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Ear, Nose & Throat Associates |
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News Archives August 2007
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August 2: Drugs Could Prevent Hearing Loss, Baltimore Sun
Three chemicals - D-methionine, ebselen and N-acetylcysteine (NAC) - have the potential to protect the ears of those exposed to hazardous levels of noise. Several groups have started testing various chemicals for their safety and effectiveness at preventing noise-induced hearing loss in people. If the tests go well and the drugs are approved by the Food and Drug Administration, they would be the first of their kind.
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August 8: Experts seek the cause of 'river nose', The Oregonian
An advocacy group tests the Columbia River to try to pin down the source of recreationists' illnesses
SCOTT LEARN
The Oregonian Staff
HOOD RIVER -- Braced against high winds, Rachael Pecore waded hip deep into the Columbia River near Rowena on Tuesday morning carrying two 100-milliliter jars and an itch to solve the 20-year mystery of "river nose."
For years, some avid wind surfers and kite boarders have complained of symptoms that can include stuffy noses, sinus infections, sneezing attacks, cuts that don't heal, nausea and fatigue.
This year, Pecore's river advocacy group says, the reports are higher than ever. And no one knows why.
Pecore's samples, to be tested for E. coli, are the first step in detecting whether the river is responsible.
She handles water quality for Columbia Riverkeeper. With an assist from an Oregon Department of Environmental Quality specialist, Pecore is hoping her samples will take the problem "from hearsay to a spreadsheet."
Riverkeeper is also asking windsurfers to see doctors when they get sick, and to fill out forms detailing symptoms. That may help investigators find their way.
Potential culprits are many in a deep, wide river that starts at a Canadian glacier and runs 1,200 miles, passing through the Hanford Nuclear Reservation and picking up agricultural runoff, heaps of allergens, dioxins from 13 pulp and paper mills, heavy metals from mines, and sewer outflows from cities and septic tanks along the way.
The Columbia Gorge from Hood River east is renowned for wind surfing and kite boarding, bolstering the local economy and drawing a unique band of enthusiasts whose devotion to the sport can border on religious.
Blogs and health histories
In lengthy Internet blog discussions, the windsurfers themselves are split on whether river nose is fact or fiction -- and whether the causes can be pinned on something as innocuous as allergens and dehydration or as sinister as sewage and industrial toxics.
Health histories varied dramatically in interviews at Pecore's sample site, Mayer State Park, east of Hood River.
David Bandel Ramirez, a 44-year-old paramedic from The Dalles, said he hasn't gotten sick from the Columbia; he's more concerned about the stuff his 2-year-old daughter catches in the city pool. Others said they worry more about wind surfing in ponds than the rapidly recycled waters of the Columbia.
But David Wickman of Rowena, a 20-year surfer at age 61, said he's taken to wearing nose plugs if he knows he'll be trying new tricks and hitting the whitecaps often.
"If you get a lot of water up your nose, you're going to get flu symptoms," Wickman said. "There are 50 rivers feeding into this one, and a lot of pesticides and runoff, and you've got the Hanford plant. It's just kind of a soup in there."
Another avid windsurfer, Jeff Castleberry of Underwood, Wash., helped spur interest from Columbia Riverkeeper.
Like other devotees, Castleberry and his wife have moved to follow the wind, relocating from Seattle to Portland to Underwood, across from Hood River. He works a late shift as a Hewlett-Packard engineer in Vancouver, leaving more free time for surfing.
Castleberry says he never had health effects from his frequent wind surfing until he hit the Columbia. Now he gets "stuffiness you would not believe," particularly in the spring, rapid-fire sneezing, some sinus infections, and, this year, unusual fatigue.
"Some of it is you spend hours in the water, and you get tossed around a lot," Castleberry said. "But I just don't want to find out 10 years from now that I've been poisoning myself."
High volume river
Oregon environmental and health regulators say the Columbia's high volume works in windsurfers' favor, diluting the effects of pollution. Much of the river's most infamous pollution -- including PCBs and the banned pesticide DDT -- persists in river sediment, not surface water.
Deanna Conners, a public health toxicologist with Oregon's Department of Human Services, said the wide variety of symptoms reported makes them less likely to be from any single cause.
A 1990s state review spurred by windsurfer concerns found no measurable problems, and 1990s monitoring by the group that preceded Columbia Riverkeeper had inconclusive results.
Oregon's DEQ regularly monitors 11 Columbia tributaries, where bacteria and other pollutants are more easily detected. The monitors haven't found high levels of contaminants likely to make windsurfers sick in the Columbia, said Agnes Lut, DEQ's Columbia River coordinator.
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But the DEQ has just one monitor on the Columbia itself, west of Hood River.
Columbia Riverkeeper would like DEQ to fill in that gap. In the meantime, it's working with a lower-cost state program that helps volunteers draw and test water samples.
Pecore plans to test the water at windsurfing sites first for the E. coli bacteria, a sign of sewage contamination. If those tests are negative, she'll proceed to tests for other bacteria, then algae, viruses and toxics.
If a health hazard is found, the end game would likely be warning signs and advice for windsurfers on when the danger is highest. It would be tough to "tag" a pollutant to its source.
Still damp from her wade, Pecore acknowledged that thorough testing could continue for months and require lots of volunteers. Given the Columbia's volume, the search has a needle-in-a-haystack quality.
But this time the work will continue, Pecore vowed, "until we figure something out."
Scott Learn: 503-294-7657; scottlearn@news.oregonian.com
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August 13: Patients, Advocates Fight for Greater Access to Experimental Drugs, Chicago Tribune
The organization CareToLive will march on Washington, DC, next month, in an attempt to raise support for greater access for experimental drugs that can treat cancer. Critics say the FDA's drug approval process has cost the lives of thousands of terminally ill patients who may have benefited from waiting-to-be-approved treatments. Read more...
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August 14: Bronchitis more resistant to antibiotics, United Press International
NORTHBROOK, Ill., (UPI) -- First-line antibiotics such as amoxicillin and ampicillin are becoming ineffective in treating chronic bronchitis, U.S. and Greek researchers say.
Second-line antibiotic use in patients with acute exacerbation of chronic bronchitis is becoming greater because of an increase in first-line drug resistance among those with chronic bronchitis, reported a study published in the journal Chest.
To compare the effectiveness of first- and second-line antibiotics, researchers evaluated patients with acute exacerbation of chronic bronchitis from 12 randomized control trials.
The researchers found that second-line antibiotics were more effective and that there was no difference in mortality or safety, when compared with first-line antibiotics, the study said.
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August 15: Clubs fail noise and light safety, Gold Coast Bulletin (Austrailia)
GOLD Coast nightclubs are likely to be told to turn their music down and their lights up because of serious concerns about health and safety.
A Liquor Licensing source told The Gold Coast Bulletin the organisation had received a report on excessive noise levels at Gold Coast nightclubs highlighting 'real concerns' staff and patrons could end up with permanent hearing damage.
Tests have shown many of our nightclubs frequently exceed 110 decibels which overseas studies have shown can damage hearing after 15 minutes exposure a day.
Police licensing officers have also tested a number of Surfers Paradise nightclubs with light meters and found they are well below the minimum Australian standard of 17 lux, the brightness scale used to measure light.
"Some of nightclubs on the Gold Coast have been so far below the standard that their highest reading is 11 lux and even if people don't really understand this light scale, it is clear how big a difference there is between 11 and 17," said the source.
Senior Gold Coast police confirmed a noise report had been compiled and sent to Liquor Licensing and they also confirmed light meters had been used in tests at Gold Coast nightclubs recently.
"This is another blow to a Gold Coast industry already beset with a raft of major problems including illegal drug use and sales, bikies' influence, violence and spiked drinks to name a few," said a Queensland Government source.
"This time these are health issues, workplace issues that show up the nightclubs for not being anywhere near accepted practice.
"It highlights that in at least some of their work practices, these Gold Coast nightclubs are still in the 1980s and these are real issues that will have to be addressed."
The police report has recommended nightclubs operate at a maximum level of 96dB.
"The report explained there are accepted medical studies that have been available for some time from the UK showing that three out of four nightclubbers are at risk of permanent hearing damage." said the source.
"Many of these nightclubbers are reporting symptoms that could lead to incurable tinnitus (continual ringing in the ear) or premature deafness.
"(The report) also touched on some problems encountered by staff and police at some Gold Coast nightclubs with not being able to communicate instructions to patrons because of the extremely loud noise."
Licensed Venues Association secretary Tom Tate said he would be surprised if there were excessive noise issues at mainstream Gold Coast clubs.
"I can imagine there might be some problems with venues that have high-energy bands, but that would be all," he said.
"If there are safety issues with poor light, then I won't argue there, but there surely can be a lighting difference from the dance floor to walkways, so that the right ambience can be maintained."
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August 16: Chronic Fatigue, Pain Linked to Sinusitis, PakTribune
ISLAMABAD:Feeling worn out and achy and don't know why?
You could have sinusitis, one of the most common chronic health problems afflicting Americans.
That's the conclusion of new research out of Georgetown University that appears in this week's issue of the Archives of Internal Medicine.
Dr. Alexander Chester, an internist at Georgetown University Medical Center, surveyed almost 300 of his patients and found that those who reported unexplained chronic fatigue were nine times more likely to have sinusitis symptoms than those who felt rested and well.
Also, patients who said they had unexplained body pain were six times more likely than the pain-free patients to have such symptoms of sinusitis as facial pressure, heavy-headedness or frontal headache, Chester says.
Doctors who specialize in sinusitis -- otolaryngologists -- know that almost one-third of sufferers experience severe fatigue and pain, Chester says, but the news hasn't trickled down to the general practitioner. As a result, he adds, many patients may not be getting treatment for sinusitis that could alleviate their fatigue or pain.
"It is known that sinusitis can make a person fatigued, but general medical doctors are less aware of this because the literature is largely aimed at the otolaryngologists," Chester says. "But all doctors should keep in mind that sinusitis might cause fatigue and pain. It should always be looked for when a person is exhausted or achy."
For the study, Chester surveyed 297 of his patients, selecting men and women who were under the age of 41 -- the mean age was 30. This was done to minimize the variables of other illnesses that might appear in an older population.
Sixty-five (22 percent) of the patients reported unexplained chronic fatigue, described as a sleepiness unrelieved by rest. And 33 (11 percent) reported unexplained body pain, which consisted of achiness or pain in almost all areas of the body. Although there were more men than women in the study (54 percent versus 46 percent), more women than men reported unexplained chronic fatigue (60 percent versus 42 percent).
When compared to a control group of people without unexplained chronic fatigue or body pain, those with unexplained chronic fatigue were nine times more likely to have sinusitis symptoms. And those who reported unexplained body pain were six times more likely to have sinus symptoms than the control group, the study found.
"People are unaware of how global the effects can be from sinusitis," Chester says. "They can feel a general sense of malaise even without direct sinus symptoms. My hope is to raise awareness among internists as to the fact that unexplained chronic fatigue can be caused by sinusitis."
Fatigue is one of the "top five" symptoms of sinusitis, says Dr. Philip Perlman, a New York otolaryngologist. The others are pain, facial pressure, nasal congestion and fever.
"To say that everyone with unexplained chronic fatigue should be worked up for sinusitis is pushing it a bit," Perlman says. "But a few easy questions -- like, 'Do you have a history of sinusitis?' or 'Do you feel facial pressure or have frontal headaches?' -- could pick out those patients who do have sinusitis."
Sinusitis is one of the most common chronic health problems in the United States, affecting an estimated 34 million people a year, according to the National Institute of Allergies and Infectious Diseases (NIAID). More women are afflicted than men.
It's characterized by inflammation of the nasal passages that can be caused by any number of triggers, from a cold to allergies to a fungal infection, doctors say. The inflammation narrows the nasal passages so mucus can't drain properly, causing discomfort and sometimes infection.
Left untreated, sinusitis can become chronic, lasting from weeks, to months or even years, according to NIAID.
The good news: There are now treatments that include nasal sprays, as well as intranasal nebulized antibiotics, certain antihistamines, and topical antifungals and antibiotics that target the specific fungi and bacteria that often plague sinusitis sufferers.
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August 23: Troops’ Ruptured Eardrums Suggest Hidden Brain Injuries, Study Says, Associated Press
An unusual study by doctors treating blast victims at a field hospital in Iraq has found that ruptured eardrums may help reveal which troops are at risk of hidden brain injury.
The finding is important because many such brain injuries have been missed in the past, especially when more severe or obvious wounds demanded attention. Researchers report their observation in a letter in Thursday's issue of the New England Journal of Medicine.
Diagnosing brain injury, especially mild damage, is based largely on subjective symptoms like irritability and forgetfulness. Imaging tests like CAT scans do not help, and neurological function tests are not very useful without baseline information.
"It’s very early in the game of understanding how to evaluate this carefully," and better ways are badly needed, said Jordan Grafman, a brain injury expert at the National Institute of Neurological Disorders and Stroke. Dr. Grafman had no role in the study.
Researchers led by Air Force Lt. Col. Michael Xydakis checked all troops brought for treatment from roadside bombs and other explosions to the Air Force Theater Hospital in Balad, Iraq, during the last three months of 2005. The study focused on the 210 surviving U.S. troops who were evaluated for eardrum rupture and loss of consciousness. Of those, 35% had ruptures and 36% had lost consciousness; the two were closely linked.
Those with ruptured eardrums had a nearly threefold greater risk of concussive brain injury. The eardrum is only half a millimeter thick -- thinner than a contact lens -- and ruptures easily, Dr. Xydakis said. It is only half an inch from the brain, so "whatever hits the eardrum is going to hit the brain," such as the pressurized shock wave that follows an explosion, he explained.
Eardrum ruptures usually heal by themselves but occasionally need to be reattached. Concussive brain injuries have a variety of treatments, depending on severity and symptoms. Early detection is thought to improve the chances of avoiding permanent damage. More research is needed to prove that eardrum rupture is a good marker for possible brain injury; Dr. Xydakis said he hopes that it will lead to more of these injuries being detected.
"We are the first to show this link," with a study done amid bombs and bullets flying in Iraq, he said. "It’s a very challenging place to do this type of research."
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August 25: ‘Everybody May Not Make It Out’, Newsweek
Dr. Anna Pou was accused of murdering nine patients in a New Orleans hospital wracked by Katrina, but a grand jury declined to indict her. Now she gives her side of the story.
By Julie Scelfo
The tragic deaths at New Orleans’s Memorial Medical Center after Hurricane Katrina are among the most notorious examples of the vast human suffering that resulted from the destruction of the levees and the flooding of the city–and the government’s incompetent response to the disaster. At least 34 people died in the hospital awaiting evacuation and it wasn’t long before dark rumors began circulating that some of them were helped along by lethal doses of morphine or other medication. Almost a year after the storm, in July 2006, authorities arrested Dr. Anna Pou, a well–known head and neck surgeon. She was eventually accused of murdering nine patients who were in a long–term acute care unit on the seventh floor run by LifeCare Hospital of New Orleans. (Two nurses were also arrested but their charges were later dropped.)
Late last month, a Louisiana grand jury refused to indict Pou and the highly controversial criminal case came to a close. Pou still faces several civil lawsuits brought by relatives of patients who died while at LifeCare. In her most extensive comments yet on the events surrounding those deaths, Pou tells NEWSWEEK’s Julie Scelfo that she did indeed administer morphine and a sedative to the nine patients and she knew that these medication might hasten their deaths. But, she says, killing them was not her intention. In the desperate calculation Pou and other medical professionals were forced to make in the chaos and madness that engulfed the hospital, she says some patients could be saved and others were almost certain to die. It was their suffering Pou says she sought to alleviate. Excerpts:
NEWSWEEK: What was it like after the levees broke?
Dr. Anna Pou: Monday after the storm passed, we figured, ‘OK, minimal damage; we began organizing how we were going to evacuate the hospital.’ We didn’t have full power so we needed to move patients. Tuesday morning we were planning our day and one of the nurses called me to the window and said you’ve got to come see this. Water was gushing from the street. So we all kind of looked in disbelief. What is this? We could tell the city was flooding, you could see water down Claiborne Street. It was rising about a foot an hour. Then the whole mood at the hospital changed and what we were doing changed. We were in hurricane mode and we had to go into survival mode because we knew we had to be there for some time.
Read more...
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August 26: Mowing ragweed now will keep down next year’s crop, Press & Sun–Bulletin
By Maria Martinez
This year, there is a great profusion of ragweed growing along the roadsides, playgrounds and parking lots, everywhere that the flood waters of June 2006 had reached. Ragweed is an annual plant which discharges great quantities of microscopic, wind-borne pollen in late summer, and this causes respiratory illness in large numbers of allergic people, especially young children.
This plant, which can grow to three feet tall, has raggedy foliage similar to a marigold’s, but it is bigger and a lighter green color. The flowers do not have petals, but resemble oak catkins, and these appear profusely on the top of the plant, yellow–green, and standing upright. When sunlight hits these catkins, they discharge huge clouds of pollen, which are unseen because the grains are microscopic. The pollen rides the winds and can cause allergic illness at a distance from these plants. The seed, which follows in September, is too small to be seen and eaten by birds, and it is spread by winds, rains and floods and vehicle tires.
The seed only can flourish on barren ground. Ragweed is abundant along roadsides, parking lots and construction sites. If the ragweed is cut down in August, just before it blooms, it cannot re–grow before frost. Since it is an annual, it will not grow back next year and other ground covers, grasses and wild flowers will soon take over.
This letter is a reminder to urge property owners, road and parking lot maintenance, and people who take care of playgrounds and public parks to cut or mow their ragweed during August. Weed killer do not help because they kill the good plants that must stay alive to seed and cover the barren spots that ragweed colonizes.
Respiratory allergies caused by ragweed can lead to chronic sinus problems and bronchitis. And since this noxious weed can be eliminated, there is no reason for children to have to start school with this allergy. The peak of ragweed bloom occurs around Labor Day, so please cut it down now.
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August 28: Study Links Increase in Oral Cancers in Men to HPV, Fox News
The rate of oral cancer in men under the age of 45 is rising and a new study links the increase to the human papillomavirus (HPV).
Although the overall incidence of head and neck cancers has fallen in the United States and the rate of oropharyngeal (tonsil and base of tongue) cancers is stagnant in females, it appears to be rising in younger men, according to a review published in the Oct. 1 issue of Cancer, a peer-reviewed journal of the American Cancer Society.
Cancers of the head and neck, which include cancers of the larynx, nasal passages/nose, oral cavity, pharynx and salivary glands, account for 3 percent of all newly diagnosed cancers in the U.S. But men are three times more likely to be diagnosed with these cancers than women, the new study concluded.
In their review, Erich M. Sturgis, M.D., M.P.H. and Paul Cinciripini, Ph.D. of the University of Texas M. D. Anderson Cancer Center in Houston, conclude that the stagnant incidence rates of oropharyngeal cancers, particularly cancers of the tonsil and base of tongue, in the face of declines in tobacco use are likely due to the rising prevalence of oropharyngeal exposure to HPV.
The two believe use of the HPV vaccination in men may reverse this trend.
Of the estimated 45,000 new cases of head and neck cancers expected this year, approximately 10,000 are cancers of the pharynx (chiefly the oropharynx). Though the prognosis for these cancers is excellent when caught early, more than half of them are caught in the advanced stages when the prognosis is much worse, making prevention critical to saving lives, the authors said.
"While the cervical cancer and dysplasia prevention policy of HPV16/18 vaccination of young women and adolescent females are commended, we fear that vaccination programs limited to females will only delay the potential benefit in prevention of HPV16/18 associated oropharyngeal cancers, which typically occur in men," the authors wrote.
The authors said that the rapid study of the safety of these vaccines in males is needed.
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August 29: Sleep Aid Studied for Effects on Ringing in Ears, HealthNews Digest
By Ohio State University Medical Center
(HealthNewsDigest.com) - COLUMBUS, Ohio – Melatonin may be taken as a supplement to help regulate sleep, but an Ohio State University Medical Center physician is testing its effectiveness in another arena – the ear.
Dr. Abraham Jacob, an otolaryngologist at Ohio State’s Medical Center, has begun a study testing whether melatonin can decrease tinnitus, a disorder characterized by the perception of sound in the absence of any external source. The sound typically manifests as ringing, chirping or roaring.
Previous retrospective studies have suggested that melatonin may reduce ringing in the ears, but Jacob’s prospective research will compare the supplement to placebo in order to determine whether this is, in fact, real relief.
The study will involve 60 patients diagnosed with tinnitus that has lasted for more than six months. These patients will be evaluated objectively with specific measures and questionnaires. Thirty will receive melatonin and 30 will receive placebo during the first segment of the trial, and then the study medications will be reversed so patients on placebo will receive the actual supplement and melatonin users will receive the placebo.
"We’d like to see whether a readily available product used for years as a supplement can be used as a therapy for a common problem," Jacob said.
Tinnitus is common, affecting about 10 percent of the U.S. population, but Jacob considers it under–diagnosed and under–evaluated.
"That may relate to each patient’s perception of the severity of the disorder," he said. "Just 1 percent of those affected by tinnitus feel significantly bothered by it to have it evaluated."
While tinnitus often starts with damage to the inner ear, chronic tinnitus is more likely a central, neurologic phenomenon. Jacob explained that brain pathways designed to interpret sound also have connections to other areas of the brain that help determine how people feel about environmental stimuli. When sound pathways in the brain are activated in the absence of external sound, many people perceive the sensation as unpleasant. Patients who cope well with adverse stimuli probably won’t have as serious a problem with tinnitus.
"If you’re less able to ‘de–focus’ from the ringing or divert your attention to other activities, you are more likely to perceive your tinnitus or develop an aversion to it. Unfortunately, many people just can’t help but focus on it," he said.
Tinnitus can occur after slow, cumulative exposure to loud noises or sudden, short exposures to extremely loud stimuli.
Several patients Jacob has evaluated for tinnitus have had an interest in singing and music. "Unfortunately, such individuals are highly attuned to sound and tend to be more bothered than most by tinnitus," he said.
He said people using newer portable MP3 players, however, should not fear developing tinnitus as long as they keep the volume at a reasonable level. "The ear is meant to hear," Jacob said. "There’s nothing wrong with listening to and enjoying music. However, moderation is best."
There is no cure for subjective tinnitus, which is a patient’s perception of sound that cannot be heard by an examiner. Objective tinnitus, or a sound that can be heard by the examiner using a stethoscope, is treated by removing the offending cause of the noise. Ringing that is present in just one ear, matches one’s heartbeat, is associated with asymmetric hearing loss, or is accompanied by balance abnormalities deserves further medical evaluation to rule out sinister causes such as tumors or vascular malformations, Jacob said.
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