The Doctors TV Show Does Adenoidectomy

Dr. Nina Shapiro was the featured otolaryngologist when The Doctors television show discussed nasal congestion as well as large adenoids. A sanitized view of adenoid removal surgery was also shown.

For a more detailed view of the surgery, click here.

For more info on adenoids and its surgical removal, click here.

Portable CT Scanner

Portable X-ray machines are commonplace... but a portable CT scanner?!!

I saw this article by MedGadget about a portable CT scanner introduced earlier this year that can be wheeled around in the hospital made by NeuroLogica.

When looking up more details, the company makes not just one portable CT scanner, but FOUR different portable machines:

• BodyTom: Portable whole-body CT Scanner
• CereTom: Portable CT Head scanner
• OTOscan: Portable CT Sinus scanner
• inSPira HD SPECT: Portable SPECT scanner

Pretty amazing.

Though the whole-body CT scanner seems a bit big to be easily moved from hospital room to hospital room, it is comparable in size to portable fluoroscopy equipment currently in use. The other models are quite a bit smaller.

Realistically, I think the CereTOM will be the big winner as CT scans of the head is probably the most ordered CT scan in the hospital, often ordered to evaluate for stroke, head injury after a fall, sinusitis, facial fractures, brain tumor, seizures, etc, etc, etc. In many of these situations, the patient is fairly immobile and it just may be easier and faster if the CT scanner is brought to the patient rather than patient wheeled to a stationary CT scanner.

Dr. House of TV Fame Would Never Survive in Real World

Would YOU as the patient see a doctor who is a well-known jerk, abuses drugs, gives the wrong diagnosis more often than not, and is known to like ordering very invasive tests??? Be honest...

The other week, a patient with a chronic cough exclaimed to me that she wished the fictional character Dr. House of TV fame actually existed in real life, because he was somebody who can diagnose anything.

I looked her straight in the eye and told her that somebody like Dr. House in the real world would be a physician nobody would want to see for many reasons:

1. In the real world, patients expect doctors to have the correct diagnosis from the beginning (might forgive one wrong diagnosis). Dr. House seems to always get things wrong multiple times before he gets it right. I seriously doubt most patients would have stuck around as long as they do on the TV shows before going elsewhere.
2. In order to achieve that correct diagnosis, Dr. House seems to pursue invasive tests which in reality is something patients rarely like to pursue... and often get second opinions to determine if really needed.
3. Dr. House is fairly abrasive with his colleagues and even with his own patients which pretty much guarantees one star ratings on physician rating websites like HealthGrades.com and Vitals.com.
4. Dr. House is addicted to vicodin, morphine, and cocaine... That pretty much guarantees loss of hospital privileges and perhaps even his medical license to practice in the real world. Furthermore, what would you do as a patient if you found out that your doctor abuses drugs??? Most will go elsewhere.

So given what I know patients want in reality, it boggles my mind why patients in the real world think Dr. House is so great and wish a fictional character like him truly existed.

To flip things around... the real question is why aren't real world patients more forgiving of physician fallibility like those on TV? I'm the first to admit that physicians (in the real world) are not perfect though the expectation is that we are.

In-Office Sinus Surgery Without General Anesthesia

There has been tremendous advances in sinus surgery over the past decade. From the elimination of nasal packing after most routine sinus surgery to the more recent use of balloons to open the sinus cavities, patient comfort has improved greatly after this particular operation. What used to be a several week recovery may now only be a few days.

Balloon sinuplasty in particular has been revolutionary in the surgical treatment of chronic sinusitis. Though sinus surgery normally is performed under general anesthesia, balloon sinuplasty now allows this operation to be performed awake WITHOUT sedation using local anesthesia only.

At its essence, sinus surgery "opens" up blocked sinus cavities to allow drainage and ventilation. Traditional sinus surgery "removes" tissue to accomplish this goal whereas balloon sinuplasty stretches open the sinus cavity without the need for tissue removal.

Given the lack of tissue removal with balloon sinuplasty, there is less pain and faster recovery after the procedure.

What are the steps?

After adequate anesthesia of the nose using both topical and injectable numbing medicine... Step 1 Under endoscopic guidance, the balloon catheter is introduced into the nasal cavity and guided towards the target sinus cavity opening. Depending on the system used, a sinus guidewire or sinus illumination may be used to help with the guidance.
Step 2 Once the sinus balloon catheter is correctly positioned across the blocked sinus opening, the balloon is gradually inflated to stretch open the ostia.
Step 3 After several seconds, the sinus balloon catheter is then deflated and removed leaving an enlarged sinus opening allowing for the return of sinus drainage. There is little to no disruption to mucosal lining.

Of course, not all patients are candidates for balloon sinuplasty, let alone this procedure to be done awake with local anesthesia alone.

In particular, balloon sinuplasty can only address blockages involving the frontal, maxillary, and sphenoid sinus cavities. Ethmoid sinus cavities can NOT be corrected using this method.

Also, balloon sinuplasty does not allow for tissue biopsies (by definition, the advantage of balloon sinuplasty is the lack of need to remove any sinus or nasal tissues). As such, if there are any masses present including nasal polyps, traditional sinus surgery is the better way to go.

Human Ear Contains a Built-In "Ear Plug"

According to one Australian researcher, by just chewing a gum or singing/talking loudly, one could be protecting your ears from noise-induced hearing damage. How???

It is not common knowledge that the human ear contains two muscles that attach to the middle ear bones called the stapedius and tensor tympani muscles.

The middle ear bones, composed of the malleus, incus, and stapes, are what transmits sounds from the eardrum to the cochlea which allows a person to hear. The stapedius muscle attaches to the stapes and the tensor tympani to the malleus.

If something prevents the middle ear bones from vibrating, that effectively dampens the sound transmission from the eardrum to the cochlea... just like an ear plug or a bad case or earwax dampens sound transmitted through the ear canal to the eardrum.

SO... if the middle ear muscles tighten which are attached to the middle ear bones preventing them from vibrating, less sound is transmitted to the cochlea... just like an ear plug, except it is built-in.

Just how effectively does this reduce sound?

According to the researcher who has been studying this phenomenon, by about 30 decibels (or 1000x fainter).

That's about the same as foam earplugs!

How does one "activate" the middle ear muscle contraction?

By chewing a gum or singing/talking loudly!

Some individuals can sense this contraction if they close their eyes and try to "pull the muscles around the ears together"... a fluttering sensation inside the ear may be heard/felt which is the contraction of the middle ear muscles. In rare patients, this contraction may occur involuntarily and continuously.

SO... if you happen to have forgotten your ear plugs and are attending a very loud rock concert, chew gum and/or sing along with the band loudly! This may actually protect your hearing!

Of course, it's better to wear hearing protection, or better yet, avoid such circumstances altogether.

Read more about this here.

Reference:
How do middle ear muscles protect the cochlea? Reconsideration of the intralabyrinthine pressure theory. Journal of Hearing Science 2011; 1(2): RA 9 - 23