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Ear, Nose & Throat Associates |
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News Archives, March 2007
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March 2: Warnings Sought on Kids’ Cold Medicine, The Washington Post
By ANDREW BRIDGES
The Associated Press
WASHINGTON – – Government health officials said Friday they are reviewing whether popular medicines like Tylenol Plus Cold & Cough and Infant Triaminic Thin Strips are safe and effective in treating children’s colds and coughs.
Disclosure of the ongoing review, which will take months to complete, came as critics charged that many over–the–counter cough and cold remedies can harm toddlers and preschoolers. Those critics, including public health officials and pediatricians, are pushing the government for stricter warnings to prevent life–threatening overdoses.
"We have been looking at this issue internally with regard to the safety and efficacy of the use of these products in children," Dr. Charles Ganley, director of the FDA’s office of nonprescription drug products, told reporters as he responded to a petition filed Thursday by city of Baltimore officials and others. The review covers medicines that include decongestants, antihistamines, cough suppressants and expectorants.
The petition is far from the first warning about tots using the medicines. The American Academy of Pediatrics began issuing those warnings to parents in 1997. And just two months ago, the Centers for Disease Control and Prevention reported that more than 1,500 toddlers and babies wound up in emergency rooms over a two–year period because of the drugs. The study’s authors told parents to consult a doctor before giving the remedies to children under age 2.
In fact, the labels of every cough and cold remedy already caution parents to do just that, said Linda A. Suydam, president of the Consumer Healthcare Products Association, which represents makers of over–the–counter, or OTC, medicines.
"OTC cough and cold remedies have a long history of safety when used according to the label. The most important information for all consumers is that OTC medicines are real medicines and must be used according to the label instructions at all times," Suydam said in a statement.
Still, product packaging often bears images of children apparently much younger than 2, as well as terms like "infant" and "baby." The petitioners called that misleading, adding that the average drug store stocks more than 30 such products.
Concentrated Tylenol Plus Cold & Cough, for instance, includes a picture of a mother and infant, even though its label recommends asking a doctor before using in children younger than 2. Manufacturer McNeil Consumer Healthcare reiterated that advice in a statement. A spokeswoman declined to comment further.
The FDA has never approved dosing recommendations for the 0–2 age group for the drugs. Nor is it known just how much of their various ingredients it would take to injure or kill children that young, according to the CDC.
The petition asks the FDA to go further and require that labels say the products shouldn’t be used to treat children younger than 6.
In Maryland alone, roughly 900 children 4 and younger overdosed on the medicines in 2004, according to the new petition. In Baltimore, the medical examiner has linked the products to the deaths of at least four children under 4 in the last five years.
Yet these products have never been proven to benefit children so young, the petitioners argued.
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March 7: Medication Errors Are Studied, The New York Times
By DONALD G. McNEIL Jr.
Young children are the most likely victims of surgery–related medication mistakes, a new study has found, and poor communication as the patient moves from the operating room to recovery is the most likely culprit.
The study, released yesterday, was done by the United States Pharmacopeia, which sets standards for the pharmaceutical industry, and by the Uniformed Services University of the Health Sciences in Bethesda, Md., and two nurses’ associations.
Medical error has been a charged topic ever since a 1999 report by the Institute of Medicine, "To Err Is Human," estimated that such mistakes led to as many as 98,000 deaths a year – more than highway accidents and breast cancer combined.
The current study did not try to estimate total error rates. Instead, it analyzed 11,000 mistakes that had been voluntarily and anonymously reported to the pharmacopeia by hundreds of hospitals since 1998.
The study was confined to errors made on patients undergoing surgery, and the rate of harm, 5 percent, was much higher than is typical for medication errors. Among children it was 12 percent.
Most of the errors involved painkillers and antibiotics. Four resulted in deaths, and one death was of a child.
Problems typically arose when a patient was handed off from the preoperative team to the operating room to the recovery room to the regular ward nurses, said Diane Cousins, a health care specialist at the pharmacopeia and one of the authors. "The system is often very fragmented," Ms. Cousins said.
Typical dangerous mistakes were failures to administer antibiotics before surgery, failures to note allergies, errors in setting pumps that dispense blood thinners or painkillers, and giving overdoses to infants.
In several cases described in the report, poor penmanship, careless listening or bad arithmetic caused patients to get doses 10 or even 50 times as high as they should.
"It’s beyond troubling that the smallest, youngest patients are the ones most at risk," Ms. Cousins said.
There are 10,000 drugs in the marketplace, she said, and many have never been tested on children in clinical trials, so doses are often made by guesswork based on weight, involving conversion of pounds to kilograms, sometimes by nurses who are not pediatric specialists.
"These may be back–of–the–envelope calculations not checked by anyone," she said, "and they are often in very tiny amounts – milliliters – and that in itself breeds errors."
The report made 42 recommendations, among them that hospitals improve communication and designate a pharmacist to be consulted for each patient.
Since 1999, committees investigating medical mistakes have routinely recommended that hospitals install computerized systems for prescribing drugs, which can sound alarms when a toxic combination is ordered for a patient. But fewer than 10 percent of all hospitals have them.
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March 12: Sleep Apnea Common in Pacemaker Users, WebMD
Sleep Disorder Often Undiagnosed; Treatment May Help Heart
By Salynn Boyles
WebMD Medical News
Reviewed by Louise Chang, MD
Heart patients with pacemakers have a high prevalence of undiagnosed sleep apnea, findings from a small European study suggest.
Researchers evaluated 98 pacemaker patients for sleep apnea. Fifty–nine percent of the patients had undiagnosed sleep apnea.
The findings are reported in the April issue of the American Heart Association publication Circulation.
Although it is not clear from the study if sleep apnea contributed to the need for the pacemakers, the findings highlight the need for a greater awareness of the potential association between the two conditions, study co–author Patrick Levy MD, PhD, tells WebMD.
"We know that there is a relationship between sleep apnea and heart arrhythmias (abnormal heart rhythm)," Levy says. "The question is, ‘If we treat the sleep apnea will we reduce the need for pacemakers?’ We don’t know, but we need to find out."
Obesity, Age Didn’t Explain Link
Sleep apnea is characterized by repeated interruptions of breathing during sleep, which leads to excessive daytime sleepiness and other health problems.
Obesity and age are both major risk factors for heart disease and sleep apnea, but they did not explain the excess of sleep breathing problems among the pacemaker recipients in the study, Levy says.
The patients in the study who were found to have sleep apnea also had less daytime sleepiness than is generally reported for the condition.
"There was no relationship with [sleep apnea] symptoms in this population, which may explain why the disorder remains undiagnosed in so many heart patients," Levy says.
He recommends that all heart patients who are candidates for pacemakers be evaluated for sleep apnea before they have the devices implanted, and that patients who have sleep apnea receive treatment for the condition.
In the absence of lifestyle changes, such as weight loss, continuous positive airway pressure (CPAP) remains the most effective treatment for sleep apnea. Patients wear a mask during sleep, which delivers pressurized air to the lungs.
More Study Needed
Levy says successful sleep apnea treatment may help heart patients avoid pacemakers.
Cardiologist Kenneth Ellenbogen, MD, tells WebMD that more study is needed to back up this claim. But he agrees that heart patients who are candidates for pacemakers should be evaluated for sleep apnea.
Ellenbogen is a professor of medicine at Virginia Commonwealth University.
"Patients who need pacemakers usually have a variety of other problems," he says. "A physician who puts a pacemaker in and tells the patient to come back in six months is doing the patient a disservice."
Ellenbogen says identifying and treating sleep apnea may prove to be as important in heart patients as identifying and treating high blood pressure and diabetes.
"It is another co–morbid condition that we can actually treat, and treat well," he says.
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March 12: Poll: Most U.S. women not sleeping enough, United Press International
By REBECCA PEARSEY
UPI Correspondent
WASHINGTON, (UPI) – – A typical night for Deborah Wischow means waking up three hours after an early bedtime and waiting to see if sleep will return.
"You’re not asleep, but you’re not really awake," said Wischow, a Minneapolis resident who has struggled to maintain sound sleep for the past few years.
Wischow, 49, is one of many American women who are stressed out and sleep–deprived due to poor time management, according to a study released recently by the National Sleep Foundation.
Sixty percent of all women surveyed reported getting a good night’s sleep only a couple of times a week, and 46 percent said they had a problem sleeping most nights.
This sleepless existence has gripped women of all ages and walks of life. The women also reported falling asleep at work and relying on caffeinated beverages during the day to stay awake. The survey results contain a 3.1 percent margin of error and were collected from 1003 people between ages 18–64 who where surveyed over the phone.
The 46 percent figure was shocking to Meir Kryger, a leading sleep researcher and doctor who served as chair of the poll’s task force.
"To me, that was the most startling number, and not surprisingly. Whenever you hear women talking, it is amazing how often (the conversation) turns to their sleep problems," said Kryger.
Wischow said it seems like no one in her office sleeps. In the corporate world where she works, getting five hours of sleep is normal. "People brag about how much they didn’t sleep," Wischow said. "There’s not enough time in the day. It’s not practical."
To Joyce Walsleben, director of New York University’s Sleep Disorder Center, sleep is not a matter of practicality.
"It’s absolutely necessary, and if you do it, you begin to understand that. Everybody seems to be happier. We just drag ourselves around with too little sleep and then we get into trouble."
A lack of sleep has put women in a bad cycle of moodiness, said the poll. Being worried or stressed can lead to sleeplessness, which in turn leads to a bad mood, which cycles back to more sleepless nights and possibly depression. One of the big symptoms of insomnia is depression, Kryger said.
"They put sleep on the back burners ... and the next day they are grouchy, irritable, (and) not very productive."
The survey also found working single women get less sleep and have more caffeine than any other category. Most women averaged less than six hours of sleep and 3.1 cups/cans of caffeinated beverages per day.
The most unexpected finding was stay"at"home moms experienced the most sleep problems of the categories, Walsleben told United Press International. Out of all the stay–at–home moms surveyed, 74 percent said they often felt symptoms of insomnia. It could be stay–at–home moms get sloppy with their time management, Walsleben said.
Women who work part time and have children, on the other hand, seemed to have the most balanced lifestyle in the survey. They reported sleeping well, with half of them getting at least eight hours of sleep a night.
"One of the reasons is they are able to schedule things with their family. We may be looking at a group of women that are better at balancing things," said Kryger.
Though 60 percent of women in their 50s said they got at least eight hours of sleep a night, 41 percent reported using sleep aids. And 44 percent of those without any children in the home, or "empty nesters," reported getting good sleep most nights.
But why are women getting less sleep than men? Walsleben said females have a different psychological makeup, and they tend to care for – – and worry about – – the people around them, and then take those issues to bed with them. The traditional role of women also has something to do with sleep deprivation.
Sleep deprivation has become a regular habit for many. Wischow, a divorced mother of teenagers, has gotten used to little sleep and says she doesn’t really take it seriously anymore.
Taking the steps to getting enough quality sleep involves purpose and discipline. For those with sleep disorders, the National Sleep Foundation recommends keeping a standard bedtime, relaxing during the hour before bed and including exercise in the day. However, exercise should be at least three hours before bedtime.
And for people like Wischow who find sleep elusive, Walsleben suggests simply adding 15 minutes onto a normal night of sleep every night until the person gradually reaches a healthy period of slumber.
"There’s nothing in our lives that we can’t cut out," she said.
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March 13: Pollen ‘superburst’ to intensify allergy season, The Arizona Republic
Connie Midey
The official start of the allergy season is eight days away, but sufferers should get ready. It promises to be a nasty spring.
Allergies will be fueled this year by a "superburst" of tree pollination, said Dr. Mark Schubert of the Allergy Asthma Clinic.
Typically, different species pollinate in sequence, one every few weeks, he said. Trees usually are first, with ash, then early junipers, cottonwoods and paloverde, with a smattering of weeds along the way. Bermuda grass arrives a bit later, when evening temperatures reach about 70 degrees.
This year, it’s different.
"Cold weather stopped everything from happening, while the rain put down a lot of water," Schubert said. "Then, it warms up sort of quickly, and you get multiple trees all (pollinating) together as a superburst."
That means jammed days at Dr. Suresh Anand’s Allergy Associates & Lab offices, with patients looking for relief–giving prescription refills, immunity–building shots and advice for managing seasonal allergies.
"It’s as if someone has turned on a switch," Anand said.
Not that it takes much to make people with allergies reach for their over–the–counter and prescription medicines and close house and car windows.
Doctors say even 20 pollen grains per cubic meter of air can cause a reaction. On an average spring day in the Valley, the count for mulberry pollen is about 3,000 grains per cubic meter; for olive trees, it's about 300 grains.
No one had to tell Sherry Queen, a Hurricane Katrina victim who moved to Phoenix from Gulfport, Miss., that pollen counts are rising.
"I really came to Phoenix hoping my allergies would just go away," she said, "but the sinus infection, runny nose, scratchy throat, and watery, itchy eyes all came right back."
She is back on a regimen of weekly shots.
"You want to hide indoors," Queen said, "but you can’t live your life like that."
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March 14: New Yorkers Feel Right at Home With House Calls, The Washington Post
Convenience Appeals To City’s Professionals
By Robin Shulman
Washington Post Staff Writer
NEW YORK – – The doctor is cruising downtown on Eighth Avenue in his black BMW when he gets the first in a string of text messages from his patient. "No one here?" reads the last one. The doctor is late.
The doctor texts back, one thumb flying over his Verizon Pocket PC, the other hand on the wheel. Natan Schleider, 31, then drives onto the curb to get around a car blocking his, parks illegally, props up the "Emergency Housecall" sign on his dashboard, and soon – – dressed in black scrubs, toting a black bag and black laptop – – is buzzing the bell of a West Village walkup.
This is the Manhattan house call. It is part retro trend, harking back to days when doctors had personal relationships with patients and dispensed care in the home. But it is also a technology–based New York convenience in a city where people expect laundry, DVDs and late–night sushi brought to their doors.
In fact, the house call is on the rise nationwide, mostly because of an aging population, increasingly portable medical devices and lab tests, and changes in Medicare in the late 1990s that allowed for higher reimbursement rates for doctors’ visits to homes.
From 1998 to 2004, the number of Medicare house calls for the homebound elderly increased 43 percent, to more than 2 million visits, according to a study in the November 2005 issue of the Journal of the American Medical Association.
But another kind of house call – – call it the convenience call – – also has growing appeal for young, relatively healthy professionals in New York and other high–income locales. They summon a doctor or physician’s assistant with a cellphone call and a wait ranging from minutes to hours, and their demand fuels several Manhattan–based practices.
Schleider, a soft–spoken man with a sympathetic way, charges $500 for the first visit and $400 thereafter, payable with major credit cards. He does not accept insurance.
"This is ideal medical care," Michael Harrison, 28, a commodity futures trader, said during an examination from Schleider in which he smoked and played with his dog in his studio apartment. "When you want it, when you need it. That’s what New York City is about."
Harrison also owns a fashion company and a record label and says he makes thousands of dollars before lunch. Almost one year ago, he became dependent on painkillers after a liposuction surgery.
For a time, the baby–faced, hyperkinetic Harrison was taking narcotic cocktails of five or six different drugs a day, including perhaps 40 Percocets, he said. Schleider researched addiction and went through special training to be certified to dispense his patient the drug buprenorphine, or Subuxone, a kind of new–generation methadone that weans addiction to opioids and narcotics.
It is difficult to get Subuxone, because so few doctors are certified, and there is often a waiting list. Schleider is in demand – – he estimates 10 percent of his practice is now Subuxone treatment, a way for genteel drug addicts to avoid dingy, depressing methadone clinics.
More than half of Americans polled are unhappy with the traditional health–care system. Convenience–call patients such as Harrison say they wait too long to see conventional physicians, and then doctors hustle them in and out to see the next one. Health plans often do not provide for a family doctor who can liaise among specialists. Tests are not ordered, or ordered without cause. A practice such as Schleider’s seems like a stopgap answer.
"My vision was for a regular family health clinic," said Schleider later, back in the car, heading to the Bronx. "That was my ideal, rather than hustling around. But this is the business."
He sees perhaps six patients a day. His practice grosses $25,000 a month, he says, with 20 percent overhead costs. And that is after less than two years and including rent on a Park Avenue office.
His accessories are mostly old–fashioned; his black bag contains probes and scopes and meters. In his downtown studio apartment, a cabinet contains a supply of medications, since a person who pays for a bedside doctor does not take a taxi into the night to find a pharmacy: Vicodin and Tramsdol, Hydrocodone and Acetamin. But he looks up diagnoses and prescriptions on his phone and keeps patient records on his laptop.
Once, Schleider got a call from a woman in her 70s who was short of breath. Within 30 minutes, a radiology technician with an SUV full of equipment had arrived at her building, carried his 100–pound X–ray machine into her apartment, taken chest X–rays and e–mailed results to a lab. Schleider knew the results before he arrived at her side.
Yet some say the house–call visit shows the inequities of the health–care system and of New York City. A two–tiered health–care system is already in place, said Jeremy Boal, the executive director of the Mount Sinai Visiting Doctors Program, one of the largest in the country to do house calls for the homebound elderly who might not otherwise get to a doctor.
He said a house call can deliver the kind of careful attention that every patient deserves. "Until our society chooses a system that’s more equal and fair, anything that gets care to patients is a positive," he said.
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March 15: Anti–epileptic drugs may help hearing loss, United Press International
ST. LOUIS, March 15 (UPI) – – U.S. medical scientists have discovered some anti–epileptic drugs might help prevent or treat noise–induced hearing loss.
On a battlefield, a soldier’s hearing can be permanently damaged in an instant by the boom of an explosion and thousands of soldiers returning from Iraq have some permanent hearing loss. But now Washington University School of Medicine researchers in St. Louis have discovered a medicinal form of hearing protection might someday become a reality.
Associate Professor of otolaryngology Jianxin Bao has found two anti–epileptic drugs can prevent permanent hearing loss to a significant degree in mice exposed to loud noises.
Bao and colleagues discovered if they exposed mice to loud sounds and then gave them trimethadione (Tridione) or ethosuximide (Zarontin) – – both anticonvulsive medications used to treat epilepsy – – they could prevent a significant amount of permanent hearing loss.
The researchers also discovered that when mice were given trimethadione, but not ethosuximide, before noise exposure, the subsequent hearing loss was significantly reduced.
The study is reported in the journal Hearing Research.
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March 15: Laser Surgery for Carcinoma of Throat and Voice Box Preserves Function, Reuters Health
NEW YORK MAR 15, 2007 (Reuters Health) – For appropriately selected patients with pharyngeal or pharyngolaryngeal squamous cell carcinoma, transoral laser surgery is as effective as open surgery in maintaining locoregional control, surgeons in Switzerland report. The functional results obtained with laser surgery, they say, are even better.
Disadvantages of functional open surgery include the need for a temporary tracheotomy and use of a nasogastric tube for several weeks, Dr. Jürg Kutter and his associates at the University Hospital in Lausanne point out.
Laser surgery preserves sensory pharyngeal nerve branches, they report in the February issue of the Archives of Otolaryngology, Head and Neck Surgery. The risk of aspiration pneumonia is reduced and hospital stays tend to be shorter. Feeding tubes and tracheostomies may still be required, but generally for short periods of time.
To verify the benefits of transoral laser surgery, the authors reviewed the outcomes of 55 patients who underwent transoral laser surgery between 1999 and 2004. Ages ranged from 46 to 87 years.
Tumor resections were performed with a carbon dioxide laser coupled to a microscope. Depending on the size, tumors were removed in one piece or in multiple resections. Neck dissections were performed in 43 patients, and 18 received adjuvant radiotherapy.
At a median follow–up of 24 months, the local control rate was 90%, Dr. Kutter and his associates report. Overall survival was 78%.
Early postoperative complications included aspiration pneumonia, laryngeal obstruction due to edema, severe postoperative bleeding, and cervical emphysema that resolved spontaneously. Median pain score during the first postoperative week was 4 on an analog scale of 0 to 10; pain was totally resolved after 4 weeks in most patients.
Median hospital stay was 13 days, versus the 33–day stays when patients undergo open surgery, the authors indicate.
Dr. Kutter’s team concludes that laser surgery is a feasible option for some patients. Referring to the high rate of aspiration pneumonia, they recommend "selecting patients with a careful evaluation of their learning capabilities before surgery to assess whether the postoperative swallowing training will be successful."
Because of the limited ability to discern positive margins, they also recommend endoscopic evaluation with biopsy or additional laser resection 1 to 4 months after the first procedure.
SOURCE: Arch Otolaryngol Head Neck Surg 2007;133:139-144.
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March 20: Antibiotics overprescribed for sinus ills, study finds, Reuters Health
CHICAGO, Illinois (Reuters) – – U.S. doctors may be over–prescribing antibiotics for sinus infections, which are often caused by viruses and not bacteria, according to a study released on Monday.
A review of two national surveys of visits to doctors and recommended treatments found antibiotics prescribed for about 82 percent of acute sinus infections and nearly 70 percent of chronic sinus infections, researchers at the University of Nebraska Medical Center in Omaha said.
That "far outweighs the predicted incidence of bacterial causes. The literature repeatedly shows that viruses are by far the most frequent cause of acute rhinosinusitis," the study, published in this week’s Archives of Otolaryngology–Head & Neck Surgery, said. (Read Dr. Sanjay Gupta’s thoughts on prescribing antibiotics for sinus infections.)
The infections are considered acute when symptoms persist up to a month. They become chronic when they last for three months or more.
Overuse of antibiotics, which are useless against viruses, is causing the evolution of drug’resistant bacteria that must be treated with the most expensive new antibiotics.
But many patients with sinus infections demand an antibiotic, Dr. Hadley Sharp and colleagues said. As many as one–fifth of antibiotic prescriptions for adults are written for a drug to treat sinusitis.
The high level of antibiotic use may partly come from doctors treating secondary infections, Sharp’s team said.
"The vast use of these agents makes the statement that they seem to be effective ... or they would have been abandoned," the researchers wrote.
It is also possible that many sinus infections will simply clear up on their own, the researchers added.
"While keeping the goals of treatment in mind, there are concerns about the overuse of antibiotics and the resultant problems, including drug resistance and increasingly virulent bacteria," they wrote.
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March 21: Treatments mean ‘no one has to live in misery’ from allergies, USA Today
By Robert Deutsch, USA TODAY
Dagmar Fisher’s sneezing spells are so impressive this time of year they serve as comic relief for her office mates.
"A few weeks ago the sneezing started. Really violent spells. I’m like a bad cartoon," the 29–year–old New York City resident says.
But to Fisher, the symptoms she suffers from every spring – sneezing, an itchy and runny nose, watery eyes and congestion – are less than humorous. The discomfort invades sleep, work, and her weekly runs in Central Park.
Fisher is one of 35.9 million Americans who have seasonal allergies, according to the American Academy of Allergy Asthma and Immunology.
But with the right diagnosis and treatment, allergies can be managed well.
"No one has to live in misery," says Fisher’s allergist, Clifford Bassett, an assistant clinical professor of medicine and otolaryngology, at Long Island College Hospital–SUNY Downstate Medical Center.
Seasonal allergies can affect any one at any age. Sometimes called hay fever or seasonal allergic rhinitis, they are triggered by substances called allergens, such as pollens from trees and weeds.
The body is fine–tuned to fight invaders such as bacteria and viruses, but when a person inhales an allergen, the immune system recognizes it as an intruder.
The body starts producing Immunoglobulin E antibodies, or IgE. IgE antibodies attach themselves to mast cells, which in turn release potent histamines and leukotrienes. The release of these chemicals increases mucous secretions causing symptoms such as a runny nose and watery eyes.
"We are beginning to increasingly realize that our immune system, our defense against foreign invasion, is very complex. It’s a delicate orchestra and can get out of control even as it protects us. In allergy that’s what happens," says Michael Phillips, medicine professor for pulmonary, allergy, and immunology critical care at the University of Pennsylvania in Philadelphia.
Why some people get them and some do not is still up for discussion, experts says. But clearly a genetic link is involved, says Marshall Plaut, chief of allergic mechanisms at the National Institute of Allergy and Infectious Diseases.
Susceptible people may be affected by other factors as well, including hormones, stress and environmental irritants.
At last month’s annual allergy academy meeting in San Diego, researchers from the University of Washington presented a study showing allergy sufferers are much more likely to react to non–allergic triggers such as cold air, perfume, cigarette smoke, exercise and household cleaning products.
Some are comfortable managing their allergies without a doctor, using over–the–counter antihistamines, decongestants, nasal sprays and sinus washes.
It’s common for the allergy–afflicted to wait years before getting medical help, especially the expertise of an allergist.
"There are a lot of jokes about allergies. Some people consider seasonal allergies a trivial disease, but they are not," Plaut says.
Left untreated, they can lead to ear, sinus and bronchial infections that may require antibiotics.
Fisher dabbled with a variety of over–the–counter drugs, delaying for a decade before she sought out an allergist earlier this month.
"I can’t control my symptoms anymore," she says.
The biggest key to helping patients is creating a personalized regime, says Louis Mendelson, clinical professor at the University of Connecticut School of Medicine in Farmington.
"Find a board–certified allergist, think about getting skin testing to help you learn which seasons affect you, work with your doctor to see which medicines help," Mendelson says.
Doctors may recommend antihistamines, such as diphenhydramine and fexofenadine, or a medication that inhibits leukotrienes. Allergists also may suggest saline washes, nasal steroid sprays, which help reduce swelling of nasal passageways, and eye drops to help quell watery eyes.
If symptoms persist, inhaled medications or immunotherapy – allergy shots – may be prescribed. Immunotherapy involves injecting an increasing dose of allergens a patient is sensitive to over weeks and months. It is successful in 90% of patients with seasonal allergies, according to experts.
One of the most promising areas of treatment is sublingual immunotherapy, Plaut says. Doctors place drops containing allergens under the tongue where they are absorbed by the lymphatic tissue. Now used in Europe, sublingual immunotherapy needs more research before it is considered for FDA approval.
Some patients are determined only to take medications when symptoms become intolerable. Mendelson says that’s too late. He and other experts recommend starting medications as soon as allergy season hits.
"Be preventative. You put your seatbelt on before the car accident, not after," he says.
"We do not have a cure yet, but we can control allergies. You don’t have to live like there’s a clothespin on your nose and salt and pepper in your eyes."
HOW YOU CAN REDUCE THE EFFECTS
Know your triggers: An allergist can give you a skin test so you can learn your triggers and avoid them.
Check pollen counts: Check local pollen counts at websites such as the American Academy of Allergy Asthma and Immunology’s National Allergy Bureau.
Avoid cross–reactions: Eating fruits such as apples and pears may cause an allergy reaction (tingling of the mouth, itchy throat) if you have seasonal tree pollen allergies due to a cross–reaction between the proteins in these fruits and the pollens.
Shower at night: Pollen clings to hair, skin and clothes. Shampooing and changing clothes before heading into the bedroom reduces allergens where you sleep.
Clean air at home: Close windows and use air conditioning set on recirculate. Avoid fans that circulate outdoor air in. Clean air filters.
Keep Fluffy on the floor: Dogs and cats that spend time outdoors are allergen transporters. Keep them off your bed and areas you spend lots of time.
By Mary Brophy Marcus, Special for USA TODAY
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March 27: Antibiotics Overused In Sinusitis, washingtonpost.com
Patient Demands Add to Problem
By Elizabeth Agnvall
Special to The Washington Post
Antibiotics are still being prescribed for seven out of 10 patients with chronic sinus infections and eight out of 10 with acute sinus infections, even though research shows that more than 90 percent of the infections are caused by viruses – – not bacteria – – against which the drugs are useless, according to new research.
The study suggests that despite several years of physician awareness campaigns about the overuse of antibiotics, doctors and patients haven’t gotten the message, say the authors, who describe their study as the largest to quantify physician habits in the treatment of sinus infections.
Is That Sinus Infection Bacterial or Viral?
Most sinus infections start out as viral infections, against which antibiotics are useless. But after seven to 10 days, about 60 percent become bacterial infections. Even then, most will heal on their own. But antibiotics may speed healing.
"Prescription antibiotic drugs are being used far more than bacterial causes would indicate," they wrote in the study, published last week in the Archives of Otolaryngology – – Head and Neck Surgery.
That behavior is problematic, they say, because overuse of antibiotics is behind the spread of increasingly virulent strains of drug-resistant bacteria. Sinus infections, which every year affect an estimated 37 million people in the United States and cost billions, account for 21 percent of all antibiotic prescriptions for adults and 9 percent of those for children. Acute sinusitis usually starts with a common cold and sinus inflammation and can last up to four weeks. Chronic sinusitis lasts for 12 weeks or longer.
Complaints of chronic sinusitis account for an estimated 14 million visits to doctors’ offices, hospital clinics and emergency rooms, and acute sinusitis an additional 3 million, according to National Center for Health Statistics data analyzed by the researchers who conducted the new study. They found antibiotics were the most frequently recommended treatment for sinusitis, followed by antihistamines, nasal decongestants and nasal steroids.
Donald Leopold, professor and chair of otolaryngology at the University of Nebraska Medical Center and one of the study’s authors, said at least part of doctors’ prescribing habits might be explained by the difficulty of diagnosing some sinus infections. There is no quick swab test that determines whether an infection is bacterial or viral: To figure that out, doctors mainly consider the severity of symptoms and the duration of the infection.
Although most sinus infections start with a virus and get better within 10 days, some people develop a secondary bacterial infection. By the 10th day of symptoms, a majority of patients develop bacterial infections. Although most of these will resolve on their own, Leopold said, antibiotics are sometimes warranted, depending on the severity and duration of symptoms.
Because there is a common misconception that all sinus infections should be treated with antibiotics, Leopold said many patients demand the medication.
"Probably to save time, I will often knuckle under and give them the antibiotics, just because it’s what they want," he said. "Often, it’s patients I know who get into trouble once in a while and I don’t want them to get into deeper trouble, so I give them the antibiotic."
Matthew Mintz, associate professor of medicine at the George Washington University School of Medicine, agrees that patient demand is part of the problem.
"We have advertisements on television from drug companies that basically tell you to ask your doctor for a pill," Mintz said. "We are a pill society. We want a pill to fix our problems."
While Mintz said he didn’t dispute the prescribing pattern identified in the study, he questioned whether the researchers’ methodology – – they extrapolated data from a large national survey – – might have exaggerated the problem. Mintz compared this kind of data sampling to an exit poll: "Sometimes they are right, and sometimes they can be drastically off."
David Fairbanks, a spokesman for the American Academy of Otolaryngology – – Head and Neck Surgery and a retired ear, nose and throat specialist, said physicians don’t have time to spend 15 minutes with each patient explaining the public health implications of drug–resistant bacteria, so they write the prescription instead.
Fairbanks recommended urging patients to hold off on antibiotics for five to seven days after symptoms begin, to give their body a chance to fight off the infection.
But then, he said, "you get a patient who says, ‘I can’t wait – – I’m flying on an airplane, or I’ve got a PTA meeting, or I can’t take off another day of work.’ Somewhere between the fifth and seventh day comes physician judgment and how persuasive he can be with the patient."
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March 27: Sleep disruptions may increase heart disease risk, Reuters
By Michelle Rizzo
NEW YORK (Reuters Health) – Relatively healthy individuals who experience sleep disruptions at night appear to have an increased risk activity of factors associated with the development of a blood clot, also referred to as a thrombus.
"There is an extensive literature demonstrating that sleep disruption is associated with increased coronary artery disease risk, but the possible mechanism for that association has been unclear," lead author Dr. Joel E. Dimsdale, of the University of California San Diego, told Reuters Health.
"In previous work, we have found that sleep disruption was associated with pro–coagulant activity in patients with obstructive sleep apnea and in patients facing major life stress," he continued. "The current study reports similar findings even in a relatively healthy population."
Dimsdale and colleagues examined whether sleep disruptions, verified by polysomnography, were associated with increased levels of prothrombotic factors previously shown to predict the risk of coronary artery disease. The findings are published in the medical journal Chest.
A polysomnograph, conducted in a sleep laboratory, involves the measurement of brain waves to record sleep cycles and stages, plus monitoring muscle activity, eye movement, breathing rate, blood pressure, blood oxygen levels and heart rate. The patient is also directly observed during sleep.
A total of 135 unmedicated subjects, an average of 37 years old, without a history of sleep disorders underwent full–night polysomnography. The researchers also recorded blood levels of factors associated with blood clotting and oxygen saturation. In their analyses, they accounted for the effects of age, gender, ethnicity, body mass index, blood pressure, and smoking history.
The investigators found that a higher score on total arousal index and longer periods of wakefulness interrupting sleep were associated with higher levels of the von Willebrand Factor antigen and soluble tissue factor antigen, respectively, both of which are linked with blood coagulation.
An association was also observed between average oxygen saturation levels of less than 90 percent and the plasminogen activator inhibitor antigen, also involved in coagulation, although this relationship was not statistically significant.
"Our findings suggest that sleep disruptions, even in a relatively healthy population, are associated with a prothrombotic state that might contribute to coronary artery disease," the authors conclude.
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