Treatment of Chronic Draining Ear Infections Using Antibiotic Powder

Rarely, some unfortunate souls have chronic draining ear infections that do not respond well to oral antibiotics nor antibiotic ear drops. What many people and even physicians are unaware of is that there are alternative ways of addressing the chronic draining ear including use of antibiotics in powder form.

The method I like best is by using the Sheehy-House Powder Insufflator Bulb.

The pharmacy will make up gelcaps containing antibiotics (anti-bacterial as well as anti-fungal) and even steroids (usually hydrocortisone).

One first removes the tip of the insufflator bulb.



Than open up the gelcap such that the powder is all in one side and insert into the insufflator tip compartment.



Than replace the bulb tip.



During an active infection, the powder is "puffed" into the ear twice a day. Once back to normal, one puff weekly prevents the ear from becoming infected again. This method eliminates adding more "moisture" to the ear (as when happens when using antibiotic ear drops) as the powder not only addresses the infection, but the drainage itself becomes a medium for the antibiotic powder to do its thing.

Keep in mind that this method requires a prescription and the gelcaps must be compounded. As such, not all pharmacies may be able to fill and not all health insurances will cover compounded medications.

Some common recipes are shown below. Each ingredient is pulverized and placed into a Lilly #4 gel capsule. Capsules should be refrigerated, except the one stored in the insufflator. The insufflator with the capsule in it should not be refrigerated. The exact recipe used depends on the ear infection present.

Recipe #1:
Chloramphenicol 50mg
Sulfanilamide 50mg
Amphotericin 5mg

Recipe #2:
Chloramphenicol 50mg
Sulfanilamide 50mg
Amphotericin 5mg
Hydrocortisone 1mg

Recipe #3:
Chloramphenicol 50mg
Amphotericin 5mg

Recipe #4:
Chloramphenicol 50mg
Amphotericin 5mg
Hydrocortisone 1mg

Recipe #5:
Chloromycetin 50mg
Sulfanilimide 50mg
Fungizone 5mg
Hydrocortisone 1mg

Recipe #6:
Chloromycetin 50mg
Sulfanilimide 50mg
Fungizone 5mg

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USC Stafon Johnson Crushes His Voicebox & Undergoes Emergency Surgery

News organizations including ABC News reported on Sept 28, 2009 that USC tailback, Stafon Johnson, was bench-pressing a 275 pound bar when it slipped and landed on his neck crushing his voicebox resulting in emergency surgery at California Hospital Medical Center. Read the story here.

An endoscopic exam of his voicebox at time of injury may have looked something like this picture shown here, but more severe.


Most likely a trach was performed for a secure airway after reconstruction. After recovery, he is at risk for vocal cord paralysis, stenosis, etc.

Click here to read the full story.

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Bifid Uvula

I recently saw a patient with a most impressive bifid uvula. For those who don't know, the uvula is the midline dangling thing in the back of the mouth. Normally, there's only one, but in this patient, there are 2.

If the clefting extended not only through the uvula, but also the palate, than that would be called a cleft palate. In other words, a bifid uvula is a birth defect that almost became a cleft palate.

A bifid uvula has no impact on swallowing or talking and no further intervention is required.

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"Smoking Kills" Doctor Warned in 1606!!!

On Sept 19, 2009, the BBC published a story "Tobacco Warning from 17th Century" in which a physician, Dr. Eleazar Duncan, wrote a letter published in 1606 stating that tobacco "is so hurtful and dangerous to youth that it might have the pernicious nature expressed in the name, and that it were as well known by the name of Youths-bane as by the name of tobacco."

It goes to show you that physicians have been trying and still trying to get people to stop smoking for over 4 centuries given its ill effects.

Read the BBC story here.

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How Does A Deviated Septum Cause A Nosebleed?

Over the years, I have been asked by a number of patients with deviated septums why that would make them more prone to nosebleeds.

Well, this blog article is to answer that very question. First off, a little anatomy...

A nasal septum is a wall that separates the right nasal cavity from the left side. Normally, this septum should be perfectly straight.

However, in some people, the septum may be deviated causing not only nasal obstruction, but increases the risk of nosebleeds.



When the septum is straight, nasal breathing proceeds such that the air smoothly enters the nose without creation of any turbulence.



However, if the septum is deviated, turbulence is created when the air hits the "curve" of the septum. When this happens, the lining of the septum becomes dried out resulting in cracking and increased vascularity which increases the risk of a nosebleed.



The lining of the nose in this situation is much like when a person's lips become so dried out to the point that it cracks and bleeds.

Surgical correction of the deviated septum would result in a more long-lasting "cure" of nosebleeds as it would eliminate this curve decreasing turbulence.

For more conservative management of nosebleeds, click here.

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Webpage on Epistaxis (Nosebleeds) Updated!

Our practice website has updated our nosebleed (otherwise known as epistaxis) webpage to include more information on procedural treatment of nosebleeds including silver nitrate cauterization, electrocautery, nasal packing, and surgery. The webpage still includes information on conservative treatment as well as causes.

Click here to read more!

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Oral Appliance Can Help With Obstructive Sleep Apnea

In the September 2009 edition of Archives of Otolaryngology Head & Neck Surgery, there was a research paper entitled "An Investigation of Upper Airway Changes Associated with Mandibular Advancement Device Using Sleep Video Fluoroscopy in Patients with Obstructive Sleep Apnea" where use of an oral appliance was found to significantly improve obstructive sleep apnea. The oral appliance increased retropalatal and retrolingual spaces as well as decreased the length of the soft palate and the angle of mouth opening.

Increased retropalatal space and decreased length of the soft palate is similar to what is accomplished by the surgical procedure uvulopalatopharyngoplasty (UPPP).

Increased retrolingual space is similar to what is accomplished by the base of tongue reduction surgery.

Click here to read more about this research.

Click here to read more about OSA and its treatment.

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Washington Post Medical Mystery: Kawasaki Disease

The Washington Post on Sept 8, 2009 published a story called "A Frightful Week for a Little Girl" in its Medical Mystery section on Kawasaki Disease. This disease is rare and difficult to diagnose given its multitude of symptoms that can be due to something more benign including:

• red eyes
• fever
• rash
• neck mass
• red lips/mouth

However, it is the constellation of symptoms according to guidelines that Kawasaki in children should be considered when there has been an unexplained fever lasting five days, when accompanied by other symptoms including red eyes without discharge, red lips or mouth, a rash and a swollen lymph node in the neck. The red eyes and lips/mouth is the hallmark symptom of something more sinister.

To miss this diagnosis and be without proper treatment within 10 days of symptom onset may result in heart attack, coronary artery aneurysm, and even death.

Read the article here.

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Most People Prefer Right Ear for Listening

A well-known asymmetry in humans is the right ear dominance for listening to verbal stimuli, which is thought to reflect the brain's left hemisphere superiority for processing verbal information. This preference for hearing with the right ear is also found in rats, Japanese macaques, harpy eagles, sea lions and dogs.

However, the left ear (and right brain) excels at picking up emotional cues. When it comes to music, pitch, timbre and loudness are discriminated better with left ear (right hemisphere), but duration is better discriminated with the right ear (left hemisphere).

These findings may explain why people are not entirely satisfied when using hearing aids for only one ear. Ideally, BOTH ears should be aided. BUT, if one had to choose between two equally deaf ears, the right ear would be the preferred side.

Read the article here.

Read the research article abstract here.

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NYT: Plastic Surgery May Cure Migraine Headaches???

The New York Times on Sept 2, 2009 published a story "Plastic Surgery May Also Ease Migraine Headaches," in which a modification of the facelift may improve and in some patients, even cure migraine headaches. The research abstract describing this surgical treatment for migraine headaches upon which the NYT story is based on can be read here.

So far, the only patients who are candidates for this type of surgery are those who respond positively to Botox injections and where the trigger points are on the face (not the neck or head region... yet).

Though our office does not offer this type of surgery, we have been successfully performing Botox injections since 2005 to those patients who suffer from migraine headaches.

Click here to read the NYT article.

Read here to read more about Botox injections for migraine headaches.

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How to Get Insurance to Pay for Rhinoplasty Nosejob!

Well... at least part of the cost. I learned of this from a patient who came to see me in order to obtain an "independent ENT evaluation" regarding her deviated septum.

In essence, in order for insurance to pay part of the cost of one's rhinoplasty, a few things need to happen.

Step 1:
See a plastic surgeon who will perform your nosejob rhinoplasty. If the plastic surgeon notes a deviated septum or if you also have a significant nasal obstruction, see an ENT. If the plastic surgeon is also ENT board-certified, you still need to see a DIFFERENT ENT in order to obtain an "independent evaluation."

Step 2:
See the ENT who will hopefully agree that there is a significant deviated septum contributing to one's nasal obstruction. Septoplasty IS an insurance covered procedure in order to address the medical condition of nasal obstruction. In the medical note, I've typically phrased the report as follows:

"The patient does have a significant deviated septum to the right (or left as the case may be) resulting in nasal obstruction. In order to correct this problem, it is recommended that the patient undergo a septoplasty procedure. However, given that the patient is to undergo a rhinoplasty by a plastic surgeon and instead of putting the patient under anesthesia twice, it is reasonable to have the septoplasty performed at the same time."

Please understand that if you do not have a significant deviated septum, that is exactly what will be reported!

Step 3:
Give the plastic surgeon the ENT report. Here, a little effort will be needed on both the patient and plastic surgeon's part. More than likely, insurance will deny payment for the surgery. As such, the plastic surgeon will need to write a letter of medical necessity including supporting documentation from the independent ENT evaluation. The insurance may still refuse payment and that's when the plastic surgeon may need to perform a peer-to-peer review.

Generally speaking, the insurance in the end may cover some of the anesthesia and rarely the septoplasty component of the rhinoplasty. As such, a few thousand dollars may at least be saved.

Hope this information helps!

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NYT: Tonsil Stones (aka Tonsilloliths)

The NYT published a story on tonsil stones on Aug 31, 2009. Tonsil stones, otherwise known as tonsilloliths, are "stones" that are found and ejected from tonsils that consist of mucus, dead cells and other debris that collect in the deep pockets of the tonsils and gradually condense into small, light-colored globs. Bacteria feed on this accumulated matter, giving rise to the odor.

The only known cure for tonsilloliths is tonsillectomy, though more conservative measures are encouraged first prior to surgery. There is also a minimally invasive procedure our office performs called tonsil cryptolysis which is a procedure to try and eliminate this problem prior to considering tonsillectomy.

A recent research paper does offer tantalizing clues to address tonsilloliths more conservatively as it found that tonsil stones are more like living biofilms rather than an inert stone. Read the abstract here.

Read the story here.

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Nosebleed Due to a Leech (IN the Nose)!

New England Journal of Medicine published a picture AND video on August 27, 2009 showing a leech inside of the nose that caused one man's nosebleed (also known as epistaxis). Apparently, he had washed his face in freshwater stream 7 days prior to presentation.

Yikes! Poor fellow...

Read the NEJM article here. Watch the video of the surgeon removing the little bugger here...

Read about more common causes of nosebleeds and how to control them here.

Watch a video of how nosebleeds can be treated with cauterization.

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Dr. Chang Featured in Local Newspaper

Well, to be more accurate, Fauquier Hospital used Dr. Chang as advertisement for its "Be Yourself" campaign. Other physicians have been portrayed in a similar fashion. This ad appeared in the September 2009 Discover Fauquier's Values publication.

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Chewing Gum Improves Memory?!!

Image by Mayr from Wikipedia

I came across interesting research that hinted at the possibility that chewing gum improves tasks that require memory recall. This was first suggested in a study published in 2002 in the journal Appetite where chewing gum was found to selectively improve aspects of memory in healthy volunteers. The researchers took seventy-five adults and separated them into three groups: those that chewed gum during a twenty-minute test of memory and attention, those that mimicked the chewing movement, and those that did not chew at all.

They found that people who chewed scored better on long- and short-term memory tests (measured by word recall).

The authors speculated on three possible explanations: brain activity in the hippocampus increases while people chew, so this might help with memory; gum chewing promotes the release of insulin, which might indirectly affect memory; and the most straightforward—chewing can increase heart rate slightly, and this increased blood flow could deliver more oxygen to the brain.

Follow-up studies in 2004 supported these initial findings.

A more recent study in 2009 using 101 student volunteers found that it wasn’t the gum per se but any candy (cinnamon candy in the study) or oral stimulus can help a person remember information. Based on this study, it was felt that the oral action as well as the scent of the candy/gum served as a memory cue for information.

Maybe those gum-smacking kids in class did know something the rest of us did not.

Fortunately, fear not teachers... There are other studies that have been done that have not replicated these results at all and even contradicts them.

Chewing gum can also exacerbate/cause TMJ problems.

Image taken from Wikipedia.

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Another Reason to Stop Smoking... Decreased Sense of Taste

Greek researchers published a study in which they described a significant decrease in taste ability in smokers compared to non-smokers. In the study titled "Evaluation of young smokers and non-smokers with electrogustometry and contact endoscopy," 62 male Greek soldiers were evaluated for smoking and taste by using two different instruments called electrogustometry (measures taste thresholds) and contact endoscopy (wich evaluated the morphology and density of papillae on the tongue's tip).

This study could explain why smokers not only complain of decreased sense of taste, but also change in the way things taste (dysgeusia).

Click here to read the study abstract.

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Online Hearing Test (Audio)

Phonak, one of the major manufacturers of high end hearing aids, has developed a screening hearing test you can do online in the comfort of your home.

Take the test here.

If you do poorly on this exam, please see your local ENT in order to get a more reliable hearing test and see what options you have to improve your hearing (or keep what hearing you have left).

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Another Article on Dangers of Hearing Loss from Loud Concerts and iPods

The Daily News on Aug 21, 2009 published yet another article on the dangers of loud concerts and iPods resulting in permanent hearing loss. The article is titled "Beware: Loud concerts and iPods make music dangerous."

In our practice, there have been a few patients every year in their 20s and 30s who have experienced sudden hearing loss as bad as 80 year olds after attending a loud rock concert. The hearing disappears after the concert... and it never comes back. This phenomenon is called Sudden Sensori-Neural Hearing Loss or SSNHL for short.

Please wear ear plugs... and if you experience hearing loss or ringing/tinnitus after being exposed to loud noises that does NOT come back within a few days, see your local ENT as soon as possible. There are only a few medications that can help reverse the hearing loss, but only works if given within the first 2 weeks ideally and not more than 4 weeks.

Read the full article here.

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Music Can Help Understanding Speech in Noisy Environments?

Many older adults will say, 'I can hear what you're saying, but I don't understand you,' especially in a location where there is background noise (such as a restaurant) leading to frustration and social isolation. However, new research is offering tantalizing clues to prevent this from happening through music training.

Musical training makes musicians really good at picking out melodies, such as the treble line or the sound of their own instruments, from surrounding complex sounds. This improved perception in noise in musicians was linked with better working memory and tone discrimination ability. The results imply that musical training enhances the ability to hear speech in challenging listening environments by strengthening auditory memory and the representation of important acoustic features

Thirty-one study participants, with normal hearing and a mean age of 23, were divided into one group with music experience and another without it. They had to listen to sentences presented in increasingly noisy conditions and repeat back what they heard. The music group did significantly better.

The study does suggest that by reinforcing the pervasive effects that musical experience has on sound-processing abilities, better speech understanding can be obtained in noisy environments and underscores the importance of music education being more accessible to the general population

Read the story here.

Reference:
Alexandra Parbery-Clark, Erika Skoe, Carrie Lam and Nina Kraus. Musician Enhancement for Speech-in-Noise. Ear and Hearing, (in press)

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NYT: Wolfgang Amadeus Mozart Death Due to Strep Throat?

Image by Wikipedia

Well according to a NYT article published on Aug 17, 2009, yes he potentially did. In the article titled "What Really Killed Mozart? Maybe Strep," the journalist reports on a paper published in the Aug. 18 issue of The Annals of Internal Medicine where the researchers have done an epidemiological analysis that suggested he was a victim of an epidemic streptococcal infection.

Read the NYT article here. Read the actual paper abstract here.

This story illustrates how far we have come in controlling what is now considered a benign infectious problem which can be easily treated with antibiotics or tonsillectomy.

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Stress Can INCREASE a Person's Allergies!

Researchers at Ohio State University recently published an article in the June 2009 journal Psychoneuroendocrinology titled "How stress and anxiety can alter immediate and late phase skin test responses in allergic rhinitis."

What they found was that allergic responses to a skin prick increased after a stressful event compared to a non-stressful event. Anxiety also substantially enhanced the effects of stress far into the future as even skin tests performed the day after the stressor reflected the continuing impact of the stressor among the more anxious participants.

Read the NYT article on this here.

Yet another thing to think about in allergic patients...

Read more about the study here.

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Does Honey Relieve Allergy Symptoms? NO!

Came across an interesting blog article by allergist Dr. Ves Dimov regarding whether honey actually helps allergic individuals.

The blunt conclusion was that honey does NOT help people with their allergies. As quoted from a Fort Worth newspaper article, "The bees don't know what you're allergic to," he said. Most people are allergic to windborne pollens that come from grass and trees, but bees mostly gather flower pollens, he said. Another problem: You'd have to eat dozens of pounds of honey for it to be beneficial, the allergist said. There isn't enough pollen in the natural sweetener to make a big impact."

In fact, there was a research study done in 2002 where 36 participants who complained of allergic rhinoconjunctivitis were randomly assigned to one of three groups receiving:

1. locally collected, unpasteurized, unfiltered honey
2. nationally collected, filtered, pasteurized honey
3. corn syrup with synthetic honey flavoring

All participants consumed 1 tablespoon/day and were instructed to maintain a diary tracking 10 subjective allergy symptoms.

Neither honey group experienced relief from their symptoms in excess of that seen in the placebo group.

This study did not confirm the widely held belief that honey relieves the symptoms of allergy.

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Our Website Referenced In An O'Reilly Textbook!

O'Reilly has published a new textbook for health-conscious consumers called "Your Body: The Missing Manual." The neat thing is that on page 146, there are 2 photos of the larynx taken (with permission) from our website. Check it out!

You can buy this book on Amazon.com:

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YouTube Video on Robotic Thyroidectomy Which Eliminates Neck Incisions

Surgeons in Texas have uploaded a YouTube video showing a thyroidectomy being performed by a robot under surgeon guidance without making any incision on the neck. The robot is utilizes the DaVinci system.

Check it out here!



Non-robotic thyroid surgery can be seen in this video here which does use a neck incision.

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Why Can Some People Eat Red Hot Chili Peppers and Others Can't?

The New York Times on Aug 10, 2009 answered this question nicely in their Science/Health Section. Read the answer here.

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NYT: Story on Phantosmia (Phantom Smells)

In the Aug 10, 2009 issue of the New York Times, a story entitled "A Pungent Life: The Smells in My Head," describes the life of an individual who suffers from phantosmia, a frustrating disorder where a person smells disagreeable odors that is not actually present. Such odors range from raw sewage/garbage to burning.

Though actual physical pathology may cause this symptom including brain tumors, sinus infection, nasal polyps, etc. Too often, everything comes back normal.

Though an otolaryngologist is usually the first person to see regarding this problem, unless there is something physically wrong, we don't have much more to offer.

There are "smell specialists" throughout the United States who are able to offer more in terms of medical management. Thankfully, at least here in Northern Virginia, there is a smell specialist in Washington DC.

Taste and Smell Clinic
Phone: 1-202-364-4180

Read the NYT article here.

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NYT: Redheads Have Lower Pain Thresholds

The New York Times on Aug 6, 2009 published a story "The Pain of Being a Redhead" that describes research why redheads experience more pain than other individuals.

Apparently, red hair color is caused by variants of the melanocortin-1 receptor (MC1R) gene. People with naturally red hair are resistant to subcutaneous local anesthetics and, therefore, may experience increased anxiety and pain regarding dental care as well as other surgical procedures. Having this gene variant significantly affected a patient's level of anxiety and pain experience when compared to others, even when controlled for general trait anxiety and sex.

It may behoove surgeons to be aware and appropriately adjust medications to take the findings of this research into consideration when dealing with their redhead patients.

Though research has not born out that redheads "bleed" more, it does bring up the thought that if a redhead has more pain and increased anxiety from a surgical procedure, it may raise their blood pressure which IS associated with greater bleeding risk.

Read more about this story here. Read the research backing this story up here.

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A New Way to Diagnose Exercise-Induced Vocal Cord Dysfunction!

Researchers in Helsinki, Finland validated a new method to diagnose exercise-induced vocal cord dysfunction (VCD). And what a simple idea they came up with! In a study titled "Fiberoptic videolaryngoscopy during bicycle ergometry: A diagnostic tool for exercise-induced vocal cord dysfunction," the authors performed fiberoptic video laryngoscopy WHILE a patient was exercising on a bicycle. Given that so often the symptoms of vocal cord dysfunction occur ONLY when a patient has been exercising, this is a logical step to perform when trying to determine whether a patient has VCD or not.

Vocal cord dysfunction is a frightening medical situation when a patient suddenly and unexpectedly experiences the inability to breath due to their vocal cords suddenly coming together resulting in a high-pitched squeal known as stridor. An episode may last to the point that the patient faints from lack of oxygen. Read more about this condition here.

At least in my practice, I usually make the patient run around my office until symptoms start appearing and than have them quickly come into my office for the fiberoptic video laryngoscopy. Observing the vocal cords coming together when trying to breath is how diagnosis of VCD is made.

Watch a video of fiberoptic video laryngoscopy being performed here.

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Does Weather Temperatures Influence Patient Sickness Levels?

According to a new Harvard Medical School Study it does. In a research paper called "Does annual temperature influence the prevalence of otolaryngologic respiratory diseases?" published in the July 2009 Laryngoscope, the author analyzed the prevalence of upper respiratory diseases between the years 1998 to 2006.

What was found by regression analysis through the study years was that there was no significant relationship between average annual temperature and the prevalence of disease for hay fever, jaw pain, or chronic bronchitis. HOWEVER, a statistically significant but small regression coefficient (0.004) was noted for an increasing prevalence of sinusitis with increasing annual temperature (P = .031).

Given global warming is occurring, this does have impact on overall population health and quality of life as temperatures slowly rise. Yet another reason to fight global warming. It is making us more sick!

Image above taken from here.

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High Tech Tonsillectomy: Quantum Molecular Resonance Tonsillectomy

I did not make that up which sounds like something out of Star Trek... there is actually a device called the Molecular Quantum Generator made by Vesalius that incorporates quantum molecular resonance coagulation that uses molecular resonance to cut and coagulate precisely, cleanly, and without any bleeding, all at low tissue temperature levels (not more than 45-50 degrees C). This technology does offer a new possibility for tonsillectomy patients allowing for faster recovery without increase in complications.

In fact, there is a study out that most favorably compares to the current coblation technology that is most commonly used to perform tonsillectomy in the United States (including that used in our practice).

You can watch a video of tonsillectomy being performed using quantum molecular resonance technology here. Here's a video of a tonsillectomy using coblation technology.

Unfortunately, this technology is not offered in the United States... yet...

A video of a coblation tonsillectomy is shown below:

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Our Office Now Carries Ear Band-Its Swimming Headband!

Due to numerous patient requests, our office now carries in stock the swimming headband called Ear Band-Its that helps keep ear plugs in and water out when kids go swimming. Too often during swimming, the ear plugs get knocked out or in spite of a parents' best efforts, water seems to get by the plugs. Though swimming caps over the ears would work/help, most kids refuse to wear them.

However, kids don't seem to mind wearing headbands as it apparently is "cool." Made of 3mm Neoprene with an adjustable Velcro-type closure, our office carries sizes S (1-3 years), M (4-10 years), and L (10+ years). At this time, we carry only the colors red and blue.

Click here to read more about it.

You can also order them from Amazon.com:

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New Webpage on Tongue Tie (Ankyloglossia) and Its Treatment

A new webpage has been added to our website discussing a condition called tongue tie (otherwise known medically as ankyloglossia) along with its treatment.

Photos on the steps on how this is surgically treated is also included!

Click here to check it out!

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RANDOM: Treatment for Kids Who Keep Putting Objects in the Ear???

So I saw this patient who had an unusual earring as depicted to the left... And I thought... AHA!!! This may be a neat way to prevent kids from putting peas, erasers, pebbles, etc in the ear, especially if they have a history of repeatedly doing so! Not sure how many parents would actually take this step.

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New Video Uploaded of Adult Laryngomalacia

A new video has been uploaded to our website showing what laryngomalacia looks like in an adult. This patient also happens to have a right vocal cord paralysis. Because of the vocal cord paralysis, there is some hooding of her arytenoid mucosa resulting in partial airway blockage, especially with strong inhalation breath (and produces a slight wheezing sound as well).

Click here to check it out!

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Echo-Location In Humans Can Be Learned/Taught!

In the March/April 2009 edition of Acta Acustica Journal, a research paper by Spanish scientists entitled "Physical Analysis of Several Organic Signals for Human Echolocation: Oral Vacuum Pulses" was published. This research has shown scientifically that human beings can develop echolocation, the system of acoustic signals used by dolphins and bats to explore their surroundings. Producing certain kinds of tongue clicks helps people to identify objects around them without needing to see them, something which would be especially useful for the blind.

In order to learn echo-location, the scientists are developing protocols to allow any person learn this unique ability.

Read more about this here.

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Distortion of Risk Assessment for Surgical Complications

Over time and experience as well as being exposed to some pop psychology by the likes of Malcolm Gladwell, Nassim Taleb, Ori & Rom Brafman, Robert Krulwich, Jad Abumrad, among others, I have realized that patients assess surgical risk in very different ways with most using irrational considerations.

Too often, physicians use statistics, numbers, and facts to counsel patients on risk whether it be surgical or some other medical intervention (medications, CT scan, etc). And we should. However, how patients process this information is more often based on emotive factors and anecdotal stories heard from friends, family, as well as internet.

Such "stories" whether from friends or the internet is perhaps one of my biggest allies as well as bane of my existence. Why? Because patients make decisions based on the experiences of a few individuals. Facts? Statistics? They play only a minor role. To make things worse, such stories are expressed in more negative terms than positive.

Why is that?

I think it's because people who experience a bad outcome are FAR more vocal from a perceived sense of injustice than those who experience the good (and expected) outcome.

As the saying goes, a person with a good outcome tells 1 or their friends whereas a person who has a bad experience tells 5 friends.

It is against just this kind of backdrop that patients "listen" to the statistics, but are influenced by the stories they hear.

To make things worse, risk evaluation is distorted by the lack of control patients feel. It is why there are so many people who are afraid of flying and yet have no trouble driving a car where the risk of death is MUCH higher. Or why most people are horrified by the idea of a gun in the house but won't blink twice about a swimming pool which kills far more kids than guns.

How is a physician to combat such forces in order to allow for a more reasoned decision made by the patient for a given medical intervention?

I have no solution to this problem other than to keep aware of what patients are hearing and being mindful of such emotive factors when providing counselling. In practical terms what does this mean? It means I read... a lot... and not just from medical journals either, but newspapers, magazines, blogs, and other sources that patients probably encounter before seeing a physician. Thank goodness for online news collators (Medical News Today, Topix.net, etc) as well as Twitter.

I also produce my own online literature to balance out (hopefully) the other materials that are out there, but more so in story format in layperson terms rather than factual & medical regurgitation and use of ambiguous language (where emphasis is "see your doctor" for more specific information) that plaque more reputable medical websites.

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Washington Post: Perfect Pitch CAN Be Taught?!!

There is a fascinating article in the July 27, 2009 edition of the Wasington Post on page A8 entitled "An Elusive Musical Gift Could Be at Children's Fingertips." This article elucidates a technique to teach any child to have perfect pitch, the ability to identify a note simply by hearing it. The technique is called "Eguchi Method" and developed by Kazuko Eguchi who developed it 40 years ago in Japan.

In essence, the technique, in order to be successful, must start before the age of 4 years old and uses colored flags (or any other object) to musical chords. Over time, more colored flags linked to different chords are added. Frequency of practice is more important than duration.

To read more about this, click here.

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Physician On-Call Communication System for Free! Thanks Google!

Since 2008, many patients in our practice are quite surprised when they actually reach a physician directly when they call our after-hours number.

What the patients don't realize is that our practice is also quite happy with this set-up!

Why? Well, that after-hours number is actually a Google Voice number and it provides amazing functionality that is FREE that would have costed us thousands of dollars otherwise.

Using Google Voice, the after-hours number can be forwarded to any physician who may be on-call easily and immediately. When the physician answers a call, an automated Google message is heard alerting the physician that the incoming call is from a patient. Should the call get missed, the patient can leave an answering machine message. Google Voice TRANSCRIBES the voice mail message and emails it to the physician's cell phone. This last bit is great as often calls come in while we may be in surgery or on another call.

SO, Google Voice provides options for the physician:

1) Answer an incoming call immediately and be alerted that it is a patient calling

OR

2) Read the transcribed voice mail (imitates an answering service and pager all-in-one) before returning a call

How cool is that... and all for free!

Check out the Google Voice service here.

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Needle Biopsy of Thyroid Masses Misidentifies 50% of Thyroid Cancers!

Surgeons at the University of Wisconsin found that fine needle aspiration biopsy (FNAB) in 26 of 52 FNAB reported as benign (50.0%) turned out to be either neoplastic (22) or malignant (4) on final pathologic analysis after thyroidectomy. Among patients with nondiagnostic FNAB results, the risk of malignant neoplasms was 27.3%.

Even for smaller thyroid masses, FNAB is still not 100% accurate with a falsely negative rate of around 10%. Why is that?

Well, one must keep in mind that the FNAB samples (or removes) only a tiny tiny tiny part of the thyroid mass (think of a needle going into an apple and trying to hit the worm in the middle). Should the needle sample a part of the thyroid cancer mass where no cancer is present, it will come back normal, even if it is truly cancer.

What does this mean for a patient with a thyroid mass?

1) The ONLY way to know 100% whether a patient has thyroid cancer or not is to remove the thyroid.
2) IF the FNAB shows thyroid cancer, total thyroidectomy is recommended.
3) IF the FNAB does not show thyroid cancer, thyroid cancer can STILL be there; it's just that the FNAB was just plain wrong. Thyroid lobectomy should still be considered.

Of course, one needs to talk with your local surgeon on what the next step is.

Just keep in mind that the FNAB is not 100% accurate!

Reference:
Accuracy of Fine-Needle Aspiration Biopsy for Predicting Neoplasm or Carcinoma in Thyroid Nodules 4 cm or Larger. Arch Surg. 2009;144(7):649-655. doi:10.1001/archsurg.2009.116.

False negatives in thyroid cytology: impact of large nodule size and follicular variant of papillary carcinoma. Laryngoscope. 2013 May;123(5):1305-9. doi: 10.1002/lary.23861. Epub 2013 Jan 4.

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Would You Find or Share Your Health Info Online?

In the August 2009 issue of US News & World Report (America's Best Hospitals 2009 Issue), there was an interesting article regarding use of the internet in order to obtain as well as share health information. This article was based on research entitled "The Social Life of Health Information" conducted by the Pew Internet Project and the California Healthcare Foundation.

Some interesting statistics mentioned:

• 61% of American adults look online for health information.
• 86% of all adults ask a health professional, such as a doctor for health information.
• 68% of all adults ask a friend or family member.
• 57% of all adults use the internet.
• 54% use books or other printed reference material.
• 33% contact their insurance provider.
• 39% of e-patients use a social networking site like MySpace and Facebook and, of those, only a small portion have followed their friends’ personal health experiences or updates, posted their own health-related comments, gotten any health information, or joined a health-related group.
• 12% of e-patients use Twitter or another service to share updates about themselves or to see updates about others, and of those, few have posted comments, queries, or information about health or medical matters.

The trends shown here is probably going to grow even more significant in the future. It would behoove physicians to start taking more seriously these trends regarding where patients are finding their information and to take advantage.

Read the US News & World Report Article here.

Read the Pew Report here.

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LA Times: Blood Tests for Food Allergies are Often Inaccurate & Misleading

On July 20, 2009, the LA Times came out with two articles discussing food allergy testing... and how often they provide misleading information leading to patient actions that are quite simply wrong.

Specifically regarding RAST food testing... Most people will come back showing some IgE food reactivity even if they are not allergic to that food. As such, patients based on these tests, limit their diets unnecessarily.

Even if a patient is truly allergic, the severity can not be predicted by the RAST scores.

At this time, the BEST way to test for food allergies is by patient history and food challenge tests where a person is fed carefully regulated amounts of food, under close supervision, and the amounts are gradually increased.

Read the articles here:
LA Times Story 1
LA Times Story 2

Contact your local allergist for more information.

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New Webpage on Vocal Cord Surgery

A new webpage has been posted on vocal cord surgery to remove vocal cord masses including polyps, cysts, papillomas, varix, nodules, etc.

The webpage goes over 3 main approaches to removing vocal cord masses and it behooves any patients considering this surgery to educate themselves in what exactly is involved.

Videos of the different surgical approaches are also included.

Read more here.

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Rachel Ray Underwent Vocal Cord Surgery

People Magazine on July 10, 2009 reported that celebrity chef, Rachel Ray, underwent vocal cord surgery. As reported in the story, even for celebrities, mandatory voice rest is required after vocal cord surgery!!!

Read the article in People magazine here.

Read more about hoarseness and its treatment here.

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Washington Post Medical Mystery: Pulsatile Tinnitus (Noises in the Ear)

The Washington Post on July 7, 2009 published a story on a lawyer who suffered from pulsatile tinnitus (hearing one's heartbeat in the ear) which was ultimately found to be due to a carotid artery dissection. A carotid artery dissection could have resulted in a serious ischemic stroke which thankfully did not happen.

The story goes thru his experiences in trying to find a diagnosis and treatment.

Keep in mind that pulsatile tinnitus is completely different from continuous tinnitus.

Read more about tinnitus here.

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New NeilMed Sinus Rinse Video

The NeilMed company has produced a sinus rinse video on YouTube. All I can say is it is about time! Our office had to produce a video on this product given the absence previously.



There are also devices that make it easier to rinse your nose and sinuses:

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NYT Article on Reflux (and NOT the Acid Kind)

A patient brought to my attention the other day that there was an article in the NYT on June 29, 2009 regarding non-acid reflux. Overall, the article is good, but readers should keep in mind that heartburn and other symptoms below the shoulders may NOT be present! Furthermore, the usual reflux medications may not work.

Read the NYT article here.

Read more about reflux here.

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RANDOM: Michelangelo's David Statue Has a Goiter???

So, I was looking at a picture of The David statue by Michelangelo standing in front of the Palazzo Vecchio when I noticed something on the neck... a bulge just off the midline and below the thyroid cartilage. Could it be a thyroid goiter or mass?

If David was alive today, I most definitely would obtain a thyroid ultrasound and perhaps a fine needle aspirate if a nodule was found. Thyroid cancer would be the concern I would counsel David about.

Read more about the surgery here or watch the video!

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Best Cell Phones for People Who Wear Hearing Aids

As wireless carriers move from analog to digital services, accessibility for the deaf and hard of hearing is a concern. Digital technology means more features and improved efficiency—but some digital phones can cause interference for hearing aid users.

Both ATT and Verizon have webpages that list cell phones that are compatible with hearing aids as well as give ratings on the level of compatibility. Such compatibility ratings are M- and T-Ratings. The higher the M- or T-Ratings, the better the cell phone will work the hearing aids.

ATT Webpage
Verizon Webpage

Phones with an M-Rating of M3 or M4 meet FCC requirements and are less likely to generate interference to hearing devices than phones that are not labeled.

A telecoil is a small device that is built into some hearing aids for use with the telephone as well as assistive listening devices. Not all hearing aids have telecoils. Phones with a T-Rating of T3 or T4 meet FCC requirements and are more likely to work well for people who use hearing aids with telecoils with telephones.

More information on M- and T-Ratings...

As always, we recommend to TRY before you buy...

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iPods & Other Music Devices Can Cause Permanent Hearing Loss!

The Washington Post wrote up a nice article regarding the increased risk of permanent hearing loss kids these days may suffer due to listening to music devices too loudly. Such noise-induced hearing loss also increases the risk of tinnitus (ringing of the ears). The key things to easily remember to ensure proper music volume is:

1) If people around you can hear the music you are listening to, it's too loud.
2) If you can't hear what people are saying while listening to music, it's too loud.

Every year, we see kids in the upper teens and young 20s with hearing equivalent to someone who is in their 80s. Sad but true, and as kids continue to listen to music too loudly, we expect this trend to increase.

Click here to read the Washington Post article.

If you are concerned that you may be suffering from hearing loss, contact us for an appointment!

Remember, if you suddenly lose your hearing, there is a window of opportunity of 10-30 days where medications may help reverse this hearing loss after which nothing more can be done. Contact your local ENT as soon as possible if this happens to you!

Watch a video of Dr. Sanjay Gupta talking about these dangers on CNN.

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