New Webpage Has Been Created to Assist Patients Diagnose Their Dizziness!

A new webpage has been created in flowchart format to help patients diagnose what may be causing their symptoms of dizziness. The questions asked to guide patients through the flowchart is to get some rough idea of what MIGHT be causing their dizziness as well as to get an idea of what kind of studies may be obtained when they see a doctor. Keep in mind that these questions are geared towards an ENT workup… ie, focus is on determing whether the ears may be playing a role or not.

Click here to check it out!

Of course, any information provided on the website should not be considered medical advice or a substitute for a consultation with a physician. If you have a medical problem, contact your local physician for diagnosis and treatment.

New Webpage on Rhinitis Medicamentosa (Nasal Decongestant Spray Addiction)

A new webpage has been created and uploaded to our website on rhinitis medicamentosa, a devastating sinus/nasal condition with symptoms of severe chronic obstruction/congestion. This condition occurs when over-the-counter nasal decongestant sprays are used more frequently (every 12 hours) and longer (3-5 days) than directed.

Such nasal decongestant sprays include the common and popular Afrin and Zicam nasal sprays. These sprays contain one of these active ingredients: phenylephrine, neo-synephrine, oxymetazoline, and xylometazoline.

This condition has also been portrayed in the New York Times and the article can be read here.

Check out the webpage here.

Fauquier ENT iPhone App Sold Thru iTunes!

Well… soon… someday…

There’s a nifty website called AppMakr that creates a customized iPhone app based on Blog articles, YouTube feeds, and Twitter accounts via keywords or a web address. Though one can play around with the customized iPhone application virtually on a computer for free, to actually publish the app onto iTunes and download to an iPhone costs a bit of money. $199.99 to be exact.

You can play around with our virtual iPhone application here.

Once we hit over 100 subscriptions to our blog and/or 500 followers on our twitter account, we’ll consider actually creating this iPhone app you can use on an iPhone (sold thru iTunes).

For $349, Test Your DNA for 100+ Hereditary Diseases

A company called Counsyl claims to be able to test an individual’s DNA and determine the risk of passing on over 100 hereditary diseases to future offspring for $349 (or free with insurance). Such hereditary diseases they are able to test for include the commonly known cystic fibrosis to more rare conditions like Nijmegen Breakage Syndrome. The full list can be viewed here.

Though many of the diseases listed are associated with ear, nose, throat problems, the list unfortunately does not include hereditary hearing loss conditions.

To do the testing, all you need to do is get the kit mailed to your home, spit into their test tube, and send the kit back to the company.

Read more about this in the New York Times here.

Though this all sounds great, there are some potentially unforeseen implications one needs to consider prior to obtaining this test beyond the issues the NYT article brought up. If the testing comes back positive, one runs the risk of:

1) Having your health insurance dropped or premiums increased… not just for you, but for your offspring (pre-existing condition)
2) Businesses may not want to hire you as you would “cost” them more (missed days from work due to illness, etc)

Though insurance may cover the testing… not sure if you actually want the insurance company to pay and have them potentially find out the results, especially if positive.

Image from wikipedia.

New Surgical Approach to Treat Small Zenker’s Diverticulum

In the January 2010 edition of Laryngoscope, an interesting paper entitled “Transoral resection of short segment Zenker’s diverticulum and cricopharyngeal myotomy: an alternative minimally invasive approach” was published on a new endoscopic approach to surgically treat very small Zenker’s Diverticulum. This endoscopic approach is also able to treat cricopharyngeal spasms/hypertrophy.

Just as for the Endoscopic Staple Diverticulostomy (ESD), the most common endoscopic approach to treat Zenker’s diverticulum, a Weerda laryngoscope is used to visualize the pouch. However, instead of using a stapler to treat the pouch, the pouch is everted into the esophagus and the pouch excised. The cricopharyngeal muscle is than incised under the microscope as well as endoscopically before the mucosal incision is closed using sutures.

The authors have called this procedure Trans-Oral Resection of Diverticula (TORD). When used to treat the cricopharyngeal muscle only, the procedure is called Trans-Oral Cricopharyngeal Myotomy (TOCPM).

Patients generally go home after 24 hours.

Read more about this research here.

No… our office does not offer these procedures at this time. Only the ESD approach.

Cold Urticaria (aka, Allergy to Cold Temperatures)

Fox 10 News did a story on Cold Urticaria which basically is an allergy to cold temperatures. With cold temperature exposure whether it be cold air, ice cube, or even ice cream, it can cause an allergic reaction resulting in lip swelling, drop in blood pressure, rash, significant itchiness, etc. There has even been cases where a person will go into anaphylactic shock if they jump into a cold swimming pool.

Oddly enough, the symptoms typically occur AFTER warming up after a cold exposure due histamine release.

Beyond avoiding cold things, there’s no “cure” for this condition. Symptoms can be controlled with antihistamines.

Read the story here.

Cell phone Use May Cause Ear Pain/Dermatitis

With increasing use of cell phones in the population, there seems to be an increasing number of patients who present with complaints of pain in/around the ear with cell phone use. When cell phone use ceases, the pain/discomfort fades only to return with use.

In this scenario, something to consider is contact dermatitis due to the cell phone. Why? Apparently, many cell phone casings contain free nickel which often causes skin problems, just like cheap jewelry.

Check out this table which shows the results of nickel spot testing on 23 different cell phones.

Read a research paper on this topic here.

WP: Runny Nose Due to Spinal Fluid Leakage and Not Allergies!

The Washington Post published a story on January 19, 2010 entitled “Doctors changed diagnosis after woman said allergies weren’t causing runny nose.” In this story, the patient’s runny nose from only one side was actually due to a CSF leak (cerebrospinal fluid leakage) and puts her at major risk for meningitis. Unfortunately for this particular patient, the hole through which this fluid was coming out from also had some brain tissue. She required major surgery in order to correct this problem.

An interesting trivia related to CSF leaks is that actor George Clooney suffered one after a blow to the head while filming a torture scene in the 2005 movie “Syriana”.

The take-home message is that not all runny noses are due to allergies, especially if it is continuous and only occurs on one side.

Read the story here.

Image taken from wikipedia.

You May Have a Condition Called Local Allergic Rhinitis Even If Allergy Testing Negative!!!

A recent study was published in Current Opinion in Allergy & Clinical Immunology (Feb 2010 10:1-7) describing a condition called “Local Allergic Rhinitis.” This condition is when a patient appears to have sino-nasal allergies, but yet, have negative allergy test results whether on skin prick or RAST.

Up to 40% of patients with negative allergy test results may have this condition.

In order to diagnose this condition, it requires the detection of local antigen specific IgE in nasal secretions during natural exposure to aero-allergens as well as positive nasal allergen provocation test with local production of tryptase, eosinophil cationic protein and antigen specific IgE.

Read the study here.

Please note, our office is not able to perform these testing. We recommend getting evaluated at University of Virginia Allergy Department if you suspect you have Local Allergic Rhinitis.

Image from Wikipedia.

Can Playing a Wind/Brass Instrument Be a Source of Recurrent Infections?

Is playing a wind/brass instrument a significant factor for recurrent strep, URI’s, sinus infections, etc in people? Is such use contagious? If so, how does one even go about “sterilizing” the instrument after use by a sick person so that they don’t infect themself again as well as players around them when blowing into it?

I got asked these questions by one astute parent of a trumpet player. After some inquiries and research, I actually don’t have a good answer to whether they may be contagious and a source of germs, though it would make sense that they would be (well-known medical principle being bacteria grows in dark wet areas).

In any case, there are various techniques as well as common sense to try and semi-sterilize the instrument to prevent potential bacterial growth deep in the pipes of wind/brass instruments:

1) Don’t share your instrument! Here’s a journal article regarding the hazards of sharing instruments.
2) Thoroughly dry out the instrument after use via air and brush.
3) Never play the instrument while you are sick.
4) Replace the reed if it looks nasty. Clean mouthpiece thoroughly daily.
5) Brass instruments can indeed be washed in the bathtub with warm soapy water (not so for silver!)
6) Many players commonly angle their instruments up in the air when playing allowing some fluid to drain back. This practice can create a path for harmful bacteria to make its way back into the mouth from the body of the instrument. Try and avoid doing this!

There is also this one company they claims to help with musical instrument sterilization.

MaestroMD

Do readers have any other suggestions? Please post a comment!