January 1: Can sleep trouble cause diabetes?, Chicago Sun-Times
U. OF C. STUDY | Volunteers who were roused needed more insulin
BY JIM RITTER Health Reporter
Researchers have identified a possible new risk factor for diabetes: not getting a good night's sleep.
In a small study, University of Chicago researchers tested the theory on nine healthy young adults in a sleep lab.
For three nights, researchers prevented volunteers from getting the deepest and most restorative type of sleep.
Afterward, volunteers' bodies did not use insulin as well as before: they needed more insulin to dispose of the same amount of a sugar solution.
This reduced insulin sensitivity was comparable to the effect of gaining 20 or 30 pounds.
Earlier studies found that not getting enough sleep can increase the risk of obesity and diabetes.
The U. of C. study is the first to suggest that not getting the right kind of sleep also could increase diabetes risk.
The study is published in the Proceedings of the National Academy of Sciences.
Researchers monitored volunteers' brain waves. As soon as volunteers started to enter deep "slow-wave" sleep, researchers sounded acoustic tones. If that didn't rouse volunteers, researchers spoke their names over the intercom or gently nudged them. Sleep was disrupted 250 to 300 times a night.
Volunteers typically had vague memories of hearing noises only three or four times. But they woke up feeling tired and cranky.
Volunteers were aged 20 to 31. But they slept like they were 40 years older. People in their 20s typically get 80 to 100 minutes of slow-wave sleep, while those over age 60 get less than 20 minutes.
If you're spending an adequate amount of time sleeping, but still wake up tired, you might not be getting enough slow-wave sleep. This often happens to people with obstructive sleep apnea.
Obesity and aging are two big risk factors for diabetes. Obesity and aging also reduce sleep quality, further increasing the risk of diabetes, researchers said.
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January 1: A cry for help at India's call centers, AP
Those working nights answering calls from the U.S. and Europe face sleep disorders, heart disease, depression and family discord.
By Rajesh Mahapatra, The Associated Press
NEW DELHI -- The call center job came with a good salary and good perks, especially compared to many other opportunities for young people in India.
But as 26-year-old Vaibhav Vats says, it was doing him no good. His weight grew to 265 pounds and long overnight hours gave him little time for a social life. Eventually, he quit.
"You are making nice money. But the trade-off is also big," said Vats, who spent nearly two years at an IBM Corp. call center handling customer calls from the United States.
Call centers and other outsourced businesses -- such as software writing, medical transcription and back-office tasks -- employ more than 1.6 million people in India, mostly in their 20s and 30s. But at this young age, they face sleep disorders, heart disease, depression and family discord, according to doctors and several industry surveys.
Experts say the brewing crisis could undermine the success of India's hugely profitable outsourcing industry, which earns billions of dollars annually and has shaped much of the country's transformation into an emerging economic power.
Heart disease, strokes and diabetes cost India an estimated $9 billion in lost productivity in 2005. The losses could grow to a staggering $200 billion over the next 10 years if corrective action is not taken quickly, said a study by the New Delhi-based Indian Council for Research on International Economic Relations.
The outsourcing industry would be hardest hit, the study found.
Reliable estimates of the number of people affected are hard to come by, but government officials and experts agree that it is a growing problem. Health Minister Anbumani Ramadoss wants to enforce a special health policy for employees in the information technology industry.
"After working, they party for the rest of the time," he said. "We don't want these young people to burn out."
Most call center jobs involve responding to phone calls through the night from customers in the United States and Europe, some of whom can be angry and rude. It's monotonous and there is little meaningful personal interaction among co-workers.
"There are times when the stress is so overwhelming that they fail to cope with it," said Archana Bisht, who started a counseling company -- 1to1help.net -- in Bangalore six years ago.
Her clientele now includes 25 companies -- seven of them were added in the last two months -- including such names as Intel Corp., IBM, Hewlett-Packard Co. and MindTree Consulting Ltd.
Each day, about 60 to 70 employees of several companies, including Intel, IBM and Hewlett-Packard, seek counseling from 1to1help.net. Marital incompatibility and relationship issues top the list of problems, Bisht said, because long, odd working hours make it difficult for couples to spend much time together.
More women than men ask for help, she said. The outsourcing boom has created new employment opportunities for Indian women, but there has been little change in social expectations. Adding workplace demands to responsibilities at home, which often include taking care of in-laws, leaves women workers with multiple stresses, Bisht said.
Loneliness also can take a toll.
"There is no social life," said Vats, who worked at night and either slept or watched television during the day. "You are not meeting new people."
Some firms have taken steps to ease the problems. The National Assn. of Software Services Companies, the main trade body of the outsourcing industry, said many of its member firms were already providing advice on health and gym facilities.
Infosys Technologies Ltd. has established 24-hour help lines for psychological counseling. HCL Technologies Ltd. has built day-care centers for children and sponsors group outings for employees.
But nighttime work hours are difficult to avoid.
"The odd hours can play havoc with your health," Vats said. "I never got good sleep because everyone was up and getting ready to go to work when I got home."
Vats' weight has dropped to 214 pounds since leaving his call center job two years ago. He's still overweight for his 5-foot, 9-inch frame, but is much happier working for a law firm at a much lower salary.
A recent survey by the Dataquest research group and IDC consulting company showed that sleep disorders topped health complaints among workers in the outsourcing industry.
About 32% of respondents complained of sleep disorders, 25% had digestive troubles and 20% reported eyesight problems, according to the survey, which covered 1,749 employees.
Sleep and digestive disorders, doctors say, can grow into bigger problems: hypertension, diabetes and heart disease.
Doctors say the rise in these ailments, alongside growing urbanization and fast-paced economic growth, is not surprising.
But India's case is alarming because of the sheer number of people affected and the factors that make them vulnerable to these diseases, said Ravi Kasliwal, a cardiologist at New Delhi's Indraprastha Apollo Hospital.
"To top it all, there is lack of awareness," Kasliwal said. "One out of 10 persons aged 35 years or more in this country is prone to heart attack."
Heart disease is projected to account for 35% of deaths among India's working-age population between 2000 and 2030, Kasliwal said, citing a World Health Organization study. That number is about 12% for the United States, 22% for China and 25% for Russia.
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January 1: Tonsillectomy significantly improves quality of life in adult and pediatric patients, Journal Otolaryngology
New research from the journal Otolaryngology -- Head and Neck Surgery
Tonsillectomies to treat chronic and recurrent tonsillitis substantially improve a patient’s quality of live in both children and adults, according to two new studies published as a supplement to the January 2008 issue of Otolaryngology-Head and Neck Surgery.
In one study involving 72 adults, patients showed improvement in all six subscales of the Tonsil and Adenoid Health Status Instrument (TAHSI), a scale used to measure the quality of life (QOL) of patients pre- and post-procedure. Among the scale-related findings, 98 percent reported fewer infections in the six months following surgery, with 76.9 percent expressing strong satisfaction with the surgery results. Patients also reported substantially fewer cases of persistent bad breath (halitosis), sore throats, and trips to the doctor because of sore throats.
In the study involving children, 92 patients also showed significant improvements when measured with the same TAHSI scale, including airway and breathing, infection, health care utilization, cost of care, eating and swallowing, and behavior. Additionally, the Child Health Questionnaire-PF28 was used on 55 of the subjects in order to measure QOL with regards to general health, physical functioning, behavior, bodily pain, and parental impact. Among the study’s findings were significant decreases in number of sore throats, antibiotic courses, days missed from daycare/school, doctor visits, and persistent halitosis.
Tonsillectomy remains one of the most common procedures performed on children each year, and while the number of incidences in adults is lower, it is still a routine operation. The current clinical guidelines produced by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), which were developed using consensus of expert opinions, recommend tonsillectomy for children with three or more documented tonsil infections in the span of a year.
Otolaryngology – Head and Neck Surgery is the official scientific journal of the American Academy of Otolaryngology – Head and Neck Surgery (AAO-HNS). The studies’ authors are David L. Witsell, MD, MHS; Laura J. Orvidas, MD; Michael G. Stewart, MD, MPH; Maureen T. Hannley, MD, PhD; Edward M. Weaver, MD, MPH; Bevan Yueh, MD, MPH; Timothy L.. Smith, MD, MPH; and Nira A. Goldstein, MD. Additionally, investigators in New York, North Carolina, Washington, Oregon, Minnesota, and Virginia assisted with information gathering.
Reporters wishing to obtain the complete copies of either study may contact newsroom@entnet.org. Expert otolaryngologists are also available to discuss tonsillectomies and other throat-related issues and how they affect the general public.
About the AAO-HNS
The American Academy of Otolaryngology – Head and Neck Surgery, one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s mission: “Working for the Best Ear, Nose, and Throat Care.”
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January 2: Saliva Test Used to Detect Cancers of Head and Neck, Reuters
WASHINGTON -- A simple mouth rinse may provide a new way to screen for head and neck cancers in people at high risk for these diseases, researchers said yesterday.
Scientists at the Johns Hopkins Kimmel Cancer Center in Baltimore are developing a saliva test -- inexpensive, easy to perform and painless -- that could spot diseases such as mouth and throat cancer in heavy smokers, heavy drinkers and others at high risk.
The screening test focuses on finding cells with genetic signatures suggesting the presence of these cancers.
In this "swish-and-spit" test, patients were asked to brush the inside of their mouths, then rinse and gargle with a salt solution. The scientists filtered out cells in the rinsed saliva that might contain one or more of 21 bits of chemically altered genes associated with head and neck cancers.
Experts say the vast majority of head and neck cancer cases are linked to tobacco use, including smoking and smokeless tobacco. Heavy drinking also increases one's risk.
If found early, these cancers are often curable -- showing the need for early detection of the tumors.
"We know who gets head and neck cancer -- people who smoke and drink a lot and tend to be at an older age. The problem is that it's sometimes difficult to diagnose until it's at its late stages and difficult to treat and cure," researcher Dr. Joseph Califano of the Johns Hopkins department of head and neck surgery said in a phone interview.
There is no screening test for head and neck cancers. "So it would be nice to have an easy way to identify people at risk for head and neck cancer that can be done by anybody -- a nurse, a doctor, a PA [physician assistant]," he said.
The study appears in the journal Clinical Cancer Research.
The mouth-rinse test was given to 211 people with head and neck cancers and 527 people who did not have these diseases. It correctly identified more than half the people with cancer as having the disease, Dr. Califano said.
The researchers have since made changes to improve the test. "I think it's actually going to be really fairly impressive in terms of ability to detect stuff," said Dr. Califano, who expects it could be years before the test is widely used.
In the U.S. alone, about 13,000 people die of cancers of the head and neck and about 55,000 develop these cancers each year, according to the American Academy of Otolaryngology -- Head and Neck Surgery.
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January 3: Short, Stout, Has a Handle on Colds, The New York Times
By CAMILLE SWEENEY
GABY HAKMAN worked as a chef in professional kitchens in Miami for nearly 20 years, standing in the vacuum of powerful venting fans, inhaling smoke. But she had even bigger nasal challenges ahead. “I work as a personal chef now, which is a lot less toxic, but I also moved to New York City, and because of the city’s pollutants and dry heat I developed painfully dry sinuses,” Ms. Hakman said.
Seeking the advice of a masseuse and acupuncturist, Jana Warchalowski, Ms. Hakman was urged to try something she didn’t even want to think about. “Jana said she had two words for me: neti pot,” Ms. Hakman said. “I’d heard about it before. I just kept thinking, ‘No way, that’s gross.’”
But this fall, Ms. Hakman relented.
“I went out and bought a pretty little ceramic neti pot from Whole Foods,” she said. “I’ve used it every day since. Now, I can breathe again. It’s even gotten rid of the bags under my eyes.”
Originally part of a millennia-old Indian yogic tradition, the practice of nasal irrigation — jala neti — is performed with a small pot that looks like a cross between Aladdin’s lamp and your grandmother’s gravy boat. The neti pot made its way into this country in the early 1970s as a yoga meditation device, but even as yoga became mainstream, the neti pot remained on the fringes of alternative culture.
That is, until now. Due to a confluence of influences, the neti pot is having what can only be termed a moment, sold in drugstores, health food stores, even at Wal-Mart and Walgreens.
The practice gained wide exposure last spring when it was introduced on Oprah Winfrey’s show by a frequent guest, Dr. Mehmet Oz, a cardiothoracic surgeon and an author of health books. Dr. Oz explained that bathing the sinus cavities in a warm saline solution can reduce symptoms of allergies, cold, flu and other nasal problems.
He called upon a chronic sinusitis sufferer, identified as Amy from Texas, to demonstrate the neti pot. “Welcome to your nose bidet,” Ms. Winfrey said enthusiastically as the woman inserted the spout of a ceramic pot into one nostril, tilted her head and let a solution of non-iodized salt and water flow up her nose and out the other nostril.
A month later, in a follow-up, Amy spoke by phone on air and reported she’d used a neti pot every day since, with happy results. She had not had a single sinus headache, she said.
A star was born.
The neti pot became a hot topic online, featured in blogs and daily journals, chatted about on message boards, demonstrated in some 60 YouTube videos. It was billed as a cure-all to ward off cold or flu, improve a sense of smell or taste, sharpen vision and even reduce snoring. “Nose bidet” became one of the most popular topics searched on Google.
Neither Whole Foods Market, where neti pots have been sold nationwide for almost a decade, nor the Himalayan Institute, one of the largest retail and wholesale distributors of neti pots in the United States, would disclose sales figures, but representatives of each company said that after the Oprah shows there were sharp spikes in demand.
Jan Mathews, the chief executive of East West Living, a seller of spiritual books and supplies with a store in Manhattan, said: “After Oprah, we went from selling dozens of neti pots a week to dozens a day, and sold out. For two weeks we couldn’t restock fast enough. It may have started with Oprah, but then it became word of mouth.”
In December, Ms. Mathews began in-store neti pot demonstrations in the store’s cafe four times a week. “There’s a growing clamor for natural alternatives to cold and allergy medicines,” she said. “In my demo, there may be about a dozen or so people in attendance, but sometimes I’ll look up and realize the whole rest of the cafe is watching.”
PROMOTERS of the neti pot link it to other methods of purifying and detoxifying the body that have become popular at spas and from providers of alternative health care, procedures like seaweed facials, liver flushes and coffee enemas.
Few if any Western medical schools teach the use of the neti pot. But Dr. Bradley Marple, the chairman of the rhinology and paranasal sinus committee for the American Academy of Otolaryngology — Head and Neck Surgery, said that nasal irrigation is a well-known remedy for various respiratory complaints.
“There are an estimated billion viral episodes of the upper respiratory tract a year,” said Dr. Marple, a professor of otolaryngology at the University of Texas Southwestern Medical School in Dallas.
“Studies indicate that saline nasal irrigation is a highly effective, minimally invasive intervention for people suffering from nasal issues,” Dr. Marple said. “But it’s just not as sexy to talk about. People want to hear about surgery or antibiotics.”
He added that there are many commercially available products that deliver a saline solution to the nasal area, including squeeze bottles and spray cans. They may be more convenient than using a neti pot, he said, but because of its gentler pressure, a neti pot can be an advantage for patients who suffer ear discomfort due to pressure.
Amy Neunsinger of Los Angeles, a commercial and fashion photographer, says she’s made using it fun for her toddler son.
“Last year when he had a sinus infection, instead of putting him on antibiotics as the doctor recommended, I had him try the neti pot,” Ms. Neunsinger said. “He was 3. I told him, ‘Hold your breath, just like in swimming lessons,’ and he tried it and it worked. He felt so much better, and his infection went away quickly on its own.”
“Now, we do it together once a week,” she said. “He loves to tear open the little packets of salt and mix it up.”
One user’s neti pot video has had nearly a quarter-million views on YouTube. In the video, “How to Irrigate Your Nasal Passages,” a cartoonist from Ohio who goes by the name Drew, demonstrates (to a song titled “I Like to Watch the Rain Come Down”) how to use a neti pot with salty water, then with black coffee, then with Kentucky bourbon, exploding with an expletive a millisecond before the video snaps off.
In an e-mail message, Drew, 28, wrote: “I haven’t had any sinus problems in a few months. Maybe the whiskey did the trick?
“The last time it was used, I filled it with half and half to serve with coffee — bad idea. The cream went everywhere when you tried to pour it, and our guests immediately recognized the neti pot as ‘that thing I saw you put in your nose.’”
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January 4: Ouch! Cervical Cancer Shots Painful, AP
By MIKE STOBBE
ATLANTA (AP) — The groundbreaking vaccine that prevents cervical cancer in girls is gaining a reputation as the most painful of childhood shots, health experts say.
As Austin Powers would say; "Ouch, baby. Very ouch."
Health officials have touted the Gardasil vaccine as an important new protection against a cancer-causing sexually transmitted virus. In recent months, they've also noted reports of pain and fainting from the shot.
During its first year of use, reports of girls fainting from vaccinations climbed, but it's not clear whether the pain of the cervical cancer vaccine was the reason for the reaction.
"This vaccine stings a lot," said Patsy Stinchfield, an infectious disease expert at Children's Hospitals and Clinics of Minnesota, speaking at a recent meeting of vaccination experts in Atlanta.
It sure does, said 18-year-old Lauren Fant. She said other shots tend to hurt only at the moment of the needle stick, and not after the vaccine plunges in.
"It burns," said the college freshman from Marrietta, Ga.
The pain is short-lived, girls say; many react with little more than a grimace. But some teens say it's uncomfortable driving with or sleeping on the injected arm for up to a day after getting the shot.
Officials at Merck & Co., which makes the vaccine, acknowledge the sting. They attribute it partly to the virus-like particles in the shot. Pre-marketing studies showed more reports of pain from Gardasil than from dummy shots, and patients reported more pain when given shots with more of the particles.
Meanwhile, U.S. health officials have noticed a rise in reports of vaccine-associated fainting in girls. From 2002-2004 there were about 50 reports of fainting; from 2005 until last July, there were about 230. About 180 of those cases followed a shot of Gardasil, which came on the market in 2006.
But it's not clear that Gardasil's sting is related to the fainting increase, said Dr. Barbara Slade, an immunization safety specialist at the U.S. Centers for Disease Control and Prevention.
Teens tend to faint from needles, so a three-dose vaccine for adolescents would be expected to prompt some added fainting, she said. Researchers aren't sure why teens faint more than other age groups, but nervousness may be a factor.
Gardasil is the first vaccine approved specifically to target the human papilloma virus, or HPV, which causes cervical and vaginal cancer. The Food and Drug Administration approved it for girls ages 9 to 26.
Preliminary studies indicate only 10 to 20 percent of them have gotten at least one dose.
But researchers said those rates are due to reasons other than worries about pain, including Gardasil's $120-a-shot price, limited supplies initially and mixed feelings by some parents and doctors about a vaccination that assumes girls have sex.
Dr. Andy Andrews, an Atlanta-area pediatrician, said he doesn't believe the shot's ouch has diminished demand.
"A lot of the older teens are coming in themselves, without a parent. So they themselves are motivated to come back in," Andrews said.
A second HPV vaccine, GlaxoSmithKline's Cervarix, is under FDA review and could become available in 2008. Complaints of injection pain have not surfaced in clinical trials, said Liad Diamond, a company spokeswoman.
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January 7: Snoring? It could be sleep apnea, AP
By LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - Loud snoring doesn't just annoy your spouse. It could signal dangerous sleep apnea, yet millions go undiagnosed.
A government move may help change that: Medicare is poised to allow at-home testing for sleep apnea — letting people snooze in their own beds instead of spending the night in a sleep laboratory.
It's a controversial proposal, but potentially a far-reaching one. Some 18 million Americans are estimated to suffer from sleep apnea, yet specialists think fewer than half know it.
"It's been awkward and inconvenient and expensive to get a sleep test, and now that should be improved," says Dr. Terence Davidson of the University of California, San Diego, a longtime proponent of home-testing.
Today, Medicare pays for sleep apnea treatment — called CPAP, a mask that blows air through the nose while sleeping — only for seniors diagnosed in a sleep lab. Last month, Medicare proposed covering those diagnosed with cheaper home tests, too. The public may comment on the proposal until next week; final approval is expected in March.
While sleep apnea is a problem for seniors, it is most common in middle-aged men. But private insurers now reluctant to cover home apnea testing are expected to follow the government's lead, thus easing access for all ages.
Sleep apnea doesn't just deprive family members of their own zzzz's. Sufferers actually quit breathing for 30 seconds or so at a time, as their throat muscles temporarily collapse. They jerk awake to gasp in air, sometimes more than 15 times an hour. They're fatigued the next day because their brains never got enough deep sleep.
Severe apnea increases the chance of a car crash sevenfold. Research from UCSD suggests 1,400 deaths each year are caused by drivers with sleep apnea.
Worse, sleep apnea stresses the body in ways that also increase risk of high blood pressure, heart attack, stroke and diabetes.
Not every apnea patient is a bad snorer, and a low rumble may not be cause for concern. But sleep apnea's trademark is bad snoring, the snorting, choking kind. Other risk factors: Being overweight, having small airways, and apnea in the family.
Yet patients don't remember the nightly breathing struggle, and often don't see a doctor unless a family member complains about snoring — or until daytime sleepiness gets so bad they can't function.
Only then comes the test debate.
There are dozens of sleep disorders. A night slumbering in a sleep lab, hooked to monitors that measure both breathing and brain waves while health workers watch, has long been the standard for telling who has sleep apnea or another disorder.
But this lab-based polysomnography, or PSG, can cost $1,500. And while access has improved, there are swaths of the country where reaching a sleep lab can mean a few hundred miles' drive.
For about $500, home tests use primarily breathing monitors to detect only sleep apnea, not other disorders. Hook it up at bedtime, and a doctor checks the recordings later.
A home test can miss apnea, because it won't signal if someone never fell into that deep REM sleep where breathing is most likely to falter, says Dr. Thomas Gravelyn of the Saint Joseph Mercy Hospital sleep center in Ann Arbor, Mich., who opposes the Medicare change.
"You have this good feeling that everything was taken care of, when in fact it wasn't," he says.
"It certainly is possible to diagnose severe apnea at home," adds Dr. Joyce Walsleben, chief of New York University's sleep center. "What if it isn't severe? Are you willing to say it doesn't exist at all if you get a negative study?"
Still, a Canadian study published last year randomly assigned suspected apnea sufferers to either a sleep lab or home testing, and found they worked equally well.
Last month, the American Academy of Sleep Medicine, which represents sleep centers, changed its position to say home tests can help certain high-risk patients — but should be administered by sleep specialists.
Medicare's proposal wouldn't limit which doctors offer home tests. The American Academy of Otolaryngology, head-and-neck surgeons, requested the change.
In fact, Medicare concluded a sleep-lab test isn't perfect, either — and thus proposed that all patients get a 12-week trial of CPAP treatment. Only if their doctors certify they're being helped would treatment continue.
That's important, because about half of apnea patients prescribed CPAP struggle to use it, says Dr. Charles Atwood of the University of Pittsburgh Medical Center, a home-test proponent. What he calls tricks of the trade — trying differently shaped masks, adjusting the air pressure, adding a humidifier to moisten nostrils — early could keep more of them in care.
Consider Raymond Miles, 57, diagnosed with a sleep-lab study a few years ago. While he felt better with CPAP treatment, Miles quit it in frustration when he couldn't get help maintaining it.
Two weeks ago, nudged by his wife, Miles underwent a home test with a different doctor to see if it's time to try care again.
"There's a different level of comfort being at home," Miles says of the testing.
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January 8: Study says most kids don't need ear tubes, United Press International
NEW YORK, Jan. 8 (UPI) -- A U.S. study says many children who have had ear tube operations may not actually have needed the procedure.
The study, published in the journal Pediatrics, said most children who had ear tube operations in the New York City area in 2002 had mild ailments for which experts recommend either medical treatment or watchful waiting.
"We found that many children are getting surgeries for minor disease and the typical child who gets ear tube surgery does not have disease severe enough to warrant the operation," Dr. Salomeh Keyhani of Mount Sinai School of Medicine said Monday in a release. "If the study findings could be applied to rest of the country, it would be particularly troubling."
Tympanostomy tubes, or ear tubes, are small implants that ventilate the middle ear space to the ear canal through the tympanic membrane. Ear tubes may be inserted to treat recurrent episodes of inflammation of the middle ear or the persistence of the inflammation along with fluid in the middle ear space
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January 8: ACHES & CLAIMS: Clearing Wax Buildup With a Candle in the Ear, The Wall Street Journal
By LAURA JOHANNES
Your grandmother may have tried to do it to you, and now you can pay big bucks for it at a spa. Practitioners say a folk-medicine procedure called ear candling removes ear wax buildup, which results in benefits ranging from better hearing to clearing clogged sinuses. Physicians say there's no credible evidence for the procedure, and warn it can cause injury to the ear.
Ear candling, also called coning, involves hollow candles made from a cylinder of fabric covered with wax. They are put in the ear canal and allowed to burn down in a process some practitioners claim creates a "negative pressure" that sucks wax, fungus and other impurities out of the ear and up through the candle. So wax and ashes don't drip on you, the candle is placed through a hole in a disposable pie tin or Styrofoam plate wrapped in aluminum foil.
The candles are sold for home use for about $1 to $3 apiece. The procedure is offered, generally from $25 to $75 a session, at spas and by natural-health practitioners such as acupuncturists. Often, a relaxing facial massage is given while the candles burn. Practitioners sometimes cut open the candle stub to show the client what was removed.
One of the only published human studies of ear candling tested the waxy substance removed using mass spectroscopy and found it all came from the candle, not the ear, says study author otolaryngologist Daniel R. Seely. Ear candling has also drawn fire from onetime magician James Randi, whose nonprofit Fort Lauderdale, Fla., foundation investigates unusual claims. The foundation's researchers tested candles and found that a nearly identical buildup is created by placing the lit candle in a glass of clean water. "It is not doing what it is said to do at all," says Mr. Randi, who adds his grandmother wanted to do the procedure on him when he was a child, but his mother vetoed it.
Ear candling also can be dangerous, adds Heather Shenk, a Lancaster, Pa., audiologist. She says one patient of hers had candle drippings in his ear after the procedure that had to be professionally removed.
Dr. Seely, of Bellevue, Wash., says other reported injuries include burns and ear-drum punctures, which can require surgery to repair. Most people don't have a problem with excess ear wax, he adds. Those who do -- including some people with hearing aids -- can ask their doctor to remove it. Techniques used in the doctor's office include manual removal using special tools and scope, or through suction and flooding the ear with water to wash it out.
Some practitioners argue the procedure is beneficial even if it doesn't remove ear wax. Greg Webb, a massage therapist in Calgary, Canada, who practices ear candling and was the keynote speaker at a 2006 international conference on the practice, says the procedure is deeply relaxing and alters "life energy" in the body.
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January 9: Budding deafness rocks the iPod set, The Age
Dewi Cooke
THEIR white earphones have become a symbol of a generation but iPod and other MP3 players are raising fears of hearing loss in young people.
A number of studies have pointed to MP3 players and "earbud" earphones as harming people's hearing. Now French researchers have found that one in five adolescents have hearing problems from exposure to loud music through such players or from music clubs and rock concerts.
Professor Christian Huggonet has told France's Le Figaro newspaper that 10 to 20% of adolescents surveyed had poor hearing.
He also said the use of "compressed" sound in modern media — in which weak signals are boosted to the level of stronger ones — is changing the way people speak.
"Once the ear has got accustomed to this kind of sound, it finds it very hard to return to sounds of weak intensity," Professor Huggonet said.
"Young children used to watching cartoons with compressed sound can end up speaking in the same loud, monotone way."
Audiologist Rebecca Verhoef from the Royal Victorian Eye and Ear Hospital said more research into the effects of compressed sound on speech was needed before drawing such a conclusion. But she acknowledged that the hospital had seen an anecdotal increase in young people presenting with hearing problems such as tinnitus, a ringing sensation in the ears.
Associate Professor Bob Cowan from the HEARing Co-operative Research Centre in Australia said devices such as mobile phone headsets and stereo headphones could be contributing to hearing problems in young people.
Professor Cowan stressed that exposure to loud noise of any kind needed to be moderated.
"I don't think the right message to use is the wowser one. Let's be sensible about it," he said
Acceptable industrial standards of noise exposure are 85 decibels over eight hours. Anything over this is considered unsafe.
Most people talked at a level of about 70 decibels, Ms Verhoef said.
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January 13: Testing for Sleep Apnea, The Wall Street Journal
By LAURIE MCGINLEY
Chronic sleep problems can be a nightmare, increasing the risk of everything from heart ailments to depression to car crashes. Now, Medicare is proposing to make it easier for seniors to get diagnosed and treated for one of the most common disorders, obstructive sleep apnea.
The problem occurs when people stop breathing for at least 10 seconds, as their throat muscles relax and collapse into their airways. Sufferers endure an exhausting pattern: sleeping, then starting suddenly awake, gasping for air. Medicare figures that about 4% of men and 2% of women in the under-65 population, and up to 10% of people 65 and older, or about four million people, have obstructive sleep apnea. Other experts put the estimate far higher.
The recommended treatment is usually "continuous positive airway pressure," or CPAP. During sleeping hours, air is blown through a face mask at a steady rate to keep air passages open. Currently, Medicare covers the treatment only for beneficiaries diagnosed by a sleep test, called a polysonogram, which costs about $1,500 and is administered in a special sleep lab.
Next: Home Testing
Medicare has proposed covering the treatment for seniors diagnosed by less-expensive home tests that cost about $500. Doctors can show patients how to use the gadget -- a small computer the size of an iPod and various tubes and belts. The patient straps himself in at night, and takes the device back to the doctor the next day to interpret the results.
Ear-nose-and-throat doctors, who are pressing for the change, say it would encourage many more people to be diagnosed and treated. "There's an enormous backlog" at the sleep labs, says Terence Davidson, a professor at the University of California, San Diego, School of Medicine. As a result, he says, only about 10% of people with sleep apnea have been diagnosed. Further, he says, older people often resist going to a lab, insisting on "sleeping in their own bed."
Sleep Doctors Complain
But many doctors who are sleep specialists are unhappy about the proposal, which they say could compromise care. The sleep tests are more complicated than they seem, they say, and have to be supervised by well-trained technicians and doctors. Currently, patients suspected of having the disorder go through two lab sessions -- to make the diagnosis and to set the proper pressure for the CPAP. If home tests are interpreted by physicians without training in sleep medicine, "there's a risk of a wrong diagnosis, or of the pressure not being set at the right level," says Nancy Collop, an associate professor of medicine at Johns Hopkins University and a member of the board of the American Academy of Sleep Medicine.
Currently, Medicare and most private insurers, besides paying for the CPAP treatment, also cover facility-based testing. The new proposal doesn't specifically call for Medicare to cover home tests, but it doesn't rule it out either. Medicare officials and many doctors expect that home tests eventually will be paid for both by the government and private insurance.
The proposal, which could be altered before being finalized in March, also would limit initial coverage of CPAP to 12 weeks. But the coverage would be extended if the patient shows he or she is benefiting.
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January 15: A Stable Life, Despite Persistent Dizziness, The New York Times
By JANE E. BRODY
On the subway, children twirl themselves around the poles in the cars until they are so dizzy I’m ready to catch them. The young seem to delight in making the world spin out of control for a few moments, causing them to flop about like drunks.
But when dizziness, vertigo or loss of balance is neither self-imposed nor short lived, it is anything but fun. It can throw one’s whole life out of kilter, literally and figuratively.
This is what befell Cheryl Schiltz in 1997, when long treatment with the antibiotic gentamicin permanently damaged the vestibular apparatus in her inner ear. For three years, said Ms. Schiltz, of Madison, Wis., her world seemed to be made of Jell-O. Lacking a sense of balance, she wobbled with every step, and everything she looked at jiggled and tilted.
Unable to work, Ms. Schiltz became increasingly isolated and struggled to perform the simplest household tasks.
Lisa Haven, executive director of the Vestibular Disorders Association, reports that “the risk of falling is two to three times greater in people with chronic imbalance or dizziness.” Nearly 9 percent of Americans 65 and older have balance problems, the prevalence of which is likely to increase as the 78 million baby boomers age.
Four Types of Dizziness
The job of the vestibular system is to integrate sensory stimuli and movement for the brain and keep objects in visual focus as the body moves. When the head moves, signals are sent to the inner ear, an organ consisting of three semicircular canals surrounded by fluid. It in turn sends movement information to the vestibular nerve, which carries it to the brainstem and cerebellum, which control balance and posture and coordinate movement. Disruption of any part of the system can result in dizziness.
These are four types of dizziness, all of which are more common with increasing age:
- Faintness, the feeling of being about to black out when upright. This can result from dehydration, abnormal heart rhythms, overmedication with blood pressure drugs and disorders of the autonomic nervous system.
- Loss of balance, feeling unsteady and about to fall even though muscle strength is normal. This can be caused by disorders of the inner ear; the cerebellum because of stroke or chronic alcoholism; or the basal ganglia, because of Parkinson’s disease, for example. It can also result from overmedication with drugs like sedatives and anticonvulsants, vision disturbances and neuropathy or spinal cord disease that causes a loss of position sense in the legs.
- Vertigo, a false sense that the person or the surroundings are moving or spinning. This can result from motion sickness, Ménière’s disease, middle-ear infections, migraines, multiple sclerosis, damage to the vestibular nerve and reduced blood flow to the brain after a stroke or transient ischemic attack. In the most common form, benign paroxysmal positional vertigo, sudden head movements cause a sensation of motion.
- Vague lightheadedness, a feeling of giddiness or detachment from the world that can be caused by a panic attack, depression, anxiety disorders or hyperventilation.
What to Tell the Doctor
About 40 percent of people experience at least one of these forms of dizziness at some time during their lives. When dizziness persists, medical care is essential, and so is the ability to provide a detailed description of the symptoms and what provokes them.
What does the dizziness feel like — faintness, loss of balance, lightheadedness, a sensation that you or your surroundings are spinning or moving? When did the symptoms begin? How long do they last? What provokes or relieves them? What other symptoms like headache, ringing in the ears, impaired vision, difficulty walking, weakness or hearing loss accompany the dizziness?
Diagnostic tests may include trying to reproduce the symptoms. For example, by rapidly standing and sitting, standing after lying down or lying on a tilt table while changes in blood pressure are measured.
The doctor may test heart function with an electrocardiogram or an echocardiogram, an exercise stress test or a Holter monitor to detect abnormal rhythms.
Vision tests may be performed, along with tests to evaluate balance and gait and C.T. or M.R.I. scans of the head, including noninvasive tests that check for narrowed or blocked arteries to the brain.
If no physical explanation for dizziness is found, the patient may be checked for psychological disorders like depression, panic attacks or dissociation from the world.
Treatment will depend on the cause of the dizziness. For example, for benign paroxysmal positional vertigo, a simple head-turning maneuver that repositions crystals in the inner ear may bring lasting relief. If ministrokes are the cause, the treatment may involve anticlotting drugs or opening a blocked artery with a stent. If medication is the problem, adjusting the dose or changing the drug can relieve dizziness.
If dizziness persists despite treatment, lifestyle adjustments can help like avoiding sudden movements, keeping often-used items within easy reach, standing up slowly and clenching hands and flexing feet before standing. Physical therapy can help, as can exercises that strengthen muscles and that combine eye, head and body movements.
Ms. Schiltz, whose vestibular system was damaged a decade ago, said she was told that nothing could be done about it. Nothing, that is, until she became the first patient to be treated with a device called a BrainPort invented by the late Dr. Paul Bach-y-Rita, a neurobiologist and rehabilitation medicine specialist, and his colleagues at the University of Wisconsin.
The device takes advantage of the acute sensitivity of the tongue and sends balance signals directly to the brain from the tongue, bypassing the ear’s vestibular apparatus. At first, she used it a few minutes at a time, but soon found longer use kept her in balance for hours, then days, then weeks and months.
Eventually, all that was needed was 20 minutes twice a day to train her brain, and she now uses it just occasionally.
She is among more than 100 study participants who have used the BrainPort, including patients with multiple sclerosis, Parkinson’s disease and stroke. The device is available commercially in Canada and is awaiting approval by the Food and Drug Administration in the United States.
Dr. Norman Doidge of the research faculty at the Columbia University Psychoanalytic Center and the University of Toronto describes Ms. Schiltz’s dramatic recovery in his new book about the plasticity of the brain, “The Brain That Changes Itself.” (Her case was also described in Science Times in November 2004.) With her sense of balance intact, Ms. Schiltz was able to return to school and on Dec. 20 received a degree in rehabilitation psychology.
“I feel like a restored, even enhanced, person,” she said in an interview. “I’m living proof that the brain can be retrained. My goal now is to help people with acquired disabilities gain increased independence.”
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January 17: FDA: Cold Medicines Too Risky for Tots, AP
By LAURAN NEERGAARD
AP Medical Writer
WASHINGTON (AP) -- Parents may be left with only love and lots of liquid to give their sniffling babies and toddlers now that the government is declaring over-the-counter cough and cold medicines too risky for tots. The Food and Drug Administration was issuing that warning Thursday to parents of children under 2.
It's a move expected for months: Drug companies last October quit selling dozens of versions of nonprescription cold remedies targeted specifically to babies and toddlers. That month, the FDA's scientific advisers also voted that the drugs don't work in small children and shouldn't be used in preschoolers, either - anyone under age 6.
The FDA still hasn't decided if OTC decongestants, antihistamines and cough suppressants are appropriate for older children, officials told The Associated Press. Expect a decision on that by spring, the deadline necessary to notify manufacturers before they begin production for next fall's cold season.
For now, FDA's first official ruling focuses on youngsters under 2, warning that "serious and potentially life-threatening side effects can occur."
FDA is worried that parents haven't gotten that message despite all the publicity last fall. They may still have infant-targeted drugs at home, or they may buy drugs meant for older children to give to tots instead, said Dr. Charles Ganley, FDA's nonprescription drugs chief.
"We still have a concern," Ganley said. "It falls out of people's consciousness. We're still in the middle of cold season right now."
Ganley was particularly struck by recent surveys that suggest many parents don't believe OTC remedies could pose a problem, especially if they've given them to an older child without harm.
Thursday's move is a good first step, said Dr. Joshua Sharfstein, Baltimore's health commissioner. He petitioned the FDA last year to end use of nonprescription cold remedies by children under 6, a move backed by the American Academy of Pediatrics.
The reason: There's no evidence that these oral drugs actually ease cold symptoms in children so young - some studies suggest they do no good at all. And while serious side effects are fairly rare, they do occur. Indeed, the Centers for Disease Control and Prevention last year reported that more than 1,500 babies and toddlers wound up in emergency rooms over a two-year period because of the drugs.
"It's one thing if you're curing cancer, but we're talking about a self-limiting illness," said Sharfstein. "If there's really no evidence of benefit, you don't want to risk the rare problem. Then you're left with tragedy that you can't justify."
Specialists are back to recommending old-fashioned steps, such as plenty of fluids and rest, saline drops to loosen stuffy noses, and humidifiers while sleeping.
Why is this an issue now? Child versions of cold remedies came on the market decades ago, when scientists thought that what worked in adults would automatically work in children. Scientists today know that is not always the case.
In fact, FDA never formally allowed infant-targeted cold remedies in the first place; Ganley said they evolved through a legal loophole.
But the FDA is investigating an even bigger question: Are OTC cold remedies safe and effective for children under 12? The agency's advisers last fall called for no use just by the under-6 crowd, but did recommend more research to determine the medicines' effects in children overall.
The drug industry says these medicines are used 3.8 billion times a year in treating children's cough and cold symptoms and are safe for those over 2.
Health groups acknowledge that while low doses of cold medicine don't usually endanger an individual child, the bigger risk is unintentional overdose. For example, the same ingredients are in multiple products, so using more than one for different symptoms can quickly add up. Also, children's medicines are supposed to be measured with the dropper or measuring cap that comes with each product, not an inaccurate kitchen teaspoon.
An internal FDA working group has a February deadline to recommend to agency leaders any action for 2- to 11-year-olds, Ganley said. The goal is a spring announcement.
Meanwhile, the FDA's advice for children over 2:
- If you try these drugs, carefully follow label directions.
- Avoid giving a child more than one product. If you do, make sure they don't contain some of the same or similar ingredients.
- Understand that these drugs only treat symptoms. Colds are viruses, and the drugs will not make them go away any faster.
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January 17: Surgeons Hone Skills on Nintendo Wii, The Wall Street Journal
Posted by Jacob Goldstein
Don’t worry about that guy about to operate on your gallbladder. He trained on the Wii.
According to a very small, very preliminary study, playing certain video games on the Nintendo Wii helps surgical residents to hone their fine motor skills and improve their performance on a serious surgery simulator.
OK, so a simple video game helps these docs with a slightly more complicated one. But bear with us here because the more sophisticated simulator is the sort of thing that’s used right now to help doctors do a better job on keyhole surgery using tiny instruments outfitted with video cameras.
Improvements in simulator performance didn’t come from just any Wii (see image), or any game. Marble Mania is good, for example. Tennis (astonishingly fun to play on the Wii, which uses a motion-sensitive wireless control) isn’t so helpful. “The key is to have subtle hand movements,” Kanav Kahol one of the authors of the study, told the Health Blog. “You can’t hit a tennis swing and expect to become a better surgeon. You need fine motor control.”
Kahol, a biomedical informatics expert affiliated with Arizona State and a hospital chain called Banner Health, worked with Marshall Smith, a Banner surgeon, to see if playing the Wii (Wii-ing?) improved residents’ scores on a standard simulator for minimally invasive, or laparoscopic, surgery.
So they bought a standard golf-club add on for the Wii (”It was like 10 bucks,” Kahol said) then cut off most of the golf club and added a laparoscopic probe (their creation is shown in the picture, above).
Out of a group of 16 residents, eight were assigned to play the Wii (Marble Mania and a suite of games called Wii Play), with the specially-rigged controller. The other eight didn’t get to play. Then all 16 did a simulated laparoscopic procedure (something having to do with a simulated gallbladder).
The ones who had played the Wii showed 48% more improvement on the procedure than those who hadn’t, according to a standard score that measures performance on the simulation, Kahol said. They plan to present the results at the Medicine Meets Virtual Reality conference in a couple weeks.
Next, Kahol and Smith plan to develop a full-blown surgery simulator for the Wii. Among other things, it would allow residents, forced by work-hour caps to spend more time outside the hospital, to practice surgery while they’re at home.
In the meantime at Smith’s hospital there’s a Wii in the room where residents take cat naps while they’re on call. We asked if the residents get competitive about the Wii. “They’re surgery residents, what do you expect?” Smith said.
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January 18: Tonsillectomy boosts quality of life: studies, Reuters
By Megan Rauscher
NEW YORK (Reuters Health) - For children and adults who suffer repeated bouts of tonsillitis, surgery to remove the tonsils (tonsillectomy) leads to substantial improvements in quality of life, according to results of two studies published this month.
In one study, researchers surveyed the parents of 92 children with recurrent tonsillitis before tonsillectomy as well as 6 months and 1 year after the surgery. The researchers defined recurrent tonsillitis as three or more tonsil infections in the span of one year. Follow-up data were available for 58 children at 6 months and 38 children at 1 year.
The children, whose average age was 10.6 years, showed "significant improvements" in a validated disease-specific quality of life instrument, Dr. Nira A. Goldstein, of the State University of New York Downstate Medical Center in Brooklyn, told Reuters Health. For example, clear-cut improvements were seen in airway and breathing, eating and swallowing, behavior, rates of infection and use of health care resources.
The children also showed significant improvements in their general health perceptions, and social and physical functioning. "Parents also reported significantly fewer sore throats, antibiotic courses, and doctor visits," Goldstein noted, as well as days missed from daycare or school and persistent bad breath.
Similarly positive changes in quality of life were seen in a study of 72 adults with recurrent or chronic tonsillitis who completed quality of life surveys before and 6 months and 1 year after tonsillectomy.
Moreover, 98 percent of the adults reported fewer infections in the 6 months following tonsillectomy and 77 percent expressed strong satisfaction with the outcome of the surgery, Dr. David L. Witsell of Duke University School of Medicine, Durham, North Carolina, and colleagues report.
The adults also reported fewer cases of persistent bad breath, sore throats, and doctor visits due to sore throat.
Tonsillectomy is one of the most frequently performed surgical procedures in children, and while the number of tonsillectomies performed in adults is lower, it is still a routine operation.
Dr. Michael G. Stewart from Weill Cornell Medical College, New York, who was not involved in either study, says these studies are "important contributions and they add to our understanding of the impact of tonsillectomy in patients with recurrent tonsillitis."
SOURCE: Otolaryngology - Head and Neck Surgery, January 2008.
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January 21: Mobiles linked to disturbed sleep, BBC
Using a mobile phone before going to bed could stop you getting a decent night's sleep, research suggests.
The study, funded by mobile phone companies, suggests radiation from the handset can cause insomnia, headaches and confusion.
It may also cut our amount of deep sleep - interfering with the body's ability to refresh itself.
The study was carried out by Sweden's Karolinska Institute and Wayne State University in the US.
Funded by the Mobile Manufacturers Forum, the scientists studied 35 men and 36 women aged between 18 and 45.
Some were exposed to radiation equivalent to that received when using a mobile phone, others were placed in the same conditions, but given only "sham" exposure.
Those exposed to radiation took longer to enter the first of the deeper stages of sleep, and spent less time in the deepest one.
The scientists concluded: "The study indicates that during laboratory exposure to 884 MHz wireless signals components of sleep believed to be important for recovery from daily wear and tear are adversely affected."
Researcher Professor Bengt Arnetz said: "The study strongly suggests that mobile phone use is associated with specific changes in the areas of the brain responsible for activating and coordinating the stress system."
Another theory is that radiation may disrupt production of the hormone melatonin, which controls the body's internal rhythms.
Electrosensitivity
About half the people in the study believed themselves to be "electrosensitive", reporting symptoms such as headaches and impaired cognitive function from mobile phone use.
But they proved to be unable to tell if they had been exposed to the radiation in the test.
Alasdair Philips is director of Powerwatch, which researches the effects of electromagnetic fields on health.
He said: "The evidence is getting stronger that we should treat these things in a precautionary way.
"This research suggests that if you need to make a phone call in the evening it is much better to use a land line, and don't have your mobile by your bedside table."
Mike Dolan, executive director of the Mobile Operators Association, said the study was inconsistent with other research.
He said: "It is really one small piece in a very large scientific jigsaw. It is a very small effect, one researcher likened it to less than the effect you would see from a cup of coffee."
Last September a major six-year study by the UK Mobile Telecommunications and Health Research Programme (MTHRP) concluded that mobile phone use posed no short-term risk to the brain.
However, the researchers said they could not rule out the possibility that long-term use may raise the risk of cancer.
In the UK, mobile services operate within the frequency ranges 872 to 960 MHz, 1710 to 1875 MHz and 1920 to 2170 MHz.
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January 21: Seawater spray cures kids colds-Czech researchers, Reuters
By Michael Conlon
CHICAGO, Jan 21 (Reuters) - For parents worried about how to treat children's colds now that some medicines have been called into question, the answer may be a dose of salt water.
A nasal spray made from Atlantic Ocean seawater eased wintertime cold symptoms faster and slowed cough and cold symptoms from returning among children ages 6 to 10, researchers in Europe reported on Monday.
It may be that the salt water has a simple mechanical effect of clearing mucus, or it could be that trace elements in the water play some more significant role, though the exact reason why such a solution works is not known, said Dr. Ivo Slapak and colleagues at the Teaching Hospital of Brno in the Czech Republic.
The study, published in the January issue of the Archives of Otolaryngology, was paid for by Goemar Laboratoires La Madeleine, Saint-Malo, France, which makes Physiomer, the seawater nasal spray used in the investigation.
The authors said that while saline washes have long been mentioned as a treatment for colds, scientific evidence about whether they work is poor.
The report was published days after the U.S. Food and Drug Administration said children under 2 should not be given nonprescription cough and cold medicines because they are too dangerous for that age group, with deaths, convulsions and rapid heart rates reported in rare cases.
U.S. health officials have not yet decided if the widely sold medicines made by companies such as Wyeth (WYE.N: Quote, Profile, Research) and Johnson & Johnson (JNJ.N: Quote, Profile, Research) are appropriate for older children, and have said they hope to have a ruling covering appropriate use for children 2 to 11 later this year.
The American Academy of Pediatrics has said cough and cold products are ineffective for children under age 6, and may also be risky.
The Czech study involved 390 children with uncomplicated cold or flu symptoms. Some of the children were given standard treatments such as nasal decongestants. Others received those same medications plus the saline nasal wash, which the authors said "preserves the concentrations of ions and trace elements at levels comparable with those of seawater."
The study lasted for 12 weeks in the winter of 2006. Children given the salt water spray got it six times a day initially and three times a day in the latter part of the study when the investigators were looking at whether it would prevent symptoms from redeveloping.
The noses of children given the spray were less stuffy and runny the second time they were checked, the study said. And eight weeks after the study began, those in the saline group had significantly fewer severe sore throats, coughs, nasal obstructions and secretions than those given standard treatments.
Fewer children in the saline group had to use fever-reducing drugs, nasal decongestants and mucus-dissolving medications or antibiotics, the researchers said. In addition children who used the salt spray were sick less often and missed fewer school days. (Editing by Maggie Fox and Vicki Allen)
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January 22: New therapy for old woes, The Boston Globe
Blue Cross measure aims to slow runaway costs, improve quality of healthcare
By Alice Dembner
Globe Staff
Massachusetts' dominant health insurer is proposing to overhaul the way it pays doctors and hospitals, in what company officials said is an attempt to slow runaway healthcare costs and improve the quality of care.
Blue Cross and Blue Shield of Massachusetts wants to stop paying doctors and hospitals for each patient visit or treatment, a common arrangement that most experts agree has led to unnecessary, inefficient, and fragmented care that is sometimes harmful to patients.
Instead, they want to pay doctors and hospitals a flat sum per patient each year, adjusted for age and sickness, plus a significant bonus if the providers improve care, Blue Cross officials said. In most cases, the payment would cover all services from primary care doctors, specialists, counselors, and hospitals - forcing them to work together closely.
"We're not looking to spend less than we do today, but we want spending to grow at a rate that's affordable," said Andrew Dreyfus, executive vice president for healthcare services at Blue Cross. "And we want to empower physicians and hospitals to provide the right care."
The ambitious proposal makes Blue Cross and Blue Shield of Massachusetts a national pioneer in the effort to transform the way healthcare is delivered, health policy specialists said. But some fear the plan could bring back the most problematic aspects of managed care.
As national and state pressure intensifies to control healthcare spending, Blue Cross hopes to halve the growth in medical costs in two to four years among providers who accept the new payment system. Blue Cross also expects the move to attract more business, increasing its market share, which already includes about half of Massachusetts residents.
Blue Cross expects patients could see dramatic changes, such as quicker access to the doctor by phone or e-mail or same-day appointments, home visits by nurses to the chronically ill, and smoother transitions between hospital, rehabilitation center, and home.
National health policy specialists praised the move.
"If we don't try something like this, the alternative is a continual free-for-all of spending or some sort of regulation," said Stuart Altman, dean of the Heller School for Social Policy and Management at Brandeis University in Waltham. Altman believes the new payment plan should be mandatory for providers instead of optional, as Blue Cross proposes.
But healthcare providers and patient advocates are giving the proposal mixed reviews - praise for the effort but concern about the details. Some question whether the plan would restrict patient choice and encourage doctors to withhold care on one hand and make doctors responsible for costs beyond their control on the other.
The most significant savings and changes may involve chronically ill patients. For example, patients sent home after hospitalization for heart failure are now frequently left to manage on their own. The condition, which affects millions of older people, often follows a heart attack.
Typically, patients go home with a list of medications, a recommended diet, and instructions to alert doctors to any significant weight gain, which could signal worsening of the illness. A follow-up office visit is scheduled a week or two later, but all too often, patients' problems escalate and they end up rehospitalized.
Under the Blue Cross contract, the hospital or doctor might instead send a nurse to visit the patient on the first day home from the hospital, since those healthcare providers could get a bonus for providing continuity of care and ensuring patients understand how to care for themselves. The nurse could make sure the patient took needed medication and help the patient stock cabinets with healthy food. For the first few weeks, the nurse might call the patient daily to check on weight and give advice.
If any problems cropped up, the patient could get in to see the doctor quickly and would be likely to avoid another hospital stay with a simple medication change. The savings from fewer hospitalizations would go to the doctors and hospitals, to pay for home visits or for bonuses, but eventually could lead to slower growth in healthcare costs, Blue Cross said.
While the bonuses are designed to drive improvement, State Senator Mark Montigny worries that the payment system could distract doctors from making "a decision based solely on medical soundness." Montigny, a New Bedford Democrat, helped establish a patients' bill of rights in the mid-1990s to counteract problems in managed care.
The Blue Cross plan has some similarities to the "capitation" payment system behind those problems, which was widely used in the 1990s but was vehemently rejected by many doctors and patients. Blue Cross says its plan includes safeguards to avoid the undertreatment, underpayment, and strict controls on patient choices that doomed capitation.
"We have no interest in returning to the heyday of managed care or denying care," Dreyfus said. He said several mechanisms would prevent patients from being denied appropriate care, including public scrutiny of doctors' performance and Blue Cross's commitment to cut off any caregiver providing substandard service.
While many insurers' contracts already include performance measures, the Blue Cross plan goes further, by offering up to a 10 percent bonus, based on progress toward dozens of quality standards, such as keeping blood pressure and diabetes under control, and providing immediate access to the doctor around the clock.
Blue Cross must get widespread participation from doctors and hospitals before the effort could slow the rise in insurance premiums. Dreyfus said they are finalizing contracts with two large doctors' groups.
Officials at Partners HealthCare, the state's largest medical system, and at Beth Israel Deaconess Medical Center said they support the principles driving Blue Cross's initiative but are not quite ready to sign on. They are worried about the impact on their bottom lines and about being held responsible for care and costs over which they have little control, such as patient stays in nursing homes.
Blue Cross is still figuring out how the plan could work for doctors in small practices and for patients not in HMOs.
John McDonough, executive director of the advocacy group Health Care for All, said Blue Cross's initiative has promise, especially if other insurers and the government adopt similar approaches.
"What we have now is killing us financially, and in some cases medically," he said.
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January 24: Sinus surgery clears up fatigue, too, study shows, Boston Globe
Posted by Elizabeth Cooney
People who suffer from sinusitis list chronic fatigue as one of their most troubling symptoms, equal to facial pain and a blocked nose. Sometimes their exhaustion is explained as sick building syndrome, chronic fatigue syndrome or multiple chemical sensitivity.
But an analysis led by a group including a Boston researcher shows that surgery to clear clogged sinuses appears to substantially improve their energy too.
Senior author Dr. Neil Bhattacharyya of Brigham and Women’s Hospital, along with researchers from Georgetown University Medical Center, St. Louis University School of Medicine, and Oregon Health and Science University, looked at 28 studies of 3,427 patients who had endoscopic sinus surgery to remove blockages. All the studies showed that patients who reported fatigue before surgery said their energy had returned to normal levels an average of one year later, the authors report today in Laryngoscope.
“Finally we have good, scientifically consistent evidence that fatigue will very often improve significantly after surgery,” Bhattacharyya said in a statement released with the study.
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January 28: Kids and Cold Medicines Don’t Mix, The Wall Street Journal
Posted by Shirley S. Wang
Some children can’t resist the bottle — a stray bottle of cold or cough medicine, that is — and end up in the emergency room because of it.
Each year, some 7,000 kids are taken to the hospital after downing cough and cold remedies, according to a study in the current issue of the medical journal Pediatrics. These visits make up about 6% of the visits to the ER for the age group studied.
The bulk of problems stem from kids getting their hands on medicine without their parents’ knowledge. This was particularly true of young kids 2-5 years old, where nearly 80% of the children seen in the ER took the medication unsupervised. One quarter of the kids who went to the ER needed treatment to rid the body of the medicine, but 93% didn’t need to be hospitalized.
The researchers from the Centers for Disease Control and Prevention gathered data on kids 11 and under in a national survey of 63 hospital emergency rooms.
The safety of these medications for kids 2-11 is currently being scrutinized by the FDA. Last fall, cough and cold products for children less than 2 years old were withdrawn from the market because of safety concerns and the FDA has since recommended that these products not be given to children under two.
“Parents need to be vigilant about keeping these medicines out of their children’s reach,” Denise Cardo, director of CDC’s Division of Healthcare Quality Promotion, who wasn’t a study author, wrote in a press release, “They should refrain from encouraging children to take medicine by telling the children that medication is candy.”
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January 28: 'It's never just one thing' that leads to serious error, Los Angeles Times
By Susan Brink, Los Angeles Times Staff Writer
A technician mistakes an "a" for an "o" in a drug name. A doctor misplaces a decimal point in a prescription order. A nurse reaches for a vial in a cabinet as she's done hundreds of times before, only this time the light is dim and she fails to notice that the powder-blue label is more of a sky blue. The slip-ups are often simple, and always human, and all have happened in U.S. hospitals.
Each simple mistake is supposed to be countered by a recommended backup, a second or third set of eyes -- in other words, guidelines to reduce human error. A lot has to be overlooked in the cascade of errors that result in serious patient harm.
"It's never just one thing that goes wrong when a serious event happens," says Michael Cohen, president of the Institute for Safe Medication Practices, an organization that tracks prescribing errors and is sometimes called in to examine a hospital's mistake. "We've detailed a situation where we found over 50 mistakes in the system before an infant was killed." The incident, he said, was a 1,000-fold overdose of the blood thinner heparin in an Indianapolis neonatal intensive care unit that resulted in the deaths of three infants in 2006.
Late last year, the infant twins of actor Dennis Quaid and his wife, Kimberly, were the victims of a nearly identical mistake, an overdose of heparin at Cedars-Sinai Medical Center. "It was the exact same situation in a hospital in Indianapolis that we investigated a year earlier," Cohen says. "The pharmacy dispensed the wrong dose to the nursing station."
The Quaids' newborns, who were being treated for a staph infection, have since been released, and the hospital has been cited by state regulators for its handling of drugs. Its practice, regulators say, had placed pediatric patients in jeopardy.
The mistake calls attention to how far hospitals have to go in preventing medical errors and in learning from the mistakes of others, even though many have made progress in protecting patients within their own institutions. Despite a decade of rising public awareness of such mistakes and research into how to prevent them, even one of the country's premier institutions and a celebrity couple were not immune. Hospitals still have a long way to go to avoid mistakenly hurting their charges.
"People used to say that hospital mistakes are kind of like the poor -- they're always with you," says Dr. Lucien Leape, one of the authors of a 1999 Institute of Medicine report that estimated 100,000 people died each year in the U.S. from preventable hospital errors. "Well, no, they don't have to be."
Hospitals are trying. In a program called the 100,000 Lives Campaign, some 3,000 of the nation's 5,000 acute care hospitals, including Cedars-Sinai, have voluntarily instituted up to six changes in practices aimed at reducing errors. The Joint Commission, a national organization that accredits hospitals and other healthcare facilities, now requires that patients be informed of "unanticipated outcomes."
But while accountability is improving, hospitals still face increasingly complex technology. And medical culture, built on individual excellence, not teamwork, is slow to change.
Unfortunately, Cohen says, few hospitals learn from the mistakes, or improvements, of others. His organization published the results of the Indianapolis incident in a newsletter sent to every hospital in the country. If hospitals are to improve, he says, they have to study errors that have happened elsewhere.
First instinct: Denial
The mid-1990s saw a rash of medical errors that caught the attention of the public, and the medical profession: A Florida man had the wrong leg amputated, a New York woman had surgery on the wrong side of her brain, and Betsy Lehman, a newspaper reporter whose beat was health, died of an accidental chemotherapy overdose at one of the nation's top cancer centers, Boston's Dana Farber.
At first, the American Medical Assn. responded with a public relations campaign, calling the incidents "isolated" mistakes, according to an analysis of the era published in the April 27, 2002, British Medical Journal. By 1996, however, the AMA launched a National Patient Safety Foundation and changed its stance, admitting that such errors were "common."
But it was the 1999 Institute of Medicine Report that shocked the country, and shamed the medical profession into voluntarily adopting systems changes. The report estimated that 100,000 patients died annually from preventable hospital errors -- about the same as the yearly tally of deaths from motor vehicle accidents, breast cancer and AIDS combined.
Leape, a leading researcher on medical mistakes, had long said the number was a conservative estimate. Sure enough, five years later, a review of Medicare records by the Denver-based healthcare ranking group HealthGrades found nearly twice as many deaths from preventable errors -- up to 195,000 -- in the country's healthcare facilities. The higher estimate was never published in a peer-reviewed journal and included deaths in settings other than hospitals, such as nursing homes.
But since then, hospitals have begun responding to their state's reporting laws, and, individually and voluntarily, launching their own efforts to improve. One of the most notable is an effort sponsored by the Institute for Healthcare Improvement, a nonprofit group based in Cambridge, Mass., whose aim is to improve healthcare. In that push, called the 100,000 Lives Campaign, 3,000 of the nation's 5,000 hospitals volunteered to concentrate on one or more of six changes statistically proven to reduce errors. Those changes included following evidence-based guidelines to reduce infections and improve care for heart attack patients and to assemble teams to respond to the earliest signs of a patient crisis.
After a year, the institute reported that the changes made within the participating hospitals probably saved more than 120,000 lives, even more that what the IOM said was its conservative estimate of accidental deaths.
A death related to a medical error can be proven, but a death avoided is more difficult to document. In the November 2006 Journal on Quality and Patient Safety, the 100,000 Lives Campaign compared the volunteer hospitals' actual deaths in one year with statistically expected deaths, based on data from the base year 2004. Based on the analysis, 122,300 people walked out of hospitals in 2005 unscathed -- and never knew it might have been otherwise.
Now, all those hospitals and 700 others are signing up for a follow-up campaign called the 5 Million Lives Campaign, aimed to halt not just deaths, but also injuries and near misses.
Even simple changes can make a difference. One statewide hospital group in Michigan followed a plan devised by Dr. Peter Pronovost, a critical-care specialist at Johns Hopkins Hospital, that involved a simple checklist, fashioned after the kind of safety list pilots are required to check on each takeoff and landing. A landmark study in the Dec. 28, 2006, New England Journal of Medicine of 108 ICUs in Michigan hospitals found that by using the checklist unfailingly, common infections from medical tubing could be reduced by two-thirds. Wash hands with soap. Check. Clean patient's skin with antiseptic. Check. Wear sterile mask, gown, glove. Check. Put sterile drapes over entire patient. Check.
The Michigan hospitals initiated safety programs involving education, in-hospital safety teams, and the daily check-off lists. The improvement in infection rate was sustained for 18 months, according to the study.
"Instead of business as usual, [the Michigan ICU teams] deployed a basic checklist," says Jonah Frohlich, senior program office at the California HealthCare Foundation. He was not involved with the Michigan study. "It was simple stuff. Nurses could stop physicians from proceeding if they weren't doing what they were supposed to be doing on the checklist. That's completely counter to medical culture."
A price for mistakes
A changing bottom line may spur the effort to change. After Oct. 1, 2008, Medicare rules will make it more worthwhile for hospitals to avoid mistakes. The federal insurance program will no longer pay for follow-up care for several preventable problems. For example, the government will not reimburse a hospital for retrieving scissors, scalpels or sponges left in a patient's body cavity following surgery. Nor will the federal insurer pay if a patient is transfused with the wrong blood type, or acquires a pressure ulcer while in the hospital. And, the new rules say, the hospital cannot pass the bill for a mistake on to the patient.
Private insurers may follow suit and refuse to pay for preventable mistakes.
The first step in controlling errors is to know how many there are and where they occur. Reporting is becoming more stringent. "One of the interesting developments is that state after state has announced that hospitals have to report these serious, preventable adverse events," says Leape. California, since 2006, has required reporting of 27 serious medical errors listed by the National Quality Forum, a group of consumers, doctors, insurers and institutions promoting improved quality in healthcare.
If mistakes must be reported, then insurers can insist that hospitals eat the cost of the error, says Leape. "The next step is to say that we won't pay for preventable infections," he says. "If that sort of thing happens, we're going to move from doing the right thing simply because it's the right thing to doing it, because if we don't, we'll be out of business."
One impediment to admitting mistakes has been the fear that an apology would lead to a lawsuit. That, too, is changing. Mistakes, and their solutions, says Dr. Thomas Gallagher, professor of medical ethics at the University of Washington School of Medicine, are human. Wronged patients, and their families, want someone to sincerely say they are sorry, studies show. Gallagher, in a Feb. 26, 2003, report in the Journal of the American Medical Assn., talked with 52 patients and 46 doctors in 13 focus groups. He found that patients wanted full disclosure of harmful errors; an explanation for why it happened; information on what the institution was doing to prevent the mistake from happening again; and an apology.
The apology, a response long mangled and silenced by fear of malpractice litigation, is making a legally protected comeback. Thirty-six states, including California, have passed apology laws. They take different forms, but at the very least they mean a hospital's or a physician's apology cannot be used against them in court.
"You can say the words, 'I'm sorry,' " says Gallagher. "The hope is that if you can't use an apology in court to prove that a doctor has been negligent, then there will be more apologies."
So far, technology is a poorly utilized partner in helping humans reduce errors. A 2005 study by the RAND Corp. found that computerizing medical records could save the healthcare system $81 billion -- and $4 billion of that savings would come from improved safety, largely by reducing prescription errors.
But computerized records and prescriptions are notoriously slow in coming to physicians' offices and hospitals. In the first comprehensive look at health Internet technology in the state, a Jan. 17 report by the California HealthCare Foundation found that only 13% of hospitals in the state use electronic health records, and only 11% use bar-code administration of drugs. Such bar codes, as those seen in supermarket checkout lines, would signal an alert if a healthcare worker grabbed, and scanned, the wrong drug or the wrong dose for the wrong patient.
Until more hospitals acquire the technological means to double-check providers' actions, nurses like those at Cedars will still reach for vials as they've done thousands of times. They may fail to notice a decimal point or a different colored label. "I can easily see how a nurse, especially an experienced one who has always done it right, can overlook the label," Cohen says. "Just like you and I do at the supermarket, reaching for what we've always known, not realizing it has changed.
"This same incident that affected the Quaids, it could happen again at another hospital in another place."
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January 29: Earbud alternatives stop aches, stay put, The San Francisco Examiner
WASHINGTON - They pop out in the middle of a great song, rub your skin the wrong way and are generally a pain in the ear. They’ve even been linked to a few infections.
Earbuds — technically termed “ear-level sound delivery devices” — are easier to tote with MP3 players, radios, phones and other audio devices than old-school headphones, but can be out of tune with the ear’s shape.
“A tight-fitting earbud may contribute to an ear canal being dark and moist, which may predispose toward the development of infections of the ear canal,” said Barry Hirsch, a Pittsburgh-based ear doctor who chairs the American Academy of Otolaryngology’s hearing committee.
To avoid problems, earbuds “should not fit too deeply in the canal, should not be composed of brittle material or have sharp edges,” Hirsch added.
New technology has put relief within reach. For example, Lobies are pliable, comfortable, slug-like slings for earbuds that slip around the ear, surrounding earphones with a cushion of air. The durable, passive acoustic support devices are made from a washable, latex-free, “thermoplastic elastomer” gel. Some users report losing a bit of bass, but little else is sacrificed aside from aching ear canals. The cost: $12.
Guided by ear canal research, Klipsch Audio Technologies parted ways with the standard model of putting a round peg in an oval hole.
“Round eartips create typically two pressure points in the ear, which ultimately can lead to a painful experience,” Klipsch product manager Tom Gospel said. To create a design that lets users “feel your music, not your headphones” while ensuring safety, his group worked with the Indiana University School of Speech and Hearing.
Ear canal impressions from 100 people revealed “that the ear canal is as individual as a fingerprint,” Gospel said. Because one size does not fit all, each package of Klipsch’s new Custom series earphones comes with a set of contour tips: small, medium and large single-flange, and small and large double-flange. The lightweight yet durable silicone gel tips stay in place and can be washed — which is good for performance as well as hygiene. A cleaning tool is included.
Also, the new earphones’ reinforced flexible wires adjust around the earlobe for comfort and the desired degree of noise isolation, from blocking out chatter to allowing some ambient sound for safety on the streets.
Bose has also introduced In-Ear headphones that rest in the bowl of the ear, not the canal. At $129 and $99 respectively, the new Klipsch Custom-1 and Bose models might not resonate with tight budgets, but their quality audio and comfort make a welcome sound for sore ears.
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January 30: Hand Gels Alone May Not Curb Infections, AP
By TIMBERLY ROSS
Associated Press Writer
OMAHA, Neb. (AP) -- Doctors and nurses on the go often skip soap and water in favor of an alcohol-based hand gel, thinking the quick-acting goo will kill bacteria on their hands and curb the spread of infection. It turns out that's not enough.
In a Nebraska hospital, medical workers nearly doubled their use of the alcohol-based gel, but their generally cleaner hands had no bearing on the rate of infections among patients.
The doctor who studied the problem pointed to many villains: Rings and fingernails that are too long and hard to clean, poor handling of catheters and treatment areas that aren't sanitized.
"Hand hygiene is still important, but it's not a panacea," said Dr. Mark Rupp, an infectious disease specialist at the University of Nebraska Medical Center. He led the study at the adjoining Nebraska Medical Center.
The results of his study appear to contradict hospital guidelines from the Centers for Disease Control and Prevention that say better hand hygiene - through frequent washing or use of hand gels - has been shown to cut the spread of hospital infections.
The spread of infection-causing germs in U.S. hospitals is a huge health problem, accounting for an estimated 1.7 million infections and 99,000 deaths each year, according to the CDC. These include drug-resistant staph, urinary tract infections and ventilator-associated pneumonia, among others.
"There are many factors that influence the development of hospital-acquired infections. It would be naive to think that a single, simple intervention would fix this problem," Rupp said.
His study appears in the January issue of Infection Control and Hospital Epidemiology.
Research has shown alcohol-based hand gels are more effective, faster and easier to use than soap and water. The findings of the new study were based on 300 hours of hand hygiene observations of nurses and doctors in two comparable intensive care units over a two-year period.
More gel dispensers were put in the units, and usage rose from 37 percent to 68 percent in one unit and from 38 percent to 69 percent in the other. Compliance for hand washing of any kind in most hospitals is estimated to be about 40 percent, according to experts, although some hospitals do better.
Every two months, bacteria samples were taken from health workers' hands, which were found to be cleaner when using the alcohol gel.
The infection rates in both ICUs were "relatively low," the study said. And researchers found "no significant relationship" between rates of hand gel use and infections among patients. In fact, in one unit the infection rate rose when the hand gel was widely available and its use promoted.
Rupp found the results surprising. However, he said hospital-borne infections cannot be stopped by better hand hygiene alone because infections aren't limited to person-to-person contact.
He suggested hand gels be combined with other measures, such as better cleaning of hospital units, proper insertion and maintenance of catheters, and doctors prescribing antibiotics only when necessary so more drug-resistant bacteria don't pop up.
He also said hospital workers shouldn't wear rings and should trim their fingernails even more than the CDC recommendation of no longer than a quarter of an inch. Rupp said bacteria showed up when nails extended just beyond the fingertip.
Mike Bell, who deals with infection control at the CDC, said that while he didn't agree that hand gels do little to reduce infection, Rupp was right to say they were just one part of the solution.
"If they don't do everything else right, having clean hands is not enough," he said.
Both Bell and Dr. David Hooper of Massachusetts General Hospital in Boston suggested that Rupp's study would have shown a reduction in infections if it was conducted over a longer period.
Hooper said the compliance rate for hand hygiene at Massachusetts General has been about 90 percent for the past several years. The number of drug-resistant staph cases was cut in half and continues to decline, he said.
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January 29: Getting an Earful: Testing a Tiny, Pricey Hearing Aid, The Wall Street Journal
Let's get one thing straight: I'm much too young for a hearing aid.
I wouldn't even consider it if the people I live and work with would only speak louder and more clearly. But they mumble, and they mock me, and words I've misunderstood are the fodder for family jokes. (Seriously, doesn't 'Wikipedia' sound a lot like 'Wake up, Edie'?)
That's why I've been testing a "personal communication assistant" -- one of those sleek mini hearing aids that sits behind the ear, with just a thin, clear tube extending into the ear canal. It's virtually invisible, and a far cry from the old kind that looked like a wad of Silly Putty.
These discreet, high-tech models are tailor-made for baby boomers like me who are starting to lose hearing, but are otherwise at the top of our game. And our ranks are set to explode, thanks to demographics and loud music. The industry estimates that the number of Americans with hearing loss will double, to 60 million, by 2030.
The industry also says that, on average, people wait seven years after they first suspect a hearing problem to do something about it. I'm right on schedule.
My first test, in 2001, showed only mild hearing loss. It's slightly worse now, and just in the high frequencies, which carry a lot of speech, particularly consonants and word endings. Those are often the first to go when the tiny hairs in the inner ear deteriorate -- "like when your toothbrush needs replacing," explains Manhattan otolaryngologist Sarah Stackpole. She says many people with such mild loss find hearing aids more irritating than helpful. But I'm determined to give it a try.
To start, Jake Marsden, an audiologist at AudioHelp Associates, fits me with a top-of-the-line Inteo model, made by Widex of Long Island City, N.Y., just in my left ear. It's tiny -- one inch long and half-inch wide -- but the price isn't. It's $3,200 per ear. Hearing aids generally aren't covered by insurance, or Medicare. Medicaid covers only the most basic kind, which this decidedly is not.
Mr. Marsden programs the Inteo via computer to amplify the exact frequencies I need. Its "integrated signal processor" will take it from there, automatically adjusting to maximize voices and minimize background noise, he explains. He leaves me with a few instructions: Don't wear it in the shower. Take it off at night, and remove the battery so it lasts longer. And, he says, "Don't expect miracles."
Day 1. Whoa -- my left ear is now bionic. I can hear sandwiches being unwrapped and zippers being zipped across the newsroom. Voices come in loud and clear. I feel more alert than I have in years. And no one would know I was wearing this thing -- if I didn't show it off to everyone I see.
Day 2. I must be getting used to it. I'm no longer hearing sandwiches, but eavesdropping is fun and effortless. It's like having an Extendable Ear from the Harry Potter books. That night at a noisy restaurant, though, it's still hard to understand my family across the table. The directional microphone is supposed to home in on the closest conversation. But I could have sworn my daughter said "Boston" not "pasta."
Day 3. I discover another downside -- talking on the telephone. Voices sound tinny and far away when I hold the receiver to my left ear, with the Inteo behind it. With the receiver to my right ear, sounds I don't want to hear are being amplified in my left. "Hearing aids and telephones are not friends," says Mr. Marsden, who suggests holding the receiver farther away or wearing the Inteo selectively in the office. I do that for the rest of the week, beginning to wonder if it's worth it.
Day 6. I wear the Inteo on and off over the weekend. On for the TV, and it's nice not to have to crank up the volume. Off for the gym, since it's incompatible with earbuds. On for the movie theater, though it's still hard to understand the dialogue in "Sweeney Todd." My family votes in favor of the Inteo. "We don't make fun of you nearly as much when you're wearing it," my husband says helpfully.
Day 8. Back in the office, all the chatter around me is actually distracting. When there's a lull, I hear faint scratching sounds. Mice in the floor boards?
Mr. Marsden says he can adjust the programming to minimize such sounds. My bigger concern is the cost. If my own hearing were worse, the trade-off would be different. But for now, $3,200 seems like too much to pay, out of pocket, to imperfectly correct my mild loss. As I give it back at the end of the trial period, Mr. Marsden says there are less expensive models, though they are also less sophisticated.
Walking away, I miss the Inteo already. Did he say "your sister ate it..."?
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