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 scratch on your nose, in a week that'll be gone,; Ulrich said. 'When you scratch your hearing or damage your hearing, it doesn't come back. I try to point out to younger kids ... once your hearing is gone, it's gone, and there's no real remedy.'"

Our office sells ear plugs for musicians as well as hearing aids and other assistive listening devices. We also provide hearing tests.

Read the story here.

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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 fracture on CT. Overall, however, he does not appear to be in extreme discomfort and there does not appear to be any functional deficits.
Dr. Chang: Tell me about the fractures.
ER: It's a left zygomatic fracture. However, he is able to open and close the mouth as well as swallow without difficulty, so it's not emergent, but probably needs followup.
Dr. Chang: OK. What's his name? Tell him to come to my office in the morning at 9AM.
ER: Sounds great. Will let him know. His name is "John Doe" (not the patient's real name).

I than went to my home computer and loaded up his CT images to evaluate the so-called fracture. Often-times, most facial fractures do not require any intervention. However, some facial fractures, if severe enough, do require repair.

I loaded up the CT images and saw this (floating left zygomatic fracture):


Hmmmm. DOES need surgical intervention, but not something I can handle and this patient will need to see a specialist in facial fracture repair down at a tertiary care center like University of Virginia Medical Center. So, I take out my iPhone and take a picture of this relevant key image and email it to the facial plastic surgeon at UVA to arrange for an appointment (of note, no patient identifiers are included with the image to abide by HIPAA regulations).


Within a few hours, I get a reply back from the UVA plastic surgeon that this patient definitely needs surgical repair and that he would be able to see him the next day afternoon with surgery time blocked off for repair 3 days later.

The moral of the story is that technology is now good enough that given all information provided including radiological images (a picture is worth a thousand words), amazing things can happen, like get a patient seen in less than 24 hours by a sub-specialist who normally is unable to see new patients for 6-8 weeks. Without this image, it may have taken more effort and surgery may have been delayed by a week or two.

Patients can also do this if they are able to email their physician. It's not enough to provide only textual information which may not provide a compelling enough story... Include relevant images!!! Of course, you may need the help of a health professional to guide which images are most important.

It's worth repeating again...

Include relevant images!!!

The extreme importance of images is also why I ALWAYS want to see the CT scan images of any patients who comes in for an appointment and why patients should ALWAYS bring a copy of their CT scan burned onto a CD before seeing their ENT. A report is NOT good enough.

HOWEVER, the very importance of an image to a surgeon can be a double-edged sword as the image you send may PROVE that there's nothing significant going on to the point that a specialist may say that scheduling an appointment would not be worthwhile.

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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. How fast? Within 60 MINUTES!!!

These findings lend support that should patients suffer from recurrent sinus infections that do not clear readily with antibiotics alone should be investigated for allergies. Furthermore, allergy testing and management should be performed in all patients considering sinus surgery. Why? Because if allergies are playing a role, opening up the sinuses via surgery will only exacerbate allergy triggered sinus infections.

What is our office protocol for evaluating patients with chronic sinus infections?

1) History supportive of recurrent sinus infections in spite of antibiotics as well as trial of allergy medications
2) CT Sinus documenting presence of sinus disease for surgical consideration as well as elucidating whether true sinus problems are causing the symptoms
3) Allergy testing (Our office performs immunoCAP blood testing instead of skin prick testing)

If allergy testing is positive, aggressive allergy control is the first step prior to (or at the very least concurrent with) any other intervention including sinus surgery.


Reference:
Diagnostic Value of Nasal Allergen Challenge Combined With Radiography and Ultrasonogrphy in Chronic Maxillary Disease. Arch Otolaryngol Head Neck Surg. 2009 Dec;135(12):1246-55. doi: 10.1001/archoto.2009.189.

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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? Only 0.001%.

Check out the website here.

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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 procedure.

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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 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 advance  as well as the surgical option Nissen fundoplication or LINX. 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 less invasive procedures called TOIF (Trans-Oral Incisionless Fundoplication) performed endoscopically without skin incisions.

Read more about non-acidic reflux here.

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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 Krespi in New York City.

We offer only coblation tonsillectomy.

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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 come.

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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.

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.

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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, 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, some dentists and oral surgeons do. There are also OTC oral appliances one can obtain (which of course do not work as well).

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