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Showing posts with label throat. Show all posts
Showing posts with label throat. Show all posts

Monday, December 10, 2012

Coffee Reduces Risk of Death from Oral Cancer

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In a prior blog, I mentioned that researchers found that regular coffee drinkers who drank more than four cups of coffee a day had a 39 percent decreased risk of two types of head and neck cancer: oral cavity and pharynx cancers. In the study published in the Journal of Cancer Epidemiology, Biomarkers & Prevention, they found however, that coffee did not decrease the risk of laryngeal cancer. Read a CNN report on this here.

In a more recent study (Dec 2012), researchers have found that not only does coffee reduce risk of cancer, but that consuming more than four cups of caffeinated coffee per day was associated with a 49 percent lower risk of oral/pharyngeal cancer death relative to no/occasional coffee intake.

Coffee contains over 1,000 different chemical compounds, including cancer-fighting antioxidants, and it’s those antioxidants that may provide a “plausible explanation” for reducing the cancer risk as well as cancer death.

However, patients should not take this study as an excuse to increase their coffee intake specifically to counteract known cancer-causing behaviors including smoking, drinking alcohol, and chewing tobacco.

Reference:
Coffee and Tea Intake and Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev. 2010 Jul;19(7):1723-36. doi: 10.1158/1055-9965.EPI-10-0191. Epub 2010 Jun 22.

Coffee, Tea, and Fatal Oral/Pharyngeal Cancer in a Large Prospective US Cohort. American Journal of Epidemiology, 2012 DOI: 10.1093/aje/kws222

Tuesday, October 30, 2012

Elbowed by Your Spouse While Sleeping? You May Have Sleep Apnea!

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Canadian researchers have determined that if a patient answers in the affirmative to two questions:

1) Do you get elbowed/poked while sleeping for snoring?
2) Do you get elbowed/poked while sleeping for stopping breathing?

There is a significant chance that the patient may have obstructive sleep apnea (OSA) with AHI score  more than 5.

This quiz has been dubbed the "Elbow Test".

Actual diagnosis for OSA is by sleep study.

Should OSA be actually diagnosed on a sleep study, initial treatment includes CPAP machine followed by oral appliance and potential candidacy for surgical interventions.

Reference:
“Elbow Test” May Predict Sleep Apnea. Chest 10.22.12

Saturday, October 13, 2012

Synthetic Vocal Cords [video]

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Synthetic vocal cords being under development at MIT and Harvard... Very good video!

What are some of the vocal cord problems that may benefit from such a synthetic gel? Vocal cord paralysisvocal cord surgery to address polyps, cystsnodulesgranulomas, etc.

As an FYI... the synthetic vocal cord gel portrayed in the video is still under development and not available for patient use yet...

Video on Zenker's Diverticulum Surgery (Endoscopic Staple Diverticulostomy)

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new video describing Endoscopic Staple Diverticulostomy to treat Zenker's Diverticulum has been produced.

For more information, click here.

Saliva Test for Laryngopharyngeal Reflux (LPR)

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Various groups have been developing a fast, cheap, non-invasive saliva swab test to determine whether laryngopharyngeal reflux (LPR) is present or not. LPR may cause symptoms of:
When you compare a spit test to the current way of how reflux is determined via barium swallow, upper endoscopy (EGD), and 24 hour ph/impedance testing, it sounds quite attractive.
How does such a test work?

It basically looks for a stomach protein called pepsin.

Given reflux is when stomach contents moves up towards the mouth and pepsin is a protein ONLY produced in the stomach... pepsin should NOT be found in the throat/mouth.

As such, the test can state yes or no whether LPR is present or not.

How good is the test?

Depending on the study, sensitivity ranges in the 80-100% (can actually detect reflux if truly present) and specificity is around 85% (truly no reflux if test is negative).

Unfortunately, such testing is not offered is most labs. (Currently working on getting such testing available in our office.)

One test company is rdbiomed using their Peptest kit.


References:

Rapid salivary pepsin test: Blinded assessment of test performance in gastroesophageal reflux disease. Laryngoscope. 2012 Jun;122(6):1312-6. doi: 10.1002/lary.23252. Epub 2012 Mar 23.

R&B Singer Maxwell with Vocal Cord Hemorrhage

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At least that's what the Washington Post reported on June 22, 2012. This has resulted in cancellation of his summer tour.

Per media reports, his vocal cords are swollen with hemorrhage.

Some fans may recall that something similar happened to Adele in winter of 2011 which resulted in her also canceling a number of engagements. She ultimately had surgery to correct her problem.

Normally, the vocal cords are pearly white without any vasculature. Watch a video of how this exam is performed.


However, when a blood vessel is present in the vocal cords, they may look something like this:


The issue with a blood vessel within the vocal cord itself is that it fluctuates in size due to whether it is irritated from phono-trauma or even hormones. Such fluctuation in size causes the voice to change in pitch and quality on an hour to hour basis depending on how much swelling occurs. For a singer, it makes the voice unpredictable.

When the blood vessel becomes engorged and traumatized, it may even rupture leading to a vocal cord hemorrhage. Especially in a woman, the blood vessel may be more prone to hemorrhage during her menstrual cycle.

This is a dangerous situation for a singer because of their regular voice use and need to use it forcefully. However with too much force, the blood vessel may suddenly rupture (even in the middle of a performance) resulting in a hemorrhage into the vocal lining itself causing a sudden and complete loss of voice. If a voice is present, it is much deeper than normal due to the additional "weight" of blood and edema (just like a violin string where the thicker the string, the deeper the pitch). There may even be mild pain associated with this occurrence.

To the right is a picture of a vocal cord hemorrhage. Note the entire vocal cord on one side (which is the patient's right side for those in the know) is brilliant red indicative of the presence of blood throughout the cord.

How is this treated?

Initially during an acute vocal cord hemorrhage, STRICT VOICE REST is mandatory. With continued voice use, the patient risks abnormal healing that may result in a vocal cord polyp or vocal cord scarring. Along with strict voice rest, steroids are often prescribed to help reduce the inflammatory swelling that often occurs as well as minimize risk of scarring.

Unfortunately, though such treatment may resolve the hemorrhage, it will typically not get rid of the culprit blood vessel.

For that, surgical intervention is required.

Such surgical intervention is much like trying to get rid of varicose veins in the leg.

One option is to precisely cut it out. Watch a video on this approach (video shows a vocal cord mass removal, but just pretend the mass is a blood vessel as the approach is identical).

The other option is use of a laser which is typically what I recommend. Why? It is relatively non-invasive and I feel the risk of scarring to be less compared with excision (though not zero). Shown below is a video of a vascular polyp being obliterated using a pulsed-dye laser (courtesy of Dr. Chandra Marie-Ivey). Another type of laser that may be used is a KTP laser.

Read more about laser treatment of vocal cord pathology here.


Read the Washington Post story here.

How Does Cervical Spine Surgery Potentially Cause Voice and Swallow Problems? [video]

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It is not unusual for an ENT surgeon to see patients with swallowing and voice difficulties after cervical spine surgery. In particular, the ACDF surgery (Anterior Cervical Discectomy and Fusion).

The key to understanding these issues is to first understand the anatomy involved.

The cervical spine is located in the back of the neck. In front of this spine is the esophagus (swallowing tube) and voicebox.

As such, when a spine surgeon goes through the FRONT of the neck in order to perform cervical spine surgery located in the BACK of the neck, (s)he has to move the esophagus and voicebox over to the side.


A plate is than fixated to the spine to fuse the cervical vertebral bodies.

Because of such manipulation of the esophagus and voicebox, it is not uncommon for a patient to complain of hoarseness and difficulty swallowing after surgery.

Fortunately, such problems usually dissipate with time, but not always.

Watch the video describing ACDF and how it can affect voice and swallow.

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