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August 2010 News Archives
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August 3: Traditional treatment called ear candling gains popularity despite warnings, The Washington Post
Brenda Thompson gets a treatment called ear candling from Schyla Poyndexter-Moore at the Secrets of Nature restaurant and health-food store in the District.
A hollow candle, or a piece of fabric soaked in beeswax or paraffin, is placed in the ear canal with a paper plate resting on the head to prevent burns from the wax. Then, the candle or fabric is lit. According to its supporters, the practice is a remedy for removing earwax and cures ailments such as ear infections, sinusitis, migraines, postnasal drip and cancer, and improves general health.
The origin of this technique is unknown, but some say it can be traced to the era before Christ, to ancient Egypt and/or India. Within the past decade, its popularity has increased. Beauty salons and spas offer candling, also known as ear coning and thermal auricular therapy, and kits are available at health-food stores and flea markets.
Medical research, however, holds that the practice is both ineffective and dangerous. It showed up in February on the Food and Drug Administration's equivalent of the FBI's most-wanted list.
The FDA has received reports of burns, perforated eardrums and ear-canal blockages that required outpatient surgery from the use of ear candles. Particular concern has been voiced over the practice of coning on children. Because kids tend to move around more, the likelihood of their being burned is higher, and their smaller ear canals may make them more susceptible to injury.
What's more, earwax, which candling is supposed to remove, is a good thing, according to data. Wax traps dirt, debris and dust and contains antimicrobial agents to stave off infection.
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August 13: Can cancer patients benefit from new drug trials?, Reuters
By Genevra Pittman
NEW YORK (Reuters Health) - Patients with advanced head and neck cancer survived just as well on experimental drugs as they did on FDA-approved standard therapies in a new study.
These patients were part of phase I trials, an early step in the approval phase for a new drug and often the first time that drug is tested in humans. There has been controversy over whether advanced cancer patients - many of them desperate for any possible chance to get better - are getting taken advantage of in such trials, or whether they can really benefit from experimental drugs.
But the findings suggest that doctors should consider referring their terminally ill patients to such trials, the authors say.
"We expect that (the results) will increase enrollment of these patients in phase I clinical trials," they write in the journal Clinical Cancer Research.
Dr. Ignacio Garrido-Laguna at The University of Texas M.D. Anderson Cancer Center in Houston and colleagues tracked 61 patients that had participated in phase I trials at their center over a five-year period. Fifty-nine of those patients had been on FDA-approved drugs before the start of the trials. The researchers calculated how long these patients had survived on their most recent treatment without their cancer getting worse. Then they made the same calculation of how well patients did on the experimental phase I drugs.
Patients survived an average of 12 weeks on FDA-approved treatments and 10.7 weeks on experimental drugs before their cancer progressed - outcomes that were not statistically different.
Four patients had some improvement in their cancer in response to the experimental drugs and 34 of them had no changes in their disease during drug trials. One patient died from a cause related to the treatment.
The point of phase I trials is to help researchers make sure that a drug is safe and to determine what the best dose is. Because these trials are not supposed to test whether the drug actually works - that comes later - "patients enrolled in them were rarely expected to derive benefit," the authors write.
That may be changing as researchers get more tools to match patients with the right drug for their type of cancer, possibly improving the odds that they'll benefit from the treatment, the authors say.
Still, some researchers and ethicists are wary of whether very sick patients are being given false hope.
"There are worries about whether people who are vulnerable in this way are able to give informed consent" to participate in a trial, Dr. Franklin Miller, a bioethicist at the National Institutes of Health in Bethesda, Maryland, who has written on phase I cancer trials, told Reuters Health. For researchers who are explaining drug trials to patients, "you have to be very careful," he said.
There is also the question of whether you can really tell if someone benefited from being in a phase I trial, Miller said. Since these studies have no control group - a set of similar patients that isn't getting the treatment - there's no way of knowing if any positive outcomes were really a result of the drug, especially when the positive outcome being measured is how long someone's disease was stable, he said.
But Miller thinks that the desire to join a phase I trial is a natural one for people who are dying of cancer. "They've exhausted all the (treatments) that are available and standard," he said. If they want to keep fighting the cancer, he said, "there really isn't any better option for them. I think this is genuinely what many people want to do."
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August 17: Early Care Urged for Patients With Trouble Swallowing, Bloomberg Businessweek
'Dysphagia' significantly impacts hospital resources and patient outcomes, researchers say
(HealthDay News) -- Difficulty swallowing (also called dysphagia) is associated with poor outcomes in hospital patients, researchers warn.
"The consequences of dysphagia can be profound. Although it is appreciated that nutrition, hydration, quality-of-life issues and social isolation may arise, aspiration (especially if not immediately recognized) may be the pivotal factor that precipitates a significant decline in a patient's outcome," wrote Dr. Kenneth W. Altman, of the Mount Sinai School of Medicine in New York City, and colleagues. An example of aspiration is when food gets into the airway.
In their study, the researchers analyzed data from nearly 272,000 dysphagia-related hospital admissions that were recorded in the 2005-2006 National Hospital Discharge Survey.
"Dysphagia was most commonly associated with fluid or electrolyte disorder, esophageal disease, stroke, aspiration pneumonia, urinary tract infection and congestive heart failure," the researchers wrote.
The investigators also found that being over 75 years of age was linked to a doubled risk of dysphagia.
The median number of days spent in the hospital was 40 percent longer for patients with dysphagia than for other patients -- 4.04 days versus 2.4 days. Among patients undergoing rehabilitation, the risk of death was 13 times higher for those with dysphagia, which also increased the risk of death among patients with intervertebral disk disorders and heart disease.
"While dysphagia occurs in only a small portion of hospitalized patients, the impact on hospital resources is substantial," the researchers concluded. "We recommend early identification of dysphagia in hospitalized patients, particularly in those with high-risk [coexisting] conditions such as older age, stroke, dehydration, malnutrition, neurodegenerative disease, pneumonia, cardiac disease and the need for rehabilitation. The plan of care in these patients should include proper assessment, early intervention using appropriate therapy and aspiration precautions, and consideration of [alternate] feeding or supplementation options in the high-risk populations."
The study findings are published in the August issue of the journal Archives of Otolaryngology -- Head & Neck Surgery.
More information
The U.S. National Institute on Deafness and Other Communication Disorders has more about dysphagia.
-- Robert Preidt
SOURCE: JAMA/Archives journals, news release, Aug. 16, 2010
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August 18: Hearing loss on rise among U.S. teenagers, HealthNews
BY MONIFA THOMAS Health Reporter
One in five American teenagers already has some degree of hearing loss -- a figure that's risen sharply since the late 1980s, new research has found.
Why isn't clear, though the period the researchers looked at has seen the rise of portable music players and earbuds.
The researchers from Brigham and Women's Hospital in Boston used government survey data to compare rates of hearing loss among 12- to 19-year-olds during the period 1988 to 1994 with the period 2005 to 2006 and found the number of teens with impaired hearing in at least one ear rose to 20 percent from 15 percent, according to a report in today's Journal of the American Medical Association.
In most cases, the hearing loss was slight.
Still, the findings are troubling since "hearing loss is usually permanent and potentially progressive," study co-author Dr. Gary C. Curhan said. "Even mild degrees of hearing loss in children can have an impact on their educational performance and their social interactions." The researchers also found that males and those living in poverty were more likely to experience hearing loss than other teens.
Extended exposure to very loud noises, including loud music, can cause permanent hearing loss. A recent study of children in Australia found a 70 percent increased risk of hearing loss with the use of personal stereo devices. Genetics also play a role, though "it would be hard to imagine" heredity alone is responsible for the increase in hearing loss, said Dr. Nancy M. Young, a children's ear specialist at Children's Memorial Hospital in Chicago, who was not involved in the research.
Young said parents who notice changes in their child's hearing -- especially in the ability to hear when there's background noise -- should consider taking their child for a hearing test.
"There are many teens who will not ask for help or say they have a problem," she said.
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August 20: Study: Hearing Loss Increases in Teens, NPR
On August 17, 2010 NPR did a story on hearing loss in US teenagers. NPR did not interview an ENT physician for this piece; they only interviewed an audiologist for the story. Please read the response letter that was sent to NPR by Member-At-Large, AAO-HNSF Board of Governors, Sujana Chandrasekhar, MD.
Dear NPR,
I am an avid listener and contributor to NPR. I value it for the new knowledge it brings me, and
for the accurate way NPR delivers stories on a myriad of topics.
However, I was perturbed by your piece on hearing loss in US teenagers on 8/20/10's ATC show,
hosted by Michele Norris and Robert Seigel, and reported by Patty Neymand.
The paper referred to in the piece appeared in JAMA this week. There are 4 authors, all MDs,
two of whom are otolaryngologists (ear-nose-throat physicians and surgeons). None of the
authors is an audiologist. The conclusion of the paper is that, yes, there is a disturbing increase in
the prevalence of hearing loss in US teens based on two large national surveys, one conducted
from 1988-94, and the other from 2005-6, but the reasons for the increase are not clear and must
be investigated more thoroughly. The paper also points out that medical causes for the hearing
loss, such as conductive hearing loss, wax, otitis media, etc. were not tested for and cannot be
excluded.
It is a well-written paper that raises a very serious issue to the national spotlight. There are
myriad causes for hearing loss, including cerumen (wax), foreign body entrapment in the ear
canal, otitis media and externa (ear infections),congenital hearing loss, inner ear malformations,
labyrinthitis, ossicular abnormalities, cholesteatoma, idiopathic sudden hearing loss, and noiseinduced
hearing loss (NIHL), to name a few. The best qualified professionals for thorough
evaluation of hearing, hearing loss and its causes are otolaryngologists - ear-nose-throat
specialists - physicians who are subspecialty trained in this field.
NPR did not interview an ENT physician for this piece; instead, you only interviewed an
audiologist. You called her Dr. Alison Grimes and stated that she 'sees patients and does
audiological tests' at UCLA Medical Center. Alison Grimes is not a medical doctor, a fact which
was never pointed out in the NPR piece. She has a doctorate in Audiology, the science of testing
hearing and balance. She is not able, by law, to make diagnoses or offer treatments. She cannot
determine the cause of hearing loss and cannot intervene to correct it, unless a medical doctor
clears the patient for fitting for amplification, such as hearing aids. Audiologists are valuable
members of the hearing healthcare team, but they are not physicians and it is very important that
patients and the public are made aware of this important distinction.
For me, as a practicing otolaryngologist with subspecialty in otology/neurotology (disorders of
the ear/hearing/balance/lateral skull base), the take-home message from this paper was that
physicians - primary care as well as ENTs-, nurses, school health personnel, and audiologists -
all members of a teen's hearing healthcare team - have to be much more proactive in examining
ears and treating obvious problems, checking for metabolic, endocrine, or infectious diseases that
can cause hearing loss, counseling parents, teens and children regarding hearing health and
avoidance of noise exposure, proper diet and exercise to maintain ear health, and being alert to
the higher probability of hearing loss in a heretofore unheralded at-risk population.
There are a number of patient-centered information leaflets available on ear function and
disorders at the American Academy of Otolaryngology-Head and Neck Surgery website, which
you might wish to peruse at entnet.org/HealthInformation/ears.cfm.
You can also learn more about my specialty at
entnet.org/healthinformation/AboutOtolaryngology.cfm.
Thank you for your attention. I look forward to continuing to enjoy NPR and its reporting, and
hope that you will stay alert to very important patient protection issues such as the one I raised
here regarding 'truth in advertising' of audiologists as audiologists and not as physicians.
Sincerely,
Sujana Chandrasekhar, MD, FACS, FAAO-HNS
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August 21: Heavy snorers more prone to heart condition: Study, The Time of India
NEW DELHI: Do you snore loudly? If so, then get a sleep study done.
A latest study -- conducted by the All India Institute of Medical Sciences and Fortis Hospital -- has found that heavy snorers face a tremendously high risk of suffering from metabolic syndrome - a combination of medical disorders that shoots up your chances of suffering from cardiovascular diseases.
In a study "Obstructive Sleep Apnea is Independently Associated with the Metabolic Syndrome" published in the US medical journal "Metabolic Syndrome and Related Disorders", Dr Randeep Guleria from AIIMS and Dr Anoop Misra from Fortis have found that 67% of patients with Obstructive Sleep Apnea (OSA) suffer from metabolic syndrome.
In comparison, around 40% patients, who don't suffer from OSA, are plagued with metabolic syndrome.
When an obese person, featured in the study with OSA, was pitted against his counterpart, not suffering from OSA, the former had a 190% increased possibility of suffering from metabolic syndrome.
"The study has found that those who suffered from severe OSA had a 80% chance of suffering from metabolic syndrome. It shows that OSA is a serious independent risk factor, and should be treated immediately. Those suffering from OSA must undergo a sleep study, get oxygen therapy and lose weight in order to avoid heart disease."
The metabolic syndrome is characterized by a group of metabolic risk factors in a person. They include Abdominal obesity (excessive fat tissue in and around the abdomen), Atherogenic dyslipidemia (blood fat disorders high triglycerides, low HDL cholesterol and high LDL cholesterol that foster plaque buildups in artery walls), elevated blood pressure, Insulin resistance or glucose intolerance (the body cannot properly use insulin or blood sugar), and elevated C-reactive protein in the blood.
Those suffering from metabolic syndrome are at an increased risk of coronary heart disease, and other ailments related to plaque buildups in artery walls like stroke and peripheral vascular disease and Type 2 diabetes.
The metabolic syndrome has become increasingly common in India.
"Obesity and the metabolic syndrome are rapidly increasing in developing countries. Whether the metabolic syndrome is independently associated with obstructive sleep apnea was not clear. This study investigated the association between OSA and the metabolic syndrome in obese Asian Indians. We studied 240 obese subjects with body mass index greater than 25 kg/m, 121 with OSA and 119 without OSA, matched for age, BMI and percentage body fat. Full-montage digital polysomnography, fasting blood glucose (FBG), lipid levels, and blood pressure ( BP) were done in all subjects. Our conclusion is that OSA is independently associated with the metabolic syndrome in Asian Indians in northern India," Dr Mishra said.
Sleep apnea is a condition in which people stop breathing for long stretches in their sleep. Nearly 60% of those who snore suffer from sleep apnea, a debilitating breathing disorder that results in cessation of breathing for 10 seconds, at least five times per hour of sleep.
In India, 36 million people are expected to suffer from OSA.
According to experts, 90% of people who have sleep apnea don't know that they have it.
Usually, it is the bed partner who first notices that the person is struggling to breathe during sleep.
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