CNN: Metallica Drummer Suffers From Tinnitus & Wears Earplugs When Performing

CNN on Dec 28, 2009 published a story on tinnitus (ringing of the ears) highlighting Metallica drummer, Lars Ulrich. Mr. Ulrich has suffered from tinnitus due to loud noise exposure and started wearing hearing plugs whenever performing to minimize further damage to his ears."Ulrich said he is concerned about young people, the so-called iPod generation, who listen to loud music, and may not be as vigilant about protecting their ears. 'If you get a...

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How To Persuade a Specialist to see a Patient Quickly!

With the advent of SmartPhones like the iPhone, communication between not only physicians but also patient-physician has become much easier.To illustrate how such technology has eased communication in order for a patient to be seen quickly by a specialist was recently demonstrated when I received a phone call at home around 9:30PM from the Emergency Room regarding a facial fracture.ER: Dr. Chang, we have a patient here who seems to have a facial...

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Recurrent Chronic Sinusitis Often Due to Allergies

A 2009 research paper lends credence that allergies may be a VERY important player in patients who suffer from recurrent sinus infections. Such patients will improve with antibiotics only to have their sinus infection symptoms recur shortly after completing the antibiotics.The research described how allergy exposure to patients resulted in a rapid and radiographically significant response of sinus disease including mucosal thickening and/or opacification....

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Website That Calculates Your Cancer Risk From Radiological Tests

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?...

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New Webpage on Submandibular Gland Surgery

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 procedu...

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

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...

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New Webpage on Laser Tonsillectomy

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...

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Dr. Chang Invited as a Guest for Online Radio Talk Show

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 co...

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Second Stage (of 3) Office Renovations Completed

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....

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New Video on Stopping Nosebleeds by Cautery

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)

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,...

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Website Updated Utilizing ReCAPTCHA To Avoid Spam Email

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...

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Cheap Quality Prescriptions Thru Costco Pharmacy Mail Order

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...

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What Is a Pulmonary Stress Test?

Image by WikipediaAt 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...

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Cool X-Ray Video of What Happens Anatomically During Speech

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...

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

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...

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Machine Gun Sneezing

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,...

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

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...

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Google Flu Shot Finder

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 he...

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McGovern Nipple for Infants Born Unable to Nasally Breathe

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...

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RANDOM: Washington Post Cartoon Making Fun of ENT

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

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New Voice-Mail Phone # for Patients With Difficulty Hearing

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 everyone whether new or established with 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...

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

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...

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USA Today on Hearing Aids

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...

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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 vid...

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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. Enj...

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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...

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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...

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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...

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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,...

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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...

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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 regio...

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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....

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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...

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Botox Treatment for Vasomotor Rhinitis (Idiopathic or Non-Allergic Rhinitis)

A new research paper has been published Oct 16, 2009 in Head & Face Medicine entitled "Minimally invasive application of botulinum toxin A in patients with idiopathic rhinitis" in which researchers successfully treated patients with a persistent runny nose not due to any known problems like allergy. Such a condition is called vasomotor rhinitis or idiopathic rhinitis or non-allergic rhinitis.In this new described method of treatment, a sponge...

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MRSA Sinusitis

There seems to be an increasing number of patients I see with MRSA sinusitis. Not many, but definitely not rare. These patients are understandably very concerned with how to treat their MRSA sinusitis.Beyond the usual protocol that applies to any MRSA infection, if the sinusitis is severe, sinus surgery is recommended for 3 main reasons.1) Get the infection cleaned out surgically (much like draining an abscess of the skin)2) Enlarge the openings...

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Tionne "T-Boz" Watkins Suffered from Acoustic Neuroma (Brain Tumor)

It was revealed in Oct 2009 that celebrity Tionne "T-Boz" Watkins of TLC fame (Celebrity Apprentice), that she was diagnosed with a type of benign brain tumor called acoustic neuroma. She underwent surgery in 2006 to have it removed and experienced a difficult recovery especially with balance.One of the earliest symptom of this type of brain tumor is an asymmetric sensorineural hearing loss (ASNHL) or a sudden hearing loss only in one ear (SSNHL)....

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Saline Nasal Sinus Irrigation Systems

I must admit... our office is a big fan of the Neilmed Sinus Rinse bottle for patients who suffer from chronic sinusitis and severe allergies as it is cheap, easy to clean, and it works. However, many patients who are already fans of flushing the nose with saline water end up purchasing saline irrigation systems. There's a bunch of these devices sold on Amazon.com. Check them out below, but I would suggest that you first become adept and able to...

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Egg Allergy and the Flu Shot

Several patients have called our office asking whether it is safe to receive the flu shot if they are egg allergic. Generally speaking, for most patients, the blunt answer is that it is safe.The flu shot vaccine (both H1N1 and seasonal) are egg-based from which this concern arises. It also doesn't help that the pre-flu shot questionnaire specifically asks about egg allergy. Though egg-based, most of the egg protein is filtered out such that there...

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New Video Produced on Proper Ear Drop Administration

We have recently produced and uploaded on to our YouTube channel a new video describing how to properly administer ear drops. This video is especially pertinent in patients who have ear tubes.Watch the video below:...

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TWO Ear Canals in the Same Ear!

I recently saw a patient who had a complaint of having two ear canals in each of the ears. To my surprise, the patient had exactly that! You can see the second ear canal in the picture below... it is above the normal one and is about 25% the size.To those in the know, this is due to a congenital birth defect related to the first branchial cleft.Read more about this birth defect here. Clearly, the way to correct this is surgic...

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LA Times: Driving a Convertible May Cause Permanent Hearing Loss!

The LA Times published a story on Oct 6, 2009 entitled "Cruising with the top down? Cover your ears" describing research that assessed noise levels in seven different scenarios where the convertible was traveling at speeds of 50, 60 and 70 miles per hour. Researchers found that drivers were consistently exposed to noise levels between 88 and 90 decibels. Even with the windows up, the noise levels were found to be at 82 decibels.To keep these findings...

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NYT: Does Snotty Colored Discharge Require Antibiotics? No!!!

The New York Times published a story on Oct 6, 2009 entitled "The Claim: With a Runny Nose, Green Calls for an Antibiotic." It actually is a pretty good article though I'm not sure how much impact this will have in clinical practice.The story reports that green discharge from the nose is NOT indicative of a bacterial sinus infection and as such, this symptom should not be the sole reason why antibiotics should be prescribed.It does reference a research...

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