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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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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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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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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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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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:

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New Video on Coblation Tonsillectomy

Fauquier ENT has produced a new video on coblation tonsillectomy for patient educational purposes. It has been added to our YouTube page as well as below. The video shows 3 different views of the procedure, each view being more magnified. It's a little over 4 minutes long in its entirety. Check it out!

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Pictures of Zenker's Diverticulum Posted

Pictures of a Zenker's Diverticulum after barium swallow has been posted here. Zenker's Diverticulum is an abnormal pouch (or diverticulum) that forms in the throat that leads to swallowing problems. It is treated endoscopically via a procedure known as endoscopic staple diverticulostomy (ESD).

Dr. Chang has published extensively on the use of ESD to treat Zenker's Diverticulum and is able to provide this service in Northern Virginia.

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