Distributed Botox Injection for Spasmodic Dysphonia (Rather than Single Injection)

For many patients with spasmodic dysphonia, botox injections to the vocal cords are a regular right of passage every few months towards a clearer voice. Spasmodic dysphonia characterized by spastic or breathy voice breaks while talking causes much problems socially as well as misunderstandings.

For many physicians who perform botox injections for spasmodic dysphonia, a single injection is performed to either one or both vocal cords.

However a few and perhaps growing number of physicians are now using a more sophisticated method of injection where not only one, but multiple "mini"- injections are performed to the vocal cord during an injection.

Why would multiple injections be performed when one will do?

For that, I would like to take the reader to the world of cosmetic botox injections for facial wrinkles.

For the millions more sufferers of facial wrinkles, patients know that from the point of injection, there is a limited region of affect... typically no more than a dime to nickle area in size depending on the volume used. SO... in order to get rid of forehead wrinkles, 5 or more injections are required as shown here by the "x" marks.

The point is... in order for a great outcome in forehead wrinkles... multiple injections are performed. Not one single injection.

The same holds true for the vocal cord muscles. Rather than a single large injection to one spot in the vocal cord muscle, there is a growing belief that multiple "mini"-injections should be performed throughout the vocal cord muscle in order to produce a better outcome... a distributed injection. No specific research to prove this, but rather anecdotal.

Here is a video of botox being injected in a patient with spasmodic dysphonia.

Making Twitter Work for a Specialty Medical Practice (Like ENT)

I've been asked by a few ENT colleagues how I got Twitter to work for my practice and how in the world I managed to get more than a few dozen followers.

I've been at it for about 1 year now (up to 355 followers @FauquierENT) and here are a few tips to making it work for a medical practice... Just an opinion... And it may not apply to everyone...

• When you tweet something, always back it up with a useful link to a webpage using a link shortner like bit.ly or goo.gl.
• Tweet about topics that the LAY-PERSON would find interesting. Twittering about "Outcomes of Vascularized Bone Graft Reconstruction of the Mandible in Bisphosphonate-Related Osteonecrosis of the Jaws" is NOT going to garner you fans even if you personally as an ENT find it riveting reading. An example of a good tweet I recently posted is "Do Cell Phone Makers Secretly Know Cell Phones May Cause Health Problems? http://ht.ly/3bBUZ"
• Follow people you find interesting. They will follow you back typically and their followers will slowly start to follow you. Given I twitter about ENT topics, I make it a point to follow ALL otolaryngologists, respected medical journalists, and health related newspapers.
• Write a blog and use twitter to "advertise" your blog article.
• ADVERTISE on your website that you have a twitter account.
• Be active with tweets. Potential followers will not be that excited to follow you if you have something interesting to say only once every few weeks.
• IF you come across something interesting in a medical journal, tweet it, and support it with a link.

So there you have it... Now go sign up with twitter and don't forget to follow my tweets!

"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!

Fauquier ENT Blog Now Published on the Kindle

We are pleased to report that our blog is now published on the Kindle! As many readers may already be aware, the Kindle is the top-selling e-book reader sold by Amazon.com. Click hereto subscribe to our blog on the Kindle!

Zenker's Diverticulum Endoscopic Treatment Confusion

Having treated many patients with Zenker's Diverticulum using the endoscopic approach, I've had many confused patients ask me how the diverticulum is treated if it is not removed.

For those unfamiliar with this disorder, click here for more information.

The basic concept of treating this rare disorder is that there is a common wall that divides the esophagus from the diverticulum pouch. This common wall is endoscopically divided such that the pouch now becomes the new back wall of the esophagus. So when the patient swallows, food/liquids can no longer get "trapped" causing symptoms.

Still confused? Here are some picture illustrations...

When endoscopically exposed, the pouch is denoted by the arrow.

When looking through the scope placed into the mouth down into the throat, there is a common wall that is between the pouch (blue arrow) and esophagus (green arrow).

Endoscopically, whether using a stapler or laser, this wall is divided down the middle. This picture shown below is when a stapler is used.

Here is the side view before and after common wall division:

After the procedure, any food/liquid substances that are swallowed can't be trapped in the pouch. Therefore, even though nothing is surgically removed, the patient's swallowing symptoms completely disappear.

Hopefully, this explanation helps clear up any confusion of what exactly happens!