Fauquier ENT Blog

Website That Calculates Your Cancer Risk From Radiological Tests

2009-12-18T17:32:00.003-05:00

In the last few weeks, there's been multiple media reports on the increased risk of cancer with common radiological tests due to radiation exposure, however minimal it may be.

Due to this concern, a website called "X-Ray Risk.com" was developed that calculates your increased cancer risk based on type of test, age, and gender.

For example, a CT Neck (a common CT test ordered by ENTs) on a 35 year-old male increases cancer risk by 0.046%. A chest x-ray? Only 0.001%.

Check out the website here.

New Webpage on Submandibular Gland Surgery

2009-12-18T14:18:00.004-05:00

A new webpage has been added to our website describing 3 different submandibular gland surgical procedures: sialolithotomy, submandibular gland resection, and sialendoscopy.

This webpage is the third in a series of webpages addressing salivary gland issues including sialadenitis (spit gland infections) and the parotidectomy surgical procedure.

New Treatment Options for Non-Acidic Reflux (LPR)?

2009-12-13T06:22:00.006-05:00

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.

New Webpage on Laser Tonsillectomy

2009-12-12T18:05:00.006-05:00

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.

Why the Delay in Seeing Patients for Ear/Hearing Problems?

2009-12-11T06:25:00.008-05:00

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. Chang Invited as a Guest for Online Radio Talk Show

2009-12-08T20:51:00.006-05:00

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.

Second Stage (of 3) Office Renovations Completed

2009-12-06T06:40:00.003-05:00

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.

New Video on Stopping Nosebleeds by Cautery

2009-12-03T07:22:00.003-05:00

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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Oral Appliances to Help Correct Obstructive Sleep Apnea (OSA)

2009-12-01T16:33:00.005-05:00

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).

Website Updated Utilizing ReCAPTCHA To Avoid Spam Email

2009-11-29T09:16:00.003-05:00

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.

Cheap Quality Prescriptions Thru Costco Pharmacy Mail Order

2009-11-27T11:47:00.004-05:00

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.

What Is a Pulmonary Stress Test?

2009-11-25T16:27:00.004-05:00

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.

Cool X-Ray Video of What Happens Anatomically During Speech

2009-11-19T06:15:00.006-05:00

Voice is sound production. Speech is what ultimately comes out the mouth after the sound is modified by the tight coordination among the throat muscles, palate, tongue, lips, teeth, etc. An example of a voice problem is hoarseness. A speech problem would be stuttering, or nasal-sounding words, or mumbling.

Speech researcher Christine Ericsdotter precisely captured the intricate movements of the tongue, lips, pharynx and jaw during speech using a rapid-fire X-ray.

Check out the video she created here!

This link provides a cartoon animation of how each sound in the English language is produced from an anatomical standpoint.

Taking Tylenol and Ibuprofen Also Has A Potential Risk of DEATH!

2009-11-18T06:43:00.004-05:00

The New York Times in July 6, 2009 published an interesting article regarding the potentially fatal risk of taking tylenol and ibuprofen. The story titled "Reasons Not to Panic Over a Painkiller" states that tylenol (due to liver damage) kills about 400 people and hospitalizes about 42,000 every year in the United States. Ibuprofen is even worse. More than 100,000 Americans are hospitalized each year with complications associated with ibuprofen and an additional 15,000 to 20,000 die from ulcers and internal bleeding linked to their use.

The reason I am mentioning these facts with such a ubiquitous medication like tylenol and ibuprofen is because many patients have a distorted sense of what is risky and what is not. I had one parent who refused to give her child zyrtec or benadryl for severe allergies as she did not want to "add poison to her child's body." Though such sentiment is usually laudable (and in some cases, even encouraged by me), in these particular cases, it's odd to say the least, mainly because she was giving her child repeated doses of motrin and tylenol for symptom relief. As far as I know, zyrtec and benadryl has not killed anyone. Tylenol and motrin have... many times.

Or get this... the average woman puts on herself 515 chemicals on her body everyday through self-inflicted use of body and facial moisturizers, perfumes, deodorants and various other make-up products. Click here to read more on this.

There are many other such examples, but it is always nice to have in perspective that even supposedly "safe" medications really aren't safe if taken improperly.

Read the NYT story here to read more about the risks of tylenol and ibuprofen.

Machine Gun Sneezing

2009-11-13T07:35:00.007-05:00

ABC News on November 11, 2009 aired a story about a 12 year old girl with an unfortunate condition called "machine gun sneezing". Apparently, she sneezes up to 16 times a minute all day except while sleeping and started after recovering from a mild cold.

To be frank, it's a condition I've never seen before.

Per an allergist interviewed for this story, the condition is extremely rare and "can be triggered by hundreds of causes, including allergies, sinus problems, or growths in the nasal passage."

Read more here. A video of the report can also be found at the link.

A personal thought of mine, the absence of sneezing during sleep suggests a psychogenic or habitual process. It might not have started out that way, but with all the attention, which is now national, there may be positive feedback from all the doting, to perpetuate the problem.

ADDENDUM: This girl now has a diagnosis called PANDAS (Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus)! Read more here.

NYT: Single Gene Mutation Allows Humans to Talk and Not Animals

2009-11-12T08:33:00.005-05:00

In the Nov 11, 2009 New York Times Science section, a story has been published titled "Speech Gene Shows Its Bossy Nature" where a single gene known as FOXP2 has been found to be responsible for speech (or lack thereof). All animals have an FOXP2 gene, but the human version’s product differs at just 2 of its 740 units from that of chimpanzees, suggesting that this tiny evolutionary fix may hold the key to why people can speak and chimps cannot.

Read more of the story here.

Google Flu Shot Finder

2009-11-11T08:58:00.005-05:00

The brainy folks at Google has been at it again... Not only did they produce a map showing the flu trends in the US... but now they have produced a Flu Shot finder based on zip code for both seasonal as well as H1N1 vaccines. The locations are displayed on their Google Maps page.

Check it out here!

McGovern Nipple for Infants Born Unable to Nasally Breathe

2009-11-07T17:28:00.008-05:00

I recently received a phone call regarding a newborn who the pediatrician suspected had bilateral choanal atresia. This is a situation in which the infant is not able to breath through the nose. This inability to nasally breath is a major problem because newborns are obligate nasal breathers (newborns do not know how to mouth-breath unless they are crying).

As such, there are two options to immediately perform in order to allow a newborn to breath to stay alive. Intubate... or place a McGovern Nipple. A McGovern Nipple is made by (see picture below):

1) Cutting off the tip of the nipple used in a milk-bottle creating a hole about 1cm in size. Try to preserve as much length as possible!
2) Inserting the nipple into the newborn's mouth
3) Placing a surgical mask such that the mask part is behind the baby's head and using the strings to keep the nipple in place inside the infant's mouth.

This forces the newborn to mouth-breath. Without this contraption, the child will literally suffocate.

I have specifically created this blog article because I had a lot of problems trying to find a picture of this contraption to show the pediatrician. Hopefully, this will make it easier for others to figure out what the heck a McGovern Nipple is and how to make and use one.

The only way to definitively correct this problem is by surgically removing the blockage that is blocking the infant's nasal passage.

Source:
Cummings Otolaryngology Head & Neck Surgery 4th Ed. Chapter 178: Congenital Malformation of the Nose. Volume 4, Page 4101.

RANDOM: Washington Post Cartoon Making Fun of ENT

2009-11-06T08:29:00.003-05:00

A patient of mine brought the funnies from the Oct 28, 2009 Washington Post of a cartoon by John McPherson poking fun at ENT.

New Voice-Mail Phone # for Patients With Difficulty Hearing

2009-11-05T14:21:00.008-05:00

Due to patient demand, we have established a voice-mail phone number that our patients who have difficulty communicating over the phone due to hearing loss can call and leave a precise message on a voice mail. This service is available only to our established patients who have been seen in our office.

This avoids frustration and difficulty communicating when talking to our front desk (because you can't hear what we say over the phone).

We will check this voice mail several times a day.

The Audiology Voice-Mail phone number is: 540-316-0588

Of course, if you want to talk to a staff member, you can still call our regular main office number at 540-347-0505.

Washington Post Medical Mystery: Rare Severe Sore Throat Caused by Lemierre Syndrome

2009-11-03T04:36:00.006-05:00

On Nov 3, 2009, the Washington Post Medical Mystery section published a story titled "Annoying bug turned out to be much more" where a 19 year old female presented with a sore throat which rapidly progressed to a blood clot in her jugular vein, pneumonia, and massive swelling in her neck.

What she ended up having was "Lemierre syndrome" suspected by the diagnosing doctor at Georgetown University Medical Center based on the two telltale symtoms of a jugular infection and presence of a blood clot.

Read the story here.

USA Today on Hearing Aids

2009-11-02T12:17:00.004-05:00

USA Today on November 2, 2009 published a story entitled "Your Health: Hearing aid guide cuts through the noise" in which best practices for buying a hearing aid is discussed. For the story, Dr. Debara Tucci at Duke University Medical Center was interviewed.

The advice is summarized by an FDA online guide (at fda.gov, click on "medical devices," then "hearing aids") that includes suggestions on how to get your hearing evaluated, how to choose a device and how to get it properly adjusted.

Our practice provides the full spectrum of hearing aid evaluation as well as hearing aid dispensing services (selling, repair, accessories, etc).

There's Always Someone With a Bigger Mouth

2009-10-31T13:13:00.003-04:00

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

2009-10-31T13:00:00.005-04:00

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!

2009-10-30T15:58:00.004-04:00

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.