New Video of Stridor Caused by Laryngomalacia

A new video has been posted of a 1 month old child with mild stridor secondary to laryngomalacia, specifically of the epiglottis. Check out the video here.

New Video Example of Pediatric Vocal Cord Nodules

A new video has been uploaded of a 5 years old child with a raspy voice due to vocal cord nodules. Click here to view.

Multichannel Intraluminal Impedance (MII) Testing for Non-Acidic Reflux

Image by Wikipedia

As far as we know, Virginia Hospital Center's Heartburn Center in Arlington, VA and now Fauquier Hospital are the only places in Northern Virginia that offers 24 hour Multichannel Intraluminal Impedance (MII) testing to look for non-acidic reflux. Oftentimes, this test is combined with pH probe testing and manometry to measure the more traditional acid reflux as well as esophageal motility. MII testing is extremely important to evaluate those patients with persistent dry cough, mucus in throat, sensation of throat swelling, etc when all other reflux measurements/testing have come back normal.

Gastroenterology Associates
(in association with Fauquier Hospital)
402 Hospital Drive
Warrenton, VA 20186
Phone: (540) 347-2470
Website

Virginia Hospital Center
Phone: (703) 717-4373
Fax: (703) 717-4374
Director: Kevin Gillian, MD, FACS
Nurse Coordinator: Susan McNeill-Smith, RN
Website


Some over-the-counter medications used to treat relux are listed below:

Explore Flu Trends Across the US

Google has discovered that certain spikes in search terms related to flu symptoms actually is a great indicator of flu activity. Google Flu Trends uses aggregated Google search data to estimate flu activity in your state up to 2 weeks faster than traditional systems including the CDC (Centers for Disease Control). Check it out!

New Video Uploaded of ABductor Spasmodic Dysphonia

A new video stroboscopy of a patient with ABductor spasmodic dysphonia has been uploaded. Audio of his speech pattern has also been posted. Check it out here.

The direct video link is here.

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Books on voice therapy found to be a useful ADJUNCT to botox injections:

My Voice is Too High (or Too Low)!

A new webpage has been posted describing the unique situation where the voice is too high or too low for a given person's gender. For example, a man may have a voice that is so high-pitched that he may often be mistaken for a woman over the phone. Even some women may find their voice to be too high often sounding like a little girl.

In the reverse situation, some woman may find their vocal pitch to be so low that they may be mistaken for a man.

In yet another scenario, some trans-gender patients may find that their voice may not fit with their new gender.

This webpage goes into each of these scenarios and possible treatments.

New Video of Adenoidectomy Uploaded

A new video showing how adenoidectomy is performed has been uploaded to our YouTube channel. Click here to watch the video on YouTube or you can watch it below.

New Video Example of Vocal Cord Immobility

A new video example of vocal cord immobility has been posted to our website. This example depicts how one can determine if a vocal cord immobility is due to paralysis (nerve damage) or due to arytenoid dislocation. Arytenoid is the joint that moves a vocal cord back and forth.

This example used direct manipulation of the vocal cord to make this determination. Another method of evaluating (not shown) include laryngeal EMG.

BOTOX for Facial Wrinkles Now Offered

For those with facial wrinkles, Dr. Chang now offers BOTOX injections to help get rid of unwanted Crow's Feet and Forehead wrinkles. The cost will range from $20-$40 per injection. As such, injections for Crow's Feet generally require a total of 4-6 injections or $120 to as high as $180. Even more injections may be required for forehead wrinkles which usually require at least 10 injections.

New Webpage on Ear Tube Placement Has Been Posted

A new webpage describing ear tube placement for chronic ear infections or eustachian tube dysfunction has been added to our practice website. The webpage goes into why tubes are place and how they help as well as risks associated with this very common procedure. Click here to read more about it.

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Over-the-counter products that may be helpful to treat eustachian tube dysfunction:

Washington Post Medical Mystery: A Deadly Sore Throat

The Washington Post on September 23, 2008, published a story of a severe sore throat due to epiglottitis, a severe infection involving the epiglottis, a structure immediately above the airway, which can result in death if not treated quickly. However, due to an accurate diagnosis, treatment with antibiotics and steroids was quickly provided and the patient recovered uneventfully.

Read the story here.

Psychologist Added to the Voice Team at Fauquier ENT

Dr. Carmen Gonzalez is a psychologist familiar with how environmental stressors contribute to vocal quality problems. She is experienced in the use of hypnosis and biofeedback to enable patients with stress-induced vocal problems learn to manage and ultimately control their neck and voicebox muscles to allow for a clear voice regardless of the environmental situation. Her techniques are also helpful for those individuals that often experience a sore neck after prolonged talking.

Click here to see other members of the voice team.

Dr. Chang to Guest Lecture at Shenandoah University

Dr. Christopher Chang will be a guest lecturer at Shenandoah University for the Health Issues for Performers (PRF201) course on October 27, 2008. The lecture will be held during normally scheduled hours at 3PM in Ruebush R128. This particular lecture will focus on hearing loss and its prevention for conservatory students and professionals.

New Webpage on Neck Masses

A new webpage has been posted going over the various causes of neck masses that may appear for a given patient. Included on the webpage is a "map" (like shown here) of where neck masses typically appear for a given problem.

Click here to check it out!

Dr. Christopher Chang Has Been Named as One of America's Top Physicians

Congratulations to Dr. Christopher Chang who has been named as one of America's Top Physicians by the Consumers' Research Council of America for 2008.

New Webpage on Tonsillectomy and Adenoidectomy (T&A)

Due to popular demand, a new webpage has been created talking about one of the most common procedures performed in the United States today... tonsillectomy and/or adenoidectomy, also known as T&A.

Click here to read more about this procedure.

New Webpage on Coblation Palatoplasty for Snoring

A new webpage has been created describing coblation palatoplasty which is used to treat snoring and mild obstructive sleep apnea. Some of the advantages of this procedure are:

1) Outpatient
2) No sedation needed
3) Takes 15 minutes to perform
4) Performed in an office-setting instead of operating room
5) Well-tolerated

The ideal patient to undergo this procedure are those with large and thick soft palates. As such, not all patients are candidates to undergo this innovative procedure.

Read more about this procedure here.

New Webpage on Lump in the Throat Sensation (Part 2)

A new webpage has been posted describing what may be causing a lump or foreign body sensation in the throat (globus pharyngeus). As many of our readers may already be aware, we already have a webpage on this subject. However, we have gone into further detail depending on where exactly the lump sensation is located.

The new webpage is specifically geared towards abnormal throat sensation between the voicebox and chin. Symptoms in this location is most often due to problems in the base of tongue region, especially the lingual tonsils.

The old webpage was specifically pertinent for lump sensations between the sternum and the voicebox. Symptoms in this location is most often due to stress or reflux (LPR).

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Some over-the-counter medications used to treat relux are listed below:

New Webpage on Endoscopic Sinus Surgery

A new webpage has been added to our website on Endoscopic Sinus Surgery. There are many misconceptions on what this surgery entails. We hope to dispel the "horror" stories of people who have undergone sinus surgery in the past. Over the past 5-10 years, much has changed in the technology as well as the surgical procedure itself that has markedly improved the safety as well as recovery from this type of surgical procedure.

Read more about it here.

ABC's "Medical Mystery" Will Feature Spasmodic Dysphonia

A story on spasmodic dysphonia will be featured on ABC's "Medical Mysteries" on Tuesday, August 19 at 10 p.m. ET. The show will feature a few celebrities stricken with this rare disorder including National Public Radio host Diane Rehm and cartoonist Scott Adams of Dilbert fame.

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Books on voice therapy found to be a useful ADJUNCT to botox injections:

New Member Added to the Voice Team at Fauquier ENT

A new member has been added to the voice team at Fauquier ENT. Her name is Ceres Artico, PhD, LPC, LMFT. Her unique contribution to the voice team is in the area of "psychological voice therapy". As is well known, a person's emotional and mental state are strong contributors to how the voice sounds, not just in terms of performance anxiety and maintaining a clear singing voice, but also resolving functional talking voice problems such as muscle tension dysphonia stemming from environmental stressors.

New Webpage on the Difference Between Voice Therapy and Speech Therapy

A new webpage has been posted describing what exactly is the difference between speech therapy and voice therapy. Often, there is confusion between these two types of therapists and it is important for patients as well as other health professionals to know the difference between the two so that proper treatment can be implemented. As a general rule of thumb, most voice therapists are speech therapists, but not all speech therapists have expertise in providing voice therapy.

Read more about it here.

New Webpage on Nasal Obstruction and Congestion

A new webpage has been added to our practice's website summarizing the various causes of nasal obstruction and congestion in patients. The most common causes include turbinate hypertrophy, deviated septum, allergies, and adenoid hypertrophy.

Read more about this aggravating symptom here.

New Webpage on the Deviated Septum and Its Correction (Septoplasty)

There is a new webpage describing what a deviated septum is and how it is corrected complete with illustrations. For those who don't know what a deviated septum is, one must first know what a nasal septum is. A nasal septum is a intra-nasal wall that separates the right and left sides of the nasal cavity. A deviated septum is when this wall is buckled over to one side resulting in nasal obstruction. The surgical correction for a deviated septum is called a septoplasty. It is one of the most common procedures an ENT surgeon performs.

Please read more about this topic here.

New Slideshow of Endoscopic Staple Diverticulostomy for Zenker's Diverticulum

A new slideshow describing a patient's experience from check-in to post-procedure recovery after Endoscopic Staple Diverticulostomy (ESD) has been added to our practice's Zenker's Diverticulum website. A total of 12 slides is shown.

Also new is a webpage comparing the different surgical approaches (ESD vs Endoscopic CO2 Laser vs Open Transcervical) to treat Zenker's Diverticulum.

For those not familiar with this procedure, it is a minimally invasive endoscopic approach used to treat patients with Zenker's Diverticulum. A Zenker's Diverticulum is an abnormal pouch located in the throat that traps food resulting in food regurgitation, swallowing difficulties, and aspiration. The neat thing about the ESD procedure is that it takes less than 45 minutes to perform and patients are allowed to start eating that evening. Furthermore, there are no incisions created in the neck. Everything is done through the mouth.

The alternative operation requires an incision in the neck and patients are in the hospital up to 1 week, not allowed to eat or drink during that time period.

New Video Example of a Glottic Mass Causing a Weak Voice

A new video of a 17 years old female with a weak and dampened voice due to a large glottic mass has been posted. The glottic mass (granulation tissue) is located at the anterior or front part of the voicebox right between the vocal cords. This mass prevents the vocal cords from coming together precisely and also dampens the vocal cord vibrations from mass effect resulting in her weak voice. When she tries to phonate, she exhibits a supraglottic squeeze as her voicebox muscles tries (in vain) to obtain a normal voice by squeezing ever harder to get the vocal cords to come together. In this particular scenario, the muscle tension is compensating for an underlying problem and is an example of compensatory muscle tension dysphonia.

Click here to read more about this and watch the video.

New Video of Coblation Turbinate Reduction (Turbinate Coblation) From a Patient's Perspective

A new video has been uploaded to our practice's YouTube channel. Though we already have a coblation turbinate reduction video, this new one actually is done from a patient's perspective with even a post-procedure interview 6 days later. Hopefully, this video will provide reassurance for those patients who are candidates for this procedure and allow for some idea of what to expect during and after the procedure.

www.TurbinateReduction.com

Real-Time 3D Image Guided Sinus Surgery at Fauquier ENT

Fauquier ENT is now able to provide state-of-the-art sinus surgery utilizing BrainLAB, an innovative technology in the area of 3D image-guided sinus surgery. What exactly is image-guided sinus surgery? Think of it as GPS in 3 dimensions for the surgeon to safely navigate your sinus cavities and therefore minimize surgical sinus complications such as brain fluid leakage and eye damage.

Not all patients needing sinus surgery are candidates for image guidance. Ideal candidates for sinus surgery image-guidance are those patients with nasal polyps, had sinus surgery in the past, and those patients with sinus disease involving the sphenoid and/or frontal sinus cavities.

Please contact our office for an appointment if you feel this technology is for you!

Journal Article By Dr. Chang Published in ENT Journal

A new peer-reviewed article by Dr. Chang has been published in the June 2008 edition of ENT Journal. The article titled "Adult-Onset Iatrogenic Tracheomalacia" describes a very unusual case of tracheomalacia that was also stenotic in an adult patient after recovering from a tracheostomy. Click here to read more about it.

New Image of a Bi-Lobed Zenker's Diverticulum Posted

A new image of a patient who had a bi-lobed Zenker's Diverticulum has been posted to our website. This patient underwent endoscopic staple diverticulostomy successfully by Dr. Chang to eliminate symptoms of food regurgitation after swallowing.

New Webpage on the Mystery Ear Pain (ie, Ear Pain NOT Caused by Ear Infection)

A new webpage has been posted describing the various causes of ear pain NOT due to ear infections. Indeed, many patients and even physicians do not realize that there are MANY different problems in the head and neck that may lead to ear pain as a patient's only complaint. The reasons can be as simple as tonsillitis (ear pain referred by cranial nerve 9) to as dangerous as throat cancer (ear pain referred by cranial nerve 9 or 10).

Click here to read more about this topic.

Allergy Free Supermarket!

It has recently come to our attention that there is a new supermarket that is specifically directed to patients with food allergies. Every single product in the store is clearly identified and labelled with what food antigens are absent. Although the retail store is located in Miami, FL, they do have a website where one can easily find and order food products that are constrained to your food allergy needs.

http://www.AllergyFreeShop.com

LECTURE: Dr. Chang to give Grand Rounds at Prince William Hospital

Dr. Chang will be presenting a Grand Rounds lecture at Prince William Hospital on July 3, 2008. CME credit available. The title of the lecture is "ENT Pearls for the Non-ENT".

New Video Example of Smoker's Vocal Cord Polyps

A new video and audio of a female patient with smoker's vocal cord polyps has been posted to our website. Check it out here.

Flying and Ear Problems

In our office, we often see patients who have ear problems who are planning to fly. Here are a few facts to consider.

1) IF you can pop your ears easily, there shouldn't be a problem with flying.
2) IF you have a hole or a tube in your eardrum, there shouldn't be a problem with flying.
3) IF you have problems popping your ears and your flight is not for a few weeks to months, read this webpage and follow the suggestions mentioned. You can watch a video as well.
4) IF you are going to fly soon (within 1 week) and have trouble popping your ears, contact your local ENT to get a tube placed in your eardrum. Why? Your middle ear is like a balloon and with pressure changes, the eardrum stretches out and causes excruciating ear pain known as ear squeeze. A tube in your ear is just like putting a hole in a balloon. Just like pressure can't build up in a balloon with a hole, pressure can't build up in your ears with a tube.

An easy way you can predict if you are going to have problems with your ears when flying is to go swimming into the deep end of the pool (>5 feet). If you are able to pop your ears as you swim deeper into a swimming pool, you generally shouldn't have any problems flying.

If you live near the mountains (Shenandoah or Rocky Mountains), take a drive up the mountains and see if you can clear your ears with the gradual elevation changes. Alternatively, if you live near a very tall skyscraper (ie, Empire State Building or Chicago Sears Tower), ride it to the top and see if you have problems popping the ears.

Spraying Afrin into your nose 30 min before ascent and descent will help with ear popping and may be something you may want to bring with you when flying to prevent problems. Do NOT use afrin daily for more than 3 days otherwise one may become addicted to it... a rebound phenomenon known as rhinnitis medicamentosa.

Read a USA Today article on this problem here.

Listed below are some products that may be helpful to get your ears popping:

 

New Video Produced on Coblation Turbinate Reduction

Fauquier ENT has produced a new video showing how coblation turbinate reduction is performed. It has been uploaded on to our YouTube homepage. Click here to view the video or watch it below.

Coblation turbinate reduction is a painless way to improve nasal breathing quickly without need for medications. This procedure can be performed in an office setting and takes no more than 10 minutes to perform. There is minimum downtime and most people complain of minimal or no pain.

To read more about this procedure, please visit our webpage describing this procedure further.

www.TurbinateReduction.com

New Webpage on Turbinate Reduction for Nasal Obstruction/Congestion

There are many factors that cause nasal obstruction, nasal congestion, and vasomotor rhinnitis in patients. Some of these factors include allergies, deviated septum, and adenoid hypertrophy. However, what many people may not realize is that turbinate hypertrophy is also a significant cause of these symptoms. A new webpage has been uploaded to our website regarding a procedure to address turbinate hypertrophy to alleviate nasal symptoms. This procedure known as turbinate reduction can be performed under local anesthesia using coblation in an office-setting with minimal downtime. Click here to read more about it.

Dr. Chang on NBC news!

Well, at least his face from 2 angles. The video appeared on 5/20/08 on the 10PM NBC local evening news in Dallas, TX. Dr. Chang was present in the OR with Dr. Thrasher while the TV crews were filming. Watch the full footage below.

This video was later nationally syndicated and shown throughout the United States including Washington DC a few weeks later.

Base of Tongue Coblation for Severe Obstructive Sleep Apnea

Fauquier ENT is offering a relatively new procedure called base of tongue reduction (as well as lingual tonsillectomy) using coblation for patients suffering from severe obstructive sleep apnea (OSA) due to an enlarged base of tongue. For many patients, an enlarged base of tongue is a significant contributing factor leading to severe sleep apnea. This area contributes to obstruction by falling backwards against the back wall of the throat during sleep leading to airway closure.

Although a number of procedures have been offered to minimize this problem in the past such as:

• hyoid advancement
• genioglossal advancement
• repose procedure
• mandibular advancement

None of these procedures directly addresses the tongue bulk/size itself. Rather, these procedures indirectly attempts to address the base of tongue by moving and anchoring the entire tongue forward. As such, these procedures only marginally improves OSA and usually only lasts for a temporary period of time.

Other traditional OSA surgeries such as:

• tonsillectomy
• adenoidectomy
• UPPP (uvulo-palato-pharyngoplasty)
• septoplasty
• turbinate reduction

These address obstructions only at the nasal and oral cavity level of the airway. Base of tongue is BELOW these levels and located immediately above the voicebox (where air enters the windpipe to get to your lungs). As such, many patients who have undergone these surgeries often find themselves still suffering from OSA. Furthermore, enlarged base of tongue is the main cause of OSA in skinny people.

Click here to read more about base of tongue reduction/lingual tonsillectomy offered only at Fauquier ENT of Northern Virginia.

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Non-surgical methods to resolve obstructive sleep apnea due to large base of tongue:

Normal Post-Tonsillectomy Appearance

Often, patients become disturbed with the way their throat looks after a tonsillectomy. However, many of the concerns are unfounded and the appearance though disturbing, is actually normal. The white plaques where the tonsils used to be are actually scabs. Just like a scab on a cut elbow turns white after taking a shower or swimming, the scabs in the throat/mouth turn white from the saliva.

Also, the uvula is swollen (3-4X bigger than usual) which also is normal and will improve over the weeks. Hopefully, the NORMAL pictures shown here will reassure patients who are concerned with their throat appearance after tonsillectomy.

These particular pictures were taken 1-7 days after tonsillectomy.

Patient Testimonials

A new webpage has been added listing testimonies from patients as well as visitors to our website. Click here to take a look.

Instruction on Correct Amounts to Use for Allergy Shots

New information with pictures has been added to our instructional webpage on how to administer correct doses for allergy shots. Given many non-allergy physician offices find themselves giving allergy shots due to patient convenience, our office has created this information to ensure mistakes are not made due to unfamiliarity.

Click here to check it out!

Phone Reminder System Upgrade

We have recently upgraded our practice's phone appointment reminder system to Televox. We hope that people like this system better than our prior system. Appointment reminders will be called 2 business days prior to a scheduled appointment.

Also, we will begin calling patients who are giving themselves allergy shots at home when their allergy vial is soon going to expire. As allergy patients should know, using an expired allergy vial is dangerous and requires one to re-build back up to maintenance in a physician office with the new allergy vial. These calls will be made one month prior to an expiration.

Laryngospasm Pressure Point

I just learned of a new technique (well, actually it has been around for at least half a century) that may help patients who suffer from laryngospasm attacks.

It is actually a technique used by anesthesiologists to abort laryngospasm while a person is under general anesthesia. Basically, there is a "pressure point" known as the laryngospasm notch located right behind a person's earlobe, but in front of the mastoid bone. One needs to press very firmly deep and forward towards the nose on both sides when an attack occurs. If performed properly, it should hurt quite a bit and resolve the attack quite rapidly (within 10 seconds).

Here is a link to a journal article on the laryngospasm pressure point.

Read more about vocal cord dysfunction and laryngospasm here.

New Video Example of a Failed Pharyngeal Flap for VPI

A new video has been posted of an exam showing a patient with a pharyngeal flap that failed to correct his hypernasal speech. Historically, the patient had a cleft lip and palate that was repaired and because of a persistent velopharyngeal insufficiency producing hypernasal speech, a pharyngeal flap was performed. However, this flap was not successful as the hypernasal speech persisted.

The reason for the persistent hypernasal speech in spite of the pharyngeal flap was made apparent on flexible nasopharyngoscopy. The pharyngeal flap was slightly off center AND too small! Compare this with a perfect outcome pharyngeal flap shown here.

Click here to read more and watch the video!

What is a parent of a child with hypernasal speech to do? Well, the first thing is to obtain a video/audio recording of a flexible nasopharyngoscopy (also known as video nasal endoscopy or VNE) just like what was performed here. This exam documents IF there is velopharyngeal insufficiency, WHERE it is located, and HOW BIG the defect is. Than you need to find a plastic surgeon with tremendous experience who can than perform the right surgery that will precisely resolve the defect... and hopefully not create a flap that is too small as in this case. Too big is not good as that would lead to nasal obstruction.

In our practice, we work closely with the INOVA Fairfax Craniofacial Team which has on staff very experienced plastic surgeons headed by Dr. Craig Dufresne.

New Webpage on Dizziness

A new webpage describing dizziness and its various causes has been created. Though our office does not consider itself "dizzy experts," and is unable to provide the comprehensive evaluation and treatment of this problem other than those disorders due to the ear or allergies, we are often able to at least point patients in the right direction even if in the end we are unable to provide relief.

Minimally Invasive Surgery to Correct Hyper-Nasal Speech

Dr. Chang performs minimally invasive correction of nasal speech due to velopharyngeal insufficiency. This procedure entails the use of endoscopic techniques to precisely correct the defect without the use of incisions or soft palate reconstruction. Only patients with a small defect are candidates. In order to determine the size of the defect to see if a patient is a candidate, video nasal endoscopy is performed. Examples of exams are shown on this webpage as well.

Please contact our office if you would like to make an appt to see if your hypernasal speech is amenable to this minimally invasive procedure.

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If You Live Far Away
Our office has treated patients who live far away. If this is true for you as well, these are the steps to take:

1) Have a local ENT video record a nasopharyngoscopy exam as shown on our website. How the exam is performed is shown here. Make sure the exam records BOTH VIDEO AND AUDIO!!! During this exam, say the following words/phrases shown on this document, especially those in bold.
2) Mail the video/audio exam to Dr. Chang.
3) After Dr. Chang reviews the exam and feels you are a good candidate, check with your insurance company to see if you can come to our office for an appointment and have surgery. If Dr. Chang is out-of-network, have your local doctor help you obtain out-of-network insurance coverage.

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Guest Editorial in ENT Journal by Dr. Chang

Dr. Chang was recently invited to write a guest editorial for the ENT Journal regarding how to get the most out of a practice website without costs. It was published in the February 2008 volume. Read the editorial here.

Podcast Library on ENT Topics Created

Podcasts are becoming increasingly popular especially in this day of iPods and other mp3 players for people on the go. Although most podcasts are not medically related, there are a few well-produced medical podcasts... and even fewer dedicated to ENT topics. Those few medical podcasts on ENT topics are now listed on our website here. If there are others, please let us know and we will add to the list.

LECTURE: The Ears in Sickness and In Health

Drs. Phillips and Chang along with Catie Chalmers, MS, CCC/A will be giving a talk about how ears work in health and in sickness. The lecture will be given on May 22 at 7PM at the Fauquier Hospital Chestnut Room. The lecture is free, but please call 540-316-3588 to register (or email referral@fauquierhealth.org).

New Webpage on How to Give Allergy Shots Properly

A new webpage has been created describing how to administer allergy shots correctly. Often, patients are not able to get their weekly injections at the allergy office and as such, have their shots given at a more conveniently located medical office. However, many medical offices are not completely familiar with how to give allergy shots since it is administered differently than most vaccines. Incorrect administration increases the risk of anaphylaxis which everyone wants to avoid.

This webpage provides the necessary information to non-allergist health professionals as well as interested patients on how to correctly give allergy shots.

Our Office Switching to Electronic Medical Records!

Starting on February 21, 2008, our office officially started using electronic medical records or EMR made by NextGen corporation. NextGen EMR is used by over 40 physicians in Warrenton, VA which hopefully will allow for better communication between physicians, reduced medical errors, and decreased chance of ordering tests already performed in another medical office.

Please be patient with us as we make this very difficult transition.

New Webpage on How BOTOX Treatments Work

A new webpage has been added discussing how BOTOX treatments work. The article goes through how BOTOX achieves its effects, dosages used, side effects, and conditions treated by BOTOX injections. In particular, how one goes about adjusting the BOTOX dose is discussed in order to minimize side effects, yet achieve the desired effect.

Dr. Chang performs BOTOX injections every Friday afternoon. The list of conditions he treats can be found here.

New Video Example of "Non-Organic Stridor"

A new video example of a young patient with audible wheezing on fast breathing due to "non-organic stridor" has been posted. Patients with non-organic stridor are often erroneously diagnosed with vocal cord dysfunction (VCD) or exercise-induced asthma. Indeed, the only thing wrong with patients with non-organic stridor is the fact they produce a wheezy noise while breathing which can be simply controlled by breathing in through the nose or slowing down their breathing rate. No medications or really any other treatment is required.

The typical patient with non-organic stridor is a young female athlete whose symptoms occur during heavy exercise. Usually, the noisy breathing is described as wheezing or stridor and most prominent on inhalation though could occur on exhalation.

Washington Post Medical Mystery: Chronic Cough Due to Fungal Pneumonia

The Washington Post on February 5, 2008 published a story of a woman who had a chronic cough that never seemed to respond to typical treatments. Only after undergoing a bronchoscopy test was diagnosis reached... a fungal infection of her lungs.

A chronic cough behooves a THOROUGH investigation of all possible causes and which unfortunately requires a multitude of tests before an explanation may be found.

Read more about chronic cough and the workup here.

New Video Example of Vocal Cord Papillomas

A new video has been posted illustrating vocal cord papillomas. Needless to say, the vocal quality is quite raspy. Click here to watch the video.

New ADductor Spasmodic Dysphonia Audio Samples Posted

A patient with a very mild case of ADductor spasmodic dysphonia speaking a variety of phrases has been posted. The nice thing with this case is that only when saying certain "voice-weighted" phrases does the loss of vocal fluency become most apparent. The spasmodic dysphonia can be made less apparent when speaking "voiceless-weighted" phrases. Click here to hear the various audio clips.

As an FYI, the voice-weighted phrases which accentuate ADductor spasmodic dysphonia are as follows:
• Counting from 80 to 89
• "We mow our lawn all year."
• "We eat eels every day."
• "A dog dug a new bone."
• "Where were you one year ago?"
• "We rode along Rhode Island Avenue."
• "Eeee eee eee."

These voiceless-weighted phrases are MUCH easier to say for patients with ADductor spasmodic dysphonia:
• Counting from 60 to 69
• "Peter will keep at the peak."
• "We eat eels every day."
• "When he comes home, we'll feed him."
• "Tap the tip of the cap, please."
• "Keep Tom at the party."
• "See see see."

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Books on voice therapy found to be a useful ADJUNCT to botox injections:

Health Insurance Billing Explained

So there are many patients who do not quite understand how billing through their insurance companies work. Words like deductible, copay, coinsurance, and premium all seem to blur together resulting in confusion in terms of what they may anticipate paying for a given medical service. This blog is to help demystify and clear up the confusion so that hopefully, there will be no surprises when you get a bill from either your physician or the hospital.

SO, perhaps the best way to explain the differences is through an example. Keep in mind that every single health insurance plan have different charges (even within the SAME plan with the same name), so look at the contract you signed to see exactly what your obligations are.

EXAMPLE: Mr. John Smith has Anthem PPO which has the following criteria:
Premium: $10,000 per year
This means he must pay $10,000 per year just to have Anthem PPO health insurance.
Deductible: $500
This means he must pay $500 in a given year BEFORE his health insurance coverage even kicks in.
Copay: $30 PCP/$50 Specialist/$75 ER
This means that if he sees a primary care doctor, he will have to pay $30 every time. $50 and $75 for a specialist or ER visit respectively.
Coinsurance: 20%
He will be responsible to pay 20% of allowable charges of his healthcare bill set by his insurance company, Anthem PPO.

In case you lost or misplaced your contract, call the number on your insurance card to get all this information. For those individuals where their health insurance is covered by their employer (ie, you are not paying premiums), you STILL are paying premiums reflected in lower wages OR hidden costs that may not be readily apparent. However, the expense of health insurance in a company is spread out through all its workers and the company gets a "group rate" that is cheaper than if an individual gets health insurance on his/her own.

HINT: Before you make an appointment with a doctor, make sure that the physician participates with your health insurance plan. Otherwise, you may find yourself paying the entire bill out of your own pocket! Click here to read more about this situation.

A final point to consider is that the copays, deductibles, co-insurances, etc discussed above apply if a physician is IN-NETWORK. OUT-OF-NETWORK coverage means a given doctor participates with your insurance, but you will be paying much more than if you remained with a physician who is an IN-NETWORK participating provider. How do you find out whether a given physician is in-network or out-of-network? Call your health insurance plan and ask. Click here for more info regarding in-network vs out-of-network.

To see what health insurance plans Fauquier ENT participates with, click here.

New Video on Pediatric Nasal Saline Flushes

A new video has been created showing a young child performing saline flushes to his nose without assistance. Indeed, kids older than 5 years are able to tolerate flushes without difficulty. A nasal saline flush kit using the Neilmed Sinus Rinse bottle is shown here. This video can also be found on YouTube.



There are also devices that perform the same thing:

Allergy Medications Explained

A new webpage has been posted going over the different types of allergy medications in the market today. Given that there is plenty of information on the internet on the science behind how these medications work, the webpage does not go into the pharmacodynamics and pharmacokinetics, but rather uses terms hopefully a layperson can understand.

Furthermore, small useful tidbits of info are given including differences between allegra and allegra-D not only in terms of medical benefit but also cost as well as why it's OK to take several different types of allergy medications at the same time.

Click here to check it out!

Dr. Christopher Chang Recently Featured in Regional Serial Publication

Dr. Chang was recently featured in Healthy Happenings, a regional quarterly publication. The article mainly focused on one of Dr. Chang's patient whom he had diagnosed and successfully treated for laryngeal sensory neuropathy as a cause of her chronic cough for over 10 years.

To read the article, click here.

New Video Example of Tracheomalacia Causing Noisy Breathing

A new video has been posted of an examination revealing upper airway collapse (aka, tracheomalacia) causing a sound similar to the bark of a seal. Patient had this peculiar breathing sound only on exhalation (especially with coughing) even though he did not feel sick or have trouble breathing. Notably, the patient did not get correctly diagnosed for over 5 years during which he was unsuccessfully treated for asthma, allergy, and vocal cord dysfunction.

Click here for more information.