 |
Ear, Nose & Throat Associates |
|
|
|
|
|
|
August 2008 News Archives
|
August 5: Screening: Higher Rates of Hearing Loss Are Found, The Wall Street Journal
By ERIC NAGOURNEY
A new study suggests that hearing loss among Americans may be more widespread than believed.
Writing in the current issue of Archives of Internal Medicine, researchers said they had evidence that as many as 29 million people in this country might have at least some hearing loss.
And while that problem may be expected in older people, the study found that younger people, too, were affected. Among people 20 to 29, it said, 8.5 percent showed some hearing loss, with the incidence apparently on the rise.
The researchers, who were led by Dr. Yuri Agrawal of Johns Hopkins, looked at the data from a federal study of more than 5,700 people ages 20 to 69.
The study found that men were more than five times as likely as women to have hearing loss, and whites more likely than blacks. The risk was also higher for people who smoked, were exposed to noise or had cardiovascular risks.
This study, in which people were given examinations, found more cases of hearing loss than did studies in which people were simply asked about it.
|
Return to 2008 News Archive Page
|
August 10: Use of anti-snoring device rises, USA Today
By Julie Appleby, USA TODAY
The retirement haven of Lady Lake, Fla., boasts several golf courses and country clubs — and apparently many residents who have restless sleep.
In three years, Medicare spending there for small bedside ventilators that help treat a serious sleep-related condition soared 324%, to $1.4 million last year.
Doctors in the central Florida town say their community is at the forefront of a national trend that has made the devices one of Medicare's fastest-growing medical equipment expenses, up 96% nationwide since 2004.
The booming sleep industry and an aging and increasingly obese population have prompted greater use of the devices, which treat sleep apnea, a condition that causes snoring, brief breathing lapses and tiredness.
"As we get older and as we get fatter, we have more sleep apnea," says Juan A. Albino, a pulmonologist and sleep specialist in Lady Lake.
Nationwide, the program for the elderly and disabled approved $571 million in payments for the devices, called continuous positive airway pressure (CPAP) machines last year, up from $291 million in 2004, Medicare data requested by USA TODAY show.
Spending could grow even faster under a new federal rule that makes it easier for patients to get the devices by testing for sleep apnea at home rather than in a sleep testing lab.
Medicare estimates that 2% to 4% of Americans have sleep apnea, which is linked to health problems such as coronary artery disease and strokes. About 10% of those over 65 and 20% of the obese suffer from the condition.
By city, Medicare data show:
- Miami, Chicago and Houston led the nation in total government payments for CPAP devices.
- Texas had six cities in the top 20 for CPAP spending; Florida had three.
- Several cities, including Lady Lake, had spending jumps of more than 100% since 2004.
Focus on sleep apnea
CPAPs are the seventh-largest category of Medicare's $12.3 billion in spending on medical equipment. Spending on oxygen supplies, the largest category, rose 5.8% from 2004 to 2007. Spending on wheelchairs fell 17.6% after a fraud crackdown.
Sleep experts say the CPAP growth is not surprising, given the increased attention to sleep apnea.
About $2 billion worth of the devices are sold annually worldwide, with most sales in the USA, says Marketdata, a market research publication based in Tampa.
The machines cost $200 to $1,500 or more. Medicare generally pays 80%. Patients pay 20%.
Some experts warn there is a potential for unneeded prescriptions for CPAPs. "Are people getting treatment they don't need?" asks Fred Holt of the National Health Care Anti-Fraud Association, composed of health insurers and law enforcement groups.
"Not everyone with a diagnosis of sleep apnea needs CPAP," says Holt, an ear, nose and throat surgeon. "Weight loss, avoiding alcohol and sedatives at bedtime or changing sleep position could eliminate the problem for some."
For others, treatment involves sleeping with a mask connected to the CPAP machine, which blows air into the patient's nose, helping prevent obstruction to breathing.
Until this spring, Medicare would pay for CPAP machines only if a sleep center diagnosed patients with apnea. New rules say a diagnosis can be made with a test taken at home.
Opponents say home testing is less accurate. "To be adequately treated, you have to make sure patients are adequately diagnosed," says Mary Susan Esther, president of the American Academy of Sleep Medicine, a trade group representing sleep labs.
Proponents such as William Abraham, a sleep expert and chief of the division of cardiovascular medicine at Ohio State University, say the change makes it possible for more patients to get tested.
"By allowing home testing, perhaps Medicare is opening the floodgates," he says. Yet given the problems of untreated apnea, "it's not only the right thing to do, but may ultimately prove to be a cost savings."
Testing centers spread
Sleep testing centers, where patients stay overnight for observation, have boomed nationwide — including in Lady Lake.
Across the USA, 1,475 centers are accredited by the sleep medicine academy, up from 857 in 2004. Sleep testing labs increased bed capacity nationwide by 13% in the past year and plan a 17% increase next year, says a July report by analyst Michael Matson of Wachovia Capital Markets.
"At one point, we had 16 beds" in sleep testing labs in the area, says Albino, whose center has four beds. "Sleep centers were seen as a profit-making venture."
Lady Lake and its surrounding community for the over-55 population, The Villages, has grown to more than 75,000 people in a few years. That's helped fuel the increase, Albino says.
Albino, who runs a sleep testing lab as part of his practice, says about four testing beds per 100,000 people is generally considered ideal. Lady Lake and its surrounding area have more than four times that number.
"This is a disease of the future," he says.
|
Return to 2008 News Archive Page
|
August 11: Sleep apnea can raise risk of death, Los Angeles Times
Obstructive sleep apnea leads to daytime drowsiness and a higher rate of death for people with the condition. Advancements have been made in effective treatment.
By Erin Cline Davis, Special to The Times
Sometimes, snoring is a sign of obstructive sleep apnea, a condition that has been associated with an increased risk for high blood pressure, heart attack, stroke and diabetes. But two studies published Aug. 1 make it official: sleep apnea is deadly.
People with obstructive sleep apnea stop breathing during the night, when the soft tissue in the backs of their throats collapses and blocks their airways. These pauses usually last between 10 and 30 seconds, but can go on for up to one minute. People with the most severe forms of the disorder can stop breathing more than 30 times per hour.
"Your brain makes a choice between breathing and sleeping -- at first, the brain chooses sleeping, but then it wakes you briefly so you can catch your breath, " said Dr. Rafael Pelayo, a professor at Stanford School of Medicine and a physician in the university's Sleep Disorders Clinic.
The two new reports, published in the journal Sleep, have shown that after adjusting for other risk factors, people with severe, untreated obstructive sleep apnea were about four times more likely to die from all causes than those without the condition.
One study followed 1,522 adults from the Wisconsin Sleep Cohort Study for 18 years, while the other tracked 380 adults in the Busselton Health Study in Western Australia for up to 14 years. Both studies used subjects who were drawn randomly from the community instead of relying on patients already seeking treatment at a sleep clinic for sleep apnea, which may skew the sample toward sicker patients.
When obstructive sleep apnea robs a patient of a good night's rest and causes daytime drowsiness, it can be a serious hazard to others as well as the patient. A 1999 report in the New England Journal of Medicine found that the odds of an obstructive sleep apnea patient getting in a traffic accident are more than six times those of a person without the condition.
Memory loss and difficulty concentrating are common complaints of people with obstructive sleep apnea. A report out of UCLA published in June in the journal Neuroscience Letters demonstrates that people with the condition actually have tissue loss in brain regions that help store memories.
The researchers compared 43 people experiencing obstructive sleep apnea with 66 controls and found that brain structures called mammillary bodies were reduced in size by 20%, on average, in the group with obstructive sleep apnea. Though the researchers haven't shown this yet, they speculate that repeated drops in blood oxygen levels caused by interruptions in breathing lead to brain injury.
Obstructive sleep apnea can be definitively diagnosed only with a sleep study that monitors breathing and other vital signs throughout the night. Traditionally, sleep studies have been performed in high-tech sleep labs where patients spend the night being monitored by technicians. But this type of sleep study is uncomfortable and expensive, and not available everywhere. New devices are now available that allow patients to be monitored from the comfort of their own beds. The Centers for Medicare and Medicaid Services recently approved reimbursement for these home sleep studies, which should make them available to more people.
If obstructive sleep apnea is diagnosed, the gold standard for treatment is continuous positive airway pressure, or CPAP. A machine sits next to the bed and pumps air through a mask that the patient wears throughout the night. The steady stream of compressed air keeps airways open.
Although CPAP is an extremely effective treatment for obstructive sleep apnea, it must be used nightly, and many patients just won't do it. According to a recent review of the literature in the Proceedings of the American Thoracic Society, somewhere between 46% and 83% of obstructive sleep apnea patients (depending on the study) fail to use their CPAP machines for more than fours hours per night.
Pelayo says that CPAP advancements are constantly being made, making the machines smaller, quieter and more comfortable. "This isn't your father's CPAP," he says.
Oral appliances that help open the airway by pushing the jaw forward are a treatment option for people who can't tolerate CPAP. Although non-prescription versions of these devices can be had for treating snoring, obstructive sleep apnea sufferers should be sure to see a dentist trained in sleep medicine for a proper fit.
So how can you tell whether you or a loved one has obstructive sleep apnea or is simply just snoring? The question to ask, says Pelayo, is "Do you wake up refreshed?"
If the answer is yes, then it's probably just snoring. But if the answer is no, no matter how much sleep you get, it's time to see a doctor.
For more information about obstructive sleep apnea, go to:
American Academy of Sleep Medicine
American Academy of Otolaryngology-Head and Neck Surgery
National Sleep Foundation
National Heart, Lung and Blood Institute
|
Return to 2008 News Archive Page
|
August 12: Waiting It Out: Antibiotics Are Unlikely to Help Sinusitis, The Wall Street Journal
By ANNA WILDE MATHEWS
Sinus infections are among the most common and aggravating medical conditions, diagnosed in around 31 million Americans each year. And for most patients, treatment has long included an antibiotic.
Some nonantibiotic treatments that may ease sinus symptoms:
- Decongestant sprays (use for up to three days)
- Saline irrigation
- Topical steroids
- Over-the-counter pain medicines, such as Advil, Tylenol
Now, medical experts are pushing for a less-aggressive approach. Around 21% of antibiotic prescriptions for adults in the U.S. are for sinusitis, even though studies show the drugs often do little or no good. Short-term sinusitis can be caused by either a bacterial infection, which may respond to treatment with antibiotics, or a viral infection, which doesn't. Doctors believe the overwhelming majority of cases begin as viral infections, and less than 2% of those turn into bacterial infections.
The American Academy of Otolaryngology -- Head and Neck Surgery, which represents ear, nose and throat specialists, issued new guidelines last year for treating sinusitis. Among these: Doctors generally should wait 10 days before even considering an antibiotic. If the sinus sufferer is feeling better by then, the bug is almost surely a virus, and antibiotics would be of no use.
But if the problem lasts more than 10 days, chances are good it is bacterial. At this point, if the patient's illness is relatively mild, the guidelines leave it up to the doctor to decide between prescribing an antibiotic or monitoring the patient for as much as another week.
Some patients, and their doctors, might not be willing to wait. Keisha Herbin Smith knew what she wanted when she called her doctor's office last month about symptoms including congestion, a headache and a runny nose. Ms. Herbin Smith, a 30-year-old research coordinator from Woodbridge, Va., asked the nurse for an antibiotic to head off a full-blown sinus infection, so it wouldn't ruin a long-planned weekend at the beach. An antibiotic "just makes you feel better sooner," says Ms. Herbin Smith, who got her prescription and enjoyed her vacation, and later went to see her doctor when she returned.
Studies have shown that antibiotics may help at least some people with bacterial infections feel better faster. An analysis of 13 previous studies, performed for the academy to gather evidence for the new guidelines, found that 87% of sinusitis patients who took antibiotics felt better after seven to 12 days. But among patients who didn't take the drugs, 73% felt better by that point.
And the drugs have drawbacks. The analysis's lead author, Richard Rosenfeld, found that 25% of sinusitis patients who got antibiotics had side effect such as gastrointestinal problems, skin rashes or headaches. By contrast, among sinusitis sufferers who didn't take the drugs, 14% also had such problems. Widespread use of antibiotics is also blamed for the emergence of resistant bacteria that don't respond to traditional drugs.
"Certainly, the path of least resistance is to write an antibiotic," says Bradley Marple, a professor at the University of Texas Southwestern Medical Center in Dallas and a co-author of the new guidelines. Dr. Marple says he has gotten more comfortable in recent years with treating relatively mild sinus infections without the drugs. He says he sits down to discuss options with each patient and lays out the evidence behind his advice.
Some patients are adjusting to drug-free treatments. Wendi Woolley, a graduate student at the University of Alabama, says her doctor recently gave her a saline rinse rather than an antibiotic for her sinus problem. "I don't want to take a chance" on possible drug side effects, she says.
Other medical authorities want to go even further than the academy's guidelines to minimize the use of antibiotics in treating sinusitis. An analysis by international researchers published in the Lancet medical journal in March said the drugs "are not justified even if a patient reports symptoms for longer than seven to 10 days." That's because the way doctors typically diagnose sinusitis, based on symptoms, isn't typically enough to determine which patients will benefit from antibiotics, the authors concluded.
Still, habits are hard to break. Daniel Merenstein, director of research programs for family medicine at Georgetown University, knows the arguments against antibiotics as well as anyone; he's a co-author of the Lancet analysis that recommended against their use. Dr. Merenstein says he nevertheless often prescribes an antibiotic for a patient after a week of difficult and worsening sinus symptoms, rather than waiting 10 to 17 days. "I think it's a patient expectation," he says. "I'm willing to risk it and say, 'maybe you're that subset that will get better faster.'"
|
Return to 2008 News Archive Page
|
August 13: Want a Face-Lift? First, Better Stop Smoking, The New York Times
By ABBY ELLIN
LISA MORRISON has always considered herself a pillar of health. She ate only organic food, exercised often and meditated. The only glitch in her otherwise exemplary existence was the pack of Marlboros that she had inhaled daily since age 18.
By the time Ms. Morrison, now 50, went to see Dr. Vincent Giampapa, a board-certified plastic surgeon in Montclair, N.J., she had tried everything to quit for the sake of her health. “Acupuncture, the patch, hypnosis,” she said. “Nothing worked.”
Nothing, that is, until 2007, when Dr. Giampapa told her she would have to toss her beloved cigarettes if she wanted a neck- and eye-lift. “The doctor strongly suggested that if I wanted to heal properly I needed to quit,” Ms. Morrison said. “When you start talking about your face, it becomes motivating.”
Each year, roughly 40 to 45 percent of the 45 million smokers nationwide try to quit, according to Dr. Michael Fiore, the director of the University of Wisconsin Center for Tobacco Research and Intervention, in Madison. Only about 5 percent quit for life.
But these days, the growing number of cosmetic-surgery patients are motivated to quit for other reasons: vanity, and the threat of not being able to get a coveted new face, stomach or pair of breasts.
“When someone hears this from an internist or cardiologist who says it’s really bad for you, it increases your risk of lung cancer, it’s bad for your heart, people tend to blow that off if they’re feeling well,” said Dr. Alan Gold, the president of the American Society for Aesthetic Plastic Surgery. “But if they have a medical problem and are not going for just a routine checkup, they may tend to listen to that advice more.
“With plastic surgery it’s a little bit different. People are desirous of an elective procedure, and that’s their main objective in coming in. It’s something they truly want.”
For the last 5 to 10 years, many plastic and cosmetic surgeons have refused to operate on smokers, especially those seeking a face-lift, tummy tuck, or breast-lift — procedures that require skin to be shifted.
“Nicotine causes the tiny blood vessels in the skin to clamp down or constrict, which reduces blood supply to the skin,” said Dr. Darshan Shah, a plastic surgeon in Bakersfield, Calif. Complications can include poor wound healing, increased risk of infection, longer-lasting bruises, and raised, red scars.
“Twenty-five years ago, it may have been more acceptable for a patient to have undergone surgical procedures while smoking,” said Dr. Patrick McMenamin, the president-elect of the American Academy of Cosmetic Surgery. “Nowadays if a doctor knew a patient was smoking and they did flap surgery,” he said, referring to an operation where shifting skin is required, “many of us would say that’s malpractice.”
Plastic and cosmetic surgeons recommend quitting a minimum of two weeks before and after procedures, though some require longer to be extra safe. (Smokers also run the risk of infection and respiratory complications during anesthesia). For instance, Dr. Jeffrey Rosenthal, the chief of plastic surgery at Bridgeport Hospital in Connecticut, mandates six weeks of smoke-free living before eyelid surgery or breast augmentation, and six months to a year before a tummy tuck.
They also take it upon themselves to devise smoking cessation plans, prescribe drugs like Wellbutrin or Chantix and recommend hypnotists or support groups.
“Why invest so much money in a cosmetic procedure for enhancement if the patient will not participate and do his or her part to help ensure the best outcome possible?” said Dr. Shirley Madhère, a plastic surgeon in Manhattan.
Nancy Irwin, a therapist and clinical hypnotist in Los Angeles, said that plastic surgeons refer 5 to 10 percent of her clientele. “They don’t mind dying for cigarettes,” she said of her patients, but if smoking gets in the way of their breast enhancement, “there’s a problem.”
“They’re putting image before health,” she said.
Plastic surgeons cite a few reasons why now, more than ever, they require patients to kick the habit. In recent years, as the number of operations has skyrocketed — roughly 11.7 million cosmetic surgical and nonsurgical procedures were performed nationwide in 2007, up from 3 million in 1997, according to the American Society for Aesthetic Plastic Surgery — more people (and smokers) are coming through the doors.
Since most plastic surgery is elective, plastic surgeons have time on their side as opposed to, say, a heart surgeon. “You can talk to people about quitting smoking, but you may not have a month’s worth of time before you try to save their life with heart surgery,” said Dr. Roger Friedenthal, a board-certified plastic surgeon in San Francisco who refuses to operate on smokers.
The arsenal of non-nicotine antismoking aids have grown, too. “With the advent of things like Chantix, we have a much higher success rate,” Dr. Shah said. (A caveat: this year, the Food and Drug Administration issued a warning against the drug, claiming it can cause depression and suicidal tendencies in some patients.)
Then there’s the matter of the cosmetic surgeon’s reputation. It can’t help business if a cigarette-loving patient ends up looking like the Bride of Frankenstein.
“I take great pride in my work,” said Dr. Rosenthal of Bridgeport Hospital, who estimates that more than two-thirds of his patients who smoke quit for good. “I want it to look great for you as well as for myself. If they smoke even one cigarette, I run the risk of it not healing. It’s like trying to water your lawn with a crimped hose.”
But all surgeons — and not just plastic or cosmetic — are increasingly urging patients to stop smoking before surgery, be it a face-lift or to repair an anterior cruciate ligament, Dr. Fiore said. It’s not as if cosmetic surgeons are responsible for a major uptick in smoking cessation, he said, adding “this is not a prime driver of quitting in America.”
No doubt some patients lie about kicking the habit. “Some won’t, but will tell you that they have,” said Dr. Scot Glasberg, a board-certified plastic surgeon in Manhattan. “These are all adults, and I’m not going to be the person looking over their shoulders.”
The fact that some plastic surgeons do no more than check the condition of their patient’s skin and smell for nicotine provides a substantial loophole.
Others want proof. Dr. Samir Pancholi, a board-certified cosmetic surgeon in Las Vegas, obtains a urine test; Dr. Madhère asks patients to sign a legal waiver stating whether they have stopped smoking and acknowledging the postoperative risks and potential complications of smoking.
Fear motivated Carolyn Davis, 42, a reformed social smoker in Sacramento, to quit cold turkey before her breast augmentation in 2005. “This was like the first major surgery I’d had as an adult,” she said, “so when my doctor, who I respect, tells me not to smoke and here are some reasons why — then I have to respect that.” (In the four years since surgery, she relapsed for just two days, she said.)
Dr. Pancholi, who is certified by the American Board of Cosmetic Surgery, takes scare tactics a step further. He shows patients graphic postoperative pictures of smokers who didn’t heed his advice to quit. “They see the wound opening up, turning red or black, the edges start coming apart,” he said. “They see the skin graft we use to put it back together.”
Margaret Pyles, 42, a human resources director for youth homes in Bakersfield, first went to Dr. Shah in 2004, looking to have a breast reduction. He told her that she needed to quit a minimum of 30 days before the surgery. A pack-a-day smoker since 16, she couldn’t face battling her addiction yet again.
But once her back pain grew constant, and her abdominal muscles too flabby for her taste, Ms. Pyles went back to Dr. Shah last month for a breast reduction and lift as well as a tummy tuck and liposuction. But not before she quit smoking with the help of Chantix and a hypnotist Dr. Shah recommended.
Both helped her overcome nicotine, she said, but fear really kept her on track. “I was afraid the anesthesia would go wrong, or I’d wake up coughing my head off and split my guts open,” she said. “And I was able to stop.”
Ms. Pyles, who has not lit up again, is thrilled that her desire to turn back the clock may help prolong her life. “I was so focused on wanting the breast reduction more than I wanted the cigarette,” she said.
|
Return to 2008 News Archive Page
|
August 14: Ear Infections May Increase Obesity Risk, WebMD
Damage to Taste Nerves May Be to Blame, Researchers Say
By Salynn Boyles
Reviewed by Louise Chang, MD
Are kids with frequent ear infections at increased risk of becoming overweight later in life?
Early research suggests they are, and that damage to the nerves controlling taste may be to blame.
The research was presented for the first time today at the 116th annual convention of the American Psychological Association in Boston.
Taste researcher Linda M. Bartoshuk, PhD, of the University of Florida College of Dentistry, tells WebMD that over time, frequent ear infections may alter taste perception in a way that leads to a heightened preference for high-fat and highly sweetened foods, which, in turn, leads to obesity.
"Ear infections are relevant to taste because one of the most important taste nerves goes through the middle ear on the way to the brain," she says.
Another taste nerve is in the throat, Bartoshuk says, and researchers also presented findings showing an increased risk for obesity in children who have had tonsillectomies.
Ear Infections and Obesity
Bartoshuk says she first suspected a connection between ear infections and obesity about six years ago after analyzing findings from a survey she conducted to explore taste and health.
About 6,600 adults -- mostly academic professionals -- completed the survey, which included questions about past ear infections and current body mass index (BMI), a measure of obesity.
People with a history of frequent ear infections were found to be 62% more likely to be obese than people who reported no history of ear infection.
"We didn't expect to find ear infections associated with BMI, but that is what we saw," she says.
Bartoshuk then began looking for other research databases that included information on ear infection history and weight.
Several of these studies were presented at today's symposium, along with Bartoshuk's original research.
In one study involving middle-aged women tested for taste sensitivity, those who showed evidence of damage to taste nerves were more likely than women without evidence of nerve damage to prefer high-fat and highly sweetened foods. They were also more likely to have larger waists.
In another study, preschoolers with a history of frequent ear infections were found to eat fewer vegetables and more sweets than children who did not have frequent ear infections. They also tended to be heavier.
Epidemiologist Kathleen Daly, PhD, of the University of Minnesota-Twin Cities, reported on her work with children up to age 2, suggesting that chronic ear infections prior to this age are associated with higher BMIs (body mass index) around the second birthday.
"All of this is intriguing, but we don't really know what it means yet," Daly says.
Finally, re-examination of data from a large, national health survey conducted in the 1960s found a 30% increase in obesity risk among children who had tonsillectomies.
'Big Leap of Faith'
The research presented in Boston largely involved reanalysis of existing databases.
All agree that studies designed specifically to examine the question of whether chronic ear infections and tonsil surgery play a role in obesity are needed to prove the hypothesis.
"Given the epidemic of obesity in this country and the fact that children are becoming overweight at younger and younger ages, this really should be something we look at more carefully," Daly tells WebMD.
But ear specialist John W. House, MD, of the House Ear Institute in Los Angeles isn't so sure.
"We see thousands of children and adults with chronic ear infections at our clinic every year," he says. "If this association were real we would see it in our patients, but we don't."
University of Pittsburgh ear, nose and throat physician Barry Hirsch, MD, FACS, tells WebMD that the studies presented at the Boston symposium fall far short of proving a link between ear infections, tonsil surgery, and obesity.
House and Hirsch are both spokesmen for the American Academy of Otolaryngology -- Head and Neck Surgery.
"It is a big leap of faith to say from this type of research that ear problems cause obesity," he says.
|
Return to 2008 News Archive Page
|
August 19: Hearing Loss, Lack Of Sleep Impair Back-To-School Health, Medical News Today
As the new school year approaches, many parents are preparing their children by buying school supplies, new clothes, and organizing fall sporting events. But in order to help kids get a healthy head start to the school year, the American Academy of Otolaryngology - Head and Neck Surgery (AAO-HNS) also recommends taking a closer look at your child's health for common ear, nose, or throat-related health issues that might affect academic success.
"Ear, nose, and throat health problems are among the most common medical conditions that children face," says Jay Youngerman, MD, chief of the Division of Otolaryngology at North Shore Hospital at Plainview in New York. "So in addition to the standard back-to-school physical, parents should also consider whether or not their child would also benefit from seeing an otolaryngologist for additional evaluation."
Dr. Youngerman cites the following common ENT health concerns in the back-to-school season:
1. Hearing Loss - Hearing difficulty or loss can greatly impact children's performance in school and their ability to interact with peers, and is increasingly a risk because of the popularity of mp3 players. Most children have their hearing evaluated after birth or in the first few years to determine any congenital conditions. However, as hearing loss is also caused by things like infections, trauma, and damaging noise levels, the problem may not emerge until later in childhood. Monitoring a child's hearing ability on a consistent basis can help a parent take action early if an issue should arise.
2. Pediatric Obstructive Sleep Apnea and other Childhood Sleep Disorders - Obstructive sleep apnea, also known as sleep-disordered breathing (SDB) is not uncommon in children, but can have a profound impact on their educational experience by causing daytime sleepiness, aggravating attention deficit disorder, and other behavioral issues, along with bed-wetting and slowed growth. The number one indicator of SDB is restless sleep and labored breathing. This includes loud snoring that occurs every night, regardless of sleep position; snoring is then followed by a complete or partial obstruction of breathing, with gasping and snorting noises.
3. Facial Sports Injuries - Many children begin the fall with a variety of team and individual sports programs. These activities are great exercise for kids, but they can result in a variety of injuries to the face, including broken noses and facial abrasions. Many injuries are preventable by wearing the proper protective gear. Check with your child's coach to make sure he/she has and is wearing all the necessary protective equipment. Also check with the coach after each practice to see if your child sustained any injuries while playing.
Dr. Youngerman says, "Other common issues like chronic allergies and sinusitis can also make a big impact on back-to-school success. Knowing the signs and symptoms will help a parent take quick action should an ENT health issue arise."
For more information on children's ear, nose, and throat health, including a detailed Q & A with Dr. Youngerman and a tip sheet for getting the most out of your child's doctor's appointment, or to find an ENT physician in your area, visit the AAO-HNS website at entnet.org.
About the AAO-HNS
The American Academy of Otolaryngology - Head and Neck Surgery, one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization's mission: "Working for the Best Ear, Nose, and Throat Care."
|
Return to 2008 News Archive Page
|
August 26: Snoring in kids could signal sleep apnea, STLtoday
By Dr. Allison Ogden
Snoring is common in children, but, in some cases, the snoring is only a symptom of a more serious health concern, obstructive sleep apnea.
The disorder is estimated to occur in one out of five children who snore, or 1 to 3 percent of the pediatric population. It is most common from ages 2 to 6.
Obstructive apneas occur when a pause or relative decrease in breathing takes place due to collapse of tissue, usually in the throat, that blocks the passage of air. This leads to a brief awakening to overcome the obstruction, and, in turn, a fragmented sleep pattern.
In children, the most common cause of obstruction is relatively large tonsils and adenoids that collapse when the throat muscles relax during deep sleep.
The common symptoms include:
- Nightly loud snoring or noisy breathing during sleep
- Disrupted or restless sleep
- Daytime mouth breathing
- Bed wetting
- Behavioral problems (inattentiveness, irritability, anxiety, mood swings, rebellious or aggressive behavior)
- Growth abnormalities (short stature, failure to thrive)
Unlike in adults with sleep apnea, daytime sleepiness is not common. In severe cases, the disorder can worsen or even cause serious medical conditions, such as pulmonary, cardiovascular and gastrointestinal disorders.
The diagnosis in children also takes a physical exam by a pediatrician and any further testing into account. The most common physical exam finding in children with suspected obstructive sleep apnea is large tonsils relative to the size of the back of the throat. Children may also have a runny nose, difficulty breathing through the nose or be mouth-breathing — all suggestive of large adenoids.
The gold standard test for diagnosis is the polysomnogram, or sleep study. This is usually an overnight exam that monitors the child during sleep to assess for apnea (breathing pause), reduced breathing (hypopnea) and low blood oxygen levels.
However, some controversy surrounds the timing of a sleep study. In many circumstances, when the child's history and physical exam are strongly suggestive of sleep apnea, treatment is undertaken without need for further testing.
The first line treatment is tonsillectomy and adenoidectomy, or surgical removal of the tonsils and adenoids. This procedure is successful in more than 75 percent to 85 percent of those affected. If a child is not a surgical candidate or continues to have apnea after surgery, a continuous positive airway pressure mask can be beneficial.
If sleep apnea in your child is a concern, discuss his or her symptoms further with your child's pediatrician, who may refer your child for further evaluation by an otolaryngologist (ear, nose and throat surgeon) or a pulmonologist.
Dr. Allison Ogden is a pediatric otolaryngologist at St. Louis Children's Hospital and an assistant professor of otolaryngology at Washington University School of Medicine.
|
Return to 2008 News Archive Page
|
August 21: Face transplants can work, studies show, Reuters Health
LONDON (Reuters) - New faces given to a Chinese man after a bear tore off part of his face and a French-Caribbean man disfigured by a rare tumor show that such transplants can work and are not medical oddities, researchers said on Thursday.
The findings give hope to some people with severe facial disfigurement and suggest the transplants could prove long-lasting without major problems, two separate research teams reported in the Lancet medical journal.
Despite recurrent episodes of tissue rejection in the first year after their transplants, neither man had psychological problems accepting their new faces and have been able to rejoin society, they reported.
Only three people have received face transplants. The world's first was carried out on French woman Isabelle Dinoire in November 2005 after she was disfigured in an attack by her dog. Last year, her doctors reported that she had recovered slowly and steadily, overcoming two episodes of rejection.
In 2006, Chinese doctors performed a face transplant on a 30-year-old mauled by a bear. While there were some complications with tissue rejection following the operation, two years later the man was doing well, his doctors said.
"This case suggests that facial transplantation might be an option for restoring a severely disfigured face, and could enable patients to readily reintegrate themselves back into society," Shuzhong Guo and colleagues at Xijing hospital in China wrote.
A French team described their work on a 29-year-old man who suffered from von Recklinghausen disease, an illness that deforms the face. The man, who was not named, was given a new nose, mouth and chin in a 2007 operation.
He began work 13 months after the transplant, has more function in his face and has not rejected the new tissue, his doctors said.
"Our case confirms that face transplantation is surgically feasible and effective for the correction of specific disfigurement," Dr. Laurent Lantieri and colleagues at the Henri-Mondor hospital outside Paris wrote.
(Reporting by Michael Kahn, Editing by Maggie Fox)
|
Return to 2008 News Archive Page
|
August 22: Smokers More Likely to Bleed After Throat Surgery, HealthDay News
Understanding link may help doctors better counsel patients before operations.
Patients who smoke are more likely to develop bleeding after throat surgery, a U.S. study finds.
This increased risk was noted in patients who had uvulopalatopharyngoplasty (UPPP) -- a procedure in which excess tissue is removed from the throat -- with tonsillectomy, but not in patients who had tonsillectomy alone.
The study authors analyzed post-operative bleeding rates among more than 1,000 tonsillectomy patients between 2000 and 2005. The overall rate of bleeding was 6.7 percent, but that number was 10.2 percent for smokers and 5.4 percent for nonsmokers.
The large difference between the two groups was due to the high rate of post-operative bleeding among smokers who underwent UPPP -- 10.9 percent vs. 3.3 percent in nonsmokers.
"Futher investigation of this relationship is needed, with stratification of patients by the number of cigarettes smoked and attention to the length of time before and/or after surgery that patients refrain from smoking," the study authors wrote.
Understanding the link between smoking and post-operative bleeding may help doctors better counsel patients before surgery, the researchers said.
The study also found that men who had tonsillectomy alone were much more likely than women to have post-operative bleeding -- 11.2 percent vs. 5.4 percent.
The findings were published in the August issue of the journal Archives of Otolaryngology--Head & Neck Surgery.
More information: The American Academy of Otolaryngology -- Head and Neck Surgery has more about tonsillectomy procedures.
|
Return to 2008 News Archive Page
|
August 26: Early ear infections may pack on pounds later, msnbc
By JoNel Aleccia
Health writer
Adults who struggle with a sweet tooth or battle a lifelong craving for bacon may have something more than weak willpower to blame — at least those with a history of chronic childhood ear infections.
A series of new studies presented this month by taste and hearing experts suggests that repeated infections may damage a vital taste-sensing nerve in kids, perking a preference for rich foods and making them prone to weight gain later.
People with a serious history of childhood ear infections appear to be about 70 percent more likely to be obese than those with no history of infections, according to preliminary research at the University of Florida College of Dentistry in Gainesville.
Worse, those who suffer harm to the crucial chorda tympani nerve — which runs through the tongue, along the side of the face and behind the eardrum on its way to the brain — may not realize why they can’t stay away from the small indulgences that pack on pounds.
“They simply like high-fat and high-sweet foods better,” said Linda Bartoshuk, a scientist with the McKnight Brain Institute's Center for Taste and Smell, housed in the University of Florida’s College of Dentistry. “The more you like food, the more you weigh.”
Bartoshuk and other scientists long have known that damage to the chorda tympani nerve makes people prefer sweet, salty and high-fat foods such as butter, bacon, salted pretzels, ice cream and Oreo cookies. When the nerve doesn’t work, two other nerves take over, but people are drawn to more intense flavors and textures, she explained.
But Bartoshuk and her team discovered the apparent link between bouts of ear infections — medically known as otitis media — and obesity after analyzing voluntary surveys submitted by more than 6,500 people who attended lectures on the science of taste over several years.
|
Return to 2008 News Archive Page
|
August 26: Throat cancer increasing among white Americans, Reuters Health
NEW YORK (Reuters Health) - The rate of throat cancer, or adenocarcinoma of the esophagus, has risen steadily among white Americans over the past 3 decades, according to a new report.
Although the rates of adenocarcinoma among white women have been lower than among white men, the 335-percent increase in new cases among women over the last three decades has been almost as fast as the 463-percent increased rate among white men, Dr. Linda Morris Brown from RTI International, Rockville, Maryland told Reuters Health.
Brown and colleagues performed a detailed examination of the trends in esophageal adenocarcinoma rates among white individuals by sex, stage, and age using data collected by the National Cancer Institute's SEER (Surveillance, Epidemiology, and End Results) program.
Total esophageal cancer rates among white men increased steadily from 5.76 per 100,000 persons per year from 1975 to 1979, up to 8.34 per 100,000 persons per year between 2000 and 2004, the researchers report in the Journal of the National Cancer Institute.
In contrast, total esophageal cancer rates among white women remained constant. A 29-percent decrease in squamous cell carcinoma rates occurred at the same time as the 335-percent increase in adenocarcinoma, the researchers note.
The major risk factors for esophageal adenocarcinoma, and the condition that precedes this cancer - Barrett's esophagus -- are gastroesophageal reflux disease (GERD -- chronic heartburn) and obesity, especially abdominal obesity, Brown pointed out. "Increases in the prevalence of these risk factors may have contributed to the upward trend in incidence."
Brown suggests that "primary prevention such as modifications in diet and physical activity and control of GERD symptoms may be able to slow this trend.
|
Return to 2008 News Archive Page
|
August 27: Alcohol detox helps head and neck cancer patients, Reuters
By David Douglas
NEW YORK (Reuters Health) - Early recognition and treatment of alcohol withdrawal syndrome can improve the outcomes of patients with head and neck cancer, researchers report in the Archives of Otolaryngology, Head and Neck Surgery.
The alcohol withdrawal syndrome includes several symptoms seen in persons who stop drinking alcohol after continuous and heavy use. Milder forms of the syndrome include seizures, tremulousness, and hallucinations, usually occurring within 6 to 48 hours after the last drink.
"Alcohol withdrawal syndrome in the postoperative, post-traumatic and other inpatient settings is a potentially life-threatening condition that is difficult to identify in its early stages and difficult to treat in its later stages," senior investigator Dr. Theodoros N. Teknos told Reuters Health.
"In this study," he added, "we employed a standardized treatment protocol which identified at-risk patients early and began treatment at the first signs of alcohol withdrawal syndrome."
Teknos of the University of Michigan Health System, Ann Arbor, and colleagues screened postoperative patients, initially using an alcohol consumption questionnaire, and identified 26 at risk for alcohol withdrawal syndrome.
Two of the selected patients showed no signs of alcohol withdrawal syndrome and three who did not meet alcohol withdrawal syndrome criteria were enrolled late after they began to develop symptoms.
Compared with 14 untreated patients who were seen before the new protocol began, the treated patients had significantly fewer alcohol withdrawal syndrome-related transfers to the intensive care unit. There was also less delirium, lower rates of breathing arrest and less violent behavior.
However, the late enrollees, say the investigators, "showed many significantly worse outcomes" than those who were identified by the initial screening.
With early screening and treatment for alcohol withdrawal syndrome, concluded Teknos, "We saw significant improvements in patient outcomes and we believe that universal application of such approaches may improve patient and health care provider safety in our nation's hospitals."
|
Return to 2008 News Archive Page
|
August 29: Now hear this: Leave your earwax alone, msnbc
New guidelines give doctors, patients the scoop on the golden stuff
By Jeanna Bryner
The gooey, golden stuff that builds up inside your ears should stay there, according to national guidelines on earwax removal released today.
"[Earwax] is not intrinsically evil stuff, and consequently does not have to be removed merely because it's present," said Peter Roland, an ear, nose and throat doctor at the University of Texas Southwestern Medical Center at Dallas. "In fact, it serves a function and so if you don't need to take it out, you should just leave it alone."
Roland chaired a panel of doctors in charge of the new guidelines for earwax removal issued by the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF). The guidelines are intended to serve two purposes: to determine under what circumstances earwax needs to be removed, and to give doctors the scoop on which removal methods work best.
They hope the guidelines won't fall on deaf ears: About 12 million people a year in the United States seek medical care for impacted or excessive earwax. Impaction, they say, can cause pain, pressure, itching, foul odor, ringing of the ears, ear discharge and, in extreme cases, hearing loss.
Good-for-you goo
There's a reason for the goo. Earwax is a self-cleaning agent, with protective, lubricating and antibacterial properties, doctors say.
That's why tiny glands in the outer ear canal constantly pump out a watery substance, which gets mixed with bits of dead hair and skin and together is called earwax or cerumen. Excess earwax normally treks slowly out of the ear canal, with an extra boost from chewing and other jaw movements, carrying with it dirt, dust and other small particles from the ear canal. Then, dried-up clumps of the stuff fall out of the ear opening.
When this natural earwax train malfunctions, or when individuals poke around in their ears with cottons swabs or other foreign objects such as bobby pins or matchsticks, earwax can build up and block part of the ear canal.
"Then there are lots of people wearing earplugs for one reason or another, either because they've got hearing aids or they're transcriptionists at work or because they're addicted to their walkman," Roland told LiveScience, "and that can increase the likelihood that the wax doesn’t come out on its own."
Older adults are more prone to earwax buildup then younger individuals.
"The wax gets much thicker and drier, and plus you actually end up with more hair in your ear, when you're older, and so it traps it," Roland said.
He added, "Unfortunately, many people feel the need to manually 'remove' cerumen from the ears. This can result in further impaction and other complications to the ear canal." He said the saying, "Don't put anything smaller than your elbow in your ear," holds true.
Leave your ears alone
For the everyday individual, the new guidelines suggest you leave your ears alone unless you experience symptoms that you think are associated with too much earwax.
"If they're going to do something at home, they should probably use drops of some sort," Roland said. The panel found no evidence that one type of over-the-counter drops works better than another, or better than just plain sterile water or sterile saline, he said.
The drops help to loosen the earwax and then the ear often can do the rest, he added.
The guidelines also state that cotton-tipped swabs or other objects should not be used to remove earwax. Oral jet irrigators and the alternative medicine technique called ear candling are also strongly advised against.
Ear candling involves making a hollow tube from fabric and soaking that in warm beeswax, which is cooled and hardens. Once cooled and hardened, the beeswax cone is stuck into the ear. The outer end of the tube is lit and burns for about 15 minutes, a process that supposedly draws the wax out of the ear.
Studies have shown, however, that the drawn-out stuff is material from the candle itself. Doctors have also reported seeing patients who have burned the outer parts of their ears with this method.
If the drops don't relieve your symptoms, or if you dislike drops but still have symptoms, it's time to see a doctor, Roland said.
The panel found that three common techniques for earwax removal at the doctor's office work best, with no single method outshining the others. These include flushing the ear out with a water solution; manually removing the earwax under a microscope using medical instruments; and sending the patient home with ear drops.
While at the doctor's office, Roland urges patients not to be embarrassed by a little earwax.
"I get a lot of people in here who are horrified when I see a little wax in their ear, and then they start apologizing for being dirty and they're just very upset it's present at all," Roland said. "And I think the big message there is that it has a physiological function, and unless there's a reason to remove it, you should just leave it alone. It's OK."
|
Return to 2008 News Archive Page
|
August 30: Treatment For Hearing Loss? Scientists Grow Hair Cells Involved in Hearing, ScienceDaily
ScienceDaily (Aug. 30, 2008) — Oregon Health & Science University scientists have successfully produced functional auditory hair cells in the cochlea of the mouse inner ear. The breakthrough suggests that a new therapy may be developed in the future to successfully treat hearing loss. The results of this research was recently published by the journal Nature.
“One approach to restore auditory function is to replace defective cells with healthy new cells,” said John Brigande, Ph.D., an assistant professor of otolaryngology at the Oregon Hearing Research Center in the OHSU School of Medicine. “Our work shows that it is possible to produce functional auditory hair cells in the mammalian cochlea.”
The researchers specifically focused on the tiny hair cells located in a portion of the ear’s cochlea called the organ of Corti. It has long been understood that as these hair cells die, hearing loss occurs. Throughout a person’s life, a certain number of these cells malfunction or die naturally leading to gradual hearing loss often witnessed in aging persons. Those who are exposed to loud noises for a prolonged period or suffer from certain diseases lose more sensory hair cells than average and therefore suffer from more pronounced hearing loss.
Brigande and his colleagues were able to produce hair cells by transferring a key gene, called Atoh1, into the developing inner ears of mice. The gene was inserted along with green florescent protein (GFP) which is the molecule that makes a species of jellyfish glow. GFP is often used in research as a “marker” that a scientist can use to determine, in this case, the exact location of the Atoh1 expression. Remarkably, the gene transfer technique resulted in Atoh1 expression in the organ of Corti, where the sensory hair cells form.
Using this method, the researchers were able to trace how the inserted genetic material successfully led to hair cell production resulting in the appearance of more hair cells than are typically located in the ears of early postnatal mice. Crucially, Dr. Anthony Ricci, associate professor of otolaryngology at the Stanford University School of Medicine, demonstrated that the hair cells have electrophysiological properties consistent with wild type or endogenous hair cells, meaning that the hair cells appear to be functional. Based on these data, the scientists concluded that Atoh1 expression generates functional auditory hair cells in the inner ear of newborn mammals.
“It remains to be determined whether gene transfer into a deaf mouse will lead to the production of healthy cells that enable hearing. However, we have made an important step toward defining an approach that may lead to therapeutic intervention for hearing loss,” Brigande said.
|
Return to 2008 News Archive Page
|
|
|
|
|
|
|
|
100 South Ellsworth Avenue, Suite 308, San Mateo CA 94401
tel 650/344 6896 fax 650/344 2794
|
|
805 Veterans Boulevard, Suite 115, Redwood City CA 94063
tel 650/369 1619 fax 650/474 2997
|
|
|
|
|
|
|
