Top Ad

Shareholic Button

November 23, 2015

Dr. Chang Article Printed in National Newsletter

Our Voice, a national newsletter published by the National Spasmodic Dysphonia Association, published a 4 page article written by Dr. Chang (Volume 25, Number 1, Pages 8-11; Nov 2015) on the topic of reflux and spasmodic dysphonia.

The article titled "Living with Spasmodic Dysphonia and Reflux" is the 2nd time Dr. Chang has been featured in this national newsletter.

The first time was in 2009 (Volume 18, Number 2, Page 3) pertaining to research that Dr. Chang performed that was published in ENT Journal May 2009. The research titled "A Survey of Current Practices of Physicians Who Treat Adductor Spasmodic Dysphonia in the US" was to determine what the common botox dosages used and method of injection for doctors throughout the United States who treat spasmodic dysphonia.

Read more about reflux and spasmodic dysphonia.
Related Posts Widget For Blogger with Thumbnails

November 22, 2015

Cochlear Implant Video - "Bionic Ear"

This video demonstrates how a cochlear implant (aka, "bionic ear") surgery is performed. Both animation and actual surgery are shown to illustrate this procedure. With this surgery, patients who are deaf or suffering from severe hearing loss may now be able to hear.

Click to see if you are a candidate for a cochlear implant.

Listen to what a cochlear implant sounds like to a patient after this surgery.

This video was created in collaboration with Dr. Ashkan Monfared who is an Associate Professor of Surgery and Neurosurgery, Director of Otology and Neurotology at George Washington University Medical Center.

November 17, 2015

Breastfeeding Milk Supply vs Demand in Tongue Tied Infants

There are some breastfeeding moms who have a TERRIFIC milk supply... I'm talking newborns who at times seem to be drowning in milk the supply is so great, accidental spraying of the infant's face with milk, numerous soaked nursing pads throughout the day, etc. BUT... they also have an infant with a significant tongue tie.

What if anything should be done from a breastfeeding perspective? After all, milk supply is definitely not a problem... or is it???

The breastfeeding concern even with an initial terrific milk supply arises from two facts... the milk supply WILL go down to meet demand... and once the milk supply is gone, it will not come back.

When it comes to a tongue-tied infant, there is legitimate concern that the infant demand for milk is not there because of the tongue-tie... rather the mom is just dumping the milk into the infant mouth and all the baby needs to do is swallow.

As such, at some future point in time if the infant demand for milk does not happen, the mom's milk supply may decrease to a point where the nutritional needs of the growing baby may not be met.

Take a look at the two graphs below.

In "normal" infant, the infant demand and mom's milk supply meet at a high supply level.

Looking at the above graph, the "normal" infant milk demand and mom's milk supply meet at an earlier point in time while the milk supply is very good. However, in the tongue-tied infant graph below, the infant milk demand and milk supply meet at a much later point in time when the milk supply has been reduced to a much lower level that may not be enough to provide adequate nutrition.
In tongue-tied infant, the infant demand and milk supply meet a a much lower level.

Even when the transition is made to a bottle for the tongue-tied infant, because they historically had to put so little effort into obtaining milk, the tongue-tied baby may take much longer to "learn" that with a bottle, they do have to put effort into feeding.  Of course, the parents can manually and continuously inject the milk from a bottle/syringe into the infant mouth, but that would be a less than ideal situation.

So that's why even if the milk supply is very good, treatment for a tongue-tied infant may still be necessary.

On a more positive note, this concern for future feeding difficulty may NOT happen. The potential for feeding problems is a "risk" and not a foregone conclusion... the infant may compensate and provide adequate demand such that milk supply does not become a problem or the tongue tie albeit present, may not be significant enough to be of concern and treatment may not be recommended.

November 13, 2015

Perfume Effectively Repels Mosquitoes

At first I thought this claim was a joke... but it's no joke. Research performed at New Mexico State University found that Victoria's Secret perfume "Bombshell" effectively repelled mosquitoes for up to 120 minutes.

The research was performed in the lab of Dr. Immo Hansen, associate professor of biology.

He and his colleagues found that DEET is still the best at repelling mosquitoes, but apparently Bombshell may be the next best thing. This perfume apparently cut down the mosquito attraction rate from 60% (no repellant used) down to 17% with Bombshell.

Researchers evaluated a total of 10 commercially available mosquito repellants. They found non-DEET products had little to no effect except for:

- Cutter-brand Lemon Eucalyptus Insect Repellent
- Avon Skin So Soft bug guard was effective in repelling the tiger mosquitoes but not yellow fever mosquitoes
- Avon Skin So Soft bath oil repelled the yellow fever mosquitoes but not tiger mosquitoes

So if DEET is a chemical that frightens you, consider Bombshell from Victoria's Secret! You can purchase this fragrance from Amazon.

This Perfume Can Repel Mosquitoes. 11/12/15

The Efficacy of Some Commercially Available Insect Repellents for Aedes aegypti (Diptera: Culicidae) and Aedes albopictus (Diptera: Culicidae). Journal of Insect Science. DOI: 140 First published online: 6 October 2015

November 12, 2015

Treatment of Gleeking

Gleeking is when an individual is able to squirt spit out of the mouth causing amazement if not disgust from surrounding people. This salivary spray comes out from Wharton's duct which is an opening located under the tongue tip that drains the submandibular glands located under the jawline (black arrows in pic).

This duct opening normally is about 0.5mm in diameter... very small! The channel that carries saliva to this opening is about 4mm in size.

However, in individuals who have a tendency to gleek unintentionally, the duct opening diameter is even smaller! So what happens with a gleek is when saliva accumulates behind this unusually tight opening (aka, stenotic papilla). Once enough saliva builds up creating enough pressure to overcome this small stenotic opening, it all gets ejected out all at once.

A gleek is analogous to a "cough" where air pressure is built up in the lungs behind a closed voicebox which is than released all at once.


Treatment is essentially to "stretch" the opening of Wharton's duct to a more normal+ size. Otherwise known as dilation, this can be accomplished through sialendoscopy.

Sialendoscopy is when tiny cameras and instruments are threaded into the duct. Such instrumentation includes dilation of the duct opening which would resolve gleeking.

November 10, 2015

Narcotics Family Tree

Sometimes it is instructive to see how all the different narcotics are related to each other. It may surprise people that when a narcotic is swallowed, it often will be converted to another different narcotic by the body.

For example, both codeine and heroin are metabolized by the liver into morphine which is the actual "active" metabolite resulting in pain relief.  Codeine is also converted into hydrocodone which is the narcotic contained in vicodin and norco.

Morphine, oxycodone, fentanyl, and methadone do not get metabolized into alternative forms.

Although most narcotics are metabolized by the liver, most are excreted from the body by the kidneys.

So now you know!

Opioid Metabolism. Mayo Clin Proc. 2009 Jul; 84(7): 613–624.

Banner Map

lump in throat clogged ears