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August 30, 2011

Poor Quality Sleep Contributes to High Blood Pressure

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Obstructive sleep apnea (OSA) is known to cause all sorts of health problems beyond sleepiness. Medical problems include increased risk of stroke, heart attack, peripheral vascular disease, high blood pressure, etc. However, what researchers have recently found is that even if you do not have obstructive sleep apnea, if a person does not have enough "deep sleep" per night resulting in poor quality sleep, that also can increase risk of hypertension.

Researchers collected data on 784 men over the age of 65 who didn't have high blood pressure initially and followed them over the next 3 years. At home sleep studies were obtained initially and at follow-up to look at their sleep patterns as well as their blood pressure.

What they found was that individuals with poor quality sleep, reflected by reduced slow wave sleep (deep sleep), puts individuals at significantly increased risk of developing high blood pressure, and that this effect appeared to be independent of obstructive sleep apnea.

Read a CNN report here.

Reference:
Decreased Slow Wave Sleep Increases Risk of Developing Hypertension in Elderly Men. HYPERTENSION AHA.111.174409. Published online before print August 29, 2011,

Nasonex Sinus Implant for Chronic Sinusitis

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The FDA on August 15, 2011 approved of a novel dissolvable sinus implant that slowly releases mometasone furoate steroid (same active ingredient as Nasonex steroid nasal spray) directly onto the sinus mucosa.

The spring-like implant is placed at the time of sinus surgery and automatically expands and conforms to the sinus cavity regardless of size and shape.

The theory is that by continuously delivering a low dose steroid directly to the sinus cavity, sinus inflammation will decrease and risk of scarring will decrease resulting in an overall decrease in chronic sinusitis for the patient after sinus surgery.

This is a GREAT idea and studies have born out its effectiveness. Hopefully other drug-eluting dissolvable stents like this will be developed in the future!

Developed by Intersect ENT, the implant is called "Propel."

Read about the FDA approval here.

References:
Safety and efficacy of a novel bioabsorbable, steroid eluting sinus stent. INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY. 2011;1(1):23-32.

Advances in the Surgical Management of Chronic Sinusitis and Nasal Polyps. CURRENT ALLERGY AND ASTHMA REPORTS. Published online 08 February 2011

Controlled steroid delivery via bioabsorbable stent: Safety and performance in a rabbit model. AMERICAL JOURNAL OF RHINOLOGY & ALLERGY. November–December 2009, Vol. 23, No. 6.

August 29, 2011

Gluing Cut Blood Vessels Together

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Gluing blood vessels together, just like gluing a cut garden hose together, does not seem like a great idea at first, but Stanford researchers just might have figured out how to do this safely and effectively.

Over the past century and still currently used today is to hand-sew the cut ends of the blood vessel together using stitches. This method of reattaching blood vessels is time-consuming and tedious, especially when the blood vessels are tiny.

In this new glue method which is FIVE times faster, a special substance is injected into the cut blood vessel on both ends called a poloxamer. This substance has the unique property of becoming an elastic solid when heated above body temperature which than turns into a biodegradable liquid that dissolves away when cooled.

In a nutshell, the steps are as follows:

  1. The poloxamer is inserted into the blood vessel where is solidifies using a halogen lamp thereby keeping the lumen open.
  2. The cut edges of the blood vessel are precisely reapproximated and "glued" together using dermabond, a substance currently used to "glue" together cut skin.
  3. The blood vessel is allowed to cool down by taking away the halogen lamp and the poloxamer contained within the blood vessel melts and dissolves away.

So far, this procedure has only been done in animals, but since all of the components of this technique has already been FDA-approved for human use for other purposes, if proven to work, can rapidly be adopted for microvascular surgery in humans.

Reference:
Vascular anastomosis using controlled phase transitions in poloxamer gels. Nature Medicine (2011) doi:10.1038/nm.2424

August 27, 2011

Actress Maggie Q Suffers From Hearing Loss

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American actress Maggie Q of Mission: Impossible III and TV show Nikita fame suffers from significant hearing loss due to a loud noise exposure from a movie set explosion.

Apparently, during shooting of an explosive stunt, her left eardrum was blown out while her right ear suffered mild hearing loss.

Such an injury could have been prevented with hearing protection.

August 26, 2011

Jay Leno Has a Degree in Speech Therapy

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Image by Lee Stranahan from Wikipedia
Yes... It is true!!!

Jay Leno admired by many for his comic personality had his beginnings as a speech therapist. He graduated in 1973 from Emerson College with a bachelor's degree in speech therapy. In order to help pay for his education, he worked in comedy clubs as well as an emcee in talent shows.

Who knew?

Reference:
Wikipedia

Earthquake Helps Man Regain Hearing... Perhaps Not!

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Fox News reported on Aug 25, 2011 about Robert Valderzak who suffered conductive hearing loss for a few months... until the earthquake shook him and the rest of the East Coast after which he was able to hear.

Though this may sound miraculous, conductive hearing loss is one of those reversible type of hearing loss. It is not permanent. Example of conductive hearing loss include:

Earwax
• Fluid in the ears
• Ear infection
Eustachian tube dysfunction
• Problems with the middle ear bones

All these problems can be "fixed" and the hearing loss reversed. Permanent hearing loss is due to nerve damage and a reversal of a nerve type of hearing loss could be considered "miraculous."

Now how could an earthquake conceivably reverse a conductive hearing loss? Without benefit of having examined Mr. Valderzak, perhaps he had a lot of earwax and the quake "shook" the earwax out or free (kind of like when a person goes swimming and gets some water in the ear that requires head-shaking to get it out).

It could also be coincidence. There are thousands of people who suffer conductive hearing loss every day for one reason or other. Often, this type of conductive hearing loss will spontaneously resolve one day after days or weeks or even months go by even if not aggressively treated medically. That's why in kids who have fluid in the ears (which causes conductive hearing loss), we sometimes wait 3 months before we put ear tubes in. Quite a number resolve on their own spontaneously.

Now if there are thousands of people with conductive hearing loss and we expect a few to spontaneously recover their hearing each day... and the earthquake was felt by millions throughout the East Coast... I'm surprised that this particular patient is the only one who regained his hearing after the earthquake. I suspect there's at least a dozen that probably regained their hearing that day that the media has not heard/reported about... as well as the day before and the day after. I also suspect that there's probably a few hundred that "lost" their hearing during the earthquake due to earwax, fluid buildup in the ears, ear infection, etc.

Read the Fox New article here.

August 21, 2011

Shape of Human Nose Influenced by Climate

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The basic function of the human nose is to warm and humidify the air before it reaches the lungs. Because of the wide variation of human habitats from the polar cold and dry air to the equatorial hot and humid weather, one would expect the nose to accommodate to these climate extremes accordingly thru evolutionary pressures.

In essence, logically one would expect the nose to change shape to enhance time that air is in contact with the warm and moist nasal interior in cold and dry climates compared to the opposite environmental extreme.

German scientists evaluated this hypothesis thru 3D modeling of 100 skulls to analyze the shape of the bony nasal cavity of 10 modern human groups living in five different climates and found that the bony nasal cavity appears mostly associated with temperature effects and the nasopharynx with humidity.

Humans living in cold, dry climates tended to have nasal cavities relatively high and long with an abrupt narrowing in the upper nasal cavity than those living in hot, humid climates. Such characteristics enhance contact between the air and the nasal mucosal tissue that helps to warm and humidify that air.

What does such a nose look from the outside? A narrow, longer internal nasal cavity is generally linked to a relatively narrower and more projected nose.

Read a magazine article about this research.

Reference:
Climate-related variation of the human nasal cavity. American Journal of Physical Anthropology. Volume 145, Issue 4, pages 599–614, August 2011

August 20, 2011

Illustrated Guide to a PhD (and Perhaps MDs Too!)

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Original work "The Illustrated Guide to a PhD" by Dr. Matt Might. Though geared towards a PhD, this guide can apply to MDs as well.

Imagine a circle that contains all of human knowledge:

By the time you finish elementary school, you know a little:

By the time you finish high school, you know a bit more:

With a bachelor's degree, you gain a specialty:

A master's degree deepens that specialty:

Reading research papers takes you to the edge of human knowledge:

Once you're at the boundary, you focus:

You push at the boundary for a few years:

Until one day, the boundary gives way:

And, that dent you've made is called a Ph.D.:

Of course, the world looks different to you now:

But, don't forget the bigger picture:


Keep pushing.

New Webpage on Facial Paralysis

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Our office has produced a new webpage on the evaluation and management of facial paralysis without any other symptoms.

Click here to read more about this condition.



New Webpage on Bumps or Lesions of the Mouth

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Our practice has created a new webpage describing the various bumps and lesions commonly seen in the mouth that leads to a doctor's visit.

Such abnormal things seen in the mouth that's discussed include:

  • aphthous ulcer
  • herpetic ulcers
  • pyogenic granuloma
  • fibroma
  • papilloma
  • cancer

Click here to read more!

August 17, 2011

How To Approach Social Media as a Physician

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Last year, I expressed why I bother blogging as a busy surgeon... but this article is more about how to approach social media as a physician.

There are numerous advice on the web how to get individuals and businesses involved in social media. Though much of this generic advice is applicable to surgeons and physicians, there are unique limitations as well as opportunities that apply only to such healthcare professionals.

I've also reached a few conclusions of my own regarding developing an online social media presence through trial and error since 2006 and certainly 2007 when I developed an overall game plan that has been tweaked over and over as I've gained experience.

1) Mission statement... As korny as this sounds, you need to have focus on what you are aiming for in order to develop a coherent strategy to not only create an online presence but to also grow it. Too often, I've come across physician twitter feeds that talk about literally everything under the sun with continuous commentary on everything and everyone. That's fine if your goal is to be the water cooler hang-out guru, but to have impact on the services you provide as a healthcare professional, focus is important. Focus is a two-edged sword however. With focus, your audience becomes small and encompass only those individuals who are interested in the same topic (or in this case, medical conditions you represent)... but their interaction with you and your healthcare business is much higher than an unfocused huge riotous mass of people with multiple dissimilar interests.

So a mission statement can be as simple as "To provide the best commentary on media topics related to ear, nose, and throat."

A secondary mission statement addendum can be "in order to build up my practice's brand name"... 

2) Really, who are we kidding? We all know that the end goal of any social media presence is to market "you" and your medical services.  Just keep in mind that whatever your persona may be in real life will now be represented by a "virtual" persona of you online and this online persona will potentially be the first time a patient interacts with you, even if you do not yet know they exist. Make sure it's a good impression... which increases the likelihood they will actually utilize your services in real life.

3) Create a blog... There are several free ones available... WordPress, Blogspot, Posterous, etc to name a few.

4) Write on a topic that pertains to your practice. It's VERY hard to come up with original material consistently, week after week, year after year. It's great if you can do it, but I'm just letting you all know that it's hard... and even harder when running your clinical practice at the same time.

So at least what I learned over the years is to "cheat"... I gain inspiration from what is published in magazines, newspapers, TV, etc. I than write about these published articles I find... and I criticize or at least evaluate it from a physician-in-the-know's perspective.

This serves several purposes. 

• I don't have to think about what topic I'm going to write about. I let the journalists do that for me. Believe me... it saves time.
• I write what I would have told patients if they brought this article to my attention during an appointment.
• The medical stuff patients are reading about in public is something they might suddenly start searching for... and gee whiz... wouldn't it be great if YOUR blog article on this very topic popped up. The media brings to the forefront of peoples' minds medical issues they want to talk about. What better time to add your voice to a problem you specialize in!

5) Make sure you link to your practice website from your blog article so that patients know how to reach you if they find you.

6) Make sure you have a good practice website to begin with.... It does not matter if you have a great online presence if your practice website stinks. Social media COMPLEMENTS your practice website. It does not replace it. You need both to have an ultimately successful social media presence that brings patients to your office.

7) Write blog articles often... I find the sweet spot to be about 3 per week. If you aren't actively writing, your social media presence will dwindle and fade away. Think of blog articles like growing a flower.

8) Now that you're writing blogs... how to make potential patients notice? The easiest way is to advertise your blog presence on your practice website. The downside with this approach is that if you don't get a lot of traffic to your website, it's going to be slow gaining an audience for your blog. As such, your blog needs help...

That's where FaceBook and Twitter come in which is where all your potential patients seem to hang out nowadays. These additional accounts should feed into your blog. To make less work for yourself, automate the process such that whenever you post a blog, it will automatically update your Twitter and Facebook accounts.

If all goes well, you will slowly build up a following for your social media accounts with correspondingly increased traffic to your website which ultimately leads to patient visits. It takes time so be patient!


August 15, 2011

Welding a Cut Nerve Together Using a Laser

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Although preliminary, researchers have successfully "welded" a cut nerve together using a laser rather than traditional suture repair.

When a nerve is cut, the only way to allow potential for the nerve to regain function is to bring the cut edges together and hope nerve regeneration crosses over. Traditionally, this was pain-stakingly accomplished under the microscope using sutures as thin as a human hair.

Using the rabbit facial nerve, researchers used a laser to weld the cut nerve edges together rather than using sutures and demonstrated a trend towards superior outcomes. Not only was the outcome better, it was way easier and faster to perform.

This new technique has tremendous application in ENT surgery, but can also apply to any surgery where nerves can get damaged or cut... vocal cord paralysis from thyroid surgery (recurrent laryngeal nerve), unable to lift shoulder from neck dissection (accessory nerve), facial paralysis from parotid gland tumor resection (facial nerve), etc, etc.

Reference:
Laser Facial Nerve Welding in a Rabbit Model. Arch Facial Plast Surg. Published online August 15, 2011. doi: 10.1001/archfacial.2011.61

August 14, 2011

Pregnant Woman Finishes Law Bar Exam While In Active Labor

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Kudos to perhaps one of the gutsiest man or woman of sheer intellectual will-power that I know of past or present... and that includes ENT surgeons  ;-)

An Illinois lawyer, Elana Nightingale Dawson, in July 27, 2011 was taking the notoriously difficult Law Bar Exam when she went into active labor halfway thru the second day of the exam.

Apparently, she went into active labor around 1PM and finished the test early at 4PM after which she was escorted by a test proctor to a hospital across the street and delivered a healthy baby boy via C-section at 5:58PM.

Of note, her contractions were about 10 minutes apart by the time she finished her exam.

Her sheer will-power and determination is further demonstrated by the fact that this was:

- Her first child
- Did not take any break at all
- Did not receive any special accomodations
- Did not make any noise throughout her ordeal

However, her determination is perhaps not surprising when considering she was:

- One of the top ranked students at Northwestern Law
- Completed her JD program in 2 rather than the normal 3 years

In early October 2011, she will find out if she passed the test.

All I can say is if this lady can go into active labor and finish a bar exam one hour early, there should be NO special exemptions of any kind for anybody during a test regardless of any medical condition or environmental disturbance.

I also hope she pursues a career in medical defense.

Read more in this article here as well as her interview here.

New Cartilage Can be Grown From Stem Cells Found in Adult Ears

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Cartilage is found throughout the body giving shape to noses and ears and cushion for the joints. However when damaged, is not easily replaced which is why synthetic materials is often used to replace damaged cartilage.

However, Japanese scientists have grown new cartilage using stem cells found in the ear of all places. Specifically, the perichondrium which lines the cartilage of the ear. Perichondrium is also the layer under which a hematoma develops after ear trauma (ie wrestling) that can lead to cauliflower ear if left untreated.

The stem cells were isolated from the perichondrium and injected into mice where chunks of cartilage developed and remained still healthy after 10 months.

So rather than using artificial materials to reconstruct knees and noses, theoretically, stem cells can be retrieved from the patient's ear, injected into mice, cartilage grown and retrieved, and used to replace the damaged cartilage in the patient without worry of rejection.

Reference:
Reconstruction of human elastic cartilage by a CD44+ CD90+ stem cell in the ear perichondrium. DOI: 10.1073/pnas.1109767108

August 10, 2011

Possible Cure for Common Cold And Other Viral Infections

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For real... at least in mice, but has potential for human application if the promise holds out!

MIT researchers have developed a radical new approach to eradicating viral infections no matter what the virus may be... common cold, HIV, Ebola, polio, dengue fever, etc.

The usual anti-viral antibiotics in use today target the viral replication process which unfortunately often fails with time as the virus adapts and develops resistance to the medication.

The new medication dubbed "DRACO" (Double-stranded RNA Activated Caspase Oligomerizers) approaches viral infections using a totally different approach. It is able to IDENTIFY cells infected with the virus and KILLS the cell itself before the virus has a chance to take over the cell and create more virus copies. As such, the virus itself is not targeted, but rather the infected cells themselves instead.

To use an analogy, let's use an ant colony as the "viral infection". Current antivirals work by trying to pick off the Queen Ant or the ants themselves. DRACO works by destroying the entire colony. It doesn't care about individual ants or where they came from. All it cares about is the colony itself and initiates it's entire destruction.

For those more intellectually curious, DRACO is able to identify "double-stranded RNA" (ds-RNA) which is ONLY found in cells infected with a virus. One part of DRACO is able to identify and bind to this unique viral marker. The other part of DRACO is a protein that signals the cell to undergo suicide (apoptosis) thereby preventing the virus from hijacking the cell to make more virus particles. If a virus can't make copies of itself, no infection can occur.

Given ds-RNA is unique to viral infections, DRACO does not care what kind of virus it is (remember, it is not targeting individual "ants" to use the analogy). As such, whether it be the common cold or the dreaded Ebola virus, DRACO kills virus-infected cells indiscriminately. If no ds-RNA is present, DRACO remains inactive and healthy cells remain unharmed.

The tests reported in this study were primarily accomplished in cultured human and animal cells, but researchers also tested DRACO in mice infected with the H1N1 influenza virus. When mice were treated with DRACO, they were COMPLETELY cured of the infection. The tests also showed that DRACO itself is not toxic to mice.

More animal tests are underway and if all goes well... human trials may hopefully occur in the future!

Very promising!

Read a media report on DRACO here.

Reference:
Broad-Spectrum Antiviral Therapeutics. PLoS ONE 6(7): e22572. doi:10.1371/journal.pone.0022572

Dr. Chang Extensively Quoted in Outpatient Surgery Magazine Article

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In the August 2011 edition of Outpatient Surgery Magazine, Dr. Chang was extensively quoted for an article describing use of image-guided sinus surgery.

In the article titled "The Benefits of Image-Guided Sinus Surgery," Dr. Chang described the advantages such technology brings to endoscopic sinus surgery.

Click here to read the full article.

Click here to read more about chronic sinusitis as well as watch a video of this technology being used.


Reflux (Acid, Non-Acid, Mixed Types) in Neonates & How It May Also Apply to Adults

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A study was published this month in the journal Pediatric Research which described reflux characteristics in neonates, but the findings can certainly be applied to adults as well.

What I found gratifying about this study was not so much that reflux was evaluated, but what measurements obtained by 24 hour pH-impedance were taken which apply just as much to adults as neonates. Just exactly what was measured and what did the study find (at least in neonates suspected of having reflux)?

• Only 54% of reflux events was associated with symptoms

• Defined by physical characteristics of reflux events:
  • 51.3% were liquid
  • 29.1% were gas
  • 19.6% were mixed
• Defined by chemical characteristics of the reflux events:
  • 48.5% were acidic
  • 51.5% were non-acidic
• Defined by how high the reflux traveled away from the stomach:
  • 79.2% reached the throat/mouth level
  • 20.8% stayed in the chest level

Although these findings are specific for neonates, adults experience similar problems, though precise numbers are probably different and need more study.

Laryngopharyngeal reflux is when reflux reaches the throat level. Depending on the chemical characteristics of the reflux (acid vs non-acid as well as how high it goes), the symptoms may be quite variable. NON-acid reflux is considered "silent" and patients may not experience any symptoms of heartburn. Rather, common symptoms include:

Phlegmy throat
Chronic cough
Swollen sensation in the throat (globus)
Chronic throat-clearing

These results point out another issue... Common medications used to treat reflux (zantac, pepcid, nexium, prilosec, prevacid, etc) only treats ACID reflux. Not NON-acid reflux.

As such, other modalities must be pursued to address symptomatic non-acid reflux beyond medications involving lifestyle changes including diet as well as surgery.

Whether it be babies or adults, characterization of the spatial-temporal-physical-chemical nature of reflux events as defined by pH-impedance methods offers the best chance of evaluating and treating symptoms due to reflux.

Or in more simplistic terms...

NOT ALL REFLUX IS ACID!!!
NOT ALL REFLUX CAUSES HEARTBURN!!!

Reference:
Significance of gastroesophageal refluxate in relation to physical, chemical, and spatiotemporal characteristics in symptomatic intensive care unit neonates. Pediatr Res. 2011 Aug;70(2):192-8.

August 07, 2011

Major League Baseball Bans Under the Tongue Deer Antler Spray Use

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On Aug 6, 2011, ESPN reported that MLB players have been issued a warning regarding use of Deer Antler spray administered under the tongue.

Deer-Antler spray contains "potentially contaminated nutritional supplements" along with IGF-1 (Insulin Growth Factor) which players have used in the past as an alternative to steroids, especially given it can't be detected in urine samples (only blood testing).

What's with Deer-Antler spray specifically? Scientists discovered IGF-1 in the velvet of immature deer antlers and IGF-1 is considered a performance-enhancer that mediates the level of human growth hormone in the body.

Why under the tongue (sublingual administration)? Because the mucus membrane is quite thin under the tongue richly underlaid with capillary blood vessels allowing for direct diffusion of the substance directly into the body's bloodstream with little or no alteration. This process takes less than a minute to occur. This is in contrast to swallowing a pill which gets digested in the stomach with acid, further digested in the intestines with enzymes, absorbed into the hepatic circulation where further degradation occurs in the liver before getting into general body circulation for effect. A 30-60 minute process.

That's why sublingual nitrogen is such a potent medication to treat chest pain due to an impending heart attack. It works FAST!

It's another reason why sublingual immunotherapy otherwise known as allergy drops is a growing acceptable alternative to allergy shots to try and cure allergies.

Read the ESPN story here.

August 06, 2011

According to Researchers 35.09 Is Age When Beauty Starts to Fade

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© Luba V Nel | Dreamstime Stock Photos
My colleague, Dr. Houtan Chaboki, shared the link to an article in Wmagazine first published in Feb 2011 regarding how Japanese researchers determined 35.09 years is the exact tipping point when beauty starts to fade.

35.09 years is exactly 33 days after the 35th birthday.

Hmmmm... I'm not sure about the science here, especially given the researchers work for skincare company SK-II. And proffer their $250 Skin Signature Melting Rich Cream as a solution.

What do the masses think if corporate scientist lackeys are to be disbelieved? Well, QVC did a survey of over 2,000 men and women and found that age 31 is the tipping point. Doubters of this age may point out that this survey also is biased as QVC is not exactly an ivory tower institution.

Read the Wmagazine article here.

Read about the QVC survey here.

August 05, 2011

What About a "Voice-Lift" with your Facelift?

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I was informed about this interesting concept on ABC news...

With many aging baby boomers tapping into cosmetic surgery in order to look younger, some are taking it a step further to "sound" younger as well with a "voice lift".

For some, it's not right to look 10-20 years younger after a facelift but still sound like 70 years old.

A hoarse voice with aging is not unusual, but a surgical "voice-lift" is not necessarily the first step that should be taken.

First things first...

• Make sure the hoarseness is not due to something bad like vocal cord cancer. As a person ages, risk of cancer does increase especially if tobacco and alcohol use is present.

• Make sure there are no physical problems with the vocal cords like paralysis, polyp, cysts, reflux, etc.

Beyond that, vocal limitations often seen with the aging voice should first be addressed with voice therapy. Bowed vocal cords as well as compensatory muscle tension dysphonia are conditions often seen in this patient population causing a significant raspy voice and often respond quite well to voice therapy. Should voice therapy fail to resolve the vocal disquality, than surgical options can be considered.

What are the surgical options?

Just like a facial wrinkle may require a collagen injection to plump it up or a chin implant to address a receding chin, the vocal cord can also undergo collagen injections or receive an implant to plump it up and give it volume lost to aging which can lead to vocal problems.

Click here to read more about this procedure.

Click here to read the ABC new report.

"Ear Picking" - A Barber Shop Service Health Hazard?

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It was only recently that I heard of "ear picking," a barber shop service that is apparently quite common in Asia and recently becoming more popular in the United States in cities with large Asian populations.

In essence, ear picking is when a variety of implements - scrapes, picks, and lights - is used within the ear canal.  Why is it popular among Asians? Mainly because of the type of earwax that is produced by Asians which is mainly dry and flaky which causes an itchy sensation. Ear picking helps remove some of this cornflake-like earwax as well as get the itch "scratched" and is apparently quite a pleasurable experience... like getting an itch on your back scratched. Caucasians have more peanut butter or wet type of earwax which is not amenable to "picking".

This unlicensed service is most often performed in barber shops and unfortunately has led to a number of ear related infections (eardrum perforations, fungal ear infections, bacterial ear infections, etc) as the tools are not sterilized in between customers.

If you want a "professional" type ear cleaning, see your local ENT. Itchy ears can be treated without resorting to ear canal instrumentation along with its risks of infection and eardrum perforations!

Read more about this phenomenon here.

August 04, 2011

Novel Treatment for Glue Ear?

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Glue ear is the layman's term for thick mucoid effusion of the middle ear, usually due to chronic ear infections.

The fluid itself is like maple syrup and usually treated with ear tube placement followed by suctioning as much of the fluid out as possible. However, given there is always some residual present, antibiotic ear drops with steroids is often prescribed.

Unfortunately, these patients are at higher risk of requiring repeated sets of tubes after the body spits them out.

Why?

Because of a phenomenon called biofilms... Think of it as teflon armour made of slime for infections. You can put antibiotics and steroids on it, but they kind of just slip off. Such biofilms make infections nearly 1000 times LESS susceptible to medications. In order to truly eradicate the biofilm (and underlying "hidden" infection), you either have to "scrape" it off which is not possible in the middle ear or use very high concentrations of antibiotics... much greater than that obtained using oral or IV antibiotics.

Though ear drops containing high concentrations of antibiotics are possible, the drops tend to come out of the ear just as easily as they go in preventing prolonged and enduring contact.

That's were the recent innovation comes in...

Scientists in England have developed a biodegradable antibiotic "pellet" that can be inserted into the middle ear during surgery where it will slowly release high concentrations of antibiotics to target any infections present (active or inactive) over 3 weeks continuously. Furthermore, the pellet contains N-acetylcysteine which effectively breaks apart the biofilm.

In essence, this pellet is like an armour-piercing bullet.

Of course, it is not available in the US yet... nor is it FDA approved.

Read more about this here.
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