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August 04, 2015

Fauquier ENT Smartphone App

Given the popularity of our blog, videos, and website articles, we have created a smartphone app for easy access to all our informational online materials. Also included in the app is a Fauquier Health System physician directory as well as online appointment request form.

The app is available for free on both Android and iPhones on Google Play and App Store respectively. The landing page address for links to both can be found here.

Check it out! Otherwise, you can go straight to the store below:

Related Posts Widget For Blogger with Thumbnails

August 03, 2015

How Many Basic Tastes Do We Have? Four? Five? Six? More?

As children, we all learn that there are 4 basic tastes: salty, sweet, sour, and bitter. Umami (savory) was discovered in 1909, but recognized more generally since the 1980s.

But there have been a number of other additional basic tastes also proposed that many may not have heard of:

Should one include taste senses due to the somatosensory system, one can potentially include these basic tastes:

  • Pungency, spiciness, hotness
  • Coolness
  • Numbness
  • Astringency
  • Temperature

However, "officially," only 5 basic tastes are currently recognized: salty, sweet, sour, bitter, and umami. With time, others may become "officially" recognized, but be aware that these additional taste senses do exist.

Did you also know that the tongue taste map is a lie? Read more here.

Chart of Pepper Spiciness

Check out this chart taken from Wikipedia showing in rank order how spicy peppers are. The #1 most spicy pepper is the Carolina Reaper which has been rated as the world's hottest chili pepper by Guinness World Records since August 7, 2013.

Compare that with the more commonly known habanero chili which is further down the chart.

August 02, 2015

Transgender Voice Change

For individuals undergoing transgender sex reassignment transformation, perhaps the most difficult outward change to accomplish is the voice which ideally should sound like the gender that has been selected. If you look like a woman, you should sound like a woman (and vice versa).

Watch a video of Caitlyn Jenner (formerly Bruce Jenner) at the end of this article.

So what can be done to try and make the voice sound more consistent with the gender?

Overall, it is easier to make a woman sound like a man and a sex voice change is easier to accomplish  the younger the age.

Step 1: Voice therapy. Essentially, it is to try and learn how to "fake it" without straining the muscles and damaging the vocal cords.

Step 2: Hormone therapy which works reasonably well to make a woman sound more like a man analogous to what a boy goes through during puberty. In fact, in the early days of hormone replacement therapy, a not unusual side effect was masculinization of the voice.

Step 3: Surgical intervention. The human vocal pitch is determined by 4 factors: vocal cord thickness, vocal cord tension, vocal cord length, and airway diameter.

The first three factors (vocal cord thickness, tension, and length) can be understood by comparison to a violin string. The thinner the string, the higher the pitch. The tighter the string, the higher the pitch. The shorter the string (by tightening it), the higher the pitch. The final factor, airway diameter, can be understood by analogy to an organ pipe in which the smaller diameter pipe produces a higher pitch.

You can see all these factors at play in this video:

Female to Male Voice Surgery
  • Decreasing the length of the vocal cords Laryngoplasty (Isshiki Thyroplasty Type 3) whereby thin strips of the paramedian thyroid cartilage are removed in order to decrease the front-to-back length of the voicebox (thereby shortening the vocal cords making them thicker). [link]
  • Laryngoplasty (Modification of the Isshiki Thyroplasty Type 3) whereby a central cartilage window of the thyroid cartilage is mobilized and recessed posteriorly with an implant in order to decrease the length of the vocal cords (thereby shortening the vocal cords making them thicker). [link]
  • Botox injection to the cricothyroid muscles (results in the inability of the vocal cords to lengthen). The cricothyroid muscle is responsible for achieving falsetto. Downside if the results are good is that the botox does wear off and reinjection needs to occur every ~3-4 months. If this works reliably, there is a surgical equivalent by cutting the nerve that goes to this muscle thereby permanently paralyzing it.
  • Make the vocal cords thicker. This can be accomplished by injecting collagen into the vocal cords (thereby making it thicker)
Male to Female Voice Surgery - Keep in mind that this is harder to accomplish reliably compared with Female to Male surgical procedures.
  • Stretching the vocal cords to make them thinner via cricothyroid approximation
  • Decreasing the length of the vocal cords by creating an anterior glottic web
  • Laryngofissure approach accomplished by excising half the vocal cord lengths and reattaching thereby making the vocal cords both shorter and tighter.
Note that there is no surgical procedure that can change the airway diameter. As such, a sex voice change may not entirely sound completely natural even if vocal cord surgery has been performed to perfection.

** Please note that our office no longer performs transgender vocal cord surgical procedures.

August 01, 2015

Does Magnetic Stimulation Help Tinnitus? (Transcranial Magnetic Stimulation)

Image from NeuroStar
Given media exposure, there has been greater public interest in the use of powerful magnetic impulses applied to the head in order to treat tinnitus. It is hypothesized that this treatment called repetitive Transcranial Magnetic Stimulation (rTMS) works by temporarily disrupting abnormally hyper-excitable brain circuits within the auditory cortex and resetting it to a more "normal" baseline. At this time, rTMS is FDA approved to treat depression only, but anecdotal reports suggest that it can not only help tinnitus, but also improve memory, increase the IQ, improve multi-tasking, insomnia, etc.

On review of the literature, there is cautious optimistic hope that this treatment may actually work, but due to limited study population sizes, more study is needed before an outright recommendation can be given. However, there seems to be little harm in trying it out other than the cost which can be high and range from $6,000 to as much as $10,000+ depending on the clinic and protocol used (not covered by insurance given research status and lack of FDA approval for this purpose). Reported (rare) side effects include seizures, headache, pain, vibration sensation, twitching, etc.

Generally speaking, rTMS treatment of tinnitus entails application of 1-Hz to 10-Hz rTMS daily for several weeks (most protocols employed 1-Hz). The rTMS is applied to the temporoparietal region which overlies the auditory cortex of the brain for about 30 minutes per session.

At this time, psychiatrists are the main physicians who have and employ rTMS (to treat depression).

Perhaps the largest network of rTMS treatment centers in the United States is NeuroStar. They do provide an online physician zip-code locator.

Repetitive Transcranial Magnetic Stimulation Treatment for Chronic Tinnitus. JAMA Otolaryngol Head Neck Surg. Published online July 16, 2015. doi:10.1001/jamaoto.2015.1219

Long-term effects of repetitive transcranial magnetic stimulation in unilateral tinnitus. Laryngoscope. 2014 Sep;124(9):2155-60. doi: 10.1002/lary.24722. Epub 2014 Jun 10.

Medium-term results of combined treatment with transcranial magnetic stimulation and antidepressant drug for chronic tinnitus. Eur Arch Otorhinolaryngol. 2015 Feb;272(2):337-43. doi: 10.1007/s00405-013-2851-z. Epub 2013 Dec 14.

Efficacy of different protocols of transcranial magnetic stimulation for the treatment of tinnitus: Pooled analysis of two randomized controlled studies. World J Biol Psychiatry. 2014 May;15(4):276-85. doi: 10.3109/15622975.2012.708438. Epub 2012 Aug 22.

Combined rTMS to the auditory cortex and prefrontal cortex for tinnitus control in patients with depression: a pilot study. Acta Otolaryngol. 2013 Jun;133(6):600-6. doi: 10.3109/00016489.2012.763181. Epub 2013 Feb 28.

Low-frequency repetitive transcranial magnetic stimulation to the temporoparietal junction for tinnitus: four-week stimulation trial. JAMA Otolaryngol Head Neck Surg. 2013 Apr;139(4):388-95. doi: 10.1001/jamaoto.2013.233.

Therapeutic impact of repetitive transcranial magnetic stimulation (rTMS) on tinnitus: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2015 May 13. [Epub ahead of print]

Repetitive transcranial magnetic stimulation as a treatment for chronic tinnitus: a critical review. Otol Neurotol. 2013 Feb;34(2):199-208.

Differences between a single session and repeated sessions of 1 Hz TMS by double-cone coil prefrontal stimulation for the improvement of tinnitus. Brain Stimul. 2013 Mar;6(2):155-9. doi: 10.1016/j.brs.2012.03.019. Epub 2012 May 14.

Effectiveness of transcranial magnetic stimulation application in treatment of tinnitus. J Craniofac Surg. 2014 Jul;25(4):1315-8. doi: 10.1097/SCS.0000000000000782.

July 30, 2015

Is Suppressing a Sneeze Bad For You?

Image courtesy of stockimages
Also known medically as the "closed-airway sneeze," it may be socially preferable, but healthwise may be harmful if not dangerous.

With a sneeze, tremendous air pressure is created in the lungs which ideally should be released out the mouth... but if internalized to prevent release out the mouth, can cause immense pressure to buildup internally which may cause significant damage ranging from minor to severe requiring hospitalization.

Although most of the time, no adverse health consequences occur, here are some of the reported damage that has happened by stifling a sneeze:

Breaking the cartilage around the voicebox
Cervical pain
Facial fracture
Rupturing the eardrum
Rib fractures
Eye damage
Vision damage
Spinal injury
Arterial rupture
Hematoma formation in the neck and other locations
• Vocal cord damage

So do as Elsa of Frozen fame would say/do... "Let it go!!!"

The "closed-airway sneeze": an unusual cause of laryngeal fracture. Otolaryngol Head Neck Surg. 2011 Sep;145(3):515-6. doi: 10.1177/0194599811402947.

Acute cervical pain syndrome resulting from suppressed sneezing. J Assoc Physicians India. 2008 Sep;56:728-9.

Sneezing and orbital fracture. Plast Reconstr Surg. 2006 Mar;117(3):1049-50.

Fractured Rib, Diaphragmatic Rupture and Chest Wall Hernia after Heavy Sneezing. Zentralbl Chir. 2015 Jun;140(3):337-8. doi: 10.1055/s-0034-1383100. Epub 2014 Nov 17.

Orbital emphysema after a protracted episode of sneezing in a patient with no history of trauma or sinus surgery. Ear Nose Throat J. 2010 Nov;89(11):E12-3.

Spontaneous Retrobulbar Haematoma. Case Rep Radiol. 2015;2015:796834. doi: 10.1155/2015/796834. Epub 2015 May 10.

Spontaneous spinal epidural hematoma after abrupt sneezing with prompt recovery of severe paraparesis. Am J Emerg Med. 2014 Dec;32(12):1555.e3-5. doi: 10.1016/j.ajem.2014.04.039. Epub 2014 Apr 26.

Internal carotid artery aneurysm with life-threatening hemorrhages in a pediatric patient: endovascular treatment options. J Endovasc Ther. 2004 Dec;11(6):734-8.

Cervico-mediastinal haematoma following sneezing. Anaesthesia. 1975 Jan;30(1):50-3.

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