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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17 Year Old Girl Dies After Tonsillectomy

Patients sometimes focus too much on the intricacies and risks of the surgery itself and not realize that subsequent care AFTER surgery may be just as important and risk-laden.

Media reported yesterday about the tragic death of a 17 year old girl after tonsillectomy.

Apparently in March 2012, the Pennsylvania teenager underwent a routine tonsillectomy without any problems. While in recovery after surgery (PACU), she was given fentanyl, a powerful narcotic to help with pain, but also has a known side effect of slowing the breathing down.

"Over the next 25 minutes, her respiratory condition rapidly worsened and went unnoticed by nurses, who failed to perform required assessments and were not warned by the equipment monitoring Mariah's vital signs because it was not set properly and was muted. Sadly, as a result of these oversights and others, Mariah sustained significant brain damage due to oxygen deprivation and died 15 days later." [link]

It is also implied that in order to give the patient privacy, curtains were drawn such that her distress was also not visually seen by nurses.

Clearly, multiple lapses occurred leading to this tragic death.

Those alarms are there for a reason!!! Why mute them? Patients (and even staff) do complain of the annoying beeps and noises such machines make and out of exasperation, they can be muted due to the many false-alarms, but as this case illustrates, those very alarms could have saved her life.

Once a patient is identified with respiratory distress, narcan could have been given that would have reversed fentanyl's sedating (as well as pain-killing) effects. At worst, the patient could have been re-intubated.

This case also highlights that in certain situations, patient safety trumps patient privacy.

In PACU (a common open room where patients go after surgery), there is absolutely no patient privacy. Everyone can see everything. That way, if there's any problems, nurses can immediately see if a patient is in distress. That's also one reason among others why family is not allowed in the PACU (due to lack of privacy for other patients).

Abington Surgical Center where the surgery was performed has imposed a series of policy changes to ensure another death like this may never happen again. According to media, these policy changes include:

• each patient who has received IV narcotics (which is pretty much all patients who have surgery) in the PACU must be assigned one-on-one nurse care
• patient monitoring equipment may no longer be muted
• curtains restricting the view of the patient can no longer be drawn
• there must be a dedicated charge nurse to oversee nurse staffing and patient flow in the unit.

Except for the first point, I agree with all these policy changes which really shouldn't be a policy change per se... It should have been always there.

However, the one-on-one nursing care certainly can't hurt, but is probably unnecessary and potentially a waste of nursing resources. I should point out that IV narcotics are given ALL THE TIME in the hospital whether in PACU, the hospital floor, ER, and ICU, but one-on-one nursing care is not usually present in any of these locations. Rather, the intensity of nursing care should depend on the acuity of the surgery as well as the medical needs of the patient. A blanket policy change that applies indiscriminately is needlessly wasteful.


Source:
17-Year-Old Girl's Tragic Death After Routine Tonsillectomy Leads to Post-Operative Care Changes. SacBee.com 2/5/13

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How Much Caffeine is Present in Coffee? Decaff? Chocolate?

© Radu Razvan Gheorghe | Dreamstime Stock Photos

There are quite a few ENT problems that can potentially be due to caffeine intake. Even death has been attributed to high caffeine intake in young adults who drink a lot of energy drinks like Red Bull.

In any case, caffeine can contribute to (some proven, some suspected, some debatable):

• Tinnitus
• Meniere's Disease
• Migraine Headaches
• Headaches
• Dizziness
• Reflux
• Lump in Throat Sensation (Globus)
• Chronic throat clearing
• Dry throat
• Phlegmy throat

Alcohol and salt are other big as well as under-recognized items that may cause similar ENT issues.

As such, caffeine abstinence is one of the first things to be tried with some of these conditions. What many people may not realize is how prevalent caffeine is even in some food items not normally considered to contain caffeine. Such unrecognized items include tea, chocolate, and even decaffeinated coffee (it has been de-caffeinated, but not to the point of being caffeine free).

Here is an infographic showing relative caffeine amounts in a variety of beverages taken from C&EN:

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Negative Ear Pressure Causing Inability to Pop a Clogged Ear

Have you ever closed the lid on an air-tight container containing a left-over hot meal and stuck it in the refrigerator? And than when you try to open the lid the next day once that hot meal cools down, it is REALLY hard to open the lid because of the accumulated negative pressure? In essence, the negative pressure has "locked" the lid down.

Well, something similar can also potentially happen inside the ear with eustachian tube dysfunction, especially with negative pressure (rather than positive pressure).

Eustachian tube dysfunction is a phenomenon whereby a person is unable to pop their ears to relieve symptoms of ear pressure, clogging, or fullness. It is much akin to the ear pressure a person experiences when flying, but at ground level. Traditionally, treatment of this condition involved medications like steroid nasal sprays and prednisone along with active valsalva (watch video below). Once medical treatment has failed, ear tube placement has been the step of last resort.

The question some patients have is WHY does it become so hard to get an ear to pop open with eustachian tube dysfunction...

It may be that the mucosal lining of the eustachian tube has swelled to the point that there is no opening present.

There may also be a physical obstruction blocking the eustachian tube due to large adenoids, nasal polyps, or some other nasal mass.

However, a lesser known phenomenon is due to the negative pressure itself creating a suction effect on the lining of the eustachian tube analagous to the stuck container lid mentioned in the first paragraph. The middle ear negative pressure itself may be literally "sucking" the lining of the eustachian tube closed. If the negative pressure is great enough, it may be very hard to get it open.

When this happens, the eustachian tube becomes "locked".

One can "mimic" this effect even in a healthy individual (not that anybody would want to try). When a swimmer dives deep into the water, some ear pain will start to develop due to the negative pressure building up in the middle ear. If the swimmer does not ear pop and continues to go deeper into the water, at around 3.9 feet, it may start to get very difficult to get the ear to pop open even with effort. At around 5 feet of water depth, it will become impossible to pop the ear open. Normally, swimmers and SCUBA divers continuously ear pop when diving at depth to prevent any ear discomfort.

As such, in situations where negative ear pressure is present and medications fail to resolve the ear clogging, a hole can be surgically made in the eardrum WITHOUT tube placement which will often resolve the symptoms fairly quickly. The hole "releases" the negative pressure to allow the eustachian tube to function normally. The analogy would be that once you release the negative pressure within an air-tight container, it becomes very easy to remove the lid thereafter.

The eardrum hole typically heals closed in a few weeks and the clogged ear sensation will often not come back. If it does, the myringotomy (surgically creating a eardrum hole) can be repeated and if necessary, a tube can be placed to prevent the body from healing the hole closed anytime soon.



Some things that have helped some people to pop their ears:

 

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Just How Contagious is the Flu (and Other Viral Infections)?

Everybody knows the flu and other viral infections are contagious, but did you wonder just how contagious???

Well, here are some facts gleaned from a few studies:

• In just 4 hours, one sick worker can contaminate 50% of surfaces in a typical office
• After 8 hours, one sick worker can contaminate 70%+ of surfaces
• Non-sick workers have a 40-90% chance of getting infected after spending one day with a sick worker
• A sneeze or cough can hurl virus 6 feet away from the mouth
• A sick person literally "emanates" virus up to 6 feet away... even if they are NOT sneezing or coughing.
• Some sick individuals are super-carriers spreading the virus around them 32 times more than others

The good news is that viruses can not survive on surfaces for long... They usually die off within a day (type of surface, temperature, and humidity affecting duration).

Source:
Flu Virus Can Travel Up to 6 Feet, Infect Up to 90 Percent of People Just from Contaminated Surfaces. Medical Daily News 2/1/13

References:
Exposure to Influenza Virus Aerosols During Routine Patient Care. J Infect Dis. 2013 Jan 30. [Epub ahead of print]

InfluenzaVirus: Here, There, Especially Air? J Infect Dis. (2013) doi: 10.1093/infdis/jis774

Germs Spread Fast at Work, Study Finds. AHSC 1/30/13

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Uvula Piercing

It happens, but thankfully rare...

Ear piercing I will do, but truly uvula piercing is not something I would recommend given a whole host of problems it may cause including:

• Gagging
• Snoring
• Airway obstruction
• Uvular stretching
• Uvular bisection
• Accidental inhalation if it comes loose
• Uvular swelling
etc. etc. etc.

Indeed, most people would rather get their uvula removed rather than "enhancing" it!

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Speech Impediment to Great Singing on American Idol

During January 2013 auditions of Season 12 of American Idol, there was Lazaro Arbos who has a terrible stutter when he talks, but sings beautifully. A week later, we encountered Micah Johnson who also suffers from a speech impediment, but rather than a stutter, it was due to "nerve damage" sustained during a tonsillectomy. (Watch videos below)

With stuttering, the problem mainly lies at the brain level. The brain coordinates how a person uses all of their throat muscles to create speech. Talking and language is mainly a LEFT-brain activity (or more precisely, the dominant hemisphere). Singing is mainly a RIGHT-brain activity and as such, uses different pathways than talking. It's also the same reason why patients who have suffered from a stroke may not be able to talk at all, but can sing their words out.

Now, in the case for Micah Johnson, it is reported that his speech impediment was due to "nerve damage" from tonsil removal surgery. As such, his speech impediment is NOT at the brain level (also known as central), but peripheral. Peripheral nerve injury is much more difficult to correct and requires extensive practice (speech therapy) in order to create brand new pathways at the brain level to help it "adapt" and compensate for the loss of function from the nerve injury. The analogy would be walking with a limp to compensate for a leg injury.

However, in Micah's case, it is a bit difficult to explain why he talks with an impediment, but sings wonderfully. It is not a matter of activating previously established brain pathways as what happens with stuttering.

With a tonsillectomy, there is a mouth gag placed to move the tongue out of the way. Typically, this surgery takes about 15 minutes to perform on average. Per Micah, his tonsillectomy took 90 minutes or almost 6 times longer than normal.

I hypothesize that the mouth gag over that time duration slowly crushed the nerve innervating the tongue (cranial nerve 12) causing it to not move as well leading to his speech difficulties. This complication is EXTREMELY rare and if it occurs, almost always temporary. This situation is analogous to a "dead" arm when sleeping on it for too long... but recovering normal function after a few minutes.

Unfortunately in Micah's case, it seems to never have recovered fully.

The puzzling issue for me is how is it that he is able to sing, but not talk well? Peripheral nerve injuries would affect ANY activity involving the affected muscle. For example, if the nerve to a leg muscle is cut, that muscle will not work well whether running or walking. The ability to sing, but not talk well due to a peripheral nerve injury is akin to stating that one can only limp when walking, but can run fantastic.

Anyone have any ideas what may be going on with Micah's amazing singing?

Just as an FYI, another rare complication of tonsillectomy that may lead to speech problems is velopharyngeal insufficiency leading to a hyper-nasal sounding speech. In this situation, there is no nerve damage present. Rather, it is an anatomic problem whereby the soft palate does not 'lift" completely to close off the nasal passage from the mouth. This problem can be surgically fixed.

In any case, best of luck to both men!

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