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January 22, 2009

Rise In MRSA Head & Neck Infections Among American Kids

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MRSA infections among American children increased during a five-year-period up to the end of 2006, according to an article published in Archives of Otolaryngology-Head & Neck Surgery, January 2009 issue.

The article explains that up to 1980, MRSA infections were generally acquired in hospital. But, over the last decade, community-acquired MRSA (ca-MRSA) infections have become significantly more common in nursing homes, prisons, and among chronically ill patients and in individuals considered to be low risk.

In recent years, there have been increasing reports of community-acquired MRSA infections in children involving the head and neck.

Iman Naseri, M.D., Emory University School of Medicine, Atlanta looked at data regarding pediatric head and neck infections that took place at over 300 hospitals across the USA during the period 2001 - 2006. Infection sites were divided into oropharyngeal/neck (head and neck), sinonasal (nose and sinuses) and otologic (ear), and demographic and antibiotic resistance patterns were reviewed.

21.6% of the 21,009 S. aureus infections that occurred during this period were MRSA. These rates rose from 11.8% to 28.1% during that five-year period. 34% of MRSA infections were found in the ears, 28.3% sinonasal, and 14.2% head and neck.

Let's hope that this disturbing trend does not continue and it reinforces the need to give antibiotics ONLY if a true bacterial infection exists and not for colds, URIs, laryngitis, etc for which antibiotics are worthless.

Click here to read more.

January 17, 2009

Chronic Throat Clearing

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A common complaint of patients seeing an ENT doctor is for persistent throat clearing. Other symptoms that a patient may complain of include throat mucus, cough, raspy voice, and a lump sensation in the middle of the throat (aka, globus). For a more in depth discussion on this topic, click here.

Reflux (Acidic or Non-acidic)

In the VAST majority of patients complaining of chronic throat-clearing, it is due to a disorder called "laryngopharyngeal reflux" or LPR for short. This disorder is due to reflux whether acidic or non-acidic from the stomach that travels up to and briefly irritates the throat region. This transient irritation is just enough to cause a person to clear the throat without causing any other symptoms. Think of this problem like a tiny drop of acid that lands in the eye causing a person to briefly itch the eye due to irritation that may last several days.

Of note, most patients with LPR do NOT complain of heartburn, nausea, indigestion and other symptoms commonly associated with reflux.

The treatment is the same as for the more common and related GERD disorder except that treatment usually takes much longer... sometimes for as long as 6 weeks to 3 months. Some over-the-counter medications used to treat reflux are listed at end of article below.

To read more about this disorder, click here.

Post-Nasal Drainage

Sometimes, mucus can accumulate in the throat due to nasal drainage triggering throat-clearing. In these patients, they literally feel the drainage travelling from the nose and down into the throat. Often, when one looks in the back of the throat, the drainage can be seen. Treatment for this drainage depends on what it is caused by. If due to sinusitis, antibiotics is the treatment. If due to allergies, allergy treatment is recommended. If due to vasomotor rhinnitis, nasal sprays such as atrovent, patanase, and astelin may be quite helpful. In these patients, turbinate reduction may quite helpful to reduce the amount of drainage.

Medication Side-Effect

Avoid all ACE-Inhibitors as well as Angiotensin Receptor Blocker medications. Both of these classes of medications address high blood pressure. However, as a side effect, they also potentially can cause a "tickle" sensation in the throat that makes a person want to clear the throat. If you are taking one of these medications, recommend having your primary care doctor change your medication to a different one (ie, beta-blocker, calcium channel blocker, etc). Would avoid these medications for at least 3 months.

Food Allergies

Rarely, food allergies can cause excessive throat mucus to develop triggering throat-clearing. The most common culprit is dairy products. Treatment for this problem is mainly avoidance.


Zenker's Diverticulum

Even more rarely, there may be an anatomic abnormality in the throat called a Zenker's Diverticulum. Basically, this abnormality is a pouch that protrudes from the esophagus (swallowing tube) which catches food and mucus preventing it from going down towards the stomach. At random times, the contents in the pouch may suddenly regurgitate causing aspiration as well as mucus collection in the throat.

Treatment is surgical. Click here for more info.

Laryngeal Sensory Neuropathy
Perhaps in the most rare situation, the throat-clearing is due to an abnormally sensitized throat where even the slightest irritation which normally would not trigger a throat-clear does trigger one. Related symptoms include chronic dry cough as well as laryngospasm. Click here for more info.


To read more about chronic persistent throat clearing, click here.


Some over-the-counter medications used to treat reflux are listed below:

January 07, 2009

Dr. Chang Quoted in Healthy Happenings Publication

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Dr. Chang was quoted in the Winter 2009 Healthy Happenings quarterly publication (page 5) in an article entitled Revolutionizing Orthopedic Surgery with Brain Lab Technology.


"Sinus Operations
Ear, Nose and Throat specialist Christopher Chang, M.D., has used Brain Lab as well and performed several hundred Brain Lab sinus cases at Duke University. He is excited to offer this service at Fauquier Hospital now.

“It is a great tool for sinus surgery,” he says. “I can see exactly where the tip of the surgical instrument is at all times in three dimensions. This is especially important since the sinuses are so close to the brain and eyes.”"

January 03, 2009

New Webpage on the Treatment of the Paralyzed Vocal Cord (Bowed Vocal Cords Too!)

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A new webpage has been created going over how paralyzed vocal cords are treated, mainly from a surgical perspective. Also included on this same webpage is treatment options for bowed vocal cords (presbylaryngeus). Surgical options covered in detail with illustrations include vocal cord medialization with injection or implantation laryngoplasty. Click here to check it out!

A video showing a vocal cord injection to medialize a paralyzed vocal cord was also created and added to our practice's YouTube channel. The video can also be viewed below.

January 01, 2009

Trouble Swallowing?

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A new webpage has been added to our website on the topic of difficulty swallowing, otherwise known as dysphagia. Click here to read more.
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