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Thursday, 1 October 2009

Treatment of Chronic Draining Ear Infections Using Antibiotic Powder

Posted on 09:30 by Unknown
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
Read More
Posted in acute, bulb, caps, chronic ear infections, drainage, dry, gel, otorrhea, powder, puff | No comments

Tuesday, 29 September 2009

USC Stafon Johnson Crushes His Voicebox & Undergoes Emergency Surgery

Posted on 11:19 by Unknown
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.
Read More
Posted in athlete, football, laryngitis, reconstruction, sport, trach, trauma, voicebox | No comments

Thursday, 24 September 2009

Bifid Uvula

Posted on 10:04 by Unknown

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.
Read More
Posted in bifid, cleft palate, uvula | No comments

Monday, 21 September 2009

"Smoking Kills" Doctor Warned in 1606!!!

Posted on 16:52 by Unknown

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.
Read More
Posted in 17th century, doctor, Physician, quit, smoking, stop | No comments

Thursday, 17 September 2009

How Does A Deviated Septum Cause A Nosebleed?

Posted on 04:57 by Unknown
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.

Read More
Posted in deviated septum, epistaxis, nasal obstruction, nosebleed, septo, septoplasty | No comments

Tuesday, 15 September 2009

Webpage on Epistaxis (Nosebleeds) Updated!

Posted on 11:01 by Unknown
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!

Read More
Posted in epistaxis, nasal, nosebleed, packing, silver nitrate, surgery | No comments

Monday, 14 September 2009

Oral Appliance Can Help With Obstructive Sleep Apnea

Posted on 15:17 by Unknown

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.
Read More
Posted in base of tongue coblation, base of tongue reduction, mad, mandibular advancement device, obstructive sleep apnea, oral appliance, osa, uppp, uvulopalatopharyngoplasty | No comments
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