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Ear, Nose & Throat Associates |
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April 2009 News Archives
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April 1: Insomnia boosts short sleepers' hypertension risk, Reuters
By Anne Harding
NEW YORK (Reuters Health) - People with insomnia who are actually getting very little sleep have a sharply higher risk of high blood pressure than their peers who have no trouble catching Z's, new research shows.
The findings make it clear that insomnia can have real medical consequences, and is not just a disorder of the "worried well," Dr. Alexandros N. Vgontzas, director of the Sleep Research and Treatment Center at the Penn State College of Medicine in Hershey, told Reuters Health.
About 1 in 10 people have insomnia, Vgontzas notes, but the health consequences of a much less common sleep problem, sleep apnea, have gotten a lot more attention. Previous research has shown, he added, that people with insomnia have higher levels of the stress hormone cortisol, greater activation of the sympathetic nervous system, and psychiatric problems such as anxiety and depression.
To investigate whether insomnia might also carry cardiovascular risks, Vgontzas and his team had 1,741 men and women spend a night in their lab to measure how long they actually slept. Self-reports of sleep duration, the researcher noted, are notoriously inaccurate.
Eight percent of the study participants reported having insomnia, defined as difficulty falling asleep that lasted for at least 1 year, while 22 percent had less severe sleep problems. The rest were normal sleepers. Lab testing showed that half of the study participants got at least 6 hours of sleep, about a quarter slept for 5 to 6 hours, and the rest slept for less than 5 hours.
Among the subjects with insomnia who slept less than 5 hours, the risk of high blood pressure was 50percent greater than for those who didn't have insomnia and logged 6 hours or more of sleep. People with insomnia who slept 5 to 6 hours had a 350 percent increased risk of hypertension.
But the people with insomnia who slept for at least 6 hours had no greater risk of hypertension. People with less serious sleep problems who slept less than 6 hours also had an increased risk of high blood pressure, but it was lower than for the true insomniacs.
lasting for 1 year or longer. Poor sleep was defined as moderate to severe complaints of failure to fall asleep, not being able to stay asleep, and early wakening without a feeling of being rested. Subjects were defined as normal sleepers if they did not fall into either of the previous categories.
Right now, Vgontzas said, insomnia is typically treated with medication and psychotherapy. While the findings make it clear that people with insomnia and short sleep should take priority in treatment, he added, this doesn't mean that people with insomnia who actually get relatively decent amounts of sleep shouldn't be treated too.
Finally, he noted, while sending everyone with insomnia to the sleep lab would bankrupt the health care system, a technique called actigraphy in which a person wears a wristwatch-like device to measure their movements is an effective and much less expensive option for identifying people with short sleep duration.
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April 2: Hispanic Children More Likely to Have Hearing Loss, Forbes
Second study finds rare eye disease missed, mistreated among urban youngsters
(HealthDay News) -- Children from Hispanic or low-income families are more likely to have hearing loss, and a serious but rare eye disease is often missed or mistreated among urban preschoolers.
The hearing finding was based on a review of five studies conducted between 1966 and 2007, all of which explored hearing loss among children of various ethnicities from birth through the age of 19.
In contrast, the vision finding was drawn from a new investigation conducted between 2003 and 2007 that looked into so-called "refractive eyesight errors" among black and white children (aged 6 months to about 6 years) living in the Baltimore area.
"Based on the data available in the various studies we looked at, it appears that in the Hispanic population and in low-income homes, there is likely a higher burden of pediatric hearing loss," said Dr. Donald G. Keamy, lead author of the hearing study and a surgeon at the Massachusetts Eye and Ear Infirmary and an instructor in the departments of otology and laryngology at Harvard Medical School.
"But we don't know the absolute cause of that increased rate," Keamy noted. "And it is also very important to point out that the information we looked at is actually both somewhat old and very fractured, in the sense that there is no unified national approach to collecting pediatric hearing loss information. So, we can not even say if the finding is absolutely true until we have a much more systematic and fresh analysis of the problem, which would require a more national approach to the assessment of hearing loss in children."
Keamy published his team's observations in the April issue of Otolaryngology-Head and Neck Surgery. The vision study team, from Johns Hopkins Medical School in Baltimore, reported its findings in the April issue of Ophthalmology.
Keamy and his colleagues point out that hearing loss is one of the most common birth disorders in the United States, noting that two to four of every 1,000 children are born either deaf or hard-of-hearing.
The current review examined prior research gleaned from medical databases and U.S. Centers for Disease Control and Prevention reports.
The hearing study authors found that the average rate of hearing impairment from birth to adolescence was "significantly higher" among all subgroups of Hispanic-Americans (Mexican-American, Cuban-American, and Puerto Rican) and to a similar degree among low-income households.
"The bottom line is that pediatric hearing loss is a largely under-recognized problem that has a great impact on a number of issues, with regard to learning and language development," noted Keamy. "And until we really completely understand the scope of the problem, we can't fix it and make things better."
"So the point here," he stressed, "is that despite the fact that most states now screen newborns for hearing loss before hospital discharge, the process is not entirely standardized, and different techniques are used which have different sensitivities for detecting hearing loss. So the indication about the higher risk among Hispanics is, of course, important. But what we truly hope to accomplish with this work is to encourage the adoption of a more systematic approach to the overall problem."
"This study really shows the need for an apples-to-apples approach to pediatric hearing loss," agreed Robert D. Frisina, an associate chair of otolaryngology at the University of Rochester Medical School in New York.
"This is a relatively novel and interesting analysis," said Frisina. "And I haven't heard of a higher risk among Hispanic households before, which makes it a little bit surprising and provocative. But before any health recommendations could be made, it does need to be followed up to find out with certainty whether or not there is a sampling error here. And to do that, I think a national repository and national standards for hearing loss data collection are very much needed."
As for the vision findings, the Hopkins team -- led by Dr. David Friedman, of the Bloomberg School of Public Health -- found that despite the fact that 5 percent of the nearly 2,300 urban children they examined had a defect in the eye's ability to focus on light that was serious enough to warrant treatment, just 1 percent actually got necessary medical attention.
On the other side of the coin, they actually uncovered some evidence of over-treatment, given that one-third of 29 children who had been prescribed eyeglasses before the study launch actually didn't need them.
More information
For additional resources on pediatric hearing and vision, visit the American Academy of Pediatrics.
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April 3: Researchers suspect oral sex to blame for rise in tonsil cancer, USA Today
The incidence of tonsil cancer has tripled in the city of Stockholm since the 1970s and doctors at the world-famous Karolinska Institute there think they know why.
Oral sex. Or perhaps French kissing. And changes in sexual behavior that took place 20 or 30 years ago, says Tina Dalianis, a professor of tumor virology at Karolinska.
Her research has directly linked the increase in tonsil cancers to the human papillomavirus (HPV). There are more than 100 different types of HPV, some of which cause cancer. One, for example, is responsible for 99.7% of all cervical cancers.
The study found that patients with HPV in their mouths are much more likely to get tonsil cancer than patients who don’t have it. In fact for patients who are HPV-positive, the rate of tonsil cancer has gone up seven times since the '70s, Dalianis says. It takes between 20 and 30 years for an HPV infection to result in cancer, so the people getting sick now were infected in the '70s and '80s.
“It’s an epidemic,” she says.
Prior to this, the greatest risk factor for tonsil cancer was drinking and smoking. As smoking rates have dropped, the number of tobacco-linked tonsil cancers has declined.
Researchers monitored everyone in the Stockholm area diagnosed with tonsil cancer between 2003 and 2007. Their study, recently published in the International Journal of Cancer, found that of 120 patients who got the cancer, at least 83 were HPV-positive.
Tonsil cancer is dangerous because it has almost no symptoms, so many people don’t seek medical attention until it has spread to their lymph nodes and is much harder to treat.
“If they have a lump in their throat, especially if it’s on one side and it doesn’t go away with antibiotics, they should see a doctor,” Dalianis says.
One bright spot is that a vaccine against the cancer-causing HPV16 virus has been available since 2006 and is now being given to many girls between the ages of 10 and 12 to prevent cervical cancer. Dalianis hopes that it may help prevent tonsil cancers as well.
--By Elizabeth Weise, USA TODAY
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April 22: Cancer risk of nicotine gum and lozenges higher than thought, The Times
Mark Henderson, Science Editor
Nicotine chewing gum, lozenges and inhalers designed to help people to give up smoking may have the potential to cause cancer, research has suggested.
Scientists have discovered a link between mouth cancer and exposure to nicotine, which may indicate that using oral nicotine replacement therapies for long periods could contribute to a raised risk of the disease. A study funded by the Medical Research Council, led by Muy-Teck Teh, of Queen Mary, University of London, has found that the effects of a genetic mutation that is common in mouth cancer can be worsened by nicotine in the levels that are typically found in smoking cessation products.
The results raise the prospect that nicotine, the addictive chemical in tobacco, may be more carcinogenic than had previously been appreciated. “Although we acknowledge the importance of encouraging people to quit smoking, our research suggests nicotine found in lozenges and chewing gums may increase the risk of mouth cancer,” Dr Teh said. “Smoking is of course far more dangerous, and people who are using nicotine replacement to give up should continue to use it and consult their GPs if they are concerned. The important message is not to overuse it, and to follow advice on the packet.”
Most nicotine replacement products have labels advising people to cut down after three months of use and to stop completely after six months.
Mouth cancer affects nearly 5,000 people each year in Britain and is usually linked to smoking, chewing tobacco or drinking alcohol. It is often diagnosed at a late stage, and consequently has a poor prognosis.
Although nicotine is acknowledged as the addictive element in cigarettes its role in cancer has long been disputed. It is not as potent a carcinogen as other chemicals found in tobacco smoke, such as tar, but some previous research has suggested that it may also contribute to the formation of tumours.
Nonetheless, it is much less dangerous than cigarettes and is therefore used in a wide variety of smoking cessation products that allow addicts to satisfy a craving for the chemical without smoking.
In the new research, published in the journal Public Library of Science One, Dr Teh’s team has investigated the role of a gene called FOXM1 in mouth cancer.
A mutation that raises the activity of this gene is commonly found in many tumours, and is also present in pre-cancerous cells in the mouth, the scientists found. This raised expression can then be worsened by exposure to nicotine, according to Dr Teh.
“If you already have a mouth lesion that is expressing high levels of FOXM1 and you expose it to nicotine, it may add to the risk of converting it into cancer,” he said. “Neither the raised FOXM1 nor nicotine is alone sufficient to trigger cancer, but together they may have an effect.
“The concern is that with smokers, you are looking at people who are already at risk of oral cancer. I’m worried that some may already have lesions they don’t know about in the mouth, and if they keep on taking nicotine replacement when they stop smoking products they will not be doing themselves any good.”
The findings could also lead to new ways of diagnosing mouth cancer while it is still in its early stages and easier to treat.
Dr Teh emphasised that smokers should not stop their attempts to give up. “There is no doubt about the harmful effects of smoking, so smokers should make every effort to quit.”
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April 22: Acupuncture Relieves 'Dry Mouth' Discomfort in Cancer Patients, MedPage Today
By Kristina Fiore, Staff Writer, MedPage Today
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston.
LITTLE FALLS, N.J., April 22 -- Even though it didn't significantly increase saliva flow, acupuncture improved symptoms of "dry mouth" in head-and-neck cancer patients.
In a pilot study, 19 patients with xerostomia resulting from radiation therapy had significantly improved measurements of physical well being and quality of life when treated twice a week for eight weeks with acupuncture, M. Kay Garcia, Ph.D., of the University of Texas M.D. Anderson Cancer Center, and colleagues reported online in Head & Neck.
However, there was no significant improvement in stimulated saliva flow rates, which rose to only 1.94 g from 1.92 at baseline with a peak at 2.59 g in the first week of treatment.
Radiation therapy for head-and-neck cancer patients often renders salivary glands incapable of producing adequate saliva. Previous research has found that acupuncture is effective in improving symptoms of xerostomia, and much literature has shown that the therapy improves salivary flow, the researchers said.
The current study found comparable results in symptom improvement. Measures of disease intensity on the Xerostomia Inventory were significantly better after eight weeks of acupuncture (P=0.0001), as were Patient Benefit Questionnaire scores (P=0.0011).
Quality of life scores on questions relating to head and neck cancer increased significantly as well (P=0.006).
And measures of physical well being improved significantly (P=0.04), although measures of social, emotional, and functional well being did not.
The researchers found no statistically significant improvements in stimulated and unstimulated saliva flow rates.
"If you look at the [quality of life] scores, they keep getting better, but if you look at saliva flow, it fluctuates over this period of time," said Gary Deng, M.D., Ph.D., of Memorial Sloan Kettering Cancer Center in New York, who was not involved in the study.
"So you have to wonder if increased salivary flow is induced by acupuncture or not," he said. "[Based on the quality of life scores], you would expect it to get better and better. So there is the possibility of natural fluctuation."
Dr. Deng and colleagues have previously reported favorable findings for improvement in xerostomia in head-and-neck cancer patients.
He said that since the present study had only a single arm, the researchers should conduct a follow-up study "with a good control group."
But Dr. Garcia said even small changes in salivary flow can result in increased oral comfort, as symptoms of xerostomia tend to appear when salivary flow rate is decreased to about half of an individual's baseline rate.
The researchers also noted that patients who have had major salivary glands irradiated do not spontaneously improve after four months, so the improvements in their study "were most likely attributable to the acupuncture treatment rather than spontaneous recovery."
The major limitation of the study was that there was only a treatment arm, raising the possibility of placebo effect.
The researchers said they plan to perform "well-designed placebo-controlled trials to ensure the findings hold in a more methodologically rigorous study."
The researchers reported no conflicts of interest.
Source reference: Garcia MK, et al "Acupuncture for radiation-induced xerostomia in cancer patients: A pilot study" Head & Neck 2009.
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