tag:blogger.com,1999:blog-86213173798734997022024-03-14T03:15:18.151-04:00Fauquier ENT BlogENT News Brought to You by Fauquier ENT of VirginiaFauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.comBlogger1854125tag:blogger.com,1999:blog-8621317379873499702.post-55373756449643019322024-02-18T20:08:00.006-05:002024-02-21T08:39:04.281-05:00Man Dies from Nose and Mouth Bleeding During Airplane Flight<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWw_3WUiPTAilVhsDS8XZcL7DkEwwPYKR3f4DjifoTDrOBuKfe5ZY3bDXfeWtXnKlQ2EnZNgstN_jW-VEjMy8h2Ni9igwBFqHEGFpxcsbOTgKggtu4Szgztd9nNb7lROKLrgkN_4rC5HlbiSfS0Fa0vwaMnxW0y130fqsXgFbsRgkr4Pxo0FJSzKqTLt0/s1540/Screenshot%202024-02-18%20at%206.58.04%E2%80%AFPM.png" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="1374" data-original-width="1540" height="359" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjWw_3WUiPTAilVhsDS8XZcL7DkEwwPYKR3f4DjifoTDrOBuKfe5ZY3bDXfeWtXnKlQ2EnZNgstN_jW-VEjMy8h2Ni9igwBFqHEGFpxcsbOTgKggtu4Szgztd9nNb7lROKLrgkN_4rC5HlbiSfS0Fa0vwaMnxW0y130fqsXgFbsRgkr4Pxo0FJSzKqTLt0/w400-h359/Screenshot%202024-02-18%20at%206.58.04%E2%80%AFPM.png" width="400" /></a></div><br />On Feb 9, 2024, <a href="https://nypost.com/2024/02/09/news/passenger-dies-mid-flight-after-blood-erupts-from-his-mouth-and-nose/" target="_blank">media</a> reported on a passenger who died during a Lufthansa flight from Thailand to Germany on Feb 8, 2024. Eyewitness reports provided the following facts:<p></p><p><br /></p><p>• 63 years old male.</p><p>• Passenger was ill-appearing even before boarding the airplane.</p><p>• Profuse bleeding occurred from the nose and mouth.</p><p>• Litres of blood was lost with splattering to the walls of the airplane.</p><p>• Flight attendants tried to resuscitate the passenger for 30 minutes before he died.</p><p><br /></p><p>There are only a few things I can think of to explain what happened. starting with the most to the least likely.</p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTGZVmpHOotFRM1CR76BL27HZLobOIxoCpT5BXymC5PRj5YTShb79QgDJgKcVSOZ41s1Ay7xKLYTLgLIucD6bIGCuCTMRIcL7teKP5Ai2CjteddroUHGfyUfANpozqr0a2KQXTmMCjbUv9sYW_lhBYXqA2-hj1ye35rbsBitApR6k27PcSLZFxdyG7CC0/s538/nasal__blood__supply.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="446" data-original-width="538" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTGZVmpHOotFRM1CR76BL27HZLobOIxoCpT5BXymC5PRj5YTShb79QgDJgKcVSOZ41s1Ay7xKLYTLgLIucD6bIGCuCTMRIcL7teKP5Ai2CjteddroUHGfyUfANpozqr0a2KQXTmMCjbUv9sYW_lhBYXqA2-hj1ye35rbsBitApR6k27PcSLZFxdyG7CC0/s320/nasal__blood__supply.jpg" width="320" /></a></div><p><br /></p><p>1) <b>A very bad <a href="https://www.fauquierent.net/epistaxis.htm" target="_blank">nosebleed</a></b>. Not the typical one that most people get (anterior nosebleed), but one that occurs from the <a href="https://en.wikipedia.org/wiki/Sphenopalatine_artery" target="_blank">sphenopalatine artery</a> (posterior nosebleed). There is a fairly large artery located in the very back of the nose which can rarely erupt causing a very bad nosebleed that typically occurs out the nose and mouth. Without bleeding control which mandates posterior nasal packing, it is entirely conceivable that death would occur within 30 minutes. Blood hitting the wall may be due to coughing as blood drips into the throat unexpectedly. However, one does not have to be ill to suffer from such nosebleeds.</p><p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://www.mayoclinic.org/-/media/kcms/gbs/patient-consumer/images/2013/11/15/17/39/an00758_-ds00676_-ds00785_-ds00820_im02167_ans7_esphogeal_varicesthu_jpg.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="591" data-original-width="632" height="374" src="https://www.mayoclinic.org/-/media/kcms/gbs/patient-consumer/images/2013/11/15/17/39/an00758_-ds00676_-ds00785_-ds00820_im02167_ans7_esphogeal_varicesthu_jpg.jpg" width="400" /></a></div><br />2) <a href="https://en.wikipedia.org/wiki/Esophageal_varices#:~:text=They%20are%20most%20often%20a,typically%20diagnosed%20through%20an%20esophagogastroduodenoscopy." target="_blank"><b>Esophageal varices rupture</b></a>. Esophageal varices develop when regular blood flow to the liver is blocked by a clot or scar tissue in the liver. To go around the blockages, blood flows into smaller blood vessels that aren't designed to carry large volumes of blood. The vessels can leak blood or even burst, causing life-threatening bleeding, conceivably resulting in death in about 30 minutes. Such bleeding can be so copious that not only will the blood drain into the stomach, but also up and out the mouth and nose. Such patients are ill-appearing at baseline. This condition is treated by a GI specialist.<p></p><p><br /></p><p>3) <b><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5506819/" target="_blank">Carotid blowout</a></b>. Passenger was ill-appearing which may have been due to a history of late-stage throat cancer that was treated with radiation therapy. In such cases, sometimes, the wall separating the carotid artery from the inside of the throat can be very thin. So thin, that it may rupture causing blood to suddenly pour out of the mouth like a geyser. The amount of bleeding can be so vigorous, it will also come out the nose and even eject out the mouth. Patients who suffer from a carotid blowout will usually die within minutes... not 30 minutes later, unless the carotid blowout is pinhole with ball-valving from surrounding soft tissues.</p><p><br /></p><p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://upload.wikimedia.org/wikipedia/commons/3/35/Relations_of_the_aorta%2C_trachea%2C_esophagus_and_other_heart_structures.png" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="630" data-original-width="800" height="315" src="https://upload.wikimedia.org/wikipedia/commons/3/35/Relations_of_the_aorta%2C_trachea%2C_esophagus_and_other_heart_structures.png" width="400" /></a></div><br />4) <b><a href="https://www.ncbi.nlm.nih.gov/books/NBK482505/" target="_blank">Tracheoinnominate fistula</a></b>. Passenger was ill-appearing which may be due to a history of a tracheostomy due to prolonged intubation from respiratory failure. Obviously recovered enough to travel... and perhaps even no longer having a tracheostomy tube. With such a fistula, the aortic artery ruptures into the windpipe over a weakened area where the trach tube rubbed against the anterior tracheal wall. Similar to the carotid blowout, the amount of bleeding can be vigorous and since blood would be pouring into the windpipe, the patient would be literally drowning in his own blood. Coughing would occur to the point it would come out the nose and mouth. Patients who suffer from a tracheoinnominate fistula usually die within minutes. Certainly not 30 minutes later... but who knows? Maybe it was a very tiny pinhole fistula.<p></p><p><br /></p><p>In the end, without more details, it is impossible to say what caused this passenger's death. No matter what the cause, without the ability to intubate to protect the airway and having the right tools immediately on hand, I'm not sure what even an ENT doctor would have been able to do to save this passenger's life in an airplane using only the on-board <a href="https://www.healthfirst.com/blog/faa-emergency-medical-kits/" target="_blank">emergency medical kit</a>. </p><p><br /></p><p>At this time, the following items can be found in a <a href="https://www.healthfirst.com/blog/faa-emergency-medical-kits/" target="_blank">FAA approved emergency medical kit.</a></p><div><br /></div>• Sphygmomanometer <div>• Stethoscope </div><div>• Airways, oropharyngeal: 1 pediatric, 1 small adult, and 1 large adult or equivalent </div><div>• Self-inflating manual resuscitation device with 1 pediatric mask, 1 small adult mask, and 1 large adult or equivalent mask </div><div>• Cardiopulmonary resuscitation masks: 1 pediatric, 1 small adult, and 1 large adult or equivalent </div><div>• IV administration set: 1 tubing with 2 Y-site connectors, 2 alcohol-soaked sponges, 1 standard roll of 1-inch-wide adhesive tape, 1 pair of tape scissors, and 1 tourniquet </div><div>• Protective nonpermeable gloves or equivalent, 1 pair </div><div>• Needles: 2 18 gauge, 2 20 gauge, and 2 22 gauge; or 6 needles in sizes necessary to administer required medications </div><div>• Syringes: 1 5 cc and 2 10 cc; or 4 syringes in sizes necessary to administer required medications</div><div>• Analgesic, nonnarcotic, 325-mg tablets, 4 </div><div>• Antihistamine, 25-mg tablets, 4 </div><div>• Antihistamine injection, 50-mg single-dose ampule or equivalent, 2 </div><div>• Atropine injection, 0.5-mg single-dose 5-mL ampule or equivalent, 2 </div><div>• Aspirin, 325-mg tablets, 4 </div><div>• Bronchodilator, metered-dose inhaler or equivalent </div><div>• 50% Dextrose injection, single-dose 50-mL ampule or equivalent </div><div>• Epinephrine injection, 1:1000 (1 mg/mL) single-dose 1-mL ampule or equivalent, 2 </div><div>• Epinephrine injection, 1:10,000 (0.1 mg/mL) single-dose 2*-mL ampule or equivalent, 2 </div><div>• Lidocaine injection, 20-mg/mL single-dose 5-mL ampule or equivalent, 2 </div><div>• Nitroglycerin, 0.4-mg tablets, 10 </div><div>• 9% Sodium chloride injection, 500 mL </div><div>• Basic instructions for use of the drugs in the kit</div><div><br /></div><div>When limited to the supplies above and possibly what may have been available in an airplane full of passengers, certainly, an IV would have been placed and the 500mL of 9% sodium chloride would have been pushed to address hypovolemic shock. </div><div><br /></div><div>Depending where the bleeding is occurring, an oropharyngeal airway might be inserted, though this alone would have done little to help overall. A resuscitation mask would have just prevented blood from getting everywhere and on everyone, but not helpful in terms of the passenger's life if drowning in blood.</div><div><br /></div><div>If one was to truly go McGyver to save this passenger's life, a <a href="https://youtu.be/2KOiKeE0lUs" target="_blank">cricothyroidotomy</a> could have been performed using the scissors in the emergency kit. The skin could have been first anesthetized with the supplied lidocaine, syringe, and needle. The scissors could be used to help enlarge the opening enough such that a large diameter ball point pen obtained from somebody could have been inserted to have an airway of some type. Somebody can then blow into the pen's tubing to provide breaths. Once airway is "secured" in this hack fashion, the nose and mouth could have been packed as tightly as possible using shoelaces for the nose and neckties stuffed into the mouth to hopefully provide enough pressure to stop the bleeding. </div><div><br /></div><div>Of course, the passenger would probably be actively fighting if any of the above was being performed until he loses consciousness from blood loss. Ideally, keeping the patient as calm as possible would minimize bleeding, but is probably unrealistic in this scenario without adequate IV medications immediately available.</div>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-9801856385660181472024-02-16T17:26:00.000-05:002024-02-16T17:26:07.681-05:00Reflux that Occurs... Past the Throat... and Up Into the Nose!!! <div class="separator" style="clear: both; text-align: center;"><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyypVY4TF_skXHbw4uydPS_U-hthLm3QqhyphenhyphenX_3hGiy4LLW3J_VG8bouQj6jQFX237708CQljP28Jl90AZqZhHdJohL8KfZ6tJEILmyqxH8O8IPkhL7QhqZvVe7S9oxvp8vr7_m5h5YZDGwBPUuwVUxlo9JG3TOgZtWlgurkKqJUX_2Eo8TPOhrqZkNCD0/s1080/mulberryIT.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="576" data-original-width="1080" height="344" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhyypVY4TF_skXHbw4uydPS_U-hthLm3QqhyphenhyphenX_3hGiy4LLW3J_VG8bouQj6jQFX237708CQljP28Jl90AZqZhHdJohL8KfZ6tJEILmyqxH8O8IPkhL7QhqZvVe7S9oxvp8vr7_m5h5YZDGwBPUuwVUxlo9JG3TOgZtWlgurkKqJUX_2Eo8TPOhrqZkNCD0/w640-h344/mulberryIT.jpg" width="640" /></a></div><p>Everyone has heard of reflux which medically is known as gastroesophageal reflux (GERD). Some may even have heard of <a href="https://www.fauquierent.net/lpr.htm" target="_blank">laryngopharyngeal reflux (LPR)</a> which is reflux that extends past the chest and up into the throat.</p><p><br /></p><p>However, few have heard of reflux that is even worse than LPR called <b>nasopharyngeal reflux</b> (NPR)where the reflux does not just reach the throat level, but extends past the throat and goes all the way up into the nose! Called nasopharyngeal reflux, this possibility is raised with certain abnormal endoscopic findings seen in the very back of the nose. Known as mulberry like changes of the posterior inferior nasal turbinate, the mucosa is not just swollen, but also bumpy in appearance as shown in the images above [<a href="https://onlinelibrary.wiley.com/doi/10.1002/lary.30766" target="_blank">reference</a>]. The full clinical picture needs to be considered as well given mulberry inferior turbinates may also occur due to <a href="https://www.fauquierent.net/allergycontrol.htm" target="_blank">allergies</a> and <a href="https://www.fauquierent.net/afrin.htm" target="_blank">rhinitis medicamentosa</a>, though the mucosa tends to be more "smooth" in appearance for these other conditions.</p><p><br /></p><p><a href="https://www.fauquierent.net/refluxmeds.htm" target="_blank">Treatment</a> is still the same regardless whether GERD, LPR, or NPR.</p>
<div class="separator" style="clear: both; text-align: center;"><a href="https://www.fauquierent.net/store_reflux.htm" style="clear: center; float: center; margin-bottom: 1em; margin-left: 1em;" target="_blank"><img border="0" data-original-height="676" data-original-width="800" height="270" src="https://www.fauquierent.net/store/a-reflux.png" width="320" /></a></div><div class="separator" style="clear: both; text-align: center;"><br /></div>
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/jzQhatzhuA0?si=1cQZlicjGlvpe5TT" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-9535694651008945802023-11-17T08:12:00.002-05:002023-11-17T08:12:58.410-05:00Ruptured Eardrums and Outer Ear Infections (Swimmer's Ear)<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/NyzexD09YyU?si=IDepWSluX2KLEuI0" title="YouTube video player" width="560"></iframe>
<p><br /></p><p><a href="https://www.fauquierent.net/eardrumhole.htm" target="_blank">Ruptured eardrums</a> are a very common ear issue that triggers an ENT office visit. A ruptured eardrum may occur due to an infection or trauma (from a q-tip or being slapped over the ear). Although it sounds serious, the vast majority of a perforated eardrum heal closed within a few weeks. Rarely, it may take up to one year to close. The <a href="https://youtu.be/NyzexD09YyU" target="_blank">video</a> shown above demonstrates a time-lapse healing of a traumatic ruptured eardrum healing closed over 3 weeks. Rarely, if a hole in the eardrum is suspected not to be closing and is causing problems such as hearing loss and recurrent ear infections, it can be <a href="https://www.fauquierent.net/eardrumhole.htm" target="_blank">surgically closed</a>.</p><p><br /></p><p>The other common urgent ear issue that is often seen in an ENT office is an outer <a href="https://www.fauquierent.net/earinfections.htm" target="_blank">ear infection</a>, also known as Swimmer's ear. This condition is due to an infection of the ear canal skin causing it to swell. The swelling can get so bad that it blocks hearing and causes severe pain. The <a href="https://www.youtube.com/watch?v=wwZ6zY7bF1c" target="_blank">video</a> below demonstrates what a Swimmer's ear looks like and how it is treated.</p><p><br /></p>
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/wwZ6zY7bF1c?si=6EDu5j7nYtmkffqO" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-8113636729560392082023-11-09T09:56:00.004-05:002024-03-06T20:50:25.153-05:00Dizziness due to Visual Vertigo, Motion Sensitivity, and Mal de Debarquement Syndrome (And How to Treat It)<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/IhJ_SlCnWb4?si=ALxdUCAX3kL2qwq4" title="YouTube video player" width="560"></iframe>
<p><br /></p><p>Normally, the human balance system incorporates information from vision, inner ear vestibular system, and the proprioceptive system. The inner ear vestibular system is responsible for detecting rotational and linear movements of the head whereas the proprioceptive system is responsible for knowing where one's body and limbs are positioned from information provided by the skin, muscles, joints. Vision provides information on where one is in space relative to other objects.</p><p><br /></p><p>Normal balance requires the brain to incorporate information from all 3 systems which is then synthesized into "normal" balance sensory output.</p><p><br /></p><p>Of course, if any of these systems are dysfunctional, <a href="https://www.fauquierent.net/dizzy.htm" target="_blank">dizziness</a> occurs. For example, <a href="https://www.fauquierent.net/bppv.htm" target="_blank">BPPV</a> is a dysfunction of the inner ear vestibular system leading to sudden transient spinning attacks with head movement. <a href="https://youtu.be/vIwSMOrsD8M" target="_blank">Cervicogenic vertigo</a> is due to dysfunction of the proprioceptive system that may occur from whiplash cervical injury. Visual dysfunction can lead to imbalance as occurs when a person is stumbling around at night.</p><p><br /></p><p>As opposed to the prior examples, <a href="https://youtu.be/IhJ_SlCnWb4" target="_blank">visual vertigo</a>, <a href="https://youtu.be/IhJ_SlCnWb4" target="_blank">motion sensitivity</a>, and <a href="https://youtu.be/a4402WcaQA4" target="_blank">mal de debarquement</a> syndrome are actually to a dysfunction of the brain. Vision, inner ear, and proprioceptive systems are all working normally and testing of these different system individually alone will all come back normal.</p><p><br /></p><p>What happens in these particular disorders is that the brain is over-emphasizing input from the visual system while ignoring data coming in from the other 2 systems. Given the lopsided emphasis on vision, dizziness occurs. Even people with normal balance will experience this for a transient time when watching a point-of-view roller coaster on a large screen. Movement will be felt due to the eyes deceiving the brain which ignores input from the inner ear and proprioceptive systems which state that no movement is present. However, unlike normal individuals, people suffering from visual vertigo, motion sensitivity, and <a href="https://youtu.be/a4402WcaQA4" target="_blank">mal de debarquement syndrome</a> will continue to have recurrent or prolonged symptoms even to minimal triggering events.</p><p><br /></p><p>Thankfully, there are relatively simple home exercises that one can perform to help the brain "reset" back to normal and regain normal balance with proper synthesis of input from the 3 different systems.</p><p><br /></p><p>Check out the videos shown here on how to perform these exercises!</p>
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/a4402WcaQA4" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-28806896288760117422023-11-08T06:07:00.001-05:002023-11-08T06:07:33.464-05:00Time Lapse of Different Skin Diseases Including Psoriasis, Wart, and a Pimple<iframe width="560" height="315" src="https://www.youtube.com/embed/9ZPmw5QJZ3E?si=2okxSgddSbYj6d--" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen></iframe>
<p><br /></p><p><br /></p><p>Although warts, pimples, and psoriasis are mainly considered dermatologic conditions, it fascinating to think about how such skin conditions develop over time from start to finish in one smooth time lapse. Using generative AI utilizing actual skin photos, it is possible to create such time lapse videos that otherwise would be impossible.</p><p><br /></p><p>Just to clarify, these are skin conditions treated by dermatologists (not ENTs). I just created these videos because I thought it would be cool!</p><p><br /></p><p>Check them out!</p>
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/KV8hY4hMiyI?si=FXEEWHfbPobw72zC" title="YouTube video player" width="560"></iframe>
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/sV7wRzCz-HE?si=idX9ytptGfoQXKhH" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-8658633697731434622023-10-17T15:07:00.003-04:002023-10-17T15:07:35.329-04:00Ballet Dance Techniques to Help with Patients Who Suffer from Dizziness<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/f8qCjBpwTaw?si=QoxqLlQgvonSzJWu" title="YouTube video player" width="560"></iframe>
<p><br /></p><p>There has been some <a href="https://doi.org/10.1093/cercor/bht266" target="_blank">research</a> to suggest that ballet dance techniques can also help patients suffering from <a href="https://www.fauquierent.net/dizzy.htm" target="_blank">dizziness</a>.</p><p><br /></p><p>Given this revelation, professional ballerina, <a href="https://www.instagram.com/moyadani/?hl=en" target="_blank">Dani Moya</a> with the <a href="https://manassasballet.org/" target="_blank">Manassas Ballet Theatre</a> has graciously provided her time and expertise to provide video instruction on 14 exercises geared towards improving balance. These exercises start out very simple, but get progressively more difficult. Although these exercises are specifically geared towards non-dancers, these same techniques are utilized by ballerinas to improve their overall sense of balance as well (and to prevent from getting dizzy when doing their dance routines).</p><p><br /></p><p>These exercises, especially after the first few, should only be performed by individuals who are reasonably physically fit.</p><p><br /></p><p>Below are two videos demonstrating the more traditional home exercises for dizziness.</p><p><br /></p>
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/9Au1Sjx2pH8?si=DWM5QrWmkwPROXk4" title="YouTube video player" width="560"></iframe>
<br /><br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/0SVkxQGY9bY?si=A9cAdM9mhDTSQ1qx" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-29180716996453795792023-09-19T04:42:00.000-04:002023-09-19T04:42:06.253-04:00Acupuncture May Help with Tinnitus<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB0mMY2s2lvRtR-dtOVsrsUnTZQzL3MZc1y_OMVhSCCeRHxW97EIS8hwpcOdNWVbM6tRYXa9MDN4YIvr0lOpOxL0CH0i_4ekWed8Qp227GzTgmgADSHEVoRH-bCty7ISg7PXgGoxp8YLyTXXOSoKAmiIgqouXYIh-dd8nniC0pv_sKxd9k-ktuYcQsWfg/s500/VgVNNQnd48dNEO4Qf.5ZVg.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="500" data-original-width="383" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB0mMY2s2lvRtR-dtOVsrsUnTZQzL3MZc1y_OMVhSCCeRHxW97EIS8hwpcOdNWVbM6tRYXa9MDN4YIvr0lOpOxL0CH0i_4ekWed8Qp227GzTgmgADSHEVoRH-bCty7ISg7PXgGoxp8YLyTXXOSoKAmiIgqouXYIh-dd8nniC0pv_sKxd9k-ktuYcQsWfg/w308-h400/VgVNNQnd48dNEO4Qf.5ZVg.jpg" width="308" /></a></div><br />There was an interesting <a href="https://journals.sagepub.com/doi/10.1177/0964528420938380" target="_blank">study published in 2020</a> that evaluated the effectiveness of acupuncture in treating <a href="https://www.fauquierent.net/audiotin.htm" target="_blank">tinnitus</a> by evaluating 8 randomized controlled trials involving 504 patients. Although there was no difference between study and control groups on a visual analog scale (VAS), positive effects on secondary outcomes, tinnitus handicap inventory (THI) and tinnitus severity index (TSI), were seen.<p></p><p><br /></p>In these studies, the most commonly used traditional acupuncture points utilized were:<div><div><br /></div><div>• GB-2 (Tinghui)</div><div>• SI-19 (Tinggong)</div><div>• TE-21 (Ermen)</div><div>• TE-17 (Yifeng)</div><div>• GB-20 (Fengchi)</div><div>• TE-3 (Zhongzhu)</div><div><br /></div><div>The frequency of acupuncture ranged from twice a week to once a day. The needle retention time ranged from 20 to 40 minutes. The total number of acupuncture treatments ranged from 10 to 25. The course of acupuncture treatment ranged from 20 days to 2 months.</div></div><div><br /></div>
Only one study mentioned follow-up which reported that 3 weeks after the end of treatment, the differences in the VAS and TSI scores between the experimental and control groups were still significant.<div><br /></div><div>Acupuncture can certainly be considered for those suffering from tinnitus, but like other tinnitus treatments, it may help some folks, but not others.</div><div><br /></div><div>Other types of <a href="https://www.checkhearing.org/tinnitustreatment.php" target="_blank">tinnitus treatments</a> that may be helpful can be found <a href="https://www.checkhearing.org/tinnitustreatment.php" target="_blank">here</a> including custom white noise, notched audio, cr-neuromodulation, etc.</div><div><br /></div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh47lkNr_wbBjKl5cohHMfxaP5DMCCoZQxaD1qHy2XWjxxl9e9qCouLojvWc_I16zfabA_L4Q1xu8MFrAwdE4rbL2_yZxICdXh8hPtt8LnEMUFo3LMX4_m2tnpAjPp2Hrl-0LdVO8sI9D16srjpzYL3jdQaUp-a-HMcnafz34FkveGUEOqbyDO2mt2OSlA/s686/Screenshot%202023-09-19%20at%204.34.41%20AM.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="686" data-original-width="648" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh47lkNr_wbBjKl5cohHMfxaP5DMCCoZQxaD1qHy2XWjxxl9e9qCouLojvWc_I16zfabA_L4Q1xu8MFrAwdE4rbL2_yZxICdXh8hPtt8LnEMUFo3LMX4_m2tnpAjPp2Hrl-0LdVO8sI9D16srjpzYL3jdQaUp-a-HMcnafz34FkveGUEOqbyDO2mt2OSlA/s320/Screenshot%202023-09-19%20at%204.34.41%20AM.png" width="302" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjV0apNhD_UoW_dxF14JJYPl3QfQ9h7dVBHsOermLUZz6oNjk8JLdgRiDjrCjWUZ-31Rxm5RxsEpKSnzTtdz2p_QxUEwviv9eV9AMzkm35_p0_ABQWE_Nd7LP9Do1j6Q-ByAk5LB9cA3jtrjrGJcv_ylZW3Ym28m1U-0RSwmPdLDJqlJkQmgT1U_RMqPLg/s410/2-gb20.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="410" data-original-width="312" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjV0apNhD_UoW_dxF14JJYPl3QfQ9h7dVBHsOermLUZz6oNjk8JLdgRiDjrCjWUZ-31Rxm5RxsEpKSnzTtdz2p_QxUEwviv9eV9AMzkm35_p0_ABQWE_Nd7LP9Do1j6Q-ByAk5LB9cA3jtrjrGJcv_ylZW3Ym28m1U-0RSwmPdLDJqlJkQmgT1U_RMqPLg/s320/2-gb20.png" width="244" /></a></div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAzt3bFV9N2mtcZrCZHFQSWWZVyjOPBZO5av5jLxz-DWQX5-n1rQ8LY1xEBIxO5EGO2RoGbCxZ7gYocefOO1pxWDsynfENcJ-oeN8YQ0dw5YxjTyZctz9Z-HXBvFHQtgJAL9tJgiTTX1ekCXTS-C5MhoEyTQj6r2MavMSp3CB5oziPQHbeogYQKS-YzoY/s720/hand.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="521" data-original-width="720" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgAzt3bFV9N2mtcZrCZHFQSWWZVyjOPBZO5av5jLxz-DWQX5-n1rQ8LY1xEBIxO5EGO2RoGbCxZ7gYocefOO1pxWDsynfENcJ-oeN8YQ0dw5YxjTyZctz9Z-HXBvFHQtgJAL9tJgiTTX1ekCXTS-C5MhoEyTQj6r2MavMSp3CB5oziPQHbeogYQKS-YzoY/s320/hand.png" width="320" /></a></div></div><div class="separator" style="clear: both; text-align: center;"><br /></div><div><b>References:</b></div><div><br /></div>
<a href="https://journals.sagepub.com/doi/10.1177/0964528420938380" target="_blank">Acupuncture for tinnitus: a systematic review and meta-analysis of randomized controlled trials.</a> Acupuncture in Medicine. 2021;39(4):264-271. doi:10.1177/0964528420938380
<br /><br />
<a href="https://pubmed.ncbi.nlm.nih.gov/29387318/" target="_blank">Acupuncture for chronic nonpulsatile tinnitus: a randomized clinical trial</a>. Caspian J Intern Med 2018; 9: 38–45.
<br /><br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/9710337" target="_blank">Effect of traditional Chinese acupuncture on severe tinnitus: a double-blind, placebo-controlled, clinical investigation with open therapeutic control</a>. Br J Audiol 1998; 32: 197–204.
<br /><br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/26747258" target="_blank">The effectiveness of acupuncture as a treatment for tinnitus: a randomized controlled trial using (99m)Tc-ECD SPECT</a>. Eur Radiol 2016; 26: 3234–3242.
<br /><br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/27352493" target="_blank">The effects of acupuncture on the inner ear originated tinnitus</a>. J Res Med Sci 2011; 16: 1217–1223.
<br /><br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/27352493" target="_blank">Cervical tinnitus treated by acupuncture based on “jin” theory: a clinical observation</a>. Zhongguo Zhen Jiu 2016; 36: 369–372.
<br /><br />
<a href="https://scholar.google.com/scholar_lookup?title=Clinical+observation+on+acupuncture+treatment+of+tinnitus+under+the+theory+of+kidney+and+sanjiao+communication&author=SD+Duan&author=HJ+Zhou&author=S+Wu&publication_year=2016&journal=Shanghai+J+Acupunct+Moxibustion&pages=440-442" target="_blank">Clinical observation on acupuncture treatment of tinnitus under the theory of kidney and sanjiao communication.</a> Shanghai J Acupunct Moxibustion 2016; 35: 440–442.
<br /><br />
<a href="https://scholar.google.com/scholar_lookup?title=Clinical+observation+on+warm+acupuncture+for+tinnitus&author=Y+Cao&author=N+Jiang&author=HY+Dong&publication_year=2014&journal=Shanghai+J+Acupunct+Moxibustion&pages=1124-1126" target="_blank">Clinical observation on warm acupuncture for tinnitus</a>. Shanghai J Acupunct Moxibustion 2014; 33: 1124–1126.
<br /><br />
<a href="https://scholar.google.com/scholar_lookup?title=Clinical+observation+on+tinnitus+of+up+disturbance+of+liver+excessive+fire+type+with+twirling-reducing+method+of+acupuncture&author=J+Li&author=XZ+Zhang&author=GH+Lu&publication_year=2017&journal=Liaoning+J+Tradit+Chin+Med&pages=149-151" target="_blank">Clinical observation on tinnitus of up disturbance of liver excessive fire type with twirling-reducing method of acupuncture</a>. Liaoning J Tradit Chin Med 2017; 44: 149–151.
<br />Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-74832657018427652362023-09-06T06:14:00.004-04:002023-09-06T06:22:37.578-04:00Jimmy Buffet Dies of Merkel Cell Carcinoma Skin Cancer<br />
<p align="center"><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="500" src="https://www.youtube.com/embed/VgkJF7aHSTM?si=WstIpbIS91b2ZPOv" title="YouTube video player" width="50%"></iframe></p>
<p> </p>
<p>On Sept 1, 2023, <a href="https://www.jimmybuffett.com/news/jimmy-buffett-1946-2023" target="_blank">Jimmy Buffet died</a> from merkel cell carcinoma which is a rare and deadly skin cancer... Way more deadly than melanoma. Melanoma has a 10 year survival rate of 61.3% whereas merkel cell carcinoma is only 17.7% [<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3161663/" target="_blank">link</a>]. 5 year survival rates for merkel cell carcinoma is 75% if localized to the skin (stage 1) and only 24% if it has already spread elsewhere in the body (stage 4) [<a href="https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/detection-diagnosis-staging/survival-rates.html" target="_blank">link</a>].</p>
<br />
<p>Jimmy Buffet died within 4 years of his merkel cell carcinoma diagnosis. It is unclear what stage his merkel cell caricnoma was at time of diagnosis, but early diagnosis is key to survival! As you can see from the video above, an early diagnosis is unfortunately uncommon because this skin cancer spreads painlessly in the early stages and <i>quickly</i>, usually to lymph nodes first and then to other parts of the body, including the brain, lungs and bones. Merkel cell carcinoma is much more likely to spread to other parts of the body compared to other types of skin cancers like basal cell and squamous cell, and grows much more quickly.</p><p><br /></p><p>I personally have encountered merkel cell carcinoma in only 2 patients within the past 20 years.</p><p><br /></p><p>Other more common skin cancer development can be seen in the video below.</p>
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/qyTws_GbSps?si=7lAs3GRmupNDXLrR" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-28989852457809753372023-09-02T06:21:00.030-04:002023-09-05T05:34:06.280-04:00What is the Most Common Tinnitus Frequency?<br /><p align="center">
<iframe height="550" src="https://docs.google.com/spreadsheets/d/e/2PACX-1vQt5FjylcSfXTO0H5LsX6bwUSz_xaWLpjQgqlNiim9L25_KVvmq-kCevPnZOO24_sO28A22s_qkld1T/pubhtml?gid=1912350706&single=true&widget=true&headers=false" width="75%"></iframe></p>
<p><b><br /></b></p><span style="text-align: center;"><div style="text-align: center;"><b style="font-weight: bold;">Low Pitch:</b> 0-1000 Hz</div></span><span style="text-align: center;"><div style="text-align: center;"><b style="font-weight: bold;">Medium Pitch:</b> 1000-5000 Hz</div></span><span style="text-align: center;"><div style="text-align: center;"><b style="font-weight: bold;">High Pitch</b><b>: </b>5000-10,000 Hz</div><div style="text-align: center;"><span style="font-weight: bold;"><b>Very High Pitch</b>: </span>10,000 - 25,000 Hz</div><div style="text-align: center;"><br /></div><div style="text-align: center;"></div></span>
<p align="center"><iframe height="250" src="https://docs.google.com/spreadsheets/d/e/2PACX-1vQt5FjylcSfXTO0H5LsX6bwUSz_xaWLpjQgqlNiim9L25_KVvmq-kCevPnZOO24_sO28A22s_qkld1T/pubhtml?gid=1230490784&single=true&widget=true&headers=false" width="450"></iframe></p>
<p><br /></p><p>The real-time graph shown above is the result of an <a href="https://forms.gle/BkP7PDppALveD3Yk7" target="_blank">on-going survey</a> of tinnitus sufferers voluntarily submitting their tinnitus frequency. The graph above is broken into pitch ranges whereas the graph shown below is further divided into hertz ranges. The graphs automatically update as new survey responses are completed.</p><div><br /></div><p>Believe it or not, we do not actually know the answer to this question which is why this survey is being taken! Nobody has done a methodical study on tabulating the tinnitus frequency of individuals. (Only two can be found on an internet search. One was performed by a company and reported on a <a href="https://audionotch.com/blog/2015/06/24/what-are-the-most-common-tinnitus-frequencies/">blog</a> and another was more focused on <a href="https://pubmed.ncbi.nlm.nih.gov/24349414/" target="_blank">psychoacoustics</a>; overall, they report most cases of tinnitus is between 5000 - 10,000 Hz which our results also seem to support.)</p><p><br /></p><p>To that end, we have created this online survey that opened on Sept 2, 2023. If you suffer from tinnitus, please consider sharing your specific tinnitus frequency on this <a href="https://forms.gle/BkP7PDppALveD3Yk7" target="_blank">ONE question survey form</a> to add to the results!</p><p><br /></p><p>To figure out your tinnitus frequency, you can use either a <a href="https://www.checkhearing.org/tinnitusmatching.php" target="_blank">tinnitus matching program</a> or a <a href="https://www.checkhearing.org/tinnitusFreqFinder.php" target="_blank">tinnitus frequency finder</a>.</p><p><br /></p><p style="text-align: center;"><b><span style="font-size: x-large;">Submit your tinnitus frequency on this</span></b></p><p style="text-align: center;"><b><span style="font-size: x-large;"><a href="https://forms.gle/BkP7PDppALveD3Yk7" target="_blank">ONE question survey</a>!</span></b></p><div style="text-align: left;"><br /></div><div style="text-align: left;">Please note that there are some weaknesses to this type of survey study... First, individuals self-determine their tinnitus frequency and voluntarily submit. Second, results may be biased to those who suffer from severe enough tinnitus that they even bother going through these steps. It is possible that the results may be different if every single patient with tinnitus, whether bothersome or not, completes the survey.</div><div style="text-align: left;"><br /></div><div style="text-align: left;">As such, due to these concerns, the results are probably more reflective of the most common <i>bothersome</i> tinnitus!</div><div style="text-align: left;"><br /></div>
<iframe height="525" src="https://docs.google.com/spreadsheets/d/e/2PACX-1vQt5FjylcSfXTO0H5LsX6bwUSz_xaWLpjQgqlNiim9L25_KVvmq-kCevPnZOO24_sO28A22s_qkld1T/pubhtml?gid=1697966261&single=true&widget=true&headers=false" width="100%"></iframe>
<br /><br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/qyFaUA14-KQ?si=HHbXKNQmlDk_YWkz" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-16934611257608196332023-08-24T11:21:00.008-04:002023-08-31T05:52:40.973-04:00Anti-Viral Treatment May Help Symptoms of Meniere's Disease<p>There is a <a href="https://pubmed.ncbi.nlm.nih.gov/25940200/" target="_blank">recent study</a> that suggested that symptoms of Meniere's disease (vertigo attacks and fluctuating hearing loss) can be reduced by taking an anti-viral medication for a prolonged period of time.</p><p><br /></p><p>Published in 2015, the <a href="https://pubmed.ncbi.nlm.nih.gov/25940200/" target="_blank">research</a> stated that 60% of patients achieved hearing improvement and vertigo resolution. Those patients who had Meniere's Disease for less than 3 years typically responded better to this treatment than those who have suffered from Meniere's Disease for a longer period of time.</p><p><br /></p><p>The anti-viral protocol used in the research was as follows:</p><p><br /></p><p><b>Valacyclovir</b></p><p> - 1g 3x per day for 3 weeks, then</p><p> - 1g 2x per day for 3 weeks, then</p><p> - 1g daily for up to 1 year.</p><p><br /></p><p><b>Acyclovir</b></p><p> - 1g 3x per day for 3 weeks, then</p><p> - 1g 2x per day for 3 weeks, then</p><p> - 1g daily for up to 1 year.</p><p><br /></p><p>Only 31 patients were in the study group and as such, larger studies need to be performed to verify these findings, ideally with placebo controls. Also, there were not many controls within this study which may complicate these findings... For example... The traditional way to treat Meniere's Disease is diet restriction (no salt, caffeine, alcohol), as well as taking betahistine and/or diuretic. Occasional administration of steroids may be of benefit as well and more rarely, surgical interventions can be considered.</p><p><br /></p><p>It is unclear whether ALL study patients (study participants are those who failed to respond to salt restriction and diuretics) attempted to continue these additional treatments at the same time and whether the diet of all participants was carefully monitored to ensure minimal variation. For example, perhaps those who had a positive effect from taking the anti-viral also finally responded to diet restrictions that they continued... whereas those who failed happened to have a high salt diet.</p><p><br /></p><p>Due to these limitations, anti-viral treatment for Meniere's is not something I personally would routinely recommend at this time. BUT, something I might consider in certain case-by-case situations.</p><p><br /></p><p><b>References:</b></p><a href="https://pubmed.ncbi.nlm.nih.gov/25940200/" target="_blank">Recovery of Hearing in Meniere's Disease after Antiviral Treatment</a>. Am J Otolaryngol
. 2015 May-Jun;36(3):315-23. doi: 10.1016/j.amjoto.2014.03.016. Epub 2014 Apr 5.
<br /><br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/qrk7OyAB_ss?si=QLklP53AZTiF_U0_" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-69400696989445540452023-08-05T06:41:00.009-04:002023-10-17T10:41:26.786-04:00Throat Cancer Treatment using Radiation Therapy<iframe width="560" height="315" src="https://www.youtube.com/embed/CNGtq-cdsQU?si=Sya42lR_9J6CXlBm" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen></iframe>
<p><br /></p><p>When an individual has been diagnosed with a form of head and neck cancer, <a href="https://www.youtube.com/embed/CNGtq-cdsQU?si=Sya42lR_9J6CXlBm">radiation therapy</a> is a very common treatment modality that may be recommended. After an initial consultation with a radiation oncologist, the video demonstrates the following prepatory steps taken to ready a patient for radiation treatment.</p>
<p><br /></p><p><b>Step 1:</b></p>
<p><br /></p><p>A custom mesh of the patient’s face, neck and shoulders is created. This mask is used to keep the head and neck absolutely still in an identical manner each time a patient has radiation therapy while allowing the patient to breathe easily.
</p><p><br /></p><p><b>Step 2:</b></p>
<p><br /></p><p>Once the mask has been created, a CT simulation scan is performed to obtain 3D images used for treatment planning. This scan allows the radiation oncologist to precisely target the tumor and surrounding areas that will require radiation exposure, while sparing normal tissues as much as possible.
Before radiation therapy begins, not only is a PET scan obtained to ensure the cancer has not spread elsewhere in the body, but the patient may also be required to see an oral surgeon to evaluate dental health, general surgeon for possible feeding tube placement, and a medical oncologist if chemotherapy is also required.</p>
<p><br /></p><p><b>Step 3:</b></p>
<p><br /></p><p>After all initial planning has been completed, radiation therapy can proceed. During this process, the head and neck is secured to the table with the mask to ensure consistent precise positioning throughout the entire course of radiation treatment. Radiation therapy is accomplished by directing a stream of radiation particles that is molded to precisely the cancer’s 3D shape via the multi-leaf collimator. Furthermore, the radioactive beam is rotated continuously around the cancer to ensure healthy tissue is not overly exposed, but collectively, keeping the focus of the radiation beams all centered on the cancer itself.</p>
<p><br /></p><p>A single treatment takes only a few minutes and is performed daily except on weekends. Treatment usually takes about 6-7 weeks. If chemotherapy or immunotherapy is given, it is typically administered once every 7 to 21 days for a total of 3-7 doses and increases the beneficial effect of radiation on eliminating the cancer. Common side effects of radiation therapy to the head and neck include temporary burns to skin and throat, fatigue, and altered sense of taste. Longer term consequences can include dry mouth and throat, teeth weakening, neck and throat stiffness. Radiation therapy will hopefully cause the cancer to shrivel away to nothing.</p><p></p>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-54414720274484974442023-08-03T07:03:00.005-04:002023-08-30T05:51:47.172-04:00Smell Loss (Anosmia) Treatment Involving Platelet-Rich Plasma Injections Show Great Promise<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDSbjEX7JIeAXStQ8MmaG_Z4ahlnR6V64i6g_4PT7kBW7P6hWgfv_N2NjcqnmeWUj_ZGMEkz8vkc3DrBEWqM_InPDXWMsFPH-eroXZkwjRQWuckMXIsNXzBr5dCmrpSooc21L7xIux3cnCGJTsrJeKAAJtoR2C2ZmdsQp8TkgHbtDzPGs_N45ENqcqVGE/s7200/smell2.jpg" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="4050" data-original-width="7200" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjDSbjEX7JIeAXStQ8MmaG_Z4ahlnR6V64i6g_4PT7kBW7P6hWgfv_N2NjcqnmeWUj_ZGMEkz8vkc3DrBEWqM_InPDXWMsFPH-eroXZkwjRQWuckMXIsNXzBr5dCmrpSooc21L7xIux3cnCGJTsrJeKAAJtoR2C2ZmdsQp8TkgHbtDzPGs_N45ENqcqVGE/w400-h225/smell2.jpg" width="400" /></a></div><br /> Research out of Stanford have suggested that injections of platelet-rich plasma derived from the patient's own blood may significantly restore sense of smell even for those patients who have suffered smell loss for a long period of time. These injections are performed into the top part of the nasal cavity where the smell nerve endings are located.<p></p><p><br /></p><p>In the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178450/" target="_blank">original pilot study</a> published in 2020, <b>ALL</b> study participants reported a subjective improvement of their smell shortly after injection which then stabilized, though most did not achieve normal smell sense. Most of the improvement occurred within the first 4 weeks.</p><p><br /></p><p>Platelet-rich plasma (PRP) is created as described by the GS30‐PURE II Protocol A (Emcyte, Ft Myers, Florida):</p><p><br /></p>
<blockquote>This protocol isolates PRP products with high platelet, low granulocyte count, and minimal red blood cells. Briefly, 20 mL of patient's whole blood was drawn and added to 5 mL of sodium citrate (SC) anticoagulant. The blood was centrifuged at 4200 rpm for 1 minute upon which the platelet plasma suspension supernatant was aspirated and re‐centrifuged at 4200 rpm for 5 minutes. The subsequent supernatant or the platelet poor plasma was discarded until 2 mL of PRP remained.</blockquote><p><br /></p><p>The PRP is drawn up into a 1ml syringe and injected into the nasal mucosa containing the smell nerve endings in 2 separate locations in divided doses. This is then repeated in the opposite side.</p><p><br /></p><p>Follow up studies (see below) confirm these findings and suggest that repeated injections every month for 3 months provide even greater benefit.</p><p><br /></p><p>At this time, these injections are considered experimental and as such, are not covered by insurance. However, with time, it is hoped that the veracity of these results become convincing enough such that insurance will start to cover these injections.</p><p><br /></p><p>Also keep in mind that this research has been limited to those who have lost their sense of smell within the past 12 months. Unclear whether those who have lost smell sense for years would benefit from this treatment.</p><p><br /></p><p>For those who have suffered smell loss and are desperate for treatment, lack of insurance coverage has not stopped many patients for self-paying for these PRP injections. Based on a <a href="https://med.stanford.edu/news/all-news/2023/01/covid-smell-loss-treatment.html#:~:text=In%20a%20Stanford%20Medicine%2Dled,derived%20from%20their%20own%20blood.&text=Early%20in%20the%20pandemic%2C%20when,%2C%20MD%2C%20figured%20as%20much." target="_blank">2023 Standford news article</a>, Dr. Zara Patel, the researcher who developed the PRP protocol for smell loss, <a href="https://stanfordhealthcare.org/doctors/p/zara-patel.html" target="_blank">runs a clinic</a> that is now 6 months backlogged with patients interested in these injections.</p><p><br /></p><p>My clinic is not offering this treatment at this time. Standard treatment for smell loss include steroids, <a href="https://pubmed.ncbi.nlm.nih.gov/23165381/" target="_blank">theophylline nasal spray</a>, and <a href="https://youtu.be/Ri5YwM6EmWM" target="_blank">smell therapy</a>.</p><p><br /></p><p><b>References</b>:</p><p><br /></p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7178450/" target="_blank">The use of platelet‐rich plasma in treatment of olfactory dysfunction: A pilot study</a>. Laryngoscope Investig Otolaryngol. 2020 Apr; 5(2): 187–193. Published online 2020 Feb 21. doi: 10.1002/lio2.357</p><p><br /></p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36507615/" target="_blank">Use of platelet-rich plasma for COVID-19-related olfactory loss: a randomized controlled trial</a>. Int Forum Allergy Rhinol. 2023 Jun;13(6):989-997. doi: 10.1002/alr.23116. Epub 2022 Dec 21.
</p><p><br /></p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/36520209/" target="_blank">Platelet-rich plasma injection in the olfactory clefts of COVID-19 patients with long-term olfactory dysfunction</a>. Eur Arch Otorhinolaryngol. 2023 May;280(5):2351-2358. doi: 10.1007/s00405-022-07788-8. Epub 2022 Dec 15.
</p><p><br /></p><p><br /></p>
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/AUvUNzkO_k0" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-67126813897895139152023-07-02T22:06:00.003-04:002023-07-18T17:43:10.193-04:00How is a Throat Stretched to Treat Swallowing Difficulties?<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/s1uh6sfQQ2k" title="YouTube video player" width="560"></iframe>
<p><br /></p><p>As an ENT, it is not uncommon to see a patient with a chief complaint of swallowing difficulties, also known as dysphagia. A common cause of dysphagia is an esophageal stricture or some other related benign narrowing of the swallowing tube going down to the stomach.</p><p><br /></p><p>The video above goes over how the throat can be stretched out to open up such areas of narrowing using either bougies or via balloon dilation. Medically speaking, this procedure is known as an esophageal dilation. The lay term of "throat" stretch is not technically correct as the stretch is not actually occurring in the throat... but in the esophagus.</p><p><br /></p><p>As such, some but not all ENTs perform these types of procedures (I do not). Usually, the GI doctors are the ones who most often perform such procedures.</p><p><br /></p><p>Related to esophageal dilations is the endoscopic balloon dilation to treat achalasia shown in the video below as well as one for Schatzki's ring.</p><p><br /></p>
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/lpOL7E1X6aQ" title="YouTube video player" width="560"></iframe><div><br /></div><div><br /></div>
<iframe width="560" height="315" src="https://www.youtube.com/embed/xQ-HbuR10KE" title="YouTube video player" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-76197403997978888342023-06-26T06:17:00.003-04:002023-06-26T06:32:45.501-04:00Based on Nystagmus, Which BPPV Maneuver to Perform to Treat Vertigo Dizziness?<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/_1kVVn2pcHA" title="YouTube video player" width="560"></iframe>
<p><a href="https://www.fauquierent.net/bppv.htm" target="_blank">BPPV</a>, or benign paroxysmal positional vertigo, accounts for about 20% of all dizzy patients seen in an ENT clinic. It is also very easy to treat by moving the head in discrete steps and angles in under 5 minutes. As such, there has been a proliferation of online videos (including videos made by our office) to show how to perform these maneuvers at home in order to avoid a doctor's visit. </p><p><br /></p><p>Unfortunately, there is not one single maneuver that works for all BPPV. Indeed, there are 3 main types of BPPV which each require their own maneuvers and when you take into consideration the side, there are 6 different forms of BPPV... each with their own distinct maneuver for treatment.</p><p><br /></p><p>The video above tries to simplify the diagnostic process to at least diagnosing the correct BPPV type and narrowing down which maneuvers would work based on direction of the nystagmus or eye twitching.</p><p><br /></p><p>The standard maneuver to trigger the nystagmus is the <a href="https://youtu.be/wgWOmuB1VFY" target="_blank">Dix-Hallpike maneuver</a> which should be the very first test anybody suspected of BPPV should perform prior to a treatment maneuver. For a more general approach to diagnose most causes of dizziness, use this <a href="https://www.fauquierent.net/dizziness/dizzy1.htm" target="_blank">flowchart</a>.</p><p><br /></p><p>Assuming BPPV, and based on the results of the Dix-Hallpike, the maneuvers to treat are as follows:</p><p><br /></p><blockquote style="border: medium; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><p><b>POSTERIOR canal BPPV (causing a torsional, diagonal nystagmus):</b></p>• <a href="https://youtu.be/9SLm76jQg3g" target="_blank">Epley<br /></a>• <a href="https://youtu.be/-omE6Vs6ZuU" target="_blank">Semont<br /></a>• <a href="https://youtu.be/Wez9SZJ7ABs" target="_blank">Half-Somersault</a><div><br /></div><div><p><b>SUPERIOR canal BPPV (causing a vertical nystagmus):</b></p></div><div>• <a href="https://youtu.be/qw1QciZWfP0" target="_blank">Deep-Head Hanging</a></div><div><br /></div><div><p><b>LATERAL canal BPPV (causing a horizontal nystagmus):</b></p></div><div>• <a href="https://youtu.be/mwTmM6uF5yA" target="_blank">BBQ Roll or Lempert</a></div><div>• <a href="https://youtu.be/N7LOSV-9DYE" target="_blank">Gufoni</a></div></blockquote>
<div><a href="https://youtu.be/9SLm76jQg3g" target="_blank"></a></div><div><a href="https://youtu.be/9SLm76jQg3g" target="_blank"></a></div>
<br />
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/videoseries?list=PLblLJazSSA3Q-VgxX-_t_gfQdBQ3udQXC" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-87614085599802816422023-06-20T19:58:00.005-04:002023-06-20T19:59:52.848-04:00Pediatric Voice Therapy for a Child with a Raspy Voice due to Vocal Cord Nodules or Swelling<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/t_Xv5FdZmk4" title="YouTube video player" width="560"></iframe><p><br /></p><p>It is not uncommon for a child to suffer from a chronic <a href="https://www.fauquierent.net/voice.htm" target="_blank">hoarse voice</a> due to <a href="https://youtube.com/shorts/rSkJcQNpL6w" target="_blank">vocal cord swelling or nodules</a>. There is no illness present. The child feels fine. Their voice just sounds raspy! Usually after a couple weeks or even months of a raspy voice that is not getting any better, an ENT visit determines the hoarse voice is due to vocal cord nodules or vocal cord swelling. This determination is made with a fiberoptic endoscope as shown in the video below.</p><p><br /></p><p>Treatment is usually voice therapy performed by a speech language pathologist (SLP) who received additional training in vocal disorders... The problem is that it is not easy to find a voice therapist who deals with kids. AND... even if a pediatric voice therapist is found, it may be months before an appointment is available. </p><p><br /></p><p>To help with this unfortunate situation, I along with a pediatric voice therapist, Danielle Campbell, created the above video which is meant to provide "first steps" on things a parent can do with their child while waiting for an appointment with a voice therapist, or to reinforce what has been learned during therapy sessions.
This video is not meant to completely replace one-on-one treatment sessions.</p><p><br /></p><p>You can search for the closest pediatric voice therapist via this <a href="https://find.asha.org/pro/#sort=relevancy&f:@provider=[Speech-Language%20Pathologist]" target="_blank">link</a>.</p><p><br /></p>
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/BrnW9xSc1Hw" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-4475223320360884032023-06-20T19:42:00.006-04:002023-06-21T05:37:24.673-04:00How Often is Tonsillectomy Performed After Prior Adenoidectomy for Sleep Apnea in Kids?<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi63fkWF0nJbPblcL_HMu0gIu-erBIGMX_MLqxfhcx0PL4JRodrikLTcQbr_obRLeEFzoSdTXqk1D2dktEMDuLNz2gO_vtQU1l90ZMvaWZ2cQm3yamTk1Ge7XTCHnQJANR5KJZbpDS1gJc/s1600/tonsil.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="174" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi63fkWF0nJbPblcL_HMu0gIu-erBIGMX_MLqxfhcx0PL4JRodrikLTcQbr_obRLeEFzoSdTXqk1D2dktEMDuLNz2gO_vtQU1l90ZMvaWZ2cQm3yamTk1Ge7XTCHnQJANR5KJZbpDS1gJc/s640/tonsil.jpg" width="640" /></a></div>
<br />
<p>Kids often see an ENT doctor for sleep apnea or other sleep disordered breathing concerns. Typically such kids have symptoms of severe snoring, nasal congestion/obstruction, restless sleep, daytime sleepiness/irritability, and/or witnessed difficulty breathing that periodically stops while sleeping (apneas).</p><p><br /></p><p>In such situations, it is common for tonsil and adenoid surgical removal to be considered (<a href="https://www.fauquierent.net/tonsillectomy.htm" target="_blank">tonsillectomy and adenoidectomy</a>). However, it is not unusual for parents to often question the need to have both tonsils and adenoids to be removed, especially when considering the significant sore throat often associated with tonsillectomy.</p><p><br /></p><p>The thinking is that if only the adenoids are removed, this would alleviate the nasal obstruction/congestion which in turn should hopefully resolve the other sleep disordered symptoms. By NOT removing the tonsils, it would save the child from a sore throat after the surgery as well.</p><p><br /></p><p>But... is that actually true?</p><p><br /></p><p>Can adenoid removal help with sleep apnea symptoms in a child?</p><p><br /></p><p>The answer is unfortunately not a simple yes or no...</p><p><br /></p><p>According to one <a href="https://pubmed.ncbi.nlm.nih.gov/27448429/" target="_blank">research in 2016</a>, the answer is yes... adenoid removal alone can help with sleep apnea in kids, <b><i>but</i></b> only in those kids with mild symptoms and small tonsils. Otherwise, there was a 20% failure rate of adenoid removal alone in resolving sleep apnea.</p><p><br /></p><p>This supports earlier studies showing that there was up to as high as 30% chance that a child who only had an adenoid removal will later require another surgery to remove the tonsils. The larger the tonsils, the larger this risk.</p><p><br /></p><p>BUT... even in kids with small tonsils, removing both the tonsils and adenoids was shown to be of benefit as found in this 2015 <a href="https://pubmed.ncbi.nlm.nih.gov/25940581/" target="_blank">study</a> conducted by Johns Hopkins.</p><p><br /></p><p>When broken down by age when adenoidectomy performed in this <a href="https://pubmed.ncbi.nlm.nih.gov/15781768/" target="_blank">study</a>, the risk of future tonsillectomy increased the younger the child... 29% if adenoid removal perform <2 years of age, 15% if adenoid removal performed between 2-4 years old, 6% if 5-7 years old, and 2% if >7 years old.</p><p><br /></p><p>If tonsillectomy performed, it usually occurred within 2 years of the adenoidectomy. The odds of undergoing a future tonsillectomy also significantly increased with increasing tonsil size at the time of adenoidectomy. A logistic regression analysis shows that each increase in tonsil size by 1 (eg, from 2+ to 3+) raised the risk of subsequent tonsillectomy by 1.6 times (95% CI, 1.2-2.1 times; p<.001); no other variables changed the risk significantly.</p><p><br /></p><p>When taking all the information into account, it is typically recommended for both tonsil and adenoid removal in kids when treating for sleep apnea regardless of tonsil size, but especially so if they are large. But... if the parents want only the adenoids to be removed, counseling should be provided that there is risk for needing tonsillectomy in the future due to unresolved symptoms.</p><p><br /></p><p><b>References:</b></p>
<a href="https://pubmed.ncbi.nlm.nih.gov/15781768/" target="_blank">Rates and risk factors for subsequent tonsillectomy after prior adenoidectomy: a regression analysis</a>. Arch Otolaryngol Head Neck Surg. 2005 Mar;131(3):252-5.
<br /><br />
<a href="https://pubmed.ncbi.nlm.nih.gov/16650485/" target="_blank">Pediatric adenoidectomy: what is the effect of obstructive symptoms on the likelihood of future surgery?</a> Int J Pediatr Otorhinolaryngol. 2006 Aug;70(8):1467-72.
<br /><br />
<a href="https://pubmed.ncbi.nlm.nih.gov/27448429/" target="_blank">Adenoidectomy for Obstructive Sleep Apnea in Children</a>. J Clin Sleep Med. 2016 Sep 15;12(9):1285-91.<div><br /></div><div><a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=25940581">Influence of tonsillar size on OSA improvement in children undergoing adenotonsillectomy. </a>Otolaryngol Head Neck Surg. 2015; 153:281-285.</div><div><br /></div><div><br /></div>
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/mR10wJOwdP0" title="YouTube video player" width="560"></iframe><div><br /></div><div><br /></div>
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://www.fauquierent.net/store_throat.htm" style="clear: center; float: center; margin-bottom: 1em; margin-left: 1em;" target="_blank"><img border="0" data-original-height="676" data-original-width="800" height="270" src="https://www.fauquierent.net/store/a-throat.png" width="320" /></a></div>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-58109858433275444992023-03-12T19:02:00.011-04:002023-03-12T19:06:40.521-04:00Time Lapse of Skin Cancer Development (Basal Cell Carcinoma, Melanoma, and Squamous Cell Carcinoma)<br />
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="j1Hv71UTeX0">
<div class="play-button"></div>
</div>
</div>
<p>It is impossible in real life to create a time lapse photo sequence of skin turning into cancer as there is no way to know if any given area of skin will turn into cancer. Obviously, somebody with such future knowledge would have to start taking such photos now in the same spot over next 10-25 years to watch it slowly turn into cancer, and then to put it together to create a time lapse video.</p><p><br /></p><p>However, technology has now enabled such hypothetical time lapses to be created. Using generative AI technology, a time lapse sequence of skin cancer development from normal has been created for 3 different skin cancers: <a href="https://youtube.com/shorts/j1Hv71UTeX0" target="_blank">melanoma</a>, <a href="https://youtube.com/shorts/-WrSIFvC12o" target="_blank">basal cell carcinoma</a>, and <a href="https://youtube.com/shorts/d_O5zHgKnP8" target="_blank">squamous cell carcinoma</a>. </p><p><br /></p><p>Check it out! Melanoma time lapse is shown above. The other two skin cancers are shown below.</p>
<br />
<p><b>Basal Cell Carcinoma Time Lapse</b></p>
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="-WrSIFvC12o">
<div class="play-button"></div>
</div>
</div>
<p><b>Squamous Cell Carcinoma Time Lapse</b></p>
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="d_O5zHgKnP8">
<div class="play-button"></div>
</div>
</div>
Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-55212234155613367922023-02-07T06:41:00.004-05:002023-06-26T08:07:34.685-04:00Decongestant Nasal Spray Addiction (Afrin, Zicam, Sinex, Neo-Synephrine, etc)<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/HLv9-usVZ4A" title="YouTube video player" width="560"></iframe><p> </p>
<p>I see about 3-6 patients a month for what I consider a <a href="https://www.fauquierent.net/afrin.htm" target="_blank">decongestant nasal spray addiction</a>. The typical story starts with a upper respiratory infection causing nasal congestion and obstruction. The patient then goes to the store and gets a decongestant nasal spray (ie, Afrin, Zicam, Sinex, Neo-Synephrine, etc) which works great to open up the nasal passages.</p><p><br /></p><p>Unfortunately, even though the upper respiratory infection seems to have resolved, the nasal congestion and obstruction persists leading to continued use of the decongestant nasal spray. Over months (and even years), what started out as using the nasal spray only at bedtime, now ends being used 2 times a day... then 3... and even more often to get the nose unblocked.</p><p><br /></p><p>At this point, the nose has become "addicted" to the decongestant nasal spray! Known medically as <b><i>rhinitis medicamentosa</i></b>, whenever the patient wants to stop using the nasal spray, there is a severe rebound congestion which is analogous to "withdrawal effects." Furthermore over time, the patient ends up needing to use the nasal spray more and more often to get the good effects... analogous to the "high" of drug abusers.</p><p><br /></p><p>Unfortunately, there is no easy way to stop decongestant nasal sprays at this point. One simply must stop using the nasal spray! There are prescription steroids that can be given to help minimize the rebound withdrawal effects, but there still will be a period of misery before the nose finally gets back to normal. This may take anywhere from 2-8 weeks depending on how long and how frequently the patient has been using the nasal spray.</p><p><br /></p><p>It is recommended to NEVER use decongestant nasal sprays for more than 3 consecutive days... followed by at least 3 weeks of avoiding its use before you can safely reuse.</p><p><br /></p><p>For more info on this condition and treatment, click <a href="https://www.fauquierent.net/afrin.htm" target="_blank">here</a>.</p><p><br /></p><p>Keep in mind that not all nasal sprays have this addiction concern. These nasal sprays are SAFE to use daily for prolonged periods of time.</p><p><br /></p>
• <a href="https://amzn.to/3jCVwlL " target="_blank">Saline Nasal Spray</a><div>• <a href="https://amzn.to/3c2He6c" target="_blank">Flonase</a></div><div>• <a href="https://amzn.to/3bnrSdt" target="_blank">Nasacort</a></div><div>• <a href="https://amzn.to/38cewib" target="_blank">Rhinocort</a></div><div>• <a href="https://amzn.to/3Iyv3QC" target="_blank">Nasonex</a></div><div>• <a href="https://amzn.to/3cvDHBH" target="_blank">Astepro</a></div><div>• <a href="https://amzn.to/38exmoY" target="_blank">NasalCrom</a></div><div><br /></div>
<div class="separator" style="clear: both; text-align: center;"><a href="https://www.fauquierent.net/store_nose.htm" style="clear: center; float: center; margin-bottom: 1em; margin-left: 1em;" target="_blank"><img border="0" data-original-height="676" data-original-width="800" height="270" src="https://www.fauquierent.net/store/a-nasal.png" width="320" /></a></div>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-13448310739635589702023-01-25T12:26:00.005-05:002023-01-25T12:26:58.562-05:00How is a Throat Biopsy Performed?<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/OMyKwZa6sis" title="YouTube video player" width="560"></iframe><p><br /></p><p>Not uncommonly, a mass is discovered in a patient's throat whether by endoscopy or discovered on a CT or MRI scan incidentally. Depending on the concern (ie cancer), a biopsy of the mass may be pursued. The question many patients have is exactly how the biopsy is obtained given the growth is not easily accessible (unlike a growth in the mouth which can typically be biopsied in the clinic without sedation).</p><p><br /></p><p>There are basically two "flavors" of how a throat biopsy is obtained. If the growth is tiny and located within the voicebox, such as a vocal cord cyst, the procedure that is performed is called "<a href="https://youtu.be/OMyKwZa6sis" target="_blank">micro direct laryngoscopy</a>" given a microscope is needed in order to obtain a magnified view of the mass to more easily remove it. If the mass is large and located anywhere else in the throat, the more typical procedure is called "<a href="https://youtu.be/awW_EkB3O8o" target="_blank">direct laryngoscopy</a>" which is performed without any image magnification.</p><p><br /></p><p>The two videos shown here demonstrate how both procedures are performed to obtain a throat biopsy.</p><p><br /></p>
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/awW_EkB3O8o" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-16598303652954034742022-12-30T09:00:00.005-05:002022-12-31T08:10:14.398-05:00Understanding a Thyroid Ultrasound Report of a Nodule: The TI-RADS (TR) Score!<p><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/yL75h4_FLpk" title="YouTube video player" width="560"></iframe></p><p><br /></p><p>Getting a thyroid ultrasound for a <a href="https://www.fauquierent.net/thyroidmass.htm" target="_blank">thyroid nodule</a> is VERY common. The main concern is whether thyroid cancer may be present which peaks in women around age 40-50 years and in men usually around age 60-70 years. However, thyroid cancer can occur at <b><i><u>any</u></i></b> age. Given many patients are able to obtain a copy of their ultrasound reports, it may be educational to understand what is being stated beyond the obvious size description.</p><p><br /></p><p>The <b><i>KEY </i></b>information patients should look for in an ultrasound report of the thyroid gland is the TI-RADS or TR score for each nodule.</p><p><br /></p><p>Based on the thyroid nodule characteristics, the thyroid ultrasound report will classify each nodule on a scale from 1-5. Known as TI-RADS or <b>T</b>hyroid <b>I</b>maging <b>R</b>eporting <b>A</b>nd <b>D</b>ata <b>S</b>ystem, this scale provides an estimate of cancer risk (abbreviated as TR in most ultrasound reports).</p><p><br /></p><p>Current published results as of 2017 provides the following risk of cancer for each TR level.</p><p></p><ul style="text-align: left;"><li><b>TR1</b>: 0.3%</li><li><b>TR2</b>: 1.5%</li><li><b>TR3</b>: 4.8%</li><li><b>TR4</b>: 9.1%</li><li><b>TR5</b>: 35%</li></ul><p></p><p><br /></p><p>Current medical guidelines of what to do next based on the TR results are as follows:</p><p></p><ul style="text-align: left;"><li><b>TR1</b>: no needle biopsy required</li><li><b>TR2</b>: no needle biopsy required</li><li><b>TR3</b>: if >1.5 cm, repeat ultrasound at 1, 3, and 5 years; if >2.5cm, perform needle biopsy</li><li><b>TR4</b>: if >1.0 cm, repeat ultrasound at 1,2, 3, and 5 years; if >1.5cm, perform needle biopsy</li><li><b>TR5</b>: if >0.5cm, repeat ultrasound every year for 5 years; if >1.0cm, perform needle biopsy</li></ul><div><br /></div><div>Now these are just medical guidelines. For many patients having a nodule classified as TR3-TR5, a needle biopsy is often performed regardless of the size (for peace of mind).</div><div><br /></div><div>In the end, it is up to the patient how to proceed based on this information. Endocrinologists are the doctors who are considered medical thyroid specialists. Most ENTs and general surgeons (though not all) can also deal with thyroid nodules.</div><div><br /></div><div>As always, you can talk to your doctor for more information.</div><div><br /></div>
<div><b>References:</b></div><p></p>
<p><a href="https://linkinghub.elsevier.com/retrieve/pii/S1546144017301862" target="_blank">Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee. (2017) Journal of the American College of Radiology : JACR. 14 (5): 587-595</a></p>
<br />
<p><a href="https://pubmed.ncbi.nlm.nih.gov/28402167/" target="_blank">Multiinstitutional Analysis of Thyroid Nodule Risk Stratification Using the American College of Radiology Thyroid Imaging Reporting and Data System. (2017) American Journal of Roentgenology. 208 (6): 1331-1341.</a></p>
<div></div><div><br /></div><div>
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/pl8m0gE3IXQ" title="YouTube video player" width="560"></iframe></div>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-9223660072585248202022-12-19T14:02:00.006-05:002022-12-24T19:46:53.995-05:00Over the Counter Hearing Aids Give Rise to DIY Fixes and Troubleshooting<p><iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/UE6qjRXjQcw" title="YouTube video player" width="560"></iframe></p><p><br /></p><p>Historically, hearing aid purchase required seeing an audiologist for hearing testing, hearing aid selection, hearing aid programming, and hearing aid fitting. That's because hearing aids unfortunately are not a one-size-fits-all solution to correct hearing loss due to the complexities of restoring hearing from a wide range of hearing loss patterns to a huge variety of different ear canal shapes/sizes. Of course, when an <a href="https://www.fauquierent.net/store_hearing.htm" target="_blank">over-the-counter hearing aid</a> is purchased, the end-user is now responsible to figure all that out themselves.</p><p><br /></p><p>Although technology has been developed to assist the end-user in terms of self-administered hearing testing and hearing aid programming, the fitting is still up to the end-user to figure out. Probably the most common complaints with hearing aids (assuming proper programming) whether over-the-counter or purchased through an audiologist are presence of feedback (warbling or whistling noises), occlusion effect (voice sounds boomy/hollow as well as hearing internal body noises), and low-frequency sounds are absent or distorted. </p><p><br /></p><p>Obviously, if a hearing aid is purchased through an audiologist, the audiologist will help resolve any hearing aid audio complaints. If purchased over-the-counter, then it is up to the end-user to figure it out!</p><p><br /></p><p>As such, our office has created a few DIY videos to help the individual fit the OTC hearing aid they purchased to work better with their ear and hearing loss pattern. AND, to trouble-shoot any sound issues that may be present. If sound issues persist, the user may have to contact the manufacturer for assistance. Or, you really do need a better medical grade hearing aid (because your hearing is too bad for an OTC model to handle).</p><p><br /></p><p>Of course, our office still sells hearing aids for which we will professionally fit and address any sound complaints, but for those who are technically inclined with only a mild to moderate hearing loss, <a href="https://www.fauquierent.net/store_hearing.htm" target="_blank">over-the-counter (OTC) hearing aids</a> are a perfectly acceptable option to consider!</p><p><br /></p><p>OTC hearing aids we recommend can be found <a href="https://www.fauquierent.net/store_hearing.htm" target="_blank">here</a>!</p>
<br />
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="W85r5AfVvV8">
<div class="play-button"></div>
</div>
</div>
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="-hhHfeEMZVQ">
<div class="play-button"></div>
</div>
</div>
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="Ujl4OWarsa0">
<div class="play-button"></div>
</div>
</div>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-42239284195689490852022-11-26T10:07:00.004-05:002022-11-26T10:49:28.722-05:00Adult Tonsillectomy Pain Levels Over Time (0 to 4+ Weeks)<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfgx2MoVGxgOefVSxmEHx2fp4gDPn1IYoyEsfLdG6WviF7xj_aXwAR9cJ527qX2w8XE_H5L5m42C7yaetQU23Aw8l0gS5jVxu1BewDxmmFNcrKmJyqWU5nHRaFjjjk7l1B5ZOwWsL52EW35mWtEc9cf3_D7udO0bbGCZEea3O_4iXYaDFFM5Cg6HsB/s2560/tonsilpaingraph.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1375" data-original-width="2560" height="344" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhfgx2MoVGxgOefVSxmEHx2fp4gDPn1IYoyEsfLdG6WviF7xj_aXwAR9cJ527qX2w8XE_H5L5m42C7yaetQU23Aw8l0gS5jVxu1BewDxmmFNcrKmJyqWU5nHRaFjjjk7l1B5ZOwWsL52EW35mWtEc9cf3_D7udO0bbGCZEea3O_4iXYaDFFM5Cg6HsB/w640-h344/tonsilpaingraph.png" width="640" /></a></div><br />Unlike children under 12 years who undergo tonsil removal surgery, adults undergoing <a href="https://www.fauquierent.net/tonsillectomy.htm" target="_blank">tonsillectomy</a> is perhaps one of the most painful recoveries anyone will ever experience in their lifetime. The pain can be quite vicious and prolonged, typically lasting about 3 weeks. Adults on average <a href="https://blog.fauquierent.net/2015/04/weight-loss-after-tonsillectomy-in.html" target="_blank">lose about 5 pounds</a> due to inability to eat solid foods and decreased caloric intake. In spite of a liquid diet and multiple prescriptions for <a href="https://youtu.be/MkRcpTbDfRw" target="_blank">pain control</a>, it is still a miserable recovery. In our office, 3 pain control prescriptions are given: a neuromodulating drug (ie, neurontin), tramadol, and a narcotic.<div><p></p><p><br /></p><p>Another way to minimize pain that is offered is to inject a long-lasting numbing medication (ie, 0.25% bupivacaine), but even this intervention has it's downside; although the pain is decreased by ~50%, when it wears off in about 2-3 days, the pain spikes causing some patients to be concerned that something terrible just happened. As such, at least in our office, patients are given the choice whether they desire this numbing injection or not prior to surgery. It works out to about 50% of patients refusing the numbing injection in order to avoid the surprise pain spike a few days later.</p><p><br /></p><p>The graph above illustrates what the pain level is like for adults over time both with and without receiving the numbing injection.</p><p><br /></p><p>It is unclear exactly why young children experience so much less pain than adults, but the typical rationale I provide is that children's pain nerve endings are not as fully developed as an adult's.</p><p><br /></p><p>Check out the video below showing a time lapse of tonsillectomy healing from 0 to 25 days.</p><p><br /></p><p><br /></p>
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="MkRcpTbDfRw">
<div class="play-button"></div>
</div>
</div>
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="hEph2tc_MkA">
<div class="play-button"></div>
</div>
</div></div>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-37635764042949365692022-11-24T21:00:00.004-05:002022-11-25T06:03:17.736-05:00World Cup Soccer Player Wearing Face Mask After Facial Fracture<p></p><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtumB-4Fp9qPAhXa5U-dVe3pOAsy6Ajlz_9GsfZci5Sv2fZNpUgBo_uosrHOvRRXrwy-CpnBjC0Ag4kGYR8y2Hytv9i_Z3dh8T3wbxYScH2UK3P_FdIHzi-MkV9uXOn0pT0h-iC8H-Utcsh49obIYb9JuNYsZ-ztjja_tuDEzwe1r5l-FNmWIzCLfs/s982/soccer.png" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="584" data-original-width="982" height="238" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtumB-4Fp9qPAhXa5U-dVe3pOAsy6Ajlz_9GsfZci5Sv2fZNpUgBo_uosrHOvRRXrwy-CpnBjC0Ag4kGYR8y2Hytv9i_Z3dh8T3wbxYScH2UK3P_FdIHzi-MkV9uXOn0pT0h-iC8H-Utcsh49obIYb9JuNYsZ-ztjja_tuDEzwe1r5l-FNmWIzCLfs/w400-h238/soccer.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Son Heung Min</td></tr></tbody></table><br />South Korean soccer star and captain, Son Heung Min, was seen wearing a face mask during the World Cup in Qatar in November 2022. This was due to an orbital <a href="https://www.fauquierent.net/facialfracture.htm" target="_blank">facial fracture</a> to his left eye during a Champions League match for Tottenham for which he had to undergo surgical correction. This fracture was sustained when his face collided with Marseille defender Chancel Mbemba. <div><br /></div><div>Another World Cup soccer player, Croatian Josko Gvardiol, also was seen sporting a face mask to protect a broken nose sustained after colliding with teammate Willi Orban. <br /><p></p><div><br /></div><div>In regards to Son Heung Min, a face mask was worn in order to minimize risk of further injury to his recently repaired facial fracture.</div><div><br /></div><div>Based on media reports, Son Heung Min likely suffered an orbital blow-out fracture whereby the thin bones surrounding the eye is fractured outward, most commonly the floor which supports the eye within the socket.</div><div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXLAGG0eQbjHpNy2mVCS-zPm1kYBp0Rud1EOQGDy_dRagzOQbpLGh13AobIn8Q5LjtQK74HuE2riJsIdhMnYaRe5w5Tn3GGsr0y6-9JjQhI_XLvHIZbKC_8rIZe1ThdQr6Nj8LMWuibqdd3gXQw8hC001QX3eXYgq15IlxrSwk-vegCaXdai5Vv7Lk/s1033/ct.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="681" data-original-width="1033" height="264" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhXLAGG0eQbjHpNy2mVCS-zPm1kYBp0Rud1EOQGDy_dRagzOQbpLGh13AobIn8Q5LjtQK74HuE2riJsIdhMnYaRe5w5Tn3GGsr0y6-9JjQhI_XLvHIZbKC_8rIZe1ThdQr6Nj8LMWuibqdd3gXQw8hC001QX3eXYgq15IlxrSwk-vegCaXdai5Vv7Lk/w400-h264/ct.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">In this CT scan, you can see the fracture between the R eye and<br />R cheek sinus (left side being normal for comparison).</td></tr></tbody></table><br /><div>Most <a href="https://www.fauquierent.net/facialfracture.htm" target="_blank">orbital floor fractures</a> do <b><i><u>not</u></i></b> require any surgical repair as long as the eye is able to move freely in all directions without any double-vision. BUT, if the fracture results in the eye's muscle getting stuck thereby preventing eye movement, surgical repair is required, typically by placing a wire or bio-absorbable mesh over the fracture site.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJswC-FUTc6tR53odZAb0ySIvguK4G2xb4bJPdSTo4mT095CO5US7VvOXaF8tVg-PZf_R-TB1zTJ3ev0gzYgUJzfnIBqug5Ehpz-IxDpepkTp7lQmjpaOa4Hk9hc116yTccWmm5_blK3rm6MQ83JFfcLzTn-LzfdpaozugYvmTzlX1lmE3B0y0SW6N/s880/pupil.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="328" data-original-width="880" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJswC-FUTc6tR53odZAb0ySIvguK4G2xb4bJPdSTo4mT095CO5US7VvOXaF8tVg-PZf_R-TB1zTJ3ev0gzYgUJzfnIBqug5Ehpz-IxDpepkTp7lQmjpaOa4Hk9hc116yTccWmm5_blK3rm6MQ83JFfcLzTn-LzfdpaozugYvmTzlX1lmE3B0y0SW6N/w400-h149/pupil.jpg" width="400" /></a></div><br /><div><br /></div><div>In the image above of a different patient, the right eye is able to fully move upward... but the left eye is able to move upward only slightly. This results in double-vision on upward gaze. As such, this patient would require surgical repair. The other reasons why surgical repair may be required is if the orbital floor fracture is so large that the eye literally sinks down into the cheek resulting in double vision or if a hematoma has formed behind the eye causing the eye's pressure to become abnormally high.</div><div><br /></div><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhWRYo9JRVcccLE3Oqzq7Y9FiQ4KLjO01YpMWoC2itTIL_kbL4WYg89eCt-_XQPe0zZ0nhU2-ENeLVLKhfNFmimb93nUdlIPLspKtUr8Phnt7gPcQXBviFIFJuHCU1OtVW48rFEBSFPOPEaSwU6cVYoFhea0UutxlV395AFEK-sIoHq_iaTIokxlcd/s1236/fracture.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="832" data-original-width="1236" height="269" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhhWRYo9JRVcccLE3Oqzq7Y9FiQ4KLjO01YpMWoC2itTIL_kbL4WYg89eCt-_XQPe0zZ0nhU2-ENeLVLKhfNFmimb93nUdlIPLspKtUr8Phnt7gPcQXBviFIFJuHCU1OtVW48rFEBSFPOPEaSwU6cVYoFhea0UutxlV395AFEK-sIoHq_iaTIokxlcd/w400-h269/fracture.png" width="400" /></a></div><br /><div>This image shows a wire mesh placed to correct an orbital floor fracture. If the cheekbone has also been fractured (<a href="https://www.fauquierent.net/facialfracture.htm" target="_blank">tripod fracture</a>), plates with screws may also be required.</div><div><br /></div><div><br /></div></div>
<div class="youtube-iframe-wrapper">
<div class="youtube" data-embed="0vUXaAwS0dA">
<div class="play-button"></div>
</div>
</div>
<br />
<ins class="adsbygoogle" data-ad-client="ca-pub-9714478253321829" data-ad-slot="1651691265" style="display: inline-block; height: 600px; width: 160px;"></ins>
<script>
(adsbygoogle = window.adsbygoogle || []).push({});
</script>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-13392552084143059982022-11-24T06:24:00.005-05:002022-11-24T06:43:28.354-05:00Blue Hairy Tongue and White Hairy Tongue Syndrome<p></p><br /><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEielddvi3g1bpHa8Z3-lXaBq3s2Ek72SeOnAmRwbzCvpBLAMbTeGNMxtic-yqUJkLBbRVzjTd07YthstY6oHJ-hRTn-k-riHc88P9HHP-5gnE62VOSFzik1PPZXYljJAr5amgBnljnQbZt0vjkfwioXfnZDpMhwteXbwuhCQQ2HOGpdnyw2IBcOnGc_/s936/blue-hairy-tongue.jpg" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="936" data-original-width="674" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEielddvi3g1bpHa8Z3-lXaBq3s2Ek72SeOnAmRwbzCvpBLAMbTeGNMxtic-yqUJkLBbRVzjTd07YthstY6oHJ-hRTn-k-riHc88P9HHP-5gnE62VOSFzik1PPZXYljJAr5amgBnljnQbZt0vjkfwioXfnZDpMhwteXbwuhCQQ2HOGpdnyw2IBcOnGc_/s320/blue-hairy-tongue.jpg" width="230" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">Blue Hairy Tongue<br /><br /></td></tr></tbody></table>Hairy tongue syndrome is a relatively uncommon tongue condition causing a thickened and discolored tongue appearance. The most common discoloration is black (see below). However, other colors may be less commonly seen such as brown, white, and most rarely, even blue. Regardless of the color, the treatment is all the same.<p></p><p><br /></p>
Normally the dorsal surface of the tongue mucosa is covered by filiform papillae protrusions that typically rise less than 1mm from the surface. However, in <a href="https://www.fauquierent.net/blackhairytongue.htm">hairy tongue</a> syndrome, these normally very short tongue protrusions can grow to over 1 cm in length and 2mm width. <br /><br />
This carpet of abnormally long filiform papillae protrusions then secondarily collect fungi, bacteria, and inorganic particles which leads to the discoloration and the appearance of <a href="https://www.fauquierent.net/blackhairytongue.htm">hairy tongue</a> syndrome. To reiterate, micro-organisms found in <a href="https://www.fauquierent.net/blackhairytongue.htm">hairy tongue</a> syndrome is coincidental and not causative. I will further stress that although fungi and bacteria may be present and do contribute to the discoloration, there is no "infection" present per se. These organisms are happily just living on the surface without actually invading the tongue lining.<br />
<br />
<a href="https://www.fauquierent.net/blackhairytongue.htm">Treatment</a> (if pursued) is really to address the long filiform papillae and not so much what's on it.
<br />
<br />
To read more about <a href="https://www.fauquierent.net/blackhairytongue.htm">black hairy tongue</a> and what is done for treatment (if pursued), <a href="https://www.fauquierent.net/blackhairytongue.htm">click here</a>.<div><br /></div><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><img border="0" data-original-height="266" data-original-width="200" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYrYm3h9bH4PHSo0koHWMbePOPMK_jpLzllCN8z1Jf76sJxr1edDjFdSXLUh5hGpvqiYpDK-VtMmZ2wUKQJfRYmqPMuZAHDZNy79ff8X4FUklfsqWcU_PDaUn9I7fKCfJTowUZGfaOeqW1w9Jh_sfbIxZhUxG5nkTtET8twqoeW1Y0_H08CdbAVw7q/w241-h320/Black_tongue.jpg" style="margin-left: auto; margin-right: auto;" width="241" /></td></tr><tr><td class="tr-caption" style="text-align: center;">Black Hairy Tongue (most common)<br /><br /></td></tr></tbody></table><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTGSorPeQYHxJTH2RY8_xKsBF9KIv79pmLUahd8MAji1zo5EZj6i1bXrEziN0-GMqKNIwR0HjeJhRK90oI_M5DWuymEf8jf4G0IOV3-HfvxwoRkufkzPQzZECY5UJbXUICdg-H6wxoGz3gL-KM3Q8pC5VVZ0xRZelckDPT5h5BeUjcULAF9gOQF9no/s698/whitehairytongue.jpg" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="698" data-original-width="537" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTGSorPeQYHxJTH2RY8_xKsBF9KIv79pmLUahd8MAji1zo5EZj6i1bXrEziN0-GMqKNIwR0HjeJhRK90oI_M5DWuymEf8jf4G0IOV3-HfvxwoRkufkzPQzZECY5UJbXUICdg-H6wxoGz3gL-KM3Q8pC5VVZ0xRZelckDPT5h5BeUjcULAF9gOQF9no/w246-h320/whitehairytongue.jpg" width="246" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;">White Hairy Tongue<br /><br /></td></tr></tbody></table><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiYrYm3h9bH4PHSo0koHWMbePOPMK_jpLzllCN8z1Jf76sJxr1edDjFdSXLUh5hGpvqiYpDK-VtMmZ2wUKQJfRYmqPMuZAHDZNy79ff8X4FUklfsqWcU_PDaUn9I7fKCfJTowUZGfaOeqW1w9Jh_sfbIxZhUxG5nkTtET8twqoeW1Y0_H08CdbAVw7q/s266/Black_tongue.jpg" style="margin-left: 1em; margin-right: 1em;"><br /></a><br /></div><br /><div><br /><br />
<br />
<div class="separator" style="clear: both; text-align: center;"><a href="https://www.fauquierent.net/store_throat.htm" style="margin-left: 1em; margin-right: 1em;" target="_blank"><img border="0" data-original-height="676" data-original-width="800" height="270" src="https://www.fauquierent.net/store/a-throat.png" width="320" /></a></div></div>
<br />
<ins class="adsbygoogle" data-ad-client="ca-pub-9714478253321829" data-ad-slot="1651691265" style="display: inline-block; height: 600px; width: 160px;"></ins>
<script>
(adsbygoogle = window.adsbygoogle || []).push({});
</script>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0tag:blogger.com,1999:blog-8621317379873499702.post-25560927664000336082022-10-23T11:55:00.001-04:002022-10-31T18:14:24.868-04:00Time Lapse of a Severe Skin Infection Healing over 30 Days (Impetigo, Cellulitis)<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/OUluRyfjZfw" title="YouTube video player" width="560"></iframe>
<br /><br /><div>
Impetigo is a mild skin infection caused by Streptococcus and/or Staphylococcus aureus. Cellulitis is when the infection spreads into the deeper layers of the skin. In this particular patient, impetigo was initially present involving the face, neck, legs, and arms. It was treated with mupirocin and cephalexin, but the infection continued to get worse. Given the lack of improvement, cultures were obtained from the oozing sores which revealed a multi-drug resistant staph infection. By the time this information was finally obtained, cellulitis was present given the surrounding redness and induration. Appropriate culture-directed antibiotics was immediately started along with steroids to help with inflammation. Immediate improvement was seen within 24 hours.
<br /><br />
As the infection resolved, the affected skin takes on a more bruised appearance. After oral antibiotics were completed, topical skin care alone was pursued until the skin completely healed. Ultimately, it took nearly a month for the skin to return back to normal.
<br /><br />
Hopefully this 30 day time-lapse showing how the skin looks from from initial onset, to worsening, to finally resolution will help patients (and parents) understand visually the overall healing time course.
<br /><br />
There is no single "right" way to treat such skin infections. But what was used successfully in the care of this particular patient (that is available over-the-counter, excluding prescriptions) included the following:
<br /><br />
• <a href="https://amzn.to/3VT9tdH " target="_blank">Neosporin</a></div><div>• <a href="https://amzn.to/3MX0W5f " target="_blank">Aquaphor</a></div><div>• <a href="https://amzn.to/3D2J9VM " target="_blank">Betadine</a></div><div>• <a href="https://amzn.to/3f16iQn " target="_blank">Clorox</a> (for Bleach Baths)<br /><br /><a href="https://youtu.be/BxNexkcaFfw" target="_blank">Bleach Baths</a> are also helpful.</div>
<br />
<iframe allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen="" frameborder="0" height="315" src="https://www.youtube.com/embed/BxNexkcaFfw" title="YouTube video player" width="560"></iframe>Fauquier ENThttp://www.blogger.com/profile/18011731559130483399noreply@blogger.com0