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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FDA Approves Ragwitek... Ragweed Allergy Tablet by Mouth (Instead of Allergy Shots)

The FDA formally approved Ragwitek, the third new sublingual allergy tablet to be sold in the United States this year that works the same way allergy shots do... but instead is dissolved under the tongue at home instead of a shot in the arm in a medical office. Ragwitek is the first sublingual allergy tablet to treat ragweed. Although Oralair and Grastek are two other sublingual tablets that have already been approved by the FDA, they treat grass allergies rather than ragweed.

Ragwitek is a tablet made by Merck and treats patients aged 18-65 years who are allergic to only short ragweed. Ragwitek has a simple regimen of 1 sublingual tablet daily starting 12 weeks before the ragweed season and continued until the end of the ragweed pollen season. As with Oralair and Grastek, the first dose is given in a medical office to ensure safety with all other doses are taken at home. The tablet dissolves in less than 10 seconds.

Although in next few weeks US physicians should be able to start prescribing Ragwitek, treatment needs to actually begin in early summer thru the fall for full effectiveness.

As with Oralair and Grastek, epipen needs to be available at home due to possible risk of anaphylaxis. As with allergy shots, patients on beta-blockers for high blood pressure are not eligible to undergo this treatment.

The wholesale price of both Grastek and Ragwitek will be $8.25 per pill, or $247.50 for a 30-day supply. The wholesale price of Oralair will be $10 per pill, or $300 for a 30-day supply.

Sources:
FDA approves Ragwitek for short ragweed pollen allergies. FDA 4/17/14

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FDA Approves Grastek... Grass Allergy Tablet by Mouth (Instead of Allergy Shots)

Today, the FDA formally approved Grastek, the second new sublingual allergy tablet to be sold in the United States that works the same way allergy shots do... but instead is dissolved under the tongue at home instead of a shot in the arm in a medical office. Although this tablet has been available in Europe for some time, only now has sale/distribution in the United States been allowed under prescription.

Just 2 weeks ago, FDA approved Oralair which also treats grass allergies.

Grastek (aka Grazax in Europe) is a tablet made by ALK-Abello and Merck and treats patients aged 5-65 years who are allergic to only Timothy Grass. Grastek has a simple regimen of 1 sublingual tablet daily starting 12 weeks before and continued until the end of the grass pollen season. As with Oralair, the first dose is given in a medical office to ensure safety with all other doses are taken at home. The tablet dissolves in less than 10 seconds.

Although in next few weeks US physicians should be able to start prescribing Oralair, it really won't do much good for this year's grass allergies because in order for this tablet to be fully effective in the treatment of grass pollen allergies, treatment needs to actually begin in December but no later than January and continue through August. Grass pollen season begins in April/May, so for at least this year, it may be too late.

For both Oralair and Grastek, epipen needs to be available at home due to possible risk of anaphylaxis. As with allergy shots, patients on beta-blockers for high blood pressure are not eligible to undergo this treatment.

Sources:
Merck's grass pollen allergy drug wins U.S. approval. Reuters 4.14.14

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FDA Approves Oralair... Grass Allergy Tablet by Mouth (Instead of Allergy Shots)

Today, the FDA formally approved Oralair, the first new sublingual allergy tablet to be sold in the United States that works the same way allergy shots do... but instead is dissolved under the tongue at home instead of a shot in the arm in a medical office. Although this tablet has been available in Europe for some time, only now has sale/distribution in the United States been allowed under prescription.

Oralair is made by a French pharmaceutical company Stallergenes (Greer is US distributor partner) and treats patients aged 10-65 years who are allergic to 5 different grasses: Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass. Treatment is composed of a buildup and maintenance phase. Starting 4 months prior to the grass pollen season, a 100 IR tablet is administered under the tongue in a medical office to ensure no significant side effects. At home on day 2, two 100 IR tablets are administered. On day three and daily thereafter, a 300 IR tablet is placed under the tongue until the end of the grass pollen season. The tablets take about 1 minute to dissolve.

Although in next few weeks US physicians should be able to start prescribing Oralair, it really won't do much good for this year's grass allergies because in order for this tablet to be fully effective in the treatment of grass pollen allergies, treatment needs to actually begin in December but no later than January and continue through August. Grass pollen season begins in April/May, so for at least this year, it may be too late.

Another grass tablet will soon receive FDA approval called Grastek (aka Grazax in Europe). This tablet is made by ALK-Abello and Merck and treats patients aged 5-65 years who are allergic to only Timothy Grass. Grastek has a simpler regimen of 1 sublingual tablet daily starting 12 weeks before and continued until the end of the grass pollen season. As with Oralair, the first dose is given in a medical office to ensure safety with all other doses are taken at home. The tablet dissolves in less than 10 seconds.

For both tablets, epipen needs to be available at home due to possible risk of anaphylaxis. As with allergy shots, patients on beta-blockers for high blood pressure are not eligible to undergo this treatment.

Sources:
Stallergenes wins U.S. go-ahead for Oralair allergy pill. Reuters 4/2/14

Grastek Recommended by FDA Panel for Timothy Grass Allergy. Medscape 12/12/13

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Man Files $15 million Lawsuit Against NYC Citi Bike Claiming Smell Loss From Bike Crash

Image by Pharos of Wikipedia

In 2013, a man rented a bicycle from New York City's Citi Bike program. Apparently while riding this rental bike, the front wheel struck a wheelstop installed near a bicycle docking station which the man did not notice, flipping him resulting in head trauma. This head trauma resulted in permanent smell and taste loss. [link]

The wheelstop is meant to prevent cars from from backing into bike stations, but the lawsuit alleges "no cones or colored warnings to alert a bicyclist of its existence... constituted a trap for the unwary."

Regardless of the legal merits of the case, how does head trauma like this cause smell and taste loss?

The smell nerve is located right between the eyes and is analogous to the roots of a plant where the plant is the nerve next to the brain and the roots are the nerve endings that go through the skull bone (cribiform plate) and into the nose where "smell" is detected (the yellow in pic below). With significant head trauma, the brain suddenly moves and "bounces" around in the skull when struck. When this happens, the delicate smell nerve endings which are going through the bone "tear" when the brain moves relative to the bone.

With such nerve damage, smell can be permanently lost. With complete smell loss, taste can be adversely affected given so much of flavor is attributable to smell. As such, the man can technically probably still taste (salt, sweet, sour, bitter, etc), but not smell.

BTW... Did you know that the tongue taste map we all learn in school is incorrect?


Source:
Conn. man files $15 million lawsuit against NYC, Citi Bike, claiming nerve damage from bike crash. Daily News 2/27/14

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What Does a Kiss Look Like from INSIDE the Mouth? [VIDEO]

Image from Wikipedia

A kiss is beautiful to behold and even better to give/receive... but it may be a matter of perspective, because what a kiss looks like from the inside is downright disconcerting. Check out this YouTube video...

On that note, I'm curious to know what kind of camera was used given it must have been tiny, and focus was unusually good given the varying focal length.

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Man Sues ENT for Wrongful Tracheostomy

Image from ParaMedicine101

In December 2012, a West Virginia man suffered angioedema causing tongue swelling due to a not uncommon reaction from lisinopril. Presumably due to airway concern from the tongue swelling, an urgent tracheostomy (cutting a hole in the throat) was performed.

The patient later filed suit against the ENT who performed the tracheostomy stating that it was unnecessary as the tongue swelling was getting better. [link]

Although a tracheostomy is not always performed for tongue swelling due to angioedema, it also is not unusual to do so, mainly because the alternative outcome is airway loss and death. It is a judgement call on the physicians who are caring for a patient with angioedema whether close monitoring alone is sufficient versus performing a tracheostomy. If the tongue swelling is large enough to cause some airway obstruction, no physician or ENT would ever question the need for a tracheostomy, regardless of whether the swelling "might" be getting better or not.

If one waited until the airway became critical before performing a tracheostomy, the risk of death and complications become MUCH larger. As such, a tracheostomy is performed well before there's any chance of airway loss. (Intubation is not recommended or at times even possible as the act of trying to intubate may trigger airway loss.)

Indeed, the patient who is suing the ENT may not be alive today to sue the ENT if it weren't for the tracheostomy. Instead, it would be the family who would be suing the ENT for wrongful death for NOT doing a tracheostomy.

Check out this lawsuit where an ENT did NOT perform a tracheostomy for airway swelling resulting in death. Here's another lawsuit for similar though under more convoluted circumstances.

Source:
Clay Co. man says doctors performed unnecessary tracheostomy. West Virginia Record. 1/29/14

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New Ragweed Under the Tongue Pill Instead of Allergy Shots Recommended by FDA Panel

Yesterday, the FDA Allergenic Products Advisory Committee supported approval for a new sublingual allergy tablets (Ragwitek) that work the same way allergy shots do... but instead is dissolved under the tongue at home instead of a shot in the arm in a medical office. Given this is only a panel recommendation, final "official" FDA approval may not occur for another year or so for sale/distribution under prescription in the United States.

Ragwitek is made by ALK-Abello and Merck and treats patients aged 18-65 years who are allergic to only short ragweed pollen. The way Ragwitek is taken is placement of 1 sublingual tablet daily starting 12 weeks before and continued until the end of the ragweed pollen season. The first dose is given in a medical office to ensure safety with all other doses taken at home. The tablet dissolves in less than 10 seconds.

Epipen needs to be available at home due to possible risk of anaphylaxis. As with allergy shots, patients on beta-blockers for high blood pressure are not eligible to undergo this treatment.

Ragwitek is similar to Oralair and Grastek which treat only grass allergy. Oralair and Grastek were both recommended by the FDA panel last year.

Source:
Sublingual Ragwitek Backed FDA Panel for Ragweed Allergy. Medscape 1/28/14

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Two New Sublingual Allergy Tablets Approved by FDA Advisory Committee

This week, the FDA Allergenic Products Advisory Committee unanimously supported approval for two new sublingual allergy tablets (Oralair and Grastek) that work the same way allergy shots do... but instead is dissolved under the tongue at home instead of a shot in the arm in a medical office. Although both tablets have been available in Europe for some time, final "official" FDA approval may not occur until end of 2014 (or later) for sale/distribution under prescription in the United States.

Oralair is made by a French pharmaceutical company Stallergenes and treats patients aged 10-65 years who are allergic to 5 different grasses: Sweet Vernal, Orchard, Perennial Rye, Timothy, and Kentucky Blue Grass. Treatment is composed of a buildup and maintenance phase. Starting 4 months prior to the grass pollen season, a 100 IR tablet is administered under the tongue in a medical office to ensure no significant side effects. At home on day 2, two 100 IR tablets are administered. On day three and daily thereafter, a 300 IR tablet is placed under the tongue until the end of the grass pollen season. The tablets take about 1 minute to dissolve.

Grastek (aka Grazax in Europe) is made by ALK-Abello and Merck and treats patients aged 5-65 years who are allergic to only Timothy Grass. Grastek has a simpler regimen of 1 sublingual tablet daily starting 12 weeks before and continued until the end of the grass pollen season. As with Oralair, the first dose is given in a medical office to ensure safety with all other doses are taken at home. The tablet dissolves in less than 10 seconds.

For both tablets, epipen needs to be available at home due to possible risk of anaphylaxis. As with allergy shots, patients on beta-blockers for high blood pressure are not eligible to undergo this treatment.

Sources:
Grastek Recommended by FDA Panel for Timothy Grass Allergy. Medscape 12/12/13

Sublingual Oralair Recommended for Grass Pollen Allergy. Medscape 12/11/13

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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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How Much Tongue Can Be Removed Without Affecting Function?

Unfortunately, whether through trauma or cancer concerns, parts of the tongue may be removed. When a part of the tongue is removed, the principal concern patients have is whether speech and swallow will be affected.

The answer to this question depends on 3 main factors.

• What orientation is the tongue removed?

• How much is removed?

• Will nerve function be preserved? The nerve is what makes the tongue move (specifically cranial nerve 12 called the hypoglossal nerve)

Regardless of how much or little of the tongue gets removed, if nerve function is lost, speech and swallow will be affected. As such, when tongue resection is performed, extreme care is taken to preserve nerve function and not to accidentally cut the hypoglossal nerve unless absolutely necessary (the nerve is invaded by cancer). As an FYI, this nerve is about 1.75cm off to the side of the tongue's midline.

When tongue removal is performed on the SIDE of the tongue, up to 1/3 of it can be removed without significant speech or swallow deficits ASSUMING nerve function remains intact and tongue tip is left alone. If more than 1/3 is removed, some degree of reconstruction will be required involving taking skin and muscle from the forearm to fill the space lost to the tongue resection (procedure is called radial forearm free flap).

If the tongue tip is removed, far less can be lost before it will start to affect speech. Why? Because the tongue tip is used to help articulate words. How much can be removed before it starts to affect speech depends on the tongue length and shape. Swallow is typically unaffected.

Typically tongue tip removal occurs through trauma when it may get bitten off during a seizure or bitten off by another individual as occurred to this man whose tongue tip was bitten off by his girlfriend when he tried to kiss her. [link]

Side of the tongue removal usually occurs through surgical excision due to cancer concerns.

Sleep Apnea

As an aside, there is another type of tongue removal procedure used to address obstructive sleep apnea where the central back part of the tongue is removed. This procedure is performed when the tongue is large and causes obstruction while a person is sleeping. If properly performed, no speech or swallow deficits will occur.

Read more about this procedure here.

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Split Tongue (aka Forking the Tongue, Snake Tongue, etc)

Photo Source Here

Splitting the tongue into two halves is a relatively rare type of body modification, though it is becoming more common. Tongue trauma can also result in such tongue bifurcation as well.

There are 3 described basic methods of creating a split tongue. scalpel (cold steel), cautery (electric or laser), and tie-off. Scalpel and cautery methods are performed by a surgeon, but the tie-off method can be performed by anybody.

The tie-off method was developed by 19 year old Dustin Allor in which he took fishing line tied through an existing tongue piercing and looped it over the tongue tip.  Over time, the fishing line is sequentially cinched tightly through the tongue tissue. This slow process (days to months) allows the tongue to heal as it is being split negating the need for stitches or cauterization due to nominal bleeding.

A split tongue can also be reversed, though more painful than creating it.

More can be read about split tongue on Wikipedia.

Needless to say, this procedure is NOT covered by insurance... but reversing it potentially can be covered by insurance.

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Infographic: HPV from Oral Sex Causes Throat Cancer

I have blogged in the past regarding how HPV transmitted through oral sex (and potentially even French kissing) has now become the number 1 cause of throat cancer in individuals under the age of 50, even more than smoking and drinking alcohol [link]. Of course, smoking and alcohol further exacerbates this risk.

Indeed, A 2007 study in the New England Journal of Medicine found that younger people with head and neck cancers who tested positive for oral HPV infection were more likely to have had multiple vaginal and oral sex partners in their lifetime. Having six or more oral sex partners over a lifetime was associated with a 3.4 times higher risk for oropharyngeal cancer; cancers of the base of the tongue, back of the throat, or tonsils. Having 26 or more vaginal-sex partners tripled the risk. The association continued to increase as the number of partners in either category increased. Of greater concern is that "French" kissing may also potentially be a mode of transmission.

In any case, Mt. Sinai Hospital published a great infographic to further educate the risks of oral sex. Needless to say, if you find/see an abnormal bump in the mouth, talk to your doctor about it!

References:
Human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007 Sep 13;357(11):1157; author reply 1157-8

Human papillomaviruses in head and neck carcinomas. N Engl J Med. 2007 May 10;356(19):1993-5.

Case-control study of human papillomavirus and oropharyngeal cancer. N Engl J Med. 2007 May 10;356(19):1944-56.

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Coffee Reduces Risk of Death from Oral Cancer

In a prior blog, I mentioned that researchers found that regular coffee drinkers who drank more than four cups of coffee a day had a 39 percent decreased risk of two types of head and neck cancer: oral cavity and pharynx cancers. In the study published in the Journal of Cancer Epidemiology, Biomarkers & Prevention, they found however, that coffee did not decrease the risk of laryngeal cancer. Read a CNN report on this here.

In a more recent study (Dec 2012), researchers have found that not only does coffee reduce risk of cancer, but that consuming more than four cups of caffeinated coffee per day was associated with a 49 percent lower risk of oral/pharyngeal cancer death relative to no/occasional coffee intake.

Coffee contains over 1,000 different chemical compounds, including cancer-fighting antioxidants, and it’s those antioxidants that may provide a “plausible explanation” for reducing the cancer risk as well as cancer death.

However, patients should not take this study as an excuse to increase their coffee intake specifically to counteract known cancer-causing behaviors including smoking, drinking alcohol, and chewing tobacco.

Reference:
Coffee and Tea Intake and Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1723-36. doi: 10.1158/1055-9965.EPI-10-0191. Epub 2010 Jun 22.

Coffee, Tea, and Fatal Oral/Pharyngeal Cancer in a Large Prospective US Cohort. American Journal of Epidemiology, 2012 DOI: 10.1093/aje/kws222

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Wrong Site Surgery Performed by ENT

In 2010, an ENT performed a tongue tie release on a 5 years old child who was supposed to undergo a tongue lesion biopsy (apparently 1cm in size over the central dorsal tongue). Tongue tie release was NOT consented for nor discussed with the parents who expected a tongue biopsy to be performed instead. In the investigative report performed by the Department of Public Health:

"When the surgeon was asked whether he examined the patient in the preop area prior to the surgery, he stated, "Usually, I don't examine anybody. I sometimes visit... In this case, there was no time to do a pre-operative visit. From now on, I need to see the patient prior to the surgery." [link]

According to the record, time-out WAS performed. Consent WAS in the chart for a tongue lesion biopsy. Records indicated that all mandated check-lists and time-outs were performed.

So what happened?

1) Surgeon Error: Let's face it... the surgeon made a mistake. Ultimately, it is his responsibility to ensure that the procedure goes smoothly which by definition means doing the correct procedure.

Seeing patients before surgery probably would have prevented this error. Not seeing the patient prior to surgery is not good practice.

Even if a surgeon employs a nurse practitioner or a physician assistant to see patients for him in the office or in the hospital, before any surgery, he personally should examine and discuss the upcoming surgery with all patients.

As an aside, at least once per week, I have patients calling who desire to schedule surgery without wanting to see me first for a consultation appointment. There are many reasons why I mandate that a patient MUST first be personally seen by me in the office PRIOR to any surgery scheduling. Preventing this scenario is one good reason why.

2) Nursing Error??? If the nurses knew what procedure was supposed to be done (according to the report, they did)... they should have spoken up! If they were too afraid to speak up, they should have contacted management to speak up for them... or ask the anesthesiologist to say something.

After all, patient welfare supersedes all else. Having wrong site surgery is the exact opposite.

However, to be fair in this particular situation, I do not believe the nurses knew what the surgeon was doing. Why???

The procedure was being done inside the mouth and a small child's mouth at that... honestly, nobody except the surgeon and possibly the anesthesiologist can really see what the surgeon is doing. The instruments used for tongue tie release is very similar to what would be used for tongue lesion biopsy.

3) Time-Out and Check-List Error: In a typical day, there are so many time-outs and check-lists being performed that it starts to get muted into background noise. It's just like the alarms and blinking lights that I imagine an instrument panel of a sophisticated machine would be for somebody who stares at it all day, everyday. You hear/see it... but than you don't hear/see it.

What people notice are sounds that are unusual for a given situation.

For example, cars make all sorts of noises when being turned on and moving somewhere. However, most people don't actually "hear" the sounds being produced by the car because of our lack of attention to it, because it is repetitive and continuous.

However, if one day, the engine starts knocking, that certainly gets a driver's attention and remembered.

Time-outs and check-lists suffer from inattention... even if performed.

They are a wonderful tool, but utterly undependable for long-term use.

So what would work given it must be done per regulations??? My suggestion would be to mix it up to prevent it from becoming "background" noise.

Have the time-out performed by different members of the surgical staff on every case rather than the same person. Ring a bell before doing time-out one time. On another time, have everyone dance a short jig before doing it. Whatever is done, do NOT make it repetitive which otherwise risks being inadvertently ignored.

The key is to make it different and notable each and every time in order to focus attention and prevent the task from becoming muted into the background.

Source:
CA Fines 14 Hospitals for Medical Errors. Health Leaders Media 8/31/12

Reference:
California Human and Health Resources Department of Public Health Report. 5/18/11

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Celebrity Chef Grant Achatz With Stage 4 Tongue Cancer

Chicago news recently published a story about their very own celebrity chef Grant Achatz who suffered from Stage 4B squamous cell carcinoma of the tongue.

Grant Achatz, chef and co-owner of Alinea/Next/Aviary, approached multiple physicians throughout the country who essentially told him the oral cancer was terminal. In the end, he underwent treatment at University of Chicago successfully, though he certainly is not out of the woods yet.

There are several approaches in the treatment of tongue cancer, especially one as advanced as Mr. Achatz's, each with its own advantages and disadvantages.

In one approach is surgery first to remove all visible disease followed by radiation and chemotherapy to get rid of microscopic tumor cells. Surgery is huge... it entails removal of most of the tongue, involved jawbone, and removal of lymph nodes in the neck (neck dissection). Given how much tissue is removed, reconstruction of the defect is typically performed using bone, skin, and muscle typically taken from the arm (radial forearm free flap). Given how massive the surgery is, a tracheostomy as well as stomach feeding tube is placed. Hospitalization is typically 1-2 weeks long.

An alternative approach is surgery second. Radiation and chemotherapy is done first to shrink the tumor. Once this course is completed, surgery is performed to remove residual disease. The amount of surgery depends on the degree of residual cancer that is left. This course of action is what Mr. Achatz chose to pursue.

Regardless of what step is pursued, there are lots of side effects from cancer treatment including:

• loss/alteration in taste and smell
• dry mouth
• difficulty with swallowing
• stiff neck
• poor teeth (often they get removed prior to cancer treatment)
• leathery skin

Unfortunately, cancer being cancer, risk of recurrence is VERY high especially for stage 4 tongue cancer no matter how well the initial response appears to be. Regularly monitoring over the next 5 years is absolutely essential starting with an exam every 2-3 months for the first two years as that's when the risk of cancer recurrence is highest.

Source:

Celebrated chef gives back. WGN 3/22/12

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Tongue Taste Map is a LIE!

As children, we all learned about the 4 different taste qualities the human tongue can appreciate: salty, sugar, bitter, and sour. Savory or umami was added in 1985. "Calcium" has been proposed in 2008 as well as more recently, "fatty" taste.

Along with the 5 (and possibly more) taste qualities we all had to memorize at some point, we also had to memorize the taste map of the tongue (yes... I know umami is missing):

Well... what a waste of time to memorize the tongue taste map because it is wrong!!! This tongue taste map was originally sketched by Edwin Boring in 1942 and has since been frequently reproduced in textbooks, wine classes, and biology courses.

The tongue taste map delineates specific areas where certain taste qualities are perceived better than in other areas like the state of Texas is distinctly a different region than Montana.

However, reality is a mish-mash patchwork spread unevenly throughout the tongue that is different for each person.

Each of the ~5000 taste buds found on the surface of the tongue contain clusters of over 100 taste cells with receptors that have different degrees of sensitivity to molecules carrying MORE than one basic taste and that these clusters are distributed across the entire surface of the tongue.

Bottom line?

Tongue taste map is a lie.


Reference:
The cell biology of taste. JCB vol. 190 no. 3 285-296, doi: 10.1083/jcb.201003144

Receptor seeks ligand: on the way to cloning the molecular receptors for sweet and bitter taste. Nat. Med. 5:381–382. doi:10.1038/7377

A Map of Taste. NYT 3/19/12

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Woman Coughs Out Her Throat Cancer

It was reported today a woman literally coughed out a previously undiagnosed throat cancer... and cured herself of it.

She apparently felt a tickle in her throat forcing her to cough... and spat out a 2 cm large mass. No kidding...

The mass was sent to pathology and was diagnosed to be malignant and was told she only had a 50% chance of survival.

To ensure no cancer was left behind, she underwent radiological scans as well as additional biopsies in the base of tongue region where the mass probably originated from and no further trace of cancer was found.

She is very lucky as most base of tongue cancers that's 2 cm large usually requires not only surgery, but also chemotherapy and radiation treatment.

As the report stated, the cancer was probably on a thin stalk (like a lollipop) that allowed her to cough the entire cancer out!

Source:
Woman in clear after coughing up a cancerous throat tumour. Mirror.co.uk 1/11/2012

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Posterior Tongue Tie

An ordinary garden-variety tongue tie (also known as ankyloglossia) is an uncommon condition whereby the tongue is anchored to the floor of the mouth preventing the tongue tip from moving freely.

Patients with tongue tie have greater difficulty with:

• feeding if infant
• speech if school-age child
• french kissing if young adult

Treatment is tongue tie release which can be done at any time if difficulties arise. In infants and young adults, this procedure can be done in the office under local anesthesia only. In school age kids, it typically requires sedation given lack of cooperation with keeping the mouth open and tongue still.

Posterior Tongue Tie

Though tongue tie is uncommon, there is an even more uncommon (or perhaps less recognized) subtype called submucus tongue tie or posterior tongue tie.

This condition is when the tongue tie is hidden UNDER the mucus lining of the tongue/mouth. You can't see this type of tongue tie, but you can feel it if you run the finger underneath the tongue from side to side where the tongue tie would be. One would feel a tissue band (speed-bump sensation with finger sweep) where the tongue tie would be.

Treatment is a bit more complicated than a regular tongue tie release in that the mucus lining has to be incised in order to expose the tongue tie prior to release. Once the tongue tie is released, the incision is sutured closed.

Read more about this condition and treatment here.

Another less known condition is upper lip tie which may also cause breast-feeding difficulty.

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