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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 t ...

Wednesday, October 24, 2012

"Mother's Kiss" to Remove Nasal Foreign Bodies

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In 1965, a general practitioner Vladimir Ctibor described the "Mother's Kiss" technique of removing nasal foreign bodies in a child.

Essentially, a trusted adult (like a mother) places her mouth over the child's mouth as if to perform mouth-to-mouth resuscitation. While pinching off the unaffected nostril, the adult than blows gently into the child's mouth until resistance is felt caused by the child closing the glottis. At that moment, the adult gives a sharp explosive exhalation to deliver a strong puff of air that passes up into the nose and out the unblocked nostril. If successful, this air puff will also blow the foreign body out the nose as well.

If the adult blow's air when the child's glottis is open, air will just go into the lungs rather than up the nose.

Prior to the procedure, the child is informed that the mom will give the child a "big kiss," hence the name of this procedure.

Now... does this technique actually work?

According to one meta-analysis, it works about 59.9% of the time.

The way I consider it... it can't hurt to try before using instruments to manually remove the nasal foreign body. A "mother's kiss" is certainly a more comfortable and familiar approach for a child versus the alternative.

However, one warning point... the child should be calmly breathing during this procedure. If the child becomes hysterical during the procedure, the child might strongly inhale through the unblocked nostril and potentially suck the foreign body (if small enough) down into the lungs making an unlucky situation into a medical emergency.

Another point for those uninformed... do NOT use this procedure on ear foreign bodies. It will NOT work. The ear canal is a closed container with no inlet or outlet for any air pressure produced by a "Mother's Kiss." In fact, trying to perform this procedure on the ear may cause a ruptured eardrum and even permanent hearing loss.


Reference:
Removal of Foreign Bodies from the Nose. NEJM 1985; 312:725.

Efficacy and safety of of the "Mother's Kiss" technique: A systematic review of case reports and case series. CMAJ 2012. DOI:10.1503/cmaj.111864 (full length pdf)

Tuesday, October 23, 2012

What do Earthquakes Have to do with Thyroid Masses?

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I'm not sure what is going on within the Italian Court system, but in October 2012, the Italian Court convicted 7 scientists to jail terms for not accurately predicting the 2009 L'Aquila earthquake that ended up killing over 300 people. Also in October 2012, the Italian Supreme Court ruled that cell phones caused one man's brain tumor. Since when does the Court decide on matters of scientific validity? And even more importantly, what does this have to do with ENT??? I'm sure people here and there wil ...

Monday, October 22, 2012

Cheerleading A Dangerous Sport from an ENT Perspective

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The American Academy of Pediatrics (AAP) published its first policy statement regarding cheerleading due to the increasing rate of injuries found in this increasingly competitive sport. Who knew that although the overall risk of injury is lower than other sports, it has one of the highest rates of catastrophic injuries including closed-head injury, skull fractures, cervical spine injuries, paralysis, and even death. After all, cheerleaders do not wear protective gear and safety is utterly dependent on external factors ...

Saturday, October 20, 2012

Tinnitus: Top 12 Topics I Teach

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by Dr. Richard Thrasher, III Tinnitus. It’s a subject I discuss at least 2-3x every time I hold a clinic. There’s a lot of misinformation out there. I’m going to break it down the way that I describe it for my patients in clinic. There is far more information out there that I’m not going to go into, but these are the bullet points I think most everyone with it should at least hear once. 1 – Tinnitus is common. If you took every person on the planet and individually put them in a soundproof booth with a complete absence of sound ...

Broken Owen Wilsons. .errr. .uh. .Noses

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by Dr. Richard Thrasher, III Probably the most famous crooked nose I know belongs to Owen Wilson. He wasn’t born that way. He broke it twice. Once in a fight with another kid at school and once playing football with buddies. Adam Foote was a great hockey player who spent much of his time with the Colorado Avalanche and has quite the crooked nose also from multiple fractures. The reason I bring up these two noses is because they are some of the more famous extremes of the results of unreduced nasal fractures of which I’m awar ...

Tongue Tie–And Not the Kind Politicians Have

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by Dr. Richard Thrasher Ankyloglossia, or tongue tie, is a very common congenital condition, meaning it’s something with which you’re born. This picture from Dr. Ghorayeb’s site shows a perfect example of a pretty dramatic one. Ankyloglossia is when the lingual frenulum (the band of tissue under your tongue which tethers it to the floor of your mouth) is either too short or extends too far to the tip of the tongue. It can then prevent normal tongue movement. While often not signficant, a severe tongue tie can impede breast fee ...

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 paralysis, vocal cord surgery to address polyps, cysts, nodules, granulomas, 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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A new video describing Endoscopic Staple Diverticulostomy to treat Zenker's Diverticulum has been produced. For more information, click here. ...

Devices That Help Fix Clogged Ears

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Clogged ears due to eustachian tube dysfunction or fluid in the ears is one of the most common complaints seen in an ENT clinic. Beyond medications like steroids & nasal sprays or even surgery (ear tubes) to resolve this complaint, a fundamental physical maneuver the patient MUST also be doing is called "valsalva". Valsalva is the attempt to "pop" the ears by yawn, swallow, or attempting to gently blow air out the nose that is pinched shut. The yawn and swallow are passive maneu ...

Azithromycin Increases Risk of Death Slightly... Well, So Does Tylenol and Ibuprofen

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The media has made much fuss about a NEJM study suggesting a slight increased risk of death from taking azithromycin or z-pack. The more unhealthy you are, the higher the risk... no duh... (I would think the sicker you are, the greater the risk of death PERIOD... a sick person by definition is closer to death than a healthy person). How slight? Compared to amoxicillin, about 47 additional cardiovascular deaths per one million courses of therapy. Never mind the blatant biases found in the study nicely es ...

Name an ENT Who Has Won an Olympic Gold Medal

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He not only won one Olympic Gold Medal, but two in men's platform diving in 1948 and 1952. Dr. Sammy Lee also won bronze medal in the 3 meter springboard and coached Bob Webster and Greg Louganis to their Olympic medals. In terms of his medical career, he studied pre-med at Occidental College followed his MD from University of Southern California (USC) Medical School in 1947. He than went on to become an ear, nose and throat specialist. Yeah! ...

ENT as Comic Book Hero (or Villain)

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I had no idea that ENTs with our head mirrors are relatively common in the comic book world alternately portrayed as heroes or villains. (Most of us have upgraded to a headlight powered by battery, but some of us ENTs still use a head mirror.) There is a Family Practice physician who has compiled all the situations where ENTs were portrayed in comic book settings in his blog Polite Dissent. The full list can be found here. I have reproduced a few of my favorites below: ...

Find an ENT Doctor App

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If you have an iPhone or Android, get the ENTLink App... You can search for an ENT by current location or by zip code. The search can be narrowed to a specific specialty area (laryngology, neuro-otology, rhinology, etc) as well. Of course, you can search for the same information from the website. Download the app for iPhone and Android. ...

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: Hoarseness Chronic (ongoing) cough Frequent throat clearing Constant mucus or phelgm in the throat Dry or sandpaper like sensation in the throat Pain or burning sensation in the throat Feeling of a lump in the throat (globus pharyngeus) Problems swallowing Bad/bitter taste in the mouth (especially in morni ...

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 ...

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 spin ...

Bacteremia IS Present During Tonsillectomy!

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@ENTHouse brought to my attention a very interesting research regarding the presence of bacteria in the bloodstream during tonsillectomy, both elective and quinsy. Elective tonsillectomy is when the tonsils are removed in the absence of any significant infection. Quinsy tonsillectomy is when the tonsils are removed in the setting of a peritonsillar abscess. The research involved obtaining blood cultures, tonsillar swabs, core tissue, and pus aspirates during the operation on 80 patients underg ...

Beastie Boys Adam Yauch Dies of Parotid Cancer

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On May 4, 2012, Adam Yauch, one of the founding members of the Beastie Boys, died of a "rare parotid gland cancer" that he had been battling since its diagnosis in 2009. For those who do not know what a parotid gland is... it is one of the major glands that produce saliva or spit and is located immediately in front of the ear (looks like fish eggs in the picture taken from Wikipedia). It is about the size of the palm of the hand. It is unclear exactly what type of parotid gland cancer Adam Yauch had, but here's ...
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