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April 30, 2012

We Know About Fingerprints... but EARprints?

MSNBC reported today about a burglar who was nabbed through DNA, fingerprint, AND EARprint evidence.

Earprints are considered just as unique to an individual as fingerprints and dozens of earprints were used as evidence in this case. It was alleged that the burglar suspect pressed his ear against doors and windows to listen for anybody being home before breaking in.

In another statistic, earprints are found in 1 out of every 20 burglaries.

FearID or the Forensic Ear Identification project financed by the European Union was the research used to establish earprints as a forensic tool.

Earprints allow German cops to nab alleged serial burglar. MSNBC 4/30/12

Earprints as evidence? PhysOrg 2/24/06

April 27, 2012

Barometric Sinus Headache

MSNBC published a story on April 26, 2012 regarding headaches that come and go with pressure changes such as when flying in an airplane.

The neurological researchers call it "airplane headache" and the story makes it sound like a newly discovered headache, but in actuality, it is something that has been known for a very long time.

Human sinus cavities are air-filled cavities. When outside pressure changes relative to the air pressure within the sinus cavity, air pressure literally increases or decreases within the sinus cavity which a patient may perceive as pain/pressure over the face. This barometric sinus pressure would occur ONLY if the sinuses are clogged shut. If they are open, no problems would occur.

This phenomenon is analogous to a balloon (sinus cavity) that increases in size with decreasing pressure (going up a mountain or ascending in a plane) or decreases in size with increasing pressure (going down a mountain or descending in a plane).

As such, just like the MSNBC story suggests, the principal way to prevent such barometric sinus headache is to take a medication that prevents sinuses from clogging shut. One of the most effective medication is afrin nasal decongestant nasal spray to be used 30-60 minutes before ascent and descent.

If this issue is a persistent chronic problem, surgical procedures such as balloon sinuplasty can be performed to make the sinus openings larger to decrease the chance of closure from mucosal edema.

Akin to barometric sinus pressure, the ears undergo a similar process which is why people "pop" the ears with pressure changes.

The ear equivalent of a barometric sinus headache is eustachian tube dysfunction.

Is flying giving you an 'airplane headache'? MSNBC 4/26/12

April 26, 2012

Video on Zenker's Diverticulum Surgery (Endoscopic Staple Diverticulostomy)

Our office has produced a new video describing Endoscopic Staple Diverticulostomy to treat Zenker's Diverticulum.

We have the unusual honor of having treated patients throughout the United States for this rare condition. Patients we have successfully treated have come from as far away as Oregon, New York, Florida, Pennsylvania, Louisiana, Arizona, etc.

For more information, please visit us here.

April 23, 2012

Video of Eustachian Tube Popping Open with Valsalva

Ever wonder what the eustachian tube looks like when the ear pops open with valsalva maneuver? Valsalva is accomplished by trying to blow air out a nose that is pinched closed. The eustachian tube is a tunnel that goes from the back of the nose to the ear.

Well, here you go! Video provided courtesy of Dr. Vijay Anand.

Watch this video to see where this eustachian tube is exactly located.

Read more about ear popping and when one is NOT able to pop the ears, a condition called eustachian tube dysfunction!

Here are a few things that have helped some people to pop their ears:


April 21, 2012

Levon Helm, Singer/Drummer for The Band, Dies of Throat Cancer

Levon Helm, legendary singer and drummer for The Band, died of throat cancer at age 71 on April 19, 2012.

It is unclear exactly what happened over this past month, but media reports state that he was diagnosed with vocal cord cancer in 1998 and underwent 28 sessions of radiation treatment at the Memorial Sloan Kettering Cancer Center. His cancer was almost certainly due to his 3 packs per day smoking and though he quit with his initial cancer diagnosis, cancer being what it is, it can always come back.

No mention of surgery or chemotherapy since than.

Given this little bit of information and the fact that he did have an albeit raspy voice to the point that he was still able to sing 1 month prior to his death on March 19, 2012, I suspect he had an aggressive recurrence of his vocal cord cancer.

Shown below is what a normal vocal cord looks like along with one that has cancer.

Typically with vocal cord cancer, radiation therapy alone is curative and allows for voice preservation. In fact, if no cancer is seen 5 years after treatment which in Mr. Helm's case would have been in 2003, one could state "cured" from this type of cancer.

So it is strange indeed that his vocal cord cancer would come back with a vengeance to the point it killed him 14 years later, though not impossible, especially if he started smoking again as well as drinking alcohol which exacerbates smoking's cancer-causing potential.

Furthermore, it is rare that vocal cord cancer alone would kill a person as there are salvage treatments in event the cancer does comes back as apparently it did for Mr. Helm.

If the vocal cord cancer comes back, it could grow in size to the point it would cut off the ability to breath. The growth could be quite dramatic taking a breathing/talking person to being unable to breath or talk in a matter of weeks.

With an aggressive vocal cord cancer recurrence, radiation therapy really is no longer an option if previously already done. Chemotherapy can be tried but with a localized aggressive cancer recurrence, surgery is really the only option... the COMPLETE removal of the entire voice-box.

This complete voice-box removal is known as total laryngectomy. It would leave the person completely unable to talk in a natural manner. It would also leave the person with a permanent hole in the neck as the only way to breath.

It just may be that Mr. Helm was offered this option, but given his life as a professional singer, it was perhaps too draconian an option for him to conceive of. As any singer can tell you, their voice is their life. Without their voice, their life might as well be over.

Of course, he may have developed a "new" cancer somewhere else in his throat... the supraglottis located immediately above the vocal cords or the pharynx which surrounds the vocal cords.

Unfortunately, the treatment options would have been still pretty much the same.

Levon Helm's Life After Cancer. CBS 2/11/09

Levon Helm Throat Cancer: Legendary 'The Band' Musician Dies At 71. HuffingtonPost 4/18/12

Levon Helm, Drummer and Singer of the Band, Dead at 71. RollingStone 4/19/12

April 20, 2012

Why Does EpiPen Have to be Injected into the Thigh?

As any severely food allergic patients know, when suffering from a potentially life-threatening anaphylactic reaction, they need to jab an epinephrine needle into the side of their thigh...

But... why the thigh? Why not the arm like most other shots?

Per AAAAI, there have been 3 anatomic sites investigated to determine which location offers the fastest systemic absorption of epinephrine when injected intramuscularly and/or subcutaneously.
  • Intramuscular injection in the upper arm (deltoid muscle) just like a flu shot.
  • Subcutaneous injection in the upper arm just like an allergy shot.
  • Intramuscular injection in the lateral thigh (vastus lateralis muscle).
Of these sites, the intramuscular thigh injection demonstrated the fastest rise in blood epinephrine.

When dealing with a life-threatening anaphylaxis, you need the speed because if the drug is too slow, the person may die before adequate epinephrine levels are achieved... and the thigh muscle provides the speed whereas the other sites do not.

Why might that be?

It's probably because the thigh muscle is large with lots of blood vessels allowing for multiple points of access for the injected epinephrine to enter into the blood circulation.

Epinephrine absorption in children with a history of anaphylaxis. J Allergy Clin Immunology 1998; 101(1):33-37.

Epinephrine absorption in adults: intramuscular versus subcutaneous injection. J Allergy Clin Immunol 2001; 108(5):871-873.

April 18, 2012

Video on Ear Clogging and What Happens When They Pop Open (or Don't)

A new video has been created describing anatomically how a person pops the ear open when it feels clogged or under pressure. Also explained is what happens anatomically when the clogged ear is very difficult if not impossible to pop open; a condition called eustachian tube dysfunction.

Check the video out here!

Here's a video explaining what is happening more from an anatomical perspective:

Here's another video showing how an ear infection may cause a clogged ear.

Here are some devices that have helped some people to pop their ears:


April 10, 2012

Dental X-rays Linked to Brain Tumors

In a study spanning over decades, researchers have found an association between dental x-rays and increased risk of a non-malignant type of brain tumor called meningioma.

Of the four types of dental x-rays, only the full-mouth series was associated with this increased risk. More specifically, the risk was elevated with the aggregate number of full-mouth series in 10-year periods from approximately 15–40 years before diagnosis, with significant elevations in the 10-year periods beginning 22–30 years before diagnosis. The risks in these analyses were even greater when only women were considered.

One needs to be aware that radiation exposure from full-mouth series was much greater in the past than it is now and as such, this risk may be nominal (though not zero) with current dental x-ray technology.

However, it also should be a reminder that x-rays should not be routinely performed unless there is a very good reason to obtain especially in children who are more susceptible to radiation injury... and that applies to not only x-rays, but any kind of testing involving ionizing radiation including CT scans.

Some x-rays should NEVER be performed including sinus x-rays for sinus problems given a nearly 50% error rate in diagnosing the presence OR absence of sinus problems.

X-rays for nasal fractures is not recommended given x-rays rarely change how such fractures are managed.

Soft-tissue lateral x-rays to look for large adenoids should also be discouraged as nasal endoscopy can provide similar if not better information without any radiation exposure.

To know what the cancer risk is with different types of x-rays, check out this website!

Dental X-rays and the risk of intracranial meningioma. Cancer. Volume 100, Issue 5, pages 1026–1034, 1 March 2004

April 07, 2012

Tonsil Bad Breath and Tonsil Stones

The Huffington Post published a story on tonsil stones on April 4, 2012 which can lead to bad breath. The author, who is a dentist, gave the perspective of conservative treatment strategies to resolve bad breath whose root cause is due to tonsil stones otherwise known as tonsilloliths.

Such "stones" are produced and ejected from tonsils and 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 which is downright foul-smelling (and foul-tasting).

The only known cure for tonsilloliths is tonsillectomy (no tonsils = no tonsil stones), though the article does outline more conservative measures which are encouraged first prior to surgery. More recently, there is a minimally invasive procedure called tonsil cryptolysis which also has the potential to eliminate this problem prior to considering tonsillectomy. Watch video of this procedure.

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

The Different Kinds of Bad Breath, Part 2: Tonsil Breath. Huffington Post 4/4/12

April 04, 2012

How Does Cervical Spine Surgery Potentially Cause Voice and Swallow Problems? [video]

It is not unusual for an ENT surgeon to see patients with swallowing and voice difficulties after cervical spine surgery. In particular, the ACDF surgery (Anterior Cervical Discectomy and Fusion).

The key to understanding these issues is to first understand the anatomy involved.

The cervical spine is located in the back of the neck. In front of this spine is the esophagus (swallowing tube) and voicebox.

As such, when a spine surgeon goes through the FRONT of the neck in order to perform cervical spine surgery located in the BACK of the neck, (s)he has to move the esophagus and voicebox over to the side.

A plate is than fixated to the spine to fuse the cervical vertebral bodies.

Because of such manipulation of the esophagus and voicebox, it is not uncommon for a patient to complain of hoarseness and difficulty swallowing after surgery.

Fortunately, such problems usually dissipate with time, but not always. Swallowing complaints may last over 1 year. [more info]

Watch the video describing ACDF and how it can affect voice and swallow.

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VIDEO: How Does the Human Voicebox Work?


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