Pacifier Use Increases Risk of Ear Infections in Infants

There are many reasons why an infant may suffer from ear infections... parental smoking, not breast-feeding, daycare, etc.

However, what many parents may not realize is that pacifier use is also an additional well-known independent risk factor for causing ear infections as well.

Numerous studies have documented this association and depending on what study you look at, the risk can be quite significant.

Furthermore, the longer and more frequently the pacifier is used, the more ear infections a child can have.

As such, it is suggested that pacifiers should be used only during the first 10 months of life and only when need for sucking is strongest.

Of course, pacifier do have benefits including analgesic effects, shorter hospital stays for preterm infants, and a reduction in the risk of sudden infant death syndrome.

References:
A pacifier increases the risk of recurrent acute otitis media in children in day care centers. Pediatrics. 1995 Nov;96(5 Pt 1):884-8.

Pacifier as a risk factor for acute otitis media: A randomized, controlled trial of parental counseling. Pediatrics. 2000 Sep;106(3):483-8.

Is pacifier use a risk factor for acute otitis media? A dynamic cohort study. Fam Pract. 2008 Aug;25(4):233-6. Epub 2008 Jun 17.

Risks and benefits of pacifiers. Am Fam Physician. 2009 Apr 15;79(8):681-5.

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Is Flu Shot Safe for Patients With Egg Allergy?

It is the season for flu shots... and with that... we invariably get phone calls from patients asking whether it is safe to receive the flu shot if they are egg allergic. Generally speaking, the blunt answer is that it is safe... even if you have a life-threatening egg allergy.

Why the concern? The flu shot vaccine (both H1N1 and seasonal) are grown inside eggs which is where this concern arises. It also doesn't help that the pre-flu shot questionnaire specifically asks about egg allergy. Though egg-based, during vaccine production the egg protein is filtered out such that there should be no egg contaminants in the final vaccine. However, it is theoretically possible that some egg may still be present in the vaccine.

Given the infinitesimal possibility of egg contaminants, is the concern still legitimate?

There has been a recent study by Canadian researchers who followed 367 egg-allergic people, mostly children, who got the flu shot over five years. Almost one-third of these patients had a significant history of anaphylaxis after eating eggs causing serious symptoms like trouble breathing or a drop in blood pressure. However, in this study, NOT ONE of those patients, experienced a serious reaction to the flu vaccine. Only 13 of the 367 had mild "allergy-like" symptoms, like itchy skin or hives, within a day of the shot.

Furthermore, numerous past studies that involved close to 4,000 egg-allergic people who got the flu shot revealed not a single case of a serious allergic reaction.

However, if such studies still do not alleviate anaphylaxis concern if egg-allergic...

You can either get one of the new completely egg-free flu vaccine Flucelvax or Flublock or...

To play it safe, the absolute safest way for a patient with egg allergy to get the flu shot is via a few steps:

1) Get a test dose of the flu vaccine where a small amount (0.025cc typically) of the flu vaccine is administered sub-dermally.
2) Wait 10-20 minutes.
3) If there's no reaction (redness and swelling of the skin), get the shot properly into the muscle.
4) If there's a large wheal reaction, it's probably best not to get the flu shot or see an allergist to get desensitized prior to receiving the injection.
5) If flu shot given, make patient wait 30 minutes to observe for any adverse reaction.

Not all practices may be familiar with these particular steps. If that's the case, request to take the flu vaccine to an allergy office (including ours), and have us administer it. (Please note that we do not provide egg desensitization.)

If you are only IgG allergic and not IgE allergic to egg, no need to worry. Get the flu shot.

For a more in depth discussion, click here to read a document prepared by the American Academy of Allergy Asthma & Immunology.

Reference:
Egg-allergic patients can be safely vaccinated against influenza. Journal of Allergy and Immunology. In Press. Published Online Oct 1, 2012

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Why Does Burping after Drinking Soda Burn the Nose?

I do not believe this question has actually been scientifically studied... but I can hazard a guess.

Sodas are those flavored fizzy drinks like Coca-Cola and Pepsi.

The "fizziness" is due to carbonation or carbon dioxide dissolved within the drink. When sodas are made, carbon dioxide is forced into the liquid under pressure so that there's more gas dissolved in the liquid than at regular air pressure. The bubbles you see and feel is caused by the carbon dioxide gas being released back into the air when exposed to back into regular air pressure (a closed can or bottle keeps the carbon dioxide under pressure within the liquid).

Such machines can even be purchased to make sodas at home (see below).

A soda becomes flat when all the carbon dioxide has been released back into the air.

In any case, why the burn?

Carbon dioxide (CO2) and water (H2O) together undergo a chemical reaction to form a very weak acid  called carbonic acid (H2CO3).

CO2 + H2O <--> H2CO3

So, after drinking some soda, the CO2 that is released reacts with the water inside your mouth, throat, and belly. The resulting carbonic acid, some of which is aerosolized, can than be burped up into the nose.

The nasal lining is quite sensitive, and when in contact with carbonic acid, can cause a burning sensation.

Now... does this actually happen?

Well, sounds like a potential neat research project that can potentially even be done by a high school student.

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Feeds for Fauquier ENT Blog Has Changed

Fauquier ENT blog has recently changed its email subscription service from FeedBurner (run by Google) to FeedBlitz.

Why?

Well, it is because Google appears to be shutting the FeedBurner service down.

• FeedBurner API will be shut down on October 20, 2012. At that point, feed metrics will be gone, though feedburner itself will continue to work.

• FeedBurner Twitter and Blog accounts were abandoned on July 26, 2012.

Though Google has not specifically stated they will shut down FeedBurner, such actions (or inactions) stated above does not exactly build confidence in me.

As such, rather than waiting for the complete shutdown to occur before making a move, transition has been made to what I believe is a superior email subscription service for blogs called FeedBlitz.

I do expect a few errors to pop up while all bugs are worked out, so please be patient.

What do current subscribers need to do?

If you have subscribed by email already, there's nothing for you to do. You will continue to receive email updates with new blog entries.

BUT, if you subscribe via RSS reader, you will need to change / resubscribe using the new feed run by FeedBlitz as the FeedBurner feeds will soon be discontinued.

Here are the new RSS feeds:

Feed URL:	http://feeds.feedblitz.com/feedburner/fauquierent
XML URL:	http://feeds.feedblitz.com/feedburner/fauquierent&x=1
Mobile Friendly:	http://m.feedblitz.com/feedburner/fauquierent

Thank you for all your support and understanding!

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ENT Surgeons Who Use daVinci Robot

Readers know my skepticism on the practicality of the daVinci robot in ENT head and neck surgeries.

However, that does not mean that I do not doubt its effectiveness in certain unique situations... as well as market forces that use such high (and expensive) technology to market a given hospital's services.

In any case, plenty of patients have asked me if there's any ENT surgeons who use the daVinci robot in the region.

There are... and here are two that I am aware of.

Dr. David Shonka at UVA
Dr. Stan Chia at Georgetown

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Does Social Media Advance Medical Knowledge?

According to a recent paper, the answer is absolutely!

A survey was distributed via email to a random sample of 1695 practicing physicians in the United States in March 2011 with responses from 485 physicians (28.61%). Rather than rehashing what was said, I quote from the abstract,

Overall, 117 of 485 (24.1%) of respondents used social media daily or many times daily to scan or explore medical information, whereas 69 of 485 (14.2%) contributed new information via social media on a daily basis. On a weekly basis or more, 296 of 485 (61.0%) scanned and 223 of 485 (46.0%) contributed. In terms of attitudes toward the use of social media, 279 of 485 respondents (57.5%) perceived social media to be beneficial, engaging, and a good way to get current, high-quality information. In terms of usefulness, 281 of 485 (57.9%) of respondents stated that social media enabled them to care for patients more effectively, and 291 of 485 (60.0%) stated it improved the quality of patient care they delivered. 

I should mention that this study was brought to my attention via tweet by Dr. Ves, an allergist who is an active blogger and tweeter.

How medically efficient, relevant, and useful social media is to a practicing physician utterly depends on "who" physicians follow on the variety of social media platforms whether twitter, facebook, linkedin, or blog. Even videos on YouTube.

It also depends on the willingness of physicians to than share interesting medical information they found useful with others who than in turn share with others.

Perhaps one of the most difficult aspects in getting started in medical social media is finding who to follow in the first place who is worth following for useful medical tidbits.

If you are new to medical social media, I would suggest the following to get started. I should also mention that twitter IS the best and most efficient way to get started learning from and sharing information.

KevinMD (Primary Care)
Dr. Ves (Allergist)
Dr. Wes (Cardiologist)
Skeptic Scalpel (General Surgery)

Of course, I should add myself to this list:

Fauquier ENT or Dr. Chris Chang (Otolaryngology)

Reference:
Understanding the Factors That Influence the Adoption and Meaningful Use of Social Media by Physicians to Share Medical Information. J Med Internet Res 2012;14(5):e117

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Mozart May Help with Tinnitus

Currently, there is no fast, good, and cheap way of resolving tinnitus. Tinnitus is in essence hearing a ringing or buzzing that does not exist in reality. At best, it may be something you hear, but does not bother.

At worst, it can literally drive a person crazy.

Neuromonics is perhaps one of the very few treatment protocols that has been proven to work resolving/improving tinnitus in 80-90% of patients over a period of months.

However, it is expensive... typically around $6000 out-of-pocket.

In a study out of Italy, a group of patients between 22 and 78 years of age who suffered from tinnitus were told to listen to Mozart's Sonata k448for 1 hour daily for 1 month. This was followed by instruction to listen to Beethoven's Fur Elisesonata for 1 hour daily for another month.

For all the parameters investigated, there was a general significant improvement between the pre- and post-listening evaluation. Significant improvement in several parameters were seen even after a single exposure to Mozart's sonata.

So apparently listening to Mozart may not help only baby's to become smarter (debatable), but it can help adults as well.

It's also cheap... about as much as it takes to download the songs from a music store.

Some other thoughts that may require additional research...

• What if a patient hates classical music?
• Does "how" a patient listens to the music affect results? (Playing the music in background while doing some other activity versus doing nothing other than listening to the music.)
• How long does the improvement last after treatment?
• What about other songs by Mozart?

But... all in all... given it is cheap... it certainly can't hurt to give it a try.

Reference:
The Mozart effect in patients suffering from tinnitus. Acta Oto-laryngologica. Posted online on October 1, 2012. (doi:10.3109/00016489.2012.684398)

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