Top Ad

Shareholic Button

October 01, 2016

Surgical Treatment of Noise Hypersensitivity

Noise hypersensitivity or hyperacusis is when sounds are painfully uncomfortable for the patient. Hyperacusis may be a symptom of a medical condition like migraine headaches, a structural anomaly like superior semicircular canal dehiscence or perilymphatic fistula, or recruitment phenomenon due to nerve hearing loss, but sometimes there is no obvious reason for it. It just is and there's no obvious etiology nor medical treatment for it. Such patients become socially withdrawn because normal sounds are just too painful.

However in 2014, researchers at the Ear Research Foundation (Sarasota, FL) described a minimally invasive way to surgically correct hyperacusis by plugging up the cochlear round and oval windows [link]. This promising technique to treat hyperacusis was further confirmed with a larger sample of patients in 2016 [link].

For the purposes of semi-objective testing, hyperacusis is defined as significant discomfort when a presented sound is below 90 dBHL, something that can be easily assessed by an audiologist. This measure is known as ULL (Uncomfortably Loud Level). Click here for a noise chart describing different sounds and their loudness level.

The surgery itself is performed through the ear canal after obtaining graft material off from the tragal cartilage. The eardrum is lifted away and the tragal graft material is plugged into the round window as well as between the crura of the stapes to plug the oval window (like putting a cork in a bottle).

Keep in mind this is a relatively new procedure with less than a dozen patients who have so far undergone this procedure, but is an option that may provide some hope for patients who suffer from hyperacusis resistant to treatment.

Minimally Invasive Surgery for the Treatment of Hyperacusis. Otol Neurotol. 2016 Sep 23. [Epub ahead of print]

Round and oval window reinforcement for the treatment of hyperacusis. Am J Otolaryngol. 2015 Mar-Apr;36(2):158-62. doi: 10.1016/j.amjoto.2014.10.014. Epub 2014 Oct 14.

Can Cell Phones Cause Brain Tumors?

I first blogged about this possibility in 2010 [link], but at that time, there were too many conflicting studies that definitive conclusions could not be made though precautions were advisable. However, in May 2016, the National Institute of Health  released partial findings from a 2 year study that exposed rats to the same radio-frequency non-ionizing radiation given off by cell phones. The study found that exposure to mobile phone radiation significantly increased the prevalence of heart and brain tumors in exposed rats as well as evidence for DNA damage in brain cells.

The evidence was convincing enough that the American Academy of Pediatrics has released a statement recommending that mobile phones be avoided by children. The International Agency for Research on Cancer (IARC) (part of the World Health Organization) has already classified mobile phones as a possible carcinogen (group 2B).

Of course, more research is needed to determine if these conclusions also apply to human beings and not just rats. These findings ARE preliminary and who knows what the final results and conclusions will be.

So, what do we know so far?

The group at greatest risk for development of brain tumors have the following characteristics:

1) Use of cell/wireless phone younger than age 20 (the younger the age with first use, the worse the risk)
2) Use of cell/wireless phone for more than 10 years
3) The more hours of cellular phone use over time, the higher the risk of developing brain tumors
4) Risk higher with analog cell/wireless phones (instead of digital)
5) Risk higher with increased overall total exposure

By some estimates, subjects who used cell phones for at least 10 years had a 2.4-fold greater risk of developing a brain tumor.

Though unclear how exposure to a phone's radiation leads to brain tumors, it is known that the radio-frequency radiation signal is absorbed up to 2 inches into the adult skull. Even more worrisome is that the depth of penetration is even deeper in children.

The risk is not just to the brain, but even the parotid gland which sits just in front of the ear. In one study published in 2008 revealed an increased risk of parotid gland tumors with cell phone use. Also, contact allergy is another not uncommon risk with cell phone use.

Symptoms that a patient may exhibit that may suggest a brain tumor are subtle and include hearing loss or ringing of the ear on the same side the phone is used on. [Blog article on cell phone use and tinnitus here.]

It is interesting to note that it is just possible that the cell phone industry is aware of these risks even as it denies any risk of health problems with phone use. If you read the small print that comes with your cell phone, cell phone makers state that mobile phones should not be in contact with your body or skin and should be kept a certain distance away when in use or when carrying around (i.e., do not carry around in your pocket, sock, etc).

For example, the iPhone 7 that just came out comes with a legal disclaimer stating that:
"To reduce exposure to RF energy, use a hands-free option, such as the built-in speakerphone, the supplied headphones, or other similar accessories. Carry iPhone at least 5mm away from your body to ensure exposure levels remain at or below the as-tested levels." [iPhone 7 legal disclaimer]
Earlier phones emitted higher doses of radiation and came with a legal disclaimer to keep the phone at least 15mm away from the body (instead of 5mm for the iPhone 7). [iPhone 3 legal disclaimer]

In any case, to be on the safe side, it is recommended to talk on speakerphone or use a wired headset (not wireless), or avoid altogether if at all possible (use a regular desk / wall telephone).

When I carry my cell phone, I use a belt holder for both safety and convenience (which many consider unfashionable and ugly). For women, use a purse to carry the phone!

Report of Partial Findings from the National Toxicology Program Carcinogenesis Studies of Cell Phone Radiofrequency Radiation in Hsd: Sprague Dawley® SD rats (Whole Body Exposures). bioRxiv preprint first posted online May. 26, 2016; doi:

Risk of Brain Tumors From Wireless Phone Use. Journal of Computer Assisted Tomography, 2010; 34 (6): 799 DOI: 10.1097/RCT.0b013e3181ed9b54

Cell phones and brain tumors: a review including the long-term epidemiologic data. Surg Neurol. 2009 Sep;72(3):205-14; discussion 214-5. Epub 2009 Mar 27.

Mobile phones, cordless phones and the risk for brain tumours. Int J Oncol. 2009 Jul;35(1):5-17.

Cell phone use and acoustic neuroma: the need for standardized questionnaires and access to industry data. Surg Neurol. 2009 Sep;72(3):216-22; discussion 222. Epub 2009 Mar 27.

Cellular phone use and risk of benign and malignant parotid gland tumors--a nationwide case-control study. Am J Epidemiol. 2008 Feb 15;167(4):457-67. Epub 2007 Dec 6.

September 29, 2016

Laryngomalacia Video in an Infant with Squeaky Breathing

A video has been created showing what laryngomalacia (floppy infant airway) looks like from the inside. Both normal infant airway as well as infant with moderately severe laryngomalacia is shown including audio.

Infants with laryngomalacia have what parents hear as a "squeaky" or "noisy" breathing, especially on inhalation. Although most infants outgrow this condition, some require surgical intervention (supraglottoplasty) due to failure to thrive, inadequate oxygenation, excessive work of breathing, etc.

For more info on laryngomalacia beyond the video as well as how it is treated, click here.

September 25, 2016

Suction Powered Nasal Irrigation

Most sino-nasal irrigation systems currently in use require passive drainage after flushing... typically into a sink. You squirt the saltwater into one nostril and the flush drains out the other side passively. However, there is a new system called "Navage" made by RhinoSystems that adds suction along with the flush.

The upper chamber is where clean water is held. There are two nasal pillows that goes into each nostril. By pushing a button, the water gets mixed with salt and flushes through one nostril pillow into the nose while the other nasal pillow suctions simultaneously to remove the flush out of the nose from the other side. The fluid is suctioned into the bottom chamber resulting in a "mess-free" nasal irrigating experience.

The upper chamber can hold 8 ounces of water and only works with a SaltPod which also needs to be purchased regularly for the device to work (button does not work if the SaltPod is expended). The SaltPods are NOT reusable. It also requires two AA batteries.

Overall, the concept is sound and essentially performs what much cheaper rinse bottles do (i.e., NettiPot, Neilmed, etc) but in an almost mess-free and convenient way though doubtful it works any better. There will be some residual nasal drainage once you remove, so you may still need that sink after use.

If cost is not a consideration to address allergies, chronic sinusitis, and nasal congestion, it may be worth considering this device for these unique advantages. However, compared to other electronic sinus irrigation systems like the SinuPulse Elite, it lacks a way to control the pressure.

Available for purchase on Amazon.

September 23, 2016

Tonsillectomy Alone Can Cure OSA in Select Adult Patients

Among adults who suffer from obstructive sleep apnea (OSA), treatments are relatively small in number and overall relatively unappetizing for many patients to pursue.

Beyond losing weight, noninvasive treatment for OSA includes CPAP which is considered the gold standard treatment for adult OSA and involves placing a mask of sorts over the face which than delivers continuous positive pressure into the lungs preventing airway collapse and obstruction. Nightly use of an oral device (mandibular advancement device) is another non-invasive intervention that may be helpful.

Otherwise, surgical interventions to treat OSA include UPPP, base of tongue reduction, hyoid advancement procedures, tracheostomy, etc. Unfortunately, all surgical interventions are quite painful to recover from and risks could be substantial.

For patients who fail to tolerate noninvasive treatment and surgical options are considered "too" invasive for a patient to consider, tonsillectomy alone may be a viable option to improve and potentially cure OSA.

According to a 2016 meta-analysis, tonsillectomy alone has a good change of improving and potentially curing OSA in adults IF:

• AHI < 30 (mild to moderate OSA)
• Large tonsils
• Not morbidly obese

In this select patient population, tonsillectomy alone cured OSA in 84% of patients. Significant improvement including OSA cures was achieved 100% of the time. Keep in mind, improvement does not mean cure and such patients will still require CPAP management.

In comparison, in patients with severe OSA (AHI > 30), only 72.4% had improvement in OSA with a cure rate of only 34.4%.

So if traditional OSA surgical options frightens a patient, a simple tonsillectomy alone may be a worthwhile surgical option given the above information and caveats.

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope. 2016 Sep;126(9):2176-86. doi: 10.1002/lary.25931. Epub 2016 Mar 22.

September 21, 2016

Dr. Chang Panel Speaker at Annual AAO-HNS Meeting San Diego

Dr. Chang was a panel speaker for one talk during the international 2016 AAO-HNS Annual meeting in San Diego, CA on September 21, 2016.

Dr. Chang was honored to participate as a panel speaker for the talk entitled Marketing Your Practice in 2016: Internet, Social Media, and PR which was sponsored by the Young Physicians Section and Media and Public Relations Committee. This talk was moderated by Cristina Baldassari, MD who is an Assistant Professor of pediatric otolaryngology at CHKD.  The other panel speakers included:

Spencer C. Payne, MD - Associate Professor of Rhinology at University of Virginia
Angela Strum, MD - Houston area facial plastic surgeon

Banner Map


ad lump in throat clogged ears