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Ear, Nose & Throat Associates |
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November 2007 News Archives
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November 5: A diagnosis that can keep our roads safer, The Journal News
Now that we've switched to standard time, many of us are coming and going in total darkness. It's hard not to feel sleepy earlier, but for some, the struggle to stay awake even during daylight hours is a symptom of an undiagnosed medical condition.
Sue Ellen Mosa is one of the 18 million Americans - up to 20 percent of the population - who suffer from obstructive sleep apnea. Due to an airway that collapses when they lie down, those with the disorder stop breathing hundreds of times a night while they sleep. As they gasp for air, OSA sufferers awaken momentarily, as often as they stop breathing. This makes for a very restless night, which leads to daytime exhaustion and can put droopy-eyed drivers on our roads.
While traveling together, Mosa's daughter told her she kept stopping breathing all night long and she was snoring and gasping for air. After a visit to Dr. Jill Zeitland at ENT and Allergy Associates in Sleepy Hollow, Mosa spent a night at the sleep clinic hooked up to electrodes that measured her blood pressure, heart and breathing rates, blood-oxygen levels, muscle movement and brain activity.
Mosa, 52, was soon fitted for a continuous-positive airway pressure, or CPAP, mask and machine. The CPAP pumps air into her throat all night as she sleeps, through a mask that covers her nose. It keeps her airway open and lets her sleep peacefully.
Like Mosa, most people with this disorder don't even know they have it. Up to 90 percent of those with OSA go undiagnosed and untreated, struggling with the symptoms for years. Left untreated, people with OSA can lose the equivalent of several hours of sleep each night. This is akin to having a blood-alcohol level of 0.10 percent, a sleep disorders clinic in Elizabeth , N.J., says.
"I would wake up at 1 a.m. with splitting headaches," said Mosa, a nurse and mother of five whose condition was diagnosed as the disorder six years ago. "By 3 or 4 in the afternoon, I'd want to close my eyes. I would drive home from work with the windows rolled down to stay awake. It was really hard to push myself through the end of the day."
Most people whose conditions are diagnosed with OSA see a sleep specialist because their snoring is keeping family members awake. People who are overweight are more likely to have OSA, although men and women and children who are not overweight can have it, too, especially when their tonsils or adenoids are enlarged. Other risk factors include loud snoring, high blood pressure, having congestion caused by hay fever or other allergies and having a short, thick neck, or a family history of sleep apnea.
"They may have ear pain or a sore throat, and you see that they're obese or overweight," said Dr. Michael Bergstein, surgical director of the Phelps Memorial Hospital Center Sleep Lab in Sleepy Hollow, and an otolaryngologist who also treated Mosa at ENT and Allergy Associates. "They're sitting in your office, and they're asleep. It's enormously undiagnosed."
And yet this disorder is no laughing matter. The national Commission on Sleep Disorders Research reports that drowsy drivers cause more fatalities per accident than drunken drivers. Drivers with untreated obstructive sleep apnea are twice as likely to have a car crash and three to five times as likely to have a crash involving personal injury.
"It is the most common cause of traffic accidents and deaths of truck drivers," Bergstein said.
For some, it takes a crisis to act. Until then, people with OSA often suffer in silence through chronic symptoms such as daytime fatigue, depression, irritability, sexual dysfunction, learning and memory difficulties. The disorder is also associated with high blood pressure and heart disease. People with OSA can have up to a 30 percent greater risk of a heart attack, stroke or sudden death, Bergstein said.
"One patient drove his boat into a mooring," Bergstein said. "I have another patient who ended up in my office who got into one car accident and another accident. He kept falling asleep at the wheel. Finally, he had his license revoked."
Because this patient had mild to moderate sleep apnea, Bergstein was able to cure his symptoms with surgical implants to the man's palate, known as pillar implants. But most patients, especially those with more severe symptoms like Mosa, are first offered nonsurgical treatment.
Bergstein documented the man's condition and his treatment to help him get his driving privileges reinstated.
"Once the patient is treated, they feel like they have a new life," Bergstein said. "It transforms their sex life, their family life, their work life."
While Mosa conceded going to bed hooked up to a machine with a mask on isn't sexy and it takes some getting used to, she said she won't travel anywhere without her CPAP machine.
"If I don't have the CPAP, I can't sleep," she said. "It's amazing, what a difference it's made. I'm clearheaded, and I'm more ambitious to do things. At this point, it's part of my life."
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November 5: Sleep may curb childhood obesity, AP
Study found third–graders who got more shut–eye had a lower risk
By CARLA K. JOHNSON
Associated Press
CHICAGO — Here's another reason to get the kids to bed early: More sleep may lower their risk of becoming obese.
Researchers have found that every additional hour per night a third-grader spends sleeping reduces the child's chances of being obese in sixth grade by 40 percent.
The less sleep they got, the more likely the children were to be obese in sixth grade, no matter what the child's weight was in third grade, said Dr. Julie Lumeng of the University of Michigan, who led the research.
If there was a magic number for the third-graders, it was nine hours, 45 minutes of sleep. Sleeping more than that lowered the risk significantly.
The study gives parents one more reason to enforce bedtimes, restrict caffeine and yank the TV from the bedroom.
The study appears in the November issue of the journal Pediatrics.
Lack of sleep plays havoc with two hormones that are the "yin and yang of appetite regulation," said endocrinologist Eve Van Cauter of the University of Chicago, who was not involved in the new study.
In experiments by Van Cauter and others, sleep-deprived adults produced more ghrelin, a hormone that promotes hunger, and less leptin, a hormone that signals fullness.
Another explanation: Tired kids are less likely to exercise and more likely to sit on the couch and eat cookies, Lumeng said.
Dr. Stephen Sheldon, director of sleep medicine at Chicago's Children's Memorial Hospital, praised the study and called for more research. He said children's sleep may be disturbed by breathing problems — some caused by being overweight, such as sleep apnea, and some caused by enlarged tonsils and adenoids.
"I'm not so sure we have enough information yet on cause and effect," said Sheldon, who was not involved in the study.
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November 7: Allergic to Christmas? Bah humbug, The Telegraph
By Roger Highfield, Science Editor
One person in every seven could be allergic to traditional Christmas trees, say doctors.
A fir tree festooned with lights and decorations is one of the archetypal Christmas images. But the Annual Meeting of the American College of Allergy, Asthma & Immunology, Dallas, will be told that they harbour a hidden danger.
Manufacturers of artificial trees will be delighted by the news that a study suggests that the evergreen spores from Christmas conifers could be responsible for a season surge in wheezing, runny eyes, rashes and headaches in allergy sufferers.
"It is difficult to get an exact handle on the percentage of the population that would be affected by Christmas tree exposure," said Dr John Santilli, chief of St Vincent Medical Centre's Division of Allergy and Immunology, in Bridgeport, Connecticut.
However, he told the Telegraph that the incidence of sneezes and wheezes likely fell in "a range of five-15 per cent based on the fact that 30-40 per cent of the population has some degree of respiratory allergy."
With William Rockwell, chief of Allergy and Immunology Bridgeport Hospital, Dr Santilli decided to study whether the trees trigger allergies because "our patients have consistently experienced a dramatic increase in asthma and sinus complaints occurring every winter. We recently noted this rise to be especially pronounced during the holiday season."
The allergic symptoms were thought to be associated with decorating the home, disturbing dust mites on Christmas ornaments and lights, or the perhaps scent of the live Christmas tree. But the team found an alternative explanation when they used an air sampler to measure the mould counts after a live Christmas tree was brought inside and decorated.
The first three days saw high counts of 800 spores per cubic metre, when normal values are 500-700 spores. After two weeks the count rose to a maximum of 5,000 spores per metre cubed when the tree was taken down, and the lights, baubles, paper chains and other decorations removed.
This level is unhealthy, said Dr Santilli. "Mould-sensitive patients may experience allergic symptoms due to an increasing spore exposure from having a live Christmas tree in the home."
"Therefore, we would recommend that families with allergies in general and mould allergies in particular not keep a live Christmas tree in their house for more than a few days at most, and remove it sooner if there are signs of increased allergic symptoms."
Mould allergy is a growing problem. "In our allergy practice we care for a great many patients who suffer from mould allergy," said Dr Santilli.
"Sensitive persons exposed to the pertinent moulds can experience a wide range of symptoms. Most commonly, allergic individuals may come up against nasal, eye, or throat irritation, nasal stuffiness, headache, and frequent sinus complaints.
"There is a well established link between moulds and asthma attacks. In patients with a compromised immune system there is the added risk of invasive fungal disease."
An earlier study conducted on 12 allergy sufferers, also presented to the American College, found they had more Christmas allergy symptoms than a comparison group of seven Jehovah's Witnesses, who do not celebrate Christmas. If your nose becomes as red as Rudolph's this coming Christmas, your tree may be the culprit.
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November 11: Sleep apnea prompts increase in surgeries, Allentown Morning Call
Doctors performing more tonsillectomies that may be linked to obesity.
Ann Wlazelek
When baby boomers were children, many had their tonsils removed because of infection. Some even had tonsils removed for the threat of infection -- a practice that fell out of favor decades ago, sending tonsillectomy rates plummeting. Now, however, the operation is on the upswing among children and some adults for an altogether different reason: obstructive sleep apnea, largely related to the nation's growing obesity problem.
A recent study of more than 8,000 pediatric patients revealed a sharp rise in operations to remove both tonsils and adenoids (often taken too) -- from 242 per 100,000 patients in the early 1970s to 491 per 100,000 in the first five years of this century. The study of mostly pediatric patients (median age 8) was conducted by researchers at the Mayo Clinic and presented at the Sept. 18 meeting of the American Academy of Otolaryngology -- Head and Neck Surgery in Washington, D.C.
The researchers attributed the surge to a dramatic increase in "upper airway obstruction" as the reason to operate. The rate jumped from 12 percent in 1970 to 77 percent in 2005.
Obstructive sleep apnea occurs when the tonsils, adenoids and uvula (dangling tissue) at the back of the throat temporarily block air flow. This can happen in a thin patient but more often affects overweight patients whose glands have become enlarged with the rest of body. The data corroborates what specialists in the Lehigh Valley and across the country have been observing.
"The No. 1, 2 and 3 reasons for sleep apnea are obesity, obesity, obesity," said Dr. Andrew Goldberg, a California professor and ear, nose and throat specialist who taught at the University of Pennsylvania in the mid to late 1990s.
Goldberg noted that Charles Dickens eloquently described the condition more than a century ago, when in the Pickwick Papers he wrote of "Joe the fat boy," who ate too much and could sleep anywhere at any time. It's only recently, he added, that obstructive sleep apnea has been recognized as a pervasive and potentially life-threatening condition.
Sleep apnea affects 4 percent of men, 2 percent of women and 2 percent of children in the country, Goldberg said, making it as prevalent as asthma or heart disease.
And because the blocked airway can cause a fluctuation in oxygen and blood pressure that leads to heart attack or stroke, he said, it's appropriate that the medical community diagnose and treat it.
Among the adults who are his primary patients, 80 percent of tonsillectomies are performed because of obstructed airways. Only 20 percent are removed because of infection.
Three-year-old Nicholas Gawronski of Hellertown and his 7-year-old brother Anthony are not overweight but both had their tonsils and adenoids removed because of sleep apnea, said their mother Vicki Gawronski, who is happy they did.
Both boys would stop breathing during sleep, snore and have bad breath from glands that were enlarged since birth, she said. Only after Anthony had his tonsils and adenoids removed two years ago and Nicholas followed suit in September did those symptoms go away and the boys become healthier.
Said Gawronski of the surgery, "It did the trick for both of them." Operations necessary?
Easton/Phillipsburg surgeon Scott Sackman questions the need to operate on an increasing number of children if the underlying condition can be prevented. He said the plethora of sleep disorder centers and relatively new group of sleep disorder specialists in business across the country are contributing to the escalation of tonsillectomies.
"Sleep apnea is being looked for more and being found more," he said. "My personal opinion is that educated parents of overfed children are finding their way to a doctor and it may beget a tonsillectomy that may or may not have been necessary if the kid hadn't been overweight in the first place."
Sackman considers his practice, methods and indications for operating conservative and not much different than when he started 30 years ago. Two-thirds of the 50-60 tonsillectomies he performs each year are children and most are performed because of repeated tonsil infections.
If an overweight child is referred to him for surgery because of sleep apnea, he tells the parents, "The best cure is to lose weight." "I am doing a few more adults, almost always for sleep apnea," he said. Most are overweight and should drop 20 pounds, Sackman said. He acknowledged it may be harder for adults than children to maintain healthy weights.
The first course of treatment for sleep apnea patients who cannot lose the extra weight or don't have a weight problem is to wear a "continuous positive air pressure" machine when they sleep, said Dr. William Pistone, a sleep medicine specialist who directs the sleep disorder center at St. Luke's Hospital-Allentown.
But if patients don't want to or can't tolerate the machine, the next step is surgery to remove tonsils or more to widen the airway, Pistone said. He estimated that 10 percent of the 170-200 patients diagnosed at the sleep center each month are referred to ear, nose and throat surgeons -- and that that number is double what it was five years ago.
Drs. Andrew Wakstein and Eric Holender of Palmerton, who started their specialty practice in 2000, said two-thirds of the tonsillectomies they perform are for apnea in overweight patients. Most are children, they said, because the operation generally is not as effective in adults.
Adults usually have other health problems that can complicate surgery and recovery, Holender said. "The risk of bleeding is slightly higher, it's not curative and it's not once and done." Although several local surgeons consider the risks of bleeding, reaction to anesthetic and pain to be greater in adults than in children, California's Goldberg said the difference is minimal. "They just complain more," he said.
In general, Goldberg said the widening of an adult's airway by removing the tonsils, uvula and some palate works on 30 percent to 40 percent of adults. "The ideal treatment is for patients to lose weight, but that's a very difficult thing for people to do," he said. "Also, there's an issue of magnitude. Patients with mild to moderate apnea who lose weight can get relief but those with more severe disease may warrant more aggressive treatment because even weight loss may not solve the problem."
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November 13: FLEXIBLE FITNESS: What’s that noise?, Daily News Transcript
By Lisa Brown/Spaulding Framingham/Daily News correspondent
Humming. Buzzing. Beating. Ringing. Roaring. Whooshing. Chirping. These are words used to describe the abnormal sound that millions of people hear in one or both ears. The technical term for this noise is tinnitus (tin-NY-tus). It is usually a symptom of damage to the auditory cells of the inner ear and associated with temporary as well as permanent hearing loss.
For most people tinnitus can be intermittent and is not given a second thought, but for many it can be a constant and debilitating problem interfering with daily activates and significantly disrupt sleep.
The leading cause of tinnitus is prolonged exposure to loud noise. A loud noise is anything that measures above 85 decibels. This includes lawnmowers and snow blowers, power tools, snowmobiles, car horns, music and gunshots. There are also a rising number of younger people complaining of chronic tinnitus due to the use of earphones when listening to loud music.
The length of the exposure is also crucial. If you are mowing your lawn for 30 minutes once a week you most likely will not experience any damage to the ears. However, people that are habitually exposed to loud noises, like in their work environment, are at a high risk for damage that may include not just tinnitus, but hearing loss as well.
For unprotected ears, noise exposure should be limited to less than 90 decibels over eight hours, 95 decibels over a four-hour period of time, and less than two hours for any noise that reaches 100 decibels. As a general rule, if you have to shout over the noise to make yourself heard, it's loud enough to damage your ears.
Some other causes of tinnitus include long term use of certain medications, trauma sustained to the head and neck, sinus infections, vestibular disorders such as Meniere's disease, a stiffening of the bones of the middle ear (or otosclerosis), Lyme disease, vitamin deficiency, lead exposure, vascular disorders such as arteriosclerosis and high blood pressure, and even high stress levels.
Treatment of tinnitus depends on the cause. If the problem is due to consistent exposure to loud noise (especially in the work environment), simply decreasing the sound and exposure levels, or wearing a hearing protector (such as earplugs or earmuffs), may diminish the symptoms. If the sound in your ears is due to a medical condition, such as an infection, your physician may be able to treat the underlying problem.
Hearing aids may be prescribed for those with age-related degenerative hearing loss. For those cases of tinnitus that are not associated with any specific cause, there are a variety of treatments available including medication, dietary adjustments such as limiting salt intake, masking devices (using white noise to desensitize the person to the sound), counseling, and of course, prevention.
An abnormal noise in your ears is annoying but not dangerous. If a person has symptoms of tinnitus that are becoming consistent or intense, an examination by your physician is warranted to rule out any contributory factors. Your doctor may then refer you to an otolaryngologist - a ear, nose and throat doctor - for a more detailed examination of your ears and hearing.
Lisa Brown, PT, is a senior physical therapist at Spaulding Framingham Outpatient Center. She has a bachelor of science degree in physical therapy from the University of Vermont and is certified in Vestibular Rehabilitation. She has extensive experience treating patients with neurological disorders.
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November 13: A Lineman in My Bed: Notes on Teeth Grinding, The New York Times
By PAUL VanDeCARR
I grind my teeth at night. Have for years. It’s my secret shame. But now I have the comfort of knowing that at least 8 to 10 percent of the adult population shares my malady.
It’s called sleep bruxism, and it refers to the grinding or clenching of teeth. There’s a waking version, too — an unconscious clenching of the teeth, most often owing to stress — but the origins are different and the effects are seldom anywhere near as bad as during sleep, when certain of the body’s protective mechanisms are turned off. Left untreated, it can cause damage to the teeth and surrounding tissue, headaches and jaw pain.
Bruxism may be at least as old as the Bible, which describes hell as a state where there is “gnashing of teeth.” I might fairly be accused of hyperbole if I reversed the equation and declared that bruxism can turn sleep into a kind of hell. But you get the idea. It’s a real nuisance.
“It’s much like having a large football player standing on the tooth,” says Dr. Noshir Mehta, chairman of general dentistry at Tufts University School of Dental Medicine and director of its Craniofacial Pain Center.
During sleep bruxism, he explained, the upper and lower teeth may come into direct contact as much as 40 minutes per hour, and — for example, on the first molar — with a force of about 250 pounds. Hence the football player. Compare that with normal circumstances, when a person’s teeth make contact for about 20 minutes a day, while chewing, and with only 20 to 40 pounds of pressure.
Even if I wanted a football player in my bed, I certainly wouldn’t want him standing on my teeth. I became aware of his presence the way that many bruxers do. My then-boyfriend told me I woke him up with a dreadful crunching noise that came from grinding; my dentist saw the wear patterns on my teeth and confirmed the diagnosis. Sleep bruxism is not a disease, but a common sleep disorder. It is more prevalent in children, who often outgrow it, and its origins may be different in adults.
“The exact causes are unknown,” said Dr. Gilles Lavigne. If anyone would know, it’s Dr. Lavigne, a professor of dentistry and medicine at the University of Montreal, and president of the Canadian Sleep Society who has published extensively on the topic. In the 1960s, he explains, bruxism was thought to be the body’s response to “malocclusion,” or problems with how the upper and lower teeth fit together; but that theory was discredited for lack of clinical evidence.
Stress was later thought to be the cause, but this failed to explain why not everyone with sleep bruxism was stressed and not everyone with stress ground their teeth. More recent research indicates some relationship of sleep bruxism to neurochemicals like dopamine, but there is still disagreement on how significant a role they play. Dr. Lavigne’s latest studies have identified a pattern of activation in the autonomic nervous system that correlates strongly with sleep bruxism. (He emphasizes that sleep bruxism is not an indicator of neurological disease.)
Whatever underlying causes science may show in time, and they may be several, the more immediate contributing factors for sleep bruxism are better understood. The medical literature shows that stress, smoking, alcohol, caffeine and other factors may set off or worsen the condition.
So what’s a grinder to do? Right away, my dentist suggested fitting me with a mouth guard, a small plastic device that covers some or all of the teeth to protect them against damage, but does not stop the grinding or clenching itself. Unable to afford the $300 price tag at the time, I got an over-the-counter version at the drugstore for $20. “The over-the-counter guards are usually better than nothing,” said Dr. Charles McNeill, director of the Center for Orofacial Pain at the University of California, San Francisco. They protect the teeth, he says, but may also be more likely to induce a chewing response and increase bruxism; they can also cause irreversible damage to the bite, or arrangement of the teeth, and so should be used only temporarily. Guards made by a dentist last longer, fit better and are generally designed to distribute the force of grinding to reduce jaw pain.
Feeling frustrated about my persistent bruxism, I was determined to find a way to stop altogether. Having started grinding during an especially hectic period in my life, I assumed that it was caused by stress. I tried relaxation techniques like yoga, exercise, biofeedback and hypnotherapy. Much as these may have helped my overall health, they didn’t seem to kick the football player out of my bed. Besides, even well after the initial stressor had passed, I was still grinding.
So I did what any reasonable person would do: I turned to drugs. The medical literature on bruxism showed that anti-anxiety medications like buspirone and clonazepam had worked on some patients; buspirone only made me jittery, but clonazepam brought my bruxism to, well, a grinding halt.
“Clonazepam would be a fantastic treatment, but it’s potentially habit-forming; it works too well,” said Dr. Michael Gelb, a clinical professor at the New York University College of Dentistry. “The better the pharmacological treatment works, the more fraught it is with difficulty.”
In two months, I became habituated to the drug and its effect began to diminish. I now use it only occasionally. So much for drugs.
Throughout, I paid attention to which factors seemed to worsen my clenching and grinding, like alcohol and poor sleep habits, and cut back where necessary. On my dentist’s recommendation, I also tried out the NTI-tss device, a hard plastic splint that for some people substantially reduces the intensity of clenching and associated headaches. But I was evidently such an insistent bruxer that I outwitted the principle on which it is based. Finally, I came back to where I started: I got a mouth guard that covers all my teeth, this time custom-fitted by my dentist.
I’d abandoned hope of ending my bruxism until I met a woman recently who stopped 10 years’ grinding after a year of regular acupuncture treatments. I was encouraged enough to try acupuncture myself, and have noticed some improvement after a few months of weekly sessions. Acupuncture has not been clinically proved to cure or calm bruxism, but I’m willing to hang my hopes on anecdotal evidence that suggests it helps.
Though I didn’t know it at the time, I had tried most of the approaches recommended for bruxism, albeit with less success than many people enjoy. Dr. Lavigne, of the Canadian Sleep Society, says people who wake up with headaches or jaw pain may clench or grind their teeth, and should consult their dentist, or doctors at a university-affiliated oral-facial pain center. There, patients may be directed to try some of the techniques I used, or others, and may be assessed for associated conditions like snoring. These approaches may reduce bruxism, but since there is no known cure, only the effects can be reliably treated. In the end, mouth guards are still the best defense.
After all, if you’re going to square off against a football player every night, you need padding.
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November 23: Saline Irrigation Eases Chronic Nasal Symptoms, HealthDay News
Salt water rinse of the airway beats saline sprays at providing relief, study finds
Saline irrigation is a safe, inexpensive and effective method for treating chronic nasal and sinus symptoms, according to a new study.
Researchers at the University of Michigan Health System also concluded that saline irrigation -- the flushing of nasal passages with a salt water mixture -- is more effective than commonly used saline sprays at providing short-term relief of chronic nasal symptoms.
The study included 121 adults with chronic nasal and sinus symptoms. Sixty were treated for eight weeks with saline irrigation, and 61 were treated with saline spray.
The patients in the saline irrigation group showed greater improvement at two, four and eight weeks.
After completion of the study, 61 percent of patients in the spray group reported having symptoms "often or always," compared with 40 percent of patients in the irrigation group.
"The irrigation group achieved a clinically significant improvement in quality of life in terms of severity of their symptoms, whereas the spray group did not. Strikingly, (the irrigation group) also experienced 50 percent lower odds of frequent nasal symptoms compared with the spray group," lead author Dr. Melissa A. Pynnonen, clinical assistant professor in the department of otolaryngology, said in a prepared statement.
The study, published in the current issue of the journal Archives of Otolaryngology -- Head & Neck Surgery, received funding from NeilMed Pharmaceuticals, which makes a saline sinus rinse.
Tens of millions of Americans suffer from chronic nasal and sinus conditions. Treatments include antibiotics, antihistamines and anti-inflammatory drugs. The findings of this study suggest that doctors should recommend saline irrigation more often for patients with chronic sinus and nasal conditions, Pynnonen and her colleagues said.
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November 26: Loud and clear on oral cancer, USA Today
By Kim Painter, USA TODAY
Brian Hill was no oral-health sloth. He had his teeth cleaned four times a year. He didn't smoke, chew tobacco or drink much.
So when Hill found an almond-size lump in his neck, he was shocked to learn he had an advanced oral cancer — and that the primary tumor, a "red velvety patch" in his upper throat, was big enough, he says, that an observant doctor or dentist could have caught it much earlier.
Ten years later, Hill is grateful to be alive. But he's unhappy that most cancers of the mouth and throat still are caught late. "We really don't have early diagnosis taking place," says Hill, 59, a former California businessman who founded the Oral Cancer Foundation (www.oralcancerfoundation.org) to increase awareness and research.
The statistics tell the story: 34,000 people a year are diagnosed with oral cancer, and 7,500 die from it. Just half of those diagnosed survive five years, according to the American Cancer Society.
A typical oral cancer is life-threatening "largely because it's detected too late," says Richard Price, consumer adviser for the American Dental Association (ADA). Many consumers aren't aware of oral cancer, even though it causes twice as many deaths as cervical cancer, he says.
The ADA launched magazine advertisements and billboards this month that urge people to seek screening for oral cancer. The ads promote the use of a brush device dentists can use to sample suspicious spots for cancerous or precancerous cells. The campaign is financed by the maker of the device.
But the cornerstone of oral-cancer detection isn't a device, experts agree: It's a five-minute exam that any dentist or doctor can do during a regular checkup. According to the American Association of Oral and Maxillofacial Surgeons, the doctor or dentist should:
- Look and feel inside the lips and the front of the gums.
- Tilt the head back to inspect and feel the roof of the mouth.
- Pull the cheeks out to see inside surfaces and back of the gums.
- Pull out the tongue and examine its surfaces.
- Feel for lumps or enlarged lymph nodes in the neck, including under the lower jaw.
"Every dentist should do this on every patient at every six-month or one-year checkup," says Baltimore head and neck surgeon James Sciubba.
About 10% of patients have spots that need further investigation, but most turn out not to be cancer, he says. Sciubba led a study supporting use of the brush test to sample such lesions.
Oral cancers, along with cancers of the larynx (voice box), are strongly linked to smoking. People who smoke and drink heavily are at highest risk. Chewing tobacco also may increase the risks. But about 25% of patients don't use tobacco, Sciubba says.
The HPV factor
Oral cancer in non-smokers is a growing problem, especially among men under 45 with cancer at the base of the tongue or in the throat, says Erich Sturgis, a head and neck surgeon at M.D. Anderson Cancer Center in Houston. The most likely culprit, he says: the same strains of human papillomavirus (HPV) that cause most cases of cervical cancer. A likely mode of transmission is oral sex, says research from the Johns Hopkins Medical Institutions published in May in The New England Journal of Medicine.
Some people may believe "oral sex is safe sex," Sturgis says. "But, at least for cancer, that's not true."
Johns Hopkins oncologist Maura Gillison says screening for oral cancer in the future might include testing for HPV. Vaccinating men and boys against HPV is another yet-untested possibility. (There is an HPV vaccine for cervical cancer.)
For now, she urges people to check out suspicious symptoms even if they don't smoke. Doctors need to take symptoms seriously, too, she says. "Almost every week, I see someone who had a persistent sore throat or had a mass in their neck and were told, 'You're healthy, you don't smoke, you don't drink, you're fine,' and they had advanced cancer."
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November 26: FDA wants warnings for kids on flu drugs, AP
WASHINGTON (AP) -- Government health regulators recommended adding label precautions about neurological problems seen in children who have taken flu drugs made by Roche and GlaxoSmithKline.
The Food and Drug Administration on Friday released its safety review of Roche's Tamiflu and Glaxo's Relenza. Next week, an outside group of pediatric experts is scheduled to review the safety of several such drugs when used in children.
FDA began reviewing Tamiflu's safety in 2005 after receiving reports of children experiencing neurological problems, including hallucinations and convulsions.
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Twenty-five patients under age 21 have died while taking the drug, most of them in Japan. Five deaths resulted from children "falling from windows or balconies or running into traffic."
There have been no child deaths connected with Relenza, but regulators said children taking the drug have shown similar neurological problems.
While FDA said it isn't clear whether the problems are directly related to the drugs, it recommends adding language about the possible side effects to labeling for physicians who prescribe Tamiflu and Relenza.
Besides being a drug side effect, the agency said the behaviors alternately could result from an unusual strain of flu or a rare genetic reaction to the drug.
Company representatives were not immediately available for comment.
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