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August 31, 2014

JCAHO Mandates Time-Out for Emergency Tracheostomy

Due to confusion from readers, please note that this is a work of satirical fiction . Washington DC August 31, 2014 - Effective September 1, 2014, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has mandated that time-outs must be performed prior to emergency tracheostomy due to any reason, no exceptions. Due to numerous incidences of "never" events and lack of consistent acquisition of consent prior to emergency tracheostomy to treat catastrophic airway…
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August 28, 2014

Joan Rivers Suffers Respiratory Arrest During "Throat" Procedure

Image by David Shankbone of Wikipedia It was reported today 8/28/14 that comedian Joan Rivers suffered some type of respiratory arrest during some type of sedated endoscopic procedure. According to reports, the endoscopy was done to "check her vocal cords." It was also reported that this procedure was performed at Yorkville Endoscopy in New York City. Just based on this limited information released to the public, I suspect the following... 1) The endoscopy procedure was pr…
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Distractions During Surgery is Common

Patients often consider surgery to be performed in a setting where there are no distractions so that the surgeon can focus on the task at hand. Unfortunately, this impression is far from the truth where distractions abound and sometimes can approach on the chaotic. Although anecdotal stories can be told, perhaps it is better to mention a few studies where third parties observed the goings on in the operating room. A study done in 2013 observed 3,557 distractions over 32 separate surgic…
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August 27, 2014

Best Headphones for Kids

MacWorld did a nice review on the best headphones for kids which is important given the increasing use of electronic devices in the classroom. It should be noted that the best headphones for adults are not the best headphones for kids due to important discrepancies in size, durability, and absence of volume-limit controls. From an ENT perspective, volume-limit controls are the most important factor when picking a set of headphones for a child as such circuitry prevents the headphones from pl…
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August 25, 2014

Steroid Injection Into the Ear May Help Bell's Palsy

Intratympanic steroid injections are typically performed for sudden nerve hearing loss. However, preliminary research suggests that it may also help resolve facial paralysis due to Bell's Palsy . In this prospective, double-blinded, randomized study , one group of patients received standard treatment with oral steroids and antiviral medications whereas the experimental group received the same medications PLUS intratympanic steroid injection as well. (I should mention that antiviral me…
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August 24, 2014

Does Upper Lip Tie Removal Help Prevent Upper Front Teeth Gap?

It is not uncommon that I see a newborn or young child for upper lip tie with a specific parental concern for development (or existence) of a gap between the two upper front teeth. Also known as maxillary midline diastema , this condition is extremely common being present in up to 50%+ of children between ages 6 and 8. It should be mentioned that upper lip tie frenulectomy  (or frenectomy) is the complete removal of the upper lip tie surgically which is different from upper lip tie release…
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August 22, 2014

Hole in Tonsil Area After Tonsillectomy

Rarely, a patient may notice a hole in the mucosa in the area where the tonsil used to be after removal ( tonsillectomy ). This hole typically is located in the anterior tonsil pillar as shown in the picture to the right. Less commonly, the hole may occur on the posterior tonsil pillar as shown below. Typically, this hole appears not immediately after surgery, but 5-10 days afterwards. Known as a fistula, this is a temporary situation as this hole will almost always close up over several …
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August 19, 2014

August 18, 2014

Video on Upper Lip Tie Release

A  new video  has been uploaded to show how  upper lip tie  is treated. Check it out! Unlike  "regular" tongue tie , upper lip tie is when the upper lip is tethered to the gum causing breastfeeding difficulties. For more information, click  here . For related info on tongue tie, click  here .
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August 13, 2014

Video on POSTERIOR Tongue Tie Treatment

A  new video  has been uploaded to show how posterior tongue tie is treated. Check it out! Unlike "regular" tongue tie , posterior tongue tie is when the tongue tie is hidden under the mucosal surface. Regardless of the type of tongue tie, it limits the mobility of the tongue which may lead to problems with breast-feeding in newborns and speech development in toddlers. Even  adults get tongue tie release  performed due to symptoms felt secondary to an immobile tongue. For m…
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August 11, 2014

Treatment for Mal de Debarquement Syndrome

Image from Frontiers in Neurology Mal de débarquement is a relatively rare balance disorder that occurs usually after traveling at sea. While on the boat, symptoms are absent, but once on land, there is a persistent swaying, rocking, and/or bobbing motion that is felt internally for months and even years. Physical findings of mal de debarquement include body oscillations at 0.2 Hz, oscillating vertical nystagmus when the head was rolled from side-to-side, and unilateral rotation during t…
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August 05, 2014

Ultrasound of Breastfeeding Baby

Ever wonder what breastfeeding looks like inside an infant's mouth? What does the tongue do exactly? Does it move up and down or is it more back and forth? How far does the nipple go into the mouth exactly? Well, using ultrasound , researchers were able to exactly see what happens during breastfeeding inside an infant mouth. The key learning point discovered from the ultrasound images is that milk expression is due to a vacuum created within the infant mouth that occurs from the …
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August 04, 2014

August 03, 2014

August 01, 2014

Lawsuit Over Neck Cancer Misdiagnosed by Smell

In December 2012, a physician assistant (PA) excised a 3 cm right neck mass from a patient. In perhaps one of the more bizarre steps taken in this case, the physician assistant than smelled the excised mass, declared it non-cancerous, and threw it out in the garbage. Unfortunately, it was actually cancer which was correctly diagnosed 6 months later after the mass which had regrown was excised and sent to pathology by a doctor. The patient ultimately underwent a radical neck dissection and …
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Mother Arrested for Buying One Too Many Sudafed

Ever since it was discovered that the active ingredient in Sudafed  can be used as a precursor for making methamphetamines, innocents have been arrested for buying a little too much allowed under the law. According to police, ignorance of the law is no excuse. So here's two cautionary tales... On July 19, 2010, a mom bought two boxes of 24-hour Sudafed  to alleviate her allergy symptoms in a Florida pharmacy. On July 30, 2009, a grandmother in Indiana bought Zyrtec-D for her hus…
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