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.

Read More

Hearing Loss Over Time

It is well-known that professional musicians have a higher risk of hearing loss and tinnitus compared to non-musicians. According to one study, the risk for musicians is 1.5x for hearing loss and nearly 4x for tinnitus.

And although people understand that as you get older, hearing loss increases, what is less clear is how quickly hearing loss occurs over time.

After analyzing over 3 million subjects, here is the graph of hearing loss with age. Intuitively, I thought there would have been a "jump" in hearing loss after a certain age. The graph indicates no such "jump," but rather a continuous increase of hearing loss from the earliest age studied (19-21 years).

This gentle slope does suggest that the vast majority of hearing loss is due to the slow accumulation of noise-induced nerve damage over time and that the vast minority of hearing loss is secondary to an acute event whether from infection or sudden loud noise exposure (i.e., gunshot without hearing plugs).

Source: http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full

Reference:
Incidence and relative risk of hearing disorders in professional musicians. Occup Environ Med doi:10.1136/oemed-2014-102172

Read More

Bee Sting Pain Worst on the Nose (Even More Than the Scrotum and Nipple)

Image by Waugsberg in Wikipedia

A Cornell graduate student took upon himself to figure where a bee sting hurts the most. His conclusion was the nostril... even more than the penis, scrotum, nipple, and 22 other body locations. Each body location was stung 3 times for consistency. [link]

He also determined that the three least painful locations to be the skull, middle toe tip, and upper arm (all scoring a 2.3 out of possible 10). The three most painful locations were the nostril, upper lip, and penis shaft (9.0, 8.7, and 7.3, respectively). Pain was rated on a 1–10 scale relative to an internal standard, the forearm.

The complete list of body locations in rank order can be found here.

Of course, this study was conducted on only one subject (the author) and as such, conclusions may not be entirely valid if done on a larger group of people.

However, I'm not sure how many people would volunteer for this kind of study and it is doubtful IRB would approve of any proposed study that would deliberately sting volunteers to various parts of the body including the genitals.

This may be a "one-of-a-kind" study.

Reference:
Honey bee sting pain index by body location. PeerJ 2:e338 http://dx.doi.org/10.7717/peerj.338

Read More

Permanent Hearing Loss From Noise May Depend on Time of Day!

Research out of Sweden have discovered that noise-induced hearing loss sustained at night is more likely to become permanent than if it occurred during the day... at least in mice.

Apparently, there are certain genes found to cycle in the cochlea of mice in a pattern that followed the hours of the day. By measuring the auditory nerve activity, they found that mice exposed to moderate noise levels during the night suffered from permanent hearing loss while mice exposed to similar noise levels during the day did not. The ability to heal after noise-induced hearing loss (temporary threshold shift) was linked to the circadian rhythm due to levels of BDNF (brain derived neurotrophic factor).

Specifically, concentration of BDNF increases in the cochlea during the day which protected hearing from permanent damage whereas levels were absent at night. Furthermore, researchers were able to artificially increase BDNF levels at night when normally absent and confer hearing protection with noise exposure.

What does this mean for humans?

IF human ears also have a biologic clock similar to mice, than researchers MIGHT be able to develop a specific way to reverse (or prevent) noise-induced hearing loss. Currently, the only way to treat acute noise-induced hearing loss is high doses of steroids whether orally or by injection directly into the ear.

Also, humans should probably avoid listening to loud music at night (i.e. concerts, night-clubs, restaurants, etc) which elevates risk of permanent hearing loss (compared to during the day).

Reference:
TrkB-Mediated Protection against Circadian Sensitivity to Noise Trauma in the Murine Cochlea. Current Biology, 27 February 2014. 10.1016/j.cub.2014.01.047

Read More

Acupuncture Helps with Ear Surgery Pain

Researchers at Boston Children's Hospital has found that acupuncture may be effective in diminishing both pain and post-anesthesia agitation in children after ear tube placement determined thru a prospective randomized controlled trial.

Typically, children are placed under general anesthesia in order to have this procedure performed and upon waking, are often tearful and agitated. In this study, acupuncture needles were placed at LI-4 and HT-7 immediately after anesthesia, but prior to ear tube placement.

A blinded assessor than determined that pain and agitation were significantly lower in the acupuncture group compared with controls during the 30 minutes after surgery. Furthermore, the number of patients who required analgesia was considerably lower in the acupuncture group than that in the control group.

Although promising, in order to be fully convinced of the effectiveness of acupuncture, further research by other groups in larger number of kids need to be performed.

BUT... because the risks and side effects are so nominal, it can't hurt to give it a try for those patients and families interested in doing so.

For full disclosure, I personally have no experience in providing acupuncture and I would suggest taking these research findings to a reputable and licensed acupuncturist to get this done in those who are interested.

Reference:
Acupuncture management of pain and emergence agitation in children after bilateral myringotomy and tympanostomy tube insertion. Pediatric Anesthesia. Volume 19, Issue 11, pages 1096–1101, November 2009

Read More

Acupuncture Alleviates Pain After Tonsillectomy in Children

The study showed that acupuncture significantly decreased pain after tonsillectomy in children (2-17 years of age) with reported pain levels before acupuncture of 5.52 (SD=2.28) out of 10 which fell to 1.92 (SD=2.43) after acupuncture.

This retrospective research was conducted in 31 patients who underwent a tonsillectomy within a 3 month period of time by Dr. James Ochi, one of only a handful of dual board-certified ENT and medical acupuncture in the United States. No study patients received any narcotics for pain control beyond tylenol, ibuprofen, and a single dose of intra-operative dexamethasone. The tonsillectomy itself was performed using electrocautery set at 24W.

The acupuncture points used for pain control are shown below and was performed bilaterally:

Image taken from the Research Paper

All patients received acupuncture at LI4 (between thumb and index finger). Additional points were found effective in relieving tonsillectomy pain and provided on an as needed basis at (in decreasing frequency) CV23, GV24.5 and GV20. Acupuncture points LI20, LI11, and LI10 were utilized in only a few patients.

LI4 point is hypothesized to work so well because:

"Stimulation at LI4 increases activity in the somatosensory cortex and a region of the brainstem known as the periaqueductal gray area, as revealed by functional magnetic resonance imaging, that are involved in processing pain signals." [link]

Although promising, in order to be fully convinced of the effectiveness of acupuncture for post-tonsillectomy pain, further research that is prospective, randomized, and controlled is required.

BUT... because the risks and side effects are so nominal, it can't hurt to give it a try for those patients and families interested in doing so.

For full disclosure, I personally have no experience in providing acupuncture and I would suggest taking these research findings to a reputable and licensed acupuncturist to get this done in those who are interested.


Reference:
Acupuncture instead of codeine for tonsillectomy pain in children. International Journal of Pediatric Otorhinolaryngology Volume 77, Issue 12 , Pages 2058-2062, December 2013

Read More

Cure for Noise-Induced Hearing Loss?

Normally, when mammals (including humans) are exposed to very loud sounds, permanent hearing loss may result due to cochlear hair cell injury. However, an experimental drug code-named LY411575 was found to regenerate new hair cells by suppressing a protein called Notch.

In essence, this drug restored hearing to mice deafened by loud noise.

Listen to an explanation by Harvard researcher Dr. Edge in this video.

However, human trials are a very long way off… so prevention is still the best way to avoid permanent noise-induced hearing loss. Wear hearing protection whenever loud sounds may be present!

Reference:
Notch Inhibition Induces Cochlear Hair Cell Regeneration and Recovery of Hearing after Acoustic Trauma. Neuron Volume 77, Issue 1, 58-69, 9 January 2013

Read More

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

Read More

Don't Like the Research Conclusions? Here's How to Belittle it...

Love this blog post published in the Washington Post by Dylan Matthews. Look at the flowchart below, but it's worth reading his WaPo article here.

Read More

Lawsuit Alleges Transcranial Magnetic Stimulation Paralyzed Patient's Face

University of Iowa Hospitals and Clinics is being sued by a patient who underwent an experimental transcranial magnetic stimulation (TMS) therapy which allegedly caused a facial paralysis which was than negligently treated. The trial is scheduled for Oct 13, 2013. [link]

Briefly, the patient in 2008 underwent experimental TMS to treat constipation and incontinence. TMS is a noninvasive method to cause depolarization or hyperpolarization in the neurons of the brain using pulses of electromagnetic induction through the scalp. Researchers were hoping to learn more about the nerve connections between the brain and the rectum and how biofeedback training may affect them.

Unfortunately, the patient contended that the treatment gave her a severe headache and by the next day, a facial paralysis. She went to the emergency room and was given an anti-viral antibiotic to take, but no steroids.

Her facial paralysis worsened and she ultimately underwent facial nerve decompression surgery 12 days later which helped with her taste loss, but not her facial paralysis.

The lawsuit contends that:
1) The patient was not informed of the risks of TMS as it relates to facial paralysis
2) Steroids should have been prescribed and the patient immediately referred for nerve decompression surgery

Does TMS carry a risk of facial paralysis?

I honestly do not know much about TMS, but I can certainly state that I've never heard of TMS causing or carrying a risk of facial paralysis. In fact, TMS is used to evaluate facial paralysis by being able to assess the integrity of the facial nerve as well as predict its potential for regeneration after injury [link].

Hypothetically, could TMS cause cranial nerve injury and swelling leading to facial paralysis??? I suppose so, but will defer to people more knowledgeable than I to answer this question.

The timing is certainly suspicious in this case with paralysis occurring within 24 hours of TMS.

But if it can, it certainly is worth a published case report.

Even more importantly, patients who are currently undergoing TMS to evaluate their facial paralysis now need to be warned of the risk that the TMS test itself may make their facial paralysis even worse!!!

What about steroids?

Although some may consider medical management of facial paralysis still controversial, I personally feel that steroids SHOULD have been immediately prescribed without any anti-virals.

The current preponderance of evidence is that anti-virals make absolutely no difference in the treatment of facial paralysis... even when the facial paralysis is due to a virus [link].  I personally do not prescribe anti-virals for patients with facial paralysis regardless of etiology.

What about steroids? Moderate quality evidence show that steroids were significantly more likely than anti-virals to produce complete recovery [link #1; link #2]. I always prescribe steroids to treat facial paralysis.

What about facial nerve decompression surgery?

Now surgical decompression of the facial nerve can be considered controversial. Decompression entails removing part of the skull, moving the brain to one side slightly, and removing all bone covering the facial nerve.

The theory being that if the facial nerve is swollen as it courses through the skull from the brain to the face, strangulation followed by nerve death occurs. To use an analogy, if a finger starts to swell from trauma, a ring being worn may prevent blood flow and eventually cause strangulation of the finger. Treatment to reestablish finger blood flow is to cut the ring off. Facial nerve decompression is akin to cutting a ring off to save a swollen finger.

Typically, surgical decompression of the facial nerve is pursued when facial paralysis occurs in the context of physical head trauma (ie, car accident). In the absence of preceding physical trauma, it would be the rare surgeon who would recommend surgical facial nerve decompression.

Obviously, the main question related to this lawsuit is whether nerve swelling occurred due to the TMS therapy necessitating surgical decompression. Presumably, an MRI scan was performed showing a highly inflamed and swollen facial nerve as well as significant nerve degeneration on ENoG testing. Supporting evidence (not mentioned in media reports) would be if profound hearing loss also occurred. Why? Because the facial nerve and hearing nerve both go through the same boney canal.

Malpractice?

TMS is not known to cause facial paralysis. As such, in a normal situation, this particular risk would not be expected to be included in the consent (as it has not been previously described). However, given this therapy was provided in the context of an experimental research protocol, the consent process is much more rigorous with much higher standards. With such higher standards, should risks never before seen be also included in the consent, especially if TMS has been performed many times for other purposes??? I don't know...

Certainly, my feeling as an ENT specialist is that steroids should have been given and not an anti-viral medication. Whether ENT specialist standards should apply to emergency room staff is harder to say.

Without more information, negligence as it pertains to delayed surgical facial nerve decompression is also hard to say.

Ultimately, we shall see what the court decides.


Source:
Lawsuit alleges Iowa doctors left patient's face paralyzed. Associated Press 8/13/13

References:
Transcranial magnetic therapy. Wikipedia

Electrical and transcranial magnetic stimulation of the facial nerve: diagnostic relevance in acute isolated facial nerve palsy. Eur Neurol. 2012;68(5):304-9. doi: 10.1159/000341624.

Antiviral therapy for Ramsay Hunt syndrome (herpes zoster oticus with facial palsy) in adults. Cochrane Database Syst Rev. 2008 Oct 8;(4):CD006851. doi: 10.1002/14651858.CD006851.pub2.

Antiviral treatment for Bell's palsy (idiopathic facial paralysis). Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001869. doi: 10.1002/14651858.CD001869.pub4.

Do either corticosteroids or antiviral agents reduce the risk of long-term facial paresis in patients with new-onset Bell's palsy? J Emerg Med. 2010 May;38(4):518-23. doi: 10.1016/j.jemermed.2009.08.016. Epub 2009 Oct 21.

Read More

Medications that (Might) Help Tinnitus?

The blunt answer is that there is no drug or supplement that has been consistently found to help with tinnitus (ringing of the ears).

Here's a partial table showing all the research that has been done either proving or disproving effectiveness to treat tinnitus (info collected from this review paper).

For a more comprehensive list going over 17 drugs, click here.

Drug	Research That Supports	Research That Disputes	Conclusion
Benzodiazepines (alprazolam, diazepam, clonazepam)	#1, #2, #3, #4	#1, #2, #3	Caution due to addiction and may worsen tinnitus if stopped.
Antidepressants (nortriptyline, amitriptyline, trimipramine, sertraline, paroxetine)	#1, #2, #3, #4, #5	#1, #2, #3, #4, #5, #6	TCA may benefit only in patients with depression symptoms
Anticonvulsants (carbamazepine, gabapentin, vigabatrin, tiagabine)	#1, #2, #3, #4, #5, #6, #7, #8, #9	#1, #2, #3, #4, #5, #6, #7	Mixed results
Antiglutamatergics (caroverine, memantine, acamprosate)	#1, #2, #3, #4	#1, #2, #3, #4	No conclusion.
(Anti)Dopaminergics (sulpiride, piribedil)	#1, #2, #3	#1	Studies are weak.
Ginkgo Biloba	#1, #2	#1, #2, #3	Not effective.
Melatonin	#1, #2, #3	#1	Potentially helpful.

For more meds, click here.

Read More

Can Melatonin Stop Ringing in the Ears (Tinnitus)?

In a rigorous study, researchers have found that taking melatonin 3mg nightly for 1 month did significantly help with patients suffering from chronic tinnitus (ringing in the ears).

Of course, the caveats are that melatonin significantly helped in patients with these specific characteristics:

• Male
• No history of depression
• Tinnitus has been present for a long time
• History of loud noise exposure
• Tinnitus is severe and on both sides

Given melatonin is a relatively benign supplement that can be purchased over-the-counter, it can't hurt to give it a try!

BTW... what did I mean by rigorous study above? It means that it was a prospective, randomized, double-blind, crossover clinical trial. That's pretty much as good a study as one reasonably achieve!

Reference:
Melatonin: can it stop the ringing? Ann Otol Rhinol Laryngol. 2011 Jul;120(7):433-40.

Read More

Reflux Increases Risk of Throat Cancer by 78%

Brown University researchers found that frequent heartburn was an independent risk factor for not only esophageal cancer but also cancer of the throat and vocal cords. This conclusion was based on a large population study involving 631 patients with throat cancer and 1,234 without throat cancer as a control group.

The study group also did not heavily smoke, drink, or have HPV (other independent risk factors for throat cancer).

Individuals with frequent heartburn were found to have a 78% increased risk of developing throat cancer. What researchers also found was that taking antacids for reflux (but not proton pump inhibitors or H2 blockers) seemed to protect against the development of throat cancer by 41% in patients with frequent heartburn.

The explanation for how reflux can cause throat cancer is similar to how it can also cause esophageal cancer. With repetitive mucosal injury by gastric juices to the delicate lining of the throat, there is a cycle of healing and injury that may eventually trigger cancer development. Patients with reflux that reaches the throat level have a condition called LPR or laryngopharyngeal reflux. Although symptoms may be similar to the more common GERD, it is not unusual for patients to experience only throat symptoms without the heartburn. Such atypical symptoms include:

• Chronic cough
• Phlegmy throat
• Chronic throat clearing
• Vocal cord dysfunction
• Globus pharyngeus

It is also notable that it takes far less reflux episodes in the throat region compared to the esophagus in order to trigger mucosal damage... it takes fewer than THREE episodes per WEEK! [link]

In any case, more research is needed to determine at what point cancer risk increases in individuals with LPR, what type of reflux (acid?, non-acid?, pepsin?, bile?) triggers cancer concern, to what degree of reflux prevention is required to protect against cancer development.

Also more needs to be done to figure out why antacids help reduce cancer risk, but not other types of reflux medications.

References:
Gastric Reflux Is an Independent Risk Factor for Laryngopharyngeal Carcinoma. Cancer Epidemiology Biomarkers & Prevention. Published Online First May 23, 2013; doi: 10.1158/1055-9965.EPI-13-0183

The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope. 1991 Apr;101(4 Pt 2 Suppl 53):1-78.

Read More

Men with Deeper Voices are More Successful

© Dreamstime Agency | Dreamstime Stock Photos

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

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

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

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

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

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

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

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

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

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

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

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

Read More

Nasal Spray to Help Motion Sickness

Over the years, many NASA initiated research has resulted in new products and treatments geared towards advancing the space-program, but has eventually led to benefits to us earth-bound mortals including:

• the computer mouse
• telemetry
• weather satellites
• cochlear implant

NASA publication Spinoff highlights these research innovations that has benefitted the general public.

Well, you can now add dizziness treatment to another NASA innovation to help motion sickness.

Born of the need to quickly treat motion sickness which astronauts can suffer from up in space (imagine vomiting in zero-gravity), NASA developed a super fast-acting nasal spray to eliminate dizziness.

Called INSCOP, it is essentially scopolamine which already is found in injectable, patch, and pill form. But, this new NASA nasal spray formulation acts faster and more reliably than the oral tablet.

Under a joint agreement with pharmaceutical company Epiomed Therapeutics, it will hopefully soon become available to the public.

This is not the only NASA dizzy research either...

Earlier, they also figured out what movements triggered the worst motion sickness as well as what at-the-time currently available medication combination(s) worked best to combat it. Read more.

Source:

Pharmaceutical Product Development: Intranasal Scopolamine Metered Dose. NASA 2012

Read More

Why Did Hair Turn Green for Residents of a Certain Town?

In 2011, in a certain township called Anderslov in Sweden, formerly blonde residents' hair mysteriously started turning green.

Was it a biological problem? Was it a disease? Was it contagious?

Nope...

Actually, suspicion initially was towards the drinking water and in particular, the copper levels since copper is known to dye things green via a complex oxidation process.

When copper oxidizes, it forms minerals that are green (and/or blue) including:

brochantite (hydrated copper sulfate) Cu4SO4(OH)6
malachite (hydrated copper carbonate) Cu2CO3(OH)3
azurite (hydrated copper carbonate) Cu3(CO3)2(OH)2

This action is known as verdigris... it is also why if you look at the Statue of Liberty, she appears greenish:

It is also why cheap copper jewelry when worn against the skin will turn it green.

However, confounded researchers found normal levels of copper in the water going into the homes.

BUT... water tested first thing in the morning inside the homes was found to contain copper levels 5-10x normal.

What scientists discovered was that the ultimate culprit was a combination of living in a new home and hot showers.

During the night, sitting hot water reacted with copper from the pipes and water heater causing levels of copper and associated minerals in the water to build up. This problem was most severe in new homes where the pipes lacked special coating. So, when residents of affected new homes took a hot shower in the morning, the copper in the water turned their hair green.

In order to avoid green hair, cold water needed to be used to wash the hair... or move to an older home which contained pipes that didn't leach copper in hot water.

What is this special coating that prevents copper from causing green problems? It is a polymer that is applied during manufacturing and includes acrylic, epoxy, polyurethane, cellulose, silicone, or vinyl depending on the copper's ultimate use.

Of note, this research on green hair won the 2012 Ig Nobel Prize for chemistry.

Sources:
'Nerdy' Swede wins faux- Nobel for green-hair find. The Local 9/21/12

'New homes' turn Swedes' hair green. The Local 12/17/11

Read More

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

Read More

Government Sponsored Studies Not Getting Published

Yale researchers published a study on whether NIH-funded studies get published after research completion.

The researchers examined all clinical trials after Sept 30, 2005 funded by NIH and registered within ClinicalTrials.gov maintained by the US National Library of Medicine.

Shockingly, among 635 clinical trials completed by 31 December 2008, only 46% (294 studies) were published in a peer reviewed biomedical journal within 30 months of trial completion. The median period of follow-up after trial completion was 51 months (25th-75th centiles 40-68 months) and 68% (432) were published overall.

Why aren't more of these completed studies being published???

It was already known that industry-sponsored studies had only a 40% publication rate. One can rationalize that such pharmaceutical-sponsored studies that do not reveal promising results do not get green-lighted for publication, but such a bias should not technically occur with government sponsored trials.

However, it just may be that there may be political pressure that may influence whether one study gets published and another does not (much like what has happened with climate research which allegedly has gotten smothered by unfriendly political forces).

It is also possible that researchers just do not prioritize publishing being more interested in doing the research and not so much the writing up of their results... OR their research findings have gotten rejected by journals for publication.

OR... maybe the unpublished studies are just THAT bad such that the research is literally unpublishable... which I find hard to believe given getting NIH grants to do the research is difficult and highly competitive.

In any case, there MUST be more effort to publish research findings for many reasons, key among them being:

1) Even if the study shows no results, that in itself is meaningful (if a drug did not work, than everyone should know that)

2) Duplicate studies would not occur which one can argue would be wasteful. Why reinvent the wheel when it already has been done? (there is a role for repeating studies, but should be done in a setting of being AWARE of repeating the research)


Reference:
Publication of NIH funded trials registered in ClinicalTrials.gov: cross sectional analysis. BMJ. 2012 Jan 3;344:d7292. doi: 10.1136/bmj.d7292.

Publish or... Don't. Yale Alumni Magazine. Page 32. March/April 2012.

Read More

Best Drops for Earwax Removal

It's about time, but some researchers actually put to the test to try and determine what is the best solution to dissolve/remove earwax.

The verdict was... WATER!

Better than mineral oil, liquid colace, and over-the-counter cerumenolytics (ie cerumol). Hydrogen peroxide was not evaluated.

How was this result determined?

Using guinea pigs, the researchers first tested whether each of these substances were safe should a hole in the eardrum be present allowing for the solution to enter the middle ear space. Colace was found to be the most ototoxic (meaning, potential for permanent hearing loss if a ear tube or a hole in the eardrum is present). Mineral oil and saltwater (normal saline) was found not to be toxic.

Next, they determined which substance provided the greatest degree of cerumen dissolving ability. Each substance was added to a cylinder filled with earwax for 5 minutes. They than determined how much weight was required for a 25G needle to fully penetrate through the earwax.

Water was found to provide far superior earwax dissolving ability compared to all other substances tested. Not surprising given water is considered the best universal solvent used to clean everything from dishes to cars to buildings.

What is the take-home message?

Given saltwater/water is completely safe for hearing even if there is a hole in the eardrum along with superior earwax dissolving ability, it seems to be a no-brainer to instruct patients with lots of earwax to use salt-water to get rid of earwax.

Reference:
Ototoxicity of intratympanic docusate sodium and mineral oil in the Guinea pig. Otolaryngol Head Neck Surg. 2012 Mar;146(3):455-60. Epub 2011 Nov 18.

Read More

New Treatment for Sore Throat

Well according to American singer-songwriter Suzi Quatro, "I used to get a lot of sore throats and then one of my sisters told me that all illnesses start in the colon. I started taking a daily colon cleanser powder mixed with fresh juice every morning and it made an enormous difference," Quatro told the Daily Mail newspaper.

It is unclear how many ounces of juice, what type of juice, and grams of colon cleansing powder was required to obtain this beneficial effect.

For her outstanding contribution to pseudo-science, she was awarded the prestigious 2011 SAS.

(If you haven't figured it out already, daily colon cleanser powder does NOT help with sore throats. However, there are rare situations where colon diseases like Crohn's Disease can cause throat problems including soreness and swallowing problems.)

Source:
Whale sperm, orgasmic feet top 2011 bad science list. Reuters 12/28/11

Read More