There’s Always Someone With a Bigger Mouth

Continuing the spirit of Halloween with semi-relevant ENT random news…

Someone forwarded me this picture of a TEN foot great white shark which was bitten by an even bigger great white shark. Apparently, the poor shark was still alive when it was captured in Australia.

Click here to read the story and watch a video!

Crazy Pumpkin Carvings Related to ENT

In celebration for Halloween today, I have found a few crazy pumpkin carvings courtesy of Extreme Pumpkins.

Here is the one that I carved, complete with snotty tissues:

If you have another relevant one, please comment and include a link to a picture. Enjoy!

Nasal Endoscopy to Evaluate Hoarseness on Dr. Oz Show!

On Oct 23, 2009, Dr. Oz (his show) with the assistance of Dr. Jonathan Aviv, demonstrated a procedure called Nasal Endoscopy which is the main method of evaluating a patient with hoarseness. A pretty good and accurate demonstration I may add.

Watch the video clip here.

Of course, I have produced a few video clips of the same of which one can be viewed below. Click here to watch one being performed on a child. Read more about this procedure here as well as what happens when the voice doesn’t sound normal here.

Why Does Brain Freeze Occur With Eating Ice Cream and Other Cold Treats?

Believe it or not, this has been the topic of research in the past and even has a medical diagnosis called “sphenopalatine ganglioneuralgia”. To sum it up, there are two theories behind this phenomenon:

1) Blood vessel phenomenon: Blood vessels constrict when any part of the body is exposed to cold temperature and dilates when it gets hot. This simple fact can be applied to the biological cause of brain freeze as well. Upon contact with ice, the blood vessels in the roof of the mouth begin to constrict, making the vessels in the head to expand, and thus creating a headache.

2) Trigeminal nerve factor: The trigeminal nerve, or cranial nerve 5 (CN5), is responsible for facial sensation. As a result of eating cold foods, this nerve in the palate of the mouth becomes overstimulated. Stimulation of the nerve causes neurons to fire pain signals to the brain, producing a headache.

Is there a cure? Avoid the culprit cold treat that triggers the pain or eat is slowly. Should you suffer from a brain freeze or sphenopalatine ganglioneuralgia, drink warm fluid or just wait!

Read the research behind these theories:
• Ice cream headache–site, duration, and relationship to migraine
• Ice cream evoked headaches (ICE-H) study: randomised trial of accelerated versus cautious ice cream eating regimen

Possible Dystonia (Rare Neurological Condition) After Flu Shot

Desiree Jennings, a former Redskins cheerleader, received a seasonal flu shot on Aug 23, 2009 and has suffered from a possible dystonia reaction from the flu vaccination resulting in difficulties in eating, talking, and walking.

Here is a link to a video where Dr. Stephen Grill (neurologist) is interviewed by Fox News regarding Desiree’s condition.

Here is a video/article of the initial story.

This story is a case of a VERY unfortunate EXTREMELY rare side effect (if true) of the flu vaccine. People should still get the flu vaccine, but be aware that it is not 100% benign in all cases.

However, it seems that Desiree’s flu shot reaction may have been psychogenic (and not a true side effect of the vaccine at all). Read this blog article which goes into this in more detail.

Regardless, people have developed rare neurological conditions called laryngeal dystonia otherwise known more commonly as spasmodic dysphonia. The way Desiree talks (from what I can hear from the videos) is distinctly different from patients who suffer from classic spasmodic dysphonia. Click here to hear what laryngeal dystonia/spasmodic dysphonia sounds like.

(Of note, I received both the seasonal and the H1N1 vaccine and have encouraged all my friends, family, and patients who inquire to do so as well.)

Our Office Has Been Renovated!

I have been hard at work all weekend with the generosity of friends as well as services of furniture reupholsters and general contractors. The waiting room as well as Exam Room 1 has been renovated for the better!

It has been a sore point for me that the walls of my waiting room have been drawn upon with crayons by errant kids. Once one kid has drawn upon it, the other squiggles soon followed (Same kid or different kids? I have no idea).

In any case, they are no more. The walls of the waiting room has been repainted in a two-tone color (sandstone/taupe) giving it a much warmer appearance than before. Furthermore, the waiting room chairs has been reupholstered with pleather to make it easier for cleaning.

Exam Room #1 has also been redone by reducing the space required by the built-in desk to half the size allowing for more free space for movement. The broken electrical outlet has also been fixed eliminating the need for an extension cord for the computer (a real eye-sore).

For those curious, the waiting room chair reupholstering was done by Miller Restorations and the exam room renovations by Cornerstone & Son Construction, LLC. Highly recommend both for pleasant services, being on-time, good price, prompt email correspondence, and excellent job.

Hopefully in the next 6-12 months, further office renovations will be pursued to take advantage of additional office space freed up by the disappearance of paper chart racks now that we’ve been using EMR the past 2 years.

NYT: How Tongues Taste Carbonation in Soda

The New York Times published a story on Oct 19, 2009 regarding how tongues taste that “carbonation” we all appreciate when drinking soda pop beverages. The story entitled “How Tongues Taste the Carbonation in a Fizzy Beverage” reveals that the carbonation is NOT due to the bubble popping, but rather a taste receptor.

As we all know, there are receptors for five tastes: sweet, sour, salty, bitter and umami (sometimes termed savory).

It is the receptor for sourness that is responsible for the taste of carbonation.

Read the story here.

Read the research here.

AP: HHS Secretary Had Skin Cancer (BCC) Removed From Forehead

Associated Press reported today (Oct 22, 2009)that Health and Human Services Secretary Kathleen Sebelius had a Basal Cell Carcinoma (BCC) skin cancer removed from her forehead. Read the article here.

BCC is a very common type of skin cancer that is often curable by complete excision. Often, this procedure is done in the office setting.

Of note, our office regularly performs skin cancer excisions of the head and neck regions.

Nasal Irrigation Beneficial for Pregnant Women With Allergies

Italian researchers have reported in the International Archives of Allergy and Immunology in Sept 2009 that saline nasal rinsing is a safe and effective treatment option for nasal problems in pregnant women with seasonal allergic rhinitis. In their paper titled “Nasal Lavage in Pregnant Women with Seasonal Allergic Rhinitis: A Randomized Study,” the researchers instructed the study group to perform hypertonic saline lavages to the nose 3X per day. Of note, HYPERTONIC saline solution was used instead of the more usual isotonic saline solution.

A statistically significant improvement in rhinitis symptoms (rhinorrea, obstruction, nasal itching and sneezing) was found during the observed weeks 2-6. Furthermore, the mean number of daily antihistamines use per patient per week was significantly reduced at weeks 2, 3 and 6. No adverse effect was reported in the active group.

Read the abstract here.

In our office, we recommend the Neilmed Sinus Rinse bottle as the cheapest and most effective way to perform nasal irrigations. Of note, the Neilmed sinus rinse bottle also comes with hypertonic saline version (along with the more common isotonic version). For convenience, irrigation devices are also sold, but much more expensive.

Click here to watch a video of how to perform nasal rinses.

WSJ: FDA Approves Gardasil for Boys (and Girls)!

This was reported by the Wall Street Journal on Oct 16, 2009. Why is this significant from an ENT perspective?

Well, gardasil is supposed to vaccinate people from getting HPV related diseases like genital warts which would help both genders when individuals become sexually active. Of more note, it has been specifically shown to help prevent cervical cancer in females which is a big killer of women.

However, it may potentially prevent other types of HPV related disorders involving the head & neck in both men and women (which has not been studied, but likely to still help), including:

Respiratory Papillomas (benign)
Throat Cancer
Oral ulcers/lesions/warts (benign)

In order to receive the beneficial effect of the vaccine, the vaccine needs to be given in 3 doses (at $130 per dose) between ages 9-26.

Read the WFJ article here.