Chin Strap May Help with Snoring

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

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

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

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

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

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

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

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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

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Does Drinking Alkaline Water Help With Reflux?

Image by WJ Pilsak from Wikipedia

Treatment in some reflux-sufferers may require addressing not just the acid in reflux, but also the pepsin. In one tantalizing research paper, alkaline water (pH 8.8) was found to instantly and permanently inactivate pepsin in vitro (ie, in a test tube). Pepsin is a stomach enzyme that can cause inflammation and mucosal damage when in the throat area. This peptic enzyme can be deposited outside the stomach due to laryngopharyngeal reflux (LPR) and can cause symptoms of globus, burning, hoarseness, chronic cough, chronic throat clearing, etc.

With pepsin triggered symptoms, treatment to resolve can become exceedingly frustrating given standard treatment with zantac, prilosec, and other "reflux" medications do not work as well. Furthermore, human pepsin remains stable at pH 7.4 and can be repetitively reactivated by acid from any source (ie, orange juice).

BUT... keep in mind that test tube results in this research may not necessarily translate to actual improvement in humans. However, drinking a small amount of alkaline water a few times a day (just enough to coat the throat) can't hurt.

Keep in mind that most tap and bottled waters (typically pH 6.7 to 7.4) would not be expected to affect pepsin stability.

I should also mention that drinking alkaline water will not do much to help acid reflux as the alkaline water will only briefly neutralize any acid and is ineffective for long-duration acid suppression. For those suffering from acid reflux, stick with the traditional reflux medications which work extremely well.

Reference:
Potential benefits of pH 8.8 alkaline drinking water as an adjunct in the treatment of reflux disease. Ann Otol Rhinol Laryngol. 2012 Jul;121(7):431-4.

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Does Acupuncture Help With Allergies?

Image from Acupuncture For All

According to one study, it does... Performed by researchers in China and Korea, they divided 238 patients suffering from allergies into 3 groups: active acupuncture, sham acupuncture, and no treatment.

They found that acupuncture, even if it was sham, did help significantly with nasal allergies. However, only active acupuncture helped with not just nasal allergies but also allergy symptoms beyond the nose!

Of course, when considering all the other research performed on this subject, the results are a bit more mixed with some reporting no improvement with acupuncture.

For those interested in avoiding medications and allergy shots, it may be something to consider trying. It can't hurt and it can potentially even help.

References:
A multicenter, randomized, controlled trial testing the effects of acupuncture on allergic rhinitis. European Journal of Allergy and Clinical Immunology. Volume 68, Issue 3, pages 365–374, March 2013

Acupuncture for allergic rhinitis: a systematic review. Annals of Allergy, Asthma & Immunology Volume 102, Issue 4 , Pages 269-279, April 2009

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Video and Audio Recording with RCA Connectors: Primer for Surgeons

In the medical world, video recording of surgical procedures is not unusual, especially when it comes to endoscopy.

A camera attached to an endoscope throws up a live image to a screen for the surgeon (and others) to watch. Video output for recording is now standard in such situations.

The monitor where the endoscopy procedure is viewed itself contains video output plugs.

The endoscopy equipment itself like the KayPentax EPK-1000 contains not just one video output, but 3... Two S-video and one RGB.

As such, one could hook up literally any type of recording device and get a beautiful video copied into any type of media very easily whether laptop computer, VHS, CD, thumb drive, etc.

HOWEVER, audio recording simultaneously with endoscopy is not typically a built-in feature and as such requires some MacGyver action.

Why in the world would a surgeon want to record audio? Well, take ENT surgeons who perform vocal cord procedures where the voice is the main outcome measure. It would be great to be able to record not just the video, but the audio of the patient's voice as the procedure is performed.

So what to do?

The simplest way to record audio and video is to take a camcorder and record the screen. The camcorder will be able to record the video (via shooting the monitor) and has built in microphone to record the surrounding audio. One can also attach a lapel microphone and plug it into the audio jack of the camcorder if available.

The downside with this simple method is the video quality. You are after all recording a screen rather than getting the pure digital video signal which would provide the best video picture.

Well, the surgeon will need to obtain a digital AV converter box which has the ability to merge separate video and audio signals and merge it into a single AV signal that is then fed into a computer to record. With this setup, the computer is tricked into thinking the video and audio as coming from a single source like a camcorder.

The problem is that all AV converter boxes (as of Nov 2011) utilizes RCA audio ports (red and white).

One can not simply buy a microphone with appropriate RCA adapters and plug it into the AV converter box. IT WILL NOT WORK!

Why? Because RCA connectors contain no power. Typically, RCA connectors go from something that already has a power source like a DVD player, camcorder, or TV. The current crop of digital AV converter boxes assumes that the user is trying to copy a movie or show onto a computer.

But for the surgeon, that's not what is occurring.

We literally just want to connect a microphone (which inherently has no power supply) to the RCA audio ports on the AV converter box.

In order to do this, a power supply needs to be provided to the microphone BEFORE plugging it into the RCA ports.

What is this power supply unit? It's called a microphone pre-amp.

So the connections go something like this:

microphone on patient --> microphone pre-amp --> AV converter box --> computer to record

A variety of plug converters will be required in order to plug each component to each other.

For those who want to duplicate what I've specifically done, here are the components (Amazon links provided below):

1) Microphone - Olympus ME-51S Stereo Microphone
2) Microphone Pre-Amp - ART Tube MP Studio Mic Preamp
3) AV Converter Box - Canopus ADVC110 Converter

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