Does WaxVac or EarVac Actually Remove Earwax?

The EarVac or WaxVac is a device that purportedly suctions out earwax. Shaped like a miniature hair dryer, one simply needs to hold it up to your ear canal in order to suction out the earwax. Recently, they have been marketing this device heavily, especially through TV commercials.

Now, does it actually work???

Not really... In fact, British researchers tested it out against the humble ear curette (Jobson-Home Probe). With their test population, the WaxVac worked in exactly ZERO percent of patients. The ear curette worked 100% of the time to restore eardrum visibility and 88% for subjective hearing improvement for the patient.

Why would the WaxVac work so poorly?

Think of a handheld vacuum cleaner. Even for a regular vacuum cleaner, it will only suck up debris only when it is right on top of it. One can't "vacuum" out a bedroom simply by holding the vacuum cleaner at the bedroom door entrance or hovering it around in the bedroom. The vacuum needs to be placed DIRECTLY over debris in order to suction it out.

Well, the same goes for the WaxVac.

Even when the ear canal is professionally vacuumed by an ENT under the microscope, it only works with some earwax types... and doesn't work at all for other earwax types.

I also wanted to point out the danger of using an WaxVac which has the potential to create high negative pressures when sealed up against the ear canal entrance which could lead to eardrum perforation as well as permanent hearing loss (similarly to kissing ear syndrome).

As such, I personally do not recommend this product. However, should you decide to purchase it, I would strongly urge people to do their homework before buying this unproven device. Even if it did work, beware that the company seems to make their money by scamming people with shipping charges [link]. 

Reference:

A non-randomized comparison of earwax removal with a 'do-it-yourself' ear vacuum kit and a Jobson-Horne probe. Clin Otolaryngol. 2005 Aug;30(4):320-3.


Watch how earwax is cleaned at an ENT office video.

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New Anti-Meth Sudafed (Pseudoephedrine)

As anybody who suffers from nasal congestion and runny nose knows, the nasal decongestant medication Sudafed can only be obtained from behind the pharmacy counter after showing identification because Sudafed can be made into meth.

This restriction applies to not just sudafed, but any medication containing the active ingredient "pseudoephedrine" which is a precursor for most meth recipes.

Well, coming soon to a drugstore near you, a new nasal decongestant has been produced that can NOT be made into meth called Zephrex-D. It still contains the active ingredient pseudoephedrine.

Made by Westport Pharmaceuticals, Zephrex-D comes in a "tamper-resistant formulation that locks this active ingredient chemically so that it cannot be used in illicit methods of methamphetamine manufacture," but maintains full clinical benefits for patients.

This drug (30mg tablets) is currently available at several national and local drug retailers throughout Missouri with nationwide deployment in 2013. Combination drugs including Zephrex-D will also become available within the next year.

Obviously, this has the potential to ease purchase restrictions for nasal decongestant drugs.

Source:
Westport Pharmaceuticals launches Zephrex-D, a tamper-resistant PSE formulation. DrugStoreNews 12/4/12

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Keyword Optimization for Medical Websites

As a general rule of thumb, physicians are terrible at running a business... including their own practice. This unfortunate inability also extends to managing practice websites.

When it comes to websites, most physicians take the attitude of "if you build it, they will come" which is doomed to failure. The better way of phrasing it would be "only if patients can find you, they might come."

Finding you is the first step... And one important element of accomplishing this step are keywords.

Let's take the medical condition "eustachian tube dysfunction" which is an annoying malady of the ear causing symptoms of clogged ears, pain, hearing loss, fluid sensation, etc.

Now, if you are to build a webpage on this particular condition, there are some do's and don'ts.

DO embed keywords that patients will actually use when searching about this condition.

clogged, ears, hearing, loss, fluid, sensation, treatment, pain, infection, etc

DON'T use only keywords that medical healthcare professionals will use (though it can't hurt to also include).

eustachian, tube, dysfunction, myringotomy, tube, cochlear, hydrops, auditory, aural, etc

Sounds simple? It is... but it almost never happens! Common mistakes I see regarding keywords on medical webpages include:

1) What keywords? There aren't any!!!
2) Medical terminology used as keywords rather than descriptive terms a patient would use in a google search
3) Poor utilization of keyword ranking for a given webpage

What do I mean by "poor utilization of keyword ranking?"

Google and other search engines rank some keywords more highly than others. Such ranking of keywords depends on placement within the webpage's code.

Keywords found in the following locations are very important:

• Webpage document title (typically ends in .htm or .html). This is what the webpage document on the server is actually called.
• Title of webpage (words used in the title bar of the webpage)
• Meta keywords and description: Has become less important, but still wise to utilize.

Keywords found in the rest of the webpage including the body text is not nearly as important though still taken into consideration when the above have been addressed first.

Check out this humorous video made by Google regarding the importance of keywords:

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A New BAHA Hearing Aid... Without the Screw Implant

For patients with a significant conductive hearing loss or mixed hearing loss, Bone-Anchored Hearing Aids (BAHA) are an option that negates the need to place anything in the ear canal.

Traditional hearing aids require some type of ear hook that is inserted into the ear canal to allow amplified sound to reach the middle and inner ear.

BAHA transmits sound to the inner ear via a different mechanism using actual bone vibration. The bone vibration can be transmitted either via direct physical coupling (traditional) or via indirect magnetic coupling (the new way).

The traditional BAHA requires a titanium screw that is drilled into the bone behind the ear. Part of this screw sticks out of the skull through the skin to which the hearing aid is attached. Sound is transmitted into the ear by direct screw vibrations which in turn vibrates the bone that gets transmitted directly into the ear thereby allowing sounds to be heard.

 

Why would anyone want a BAHA? It would be a better option than a traditional hearing aid if the ear canal is extremely small, prone to getting infected, chronically draining, and/or absence of the middle ear anatomy including eardrum and middle ear bones.

But who wants a metal screw sticking out of their head???

That's where this "new" magnetically coupled BAHA device called Sophono Alpha 1 comes in.

Rather than a screw sticking out of the bone to transmit vibrations, magnets are used instead. First, flat magnets housed within a titanium plate is surgically screwed into the skull underneath the skin. Nothing sticks out!

Over the skin, an external base plate is magnetically coupled to the surgically screwed in plate.

The hearing aid, which is held in place to this external plate, houses a bone oscillator that uses a metal disc and spacer shim to magnetically couple to the internal component in order to deliver auditory stimulation (vibration) through the closed skin.

Early studies suggest, however, that the hearing amplification is not as great as the traditional direct coupling BAHA.

Read more about this new Sophono BAHA here.

Though our office does not offer this device, please contact your local otologic surgeon to see if (s)he offers it!

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Voice Amplification for Patients with a Weak Voice

There are certain voicebox conditions that naturally tends to a weak sounding voice.

For some, the voice is weak all the time sounding breathy or just lacks projection. For others, the voice starts out OK, but than becomes weak after talking for some period of time. There are both pathological (ie, vocal cord paralysis) as well as functional (ie, muscle tension dysphonia) causes of a weak voice, but in the end, a patient just wants a better sounding voice one way or another.

Although voice therapy is a standard way of addressing vocal weakness regardless of causation as well as possible surgical interventions, patients still need to use their voice and in order to obtain an immediately improved vocal strength is to use electronic amplification.

For the same reason a pop star singer uses a microphone to amplify their voice to be heard in a gigantic stadium, a person with a weak voice can use a similar system to amplify their voice in more mundane situations.

In essence, such personal voice amplification systems contain 2 components: microphone and speaker. The microphone is placed near the mouth and the speaker placed near the person, typically on a belt.

Such systems are relatively cheap costing less than $100. Many models can be found on Amazon.comat a discount.

The "premium" voice amplification systems are by Chattervoxand cost several hundred dollars.

Some examples can be found here.

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Julie Andrews and Her "Botched Throat Surgery"

It has already been well-publicized that the former singing sensation Julie Andrews underwent some type of throat surgery in 1997 after which she never regained her phenomenal 4-octave voice thus relegating her to more conventional roles of being an actress without the singing. This "botched throat surgery" per Julie Andrews lead to a lawsuit that was ultimately settled.

It is unknown precisely what type of (presumed) vocal cord pathology was present as well as what type of surgical approach was used to try and fix it. In a recent interview, she stated:

"The operation that I had left me without a voice and without a certain piece of my vocal chords"

However, given her aggressive and active singing career prior to surgery, she probably had vocal cord nodules, a benign growth that occurs due to vocal overuse, a situation not uncommon with professional singers.

Vocal cord nodules are most always due to excessive voice use leading to "callous" formation on the vocal cord lining, much like shoveling dirt will eventually lead to callous formation on the hands.

Traditional standard of care management of vocal cord nodules is voice therapy and avoidance of any activities leading to voice abuse (screaming, yelling, etc). However, resolution of nodules with such behavior focused treatment takes months. However, although it takes a while for the nodules to resolve with this treatment method, they typically do not come back.

For patients who are more "impatient" for results (not unusual with professional singers whose livelihoods depend on singing), there are more aggressive ways to address vocal cord nodules with possible resolution within weeks. However, the caveat is if the underlying voice behavior that led to nodule formation in first place is not addressed, the vocal cord nodule WILL recur after initial resolution/improvement. Furthermore, as with any more invasive treatments to obtain a "quick fix", scar formation may occur leading to permanent voice changes, usually for the worse which obviously happened with Julie Andrews.

What are some of these more invasive treatments beyond voice therapy? To reiterate, these procedures also have a high risk of recurrence if underlying abusive voice behavior that led to the nodule formation in first place is not first addressed.

• Surgical excision can be performed, but can lead to permanent scar formation during the healing process that can lead to persistent irreversible hoarseness.

• Botox injection can also be pursued which causes a "partial" vocal cord paralysis preventing the repetitive trauma in the region of the vocal cord nodule.

• Steroid injection to the vocal cord nodule(s) can possibly resolve or reduce the nodule resulting in improved vocal quality within weeks. Such local injection technique has mainly been performed in the treatment of spasmodic dysphonia (botox injection), vocal cord granulomas, and vocal cord paralysis. Watch a video how a "local injection" to the vocal cord can be performed (video shows injection of vocal cord granuloma rather than nodule, but overall approach is identical).

Read more about vocal cord nodules here.

Source:
Julie Andrews' Voice Isn't Coming Back, But She's Not Staying Silent. Huffington Post 12/5/12

PUBLIC LIVES; Julie Andrews Sues Throat Surgeon. NYT 12/15/99

Julie Andrews Settles Lawsuit Against Doctors. ABC News 9/7/12

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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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