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Ear, Nose & Throat Associates |
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July 2009 News Archives
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July 2: Cystic Fibrosis Treatment May Cause Hearing Loss, HealthDay
Ear evaluation urged for youngsters taking common antibacterial medication.
THURSDAY, July 2 (HealthDay News) -- A common antibacterial treatment for cystic fibrosis can cause sensorineural hearing loss, finds a new study.
Researchers reviewed the medical records of 50 cystic fibrosis patients treated over a 13-year period at Children's Hospital Boston and found that seven (14 percent) of them suffered from sensorineural hearing loss. Of those seven patients, 43 percent had received more than 10 courses of aminoglycosides intravenously.
Patients who underwent more than five treatments with nasal irrigation of aminoglycosides were also at risk for sensorineural hearing loss, the study found.
Pulmonary and sinonasal infections are common in cystic fibrosis patients. Because of their potency against bacteria, aminoglycosides are often given to cystic fibrosis patients, even though the treatments are known to cause side effects such as hair cell loss, which leads to hearing loss, according to information in a news release from the American Academy of Otolaryngology -- Head and Neck Surgery.
Cystic fibrosis patients should have regular hearing tests that specifically assess sensorineural hearing loss, especially when patients have undergone repeated courses of systemic or intranasal aminoglycoside treatments, the researchers concluded.
The study appears in the July issue of the journal Otolaryngology--Head and Neck Surgery.
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July 10: Drug Might Restore Sense of Smell, HealthDay News
Study found more than half of patients reported improvement
By Amanda Gardner, HealthDay Reporter
FRIDAY, July 10 (HealthDay News) -- A drug once used to treat asthma and other respiratory conditions shows promise in restoring a sense of smell to those who have lost that precious ability.
"More work needs to be done but, for patients for whom other treatments don't work, this may be an option worth trying," said Dr. Ronald Kuppersmith, clinical assistant professor of surgery at Texas A&M Health Science Center College of Medicine and president-elect of the American Academy of Otolaryngology-Head and Neck Surgery.
The drug, theophylline, does have side effects and is now out of vogue for asthma and related disorders, said Kuppersmith, who was not involved in the study.
According to background information in the article, about 20 million people in the United States have some degree of hyposmia, or loss of the sense of smell, affecting their ability to enjoy the flavor of artichokes and the fragrance of azaleas.
"There's a whole spectrum from having mild changes in your sense of smell to complete loss," Kuppersmith said. "It can be very frustrating for the patient, but also for the physician. A lot of people can't enjoy coffee because they can't smell it. They lose weight. They can't smell flowers."
Any number of things can cause the problem. "The most common causes are viruses, head trauma, severe allergies or some kind of anatomic obstruction in the nose or nasal polyps," Kuppersmith explained.
In June, U.S. health officials warned consumers to stop using Zicam nasal cold remedy products because they can cause the loss of a sense of smell.
According to Dr. Robert Henkin, lead author of the study that appears in the June issue of the American Journal of the Medical Sciences, there are few effective treatments out there.
Henkin, director of the Center for Molecular Nutrition and Sensory Disorders in Washington, D.C., and his colleagues had previously discovered that people with hyposmia had reduced levels of cyclic nucleotides in their saliva and nasal mucous, and that treatment with theophylline had increased levels of this growth factor and restored some of the sense of smell.
These cyclic nucleotides are growth factors for olfactory (related to smell) and other neural tissues.
"I had earlier done the first total protein analysis of saliva and mucous to learn what was in there, and found these growth factors and found that people who couldn't smell had diminished levels of the factors," Henkin explained. "Theophylline, in a sense, inhibits the breakdown of growth factors so more are going to stick around."
Henkin and his team have now confirmed the efficacy of theophylline in this context in 312 patients with hyposmia over a seven-year study period.
All of the study participants had decreased levels of growth factors cAMP and/or cGMP, as measured in their nasal mucous.
More than half of participants said their sense of smell improved after being treated with theophylline, while more than 20 percent said their smell returned to normal. Larger doses of the compound and longer treatment times resulted in greater improvements.
"People who had relatively mild or moderate disease seemed to respond to this treatment but those patients tend to respond to other treatments as well," Kuppersmith said. "Most of those who had severe or complete loss of sense of smell didn't respond, which is typical of a lot of treatments out there."
Also, he said, "some people who lose their sense of smell get better anyway, especially if they have mild cases, so they would have gotten better with or without treatment."
But, Kuppersmith added, for certain patients this might be a helpful option if other things don't work.
Side effects of theophylline were minimal, the researchers noted, but can include jitteriness, nervousness and difficulty falling asleep.
Henkin said that the findings need to be verified with a clinical trial. His team is now looking at ways to deliver the drug intranasally (this study involved pills). He also needs a drug company to develop and market the medication, should it continue to prove useful.
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July 14: Increase in Thyroid Cancer Puzzles Experts, HealthDay News
TUESDAY, July 14 (HealthDay News) -- Intensified screening doesn't entirely explain the jump in thyroid cancers noted in the United States since 1980, and scientists now believe that other as-yet-unknown factors are to blame.
A new study finds that thyroid tumors of all sizes are being picked up, not just the smaller ones that more aggressive screening would be expected to detect.
"You cannot simply explain this by increased screening, there's a real increased incidence," said Dr. Amy Chen, lead author of a study published online July 13 in the journal Cancer.
Although, "some of this increased incidence is due to increased screening finding smaller tumors," she added.
The findings surprised one expert.
"I wrote a chapter about this for a textbook about a year ago and I came away thinking this [rise in cancers] is a reflection of enhanced diagnostics," said Dr. Bruce J. Davidson, professor and chairman of otolaryngology-head and neck surgery at Georgetown University Hospital in Washington, D.C. But, "it is more disturbing that it's not just small tumors; it seems to be all tumors," he said.
An estimated 37,200 new cases of thyroid cancer will be diagnosed this year, according to the U.S. National Cancer Institute. Fortunately, the cancer is considered highly curable, but the researchers said survival rates have not improved with better detection.
Until now, an uptick in cases seen over the past three decades was attributed to increased use of ultrasound and image-guided biopsy to detect tumors. Some researchers had found that thyroid cancer was diagnosed more often in areas with higher incomes and less in uninsured populations, adding further credence to this theory.
Looking at thyroid cancer cases from 1988 to 2005 reported in a large cancer database, Chen and her team found a higher incidence not just in small tumors, but across all sizes.
The most pronounced increase was seen in primary tumors under 1.0 centimeters -- small ones for which many experts consider it safe to take a wait-and-see approach. The rate for these tumors rose almost 10 percent per year in men (1997 to 2005) and 8.6 percent per year in women (1988 to 2005).
But the authors also saw a 3.7 percent annual increase in tumors exceeding 4 centimeters in men and a 5.7 percent yearly rise in these tumors in women.
Cancers that had spread also increased in men by 3.7 percent annually and in women by 2.3 percent.
Thyroid cancer can be caused by exposure to radiation but there has been no evidence of increased exposure to radiation among Americans.
"People have looked at background radiation and nothing really has come of that that's very useful. And certainly not useful to us in why there would be a bump in incidence in the last 15 years," Davidson said.
Chen proposed in the study that environmental, dietary and genetic issues be explored.
More information: There's more on thyroid cancer at the American Cancer Society.
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July 28: Balloon Procedure for Blocked Sinuses Stirs ENT Controversy, MedPage Today
By John Gever, Senior Editor, MedPage Today
WHEELING, W.Va., July 28 -- A nonsurgical procedure for opening blocked sinus passages has failed to win over many otolaryngologists, despite intense marketing efforts by its commercial developer.
The procedure is patterned after balloon angioplasty -- a balloon catheter is snaked endoscopically into the ostium and slowly inflated to expand the opening and allow normal sinus drainage.
It was developed by Acclarent, a company based in Menlo Park, Calif., which began marketing the balloon catheter device, sold under the name Relieva, in 2006. It calls the procedure "sinuplasty" and has trademarked that word.
Some 16 studies have been published or presented since 2006 testifying to the procedure's effectiveness in relieving chronic sinus blockage.
Presentations last year indicated that most patients with two years of follow-up reported that benefits were durable, with less than 10% needing additional procedures.
And this past weekend, Acclarent sponsored a meeting in Washington -- which included live broadcast demonstrations of the device being used in actual patients -- to promote its technology.
Last year, another firm, Entellus Medical of Maple Grove, Minn., won FDA approval for a similar balloon catheter system called FinESS for treating chronic sinusitis.
But several otolaryngologists contacted by ABC News and MedPage Today were less than enthusiastic about this type of treatment.
"We have not found these techniques and instruments to be more effective than traditional endoscopic sinus surgery techniques," said Greg Davis, MD, MPH, of the University of Washington in Seattle, in an e-mail.
Ralph Metson, MD, of the Massachusetts Eye and Ear Infirmary in Boston, doubted whether balloon sinusotomy "is ready for prime time."
Dr. Metson said that he had performed about 30 of the procedures and it appears to be safe.
But, he added, "we really don't know its long-term efficacy or who are the best candidates for the procedure."
He also noted that most of the published research on the balloon procedure was sponsored by Acclarent.
Two medical societies in the ENT field issued position statements on balloon sinusotomy shortly after it became available and have not revised them.
The statements, from the American Rhinology Society in 2006 and the American Academy of Otolaryngology--Head and Neck Surgery in 2007, both cautioned against broad use of the procedure until more hard data were available.
The academy's statement suggested that it would be indicated primarily "for selected cases of rhinosinusitis without polyposis involving the frontal, sphenoid, or maxillary sinuses."
But, according to the academy, "inflammatory disease of the ethmoid sinuses, which constitutes the most commonly involved site of paranasal sinus disease, still requires the use of conventional surgical instrumentation when surgery is indicated."
The statement said balloon catheterization "may hold a potential role as an adjunct to currently accepted treatments."
Dr. Metson and other academic otolaryngologists suggested that that guidance still holds.
"In the future, if sinuplasty is found to work well, it will likely become a popular technique for the treatment of patients who suffer from sinusitis. But for right now, the answer is not in," Dr. Metson said.
Michael Benninger, MD, chairman of the Cleveland Clinic's Head and Neck Institute, said through a spokesperson that the procedure appears useful in minor disease, but those with serious blockages still need open surgery.
He added that the institute does not offer the procedure at this time.
Peter Casano, MD, a private-practice ENT physician in Flowood, Miss., agreed that the role of balloon catheterization hasn't been fully established yet and wouldn't replace standard surgery in most cases.
Nevertheless, he said, "I am confident that this device has an important place in the treatment of chronic sinus disease and will discuss this option with patients whom I believe to be candidates."
He said the main drawbacks are its cost -- an extra $1,200 -- and the unknowns about long-term results.
Peter J. Catalano, MD, of the Lahey Clinic in Burlington, Mass. -- a member of Acclarent's advisory board -- said the procedure is actually less costly overall.
"No patients are out of work for more than a day. No loss of income on the patient's side," he told ABC News. "They don't require all of the medicines year after year after the surgery. Under the conventional technique, patients have to come back into the office twice a week in the first two to three weeks, and have scabs and old tissue pulled out. There is no crusting or scabbing with the balloon dilation technology. I don't have to see them back for months."
He also noted that because no tissue is removed with the procedure, there is less risk than with conventional sinusotomies. "If I took out part of the inside of your nose and you needed that for proper function, then you would be compromised for the rest of your life," he said.
But Martin Citardi, MD, of the Texas Sinus Institute in Houston, said many of the claims for balloon catheterization were exaggerated.
"This thing about being a minimally invasive alternative, that's mostly marketing," he said in an e-mail.
"The patients who are candidates for the procedure are not the patients who are getting conventional endoscopic surgery," he said. "Those gains and savings do not accrue to the place where surgeries are being performed. You're subsidizing recovery after a procedure for a surgery the patient may not have needed."
He said he had completed Acclarent's training in the procedure and had the required kits on a shelf. "We talked about possibly doing a few [balloon procedures] at my hospital a few months ago. But, it was too costly."
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July 28: President vs. Physicians, FOXNews.com
Doctors upset over Obama's 'tonsils' comment - Video
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