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June 26, 2009

New Webpage on Ear Infections

A new webpage has been posted on ear infections. The 3 different types of ear infections (external, middle, and inner) and their treatment are explained. Click here to read more about it.

Products to try to prevent ear infections

June 21, 2009

Neat ENT-Related iPhone Applications (Decibel Meter and Tinnitus Relief)

So I was browsing around the app store on iTunes and encountered a few applications that may be of interest to readers...

The first is related to measuring in decibels the ambient noise level called "Volume Decibel Reader". I like it in that it has a handy chart that shows what can happen to your hearing if you remain in the environment. You simply open the application and hit start and hold up the phone up in the air.
Volume Decibel Meter

The other application purportedly provides tinnitus relief in a method reminiscent of much more expensive alternatives (ie, Neuromonics which costs $5000+) using scientifically validated principles.
Tinnitus Relief - 48HR SALE

Any comments from readers who have actually tried either of these programs out?

June 20, 2009

Fauquier ENT Now Available on Your Phone!

Fauquier ENT has deployed a website optimized for viewing on a cell phone. In essence, it is a stripped down version of the main practice website. The web address for phone users is:

Check it out here!

This blog you are reading has also been converted to a mobile version which can be found here.

For those curious, the mobile website was created using MobiSiteGalore with some additional tweaks using Dreamweaver.

June 18, 2009

Itchy Ears

A common complaint we often see patients for are itchy ears. The don't hurt or drain... They just itch... a lot...

There are a few common causes of such itchy ears including earwax, allergies, and a piece of hair in the ear canal. However, there are a few other etiologies which are not often considered.

Ear Canal Dermatitis

Yes... the skin of your ear canal can become dry and irritated (just like the hands after washing your hands too often). People sometimes complain of very dry flaky earwax with this condition, similar to the dry flaky skin of psoriasis.

Treatment is easy... steroids! Whether it be in cream form (elicon, triamcinolone) or drops (dermotic). For those a bit wary of using steroids, one can try facial lotion, mineral oil, or sweet oil.

Fungal Otitis Externa

Also known as thrush of the ears. This often happens when antibiotics are given repeatedly over time for an "ear infection" whether in ear drop or oral pill form. Pain may be present, but even with pain, the adjective itchy is always included.

Treatment is also a snap... anti-fungal cream! We like to use lotrisone for this condition. However, the other key to successful treatment is complete debridement of the ear canal prior to cream insertion. Also, when the cream is used, one needs to completely fill the ear canal from eardrum to ear canal entrance.

Often, one single treatment is all that is required!

Worst comes to worst, antifungal powder can be tried.

NYT Article: Weight Loss By Manipulating Sense of Smell

There was an interesting NYT article on June 17, 2009 where some niche companies are claiming one can lose weight by saturating your sense of smell... either by enhancing or decreasing.

Read the article here.

Personally, I would think that decreasing your sense of smell would do more to help as this would decrease your sense of taste making food taste more like cardboard and/or sand.

There is a medical condition called "anosmia" where a person has completely lost their sense of smell. These individuals also are unable to really taste food as well. Anecdotally, most people with anosmia I've encountered are not overweight. Probably because nothing they eat tastes good... and so they eat what they must to not be hungry... and eat no more than they have to.

June 16, 2009

Zicam Can Cause Permanent Loss of Smell!!! today reported that the FDA has come out with a warning to consumers that three popular Zicam nasal products can cause users to lose their sense of smell permanently, a medical condition called anosmia. Apparently, there has been over 130 reports of anosmia after use of these Zicam products since 1999. Specifically, the products are:

Zicam Cold Remedy Nasal Gel
Zicam Cold Remedy Nasal Swabs
Zicam Cold Remedy Swabs, kids size

Indeed, the FDA has stated that consumers should stop using the products immediately.

Click here to read more about this.

Here is the FDA letter sent to the company that makes Zicam.

New Member Added to the Voice Team at Fauquier ENT

Please welcome Sarah Maines, BM, MM who recently joined the voice team at Fauquier ENT as a singing voice therapist and fills the place of Jennifer Sharp and Mark Greenawalt who have left. Sarah is on faculty at the Shenandoah Conservatory of Shenandoah University as a Doctoral Student of Musical Arts. She is a trained classical singer who performed as the First Lady in The Magic Flute with conductor Jan Wagner and director Daniel Helfgot. She sang Euridice and Donna Elvira in the Lexington Opera Society 2006 Spring Opera Workshop and Despina in scenes with the Kentucky Institute for International Study in Salzburg, Austria and with the Shenandoah University Opera Workshop program. Other roles Sarah has performed in opera scenes programs include Mélisande, Marie, Titania, Konstanze, and Adina. Her appearances as a guest soloist include Alice Parker’s Melodious Accord, Vivaldi’s Gloria and Britten’s Ceremony of Carols, as well as numerous jazz, music theatre, and cabaret performances.

Through her experience as a singing instructor and an active researcher in the area of voice, Sarah has developed a special interest in the biomechanics of voice production in disease and in health. Voice therapy sessions with Sarah include methods by Thomas R. Blaylock as well as Oren Brown and Joseph Stemple that help any voice user (not just singers) develop and maintain a strong, coordinated, and healthy vocal instrument.

New Webpage on Sudden Hearing Loss

A new webpage has been posted on Sudden Hearing Loss, or medically also known as Sudden Sensorineural Hearing Loss (SSNHL). The webpage goes over symptoms and treatment (steroids and/or intra-tympanic steroid injections). Read more about it here.

June 12, 2009

Drinking Alcohol Increases Risk of Allergies!

Well at least in women and only for perennial allergies (not seasonal allergies) according to a study published in July 2008 in the journal "Clinical Experimental Allergy." The study entitled Alcohol consumption and the risk of self-reported perennial and seasonal allergic rhinitis in young adult women in a population-based cohort study found that in Danish women between the ages of 20-29 who drank more than 14 drinks/week were significantly more likely to develop around the year allergies when compared to those who drank <1 drink/week.

Interestingly, smoking was found to not increase the risk of allergies.

It seems there is yet another reason not to drink alcohol! Whether men and other age groups are similarly affected is unknown.

Read more about this here.

June 11, 2009

Allergies CAN Appear for the First Time in the Elderly!

Although most patients with allergies develop symptoms of allergy during childhood or young adulthood, allergies CAN appear for the first time even in the elderly population!!! This fact is important as many elderly with allergies are misdiagnosed with sinusitis and other conditions for which they are treated with a number of medications which do little to help. Some even fail to seek treatment since they attribute their symptoms to the aging process or other non-allergy problems.

It is felt that many of these elderly patients develop allergies due to the "lifetime load theory" which states that living among a lifetime of exposure to pollen, dust, mold, etc can aggravate the immune system to the point that allergies develop much later in life than usual.

As such, if an elderly patient presents with symptoms that appear to be allergies, than you may be right even if the patient has never had allergies before!

Read more about this topic in an article published in the Wall Street Journal here.

June 10, 2009

What To Do With a Broken Nose?

The only reason to see a physician immediately after an injury to the nose is to assess whether a septal hematoma has formed. The septum is a wall that divides the right nasal cavity from the left. If a hematoma has developed (which is VERY rare), it needs to be drained in an approach similar to doing a deviated septum repair.

Regarding the "broken" nose itself...

I personally think getting an X-ray to look for an isolated broken nose is a waste of time and money. Perhaps the ONLY time I would think about getting it is for legal reasons (the victim plans to sue the assailant if applicable).

However, my standard spiel is one only does something about a nasal fracture (surgically) if there is a problem with

1) Function (ie, can't breath through the nose due to fracture and not because of mucosal swelling)


2) Form (cosmetically unacceptable to the patient once soft tissue swelling goes down all the way)

Otherwise, you do nothing... even if it is clearly broken on X-ray (if one was obtained). If the answer is affirmative to the one or both of the above, than you fix it. Therefore, why bother with the X-ray if it doesn't change management?

In any case, the best thing to do if there is a concern for a broken nose is to ice it like crazy (20 min on, 20 min off in cycles throughout the day while awake), keep the head elevated (even when sleeping), and take motrin for any pain/discomfort.

These measures minimize and resolve any swelling as quickly as possible.

Make an appointment with a plastic surgeon or ENT within 3-5 days.

If there is concern for other facial fractures beyond a broken nose, go to the ER and make sure they get a CT of the maxillofacial (no contrast).

For the athlete with a broken nose who wants to keep active, recommend getting a nose guard like this:

WSJ Article on Sleep Disorders Including Obstructive Sleep Apnea

The WSJ published a story on June 9, 2009 on sleep disorders including obstructive sleep apnea or OSA for short.

Read the story here.

Read more about OSA here.

June 09, 2009

Pictures Showing Steps to Parotid Mass Removal Added

We have added actual surgical photos of a parotid mass removal to our parotidectomy webpage. 6 photos (including the one shown here) were taken during each stage of the surgery. A small description has been added as well explaining what is going on. Check it out here!

June 08, 2009

New Webpage on the Perforated Eardrum

A perforated (or hole) eardrum is a common condition many patients have when presenting to their ENT doctor. Given how common this problem is, a new webpage has been created that describes this condition as well as how it is managed/treated. Click here to read more.

New Webpage on Earwax (Cerumen) and Its Treatment

A new webpage has been posted on earwax (also known as cerumen) and its treatment. Pictures of a variety of different types of earwax is also displayed. Check it out here!

Over-the-counter treatment for earwax:

June 07, 2009

Blogger Template Customization

A few people have recently contacted me on instructions on how I made the changes to the blog template beyond what blogger provides. Well, here goes and rather than providing a step-by-step instruction for each customization, I will provide the links to where I learned how to do it. Keep in mind that most require some programming in order to install!

Related Posts List at End of Post
Adding Navigation Buttons to Header
Add Tabbed Interface Widget (About Us, Ear, Nose, Throat)
• Customized Header: This Article and This One as Well
Browser Title Showing Post Title (Instead of Blog Name)

As I perform further customizations, I will add to the list here.

June 05, 2009

Sharing Added to Website Pages and Blogs

We have recently upgraded our practice website and blogs with the ability to share. What do we mean? Perhaps the easiest way to explain is to go ahead and click on this icon here:


This icon has been added to each and every blog article as well as educational articles on our practice website to enable a person to easily share information found with others through a variety of social media outlets including email, facebook, digg, twitter, myspace, etc etc. Go ahead and give it a try!

Cavaliers Forward LeBron James Underwent Parotidectomy

Reuters on June 3, 2009 reported that LeBron James underwent a 5 hour surgery to remove a benign cyst from his parotid gland. People may ask why it would take so long to remove a cyst. It's because the nerve that makes the face move goes through the parotid gland and if the nerve is not identified first prior to cyst removal, the patient may end up with a permanent facial paralysis.

Read the story here.

I would bet that it took 4 1/2 hours to identify and trace out all the facial nerve branches (can be as thin as a hair) and 30 minutes to remove the cyst and close the wound.

Read more about this type of surgery here.

June 04, 2009

Brains of People with OSA Similar to People Dying or Severe Stroke

Image From Gutenberg Encyclopedia in Wikipedia
Sufferers of obstructive sleep apnea experience similar changes in brain biochemistry as people who have had a severe stroke or who are dying, research showed published in the May 2009 edition of Journal of Cerebral Blood Flow and Metabolism. Apparently, when oxygen desaturation >10% occurs, a significant and severe disorder occurs to the brain bioenergetics, even if transient.

This research (determined by using MRI) does suggest that OSA does impair brain function much more severely than once thought.

For those who have untreated OSA, please see your physician and get this treated!!!

Read more about this here.

June 03, 2009

Online Fan Overview: The Good and The Bad

Every once in awhile, I take a look and see how the online presence of our practice is doing... As of today, our numbers our astounding in some areas!

382 subscribers

Stroboscopy Video on YouTube:
7,030,395 views with over 1900 ratings (WOW!!!)

Other YouTube Videos:
Many of our other videos have over 50,000 views

Practice Website:
Average about 4000 hits/day

However, there is room for improvement in other areas:

9 followers (though we just started this up a few weeks ago)

Practice Feed:
10-15 subscribers

17 fans (just started last month)

Regardless of our numbers, I just wanted to take this time and thank our supporters! Without your support, our online presence would still be mainly limited to the Yellow Pages...

ENT Problems Due to Toxic Drywalls in Homes Built/Remodeled After 2000

There have been a number of news reports in the past year reporting on the use of toxic drywall made in China in new or re-modelled homes built after 2000 that have caused a number of ear, nose, throat symptoms in families living in these affected dwellings.

CNN Article #1
CNN Article #2
CNN Article #3
CNN Article #4

Such symptoms include: nosebleeds, headaches, coughs, upper respiratory or sinus issues, rashes. The Homeowners Consumer Center believes that exposure to toxic Chinese drywall, and some of these medical symptoms are related, because homeowners in new homes in different parts of the country, different states, all share two things in common: 1) the fact that Chinese drywall is in their house, and 2) they have these medical conditions. In many cases not everyone in the family will share the same symptoms.

These symptoms appear only when living in the home and disappear after a period of time when on vacation or at work. Unfortunately, the symptoms return shortly after coming back home.

If you live in a home and suspect toxic Chinese drywall is present, you can call the Homeowners Consumer Center anytime at 866-714-6466 or contact the group via their web site at

Foul Smelling Earwax (and/or Armpits) Suggest Increased Potential Risk of Breast Cancer

Researchers in Japan recently published a research article in the June 2009 edition of The FASEB Journal that explains why females with foul smelling earwax as well as armpits may be at risk for breast cancer. Apparently, the secreting glands of the breast tissue are similar to the cerumen-producing glands of the ear canal and sweat-producing glands of the armpits. Apparently, one of the genes, ABCC11 WT variant, is responsible for causing breast cancer. This genetic variant is also responsible for foul smelling armpits (osmidrosis) as well as smelly and wet earwax.

As such, it is felt that if a woman suffers from malodorous armpits and earwax, she may be at higher risk for breast cancer.

Read more about it here.

This factoid was also mentioned in Nancy Snyderman's book, "Medical Myths That Can Kill You: And the 101 Truths That Will Save, Extend, and Improve Your Life."

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