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Ear, Nose & Throat Associates |
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September 2008 News Archives
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September 22: Sweet smells foster sweet dreams, BBC News
Smells may influence the emotion of the dream
Sleep with flowers in your bedroom if you want sweet dreams, work suggests.
When the smell of roses had been wafted under the noses of slumbering volunteers they reported experiencing pleasant emotions in their dreams.
An odour of rotten eggs had the opposite effect on the 15 sleeping women, the German scientists found.
They told a Chicago meeting of the American Academy of Otolaryngology that they now plan to study people who suffer from nightmares.
Sweet dreams
It is possible that exposure to smells might help make their dreams more pleasant, believe Professor Boris Stuck and his team from the University Hospital Mannheim.
They waited until their subjects had entered the REM phase of sleep, the stage at which most dreams occur, and then exposed them to a high dose of smelly air for 10 seconds before waking them up one minute later.
"Smell is the only sense that doesn't 'sleep'" - Professor Tim Jacob, an expert in smell and taste at Cardiff University
The volunteers were then quizzed about the content of their dreams and asked how it made them feel.
The sleeping women hardly ever dreamed of smelling something. Nevertheless, the emotional tone of the dream did change depending on the stimulation.
Previous research has shown that other types of stimulation, such as sound, pressure or vibration, can influence the content and the emotional tone of dreams.
Dr Irshaad Ebrahim of The London Sleep Centre said: "The relationship between external stimuli and dreaming is something we are all at some level aware of.
"This initial research is a step in the direction towards clarifying these questions and may well lead to therapeutic benefits."
Professor Tim Jacob, an expert in smell and taste at Cardiff University, said: "Smell is the only sense that doesn't 'sleep'. Information continues to reach the limbic system of the brain and that includes the hippocampus, or memory area and the amygdala, that is involved with emotional response.
"Other senses have to pass through the 'gate' of the thalamus, which is closed when we sleep."
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September 22: Acid Reflux Linked to Chronic Croup, Washington Post
By Steven Reinberg
HealthDay Reporter
SUNDAY, Sept. 21 (HealthDay News) -- Children who have continuing recurrence of croup could be suffering from stomach acid reflux problems, University of Utah researchers report.
Croup is typically recognized by a loud cough that often sounds like the barking of a seal. The condition can cause fast or difficult breathing, and sometimes wheezing. Croup has been thought to be caused by a virus, but upper airway problems have also been suggested as a possible trigger.
"We did find a number of children that had congenital narrowing of the upper airway," said study lead researcher Dr. Harlan R Muntz, a professor of pediatric otolaryngology. "In addition, a number of children have findings that appear to indicate that they have gastroesophageal reflux disease."
In gastroesophageal reflux disease, stomach acid causes swelling and inflammation of the larynx, which narrows the airway, Muntz explained. "More importantly, it can trigger more swelling with any kind of viral or respiratory infection," he said.
Muntz thinks that identifying children with gastroesophageal reflux disease could help treat and improve recurring croup. He was expected to present the findings Sept. 21 at the American Academy of Otolaryngology -- Head and Neck Surgery Foundation annual meeting, in Chicago.
For the study, Muntz's team used endoscopy -- a tiny camera attached to a long, thin tube -- to evaluate the airways of 80 children with recurrent croup. The researchers found that 33 percent of the children had narrowing of the airway, and 19 of those children had gastroesophageal reflux disease.
The researchers then treated the children with gastroesophageal reflux disease for one year, and 14 showed improvement in croup, Muntz said.
Muntz said it's unusual for a child to have three or more bouts of croup over a short period of time. "These children need to be evaluated to make sure we know what's happening, and if they have reflux that that's treated to help reduce the frequency and severity of the episodes of croup," he said.
Dr. Dennis Scolnik, a staff physician in the divisions of pediatric emergency medicine and clinical pharmacology & toxicology at the University of Toronto, said he thinks the new study findings may apply to just a small number of croup patients. And, he added, he's concerned that too many children with croup might undergo endoscopy, and cases of asthma could be missed.
"The vast majority of croup is caused by viral infections, and this applies even to recurrent cases," Scolnik said. "This study presents insights into the rare patients with frequently recurrent croup severe and significant enough to warrant endoscopy," he said.
More information
For more on croup, visit the U.S. National Library of Medicine.
SOURCES: Harlan R. Muntz, M.D., professor of pediatric otolaryngology, University of Utah, Salt Lake City; Dennis Scolnik, M.B., staff physician, divisions of pediatric emergency medicine and clinical pharmacology & toxicology, University of Toronto, Ontario, Canada; Sept. 21, 2008, presentation, American Academy of Otolaryngology -- Head and Neck Surgery Foundation annual meeting, Chicago
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September 23: A voice for the elderly, Los Angeles Times
Lots of things change as we get older — our hair turns gray, our skin wrinkles, and we become more forgetful.
Our voice may alter, too, from a once robust tone to a weaker timbre. While some voice changes are a normal part of aging, others could be a sign of something more serious.
ElderlyA recent study found that among 248 people in their 80s, almost 20% had dysphonia, meaning hoarseness or other voice changes such as weakness or loss of voice. In addition, 14% had dysphagia, or painful swallowing. Despite that, more than 75% of the respondents hadn’t looked for treatment, although more than half were interested in getting it.
"The interesting thing is that they’re not doing much about it," says Dr. Seth Cohen, associate professor of otolaryngology and head and neck surgery at the Duke Voice Care Center in Durham, N.C. He’s also lead author of the study that was presented at American Academy of Otolaryngology-Head and Neck Surgery this week in Chicago. "The most common reason they gave was that they weren’t aware there was anything they could do about it. We now know there is a big barrier on the patient’s side."
Voice changes, Cohen adds, can stem from weakened muscles or allergies, or more acute conditions such as neurological problems. Treatments are available, and not all are invasive. "Just because you’re getting older doesn’t mean you should ignore [symptoms]," he says. But voice or swallowing problems can also affect quality of life. In the study, more severe swallowing problems were associated with worse voice-related quality-of-life issues. Those with both dysphonia and dysphagia scored higher on a depression scale that those with neither symptom.
The findings bring up a couple of issues: Cohen believes better screening programs are needed to assess voice and swallowing problems in the elderly that may get overlooked by their primary care physicians, and family and friends may need to serve as advocates for their elderly loved ones.
"Lots of things change as we age — physically, emotionally, economically — and people need to have a good quality of life," Cohen says. "We’re trying to understand and meet those needs, but it’s important for the public to grasp these concepts as well."
-- Jeannine Stein
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September 23: Early Clinical Stage of Recurrent Squamous Cell Carcinoma of the Mouth and Oropharynx Is a Significant Prognostic Factor for Salvage Surgery: Presented at AAO-HNSF, Peer View Media Bar
By Mary Beth Nierengarten
CHICAGO -- September 23, 2008 -- For patients with squamous cell carcinoma of the upper airways and digestive system being treated with curative intent, early clinical stage of the locoregional recurrence is one of the most significant prognostic factors associated with salvage therapy, according to results of a study presented at the American Academy of Otolaryngology - Head and Neck Surgery Foundation (AAO-HNSF) 2008 Annual Meeting & OTO EXPO.
"Early clinical stage of recurrence enables a higher likelihood of indication for salvage treatment," said lead author Helma Maria Chedid, MD, Department of Head and Neck Surgery and Otolaryngology, Hospital Heliopolis, São Paulo, Brazil, who presented the study on September 21.
"If locoregional recurrence is identified at an early stage, salvage surgery is undoubtedly the first-choice treatment," Dr. Chedid said.
To identify prognostic factors for salvage surgery and assess the disease-free survival interval after salvage treatment for recurrent squamous cell carcinoma of the mouth and oropharynx, Dr. Chedid and colleagues retrospectively examined 127 patients treated with surgery for carcinoma of the oral cavity (n = 90) or oropharynx (n = 37).
In the study, all patients were initially treated with surgical curative intent and had a histological confirmation of locoregional squamous cell carcinoma recurrence. Postoperative radiotherapy was given to 53 patients at a mean dose of 59.8 Gy.
After an average follow-up period of 35.3 months, 76 of the 127 patients underwent salvage surgery, with 22 also receiving postoperative radiotherapy and 13 receiving only salvage chemoradiotherapy. Of the 127 patients, 25 had clinical stage I disease, 11 had stage II disease, 16 had stage III disease, and 71 had stage IV disease.
Salvage therapy involved the mouth in 65% of patients owing to the higher predominance recurrence in that region.
The main indication for salvage surgery was early clinical stage of locoregional recurrence. Significantly more patients with clinical stage I/II recurrent disease received salvage surgery compared with those who did not (33 vs 3, P = .0001).
Other factors also independently associated with receiving salvage surgery on univariate analysis were the site of tumour recurrence, initial clinical stage, and previous radiotherapy. On multivariate analysis, clinical stage of locoregional recurrence, site of primary tumour, and previous radiotherapy remained independent clinical prognostic factors.
The study also found that disease-free survival after salvage was significantly associated with time to recurrence. Disease-free survival was 13% for patients with recurrence within 6 months, 40% for those with recurrence between 6 and 12 months, and 48% for those with recurrence >12 months after treatment (P = .0001).
Based on these results, Dr. Chedid emphasised the need to perform outpatient consultations every month during the initial 18 months after treatment and then bimonthly up to the third year. After that, she suggested follow-up every 3 months up to 5 years and every 6 months thereafter.
"Follow-up for patients with squamous cell carcinoma is of fundamental importance," said Dr. Chedid. "Emphasis has been placed on disease with early clinical stage, as this is considered to be a priority for a rapid approach [to treatment]."
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September 24: A Honey of a Sinusitis Treatment, The Washington
By Steven Reinberg
HealthDay Reporter
WEDNESDAY, Sept. 24 (HealthDay News) -- Honey may help bring sweet relief to chronic sinusitis sufferers, new Canadian research suggests.
Scientists say natural germ fighters in honey attack the bacteria that cause the discomforting disorder.
"Honey has been used in traditional medicine as a natural anti-microbial dressing for infected wounds for hundreds of years," noted study co-author Dr. Joseph G. Marsan, from the University of Ottawa.
The objectives of the study were to evaluate the activity of honey on so-called "biofilms," which are responsible for numerous chronic infections, Marsan explained.
"Certain bacteria, mainlyStaph aureusandPseudomonas aeruginosa, have found a method of shielding themselves from the activity of anti-microbials by living in substances called biofilms, which cannot be penetrated by even the most powerful anti-microbials," he said.
The report was to be presented Tuesday at the American Academy of Otolaryngology-Head and Neck Surgery Foundation's annual meeting in Chicago.
In the laboratory, Marsan's team applied honey to biofilms made up of the bacteria that cause sinusitis.
They found that honey was more effective in killing these bacteria than antibiotics commonly used against them.
"Our study has shown that certain honeys, namely the Manuka honey from New Zealand and the Sidr honey from Yemen, have a powerful killing action on these bacterial biofilms that is far superior to the most powerful anti-microbials used in medicine today," Marsan said.
This study has shown that certain honeys may play some role in the management of these chronic infections that are extremely difficult to treat, Marsan said. "This study was carried out in-vitro in the lab and we must now find how to apply this activity in-vivo on lab animals and subsequently on patients," he added.
The Canadian findings echo research published last year in theArchives of Pediatrics and Adolescent Medicine, by a team at Penn State College of Medicine. That group found that honey worked better than commercial cough medicines containing dextromethorphan (DM) in easing children's cough.
But Dr. Ian Paul, director of Pediatric Clinical Research at Penn State and the leader of the cough study, isn't sure how the sinusitis findings would be applied clinically.
"Bacteria do not grow very well in honey," Paul noted. "There is data that honey works well for wounds, in smothering the bacteria that that grow in wounds. So it's not altogether surprising that honey would be effective in killing these bacteria."
However, whether honey could be used clinically to treat sinusitis isn't apparent, Paul said.
"I wonder how they are going to propose using honey, clinically, in sinusitis," Paul said. "I'm wondering how they are proposing it would be curative or helpful in that setting?"
Results of another study, slated to be presented at the meeting Tuesday, show that many patients with sinusitis sufferer from aches and pains that are equal to those experienced by people with arthritis or depression.
Researchers found that endoscopic sinus surgery to relieve the blockage in the sinuses, also significantly people's reduced pain.
"This study highlights an important point: Chronic sinusitis should not be considered as a minor localized disease condition rather, as this study emphasizes, sinusitis can cause serious clinical levels of discomfort in many patients," study co-author Dr. Neil Bhattacharyya, an otolaryngologist and sinus surgeon at Brigham and Women's Hospital and Harvard Medical School, said in a statement.
More information
For more information on sinusitis, visit the U.S. National Library of Medicine.
SOURCES: Joseph G. Marsan, M.D., University of Ottawa, Canada; Ian Paul, M.D., M.Sc., director, Pediatric Clinical Research, Penn State College of Medicine, Hershey; Sept. 23, 2008, presentation, American Academy of Otolaryngology-Head and Neck Surgery Foundation Annual Meeting, Chicago
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September 26: Cochlear Implants In Children A Safe Procedure, Study Suggests, ScienceDaily
ScienceDaily (Sep. 26, 2008) — In the six decades since French and American surgeons implanted the first cochlear hearing devices, the procedure in children has become reliable, safe, and relatively free of severe complications, according to research presented during the 2008 American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) Annual Meeting & OTO EXPO, in Chicago, IL.*
The study, conducted by researchers at the Washington University School of Medicine in St. Louis, MO, determined that out of 155 cases of pediatric implantation between 2001 and 2006, the rate of the most common complications in patients was below 3 percent, with only 25 total complications observed during that period. The most common complication was related to local surgical wounds in the ear flap. Furthermore, the rate of device failure, which was cited as the most common complication in previous studies, was very low in this study.
The researchers stress that it is critical that patients undergo a lifetime of continuous follow-up.
Cochlear implants were introduced by French researchers in the 1950s, with the first American implantation taking place in 1961 in Los Angeles. Since then, an estimated 120,000 patients worldwide have undergone implantation, including over 10,000 children in the United States alone.
*Title: Complications in Pediatric Cochlear Implants. Authors: Anita Jeyakumar, MD, MS (presenter); Randall A. Clary, MD. Date: September 24, 2008.
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