Rush Limbaugh Has a Cochlear Implant

Infamous conservative talk show host, Rush Limbaugh, suffered from a rare hearing disorder called Autoimmune Inner Ear Disease.

This rare inner ear disease is principally characterized by progressive bilateral fluctuating hearing loss and occurs when the body's own immune system starts to attack the hearing mechanism of the ear... much like rheumatoid arthritis is when the body's immune system attacks the joints. Just as with any other auto-immune disorder, it is mainly treated with repeated courses of prednisone.

However, if the hearing gets poor enough, the patient may become essentially deaf for which even hearing aids are ineffective which is what happened to Mr. Limbaugh.

To restore his hearing, he underwent surgical placement of a cochlear implant at the House Ear Institute in Los Angeles. It is truly a "bionic" ear in that a computer hears the world around him and directly stimulates the hearing nerve bypassing the cochlea.

Here's a transcript of him describing what it's like.

Source:
Questions on the Host's Hearing. March 18, 2011
Rush Limbaugh's Cochlear Implant Surgery A Success. Audiology Online. 1/3/2002.

Nasonex Sinus Implant for Chronic Sinusitis

The FDA on August 15, 2011 approved of a novel dissolvable sinus implant that slowly releases mometasone furoate steroid (same active ingredient as Nasonex steroid nasal spray) directly onto the sinus mucosa.

The spring-like implant is placed at the time of sinus surgery and automatically expands and conforms to the sinus cavity regardless of size and shape.

The theory is that by continuously delivering a low dose steroid directly to the sinus cavity, sinus inflammation will decrease and risk of scarring will decrease resulting in an overall decrease in chronic sinusitis for the patient after sinus surgery.

This is a GREAT idea and studies have born out its effectiveness. Hopefully other drug-eluting dissolvable stents like this will be developed in the future!

Developed by Intersect ENT, the implant is called "Propel."

Read about the FDA approval here.

References:
Safety and efficacy of a novel bioabsorbable, steroid eluting sinus stent. INTERNATIONAL FORUM OF ALLERGY & RHINOLOGY. 2011;1(1):23-32.

Advances in the Surgical Management of Chronic Sinusitis and Nasal Polyps. CURRENT ALLERGY AND ASTHMA REPORTS. Published online 08 February 2011

Controlled steroid delivery via bioabsorbable stent: Safety and performance in a rabbit model. AMERICAL JOURNAL OF RHINOLOGY & ALLERGY. November–December 2009, Vol. 23, No. 6.

"Sinus Lift" Procedure - The Return of Intra-Oral Sinus Surgery

I saw a patient today who informed me that she underwent a "sinus lift" procedure in the past.

This statement made me realize that though ENTs are generally considered the sinus surgery experts, dentists and oral surgeons perform some sinus surgery as well like the "sinus lift" procedure. As far as I know, there is no ENT surgeon that does that specific sinus operation.

In essence, the "sinus lift" procedure is when the floor of the maxillary (cheek) sinus cavity is raised with bone graft material in order to accommodate a dental implant. Though there are many approaches to accomplish this task, most require entering into the maxillary sinus cavity. See image below:

It is somewhat strange when considering that back in the old days (like a few decades ago), ENTs routinely performed a similar intra-oral approach (Caldwell-Luc) in order to enter into the maxillary sinus cavity when performing sinus surgery for chronic sinus infections. However, with the advent of endoscopic techniques, this approach is now very rarely performed. Indeed, we try to avoid any incisions if at all possible.

So while ENTs have significantly decreased the use of intra-oral approaches for maxillary sinus surgery, the dental world has brought this approach back!

Who knows? Perhaps ENT and oral surgery will join forces at some point in the future in order to perform an endoscopic "sinus lift" procedure in order to avoid making any incisions in the mouth!