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July 2010 News Archives
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July 1: Ear injections could reverse 'permanent' hearing loss caused by loud noise, Mail Online
By Claire Bates
A potent new drug could reverse hearing loss caused by prolonged exposure to loud noise, scientists revealed today.
Hearing loss caused by loud noise is one of the leading occupational hazards in industrialised countries, especially for those working in the military of construction industry. The RNID also estimates that four million young people are at risk of noise induced hearing loss from amplified music.
Hazardous levels of noise can cause the build up of free radicals, which can overwhelm the defensive systems of sensory hair cells in the inner ear causing cell damage and permanent hearing loss.
Exposure to loud music at work or on nights out over an extended period can cause permanent hearing damage.
At present, sufferers can only resort to wearing a hearing aid or having a cochlear implant.
But now researchers from the University of Auckland, New Zealand, have found injecting a chemical agent called 'ADAC' into the inner ear can repair damage caused by noise stress.
The scientists found that a five day treatment of daily injections through the skin starting six hours after noise exposure were most effective. Single treatments were less effective but also resulted in some hearing recovery.
The ear has a sensitive lining that can be easily damaged by noise.
They targeted molecules known as A1 adenosine receptors, which are found in the inner hair cells.
The drug is thought to work by increasing the sensory hair cell’s ability to break down the damaging waste products, which build up during noise exposure.
Lead researcher Dr Srdjan Vlajkovic and his team injected the chemical adenosine amine congener (ADAC) into rats who had been exposed to loud noise.
They measured the hearing in the rats before and after the treatments by measuring the response to a series of clicking noise via electrodes placed on the skin.
The team found both cochlear injury and hearing loss in rats was substantially restored.
Dr Vlajkovic said: 'To our knowledge, this study presents the most effective pharmacological strategy to date for reducing noise-induced hearing loss after exposure to damaging noise.
'We now hope to test its effectiveness in humans and are currently seeking industry partners to move this to clinical trials.'
The finding paves the way for effective therapies to restore hearing loss without the need for surgery.
Dr Sohaila Rastan, RNID's Chief Scientific Advisor, told the Mail Online: 'This is a very promising discovery. At the moment, there are only very basic ways to protect your hearing and once the damage is done, it is irreparable.
'This research could mean that, in future, people who are exposed to loud noise and risk damage could be administered a drug to stop the hearing loss becoming permanent.'
The research was funded by the UK charity RNID and is published in a special edition of Springer's journal Purinergic Signalling.
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July 12: Sleep Apnea Could Raise Heart Risks for Older Men, Bloomberg Businessweek
From middle age to age 70, the sleep-time breathing disorder could pose a hazard, study suggests
By Ellin Holohan
HealthDay Reporter
(HealthDay News) -- The snoring and breathing disturbances of sleep apnea may be more than just a nuisance, with a new study linking the condition to higher risks for heart failure and heart disease in middle-aged and older men.
However, the study found no correlation between sleep apnea and coronary heart disease in women, or in men older than 70.
"The key here is that there is a lot of undiagnosed sleep apnea, and that, at least in men, it is associated with the development of coronary heart disease and heart failure. Only about 10 percent of sleep apnea cases are diagnosed, " said Dr. Daniel Gottlieb, associate professor of medicine, Boston University School of Medicine.
Gottlieb noted that while the jump in heart risk was noteworthy, it was not as large as that seen in previous clinic-based studies of sleep apnea because the participants were drawn from a broad community-based population.
According to background information in the study, sleep apnea sufferers awaken suddenly during the night struggling to breathe, often experiencing a shot of blood pressure- raising adrenaline. Most often, they go right back to sleep, unaware of what happened. But the awakenings are repeated, sometimes up to 30 times an hour, depriving the sufferer of vital oxygen and sound sleep.
The research is published online July 12 in Circulation.
In the study, almost 2,000 men and about 2,500 women -- all free of heart problems at the beginning of the research -- were recorded as they slept using polysomnograms, which measured the presence and severity of sleep apnea as calibrated on the Apnea-Hypopnea Index.
About half had no symptoms of sleep apnea, the team found, while half had mild, moderate or severe symptoms.
Participants were then contacted at various times from 1998 to the final follow-up in April 2006. During that time, 473 cardiac events occurred, including 185 heart attacks, 212 heart bypass operations, and 76 deaths. There were also 308 cases of heart failure; of these 144 people also had a heart attack.
The study found that men between 40 and 70 years of age who had severe sleep apnea were 68 percent more likely to develop heart disease, and 58 percent more likely to develop heart failure, than those without the condition. Increasing severity of sleep apnea was also associated with obesity, high blood pressure, hypertension and diabetes, all of which are known contributors to heart disease.
According to the U.S. National Institutes of Health, approximately 14 million Americans suffer from coronary heart disease, the most common cause of death in the United States.
Dr. Jordan S. Josephson, a sinus, snoring and sleep apnea specialist at Lenox Hill Hospital in New York City, said the study is important because "it brings a greater awareness to the public about sleep apnea." He believes that sleep apnea, linked to heart disease through this and other studies, may be an indirect factor in many heart deaths.
Experts estimate that the condition affects 24 percent of men and 9 percent of women, but Josephson believes the numbers are actually higher because people don't know they have a problem unless a partner or spouse tells them they snore.
"Sleep apnea is [also] the number one medical cause for divorce and the ending of partnerships," added Josephson, because many couples end up sleeping apart, not sleeping well, and not functioning well during the day.
Dr. Stuart Fun Quan, another of the study's authors, agreed that the under-diagnosis of sleep apnea is "unfortunate."
"The study suggests that sleep apnea, at least in men, is a potentially remediable cause of coronary heart disease and heart failure," said Quan, a professor of medicine at Harvard Medical School, Boston.
Treatment for the condition sometimes involves a simple surgical procedure, but many people with sleep apnea opt for a mask at night connected to a Continuous Positive Air Pressure (CPAP) machine that pumps oxygen into the blood. But many with sleep apnea do not receive any treatment, Quan said, because it is often not recognized as a serious condition.
Josephson -- who believes that even plain old snoring constitutes an oxygen-depleting stress on the heart -- sounded the alarm for those who would ignore sleep apnea.
"The take-home message is that if you know you snore or have sleep apnea, or someone tells you (that) you snore, you have to go to a specialist to make the correct diagnosis," said Josephson, adding that it's vital to get treatment.
More information
Find out more about sleep apnea at the U.S. National Heart, Lung, and Blood Institute.
SOURCES: Jordan S. Josephson, M.D., sinus, snoring and sleep apnea specialist, Lenox Hill Hospital, New York; Dr. Fun Quan, M.D., professor, medicine, Harvard University, Boston; Daniel J. Gottlieb, M.D., MPH, director, Sleep Disorders Center, VA Boston Healthcare System, associate professor of medicine, Boston University School of Medicine; July 27, 2010 Circulation: Journal of the American Heart Association, online, July 12, 2010
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July 12: Obese Children at Greater Risk for Reflux Disease, EmaxHealth
Submitted by Denise Reynolds RD
A new study has found that obese children have a 30 to 40% higher risk for gastroesophageal reflux disease (GERD) than normal-weight children. Early-onset GERD may make people more vulnerable to conditions such as Barrett’s esophagus and esophageal cancer.
GERD is a condition that occurs when the contents of the stomach reflux back into the esophagus causing irritation and tissue damage. Obesity can increase the risk of GERD because the excess abdominal weight compresses the stomach and raises the pressure inside, leading to gastric reflux. Other factors, such as inflammation and poor diet can also affect GERD risk.
About 10% of GERD patients develop a precancerous condition called Barrett’s esophagus, which increases the risk for esophageal cancer, the fastest growing cancer in the US.
The latest study, conducted by Kaiser Permanente research scientist Corinna Koebnick PhD, analyzed the medical records of more than 690,000 children who were enrolled in the Kaiser Permanente Southern California health plan in 2007 and 2008.
An association between obesity and reflux disease was found in children aged 6 and older and in teens, but not in younger children. About 1.5% of boys and 1.8% of girls suffered from GERD.
Moderately obese children were found to have up to a 30% increased risk of developing GERD while 40% of those who are extremely obese are at risk. The study also found that 8-25% of children already have frequent symptoms of reflux disease, according to Koebnick.
"Although we know that childhood obesity, especially extreme obesity, comes with risks for serious health conditions, such as diabetes, cardiovascular disease and cancer, our study adds yet another condition to the list, which is GERD," said Dr. Koebnick.
GERD can also decrease quality of life, said Koebnick. The disease can cause chronic heartburn, nausea, and has the potential for increasing respiratory problems such as persistent cough, inflammation of the larynx, and asthma.
Across the United States, gastroesophageal reflux disease is thought to affect 2 to 10 percent of children, according to other studies. In one school-based study, 40 percent of teens 14 to 18 reported at least one symptom of esophageal GERD.
Source reference: Koebnick C, et al "Extreme childhood obesity is associated with increased risk for gastroesophageal reflux disease in a large population-based study" Int J Pediatr Obes2010; DOI: 10.3109/17477166.2010.491118.
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July 19: Zinc cold remedy can cause loss of smell: study, API
WASHINGTON — A popular zinc-based homeopathic remedy for the common cold that is sold over the counter is not only ineffective but can cause users to lose their sense of smell, a study published Monday warned.
Clinic trials found that zinc nasal gels and sprays were ineffective in preventing or reducing the duration of the common cold, as well as links to a loss of smell, the study in Archives of Otolaryngology said.
The authors of the study sounded the warning about zinc nasal cold remedies after evaluating 25 patients and analyzing reports of clinical, biological and experimental data.
Only one of the studies analyzed showed that zinc therapies reduce the severity of a cold -- but it was funded by the makers of the medicine used in the study.
"In addition to concerns regarding the efficacy of intranasal zinc therapy, increasing evidence indicates that this medication may be linked to severe, potentially permanent hyposmia (reduced sense of smell) and anosmia (loss of smell)," the study says.
In the light of their findings, the authors urged the US Food and Drug Administration (FDA) to more strictly regulate zinc cold therapies and other homeopathic remedies.
"Only homeopathic drugs offered for treatment of 'serious disease conditions' must be dispensed by a licensed practitioner," the study said.
Homeopathic products that treat less serious illness, such as the common cold, can be sold over the counter and are exempt from "the rigorous premarket approval process that allopathic medications must go through before entering the market," the authors of the study said.
Archives of Otolaryngology is a journal of the American Medical Association.
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July 23: Device combats common cause of vertigo, Reuters
By Dave Levitan
NEW YORK (Reuters Health) - A new device lets people treat a common cause of dizziness in the comfort of their own home, Canadian researchers say.
So-called "benign paroxysmal positional vertigo" (BPPV) affects roughly 10 percent of the population over age 60, according to studies done in the late 1980s. It is characterized by intense vertigo (room spinning), which often occurs when looking up, rolling over in bed, or bending under things.
BPPV results from the build-up of crystals in the inner ear. Doctors typically treat BPPV with a physical maneuver to shift the crystals out of a canal in the inner ear where they cause the feeling of dizziness.
The so-called "Epley" maneuver is fairly simple and highly effective -- but difficult for patients to remember how to do on their own. So Dr. Matthew Bromwich and colleagues at Children's Hospital of Eastern Ontario in Canada developed a device to help them.
The device, which attaches to the brim of any common baseball cap, is called the DizzyFIX and costs $150. Bromwich is now the CEO of the company that manufactures it, Clearwater Clinical Limited, but he told Reuters Health that his financial involvement began only after the present study was completed.
The device consists of a plastic tube that attaches to the hat in a way that makes it visible to the person wearing it. The tube contains a thick fluid and a particle. As the patient moves, the particle moves too, giving visual feedback. The user simply guides the particle through the device to relieve their dizziness.
"The tube shape was designed to enable accurate replication of the Epley maneuver," say the researchers. The particle will only move ahead if the patient performs the maneuver correctly.
In their study, published in the Archives of Otolaryngology Head & Neck Surgery, the researchers gave the DizzyFIX to 40 patients suffering from BPPV. After one week of home treatment, 35 patients (88 percent) had no evidence of BPPV.
There were no serious complications.
The researchers did not include a group of patients with BPPV who did not use the device, but the findings compare "very well to physician-guided treatment for BPPV," Bromwich told Reuters Health by e-mail. In a follow-up phone interview, he added that BPPV often recurs, both after home treatment with the new device and after physician-guided treatment.
"Recurrence is about 60 percent," he said. "(The device) cures BPPV about as much as Tylenol cures a headache. The only difference (between the device and physician treatment) is that when you get a recurrence you just reach under the bed, pull out the DizzyFIX, put it on your head, and two and a half minutes later you're cured and you go back to sleep."
The DizzyFIX is approved by the FDA for use with a prescription in the U.S. It's also approved for use in Europe and Canada.
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July 27: Medical Mysteries: Sudden hearing loss in one ear was no minor irritant, The Washington Post
By Sandra G. Boodman
Special to The Washington Post
As he picked up the phone to make the call, Wayne Curtis worried that his doctor might think he was a hypochondriac.
Three weeks earlier, Curtis, then 48, had consulted Baltimore internist Charles Locke about a pulled muscle. Now the real estate agent had a new and seemingly trivial complaint: He couldn't hear anything out of his left ear, which seemed blocked. Curtis assumed that his problem was related to the thick coating of tree pollen that blanketed his downtown Baltimore neighborhood.
Normally Curtis, who has long battled spring allergies, would have toughed it out and waited several weeks to see if his hearing returned as the pollen counts dropped. But a newly formed choral quartet of which Curtis was a member was about to have its first concert, and the tenor, who has performed with the Boston Symphony Orchestra, was concerned that his impaired hearing was affecting his singing.
"I expected him to put me on a stronger decongestant, not to tell me to come in the very next day," said Curtis, who was taken aback by Locke's emphatic response.
"It's probably a classic case of 'It's better to be lucky than good,' " Locke quipped. His sense of urgency was fueled by a memorable patient he had seen more than a decade earlier.
Curtis's season of misery was as perennial as the pollen, and he was accustomed to loading up on antihistamines and decongestants every spring to get through it.
The morning in April 2009 when he woke up and suddenly realized he couldn't hear anything out of his left ear seemed like just another manifestation of his severe allergies. He felt the same sensation experienced by an airline passenger before his ear pops as the altitude changes.
"I kept expecting it to pop, but it never did," Curtis said, "but there was no pain so I didn't worry about it." He knew he hadn't injured his ear or done anything unusual, so he figured it would clear up on its own. Several days passed, and during rehearsals for the upcoming concert, Curtis became aware of a new and bothersome symptom: loud static or "white noise" in that ear.
Five days after he first noticed the problem and the day after the phone call, Curtis sat in Locke's office, describing his condition as the doctor listened intently. He had no headaches or dizziness, he told Locke, and the hearing in his right ear seemed normal. Locke peered into Curtis's ear and tested his hearing using a tuning fork. The tests revealed that Curtis was virtually deaf in his left ear and that the problem appeared to be located in the inner ear.
At that point, Locke recounted, he was fairly certain what was wrong: Curtis was suffering from idiopathic sudden sensorineural hearing loss -- sudden deafness in one ear, which affects between five and 20 people per 100,000 annually.
Unlike conductive hearing loss, which affects the outer ear, sudden sensorineural hearing loss is an urgent medical problem that can range in severity from mild to profound. Curtis's was so severe it could have left him permanently and totally deaf in one ear. In most cases, including Curtis's, the cause is unknown; treatment with corticosteroids has demonstrated success in some patients.
Curtis was stunned, particularly after Locke described the first case he had seen, which left an indelible impression.
Soon after finishing his residency in 1996, Locke saw a patient who told him that 20 years earlier she had woken up unable to hear anything in one ear; her hearing never returned and Locke does not know if she sought treatment. Locke treated her for a seemingly minor problem in her good ear; two days later she was back in his office, unable to hear out of that ear and now completely deaf.
"Obviously this was quite dramatic, and we were able to get her an immediate appointment with an ear, nose and throat specialist," Locke said, adding that treatment restored hearing in the second ear. The ENT later told Locke that some patients suffer permanent deafness as a result of delays in diagnosis and treatment of sudden sensorineural hearing loss. Often they or their physicians mistakenly attribute the problem to allergies or respiratory congestion from a cold.
For reasons that are unclear, the window for effective treatment appears to be two to four weeks from the time a patient is aware of diminished hearing; after that, hearing loss can become permanent, writes Harvard professor of otolaryngology Steven D. Rauch in a 2008 article in the New England Journal of Medicine. Rauch reports that the malady affects men and women equally and typically occurs between the ages of 43 and 53.
Some patients, he writes, never seek treatment and recover spontaneously, usually within 14 days. Prognosis depends on the severity of the problem: Patients with mild hearing loss are most likely to make a full recovery without treatment, while those with profound hearing loss, such as Curtis, rarely show spontaneous improvement. Even with treatment, which typically involves a few weeks of oral corticosteroids such as prednisone, some patients never recover their hearing.
Proof that treatment works remains ambiguous. A 2006 Cochrane Review, updated last year, found that one small study demonstrated that prompt treatment with steroids was linked to a significant improvement in hearing -- 61 percent of patients compared with 32 percent who took a placebo -- while another study failed to demonstrate a benefit. Both studies, researchers said, contained too few patients upon which to draw a firm conclusion.
Even so, most doctors prescribe prednisone for the problem because the potential benefits outweigh the risks of the drug.
Locke's office arranged for Curtis to be seen immediately by an ENT at Johns Hopkins Medicine. After further testing, Curtis agreed to enroll in a multi-center study, funded by the National Institutes of Health and led by Rauch, comparing several weeks of oral steroids with medication injected directly into the ear. Called intratympanic treatments, this method delivers a high concentration of drug to the affected area, avoiding the systemic effects of steroids, which can include mood changes, insomnia and weight gain. Results of the study are pending.
Curtis called the injections "one of the most painful treatments I've ever had to endure. It felt like acid eating into my ear."
But within weeks, his hearing was fully restored.
He says he feels lucky that he called his doctor in time and grateful that Locke recognized the medical emergency and ensured that he received rapid treatment.
"I had always assumed that something as serious as losing your hearing would be accompanied by pain like an earache or damage," Curtis said. "This was just so out of the blue."
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July 27: Sniffing device may help the severely disabled communicate, Los Angeles Times
For those unable to move or speak, a new mechanism using nasal breath control is shown to help them write and guide a wheelchair. A patent is being pursued.
The severely disabled, including those "locked in" to their bodies as a result of accidents or disease, may soon have a new way to communicate and move around, Israeli scientists said Monday.
By sniffing, more than a dozen quadriplegics were able to control computers that allowed them to write and to guide a wheelchair, the team reported in the Proceedings of the National Academy of Sciences.
The technology relies on the fact that quadriplegics and others retain control of their soft palates, which regulate breathing through the nose. Even people who are not able to breathe on their own can control the new device by blocking and releasing the flow of air forced through their noses by a pump.
The technology "may provide a host of viable solutions for the growing population of individuals who are severely disabled," the team wrote.
The device "is pretty ingenious in giving people who can't control their environment another way to do that," said Dr. Adam Stein, chairman of physical medicine and rehabilitation at North Shore-Long Island Jewish Health System in Great Neck, N.Y.
It would be particularly valuable for people who have locked-in syndrome, in which they can do little more than flutter an eyelid, he said. For many other patients, however, alternatives exist, including controlling devices through a breathing tube or with the tongue.
The mechanism is relatively simple. Small tubes in the nose monitor sniffs and exhalations, enabling the user to control a computer. To control a wheelchair, for example, two short sniffs signal a forward move, and two short exhalations signal backward. An exhale followed by a sniff signals left, and a sniff followed by an exhale signals right. Similar protocols can move a cursor on a computer screen for writing.
Neurobiologist Noam Sobel of the Weizmann Institute of Science in Tel Aviv and his colleagues initially studied the device in 96 healthy people, demonstrating that they could control the movement of a cursor with it as easily as they could with a joystick or mouse. About 1 in 4 could not work the device properly, however.
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