Actor Larry Hagman Treated for Throat Cancer

In June 2011, actor Larry Hagman was diagnosed with stage 2 throat cancer. It is unclear exactly where the throat cancer was localized to (tongue, tonsil, supraglottis, hypopharynx, oropharynx, etc), but it was treated medically with radiation and chemotherapy.

Larry Hagman is a well-known actor playing oil baron J.R. Ewing in the soap opera Dallas (1980s as well as 2012) as well as Major Nelson in  the TV sitcom I Dream of Jeannie. Most impressive was the fact that he continued to act while undergoing cancer treatment for the Dallas remake.

Yesterday, Aug 29, 2012, media reported that the actor is now "cancer free."

Hogwash...

Throat cancer, especially stage 2, has the potential to come back. Though there may be no detectable signs of cancer currently, there is the possibility of cancer coming back in the future.

The risk of cancer recurrence is highest within the first 2-3 years after treatment completion, and markedly decreases after 5 years.

Typically if cancer has not come back after 5 years, the word "cure" may than be used, but even than, such patients are seen yearly for the rest of their life for cancer monitoring.

Given the high risk of cancer recurrence, patients are seen frequently for the first 2-3 years after treatment.

Every 2 months for the first year. Every 3-4 months in the 2nd year. Every 4 months in the 3rd year. Every 6 months in the 4th year. Yearly starting at 5 years after treatment.

This type of follow-up applies to all head and neck cancer.

Source:
Larry Hagman is cancer-free. SFGate 8/29/12

Larry Hagman. Wikipedia

Bi-Lobed Zenker's Diverticulum

In the not so distant past, I saw a patient who suffered from a bi-lobed Zenker's Diverticulum. Zenker's diverticulum for those who don't know is the abnormal development of a pouch in the throat causing symptoms of phlegm in the throat, food regurgitation, swallowing difficulties, and aspiration.

Most Zenker's Diverticulum is composed of a single central pouch. However, there are more rare varieties such as this bi-lobed pouch seen on barium swallow.

However, at time of surgery (endoscopic staple diverticulostomy), the bi-lobed nature of the pouch essentially disappeared.

Video of how the surgery is performed:

Congressman Putney with Vocal Cord Cancer

Media has reported that Congressman Lacey Putney, chairman of the powerful Appropriations Committee in the House of Delegates, has early stage vocal cord cancer.

He is currently undergoing radiation therapy which has a high chance of cure with relatively minimal side effects along with voice preservation.

My suspicion is that he is suffering from squamous cell carcinoma which is the most common type of vocal cord cancer. Though radiation therapy is a common form of treatment for this type of early stage cancer, surgical excision without the need for radiation is also possible. No chemotherapy is necessary for early stage vocal cord cancer.

Below is a picture of an early stage right vocal cord squamous cell carcinoma.

Compare to normal:

Source:
Putney undergoing treatment for throat cancer. WSLS10 8/15/12

New Webpage on Non-Acid Reflux

Given the frequency of patients I have seen over the years suffering from non-acid reflux causing symptoms of:

• Chronic cough
• Chronic throat-clearing
• Phlegmy throat
• Lump in throat sensation (globus)

I have decided to write a formal webpage to this condition.

Check it out here!

Lithium Disc Battery Danger for Kids (and Hot Dogs)

In the last 10 years, 13 deaths related to swallowed batteries have been reported, 12 of which were due to disc batteries (20 millimeter lithium cells).

The danger is that when a disc battery is inserted into a nose (for example), a localized electric current is created between the positive and negative poles of the battery within the nose. This electric current basically "electrocutes" the lining inside the nose leading to tissue damage and ultimately necrosis (tissue death) within an hour. The same applies even if the battery is swallowed or put into the ear canal.

When swallowed, it can burn through the esophageal/intestinal lining causing a perforation which can lead to death if not promptly treated (or even in spite of it if too much time passes before treatment).

Treatment is IMMEDIATE removal... as soon as possible. Regardless of the day or time. STAT...

For illustrative purposes, lets see what happens to a hot dog when a lithium disc battery is placed inside it. This example was created by Dr. Stephen Marcus who is the director of the New Jersey Poison Information Center and published in the Pediatrics Blog here. You can also do this at home... give it a try (make a slit in the hot dog and push a lithium button battery into it... than watch).

Just 3 hours later, this is what you would see...

Keep disc batteries away from kids!!!

Please!!!

References:
A lithium battery in a hot dog is no picnic. Pediatrics Blog 7/2/2012


Pediatric Battery-Related Emergency Department Visits in the United States, 1990–2009. PEDIATRICS Vol. 129 No. 6 June 1, 2012 pp. 1111-1117

Preventing Battery Ingestions: An Analysis of 8648 Cases Published online May 24, 2010 PEDIATRICS (doi:10.1542/peds.2009-3038)

A Review of Esophageal Disc Battery Ingestions and a Protocol for Management Arch Otolaryngol Head Neck Surg. 2010;136(9):866-871. doi:10.1001/archoto.2010.146

R&B Singer Maxwell with Vocal Cord Hemorrhage

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.

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

Our office has produced a new video describing Endoscopic Staple Diverticulostomy to treat Zenker's Diverticulum.

We have the unusual honor of having treated patients throughout the United States for this rare condition. Patients we have successfully treated have come from as far away as Oregon, New York, Florida, Pennsylvania, Louisiana, Arizona, etc.

For more information, please visit us here.

Levon Helm, Singer/Drummer for The Band, Dies of Throat Cancer

Levon Helm, legendary singer and drummer for The Band, died of throat cancer at age 71 on April 19, 2012.

It is unclear exactly what happened over this past month, but media reports state that he was diagnosed with vocal cord cancer in 1998 and underwent 28 sessions of radiation treatment at the Memorial Sloan Kettering Cancer Center. His cancer was almost certainly due to his 3 packs per day smoking and though he quit with his initial cancer diagnosis, cancer being what it is, it can always come back.

No mention of surgery or chemotherapy since than.

Given this little bit of information and the fact that he did have an albeit raspy voice to the point that he was still able to sing 1 month prior to his death on March 19, 2012, I suspect he had an aggressive recurrence of his vocal cord cancer.

Shown below is what a normal vocal cord looks like along with one that has cancer.

Typically with vocal cord cancer, radiation therapy alone is curative and allows for voice preservation. In fact, if no cancer is seen 5 years after treatment which in Mr. Helm's case would have been in 2003, one could state "cured" from this type of cancer.

So it is strange indeed that his vocal cord cancer would come back with a vengeance to the point it killed him 14 years later, though not impossible, especially if he started smoking again as well as drinking alcohol which exacerbates smoking's cancer-causing potential.

Furthermore, it is rare that vocal cord cancer alone would kill a person as there are salvage treatments in event the cancer does comes back as apparently it did for Mr. Helm.

If the vocal cord cancer comes back, it could grow in size to the point it would cut off the ability to breath. The growth could be quite dramatic taking a breathing/talking person to being unable to breath or talk in a matter of weeks.

With an aggressive vocal cord cancer recurrence, radiation therapy really is no longer an option if previously already done. Chemotherapy can be tried but with a localized aggressive cancer recurrence, surgery is really the only option... the COMPLETE removal of the entire voice-box.

This complete voice-box removal is known as total laryngectomy. It would leave the person completely unable to talk in a natural manner. It would also leave the person with a permanent hole in the neck as the only way to breath.

It just may be that Mr. Helm was offered this option, but given his life as a professional singer, it was perhaps too draconian an option for him to conceive of. As any singer can tell you, their voice is their life. Without their voice, their life might as well be over.

Of course, he may have developed a "new" cancer somewhere else in his throat... the supraglottis located immediately above the vocal cords or the pharynx which surrounds the vocal cords.

Unfortunately, the treatment options would have been still pretty much the same.

Source:
Levon Helm's Life After Cancer. CBS 2/11/09

Levon Helm Throat Cancer: Legendary 'The Band' Musician Dies At 71. HuffingtonPost 4/18/12

Levon Helm, Drummer and Singer of the Band, Dead at 71. RollingStone 4/19/12

How Many Infections in a Child is "Normal" Per Year?

Kids get a lot of infections... but at what point should a parent be concerned on how often these infections occur, particularly upper respiratory infections?

A German study went about to determine the answer to just that question... They prospectively followed 760 children born in 1990 and followed them for 12 years. Parents recorded the child’s illnesses in a diary and answered structured questions yearly up to age 12.

This is what they found... The mean number of infections per year for each age group (standard deviation):

• 0-2 years: 3.4 episodes (3.7) per year
• 3-5 years: 2.3 episodes (2.6) per year
• 6-12 years: 1.1 episodes (1.2) per year

Two standard deviations above the mean can be still considered within normal limits, though on the high side of normal:

• 0-2 years: 11 episodes per year

• 3-5 years: 8 episodes per year

• 6-12 years: 4 episodes per year

If a child gets more than this number of infections per year, one may need to consider possible immunodeficiency.

Source:

History of respiratory infections in the first 12 yr among children from a birth cohort. Pediatric Allergy and Immunology. Volume 19, Issue 6, pages 505–512, September 2008.

How many respiratory infections in children are "normal" per year? Allergy Notes by Dr. Ves.

Adele Speaks About her Vocal Cord Surgery on 60 Minutes

When it was first reported that Adele was undergoing vocal cord surgery in October 2011, there was much speculation regarding what exact vocal cord pathology she suffered from (hemorrhage? polyp?) and what type of vocal cord surgery she underwent for correction (laser? cutting?).

During her 60 Minutes interview with Anderson Cooper which aired on February 12, 2012, many details regarding her vocal cord problems have clarified.

She apparently suffered from a vocal cord polyp with hemorrhage.

Typically, this problem is normally treated with strict voice rest followed by extensive voice therapy prior to surgical consideration. However, this (safe) course of action takes time and as such, she pursued a much more aggressive approach in order to recover her voice as quickly as possible.

To explain, a lesson in some basic anatomy first...

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:

When there is a hemorrhagic polyp with a blood vessel as in Adele's case, her vocal cords may have looked like this where the blue arrowhead is pointing to a hemorrhagic polyp. The green arrow is pointing towards a feeding blood vessel.

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. When a polyp is present, the vocal changes are even more dramatic. 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 very 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. There may even be mild pain associated with this occurrence.

In Adele's case, she remembers the very moment this occurred during a radio interview when she "felt a pop" and her vocal pitch suddenly dropped into the bass range.

This makes perfect sense... To use the analogy of a violin string, the thicker the violin string the deeper the pitch. When hemorrhage occurs, the vocal cord becomes thicker due to blood pooling resulting in a deeper voice instantly.

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 the development or exacerbation of a vocal cord polyp. With repetitive cycles of healing and trauma, vocal cord scarring may even develop. 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 and associated polyp.

For that, surgical intervention is required.

One option is to precisely cut out the polyp and cauterize the feeding blood vessel at the same time. This approach was the course that Adele pursued. Watch a video on this approach (video shows a generic vocal cord mass removal, but the approach is identical).

The other option is use of a laser first to extinguish blood vessels present which may also significantly resolve the polyp followed by excision of the residual polyp at a later date. This latter approach is typically what I recommend. Why? It is relatively non-invasive and I feel the risk of scarring to be less compared with excision and vessel obliteration with a laser at the same time (though not zero). Furthermore, a smaller polyp also means a smaller wound that needs to heal.

Shown at end of this blog article 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.

Regardless of how or in what order the surgery is performed, strict voice rest is mandatory for a period of time post-operatively. For Adele, that was strict voice rest for nearly two months (Nov and Dec 2011). Why? Because with talking or any other vocal activity, the vocal cords come together. After surgical removal of a polyp, there is a raw surface present which won't heal as well if the other vocal cord is banging against it. Talking after vocal cord surgery is analogous to jogging right after foot surgery.

The vocal cord surgical wound MUST heal prior to talking let alone singing for normal recovery. That means strict voice rest. Strict voice rest means no talking, no singing, no whispering, no mouthing words, no throat-clearing, no humming, etc.

Read more about vocal cord polyps here.

Read the 60 Minutes interview here.

Of note, she later went on to sing a stellar performance at the Grammy Awards debuting her new voice for the first time after her surgery.

Woman Coughs Out Her Throat Cancer

It was reported today a woman literally coughed out a previously undiagnosed throat cancer... and cured herself of it.

She apparently felt a tickle in her throat forcing her to cough... and spat out a 2 cm large mass. No kidding...

The mass was sent to pathology and was diagnosed to be malignant and was told she only had a 50% chance of survival.

To ensure no cancer was left behind, she underwent radiological scans as well as additional biopsies in the base of tongue region where the mass probably originated from and no further trace of cancer was found.

She is very lucky as most base of tongue cancers that's 2 cm large usually requires not only surgery, but also chemotherapy and radiation treatment.

As the report stated, the cancer was probably on a thin stalk (like a lollipop) that allowed her to cough the entire cancer out!

Source:
Woman in clear after coughing up a cancerous throat tumour. Mirror.co.uk 1/11/2012

Natural Remedies for a Sore Throat, Cough, and Viral Infections

Homeopathy and alternative medicine often get a bum rap, but they have come up with some treatments for sore throats and upper respiratory viral illnesses that actually have been proven to work.

Here's a few...

1) Honey

Sore throats (and coughing) can be soothed by swallowing honey straight-up or slightly diluted with warm water with honey to make it easier to swallow. The best time to do this is at bedtime given it will stick around for awhile (eating/drinking will wash away the coating). The purpose of honey is to create a throat barrier to ease the discomfort.

Think of it like chapstick to coat irritated lips, but meant for the throat.

Use of honey is also recommended by the World Health Organization which has also published a monogram on viral colds and the various treatments explained. Pay particular close attention to Annex 3 (Page 11) which gives various recipes to treat pediatric cough including the use of honey.

Reference:
Effect of Honey, Dextromethorphan, and No Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.

2) Humidification

Dry cool air increases risk of viral infections as well as giving it to others. As such, add room humidification to a bedroom and keep the door closed (small room humidifiers can't humidify an entire house... so keep door closed!).

Why does this help? Increased humidification inactivates viruses!

Humidification also helps minimize a persistent dry cough worse at night often due to reactive airway disease triggered by breathing in dry air.

However, keep in mind that if you actively have a viral illness, it is too late for humidity to help. It is best used as a preventative measure.

Reference:
Dynamics of airborne influenza A viruses indoors and dependence on humidity. PLoS One. 2011;6(6):e21481. Epub 2011 Jun 24. Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathog. 2007;3:e151.

Heated, humidified air for the common cold. Cochrane Database Syst Rev. 2011 May 11;(5):CD001728.

3) Gargling and Saline Flushes

Gargle with saline water... or even just tap-water on a daily basis. Why does this help prevent viral infections? It washes away the viral particles before it gets a chance to cause problems.

It's also probably why drinking lots of fluids also helps since the viruses get deactivated in the stomach from the acidic digestion.

Unfortunately, gargling only helps with the throat... saline flushes are required to help with sino-nasal problems.

Reference:
Can we prevent influenza-like illnesses by gargling? Intern Med. 2007;46(18):1623-4. Epub 2007 Sep 14.

4) Xylitol

This naturally-occurring sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties and has been known to doctors and scientists but hardly marketed or promoted in any fashion.

However, the importance of this compound is that it DOES appear to significantly decrease the incidence of ear infections and sinus infections when used regularly. It comes in nasal spray form as well as gum.

Reference:

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

Conclusion

Sometimes the BEST medicine are things you can do at home without need for a physician visit... and is based on fact rather than anecdotal evidence.

The Doctors TV Show Does Chronic Throat Clearing

The Doctors TV show recently did a segment on chronic throat clearing. The ENT expert who explained this very annoying condition was Dr. Reena Gupta, a well-respected laryngologist with the Osborne Head and Neck Institute.

During this TV show, Dr. Gupta provided the two most common reasons for chronic throat clearing which were post-nasal drainage and reflux.

At its most basic explanation, mucus can come from the nose down into the throat (post-nasal drainage) OR mucus can come up from the stomach into the throat (reflux). The end-result is a person desiring to throat clear the mucus up and out.

However, there are other causes which were not addressed by Dr. Gupta during the show.

Other reasons for chronic throat clearing include:

Medication Side Effect
Food Allergies or Sensitivities
Zenker's Diverticulum
Laryngeal Sensory Neuropathy
Anatomic Triggers
PANDAS
Non-Organic Tic

Read more about chronic throat-clearing here.

Watch the TV show segment here.

Singer Adele Has Vocal Cord Hemorrhage and to have Surgery

At least that's what the LA Times reported on Oct 28, 2011. And supposedly will be having surgery to treat it in the near future.

Before going any further, the title to the LA Times story was "Adele to have surgery to treat vocal cord hemorrhage. What is it?"

I sincerely hope that whomever her surgeon is knows not to perform surgery when the vocal cord is in the middle of a hemorrhage. You do the surgery when the hemorrhage is gone and the culprit blood vessel is left behind which likely is the reason for the hemorrhage happening in the first place.

What do I mean?

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. 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 LA times story here.

Working in a Salon Can Be Unhealthy for Your Nose and Throat!

We already know that small hair clippings from cutting hair can cause septal perforation and chronic sinusitis due to long-term inhalation. Worse case scenario, it can even lead to an external nasal deformity! (Read blog about this here.)

However, it seems that it's not just hair that can damage the nose, but also hair products especially to straighten/smoothen hair popularly known as "Brazilian" treatments.

In a report published by Washington Post on Oct 17, 2011, such Brazilian hair smoothing treatments often contain a known toxic chemical called formaldehyde and methylene glycol. The FDA has pronounced such products to be unsafe. These chemicals are most commonly used as a preservative to prevent dead tissue (ie, corpses) from decay.

And yet... these products are commonly used in hair salons to potentially unsafe levels resulting in health problems to not just workers, but also customers.

Common symptoms that can result from formaldehyde and methylene glycol exposure include:

• nose-running (rhinitis)
• eye tearing
• throat burning

It can also cause symptoms of chronic sinusitis, taste alteration, smell loss, dry nose, scabbing at the nose entrance, etc.

Best to avoid if at all possible!

Read the WP article here.

Fauquier ENT Now Participates with Chase Health Advance Flexible Payment Options

Due to popular demand, our office now participates with Chase Health Advance. This plan is for those patients without insurance coverage or to help pay for uncovered procedures/services. Flexible payment options are offered only if total charges exceed $1000 (cost can be as low as $48 per month over 24 months). Depending on the promotion offered by Chase Health Advance, there may even be no interest charged! Click here to calculate your monthly payments.

New Webpage on Thyroid Mass (Evaluation and Management)

A new webpage has been uploaded to our practice website describing the evaluation and management of a thyroid mass. Surgical removal is discussed along with risks involved.

Click here to read more!

Reflux (Acid, Non-Acid, Mixed Types) in Neonates & How It May Also Apply to Adults

A study was published this month in the journal Pediatric Research which described reflux characteristics in neonates, but the findings can certainly be applied to adults as well.

What I found gratifying about this study was not so much that reflux was evaluated, but what measurements obtained by 24 hour pH-impedance were taken which apply just as much to adults as neonates. Just exactly what was measured and what did the study find (at least in neonates suspected of having reflux)?

• Only 54% of reflux events was associated with symptoms

• Defined by physical characteristics of reflux events:

• 51.3% were liquid


• 29.1% were gas


• 19.6% were mixed

• Defined by chemical characteristics of the reflux events:

• 48.5% were acidic


• 51.5% were non-acidic

• Defined by how high the reflux traveled away from the stomach:

• 79.2% reached the throat/mouth level


• 20.8% stayed in the chest level

Although these findings are specific for neonates, adults experience similar problems, though precise numbers are probably different and need more study.

Laryngopharyngeal reflux is when reflux reaches the throat level. Depending on the chemical characteristics of the reflux (acid vs non-acid as well as how high it goes), the symptoms may be quite variable. NON-acid reflux is considered "silent" and patients may not experience any symptoms of heartburn. Rather, common symptoms include:

• Phlegmy throat
• Chronic cough
• Swollen sensation in the throat (globus)
• Chronic throat-clearing

These results point out another issue... Common medications used to treat reflux (zantac, pepcid, nexium, prilosec, prevacid, etc) only treats ACID reflux. Not NON-acid reflux.

As such, other modalities must be pursued to address symptomatic non-acid reflux beyond medications involving lifestyle changes including diet as well as surgery.

Whether it be babies or adults, characterization of the spatial-temporal-physical-chemical nature of reflux events as defined by pH-impedance methods offers the best chance of evaluating and treating symptoms due to reflux.

Or in more simplistic terms...

NOT ALL REFLUX IS ACID!!!

NOT ALL REFLUX CAUSES HEARTBURN!!!

Reference:
Significance of gastroesophageal refluxate in relation to physical, chemical, and spatiotemporal characteristics in symptomatic intensive care unit neonates. Pediatr Res. 2011 Aug;70(2):192-8.

New Webpage on Peritonsillar Abscess Added to Website

Our office has created a new webpage on the evaluation and treatment of peritonsillar abscess.

Peritonsillar abscess is when a pus collection develops behind the tonsil causing a severe sore throat and trouble swallowing.

Read more on how this condition is treated here.

R&B Singer R. Kelly Undergoes Peritonsillar Abscess Drainage

Reuters on July 20, 2011 reported that R&B singer R. Kelly suffered from a peritonsillar abscess that required emergency drainage.

Peritonsillar abscess is when a pus collection develops within the tonsil causing it to swell. This may occur over a period of 24 hours resulting in a severe sore throat and trouble swallowing. This condition is in contrast to tonsillitis which is when the tonsil itself is infected, but no pus collection is present.

On exam, the affected tonsil may be huge crossing the midline (see picture). The uvula often is pushed to the opposite side and the soft palate may be asymmetrically huge as well.

Treatment is immediate incision and drainage. In an adult, this can be easily performed in the clinic after adequate local anesthesia. The pus is allowed to drain out and the patient often feels much improved within 12 hours. Antibiotics and a short burst of steroids is often prescribed afterwards.

Read the story here.

Read more about peritonsillar abscess management here.