It just came to my attention through anecdotal reports that there may be two additional options to treat non-acidic laryngopharyngeal reflux (LPR) causing symptoms of:

• Hoarseness
• Throat clearing
• Phlegmy throat
• Cough
• Globus (sense of swelling in the throat)

Non-acidic reflux is different from the more widely known acid reflux in that traditional medications such as prilosec, zantac, pepcid, etc do not help. Non-acidic reflux basically is when gastric secretions without acid refluxes up into the esophagus to as far as one’s voicebox causing symptoms listed above. Heartburn does not occur.

Traditional treatments for non-acidic reflux include the medication reglan (which has gone out of favor) and gaviscon as well as the surgical option Nissen fundoplication. However, there are now anecdotal reports that the medication robinul forte may be helpful by decreasing the overall amount of secretions the stomach produces as well as a less invasive procedure called Stretta performed endoscopically without skin incisions.

Read more about reflux here.

A new webpage has been uploaded describing laser tonsillectomy given how often patients come to our office inquiring about it. We do NOT offer laser tonsillectomy and are not aware of anybody in our region who does offer. However, we are slowly compiling a list on the webpage of surgeons who do offer. If you know of somebody not listed, please let us know.

The closest surgeon to Virginia who offers laser tonsillectomy that we are aware of is Yosef Krespi in New York City.

We offer only coblation tonsillectomy.

Currently in our practice, there may be a longer wait to be seen for patients with hearing or ear problems including dizziness compared to other non-ear issues like chronic sinusitis, tonsilitis, etc.

Why is that?

Well, it’s because 90% of the time, a hearing test is required in order for proper treatment. Ideally, an appointment for ear issues is created for both the physician AND audiology at the same time to save you, the patient, another appointment on a different day and time.

Unfortunately, at this time, our audiology appointment slots are backed up longer than the physician appointment slots. As such, even though the physician may be able to see you quite quickly, if an appointment is made at a time when no audiology is available, you will need to make ANOTHER appointment on a different day and time for a hearing test prior to treatment.

So what are your options?

1) Go ahead and make an appointment to see the physician, even if audiology is not available. Just be aware, there is a high chance you will need to make another appointment for a hearing test.

2) Make an appointment when audiology is available. Just be aware that it may be a longer wait before you can be seen.

3) Go ahead and make an appointment to see the physician, but get a hearing test done by an audiologist outside our office PRIOR to your appointment. Bring the hearing test with you. There are a few audiologists in our area that may be able to accomodate this including Dr. Diane Markva of Fauquier Hearing Services as well as others in surrounding areas.

Dr. Chris Chang has been invited to participate as a guest in an hour long online radio show hosted by Trish Causey of Musical Theatre Talk. The radio show with Dr. Chang will be aired on January 10, 2010 at 5PM.

Two other members of the voice team that Dr. Chang works with will also be participating including Sarah Maines (singing voice therapist) and Melissa Mainville (functional voice therapist).

More details to come.

Over this past weekend, the second stage of 3 office renovations have been completed. One room has been renovated with new flooring, electrical work, paint, and furniture.

Electrical work was done by a friend whereas the other renovations were performed by Cornerstone & Son Construction, LLC. Furniture was purchased at Gerstel Office Furniture which is a fantastic place! They basically purchase furniture from companies that have gone bankrupt or undergoing renovations and sell them to the general public after refurbishing them at huge discounts.

Highly recommend both for pleasant services, being on-time, good price, prompt email correspondence, and excellent job overall.

The final stage will occur once all our paper chart medical records have been cleared out and this space changed to another use. Hopefully this will occur in the next 1-2 years.

A new YouTube video has been uploaded describing how nosebleeds are stopped using silver nitrate cauterization. The video was produced by our office and just in time for the cold and dry air that winter brings along with numerous nosebleeds.

The video is part of our collection of videos on our YouTube channel.

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In the November 2009 issue of ENT Today (vol 4; number 11), there was an interesting article titled “Evaluation and Management of Patients After Unsuccessful Sleep Apnea Surgery.”

What I found particulary informative was the picture that came with the article which I have reproduced below. It is basically a list of all the companies who make oral appliances specifically for patients with obstructive sleep apnea. How nice!

Regardless of the company, they all have the same basic feature of having both an upper and lower occlusal guard which can be adjusted in order to bring the lower jaw forward to prevent obstruction due to tongue collapse. Though our office does not offer any of these devices, oral surgeons do. There are also OTC oral appliances one can obtain (which of course do not work as well).

Our website over the past few months has been visited over 4000 times a day. Though such high numbers are great, the downside is that we have started seeing an increasing amount of spam email such that more spam is received than legitimate email.

In order to combat such spam, we have had no choice but to institute a system whereby our email address is hidden until 2 word images are correctly typed in. We have selected ReCAPTCHA to provide this service for two main reasons… it is free and by entering the words in the box, we help to digitize texts that were written before the computer age. Read more about this here.

Of course, we still have a secure email submission form which prevents spam as well as protects confidential private information.

A patient recently brought this to my attention… but Costco Pharmacy offers very good prices on drugs, especially generics, even if a patient has no health insurance. Furthermore, you do NOT have to be a member to purchase these drugs! Even more importantly, the medications can be considered “good” unlike medications purchased from other online sources from Canada or Mexico.

For example, I searched for these drugs on 11/27/09 and these are the prices that came up:

Allegra 180mg
$79.19 for 30 (Brand Name)
$36.18 for 30 (generic)

Prilosec 20mg
$158.13 for 30 (Brand Name)
$15.18 for 30 (generic)

Flonase
$87.36 for 1 (Brand Name)
$15.28 for 1 (generic)

Of course, with insurance, these prices may be even cheaper!

Check it out here. Click on pharmacy at the top and than look for the “Prescription Price Checker” link.

At least in the ENT world, a pulmonary stress test is a very useful test when evaluating a patient with symptoms of shortness of breath, stridor, and/or wheezing that occurs only when exercising. The most common reason for an ENT evaluation in these patients is to determine whether paradoxical vocal cord motion is occurring or some other pathology such as tracheomalacia or laryngomalacia. Usually, the patient has already undergone extensive pulmonary testing for asthma and allergies with everything being normal. Even use of inhalers has not been found to be helpful.

The most difficult part of the evaluation in these patients is to perform the exam WHEN the patient is actually having symptoms (ie, during exercise). Doing an evaluation when without symptoms usually results in a normal exam (not surprisingly).

That’s where the pulmonary stress test comes in. The philosophy behind this test is to allow for an evaluation when the patient is actually having symptoms.

Under a controlled situation, the patient is asked to start exercising on a treadmill or bicycle. Heart rate, EKG, respiratory rate, etc are all monitored during exercise. When symptoms of stridor or shortness of breath occur, the ENT performs a fiberoptic laryngoscopy exam on the spot to evaluate vocal cord motion and laryngeal structure. In some cases, even awake bronchoscopy may be performed to look for tracheomalacia.

Our office in cooperation with Fauquier Hospital offers this service.

Image taken from wikipedia.