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January 2010 News Archives
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January 1: Sinus Surgery Brings Relief to Many, Times
Study found 76% of sinusitis sufferers felt better afterwards
By Amanda Gardner
HealthDay Reporter
FRIDAY, Jan. 1 (HealthDay News) -- Three-quarters of patients undergoing surgery for stubborn sinusitis saw significant improvements in their quality of life, new research shows.
Most of the remaining 25 percent also saw some improvement, just not as dramatic, said Dr. Timothy Smith, lead author of a study appearing in the January issue of Otolaryngology -- Head and Neck Surgery.
"Certainly this reinforces our belief that sinus surgery increases the quality of life of patients, and I see that clinically as well as scientifically," added Dr. Jordan S. Josephson, a sinus and allergy specialist at Lenox Hill Hospital in New York City. "Previous studies have been single-center studies, and this is a bigger study using multiple centers and using a fairly large population, so it further says sinus surgery is a really good thing to do if you need it."
Chronic rhinosinusitis (CRS) affects a sizable minority -- 14 percent to 16 percent -- of U.S. residents. The condition, marked by symptoms such as sinus pain and pressure, headache, stuffy nose and sneezing, can compromise quality of life more than even congestive heart failure, back pain or chronic obstructive pulmonary disease, the study authors said.
Endoscopic sinus surgery has been performed in the United States since the mid-1980s, said Smith, who is director of the Oregon Sinus Center at Oregon Health & Science University in Portland.
"It's a minimally invasive type of surgery performed with a telescope that goes into the nostril," then basically snips away abnormal and interfering tissue while leaving normal tissue behind, Smith explained.
Smith and his co-authors studied 302 patients with CRS from three academic medical centers, following them for an average of a year and a half after their surgery.
"These were patients who have chronic sinusitis so, by definition, they have at least three months of symptoms and they have evidence of an ongoing inflammation or infection of their nose and sinuses on either a CT scan or an examination of the nose and sinuses," Smith said.
Following the surgery, about 76 percent of patients had "clinically significant" improvement in quality of life, as measured by various validated scales.
Patients with worse disease at the outset seemed to fare the best after the procedure, as did those undergoing surgery for the first time. This second finding is probably explained by the fact that people going for second or further surgeries were probably sicker to begin with, Josephson said.
None of which is to say that patients shouldn't try medical therapies first, he added.
"I don't think it means everyone with CRS should consider surgery. They should try medical therapy, and if medical therapy fails and the surgeon feels that part of the problem is anatomic, then surgery would be a good tool for them to use," Josephson said. "Some people with stage 1 and 2 diseases may even get cured. This is a wonderful renewed hope of feeling better."
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January 4: Suppressing Tinnitus With Music Therapy, The New York Times
By HENRY FOUNTAIN
Subjective tinnitus, the ringing or other noise that often accompanies noise-related hearing loss, is a tough problem to treat. But researchers in Germany have come up with a novel approach, a kind of music therapy in which the music is custom-tailored to the person with tinnitus.
The technique, by Hidehiko Okamoto, Henning Stracke and Christo Pantev of Westfalian Wilhelms-University and Wolfgang Stoll of Muenster University Hospital, makes use of recent findings about a possible cause of tinnitus: reorganization of the auditory cortex, the part of the brain responsible for perceiving sound, in response to noise exposure. Other research has shown that behavioral training may reverse faulty cortical reorganization.
The researchers allowed patients to choose their favorite music, which was then “notched” — a one-octave frequency band, centered on the frequency of the ringing experienced by the subject, was filtered out. The subjects listened to the music on average about 12 hours a week.
After a year, the researchers report in The Proceedings of the National Academy of Sciences, those who listened to this custom-notched music reported a significant improvement in their tinnitus — the ringing was not as loud — compared with others who listened to music that was notched at frequencies not corresponding to their ringing frequency.
The researchers suggest that two things might be happening in the auditory cortex to bring about the improvement. The neurons in the cortex related to the ringing frequency are presumably not being stimulated, because those frequencies are absent from the music. At the same time, nearby neurons may have been actively suppressing the tinnitus-related neurons, through a process known as lateral inhibition.
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January 7: A chorus of thanks as hospital gives girl her voice, The Washington Post
By John Kelly
Imagine if you had to make a conscious decision before every breath, telling yourself: Breathe, breathe, breathe. What would happen when you fell asleep?
Death would creep silently into your bed.
That's the fate that seemed to await Zoe Colquitt when she was born eight years ago. The official name for her condition -- a genetic disorder of the autonomic nervous system -- is congenital central hypoventilation syndrome, but doctors from an earlier generation know it as Ondine's curse.
Ondine is a character in a German fairy tale, a mermaid whose father, Poseidon, punished her unfaithful human lover by fating him to stop breathing when he fell asleep.
Zoe has seen experts all over the country, her family occasionally choosing where to live based on proximity to knowledgeable doctors. (Not difficult to understand when you realize that only 400 children in the world have Ondine's curse.)
She has made remarkable progress. A device called a diaphragm pacer means she needn't be hooked up to a ventilator at night. Planted under the skin on her chest when she was 3 1/2 , it stimulates her phrenic nerve, signaling her diaphragm to take precisely 15 breaths every minute.
But Zoe was gripped by another fairy-tale curse: She seemed unable to talk.
"Zoe hadn't heard her own voice, hadn't heard herself cry," said her mother, Shelley. "She never said 'Mommy,' 'Daddy,' 'goo goo, ga ga.' Nothing."
It didn't seem to be a result of her autonomic condition or earlier procedures that included a tracheotomy. When the Colquitts moved to Gaithersburg in 2005 so dad Kevin could attend Georgetown's law school, Zoe started seeing doctors at Children's Hospital.
Zoe's problem, pediatric otolaryngologist Diego Preciado discovered, was that she was unable to close off the back of her throat and seal the passageway between her palate and her nose. It's a condition called velopharyngeal insufficiency.
The back of the palate is critical for making explosive consonants: K's, S's, T's. Zoe could not articulate those sounds properly. Her voice, if she ever decided to talk, would sound like a nasal whine.
"Speaking through the nose makes it so the person is perceived as uneducated and of low IQ," Preciado said. "These people have traditionally carried a huge stigma in society. In the childhood years, there's a huge problem with social development because of that."
With Zoe under general anesthesia (and on a ventilator), Preciado cut a flap of tissue from the back wall of her throat, hinged it, rotated it and then sutured it to her palate. That partially sealed the nose from the mouth.
Shelley remembers Zoe's first words when she woke up in the ICU, sore and covered in tubes and wires. "She raises out of bed, and she looks at me and she goes, 'Momma, I feel like I look like a horse's patoot.' Mind you, Zoe hasn't said anything in four years."
She has made up for lost time. Joked Shelley: "My oldest daughter, who is 11, really hates Dr. Preciado. She says life was so much better when Zoe didn't know how to talk."
Lift every voice
The Colquitts recently moved to Dallas, where Zoe sings in the school choir. Every night, she attaches herself to the machine that breathes for her.
"My medical bills have almost ruined us as a family," Shelley said. "Even though I have insurance, there are still things I have to buy. But some things you can't buy. And what Children's has done for Zoe, I can't buy."
Children's gave Zoe her voice.
You can add your voice to those who are supporting Children's Hospital. Our annual campaign ends Friday. We've raised $263,205.75. To join our chorus, send a check or money order payable to "Children's Hospital" to Washington Post Campaign, P.O. Box 17390, Baltimore, Md. 21297-1390. To donate online using a credit card, go to http://www.washingtonpost.com/childrenshospital. To give by phone using Visa or MasterCard, call 202-334-5100.
A final note: At 8 p.m. Jan. 16, Cedar Lane Unitarian Universalist Church will host an all-Mozart concert featuring pianist Barbara Wing, a chorus and a chamber orchestra. Admission is free, but the hat will be passed for the Children's Hospital campaign. (Go to http://www.cedarlane.org/concerts.htm for info.) My family attends Cedar Lane, and I'm touched that Henry Sgrecci, the music director, has chosen to support this worthy cause.
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