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August 31, 2009

NYT: Tonsil Stones (aka Tonsilloliths)

The NYT published a story on tonsil stones on Aug 31, 2009. Tonsil stones, otherwise known as tonsilloliths, are "stones" that are found and ejected from tonsils that consist of mucus, dead cells and other debris that collect in the deep pockets of the tonsils and gradually condense into small, light-colored globs. Bacteria feed on this accumulated matter, giving rise to the odor.

The only known cure for tonsilloliths is tonsillectomy, though more conservative measures are encouraged first prior to surgery. There is also a minimally invasive procedure our office performs called tonsil cryptolysis which is a procedure to try and eliminate this problem prior to considering tonsillectomy.

A recent research paper does offer tantalizing clues to address tonsilloliths more conservatively as it found that tonsil stones are more like living biofilms rather than an inert stone. Read the abstract here.

Read the story here.

August 27, 2009

Dr. Chang Featured in Local Newspaper

Well, to be more accurate, Fauquier Hospital used Dr. Chang as advertisement for its "Be Yourself" campaign. Other physicians have been portrayed in a similar fashion. This ad appeared in the September 2009 Discover Fauquier's Values publication.

August 25, 2009

Chewing Gum Improves Memory?!!

Image by Mayr from Wikipedia
I came across interesting research that hinted at the possibility that chewing gum improves tasks that require memory recall. This was first suggested in a study published in 2002 in the journal Appetite where chewing gum was found to selectively improve aspects of memory in healthy volunteers. The researchers took seventy-five adults and separated them into three groups: those that chewed gum during a twenty-minute test of memory and attention, those that mimicked the chewing movement, and those that did not chew at all.

They found that people who chewed scored better on long- and short-term memory tests (measured by word recall).

The authors speculated on three possible explanations: brain activity in the hippocampus increases while people chew, so this might help with memory; gum chewing promotes the release of insulin, which might indirectly affect memory; and the most straightforward—chewing can increase heart rate slightly, and this increased blood flow could deliver more oxygen to the brain.

Follow-up studies in 2004 supported these initial findings.

A more recent study in 2009 using 101 student volunteers found that it wasn’t the gum per se but any candy (cinnamon candy in the study) or oral stimulus can help a person remember information. Based on this study, it was felt that the oral action as well as the scent of the candy/gum served as a memory cue for information.

Maybe those gum-smacking kids in class did know something the rest of us did not.

Fortunately, fear not teachers... There are other studies that have been done that have not replicated these results at all and even contradicts them.

Chewing gum can also exacerbate/cause TMJ problems.

Image taken from Wikipedia.

August 24, 2009

Another Reason to Stop Smoking... Decreased Sense of Taste

Greek researchers published a study in which they described a significant decrease in taste ability in smokers compared to non-smokers. In the study titled "Evaluation of young smokers and non-smokers with electrogustometry and contact endoscopy," 62 male Greek soldiers were evaluated for smoking and taste by using two different instruments called electrogustometry (measures taste thresholds) and contact endoscopy (wich evaluated the morphology and density of papillae on the tongue's tip).

This study could explain why smokers not only complain of decreased sense of taste, but also change in the way things taste (dysgeusia).

Click here to read the study abstract.

August 23, 2009

Online Hearing Test (Audio)

Phonak, one of the major manufacturers of high end hearing aids, has developed a screening hearing test you can do online in the comfort of your home.

Take the test here.

If you do poorly on this exam, please see your local ENT in order to get a more reliable hearing test and see what options you have to improve your hearing (or keep what hearing you have left).

Another Article on Dangers of Hearing Loss from Loud Concerts and iPods

The Daily News on Aug 21, 2009 published yet another article on the dangers of loud concerts and iPods resulting in permanent hearing loss. The article is titled "Beware: Loud concerts and iPods make music dangerous."

In our practice, there have been a few patients every year in their 20s and 30s who have experienced sudden hearing loss as bad as 80 year olds after attending a loud rock concert. The hearing disappears after the concert... and it never comes back. This phenomenon is called Sudden Sensori-Neural Hearing Loss or SSNHL for short.

Please wear ear plugs... and if you experience hearing loss or ringing/tinnitus after being exposed to loud noises that does NOT come back within a few days, see your local ENT as soon as possible. There are only a few medications that can help reverse the hearing loss, but only works if given within the first 2 weeks ideally and not more than 4 weeks.

Read the full article here.

August 19, 2009

Music Can Help Understanding Speech in Noisy Environments?

Many older adults will say, 'I can hear what you're saying, but I don't understand you,' especially in a location where there is background noise (such as a restaurant) leading to frustration and social isolation. However, new research is offering tantalizing clues to prevent this from happening through music training.

Musical training makes musicians really good at picking out melodies, such as the treble line or the sound of their own instruments, from surrounding complex sounds. This improved perception in noise in musicians was linked with better working memory and tone discrimination ability. The results imply that musical training enhances the ability to hear speech in challenging listening environments by strengthening auditory memory and the representation of important acoustic features

Thirty-one study participants, with normal hearing and a mean age of 23, were divided into one group with music experience and another without it. They had to listen to sentences presented in increasingly noisy conditions and repeat back what they heard. The music group did significantly better.

The study does suggest that by reinforcing the pervasive effects that musical experience has on sound-processing abilities, better speech understanding can be obtained in noisy environments and underscores the importance of music education being more accessible to the general population

Read the story here.

Alexandra Parbery-Clark, Erika Skoe, Carrie Lam and Nina Kraus. Musician Enhancement for Speech-in-Noise. Ear and Hearing, (in press)

August 17, 2009

NYT: Wolfgang Amadeus Mozart Death Due to Strep Throat?

Image by Wikipedia
Well according to a NYT article published on Aug 17, 2009, yes he potentially did. In the article titled "What Really Killed Mozart? Maybe Strep," the journalist reports on a paper published in the Aug. 18 issue of The Annals of Internal Medicine where the researchers have done an epidemiological analysis that suggested he was a victim of an epidemic streptococcal infection.

Read the NYT article here. Read the actual paper abstract here.

This story illustrates how far we have come in controlling what is now considered a benign infectious problem which can be easily treated with antibiotics or tonsillectomy.

Stress Can INCREASE a Person's Allergies!

Researchers at Ohio State University recently published an article in the June 2009 journal Psychoneuroendocrinology titled "How stress and anxiety can alter immediate and late phase skin test responses in allergic rhinitis."

What they found was that allergic responses to a skin prick increased after a stressful event compared to a non-stressful event. Anxiety also substantially enhanced the effects of stress far into the future as even skin tests performed the day after the stressor reflected the continuing impact of the stressor among the more anxious participants.

Read the NYT article on this here.

Yet another thing to think about in allergic patients...

Read more about the study here.

August 12, 2009

Does Honey Relieve Allergy Symptoms? NO!

Came across an interesting blog article by allergist Dr. Ves Dimov regarding whether honey actually helps allergic individuals.

The blunt conclusion was that honey does NOT help people with their allergies. As quoted from a Fort Worth newspaper article, "The bees don't know what you're allergic to," he said. Most people are allergic to windborne pollens that come from grass and trees, but bees mostly gather flower pollens, he said. Another problem: You'd have to eat dozens of pounds of honey for it to be beneficial, the allergist said. There isn't enough pollen in the natural sweetener to make a big impact."

In fact, there was a research study done in 2002 where 36 participants who complained of allergic rhinoconjunctivitis were randomly assigned to one of three groups receiving:

1. locally collected, unpasteurized, unfiltered honey
2. nationally collected, filtered, pasteurized honey
3. corn syrup with synthetic honey flavoring

All participants consumed 1 tablespoon/day and were instructed to maintain a diary tracking 10 subjective allergy symptoms.

Neither honey group experienced relief from their symptoms in excess of that seen in the placebo group.

This study did not confirm the widely held belief that honey relieves the symptoms of allergy.

Effect of ingestion of honey on symptoms of rhino conjunctivitis. Ann Allergy Asthma Immunol. 2002 Feb;88(2):198-203.

Our Website Referenced In An O'Reilly Textbook!

O'Reilly has published a new textbook for health-conscious consumers called "Your Body: The Missing Manual." The neat thing is that on page 146, there are 2 photos of the larynx taken (with permission) from our website. Check it out!

You can buy this book on

YouTube Video on Robotic Thyroidectomy Which Eliminates Neck Incisions

Surgeons in Texas have uploaded a YouTube video showing a thyroidectomy being performed by a robot under surgeon guidance without making any incision on the neck. The robot is utilizes the DaVinci system.

Check it out here!

Non-robotic thyroid surgery can be seen in this video here which does use a neck incision.

August 11, 2009

Why Can Some People Eat Red Hot Chili Peppers and Others Can't?

The New York Times on Aug 10, 2009 answered this question nicely in their Science/Health Section. Read the answer here.

NYT: Story on Phantosmia (Phantom Smells)

In the Aug 10, 2009 issue of the New York Times, a story entitled "A Pungent Life: The Smells in My Head," describes the life of an individual who suffers from phantosmia, a frustrating disorder where a person smells disagreeable odors that is not actually present. Such odors range from raw sewage/garbage to burning.

Though actual physical pathology may cause this symptom including brain tumors, sinus infection, nasal polyps, etc. Too often, everything comes back normal.

Though an otolaryngologist is usually the first person to see regarding this problem, unless there is something physically wrong, we don't have much more to offer.

There are "smell specialists" throughout the United States who are able to offer more in terms of medical management. Thankfully, at least here in Northern Virginia, there is a smell specialist in Washington DC.

Taste and Smell Clinic
Phone: 1-202-364-4180

Read the NYT article here.

Redheads Have Lower Pain Thresholds

The New York Times on Aug 6, 2009 published a story "The Pain of Being a Redhead" that describes research why redheads experience more pain than other individuals.

Apparently, red hair color is caused by variants of the melanocortin-1 receptor (MC1R) gene. People with naturally red hair are resistant to subcutaneous local anesthetics and, therefore, may experience increased anxiety and pain regarding dental care as well as other surgical procedures. Having this gene variant significantly affected a patient's level of anxiety and pain experience when compared to others, even when controlled for general trait anxiety and sex.

It may behoove surgeons to be aware and appropriately adjust medications to take the findings of this research into consideration when dealing with their redhead patients.

Though research has not born out that redheads "bleed" more, it does bring up the thought that if a redhead has more pain and increased anxiety from a surgical procedure, it may raise their blood pressure which IS associated with greater bleeding risk.

Read more about this story here.

Genetic Variations Associated With Red Hair Color and Fear of Dental Pain, Anxiety Regarding Dental Care and Avoidance of Dental Care. The Journal of the American Dental Association (July 2009) 140, 896-905. doi: 10.14219/jada.archive.2009.0283

August 08, 2009

A New Way to Diagnose Exercise-Induced Vocal Cord Dysfunction!

Researchers in Helsinki, Finland validated a new method to diagnose exercise-induced vocal cord dysfunction (VCD). And what a simple idea they came up with! In a study titled "Fiberoptic videolaryngoscopy during bicycle ergometry: A diagnostic tool for exercise-induced vocal cord dysfunction," the authors performed fiberoptic video laryngoscopy WHILE a patient was exercising on a bicycle. Given that so often the symptoms of vocal cord dysfunction occur ONLY when a patient has been exercising, this is a logical step to perform when trying to determine whether a patient has VCD or not.

Vocal cord dysfunction is a frightening medical situation when a patient suddenly and unexpectedly experiences the inability to breath due to their vocal cords suddenly coming together resulting in a high-pitched squeal known as stridor. An episode may last to the point that the patient faints from lack of oxygen. Read more about this condition here.

At least in my practice, I usually make the patient run around my office until symptoms start appearing and than have them quickly come into my office for the fiberoptic video laryngoscopy. Observing the vocal cords coming together when trying to breath is how diagnosis of VCD is made.

Watch a video of fiberoptic video laryngoscopy being performed here.

Does Weather Temperatures Influence Patient Sickness Levels?

According to a new Harvard Medical School Study it does. In a research paper called "Does annual temperature influence the prevalence of otolaryngologic respiratory diseases?" published in the July 2009 Laryngoscope, the author analyzed the prevalence of upper respiratory diseases between the years 1998 to 2006.

What was found by regression analysis through the study years was that there was no significant relationship between average annual temperature and the prevalence of disease for hay fever, jaw pain, or chronic bronchitis. HOWEVER, a statistically significant but small regression coefficient (0.004) was noted for an increasing prevalence of sinusitis with increasing annual temperature (P = .031).

Given global warming is occurring, this does have impact on overall population health and quality of life as temperatures slowly rise. Yet another reason to fight global warming. It is making us more sick!

Image above taken from here.

High Tech Tonsillectomy: Quantum Molecular Resonance Tonsillectomy

I did not make that up which sounds like something out of Star Trek... there is actually a device called the Molecular Quantum Generator made by Vesalius that incorporates quantum molecular resonance coagulation that uses molecular resonance to cut and coagulate precisely, cleanly, and without any bleeding, all at low tissue temperature levels (not more than 45-50 degrees C). This technology does offer a new possibility for tonsillectomy patients allowing for faster recovery without increase in complications.

In fact, there is a study out that most favorably compares to the current coblation technology that is most commonly used to perform tonsillectomy in the United States (including that used in our practice).

You can watch a video of tonsillectomy being performed using quantum molecular resonance technology here. Here's a video of a tonsillectomy using coblation technology.

Unfortunately, this technology is not offered in the United States... yet...

A video of a coblation tonsillectomy is shown below:

August 05, 2009

Our Office Now Carries Ear Band-Its Swimming Headband!

Due to numerous patient requests, our office now carries in stock the swimming headband called Ear Band-Its that helps keep ear plugs in and water out when kids go swimming. Too often during swimming, the ear plugs get knocked out or in spite of a parents' best efforts, water seems to get by the plugs. Though swimming caps over the ears would work/help, most kids refuse to wear them.

However, kids don't seem to mind wearing headbands as it apparently is "cool." Made of 3mm Neoprene with an adjustable Velcro-type closure, our office carries sizes S (1-3 years), M (4-10 years), and L (10+ years). At this time, we carry only the colors red and blue.

Click here to read more about it.

You can also order them from

New Webpage on Tongue Tie (Ankyloglossia) and Its Treatment

A new webpage has been added to our website discussing a condition called tongue tie (otherwise known medically as ankyloglossia) along with its treatment.

Photos on the steps on how this is surgically treated is also included!

Click here to check it out!

August 04, 2009

RANDOM: Treatment for Kids Who Keep Putting Objects in the Ear???

So I saw this patient who had an unusual earring as depicted to the left... And I thought... AHA!!! This may be a neat way to prevent kids from putting peas, erasers, pebbles, etc in the ear, especially if they have a history of repeatedly doing so! Not sure how many parents would actually take this step.

August 03, 2009

New Video Uploaded of Adult Laryngomalacia

A new video has been uploaded to our website showing what laryngomalacia looks like in an adult. This patient also happens to have a right vocal cord paralysis. Because of the vocal cord paralysis, there is some hooding of her arytenoid mucosa resulting in partial airway blockage, especially with strong inhalation breath (and produces a slight wheezing sound as well).

Click here to check it out!

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VIDEO: How Does the Human Voicebox Work?


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