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Ear, Nose & Throat Associates |
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October 2008 News Archives
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October 2: Older ears hear again with cochlear implants, msnbc
More seniors opt for device that can repair profound to severe losses
JoNel Aleccia
Health writer
At age 64, Evelyn Gardner of San Jose, Calif., began avoiding her neighbors because she could no longer hear what they said.
Fred “Woody” Meyer, 74, of Marshalltown, Iowa, grew depressed at having to rely on lip reading and message boards to communicate with family and strangers.
And Betty Coombs, 83, of Banning, Calif., nearly resigned herself to a life of silence when even the most powerful hearing aids weren’t powerful enough.
“I had about given up on expecting miracles,” Coombs said.
Six years later, however, all three can hear well enough to talk on the phone, recognize family voices and relish the sounds of wind and rain, thanks to cochlear implants, tiny electronic devices able to restore hearing to ears of any age.
They’re among growing numbers of seniors turning to the quarter-sized implants and external processors to restore communication and connection — and to prove that a slow descent into deafness is not an inevitable consequence of aging.
“If I could have realized how wonderful it would be, I would have had champagne at my hookup,” said Coombs, now 89.
Of some 33 million hearing-impaired people in the United States, perhaps 1 million suffer from the severe to profound losses that can be helped by the implants, said Dr. Bruce Gantz, professor and head of the University of Iowa’s Department of Otolaryngology.
That likely includes a burgeoning number of aging baby boomers whose hearing was squandered by loud music, loud traffic, road construction and other sources of noise pollution that have flourished in the last century, he said.
Still, only about 100,000 people in the U.S. have implants, which have been approved by the federal Food and Drug Administration since 1985 in adults and since 1990 in children. The fastest growth is among children younger than age 5, but increasingly, people older than 60, 70 — even 90 and beyond — are getting the devices that correct hearing structures damaged by disease or injury.
This year, a 105-year-old woman from Hartford, Conn., was implanted with a model from Advanced Bionics of Valencia, Calif., one of the three large manufacturers who supply the global market. Together with the Australian firm Cochlear and MED-El of Austria, the firms have implanted at least 220,000 people worldwide, company figures indicated.
Age is no limit
“Age is not necessarily a factor in how you’re going to do,” said Dr. Patrick Maiberger, a resident at the Virginia Commonwealth University School of Medicine.
He’s the co-author of a recent study presented at the annual meeting of the American Academy of Otolaryngology — Head and Neck Surgery that showed that quality of life improved for people older than 55 who received cochlear implants, even when those people also suffered from chronic diseases of aging, including high blood pressure, diabetes and heart disease.
“What it does is take people who have not benefited from the most powerful hearing aids and lets them have a conversation, talk on the phone, watch TV, even listen to music,” Maiberger said. “It’s not what God gave us, but it’s as close as we can get.”
A cochlear implant artificially stimulates the cochlea, a tiny, shell-shaped organ in the inner ear that allows hearing. The device is made up of two systems: an external system that collects and transmits sounds, and an internal system that translates them into electrical pulses that stimulate the auditory nerve and travel directly to the brain, where they’re perceived as hearing.
Each implant costs about $29,000, with total fees typically ranging from $60,000 to $70,000. Medicare, Medicaid and most private insurers typically cover the costs for qualifying patients. To qualify, people must have profound to severe hearing loss in both ears and be able to recognize fewer than 40 percent of words on a special test conducted in a quiet room with the best hearing aids they have.
Gantz and others grumble at those limits, which they say may penalize people who are on the border of deafness. “You put them in a little noise and they can’t hear at all,” he said.
Unlike hearing aids, which only amplify sound, cochlear implants help users distinguish sounds, particularly those in the higher register, which is essential to comprehension, experts say.
“It was like listening to a sentence made entirely of vowels,” Brenda Battat, executive director of the Hearing Loss Association of America, who received a cochlear implant four years ago at age 62.
Isolation, depression common
Like many older people who choose implants, Battat grew increasingly frustrated with the impact of her hearing loss on her personal and professional life.
“It got to where I couldn’t use the phone, I couldn’t watch TV without captions, I couldn’t go to movies without captions,” said Battat, who has a hereditary hear loss that started in her 20s and gradually got worse.
Even the most gregarious people find themselves increasingly socially isolated, said Evelyn Gardner, the San Jose woman who got her first implant two years ago, at age 64, and another one last summer. Her hearing loss was sparked by Meniere’s disease, an inner ear disorder, diagnosed at age 21.
“I know what it’s like to be in an area where people are laughing and you have no idea what they’re laughing about,” said Gardner, a fabric designer who considers herself a positive, outgoing person. “I was becoming very introverted and sad.”
Woody Meyer, a 77-year-old former ham radio operator, said his hearing loss began with a bout of tinnitus in his mid-50s, worsened with Meniere’s disease and finally left him totally deaf by age 74. Losing his hearing was a slow spiral into a world of silence, he said.
“I would struggle to hear, and try to memorize bird calls and other noises,” he said. “Depression is a real downer for individuals, especially myself.”
The best candidates for cochlear implants are people like Gardner and Meyer who previously could hear and speak and who seek implants soon after becoming deaf, Gantz said. The worst candidates are people who grew up primarily using sign language to communicate and never really learned sound, and those with a very long history of deafness, he noted.
“If you are 65 and lose your hearing and then at 75 you get implanted, you do well,” he Gantz. “If you have 40 years of deprivation from sound, you’re not going to do as well.”
People have to be motivated to undergo the surgery and willing to keep up with frequent adjustments, called mapping, that maintain the device. They also have to be able to withstand the physical demands of the average 90-minute surgery, including anesthesia, and they need to watch out for risks of infection. If the device fails, as it does in about 2 percent of recipients, all hearing in that ear will be lost. Other than that, there are no limits, Gantz said.
‘Can you hear me now?’
It typically takes several weeks between the time the device is surgically implanted and the time the receiver is turned on. Almost universally, implant recipients consider their “hookup” a transformative event.
“I heard this little tiny voice saying ‘Can you hear me now?’” said Meyer, recalling the voice of his technician. “I’ll never forget it.”
Ordinary noises were overwhelming at first, people with implants said. Car tires on a road. Rain on a windshield. Electronic alarms on everything from washing machines to toasters.
“My goodness, the whole world was talking to me, all these objects,” Battat recalled. “Everything beeps.”
Gradually, though, recipients were able to recognize — and appreciate — the sounds they’d missed.
“I knew exactly what my husband’s voice should sound like,” Gardner said, adding later: “There’s nothing like going outside and hearing the birds and the wind and the rain.”
Although cochlear implants have been available for more than two decades, few seniors seem aware of the device — or its potential to ease one of the hardships of aging, Battat said.
“It may be based on an old-fashioned idea that when you get older, you don’t need to hear so much,” she said. That’s ridiculous, she added, especially considering that people are living so much longer than they once did.
“You could be talking another 20 to 30 years of active life,” Battat said. “That’s a long time not to hear.”
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October 6: Runny Nose Was First Sign of Deadly Ailment, ABCnews
Student Overcoming Life-Threatening Illness
By JOSEPH BROWNSTEIN
ABC News Medical Unit
David Cosner has changed a lot since the summer of 2006—ever since he first noticed a runny nose while attending a motorcycle race in California.
He suspected a cold and when he and his family returned to Austin, Texas, he had his condition checked out.
A series of cold and sinusitis diagnoses followed. Cosner said he visited more doctors than he can remember--a number he places somewhere between 15 and 50 visits.
But it was clear that what he had was far worse than the common cold.
"I was feeling horrible, I was losing lots of weight," Cosner recalled.
The 6-foot-4, 164 pound lacrosse player dropped to 132 pounds, and suffered numerous nosebleeds. Finally, he visited his father's ear, nose and throat doctor.
After an inspection of his nose, Cosner remembers being given a strong antibiotic and instructions to return in a few days if he didn't feel better.
He didn't get better. On the day he turned 17, Sept. 20, 2006, Cosner underwent a nasal biopsy.
"It wasn't two days after that that the biopsy came back positive for WG," said Cosner, referring to Wegener's granulomatosis. "I really didn't know the severity of it at the time."
Now 19, the Texas State University at San Marcos student has adjusted to life with the disease, and is making efforts to publicize it to others in the hopes that the rare condition can be diagnosed more quickly.
Wegener's granulomatosis is an inflammation of the blood vessels that can ultimately lead to problems with the kidneys, lungs, joints and other areas of the body.
"We don't know exactly what causes it. It's thought to be an autoimmune disease," said Dr. David Hellmann, chairman of the department of medicine at the Johns Hopkins Bayview Medical Center.
Hellmann characterizes autoimmune diseases as being like police brutality, where immune cells that are supposed to be protecting the body begin to attack it instead.
For Cosner, his own diagnosis was intimidating, but he has resolved to live his life in spite of it.
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October 7: Drug companies: No cold medicines for kids under 4, AP
WASHINGTON (AP) — Don't give over-the-counter cold remedies to kids under 4, drug companies said Tuesday. What sniffling little ones need, doctors said, are plenty of fluids and lots of tender, loving care.
"The best thing a parent can do is comfort their children," said Dr. Laura Herrera, a Baltimore family practitioner and mother of two. "Keeping them as comfortable as possible is certainly better than giving cough and cold medicines."
In a concession to pediatricians, who doubt the drugs do much good for children and worry about risks, the companies that make over-the-counter remedies like Dimetapp and Pediacare announced they had changed their advice to parents for the second cold season in a row.
Besides recommending against cold medicines off drugstore and grocery shelves, the companies say not to give antihistamines to kids to help them sleep. The new instructions are on packages that started hitting stores this week.
Last year, the industry went against cough and cold medicines for children under 2.
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October 7: Drug companies: No cold medicines for kids under 4, The Wall Street Journal
By MELINDA BECK
Does the sinking stock market cause you to clench your teeth?
Do you wake up with a headache, sore teeth or a sore jaw? Millions of people clench and grind their teeth without realizing it, particularly while they're sleeping. Both habits can escalate into serious pain and problems of the temporomandibular joint, or TMJ, which joins the jaw to the skull. And they are far more common at times of stress.
Insurance Ping Pong Can Aggravate TMJ Pain
"TMJ and Wall Street go hand in hand, especially lately," says Anthony Chillura, a longtime dentist in New York City's financial district. "Some people get ulcers. Some people get high blood pressure. Some manifest their stress dentally."
While most people clench or grind their teeth (a condition known as bruxism) from time to time, about 10% suffer from TMJ problems -- and those can set in suddenly. Sarah Aroeste, a professional singer, woke up one morning last summer with shooting pain every time she tried to open her mouth. "It was excruciating, and it happened right before an important concert," she says. The pain persisted for weeks until a combination of a mouth guard, painkillers, Valium, a liquid diet and massage made it ease up.
TMJ disorder can mimic migraine headaches, earaches, sinus infections and tooth abscesses. It can cause dizziness, ringing in the ears and muscle pain that radiates down the neck and shoulders. Adding to the frustration, it's often hard to get insurance coverage for treatment, since medical insurers view it as a dental problem, and dental insurers view it as medical.
In some people, the real culprit is a misaligned bite -- either from birth or a trauma like a fall or a collision in sports. "It's like you're chewing with a limp," says Harold Gelb, an oral orthopedist in Manhattan who says problems can be building for years and flare up under stress.
Other people "brux" only when they're under stress, especially at times of change like a divorce or financial crisis, says Andrew S. Kaplan, another Manhattan TMJ expert and former president of the American Academy of Orofacial Pain. "Once they get acclimated to the new situation, the grinding sometimes stops."
Much of the tension comes out at night, when higher centers of the brain that keep it in check during the daytime are asleep, says Noshir Mehta, director of the Craniofacial Pain Center at Tufts University School of Dental Medicine.
A clenched jaw can exert up to 300 pounds of pressure, which can wear teeth down and crack them, particularly where there are cavities or old fillings. Over time, arthritis, inflammation and degenerative changes can occur in the jaw joint. The disc in the joint can shift and make clicking or popping sounds. It can also "lock" out of place, making it impossible to open the mouth more than an inch or so, as it did with Ms. Aroeste.
All that tension also strains the big jaw muscles, making them contract continuously and activates irritable knots called myofascial trigger points, which produce still more tension and refer pain to other muscles.
Women have more TMJ problems than men -- possibly because the jaw muscle bulks up in men, whereas it becomes dysfunctional in women, says Dr. Mehta. He notes that people taking antidepressants are also more prone to bruxing, for reasons not well understood.
If you suspect that you're bruxing -- if you wake up with a sore jaw or your partner complains about a grinding noise -- it's a good idea to check with a dentist before it escalates.
The most common treatment for TMJ is a night guard that fits between the teeth and makes grinding more difficult. "You can't prevent anybody from bruxing, unless they are heavily sedated. The appliances just functions as a buffer so that when they do clench and grind at night, the stresses are distributed well," says Dr. Chillura, who also makes smaller appliances that permit talking for patients who can't stop clenching during the day. Custom-made appliances cost anywhere from $300 to $1,800. Devices that correct misaligned bites can cost $2,500. Over-the-counter mouth guards cost as little as $20 and are better than nothing, some dentists say.
While night guards are generally very effective, some people grind right through them or remove them in their sleep. Dr. Mehta says that may happen because the appliance is so thick that it crowds the tongue or restricts the airway and needs adjusting.
Once TMJ problems have set in, anti-inflammatories or muscle relaxants can be helpful. Studies at Tufts have shown that magnesium citrate -- 250 to 400 milligrams daily -- can also help relieve muscle tension.
Physical therapy -- with massage, ultrasound or electrogalvanic stimulation -- can help relax contracting muscles, and exercises can help keep them limber. Injections of Botox can temporarily weaken jaw muscles that are in spasm. A trained dentist or physical therapist can relieve activated trigger points with an injection of saline or even a dry needle. Massaging the trigger points can also keep them from becoming active.
In rare cases, surgery -- either open or arthroscopic -- may be used to reposition the TMJ disc, but that's generally a last resort. Some specially trained dentists now can manipulate the disc back into position in an office procedure.
Learning some new habits can be just as effective. If you work at a computer, keeping your keyboard low and your monitor high -- propped up on phone books if necessary -- will straighten your posture and keep your chin from jutting forward.
Avoid sleeping on your stomach, which can strain your neck and jaw muscles. Try reducing your stress with exercise, yoga or meditation.
Biofeedback techniques can teach you to deal with it differently. In one method, electrodes are attached to the patient's jaw and the level of muscle tension is displayed on a computer monitor. The patient learns relaxation techniques to bring the level of tension down. Portable gizmos rest in the the back of your jaw and emit a beep or a bad taste if your try to close.
For try this no-cost, low-tech tip: get in the habit of resting your tongue behind your upper teeth and closing your lips as you go about your day. That will naturally keep your jaw open and at ease.
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October 12: Study Warns of Hearing Loss From Music Players, The New York Times
By STEPHEN CASTLE
BRUSSELS — Noise from personal music players is a routine annoyance for travelers on buses, trains and planes.
But it also threatens permanent hearing loss for as many as 10 million Europeans who use them, according to a scientific study for the European Union that will be published Monday.
The report said that those who listened for five hours a week at high-volume settings exposed themselves to more noise than permitted in the noisiest factory or work place. Maximum volume on some devices can generate as much noise as an airplane taking off nearby.
The study — from a team of nine specialists on the Scientific Committee on Emerging and Newly Identified Health Risks — also warns that young people do not realize the damage until years later.
“Regularly listening to personal music players at high-volume settings when young,” the report said, “often has no immediate effect on hearing but is likely to result in hearing loss later in life.”
The report is the latest of several to warn that the “MP3” generation of youths may be heading for hearing impairment in later life.
But older people may also be vulnerable. In the 27 countries in the European Union, an estimated 50 million to 100 million people out of about 500 million may be listening to portable music players daily, the report said.
Users listening at high volumes for more than an hour a day each week risk permanent hearing loss after five years. This is equivalent to 5 percent to 10 percent of the listeners, which may be 2.5 million to 10 million people in the European Union, the study concluded.
Such fears have already prompted litigation. In 2006 a man in Louisiana filed a lawsuit against Apple, claiming the company had failed to take adequate steps to prevent hearing loss among iPod users.
The suit, filed in Federal District Court in San Jose, Calif., claims that the iPod can produce sounds as loud as 115 decibels, when 89 decibels is considered that maximum for safe listening. Apple warns its customers about the danger of hearing loss in its iPod manual.
Personal stereos and portable phones with a music-playing facility are considered a particular threat because ear-bud type earphones lead to a greater sound exposure than other types of listening devices.
“Some authors stress that if young people continue to listen to music for long periods of time and at high volume levels during several years, they run the risk of developing hearing loss by the time they reach their mid-twenties,” the report said. “Among young people, there are many reports of temporary or persistent tinnitus induced by loud music, but very few studies have focused on the relationship between the use of personal music players and tinnitus.”
Meglena Kuneva, the European consumer affairs commissioner, planned to announce a proposal on Monday for a conference in Brussels in 2009 to evaluate the findings with national governments as well as representatives of industry and consumers.
The conference will discuss precautions that users can take, as well as technical solutions to minimize hearing damage. It will also consider whether there is a need for further regulations or revisions of existing safety standards.
The report refers to a 2004 study that recommends limiting listening time to one hour per day and setting the volume to no more than 60 percent of maximum sound output when using headphones that are placed over the ears — and even less when using ear buds.
It said another study suggested restricting the maximum output level of personal music players to 90 decibels.
The Scientific Committee opinion argues that if users of personal music players listen for only five hours a week at volumes exceeding 89 decibels, that level would exceed the current limits in place for noise allowed in the work place.
Last year in Britain, the Royal National Institute for Deaf People warned that more than two-thirds of young people who regularly use MP3 players faced premature hearing damage.
The market for personal music devices continues to boom. In the last four years, estimated sales ranged from 184 to 246 million for all portable audio devices and from 124 to 165 million for MP3 players.
The European Union specialists add that although such listening devices are beneficial to many listeners, there are other dangers apart from hearing loss.
“Listening to music through personal music players can be beneficial when performing boring and repetitive tasks,” the report said.
“However, it may be a hindrance for complicated tasks that require thinking. Music can distract the listeners and isolate them from their environment which can be very dangerous when driving or walking on busy roads.”
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October 13: Worrisome Infection Eludes a Leading Children’s Vaccine, The New York Times
By LAURA BEIL
A highly drug-resistant germ has become a common cause of meningitis, pneumonia and other life-threatening conditions in young children. The culprit — a strain of strep bacteria — can conquer almost all antibiotics in pediatrics, and has dodged a vaccine otherwise credited with causing the number of serious infections in children to plummet.
The rates of diseases caused by strep bacteria have increased.
Since 2000, American toddlers have been immunized against Streptococcus pneumoniae, or pneumococcus, an organism that preys largely on children younger than 5 and the elderly. Pneumococcal meningitis can be fatal, and survivors are often left with deafness and other lifelong neurological problems.
And by most measures, the vaccine has worked: by 2002, rates of infection from these bacteria had dropped as much as 80 percent in some places. But progress has now stalled, and infection with a particular type of pneumococcus, Serotype 19A, is steadily rising.
“It’s very much a concern,” said Bernard Beall, a pneumococcal expert at the federal Centers for Disease Control and Prevention. Last year, in The Journal of the American Medical Association, pediatricians described an outbreak of Serotype 19A ear infections in Rochester that could be cured only by surgically implanting tubes, or by turning to adult medicines not yet tested for safety in children.
A greater worry, however, is the frequency of meningitis, pneumonia and bloodstream infections from Serotype 19A. Since 2001, rates of these and other invasive pneumococcal diseases have crept upward, to more than 10 per 100,000 children from about 2 per 100,000. A fourfold increase in life-threatening infections has also occurred among the elderly.
The vaccine, Prevnar, is aimed at seven types of bacteria that were responsible for 70 to 80 percent of pneumococcal illness during the 1990s. Because pneumococci come in 91 forms, experts have worried from the start whether bacteria that were just as deadly, but not wiped out by the vaccine, might move in as opportunists when the competition suddenly vanished.
“Nature abhors a vacuum,” said Dr. Steven Black of Cincinnati Children’s Hospital. Indeed, almost all pneumococcal infections among American children today are caused by versions not covered by the vaccine, and 19A is leading the way. “People hoped against hope it wouldn’t happen,” he said.
The vaccine’s manufacturer, Wyeth, says it has been working quickly to develop a new product to counter 19A and five other pneumococcal variations, along with the original seven. The company will release results of the first large studies of the newer version this month at an infectious disease meeting in Washington.
“There was no point where we said to ourselves, ‘We missed it, we need to put in 19A,’ ” said Emilio A. Emini, head of vaccine research and development for Wyeth. The company was always prepared to remake the product, he said.
Once a new vaccine demonstrates that it can protect against pneumococcus, it must work its way through the approval process — passing tests of effectiveness and safety — before it can be licensed. Researchers will also try to determine whether young children who have been immunized with the old Prevnar should be revaccinated to protect themselves from 19A.
The remodeling of a vaccine so soon after its approval is highly unusual, but so was the effort to tackle pneumococcus.
The bacteria live in the nose and throat, usually as microbial freeloaders of no consequence. Occasionally — often after a simple viral infection — pneumococci slip into inner areas of the body and cause disease. Weaker immune systems in the very young and the very old leave them most vulnerable. (The pneumonia shot in older people includes 19A, but many elderly people have not received the immunization.)
Not all of the 91 incarnations of pneumococcal bacteria are dangerous. They developed so much variety by mingling in the back of the throat, exchanging genetic material as eagerly as children trading Halloween candy. The variation in genes slightly alters how the bacteria function and how they are received by the immune system.
For vaccine manufacturers, pneumococci’s diversity presented a challenge: how to teach the immune system to recognize a target that may look a little different from child to child. “This is the most complex biological product ever made,” Dr. Emini said.
Serotype 19A was around in the 1990s, though uncommon, and the vaccine includes a similar version called 19F. The hope in 2000 was that 19F looked enough like 19A to set off an immune reaction. It did not.
Experts say it is hard to know what role the introduction of Prevnar may have played in the rise of the bacteria, which was gaining momentum in some countries before the vaccine’s adoption. For example, researchers from GlaxoSmithKline, which is introducing its own pneumococcal vaccine, reported last month that Serotype 19A became more common in Belgium from 2001 to 2004 — years when pneumococcal vaccination was rare in that country. Similar reports have emerged from China, South Korea and Israel.
Pneumococci ebb and flow in natural cycles, and some types have gained a survival advantage by growing resistant to a host of drugs. The vaccine may have simply amplified natural trends..
“I don’t think anyone can tell you the relative contributions of these factors,” said Dr. Sheldon L. Kaplan of Texas Children’s Hospital in Houston. This summer, he and his colleagues described a growing number of cases of drug-resistant mastoiditis, an infection of an inner-ear bone, from 19A.
Experts are now watching to see how forcefully the organism will spread before the new immunization arrives. Wyeth says it hopes to file an application with the Food and Drug Administration in 2009.
Disease experts also wonder what organisms like 19A mean for the future of pneumococcal infections. Public health experts once hoped the infection could be defeated, but it now appears that pneumococci may be playing a game of cat and mouse.
“The pneumococcus has shown an extraordinary ability to evolve to our strategies,” said Dr. Beall of the C.D.C.
Yet he and others are quick to say that immunization remains highly effective, even if it leaves some children behind. “This is not a failure of the vaccine,” said Dr. George H. McCracken Jr. of the University of Texas Southwestern Medical Center at Dallas. Even with the rise of 19A, children are much less likely to become ill from pneumococcal infections.
Dr. McCracken hopes that researchers will one day avoid threats like 19A entirely by developing a vaccine that primes the immune system to recognize some element common to all 91 types of pneumococci — in the way a quiche, an omelet and a custard pie are all versions of eggs. But until such an immunization comes along, he said, pediatricians will be forced to battle the pneumococcus as they always have, by trying to stay one strain ahead of its game.
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October 15: The Oral Sex Cancer Connection, ABC News
By CATHY BECKER
Teresa Dillon was surprised to learn four years ago that what she deemed as an average sore throat actually was stage 2 cancer on her tonsil.
"People think the face of oral cancer is a 70-year-old man who's been chewing tobacco and drinking whiskey all his life," she said. "But the face of oral cancer now is — it's me, a young woman, healthy, nonsmoking, fit."
But what really shocked the waitress and then 38-year-old was that the human papillomavirus may have caused her illness, a illness that is often sexually transmitted.
"It was a virus that caused my tumor, the HPV virus, which just knocked me over," Dillon said.
Dillon is part of a new trend that's puzzling scientists. While most HPV infections clear on their own, there is an alarming surge of oral cancers linked to the virus.
Johns Hopkins researchers reported in a study published in February in the Journal of Clinical Oncology that between 1973 and 2004 the incidence of HPV-related oral cancers among people in their 40s nearly doubled. Today more than 34,000 people have oral cancer and 39 percent of those cases are related to HPV, according to data from the American Cancer Society.
"These are patients that are young. They are in their 30s and 40s. They are nonsmokers, and they don't drink alcohol excessively. And every time we look we are able to find HPV-16 in their tissue, in the biopsy specimen," said Dr. Robert Haddad, a Dana Farber Cancer Institute head and neck surgeon.
High-risk HPV strains cause cancer by using special proteins to disrupt healthy cells. It makes cells unable to repair themselves and unable to control how they are duplicated.
The virus is transmitted by direct contact. You only get HPV in the location it attaches to, so it never travels through the bloodstream.
So just exactly how it gets in the mouth may stun you.
"There is absolutely a link between oral sex and oral cancer," said Dr. Ellen Rome, of the Cleveland Clinic.
Although no proof exists yet, there is a chance that HPV can be transmitted mouth to mouth.
"We can't rule out the virus could be transmitted in saliva by other types of contact — like for instance sharing a drink or sharing a spoon," said Dr. Maura Gillison, of Johns Hopkins Kimmel Cancer Center.
And once the virus is in your mouth, you can't just wash it out. The only way to get rid of it is extensive drug treatment.
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October 21: Chest CT Scans Detect Spread of Head, Neck Cancers, U.S. News
This imaging was best at spotting disease progression in high-risk patients, study finds
CT scans of the chest may help detect disease progression in high-risk patients with head and neck cancer, say researchers in Taiwan.
They evaluated 270 screening chest CT scans conducted over 42 months in 192 patients with head and neck squamous cell carcinoma, which accounts for most head and neck cancers. The results were classified as either normal or abnormal.
Of the 270 scans, 79 (29.34 percent) were considered abnormal, including 54 (20 percent) that showed a malignant neoplasm of the lung and 25 (9.3 percent) that showed indeterminate abnormalities, said Dr. Yen-Bin Hsu, of Taipei Veterans General Hospital, and colleagues.
Patients most likely to have a malignant neoplasm of the lung included those with cancer classified as stage N2 or N3 (indicating some degree of lymph node involvement), those with stage IV disease (cancer has spread to another organ), and those who had recurrent disease or had a distant metastasis in another site.
"Indeterminate lesions were common on chest CT in our study, and special attention should be paid to them," the researchers wrote. "Based on the progressive changes in follow-up scans, 44 percent of indeterminate lesions were eventually considered a malignant neoplasm of the lung. We also found that small (less than 1 centimeter) solitary nodules, which were usually resectable [operable], carried significantly higher chances (66.7 percent) of being a malignant neoplasm."
"For patients with head and neck squamous cell carcinoma, chest diagnosis is crucial and may influence their treatment plan," they noted. "In conclusion, chest CT is recommended for high-risk patients, especially every six months for the first two years during the follow-up period, although its role is controversial for patients newly diagnosed as having head and neck squamous cell carcinoma. High-risk patients include those with N2 or N3 disease, stage IV disease or locoregional recurrence. For patients with indeterminate small [less than 1 centimeter] solitary pulmonary nodules, aggressive evaluation and management are imperative because of the high rate of a malignant neoplasm of the lung."
The study was published in the October issue of the Archives of Otolaryngology.
The National Cancer Institute has more about head and neck cancer.
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October 22: Poorer diets seen in people with sleep apnea, Reuters UK
By Amy Norton
NEW YORK (Reuters Health) - People with severe sleep apnea tend to eat a less healthy diet than people with milder apnea symptoms and those without the disorder, a new study suggests.
Obstructive sleep apnea, or OSA, occurs when the soft tissues at the back of the throat temporarily collapse during sleep, causing repeated breathing interruptions. Major symptoms include loud snoring and daytime sleepiness.
In the new study, researchers found that among 320 adults they assessed, those with severe symptoms of sleep apnea generally ate diets higher in cholesterol and artery-clogging saturated fat. While obesity does raise the risk of severe sleep apnea, the findings were not explained by the study participants' weight.
The results, say the researchers, suggest that eating habits may contribute to the increased risks of heart disease and stroke seen in people with sleep apnea.
"This unhealthy diet may be one reason why sleep apnea contributes to a greater risk of cardiovascular disease," senior researcher Dr. Stuart Quan, of Harvard Medical School in Boston, told Reuters Health.
He and his colleagues report their findings in the Journal of Clinical Sleep Medicine.
People with OSA have been found to have a higher risk of cardiovascular disease than those without the breathing disorder. Experts are not certain that this is a cause-and-effect relationship, but there are reasons to believe that OSA can directly lead to cardiovascular problems.
It's thought, for example, that repeated bouts of oxygen deprivation during sleep raise blood pressure, which takes a toll on the cardiovascular system over time.
The latest findings from Quan's team suggest that OSA may have indirect effects on the heart as well, via a less healthy lifestyle.
Among the patients assessed, those with severe OSA consumed an average of 9 extra grams of saturated fat and 88 extra milligrams of cholesterol per day compared with patients with mild symptoms or none at all.
Those with severe OSA also exercised less, but that link appeared to be explained by their higher rate of obesity. In contrast, the higher fat and cholesterol intakes were independent of patients' weight, Quan said.
He noted that the study also failed to show that poorer diet quality was related to the severity of patients' sleep deprivation; past research has suggested that sleep deprivation may upset the balance of certain appetite-controlling hormones.
More studies are needed, the researchers say, both to understand why severe OSA sufferers have fattier diets and whether this pattern helps explain their higher rate of cardiovascular disease.
SOURCE: Journal of Clinical Sleep Medicine, October 15, 2008.
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October 22: Picking Up Good Vibrations (With Limitations), The New York Times
By JULIE CONNELLY
HEARING aids provide many benefits, but they do not restore hearing to normal, and that is a tough lesson to learn for many people who use them.
TUNING IN Dr. Cochran, who has limited hearing capacity, has a digital hearing aid, which restores some loss but not all.
“Regardless of how good they are, they never match the quality of your hearing at its best,” said William McKenna, a lawyer and former deputy district attorney in Westchester County, N.Y., who has been wearing hearing aids in both ears for nearly 20 years. “Recently my audiologist asked me how good my hearing was on a scale of 1 to 10. I said, 8 ½.”
People who use hearing aids, on average, live with hearing loss for seven years before resigning themselves, usually around age 70, to using a device, according to the Hearing Loss Association of America. “You are in a position where you’ve been struggling, and you get tired of asking people to repeat themselves,” Mr. McKenna said.
Most people with hearing loss eventually acknowledge that “the standard becomes hearing better than you heard before,” said Eduardo Bravo, an audiologist with Audio Help Associates in Manhattan.
Today, baby boomers account for 10 million of the 31.5 million Americans with hearing loss, according to the Better Hearing Institute, a nonprofit educational organization, and many hearing experts attribute this to listening to overly loud rock music.
“The noise exposure just builds up, and with baby boomers it’s been a lifetime of amplified music,” said John M. Burkey, director of audiology at the Lippy Group for Ear Nose and Throat, in Warren, Ohio. Most of these boomers are still in the work force and can’t afford not to hear.
“I had to have the best hearing I could because I wanted to remain a psychologist,” said Teresa Cochran of Alexandria, Va., who has a cochlear implant in one ear but depends on a hearing aid in the other to augment her range of hearing. “I see patients six hours a day during weekdays, and I need to be alert to what they say.”
Why do hearing aids fall short of restoring hearing to the equivalent of 20/20 vision? Because there is no cure for sensorineural hearing loss, by far the most common problem. It is caused by degeneration of the nerve cells, known as hair cells, that line the cochlea, the inner ear structure that looks like a snail.
The hair cells transmit signals received from the bones in the middle ear to the auditory nerve, which sends them to the brain. Aging and exposure to noise cause hair cells to die off, starting with those that transmit high-frequency sounds like “s” and “t.” Medical science has not yet found a way to repair this nerve damage.
“Birds and fish can regenerate their hair cells, and we’ve done it on frogs,” said Dr. John House, president of the House Ear Institute, a nonprofit research group in Los Angeles, which is working on hair-cell regeneration. “But taking a dead or damaged nerve and replacing it — that’s 5 or 10 years off.”
Or even 20, in the view of Mr. Burkey, who is also the author of “Baby Boomers and Hearing Loss: A Guide to Prevention and Care.” Hair-cell regeneration is “going to be the future” of hearing technology, he said.
Meanwhile, consumers expect the devices to work as well as glasses or contact lenses. But eyes pose a different problem, one that is more often readily solved. “There is a perfectly good optic nerve,” Dr. House said. “The only problem is that the focus is not perfect on the retina. Glasses focus the image on the retina.”
With the ear, the problem is the nerve itself. But hearing aids can do a lot, especially for those with mild to moderate high-frequency loss, a group that encompasses most people who are hard of hearing.
Digital technology allows fine-tuning to address the wearer’s specific loss rather than amplifying sounds indiscriminately, a common complaint about older hearing aids.
Feedback cancellation eliminates most of the whistling that bedevils wearers and distracts many others at movies and concerts. Open-fit hearing aids, tucked discreetly behind the ear with an almost invisible plastic tube going into the canal, offer a more natural sound by allowing low-frequency sounds to penetrate the ear while amplifying the high-frequency ones. A telecoil, a small device that can be embedded in the hearing aid to eliminate feedback, can improve hearing on the telephone.
And the entire package can be encased in colors or leopard-skin plastic for the fashion-forward.
A problem that remains unresolved is background noise. While directional microphones reduce sounds from behind the wearer and amplify those in front, no technology can pull the one voice you want to hear from the babble of other voices.
“Wearers get frustrated,” said Brenda Battat, associate executive director of the Hearing Loss Association of America. “Their reaction is, ‘I still can’t hear at a party, and I just spent $4,000 for these things.’ ”
Because digital hearing aids are tiny computers that can be adjusted for subtle changes, wearers must keep returning to the audiologist who sold them the devices until they feel comfortable. Sometimes, the process takes months.
Typically, the price of a hearing aid — $1,986 per ear on average in 2007, according to Hearing Aid Journal — includes two or three return visits to the audiologist during a 30- to 45-day trial period. Even after the trial period, many audiologists do not charge for adjustments.
“We have a number of patients who come back and back,” said Dr. Bravo, the Manhattan audiologist. “We stay with them until they are happy.”
Medicare does not pay for hearing aids, although it does cover cochlear implants. Coverage among insurers varies, but most do not pay for hearing aids.
Dr. Cochran, the psychologist, suggested that people with hearing loss try to take control of their environments. She asks for a quiet table in restaurants and sits with her back to the wall to eliminate distracting noise behind her. And she reminds herself: “Your hearing becomes better, but it does not become perfect.”
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