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Kristin Hayes, R.N.

Ear, Nose, & Throat

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NIH Spends $26 Million on Flu Research

Tuesday April 15, 2014

The National Institutes of Health has awarded $26 million to 5 institutions for influenza research. The goal is to reduce the estimated 30,000 flu related deaths that occur annually in the United States and to head off future influenza pandemics. Among the institutions awarded funds includes the Icahn School of Medicine at Mount Sinai. Scientists at Mount Sinai plan to study the ways that the flu is spread from one human to another and also from animals to humans. Researchers hope that their work will lead to better flu vaccines to prevent the transmission of influenza in the future.

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Spring Allergy Hype

Monday March 31, 2014

The headlines state that snow melting from the polar vortex will make this year the worst allergy season yet, or that the brutal winter will cause horrible spring allergies. In other news, a list of the 10 worst states for spring allergies. The message is clear... this spring is bound to be the worst ever. The only problem is that if you pay attention for a few years in a row you'll notice a pattern, experts seem to predict every spring to be the worst allergy season yet. Why is this? It's a good question, that probably has multiple answers.

First of all, there is some research indicating that the number of people who suffer from allergies is on the rise. Some health professionals believe this is due to global warming, a couple studies have shown possible links to things like low vitamin D, or more people living in cities. Some experts are skeptical that the incidence is rising at all but believe that more awareness means more people are just being diagnosed than before. Whatever the reason don't let these doomsday headlines get you down. Just because experts predict a lot of pollen this spring doesn't necessarily mean it will affect you. For your allergies to get worse there has to be an increase in the specific allergen that causes your symptoms and it has to be in your area.

Even the highly publicized list of the 10 worst states for spring allergies might be considered suspect. Which cities make the list and in which order is based on previous pollen counts, the number of allergists in an area, and the amount of allergy medication sold. Of the three only pollen counts could be considered a reliable indicator, but even so, just because previous years have meant high pollen counts in an area doesn't mean that same area will have a lot of pollen this year. However, if you do find yourself suffering from spring allergies we hope that the information in these articles can help:

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Investigational Drug Offers Hope for People With Meniere's Disease

Monday March 31, 2014

Meniere's disease is a frustrating disorder which can cause chronic and debilitating symptoms including vertigo, hearing loss, tinnitus, nausea and vomiting and more. Health professionals don't really understand what causes Meniere's disease but think it is a disorder of the inner ear and lymphatic system. With no cure currently available, treatments are aimed at controlling symptoms. An investigational drug initially showing promising results can offer new hope to those with the disorder, however.

The drug is currently referred to only as OTO-104 but initial research has shown that the medication reduces the frequency of vertigo and may improve the tinnitus associated with Meniere's disease. Initial results also indicate that the drug is safe and well tolerated. However, OTO-104 is still a ways off from being available to the public. The medication is currently undergoing additional testing. If you have Meniere's disease and are interested in participating in this research you can learn more at http://menieresdiseasestudy.com/about-the-study.html.

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Runner Gabrielle Grunewald Survivor of Two Types of Cancer

Saturday March 29, 2014

Runner Gabrielle Grunewald made headlines earlier this month when she was disqualified and later reinstated as the women's 3000 meter champion at the USA Track and Field Indoor Champtionships but the most amazing thing about Grunewald is that at only 27 years old she has survived not one but two types of cancer. Grunewald is a survivor of thyroid cancer and salivary gland cancer. While the diagnosis of thyroid cancer among young women has become increasingly more common, I myself was diagnosed at the age of 24, salivary gland cancer is rare and can be difficult to treat.

When asked if beating cancer has made her a tougher runner, Grunewald stated in an interview with Athletics Illustrated, "Yes, I think so. It just made my dreams crystallize a little bit more and it helped me prioritize certain things in my life that have ultimately helped my running too. Sometimes at the end of races when you have that choice of giving up and settling for a certain place or really going for broke, I have that little voice (sometimes it's really loud, actually!) telling me that I have to go for it -- because you just never know when you'll get another shot. That is something that has stayed with me throughout all the years since my initial diagnosis."

Congratulations to an amazing woman on this latest win, I for one, look forward to seeing more great things from her!

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Age and Health Status Before Esophagectomy Predict Outcomes

Saturday March 29, 2014

Esophagectomy, the surgical procedure to completely remove the esophagus, is a major surgery that has a high risk of complications. While the procedure can be used to treat conditions such as achalasia and jackhammer esophagus it is normally reserved for the treatment of esophageal cancer.  According to an article which appeared in The Oncology Report this month, the biggest predictor of poor outcomes might be the patient's health status before the surgery and their age. According to the report, patients over the age of 70 were much more likely to experience longer hospital stays and to incur higher costs due to complications. Poor outcomes were also impacted by poor patient health before the procedure.

What is scary about results like these is that with Obama Care, and the changes going on in the health care industry, surgeons and hospital facilities will be compensated based on positive outcomes. This means that some surgeons might be tempted to refuse patients who are at high risk for experiencing complications since it could damage their bottom line. While it is true that poor outcomes after surgery are affected by the surgeons technique and the quality of care the patient receives, this is one example of a situation where factors out of the patient's control (age) will negatively impact both the patient, surgeon, and hospital.

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New Procedure Offers Hope to Those With Jackhammer Esophagus

Tuesday March 25, 2014

Jackhammer esophagus is a disorder that is aptly named since those who suffer from it often describe feeling like there is a jackhammer in their chest. Characterized by intense spasms of the muscles in the esophagus, the cause of the disorder is unknown and symptoms may be unresponsive to available treatments. Even surgery may not cure the disorder which is why a new less invasive procedure to treat jackhammer esophagus is such good news.

The procedure is called Per Oral Endoscopic Myotomy (POEM), and unlike a traditional myotomy the entire procedure is done through the mouth without any incisions. The result is a much faster recovery time, no scars, and supposedly no pain. Another condition, called achalasia of the esophagus, may also be successfully treated with POEM. Since the procedure is new it may not be available in many areas yet, but with continued positive results POEM is likely to make traditional myotomy a thing of the past.

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Salivary Duct Stones

Monday March 24, 2014

Kidney stones, gallbladder stones, tonsil stones... and salivary duct stones? That's right you can get stones in your salivary ducts. The condition, called sialolithiasis, is thought to occur when we are dehydrated and the water content of our saliva is reduced. Under the right conditions the calcium and phosphorus normally found in small amounts in our saliva can form stones which can block our salivary ducts. Blockages cause pain and swelling in the associated salivary gland which comes and goes, usually getting worse when we try to eat. Depending on the size of the stone, it may have to be removed in your doctor's office or even surgically excised under anesthesia. Sialolithiasis may occur in about 1% of the adult population and is rare in children.

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Is Thyroid Cancer Overdiagnosed?

Friday February 28, 2014

A huge surge in the diagnosis of papillary carcinoma of the thyroid since 1975 has led some medical professionals to conclude that the condition is overdiagnosed. As both a medical professional and a survivor of this type of thyroid cancer I have strong opinions about this theory.

In an article published in JAMA - Otolaryngology Head and Neck Surgery researchers argue that thyroid cancer is overdiagnosed rather than increasing in incidence because while diagnosis rates have nearly tripled since 1975, the mortality rate from this type of cancer has stayed the same. Some medical professionals argue that because papillary carcinoma, (the most common type of thyroid cancer diagnosed), is highly curable, and rarely fatal, that small tumors are being treated when they pose no threat to life or the quality of a person's health. Others add that many thyroid cancers are being diagnosed incidentally when patients have medical imaging procedures for separate conditions.

While I agree with the facts and statistics presented in the article, and the idea that the supposed increase in thyroid cancer may be representative of increased diagnosis rather than a true increase in the incidence of thyroid cancer, I object to the word overdiagnosis. To me, overdiagnosis implies that we do not need to diagnose thyroid cancers and subsequently treat them. While some small papillary carcinomas may be monitored and treated later on if they become larger without resulting in complications for the patient, in other cases, lack of treatment could lead to metastasis. While it's true that few people die from papillary carcinoma, once the cancer leaves the thyroid and spreads to surrounding lymph nodes or other areas of the body, treatment becomes significantly more complicated, more expensive, and more traumatic.

My opinion is largely due to my own experience. When I was 17 years old my general practitioner found a very tiny, barely palpable lump on my thyroid and sent me for a needle biopsy. Because the nodule was so small at this point it was misdiagnosed as a colloid nodule and nothing was done. According to what most sources say about the growth rate of papillary carcinoma this tiny lump shouldn't have grown much at all for the next ten years. However, 6 years later, when I was pregnant with my first child this lump, which was actually a tumor, began to grow rather rapidly.

By the time my son was a week old this tumor on my thyroid looked like an off center adam's apple every time I swallowed. I had a total thyroidectomy when my son was 3 weeks old. The biopsy report from the surgery stated that the tumor had penetrated into the capsule surrounding the thyroid and was within 1mm of the other side. In other words, it was lucky I had it removed when I did. I found out just how lucky about a year later when I took care of a patient about the same age as me who also had papillary carcinoma. This patient wasn't so lucky, her cancer had spread to her lymph nodes. I don't want to reveal much about her case out of respect for her privacy and out of professionalism,  but suffice it to say I was shocked at how much worse things could have been for me.

As my own experience demonstrates, the problem with waiting and watching a tumor is that you can't predict which ones will become problematic. Sometimes conditions, (such as pregnancy, hormone imbalances etc...), cause a typically slow growing type of cancer to become unpredictable.

The current research published in JAMA is unlikely to change current treatments for thyroid cancer but more research is underway to evaluate the potential overdiagnosis and possible over treatment of thyroid cancer.

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Ear Wax Fact and Fiction

Thursday February 27, 2014

There's a lot in the news lately about what for most of us is a seemingly uninteresting topic: ear wax. Headlines state that ear wax can reveal secrets about your personality,  what you've eaten, your ethnicity, your daily habits and diagnose illness early on. Is this true?

Most of the headlines are based on a recent study which was published about ear wax. The study, which took place at Monell Chemical Senses Center in Philadelphia, analyzed the ear wax of 16 men and found that the men who were of Caucasian descent had ear wax which contained more volatile organic compounds (VOC's) than men who were of East Asian descent. So, according to the results of the study, your ethnicity may change the chemical makeup of your ear wax. Other studies have shown that the lipid content of ear wax varies between ethnic groups.

The rest of the hype, in my opinion, came about based on the misinterpretation of a statement made by study author George Preti, PhD, who said, "Our previous research has shown that underarm odors can convey a great deal of information about an individual, including personal identity, gender, sexual orientation, and health status. We think it possible that earwax may contain similar information."

While Dr. Preti speculates that future research may reveal that ear wax composition can tell us more information about an individual (other than ethnicity), this is currently far from scientific fact. It should also be noted that this particular study was very small and to my knowledge, the results have not been duplicated. To wrap things up, while current ear wax research is intriguing, more research will be needed before your doctor will be able to diagnose your health status based on an ear wax sample! For more info about ear wax read:

Everything You Need to Know About Ear Wax

Ear Wax Blockage

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New Guidelines for the Treatment of Swimmer's Ear

Tuesday February 25, 2014

Swimmer's ear, which is also called otitis externa, is an infection of the outer ear canal which usually occurs when contaminated water is allowed to sit in the ear long enough for bacteria to grow. New guidelines for the treatment of swimmer's ear were published this month in Otolaryngology - Head and Neck Surgery. The new guidelines emphasize the need for physicians to adequately treat ear pain associated with otitis externa and to refrain from prescribing oral antibiotics unless complications such as malignant otitis externa are present or it is clear that the infection has spread into nearby tissue. The first line of treatment should be topical antibiotic ear drops.

Swimmer's ear causes ear pain, redness, inflammation, and itchy, flaky skin. The condition can be prevented by taking diligent precautions to keep the ears dry. Tips for prevention include wearing ear plugs while bathing or swimming and gently blow drying your ears after bathing and swimming.

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