inhibitors showed no difference compared with ranitidine or alginates.

Conclusion
If GERD symptom control is the main goal, proton pump inhibitors should not be used in infants. In older children, these medications are helpful but potentially no better than alginates and zantac which have better side effect profiles. As is true with most studies, more study is needed.

Reference:
Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Pediatrics. 2011 May;127(5):925-35. doi: 10.1542/peds.2010-2719. Epub 2011 Apr 4.

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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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Stem Cells Restore Toddler's Congenital Hearing Loss

In a potentially revolutionary treatment, a two years old toddler born deaf has had her hearing restored after receiving stem cells from her banked umbilical cord blood. (Reported in ABC News)

Madeline Connor at age 1 year old was completely deaf in the right ear and had severe hearing loss on the left. Normally hearing aids or cochlear implant would have been the only options.

However, in January 2012 at the age of 2 years old, Madeline underwent a "simple" experiment whereby stem cells were infused into her damaged inner ear. The stem cells were derived from umbilical cord blood that was banked at the time of her delivery at the Memorial Hermann-Texas Medical Center.

Over the next 6 months, there has been dramatic improvement in her hearing. She is also now talking for the first time.

Madeline also is not the only child who has undergone this revolutionary stem cell treatment. Apparently, there are ten other children who are being followed after undergoing similar stem cell infusion derived from banked cord blood.

It must be stressed that though Madeline's progress is quite amazing, it is still too early to say if this is a "bona fide" treatment for congenital hearing loss.

• Will the improvement continue and more importantly, last over years to decades?
• Will it work for other children?
• What is the expected hearing improvement with stem cell infusion?
• Will it treat ALL forms of nerve-damaged hearing loss?
• Does it have to be stem cells derived from cord blood or are stem cells derived from other sources possible (i.e., skin)?
• Can adults with non-congential hearing loss also benefit?

I eagerly await the outcome of this FDA approved trial which hopefully will be published at some point in the near future.

I also eagerly await the protocol used to obtain and infuse the stem cells. I suspect the infusion of stem cells is similar to that done when steroids are infused into the ear for sudden hearing loss as shown in this video below. However, this is just a guess of mine.

Source:

Cord Blood Stem Cells Restore Toddler's Hearing. ABC News 7/11/12

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Kissing the Ear Can Cause Permanent Hearing Loss

MSNBC reported 3/29/12 about a phenomenon called cochlear ear-kiss injury. This condition is when hearing loss occurs after a person kisses someone else over the ear, usually a mom over a baby's or child's ear.

Right after the kiss, a person can suffer from immediate and potentially permanent hearing loss along with other symptoms including ringing, sensitivity to sound, sound distortion, and aural fullness.

How or why does this occur?

With a kiss, a strong suction is created within the ear canal that pulls on the eardrum which tugs on the middle ear bones that can lead to turbulence within the inner ear.

Infants are particularly susceptible to this condition given their ear canals are SO small and the suction created by an adult kiss over the ear can be so strong.

There are other variations of this type of ear/hearing injury.

Barotrauma of the ear can lead to similar type issues due to sudden pressure changes from flying, parachute jumping, diving into water, SCUBA, snorkeling, etc.

Getting slapped over the ear can do the same thing as cochlear ear-kiss injury, but in reverse. Rather than suction from a kiss creating strong negative pressure within the ear canal, a slap over the ear creates sudden strong positive pressure.

At times, such pressure changes can get so severe that the eardrum can rupture.

Source:
Innocent 'kiss of deaf' can cause permanent hearing loss. MSNBC 3/29/12

The kiss of deaf: Four-year-old's big smooch left her mom with partial hearing loss. Newsday. June 7, 2008

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New Video on Newborn Hearing Testing

Given how often we see newborns in need of hearing testing, we have produced a video showing how the two main types of non-verbal hearing tests are performed today: Auditory Brainstem Response (ABR) and Otoacoustic Emission (OAE).

Given newborns can not communicate whether they can hear or not, such hearing tests depend on the ability to detect nerve signals transmitting sound information from the ear all the way to the brain. This type of test is much like an EKG which can detect the electrical activity of the heart.

Watch the video to see how ABR and OAE hearing testing works in infants (as well as adults)!

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How to Make Xylitol Nasal Flush at Home

Given the unusually large reader response to my last blog regarding xylitol nasal rinses regarding the "recipe," I thought it easier to write a blog about it!!!

To be brief, xylitol is a naturally-occurring plant-based sugar substitute that apparently has all sorts of anti-bacterial as well as anti-fungal properties. Given these properties, daily xylitol gum chewingor xylitol nasal sprayuse has been shown to help prevent recurrent acute ear infections and sinus infections... safe for use even in infants.

When used as part of nasal flushes to the nose, it seems to work even better than traditional saline flushes to the nose (read more about this here).

So, I have provided below a few different recipes to make xylitol nasal flushes at home. One may be more comfortable than the other, but it is user dependent. Obviously, convenience will play a role as well.

Just as an FYI, you can also purchase pre-packaged packets that contain xylitol for the ultimate convenience. Just open one packet and mix it in with water inside your nasal flush kit of choice (Nasopure, Neti Pot, Neilmed, etc)

Recipe #1 (Complex):
1 cup of water (8 ounces)
1/4 tsp salt
1/2 tsp of xylitol crystals
1/4 tsp baking soda
4 drops of grapefruit seed extract

Recipe #2:

1 cup of water (8 ounces)

1/4 - 1/2 tsp salt

1/2 tsp of xylitol crystals

Recipe #3:

1 cup of water (8 ounces)

1/4 - 1/2 tsp of xylitol crystals

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Can What Makes a Lion Roar Help Human With a Weak Voice?

Researchers in Iowa have discovered what makes a lion or tiger roar so effectively. Apparently, there is a layer of fat within large feline vocal cords that makes the vocal cords especially prone to vibrate easily with minimal exhalation effort.

What import does this have to humans?

Well, there are patients who have a very weak voice due to vocal cord atrophy as well as vocal cord paralysis. Standard interventions include voice therapy as well as surgical procedures using an implant or injectable material in order to "bulk" up the vocal cord.

In fact... one such injectable material that has been used to inject into vocal cords is fat, typically taken from the belly of the patient!

Two points to keep in mind however...

Just like in lions and tigers, it DOES improve the vocal strength and volume to a patient who previously had a weak voice, may now have a much stronger voice after the procedure.

However, the second point is that by making the vocal cord "bulkier" you are making it thicker which can decrease the vocal pitch... just like a violin string where the thicker the string, the lower the pitch.

On another related note... human infants have fat within their vocal cords... that may be why something so small with tiny lungs can produce such a terrific loud cry!

Read a story in the NYT regarding this research here.

Reference:
Adapted to Roar: Functional Morphology of Tiger and Lion Vocal Folds. PLoS ONE 6(11): e27029. doi:10.1371/journal.pone.0027029

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Sedated Anesthesia for Kids Under 2 Years May Cause Learning Disability

There is mounting evidence in animals and in humans that general anesthesia might damage developing young brains.

Researchers at Mayo Clinic compared the learning skills of 350 kids who underwent 1 or more general anesthesia before age 2 to 700 kids who have never been under sedated (general) anesthesia. What they found was that before the age of 19 (after statistical normalization):

No significant difference in learning disability between kids who have been under anesthesia once (23 out of 100) with kids who have never been under anesthesia (21 out of 100).  

However, those kids who have been under anesthesia 2 or more times had increased rate of learning disability (36 out of 100). 

Based on animal studies, anesthetics are known to cause accelerated loss of brain cells during development which leads to learning and behavior problems later in life. Whether that's also true for humans has not been studied.

However, further study is required as the results were obtained based on observation and did not account for other variables (type of surgery for example).

This information, though not definitive, does warrant extra circumspection by parents and surgeons when deciding to pursue surgery in kids under age 2 years, no matter how minor the surgery including ear tubes, tonsillectomy, adenoidectomy, and turbinate reduction.

IF surgery pursued, one should perform as much as required to minimize need for a 2nd procedure at a later date. That means multiple procedures under one anesthesia would be preferable than multiple procedures at different times.

Of course, surgery should only be done if the benefits outweigh the risks including anesthetic risks.

Read the MSNBC report here.

Reference:
Cognitive and Behavioral Outcomes After Early Exposure to Anesthesia and Surgery. Published online in Pediatrics October 3, 2011. doi: 10.1542/peds.2011-0351

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