 |
Ear, Nose & Throat Associates |
|
|
|
|
|
|
2006 News Archives
|
November 1: A Surgeon on a Special Mission Deep in the Heart of Vietnam, The New York Times
By JEANNETTE CATSOULIS
"As the Call, So the Echo," Keir Moreano’s muted yet moving record of his father’s experience as a volunteer doctor in Vietnam, documents a journey that’s substantially more philosophical than medical. In 2003 Dr. Alex Moreano, an ear, nose and throat surgeon from Albuquerque, spent several weeks in a hard-pressed hospital in Hue treating patients with advanced disease and demonstrating surgical techniques to the overworked staff. By the end of his stay, whatever Dr. Moreano had done for the Vietnamese was nothing compared with what they had done for him.
Maintaining a polite but unflinching gaze, "As the Call, So the Echo" observes Dr. Moreano as he performs complicated operations, counsels patients and laments the lack of basic diagnostic equipment. Short on background but long on introspection, the movie presents a portrait not of a saint but of a temperamental man who has faced depression and is often bored by a specialty whose symptoms are — in the first world, at least — rarely life-threatening.
In the deprivation of Vietnam, however, free of the safety blanket of the American medical establishment, Dr. Moreano rediscovers the rush of risk and with it a passion he has begun to question. And as he fights to save a young mother with an invasive facial tumor, he wonders why a single life should matter so much.
"Somehow it seems to," he says, clearly understanding that the life he’s saving is his own.
AS THE CALL, SO THE ECHO
Opens today in Manhattan.
Produced and directed by Keir Moreano; in English and Vietnamese, with English subtitles; directors of photography, Matthew J. Santo and Gordon Arkenberg; edited by Tim Malieckal; music by Joel Douek; released by Necessary Nomad Films. At the Two Boots Pioneer Theater, 155 East Third Street, at Avenue A, East Village. Running time: 74 minutes. This film is not rated.
|
Return to 2006 News Article Index
|
November 6: Intravenous Chemoradiation Effective for Inoperable Head, Neck Cancer; Easier for Patients, Doctors, Newswise
Chemoradiation (radiation and chemotherapy given at the same time) given through a needle or tube inserted into a vein (intravenous) is as effective as treatment given directly to the tumor through a tube inserted into an artery (intra-arterial) for patients with inoperable head and neck cancer, according to a randomized study presented at the plenary session November 6, 2006, at the American Society for Therapeutic Radiology and Oncology’s 48th Annual Meeting in Philadelphia.
"We were surprised about the findings because previous studies that were not randomized found that intra-arterial chemoradiation was more effective than intravenous treatment," said Coen Rasch, M.D., Ph.D., lead author of the study and a radiation oncologist at the Netherlands Cancer Institute/Antoni van Leeuwenhoek Huis in Amsterdam, The Netherlands. "Since intravenous chemoradiation is an easier treatment procedure for patients and doctors, it should be considered the standard of care for inoperable head and neck cancer."
The study compared intra-arterial to intravenous chemoradiation in 240 patients with inoperable head and neck cancer, who were assigned to one of the treatment procedures by chance. The chemoradiation was a combination of radiation and cisplatin, a type of chemotherapy that can kill cancer cells, especially when combined with radiation. Results found that both treatment methods were able to control the same amount of cancer growth.
For more information on radiation therapy for head and neck cancer, visit rtanswers.org.
|
Return to 2006 News Article Index
|
November 7: Strep Throat Again? Tonsils May Be Key, WebMD
Removing Tonsils May Make Kids Less Likely to Get Strep Throat Again
By Miranda Hitti
WebMD Medical News Reviewed By Louise Chang, MD
Children who have their tonsils removed after having strep throat may be less likely to get strep throat again.
So say Mayo Clinic doctors including Laura Orvidas, MD.
Tonsillectomy (surgery to remove tonsils) may be a "useful therapy for treating children" with recurrent strep throat, write Orvidas and colleagues in Laryngology.
They note that strep throat is one of the most commonly diagnosed childhood illnesses, sending about 18 million kids to doctors every year.
Tonsillectomy should reduce throat infections and "therefore diminish the number of missed school days and hopefully improve overall quality of life," Orvidas says in a Mayo Clinic news release.
Strep Throat Study
Orvidas and colleagues studied the medical records of 290 children aged 4-15.
The kids had had strep throat three or more times in a year while living in Olmstead County, Minn., from 1994 to 1998.
After their repeated bouts with strep throat, 145 kids got tonsillectomy. The other 145 children didn't undergo tonsillectomy.
The researchers didn't ask any of the kids to get tonsillectomy. Each family made its decision to get (or skip) tonsillectomy on its own.
Orvidas and colleagues checked the kids' medical records for the next four years, on average. During that time, the children who hadn't gotten tonsillectomy were three times more likely to get strep throat again before their 16th birthday.
They were also more likely to get strep throat sooner, and more often, than the children who got tonsillectomy.
Strep Throat Statistics
About half of the kids who got tonsillectomy had strep throat at least once -- four years after tonsillectomy but before turning 16 -- compared with 84% of those who didn't get tonsillectomy.
On average, strep throat returned about a year after tonsillectomy -- four months later than its average recurrence without tonsillectomy.
During the follow-up period, strep throat returned once, on average, after tonsillectomy, compared to nearly three times without tonsillectomy.
"Our study showed a low complication rate for tonsillectomy as well, with less than 2% of patients requiring a return to the operating room," the researchers write.
But surgery can have complications, so the researchers call for more studies to weigh tonsillectomy's risks and benefits in treating recurrent strep throat.
|
Return to 2006 News Article Index
|
November 7: Most Ear Infections Host Both Bacteria And Viruses, Study Shows, ScienceDaily
Ear infections are among the most common diseases seen in pediatric practice. They have generally been considered bacterial diseases and are therefore usually treated with antibiotics. New research, published in the December 15 issue of Clinical Infectious Diseases and currently available online, provides evidence that viruses are found in a great many ear infection cases and may complicate treatment.
The researchers used a variety of laboratory techniques to identify the pathogen that caused ear infections, known clinically as acute otitis media (AOM), in 79 young children. They found bacteria in 92 percent of the cases, viruses in 70 percent, and both bacteria and viruses in 66 percent.
According to Aino Ruohola, MD, PhD, from the Turku University Hospital in Finland and lead author of the study, "the major finding of the study is that acute otitis media is a coinfection of bacteria and viruses in the great majority of children. This is actually logical since acute otitis media is virtually always connected to viral respiratory infection."
Antibiotics, which are effective against the bacteria that cause AOM, have no effect on the viruses found in AOM infections. Therefore, the standard treatment for AOM--antibiotics--can be, at best, partially effective in the majority of cases. "Based on this and previous research," said Dr. Ruohola, "it is possible that viruses cause a considerable proportion of clinical treatment failures. Thus, in these cases a new antibiotic is not necessarily the best choice although bacteria resistant to common antibiotics are wide-spread."
The good news is that many cases of AOM recover spontaneously without antibiotic treatment, a fact that has led the American Academy of Pediatrics and the American Academy of Family Physicians to recommend withholding antibiotic treatment in mild AOM cases.
In an accompanying editorial, Tasnee Chonmaitree, MD, from the University of Texas Medical Branch, notes that studies of AOM have shown that viruses may impair antibiotic efficacy by several mechanisms. "Further studies," she writes, "are required to determine the effect of combined bacterial and viral infections of the respiratory tract in adults and children." She says that if this joint bacterial/viral infection concept also applies to respiratory diseases such as sinusitis and pneumonia, then the expectation of antibiotic efficacy in these diseases needs to be adjusted.
Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Alexandria, Va., IDSA is a professional society representing about 8,000 physicians and scientists who specialize in infectious diseases. For more information, visit idsociety.org.
|
Return to 2006 News Article Index
|
November 7: Oh, my ailing sinuses - Balloon sinuplasty may offer relief for sinusitis sufferers, Chigago Tribune
By Amanda Vogt
A new technology that uses balloons to widen inflamed sinuses promises to ease the misery -- and surgery fears -- of many chronic sinusitis sufferers.
Initial study results of balloon sinuplasty generated a buzz at a recent meeting of the American Academy of Otolaryngology, said Dr. Howard L. Levine, president of the American Rhinologic Society.
"This new technology is another important tool in the otolaryngologist's arsenal," Levine said. "The long-term implications are excellent" for patients' quality of life and for cost savings. "Since the technology appears to result in fewer postoperative visits and less time in the operating room than [conventional sinusotomy], ultimately it can lower health-care costs."
In conventional sinus surgery, tissue and diseased bone are cut away to open sinus passages, which are located dangerously close to the brain. In balloon sinuplasty, a balloon-tipped catheter is threaded over a guide wire that is inserted through the nose and into targeted sinus cavities. Then it is slowly inflated, gently stretching tissue and bone and widening inflamed sinus passages without cutting.
Study patients who underwent balloon sinuplasty generally recovered faster and required fewer postoperative doctor visits than patients who had the more invasive conventional surgery. Six months after the procedure, the majority of study patients remained free of infection and maintained unobstructed sinuses.
That is promising news for the 30 million to 50 million Americans who suffer from the headaches, stuffiness, repeated infections and general malaise that characterize chronic sinusitis. Caused by allergies, tissue abnormalities, barometric pressure-induced inflammation and infection, chronic sinusitis accounts for countless days of missed work and billions of dollars in pharmaceutical revenue.
Yet traditional surgery offers no guarantee of relief, and feeding the fears of many sufferers is the rare but undeniable risk of surgeons working so close to the eyes and brain.
Balloon sinuplasty is not for everyone; patients with nasal polyps are not candidates, for example. But the procedure can be performed under local, rather than general, anesthesia, and there is little to no postoperative bleeding.
Dr. Michael Friedman, professor of otolaryngology at Rush University Medical Center and chairman of otolaryngology at Advocate Illinois Masonic Medical Center in Chicago, has used the technology for more than a year and is optimistic about its future.
"Nobody is ready to say it will replace traditional sinus surgery," Friedman said. "But it certainly gives [doctors] and patients another option."
One of Friedman's patients is Lisa Wilson, 35, a mother of two from Clarendon Hills. She underwent a half-hour procedure in June and is thrilled with the results so far. Experiencing very little discomfort afterward, she was home within four hours.
"I can breathe through my left nostril for the first time in years and taste food again," said Wilson, who in the months preceding the surgery was prescribed 11 courses of antibiotics for chronic sinus infections.
Generally, the cost of balloon sinuplasty is comparable to traditional sinus surgery. In the long term, however, costs can be reduced because of lower anesthesia and operating-room costs, Friedman said. Since the use of balloon sinuplasty has been approved by the Food and Drug Administration, many insurance companies now cover the procedure.
|
Return to 2006 News Article Index
|
November 13: Research Questions Use of Sleep Meds for Patients with Apnea, Newswise
Prescription sleep aids may do little to improve the use of continuous positive airway pressure (CPAP) among patients with obstructive sleep apnea (OSA). A new study published in the November issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), finds that patients with OSA who were given prescription sleep aids were no more likely to use their CPAP machines than patients with OSA taking a placebo.
"CPAP treatment improves daytime alertness and quality of life for most patients with OSA and may prevent some of the long-term complications of this disorder, including heart attacks and strokes," said the study's lead author Capt. David A. Bradshaw, MD, FCCP, Naval Medical Center, San Diego, CA. "Yet, many people find CPAP difficult to use. People with a good initial experience are more likely to use CPAP regularly. Our hypothesis was that a sleeping pill might help new CPAP users adjust to sleeping with the equipment and promote long-term usage."
To determine the effect prescription sleep medications have on CPAP compliance, Capt. Bradshaw and colleagues compared CPAP use among 72 newly diagnosed male patients (mean age 38 ± 7 years) who were referred for CPAP treatment. All patients participated in standardized CPAP training and were randomized to receive the sleeping agent zolpidem (N=24), a placebo pill (N=24), or standard care (N=24) with no sleeping pill or placebo. Patients taking zolpidem or placebo were instructed to take one pill each night, 30 minutes prior to bedtime for the first 14 days of treatment. During the four-week trial, CPAP use was recorded by an internal data chip.
Compared with the placebo pill and standard care groups, the zolpidem group did not show greater CPAP usage in terms of total days used or average time used per night over the course of four weeks. When the initial 14 days of CPAP treatment were analyzed separately, there was also no difference in number of days used or average nightly use. Despite results, researchers believe prescription sleep medications, when used correctly, may prove helpful for a subset of patients with OSA.
"Studies have shown that almost half of patients with OSA have insomnia complaints," said Capt. Bradshaw. "Our study does not support prescription sleeping pills for all new CPAP users, but OSA patients with insomnia symptoms might benefit." Still, researchers remain cautious regarding the use of prescription sleep medications for patients with OSA.
"We are concerned, however, about the potential risk for worsening sleep apnea if patients intentionally or inadvertently remove the mask before the effects of the sleeping pill have worn off," said Capt. Bradshaw. "Also, sleeping pills sometimes have residual daytime effects, such as sleepiness, and can interfere with cognitive function - both of which are already problems for many patients with OSA, even after treatment with CPAP."
Upon completion of the trial, all patients showed significant symptom improvement on the Epworth Sleepiness Scale (ESS) and Functional Outcomes of Sleep Questionnaire (FOSQ). Baseline demographics revealed no difference in age, body mass index, ESS, FOSQ, nadir oxygen saturation, or CPAP pressure setting among the three groups. Despite randomization, the standard care group had a higher apnea/hypopnea index than the other two groups.
"When used consistently, CPAP is a highly effective therapy for patients with obstructive sleep apnea," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "More research is needed to determine interventions that can help optimize the initial experience with CPAP and improve long-term usage."
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at http://www.chestnet.org.
|
Return to 2006 News Article Index
|
November 13: Group Gives Advice on Face Transplants, Forbes
Britain's Royal College of Surgeons on Monday laid out 15 conditions surgeons must meet before carrying out face transplants.
The august medical body said such procedures must be performed in a strict research setting and are not merely as a surgical exercise.
Last month, an ethics panel approved a London hospital's plan to carry out what could be the world's first full-face transplant, but said no candidates for the surgery have yet been selected.
French surgeons carried out the first partial face transplant last year. The Cleveland Clinic in the United States is also working on plans for full-face transplants.
In a report issued Monday, the Royal College of Surgeons said it still has "considerable reservations" about such operations.
But Sir Peter Morris, who chairs a college committee on face transplantation, told a news conference that a procedure could go ahead "as long as it is performed in a research setting, with all that goes with that."
"It is not just a surgical exercise," he said, adding that the necessary surgical expertise "has been available for over 30 years."
The report said requirements for carrying out a transplant include supporting the donor's family, ensuring a patient knows what will happen if tissue is rejected and providing full psychological assessments.
"We believe that facial transplantation should only take place if all these minimal requirements can be met," the report said.
The Special Ethics Committee of London's Royal Free Hospital last month approved a proposal for a series of four transplant operations, saying a list of candidates could be completed within six months or a year.
The surgical team headed by Dr. Peter Butler will initially choose four patients from Britain or Ireland for staged operations, possibly six months apart.
Butler says the patients are all likely to be those with injuries such as severe burns affecting the whole face.
Isabelle Dinoire, a French woman, received the world's first partial face transplant last November. She had lost much of her face when she was mauled by her pet Labrador, making it difficult to speak and eat.
Her surgeons were widely criticized at the time for going ahead with a radical, untested procedure without trying traditional reconstruction first. However, the operation has been widely hailed as a success, with Dinoire regaining sensation in her new features.
|
Return to 2006 News Article Index
|
November 14: Prevention: After Tonsillectomies, Fewer Recurrences of Strep, The New York Times
By NICHOLAS BAKALAR
Children with recurrent strep throat who still have their tonsils are about three times as likely to develop subsequent episodes of strep as children who have had their tonsils removed, a new study has concluded.
Researchers examined the medical records of children ages 4 to 16 who had three or more episodes of strep throat within 12 months. From these, they selected 145 children who had later had a tonsillectomy and compared them with a group of 145 children, matched for age and sex, who had not had the operation.
By one year after the start of the study, the incidence of strep infection among the children who had a tonsillectomy was 23.1 percent, compared with 58.5 percent for those who had not. Children who still had their tonsils developed a new infection in an average of 0.6 years, compared with 1.1 years for those whose tonsils had been removed. The study was published in the November issue of The Laryngoscope.
Dr. Laura J. Orvidas, the study’s lead author and an ear, nose and throat specialist at the Mayo Clinic, said it would be inappropriate for her to make recommendations about tonsillectomy. "Every kid is different," Dr. Orvidas said. "Regardless of these findings, it’s still a gray area. You need to discuss your child’s situation with your physician."
The researchers did statistically control for the number of strep infections in the year before the tonsillectomy and for the presence of other conditions that might dispose someone to having strep. But they acknowledged that the children were not randomly assigned to have an operation or not to have one and that there might have been unmeasured characteristics that made the two groups different.
|
Return to 2006 News Article Index
|
November 14: Sleep apnea linked to arrhythmia in some, United Press International
CHICAGO, (UPI) -- U.S. adults with sleep apnea could also be at risk for a particular kind of deadly heart arrhythmia, a study finds.
Saint Louis University researchers looked at 134 patients with coronary heart disease who hadn't been diagnosed with a sleep disorder.
In the patients who had a type of an irregular heartbeat called ventricular premature contraction, more than 40 percent also had severe sleep apnea -- and didn't realize it, according to principal investigator Dr. Raj Bhalodia of Saint Louis University School of Medicine.
"The real worry is that benign arrhythmia can be a harbinger of a much more serious -- and lethal -- heart rhythm disorder," says Bhalodia. "While most people with the mild version of arrhythmia will be just fine, in some people, it's possible it can worsen during the night and lead to sudden death."
The researchers found that sleep apnea -- which is the collapse of the upper windpipe during sleep, leading to decreased levels of oxygen in the blood -- seemed to exacerbate ventricular premature contraction, especially during the dream stage, or REM, of sleep.
"There's less oxygen being pumped through the body in REM than in other stages of sleep, and this can bring on arrhythmia," Bhalodia says.
The findings are being presented this week at the American Heart Association Scientific Sessions meeting in Chicago.
|
Return to 2006 News Article Index
|
November 20: Short Recovery Room Stay After Tonsillectomy Found Safe, MedPage Today
LOS ANGELES –– After an outpatient tonsillectomy, most patients can go home safely within a couple of hours, according to researchers here.
"Every child and every situation needs to be taken on an individual basis," said Nina Shapiro, M.D., of Mattel Children’s Hospital at the University of California at Los Angeles. "But, in general, we found that very short recovery room stays are safe."
Currently, Dr. Shapiro said in an interview, "there is no true standard of care" criteria for how long patients are observed after the procedure before being discharged. Every facility has different criteria.
She and colleagues noted that their institution had shorter recovery rooms stays, on average, than were being described in the medical literature and decided to see whether they had higher post–operative complication rates.
In fact, the complication rates were lower than those usually ascribed to the surgery, Dr. Shapiro and colleagues reported in the Nov. 29 issue of the International Journal of Pediatric Otorhinolaryngology.
The finding is part of a sea change in tonsillectomies over the past decade or so, Dr. Shapiro said. A combination of safer anesthetics, new non–sedating anti–emetics, and new surgical techniques has meant that the outpatient tonsillectomy is now standard.
(A recent study from the Mayo Clinic in Rochester, Minn., suggested that tonsillectomy be considered as a therapeutic option in children with recurrent strep throat, after a study showed the procedure reduced infection rates.)
But with more than half a million procedures performed every year in the U.S., the operation is still not completely standardized. "If you talk to 100 surgeons, you'll probably get 100 different techniques," Dr. Shapiro said.
The same is true for recovery room practices, she said.
The researchers examined 798 patient charts from January 1998, when the Mattel Children’s Hospital began using the newer techniques, through June 2005.
The study found:
- The average patient age was 6.8 years, with 53 patients under three, 655 aged from three to 12, and 89 patients from 12 to 21 years.
- The average recovery room observation time before discharge was 1.47 hours, but ranged from as short as 27 minutes to as long as seven hours and 15 minutes.
- The complication rate in the first 24 hours was 0.0075%.
- The rate after the first 24 hours was 0.0063%.
- All three age groups had much the same time in the recovery room and rates of post-op complications.
Dr. Shapiro said rates of complications ascribed to the outpatient surgery usually range from 1% to 6%.
The finding is good news for parents and children, she said. "It’s always nicer to recover at home than in a hospital," Dr. Shapiro said.
But it may also be good news for medical facilities, because it can add "significant efficiencies" to the way care is delivered, she said.
Additional General Surgery Coverage
Primary source: International Journal of Pediatric Otorhinolaryngology
Source reference:
Kalantar N. "Outcomes of reduced postoperative stay following outpatient pediatric tonsillectomy." Int J Pediatr Otorhinolaryngol 2006; 70(12): 2103-07.
|
Return to 2006 News Article Index
|
November 20: Aspirin May Cut Head and Neck Cancer Risk, Forbes
Along with its other benefits, an aspirin a day may help keep head and neck cancers away, a new long–term study suggests.
It wasn’t so much the amount of aspirin that was taken but the length of time that people were on the drug that mattered, said study co–author Mary E. Reid, an assistant professor of oncology at Roswell Park Cancer Institute, in Buffalo, N.Y.
"We found that duration really seemed to make a difference," Reid said. "It was more duration than frequency. Taking aspirin for under 10 years did not have a significant effect, [but] taking it 10 years or more was associated with a 30 percent reduction in cancer."
The protective effect was not seen in heavy smokers and drinkers, however.
Her team reported the findings in the November issue of the Archives of Otolaryngology.
According to the U.S. National Cancer Institute, head and neck cancers comprise about 2 percent to 5 percent of all malignancies in the United States, with about 39,000 new cases diagnosed each year. Experts estimate that about 85 percent of these cancers are linked to tobacco use.
Reid and her colleagues’ study included patients treated at Roswell Park –– 529 with head and neck cancer, another 529 without the malignancy. Participants were matched for age, sex and smoking status. They were also asked about their use of aspirin over the preceding decades.
"A consistently decreasing trend in risk was noted with increasing duration of aspirin use," the researchers reported. "Risk reduction was observed across all five primary tumor sites, with cancers of the oral cavity and oropharynx [upper throat] exhibiting greater risk reduction."
Earlier studies have linked aspirin use to reduced risk of other forms of cancer, such as prevention studies of colorectal cancer that Reid herself has worked on.
But it’s still too early to recommend routine use of aspirin as a cancer–preventive measure, said Dr. Michael Thun, vice president for epidemiology and prevalence research at the American Cancer Society.
The new retrospective study "does not have the strongest kind of design" because participants were asked about aspirin use after they were diagnosed with cancer, Thun noted. Still, he said, "the results were internally quite consistent, with a lower risk the longer they used aspirin."
The idea that aspirin and other non–steroidal anti–inflammatory drugs (NSAIDs) can help prevent cancer is "quite plausible, but the evidence is limited," Thun added. However, the theory is plausible enough for the U.S. National Cancer Institute to be sponsoring a large–scale study using Celebrex, also a member of the NSAID family. Results are expected in about two years, Thun said.
Aspirin’s cancer–fighting effect appears to be linked to the molecular mechanism by which NSAIDs fight pain, both Reid and Thun said. The medications inhibit an enzyme called cox–2, whose activity is known to increase in pre-malignant lesions. Inhibiting the enzyme may also help slow the proliferation of cells, Reid said.
Anyone who wants to take aspirin as a cancer preventive should first consult their physician, Reid cautioned. "You should always talk to a physician before taking anything chronically," she said.
Taking aspirin each day does have its risks, Thun said. "At this point, aspirin is still not recommended for prevention of any cancer because of the risks of bleeding, particularly gastrointestinal," he said. "What is still missing is proof that the benefits of taking aspirin outweigh the risks."
More information
Learn more about head and neck cancer at the U.S. National Cancer Institute.
|
Return to 2006 News Article Index
|
November 27: Sleep Problems In Overweight Children Appear Fairly Common, Medical News Today
One–fourth of overweight children may have sleep problems that regular physical activity can largely resolve, researchers say.
Research published in the November issue of Obesity shows a surprising 25 out of 100 overweight, inactive children tested positive for sleep–disordered breathing, including telltale snoring.
After about three months of vigorous after–school physical activity such as jumping rope, basketball and tag games, the number of children who tested positive for a sleep disorder was cut in half, according to lead researcher, Dr. Catherine L. Davis. In children who exercised the longest, the number was reduced by 80 percent.
The children were among 100 black and white boys and girls ages 7 to 11 enrolled in a study looking at the effect of exercise on metabolism. For the purposes of that study, the children were divided into three groups: a control group as well as those who exercised 20 or 40 minutes daily.
In fact researchers found the average score for all children who exercised – even those who did not test positive for sleep disorders – improved on the Pediatric Sleep Questionnaire.
"Existing data suggests about two percent of children have sleep problems but with 37 percent of children now considered overweight, the percentage may be much higher," says Dr. Davis, clinical health psychologist at the Medical College of Georgia and the study’s first author.
"We believe this study is a red flag to pediatricians to ask parents about their children’s snoring," she says. "Snoring does not appear to be benign in children. Not sleeping well can affect children’s behavior, their ability to function in school. We don't know yet if it affects their development."
"The long–term consequences of sleep–disordered breathing on children are unknown," study authors write. "There may be lasting benefits of prevention or amelioration of sleep–disordered breathing as a result of protection from neural insult during childhood."
Dr. Davis likens the possible increase in sleep–disordered breathing in children, which includes sleep apnea and less severe problems, to the increasing incidence of lifestyle–related type 2 diabetes. "Nobody used to think type 2 diabetes happened in kids either," says Dr. Davis who studies the impact of exercise on the risk of the disease in children. "We thought type 2 diabetes was something you got at maybe 50, not 15. It has become a major media sensation because it is so shocking."
When Georgia researchers first gave the Pediatric Sleep Questionnaire, which looks at symptoms of sleep disordered breathing – such as snoring, loud breathing and daytime inattentiveness – they were surprised as well by how many children tested positive.
The questionnaire, given to parents, has been shown to provide results similar to those of polysomnography, a monitoring of physiological activities such as breathing during sleep. "We asked parents about caffeine intake, medications, usual bed and wake times to see if the children are chronically sleep–deprived, asked if they had a tonsillectomy because that usually fixes sleep apnea in children," Dr. Davis says.
Interestingly sleepiness was not an issue because children instead tend to display attention deficit/hyperactivity disorder–type behavior when they don’t get enough sleep, she says. Caffeine intake also may have played a role in subverting sleepiness, the researchers say.
Also, the body mass index, based on height, weight, age and sex, did not improve as children exercised and became asymptomatic. However the growing children got fitter, built muscle and lost fat, Dr. Davis says. "It affects their fatness, their fitness, their cardiovascular risk factors, it’s just their weight doesn’t go down without a change in diet, just like adults," she says. Adult studies have shown a similar relationship between obesity and sleep apnea and how exercise can ameliorate sleep apnea.
To learn more about sleep patterns in overweight children, Dr. Davis has started a similar study using wristbands to record movement during sleep and fingertip pulse oximeters to measure oxygen levels.
Dr. Amy R. Blanchard, pulmonologist and director of the MCG Georgia Sleep Center, is working with Dr. Davis on the new study and hopes their monitoring approach will prove an effective, inexpensive and unobtrusive way to identify early problems.
"It may give us an early diagnosis of something that could potentially affect their outcome in many ways," says Dr. Blanchard who has been surprised by the amount of sleep disruption they’ve already seen in the children, some of whom are only slightly overweight. She notes that some may even be playing video games or watching television when they are supposed to be sleeping, further detracting from a good night's rest.
"Kids can have sleep apnea for a couple of reasons," she says. "A normal–weight child can have sleep apnea because they have big tonsils and adenoids and many times their problems can be cured with surgery."
Gaining weight can exacerbate sleep problems or even cause them by contributing to a narrowed airway, she says. The child lies down, throat muscles relax, the tongue falls back, the airway gets obstructed, oxygen levels may drop, the child is aroused and the cycle begins again. Snoring, present in essentially everyone with sleep apnea, results from the vibration of excess tissue – whether it’s fat, large natural anatomy or both – as the child breathes in.
"The published study suggests we need to be looking more diligently at kids, not necessarily just kids with big tonsils who snore, but any child that is snoring or heavy," Dr. Blanchard says. "It’s just like in adults, when doctors start asking their patients, they find a lot of people snore."
The published research was funded by the National Institute of Diabetes & Digestive & Kidney Diseases.
|
Return to 2006 News Article Index
|
November 29: Inflammatory Response to Innocuous Fungi is Gaining Greater Acceptance as Cause of Chronic Sinusitis, Newswise
Sinusitis, inflammation of the sinus passages around the nose and throat, is one of the most common illnesses in the United States, affecting between 30 and 40 million people each year, and triggering between 18 and 22 million doctor visits. Among the symptoms are nasal congestion, thick mucus production, headaches, tenderness in the face, and aching behind the eyes. Chronic sinusitis persists for weeks, months, or longer, causing misery for sufferers. In the most severe cases the sinus cavity clogs, preventing drainage of mucous and making it difficult to breathe through the nose.
Prior to the research on fungal etiology, the prevailing opinion among the healthcare community was that upper respiratory infections such as colds and flu caused chronic sinusitis by damaging the upper respiratory epithelium. Within the last decade, physicians at the Mayo Clinic hypothesized that most cases of chronic sinusitis were caused not by epithelial dysfunction, but by an inflammatory reaction to the presence of fungi in the mucus. This novel idea was initially rejected by medical specialists, but in a few short years, evidence in favor of the fungal etiology of chronic sinusitis has accumulated. Surveys of ear, nose, and throat specialists (ENTs, also known as otolaryngologists) and allergists revealed that a large number of the specialists treating this disease have adopted the theory that an inflammatory response to fungus in susceptible patients (almost 10%) is the cause of Chronic Sinusitis.
Accentia Biopharmaceuticals has conducted three surveys, presented at a recent American College of Allergy, Asthma and Immunology symposium. The surveys revealed that prevailing perceptions among ENT’s regarding the possible fungal cause of chronic sinusitis, especially for patients who do not benefit from surgery to correct chronic sinusitis. This group of patients is classified as "surgery refractory."
The first two surveys suggested that ENTs in the United States saw up to twice as many patients with chronic sinusitis as their counterparts in Germany, France, and the United Kingdom. Approximately 25% of their chronic sinusitis patients were refractory to surgery, meaning their condition does not improve after an operation to remove sinus tissue. In addition, 90% of US and EU (European Union) specialists expressed dissatisfaction with current treatment options for chronic sinusitis, and acknowledged the significant impact to quality of life associated with this condition.
The third survey polled eighty American ENTs and allergists to determine the physicians’ prevalent belief regarding the etiology, or cause of chronic sinusitis. In this survey, three–quarters of physicians (75%) attributed the root cause of chronic sinusitis to a fungal infection, and 84% believed that surgery–refractory patients were more likely to fall into the fungal etiology category. Sixty–nine percent of specialists surveyed considered intranasal antifungal drug therapy to be an appropriate treatment for chronic sinusitis patients, with 74% supporting this approach for surgery-refractory patients.
"Fungal etiology is gaining greater acceptance among U.S. and European physicians," noted Angelos Stergiou, MD, Medical Director at Accentia Biopharmaceuticals. Accentia is currently planning to test the effects of SinuNase™, an intranasal form of Amphotericin B, in patients with chronic sinusitis. SinuNase belongs to a class of medicines known as anti–fungals.
The seriousness of chronic sinusitis, and the potential of SinuNase to become the first approved treatment for treating this condition prompted Accentia to seek "Fast Track" status for this drug. In response to this application, the U.S. Food and Drug Administration granted "Fast Track" status for SinuNase in April 2006. For more information on the clinical trials and their location, please visit accentia.net.
|
Return to 2006 News Article Index
|
November 30: Seeking relief for sinus sufferers, University at Buffalo Reporter
Ponikau’s work contributes to development of new treatment for sinusitis
By KEVIN FRYLING
Reporter Staff Writer
When Jens Ponikau left Germany 10 years ago to do research in the United States on chronic sinus inflammation, he expected to stay nine months.
Then a major breakthrough–uncovering the root cause of a persistent sinus ailment that, despite its effect on 37 million people in the United States alone, has no FDA–approved treatment–changed everything.
"Not many people have the chance to make a significant change for the better," says Ponikau, clinical assistant professor in the Department of Otolaryngology, School of Medicine and Biomedical Sciences. "I felt that it came to me, that I could make a significant influence or change, so I took it and I ran with it."
His research—conducted over the course of nine years at the Mayo Clinic and continuing now at UB—shows that chronic sinus inflammation, or sinusitis, is caused by a reaction to fungus in nasal mucus. Ponikau was the first to discover the fungus in sinusitis sufferers because he was the first to examine not only tissue samples from patients’ nostrils, but the mucus inside as well.
"We had never found the fungus because we had never looked at the snot," he explains.
While previous research had focused on nasal tissue because sinusitis sufferers get frequent bacterial infections, Ponikau says nasal infections are merely a symptom caused by an underlying fungal reaction.
"Antibiotics have never worked long–term in chronic sinusitis," he points out. "We found an underlying inflammation in the tissue, which erodes away the protective layer. Patients had secondary bacterial infections—not because bad bacteria were there, but because the nasal skin was eroded away."
Ponikau recalls the actual moment he realized he might hold the key to unlocking a condition affecting about 15 percent of the population. It happened late one night, while he was alone burning the midnight oil in a lab at the Mayo Clinic.
"I always tell people there was this eureka moment when I was looking at snot under an electron microscope," he laughs.
Although the initial discovery of fungus in sinusitis sufferers came in 1994 while he was a fourth–year German medical student studying at Mayo, Ponikau explains the significant breakthrough–the one that kept him in the U.S.–came after he returned to the famous Minnesota research hospital fresh from a two–year residency at his father’s small ear, nose and throat clinic in Hof, Germany. He then uncovered the fundamental connection between the fungus’; presence in patients’ mucus and the actual nasal infections that characterize the condition.
Under the electron microscope, Ponikau noticed an unusual level of inflammatory white blood cells, called eosinophils, in the mucus of sinusitis sufferers. These cells had been noted in the nasal tissue of some sinusitis patients, he says, but no one had explained their presence.
Studying the mucus, he realized the true target of the destructive cells lay outside the body. The eosinophils were traveling though the tissue to cluster around the fungus in the mucus.
"That was the big breakthrough," he says. "I saw that the inflammatory cells were destroying the fungi and releasing all their toxins in that process."
But pinning sinusitis on fungus, rather than bacteria, represented such a "big step out of the box" that Ponikau spent years convincing the medical community.
"When we introduced it, the whole scientific field was up in arms," he says. Since then, however, support has started pouring in from such prestigious organizations as the National Institutes of Health, which has contributed about $5 million to the project. In addition, he notes the Food and Drug Administration is nearing the final phase of tests on an anti–fungal treatment for sinusitis, which he has co–developed with David Sherris, his closest research collaborator at the Mayo Clinic and now chair of UB’s Department of Otolaryngology. Sherris joined the UB faculty in 2003 to reinvigorate the ear, nose and throat department and re–establish its residency program, which was disbanded in 2002. Ponikau followed Sherris to UB this fall to direct the research branch of the department and guide the projects of its medical residents, the first of whom will join the program in July 2007.
"I think there’s a lot of excitement about having the residency program back," Ponikau says, noting that a good medical program provides students with a combination of experience in the classroom, a clinical environment and a research lab.
"You cannot have a department without having a research arm," he points out. "We’re in the process of getting a team together here focusing on fungal sinusitis."
In addition to his UB duties, Ponikau serves as president of Gromo L.L.C., an intellectual–property holding company that protects the rights to his discoveries. He says the license to market the first–ever fungal sinusitis test has been granted to a Buffalo–based biomedical company, Immco Diagnostics Inc., which currently processes several hundred of the tests per month.
On top of the business–and–research opportunities offered by Buffalo and UB, Ponikau notes that settling in New York State’ second–largest city has been a welcome change from living in Rochester, Minn., a city of less than 100,000. Today, he resides in Amherst with his wife, Ragna, and three children: Sidney, 8, Felicia, 7, and Isabella, 2.
"I think Buffalo is great," he says. "It’s my kind of town, a blue–collar town. Plus, the restaurants are great here. I’ve never had a bad meal in Buffalo."
Nor does the region’s winter weather concern the former ski instructor, who earned extra cash in medical school teaching on weekends in the Alps. "I just bought a boat to do some water skiing with the kids," he says, "and I also like to (snow) ski. So I don’t mind a place where you can do both."
|
|
|
|
|
|
|
|
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
|
|
|
|
|
|
|
