When I saw this research, I had to re-read it to believe it… Nasal packing with good-old fashioned bacon stops nosebleeds!!!
Yes… you heard me correctly… and it was actually published in a reputable ENT journal in Nov 2011. AND, it was conducted here in the USA (Detroit, Michigan).
“Cured salted pork crafted as a nasal tampon and packed within the nasal vaults successfully stopped nasal hemorrhage promptly, effectively, and without sequelae … To our knowledge, this represents the first description of nasal packing with strips of cured pork for treatment of life-threatening hemorrhage in a patient with Glanzmann thrombasthenia.”
The current standard of care for nasal packing to treat nosebleeds is using synthetic hemostatic products that appear similar to tampons used for menstruation.
However, this publication in 2011 wasn’t the first to document use of bacon for nosebleeds.
There have been reports on use of bacon since 1940 sporadically (see references below).
In this day and age of cost-cutting and finding cheaper alternatives, bacon is pretty much as cheap as one can go to address nosebleeds. Compare this to synthetic nasal packing which costs on upwards of $50 or more.
In the past few weeks, there have been numerous stories about the 2nd death in Louisiana from Neti-Pot use leading to an amoeba infection of the brain. The culprit organism Naegleria fowleri causes a life-threatening encephalitis after passing thru the nose and up into the brain where the organism eats neurons for food.
As such, recommendations have been issued to use water as instructed with the Neti-Pot packaging… water should be boiled, distilled, or filtered.
However, before the millions of people who may have elected to simply use tap-water change their daily routine, consider that more commonly, swimming in warm lakes or rivers causes 2-3 amoeba related deaths per year… and swimming in and of itself leads to thousands of drownings per year. So far, there have been only TWO amoeba-related deaths linked with Neti-Pot usage that we know of so far.
In any case, lets talk about boiled, distilled, or filtered water and what a Neti-Pot user can do keep their daily routine simple. After all, it is so simple to simply fill the container with running tap-water. The additional step to keep things safe can become annoying.
Boiled Water: Naegleria fowleri can not survive in temperatures above 47°C. As such, by boiling water, you guarantee death if any are present in the water.
Save time by boiling a large amount of water and storing in 1 gallon containers for daily use.
Distilled Water: By definition, distillation involves boiling the water and then condensing the steam into a clean container. It’s a slow process, but it not only kills any micro-organisms much like simple boiling does, but also removes any inorganic “impurities” that may be harmful like mercury as well as beneficial minerals including calcium, magnesium, and sodium. Distillation does not discriminate.
It is not feasible for most individuals to set up a home water distillation process just so they can use the Neti-Pot. Though can get expensive over the years, save time by purchasing large volumes of distilled water to have at home. But, there are portable water distilling machines you can purchase as well.
Filtered Water: Water that is filtered is cleaned by means of a fine physical barrier, a chemical process or a biological process. In most homes, filtered water is almost universally achieved by a physical barrier. There are numerous vendors out there that sell devices to filter the water including Pur Water and Brita.
Save time by purchasing a faucet attachment that automatically filters water into your Neti-Pot when you need it.
Though most people like the professional nose whistler shown here require an instrument to enable the nose to whistle, in others it occurs naturally due to unique anatomic features within the nose.
Why might someone’s nose whistle?
Septal Perforation
The most common reason it may occur constantly is due to a hole in the septum (septal perforation). The septum is a wall that divides the right nasal cavity from the left side. Normally, it should be straight and without any openings.
However, when a hole is present in the septum and it is in just the right size and place, whenever air is breathed in and out the nose, it will whistle. In this situation, the hole is the “window” of the whistle and the nose itself is the mouthpiece.
Correction of this problem is by either closing the hole (septal button or surgery) or making it bigger such that the aerodynamics eliminate the conditions conducive to nasal whistling. As an FYI, surgical correction of a septal perforation is quite difficult.
Septal Deviation and Some Nasal Congestion
The other situation when the nose may whistle, but only intermittently, is when there is a deviated septum. In this scenario, the septum rather than being straight, it is slightly crooked to one side making one side more narrow than the other.
Add some slight swelling of the nasal lining such that the opening of the nose is restricted to just right size and shape, and it may whistle.
This type of nasal whistling is akin to grass whistling (blowing between two thumbs holding a blade of grass).
Thankfully, the nasal conditions that lead to nasal whistling is quite rare and requires the perfect storm of just the right amount of septal deviation with just the right amount of nasal congestion.
As such, correction of this problem is fairly easy as one needs to change either the congestion causing the nasal lining to swell with a nasal spray or anti-histamine OR fix the deviated septum. If the inferior turbinates are enlarged, they can be reduced in size as well.
Of course, one can take this unusual condition and make it a positive feature worthy of a concert hall… WITHOUT the assistance of any instrument!
Due to popular demand, our office now participates with Chase Health Advance. This plan is for those patients without insurance coverage or to help pay for uncovered procedures/services. Flexible payment options are offered only if total charges exceed $1000 (cost can be as low as $48 per month over 24 months). Depending on the promotion offered by Chase Health Advance, there may even be no interest charged! Click here to calculate your monthly payments.
The basic function of the human nose is to warm and humidify the air before it reaches the lungs. Because of the wide variation of human habitats from the polar cold and dry air to the equatorial hot and humid weather, one would expect the nose to accommodate to these climate extremes accordingly thru evolutionary pressures.
In essence, logically one would expect the nose to change shape to enhance time that air is in contact with the warm and moist nasal interior in cold and dry climates compared to the opposite environmental extreme.
German scientists evaluated this hypothesis thru 3D modeling of 100 skulls to analyze the shape of the bony nasal cavity of 10 modern human groups living in five different climates and found that the bony nasal cavity appears mostly associated with temperature effects and the nasopharynx with humidity.
Humans living in cold, dry climates tended to have nasal cavities relatively high and long with an abrupt narrowing in the upper nasal cavity than those living in hot, humid climates. Such characteristics enhance contact between the air and the nasal mucosal tissue that helps to warm and humidify that air.
What does such a nose look from the outside? A narrow, longer internal nasal cavity is generally linked to a relatively narrower and more projected nose.
Meda Pharmaceuticals has announced a new nasal spray “Dymista” that contains both a steroid and an anti-histamine active ingredient. Why is this significant? It’s because it’s the first and only one to do so. Of course, it’s not available yet until the FDA approves it, but at least it has shown effectiveness in Phase 3 clinical trials.
At this time, nasal sprays as it relates to nasal allergies come in two separate flavors:
This new combo nasal spray “Dymista” contains fluticasone and azelastine. Fluticasone is a steroid that is also found in flonase nasal spray whereas azelastine is an anti-histamine also found in astepro and astelin nasal sprays.
Clinical trials in the past have shown that using a steroid nasal spray and an anti-histamine nasal spray was more effective than using one or the other individually.
Similarly, Dymista has also been found to be better than either nasal spray alone, but with the convenience of using a single nasal spray.
Look for it in the near future! Let’s just hope insurance will cover it however.
Periodically, ICD undergoes an update and in the United States, it is about to undergo a MAJOR update come October 1, 2013 to version ICD-10-CM. The current ICD being used in the Unites States is ICD-9-CM.
What are these changes as it relates to otolaryngolgists?
First the basics:
Differences in organization & structure, code composition, and level of detail.
ICD-9-CM
ICD-10-CM
Consists of three to five characters
First digit is numeric or alpha (E or V)
Second, third, fourth, and fifth digits are numeric
Always at least three digits
Decimal placed after the first three characters
Consists of three to seven characters
First digit is alpha
All letters used except U
Second and third digits are numeric
Fourth, fifth, sixth, and seventh digits can be alpha or numeric
Decimal placed after the first three characters
ICD-10-CM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or sequelae for injuries and external causes.
ICD-9-CM Code Format
ICD-10-CM Code Format
SO… here are some examples of how the code changes from ICD-9-CM to ICD-10-CM:
Diagnosis
ICD-9-CM
ICD-10-CM
Right Earwax
380.4
H61.21
Left Earwax
380.4
H61.22
Bilateral Earwax
380.4
H61.23
Unspec Earwax
380.4
H61.20
Right Acute Otitis Externa
380.1
H60.311
Left Acute Otitis Externa
380.1
H60.312
Bilateral Acute Otitis Externa
380.1
H60.313
Unspec Acute Otitis Externa
380.1
H60.319
As you can see, what used to be a single code like 380.4 for earwax is now split into as many as 4 different codes based on side. Such increased specificity goes across the board for pretty much every diagnosis.
ICD-10-CM has numerous other new features allowing for a greater level of specificity and clinical detail.
Combination codes for conditions and common symptoms or manifestations
Combination codes for poisonings and external causes
Expanded detail relevant to ambulatory and managed care encounters
Changes in timeframes specified in certain codes
External cause codes no longer a supplementary classification
ICD-10-CM also includes added standard definitions for two types of excludes notes. Excludes1 indicates not coded here. The code being excluded is never used with the code. The two conditions cannot occur together. For example, B06 Rubella [German measles] has an Excludes1 of congenital rubella (P35.0).
Excludes2 indicates not included here. The excluded condition is not part of the condition represented by the code. It is acceptable to use both codes together if the patient has both conditions. For example, J04.0, Acute laryngitis has an Excludes2 of chronic laryngitis (J37.0).
An additional feature is the expansion of codes for certain conditions like postoperative complication codes. Here’s one if you accidentally leave behind a neuro paddy in the nose after sinus surgery causing nasal obstruction:
T81.524 codes for “obstruction due to foreign body accidently left in body following endoscopic examination”
Code extensions (seventh character) have been added for injuries and external causes to identify the encounter: initial, subsequent, or sequela. The extensions are:
A Initial encounter
D Subsequent encounter
S Sequelae
So that’s a primer on how ICD-10-CM coding WILL affect otolaryngologists. A lot more time will be spent on coding than now.
The American Academy of Family Physicians has produced a superbill comparing ICD-9 and ICD-10. What took only 2 pages with ICD-9 will take up 9 pages once ICD-10 goes into effect. Sigh!
Recently, there has been some confusion regarding whether our office deals with adults only or do we see kids as well… Strangely enough, we also get asked by parents whether our office sees adults when seeing a pediatric patient.
To clear up any confusion, our office does see kids AND adults… starting from birth to the elderly.
Dr. Chang who joined the office in October 2005, was named one of America’s Top Physicians by the Consumer’s Research Council of America in 2008 as well as a Northern Virginia Top Doctor for 2011 (to be published in February 2011).
Some common problems and procedures for which Dr. Chang sees kids specifically include:
