Motley Crue Bassist Facing Sinus Surgery

Dr. Feelgood may be just a song by Motley Crue, but the band's bassist, Nikki Sixx may be facing sinus surgery.

Per his twitter comment on June 27, 2012:

"Spent a lot of the day at the doctors. The 80s and the damage done. Yes the sinuses are a mess. Eventual surgery. The price we pay."

Typically, before sinus surgery is considered in a patient who is suffering from recurrent sinus infections, a workup is required followed by maximal medical management.

A typical workup includes a CT sinus scan, allergy testing, and nasal endoscopy. If allergy testing is significant, aggressive allergy management is required prior to surgical consideration.

Depending on the CT scan and endoscopic findings, there are two "flavors" of sinus surgery: traditional and balloon sinuplasty.

In traditional sinus surgery, otherwise known as functional endoscopic sinus surgery, is when all sinus disease is physically removed endoscopically from the nose and sinus entrances are enlarged.

Balloon sinuplasty is when the sinus openings are enlarged using a balloon and can potentially be performed in the office assuming no anatomic contraindications (significant deviated septum, nasal polyps, etc).

Exactly what type of sinus surgery Nikki Sixx will pursue is not clear, but regardless of what method is selected, there will be a period of recovery afterwards which almost certainly will include saltwater sinus rinses.

Our office provides both sinus surgery options as well as in-office sinus surgery.

Source:
Nikki Sixx needs surgery for sinus problems. SFGate 6/28/12

New Medical Device to Cure Excessive Sweating

Everybody sweats, but some sweat more than others to the point where even constant anti-perspirant usage is insufficient.

Beyond botox which is painful and lasts only a few months, options have been few until now...

A new medical device called Miradry destroys sweat glands by heating up the junction between the second and third layer of the skin using microwave after sucking up secretions. Before the procedure, numbing injections are required.

A company study shows patients who used Miradry experienced an 82 percent reduction in sweat over 18 months. Patients may require the procedure to be repeated for ultimate sweat control.

So far, it is available ONLY for underarm treatment.

However, for those with excessive facial sweating, botox injections or robinul medication is still the only treatment, but who knows... perhaps Miradry will soon be available for the face/neck area at some point.

References:
Clinical Evaluation of a Microwave Device for Treating Axillary Hyperhidrosis H. Chih-Ho Hong, MD, Mark Lupin, MD et al; Dermatologic Surgery 2012; 38:728-735

A Randomized, Blinded Clinical Evaluation of a Novel Microwave Device for Treating Axillary Hyperhidrosis: The Dermatologic Reduction in Underarm Perspiration Study Dee Anna Glaser, MD et al; Dermatologic Surgery 2012; 38:185-191

Microwave thermolysis of sweat glands Jessi Johnson, PhD et al; Lasers in Surgery and Medicine 2012; 44:20-25

American Girl Doll Gets Hearing Aids

The American Girl doll company now offers hearing aids for their 18 inch doll models only through their Doll Hospital. Thanks to Tampa Bay ENT who shared this information.

Unlike humans who are able to obtain many different styles of hearing aids, only BTE (behind-the-ear) style is available for American Girl dolls.

Interesting, the medical services offered through the Doll Hospital is MUCH more impressive than what can be offered for humans. Services beyond hearing aids include new heads, new bodies, eye replacements, and limb replacements.

Though we do not offer hearing aids for American Girl dolls, we do offer the full array of hearing aids (selling, repairing, adjusting) for humans from Oticon, Phonak, and Widex.

New Oral Appliance for OSA (Only Needs Heat to Fit)

A new sleep apnea oral appliance can be fitted and used at home without going to a dentist called ApneaRx!

Oral appliances to treat obstructive sleep apnea (OSA) have an upper and lower component that fit into the upper and lower jaws. A mechanism within the device than allows for the lower jaw to be thrust forward to some degree which pulls the tongue and anterior airway forward thereby enlarging the airway and preventing obstructive apneas during sleep. It can also help with snoring.

Typically, such OSA oral appliances must be fit by a dentist and cost upwards of $300 or more.

Most patients or loathe to spend that kind of money if they are not sure if:

1) It will actually help
2) It will be something they can actually tolerate or use

That's where this new OSA oral appliance called ApneaRx comes in which is considered a "transition" device to try and see if oral appliances will work for a given patient before going with an expensive dentist-fit customized oral appliance.

In essence, the device is heated and bitten into for fitting. The device can than be adjusted in 1mm increments by squeezing from the sides.

If this device "works" for a patient, they can either continue to use this device, or now take the time and expense of getting a customized device from a dentist.

Best of all, you can get it on Amazon!

However, please be aware that there's only one size currently available which may be too large for 20% of patients, especially women. There will soon be a smaller version for those with a smaller mouth by the end of 2012.

Read brochure.

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.