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.

Read More

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

Read More

Healthcare Mobile Web Presence

It is pretty much a given that healthcare organizations, medical offices, and physicians maintain a web presence given how frequently consumers turn to the internet and google especially for health information.

Given that... I would like to point out that more and more of this web traffic occurs on a smartphone rather than a computer and in an effort to retain consumers who seek healthcare, it behooves that any web presence be also mobile friendly.

According to my own personal web statistics using google analytics (free), in the month of Sept 2012, more than half (59.7%) of all web visits occurred using a smartphone.

Compare this to 53% in July 2012 and 39% in January 2012.

In January 2011, it was a laughably small 12.5%.

Overall, mobile web browsing accounts for 20% of all web traffic in North America. Cisco in February 2012 predicted that:

"global mobile data traffic will increase 18x between 2011 and 2016... By the end of 2012, the number of mobile-connected devices will exceed the number of people on earth, and by 2016 there will be 1.4 mobile devices per capita. There will be over 10 billion mobile-connected devices in 2016, including machine-to-machine (M2M) modules-exceeding the world's population at that time (7.3 billion)."

Also, google's own internal research revealed that half of consumers will use a website less often if it does not work well with a smartphone even if they like a business. In essence, you WILL lose customers at the moments that matter without a website specifically made for mobile devices.

It is based on just such statistics that persuaded me to take the time and money to convert my practice website such that it is now mobile friendly earlier this month.

So what does it mean to have a mobile friendly web presence?

It means that a consumer does not have to enlarge or scroll around horizontally to view a single webpage. Information appears formatted specifically for the smaller smartphone screens automatically.

In the past, there was a call for healthcare to have a web presence. In the future, that may not be good enough... modern IT demands a web presence that is mobile-friendly. Indeed, if one made decisions purely based on statistics, the focus should be on "mobile presence" rather than "web presence".

Food for thought...

Sources:
Mobile-friendly sites turn visitors into customers. Google 9/25/12.

Google Research: No Mobile Site = Lost Customers. Forbes 9/25/12

Mobile is Not a Sideshow. Information Week 9/21/12

Cisco Visual Networking Index: Global Mobile Data Traffic Forecast Update, 2011–2016. Cisco 2/14/12

Mobile Devices Now Make Up About 20 Percent of U.S. Web Traffic. All Things D 5/25/12.

Read More

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

Read More