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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Anal Massage Cures Hiccups?

So... I came across a few references addressing treatment of hiccups (otherwise known as singultus), but perhaps the most bizarre treatment for hiccups I saw was rectal massage.

Digital rectal massage (see references below) has apparently been reported in the literature to help stop hiccups, mainly by disrupting the vagal afferent limb of the hiccup reflex arc. Name says it all. Essentially, you stick a finger up the bungholio and massage the area firmly until the hiccups stop.

It apparently stops hiccups fairly quickly.


Reference:
Termination of intractable hiccups with digital rectal massage. J Intern Med. 1990 Feb;227(2):145-6.

Termination of intractable hiccups with digital rectal massage. Ann Emerg Med. 1988 Aug;17(8):872.

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How Common is Hoarseness?

At some point, we all have suffered from a hoarse voice whether from illness or from yelling. However, it was unclear exactly how common this malady is until now... and apparently, the answer is "very common"...

According to a study looking to answer this question, hoarseness affected 17.9 million adults in 2012.   The average age was 49 years old and 63% were women. Overall, 10% saw a health care professional for their hoarseness and 40% were given a diagnosis.

Infectious laryngitis was the most common diagnosis mentioned (685±86 thousand cases, 17.8±2.0%). Gastroesophageal reflux disease was mentioned in 308±54 thousand cases (8.0±1.4%).

33% reported their voice problem to be a significant problem. Bad enough that the mean number of days the hoarseness lasted was about 56 days. Because of the hoarseness, patients missed work about one week in the past year.

A general rule of thumb is to see your local ENT if the hoarseness lasts more than 1 week. Intervention can be performed to minimize the duration of hoarseness as well as to alleviate the morbidity associated with this problem.

Another general rule of thumb is to minimize using your voice if it becomes unexpectedly hoarse.

Reference:
The prevalence of voice problems among adults in the United States. Laryngoscope. 2014 Apr 29. doi: 10.1002/lary.24740.

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Cricoid Pressure May Minimize Symptoms of Reflux (LPR)

Specifically throat symptoms attributable to reflux such as globus, throat-clearing, phlegmy throat, chronic cough, etc. However, cricoid pressure may not be realistic nor practical even if it does help.

In one of the more unusual studies I have seen, researchers deliberately infused 60 cc of hydrochloric acid into the esophagus of 14 patients who suffered from LPR as well as 12 healthy controls. 9 patients exhibited confirmed LPR (laryngopharyngeal reflux) events, but none in the control group. With moderate sustained cricoid pressure (20-30 mmHg), only one patient had a confirmed LPR event.

Theoretically, why would cricoid pressure work?

The cricoid cartilage is located immediately below the voice box. It is a circular cartilage that is right at the level where the throat connects to the esophagus. By putting pressure on the cricoid cartilage, the top part of the esophagus is manually compressed shut which theoretically would prevent reflux from regurgitating up into the throat.

It is based on this theory that anesthesiologists often perform cricoid pressure to prevent aspiration during intubation for surgery, especially if a patient is suspected of drinking/eating something prior to surgery.

The problem with cricoid pressure is that in order for this to work, it needs to happen continuously which may make it unrealistic and impractical for patients who suffer from LPR. Continuously means 24/7/365. Not just when symptoms are present (because it's too late than).

Reference:
Prevention of esophagopharyngeal reflux by augmenting the upper esophageal sphincter pressure barrier. Laryngoscope. 2014 Apr 29. doi: 10.1002/lary.24735.

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Map of Vaccine-Preventable Outbreaks Over Time

Image by Council of Foreign Relations

The council of foreign relations have produced an interactive map the shows the concentration of vaccine-preventable outbreaks throughout the world over time. Such diseases include measles, mumps, rubella, polio, and whooping cough.

The take-home point of the map is that diseases that were once considered "eradicated" due to near-universal vaccinations have now made a tremendous comeback which is felt almost certainly due to the anti-vaccine movement.

Vaccinate!!!

Reference:
Vaccine Preventable Outbreaks. Council of Foreign Relations.

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Hearing Loss Over Time

It is well-known that professional musicians have a higher risk of hearing loss and tinnitus compared to non-musicians. According to one study, the risk for musicians is 1.5x for hearing loss and nearly 4x for tinnitus.

And although people understand that as you get older, hearing loss increases, what is less clear is how quickly hearing loss occurs over time.

After analyzing over 3 million subjects, here is the graph of hearing loss with age. Intuitively, I thought there would have been a "jump" in hearing loss after a certain age. The graph indicates no such "jump," but rather a continuous increase of hearing loss from the earliest age studied (19-21 years).

This gentle slope does suggest that the vast majority of hearing loss is due to the slow accumulation of noise-induced nerve damage over time and that the vast minority of hearing loss is secondary to an acute event whether from infection or sudden loud noise exposure (i.e., gunshot without hearing plugs).

Source: http://oem.bmj.com/content/early/2014/03/28/oemed-2014-102172.full

Reference:
Incidence and relative risk of hearing disorders in professional musicians. Occup Environ Med doi:10.1136/oemed-2014-102172

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A Single Sneeze Can Spread Throughout Entire Building

MIT researchers using high-speed cameras and applying fluid dynamics have discovered that although ejected droplets from a sneeze typically fall to the ground, the "cloud" of moisture from a single sneeze actually floats and can enter ventilation ducts and can potentially spread throughout an entire building or airplane. Watch video below.

These findings have profound implications as to how infections may travel within buildings and other contained structures like cruise ships and airplanes.

So although most people cover their mouths when sneezing in public, it also needs to happen in private even when there's nobody around. Of course, more study is needed to see if the sneeze "cloud" is even minimized with mouth-covering.

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