Carbon Dioxide Helps with Nasal Allergies

MSNBC reported recently that a shot of carbon dioxide gas into the nose can help with allergies based on preliminary findings funded by Capnia, a company that makes the product.

Upside:
Symptoms of nasal allergies improved within 30 minutes.
No liquid is involved... just carbon dioxide gas.

Downside:
Lasts only 4 hours
80% has nasal discomfort after use
25% became teary eyed
14-20% developed headaches

My take?
I'll pass on this drug... There are already good drugs with minimal side effects that lasts up to 24 hours already on the market .

Read the story here.

Of note, some readers may point out that there is an older study that had better results. With two one-minute carbon dioxide treatments into the nose resulted in symptom relief within 10 minutes and lasted for 24 hours. Even with these results, I'll still pass... not sure how many people will go with 2 one-minute treatments when a 1 second swallow with an allergy pill or nasal spray use works just as good.

Reference:
Nasal carbon dioxide for the symptomatic treatment of perennial allergic rhinitis. Annals of Allergy, Asthma & Immunology - 19 August 2011 (10.1016/j.anai.2011.07.014)

Intranasal noninhaled carbon dioxide for the symptomatic relief treatment of seasonal allergic rhinitis. J Allergy Clin Immunol. Volume 121, Issue 1, Pages 105-109 (January 2008).

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Xylitol (Natural Compound) to Prevent Recurrent Sinus and Ear Infections?

Image by Lauri Andler from Wikipedia

I only recently became aware of a natural sugar compound called "Xylitol" from a colleague's blog, BoogorDoctor, managed by Dr. Russell Faust. I certainly have never heard of it during medical school or surgical training.

This naturally-occurring sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties and has been known to doctors and scientists but hardly marketed or promoted in any fashion.

However, the importance of this compound is that it DOES appear to significantly decrease the incidence of ear infections and sinus infections when used regularly (in essence, xylitol mixed in with salt-water sprayed into the nose several times a day). See references below for links to research papers.

It's cheap, over-the-counter and at least from the studies I've reviewed, does seem to work. However, to be fair, it only works when given regularly even if healthy. If given when sick, it does not work (see this study). Also to be fair, there are some studies that suggest that xylitol does NOT work at all.

However, given there are minimal (if any) side effects and safe for kids, it is certainly something worth trying before surgical consideration, especially in children.

Why is this compound not more well-known?

Probably because it's cheap and therefore not a money-maker... which means not a lot of dollars goes into marketing the product whether directly to patients or doctors.

In any case, you can get it on Amazon.com here (or possibly at a local pharmacy).

I should also mention that Xlear is the only product series that uses the optimal concentration xylitol (others use only the bare minimum concentration to meet ingredient inclusion).




References:
A Story About a Sugar: The X-Factor. Blog by Dr. Faust

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

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Saline Nasal Flush - Mayo Clinic Video

Ever since our office produced one of the first videos on saline nasal flushes back in December 5, 2007, there have a been a number of additional videos created by medical offices and companies ever since.

The most recent is Mayo Clinic which you can watch here.



Here's our video we made back in 2007.

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New and Only Over-The-Counter Anti-Histamine Nasal Spray

Up until now, there has been three anti-histamine nasal sprays in the United States market available only by prescription... Astelin, Astepro, and Patanase.

However, in May 2011, Meda Pharma announced a new anti-histamine nasal spray Rhinolast Allergy that is available over-the-counter.

The active ingredient is azelastine, the same one as found in the prescription nasal spray Astelin and Astepro.

Azelastine has a triple mode of action: anti-histamine effect, m,ast-cell stabilizing effect, and anti-inflammatory effect. Azelastine has a rapid onset of action of 15 minutes.

It can be used from the age of 5 years.

This nasal spray can be used in combination with other over-the-counter anti-histamines medications taken orally like zyrtec, claritin, allegra, and benadryl.

Read more about this new nasal spray here.

Read more about allergy medications in general here.

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Septal Stapler for Septoplasty Surgery

Septoplasty is a surgical procedure whereby the septum, which is the wall that separates the right and left nasal cavities, is straightened out. Read more details of the surgery here.

During this surgical procedure, it is not uncommon for ENT surgeons to place splints and/or packing to bring the septum back together after the procedure is performed. Other surgeons avoid placing splints/packing by suturing the septum together.

A relatively new device called the ENTact Septal Stapler is yet another way to get the septum back together after straightening. I tried this device a few years ago, but stopped due to some instrument shortcomings. However, the company has made a few improvements that has made me reconsider trying it.

Check out this video animation on how this device works.

Watch how septoplasty is performed.

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New Video on Septoplasty to Correct Nasal Obstruction Due to a Deviated Septum

A new video has been created and uploaded onto our YouTube channel depicting how a deviated septum causing nasal obstruction is corrected by a septoplasty surgery.

Watch the video below or on our YouTube channel.

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Does the Nose Appearance Change After Septoplasty? (Answer: No)

Septoplasty is a surgical procedure to straighten out a deviated septum causing problems with nasal obstruction/congestion.

A common question I get asked is whether the nose appearance will change after this surgery. The answer is no (if correctly done). In fact, if the nasal appearance DID change afterwards, you would also have undergone rhinoplasty nosejob.

The explanation for why the nasal appearance does not change after septoplasty is actually quite simple. The analogy would be a house where the appearance on the outside would not change even though you may knock down a wall between two rooms inside the home.

SO... Here is a side view of the septum. The blue arrow is pointing to the nostril opening and the red arrow is pointing to the lip.

In this picture below, the septum has been removed.

As you can see, the outside appearance of the nose remains unchanged as the rim of the nose is kept intact as shown by the red arrows here:

So that in a nutshell is the explanation for why deviated septum surgery does not change the outside nasal appearance.

Read more about the septoplasty surgery here.

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Pediatric ENT Care of Warrenton, Virginia (Fauquier County)

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:

- Tongue Tie Release (starting from ONE DAY OLD!)
- Tonsillectomy
- Adenoidectomy
- Sinus Surgery starting with adolescents
- Ear Tube placement
- Hearing Loss
- Nasal Obstruction
- Nasal Congestion
- Snotty Nose
- Speech Delay
AND many other issues...

Our office has even created videos on a few common pediatric procedures including tonsillectomy, adenoidectomy, earwax removal, ear tubes placement. Watch the video below on tonsillectomy.

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Being a Hairdresser Can Destroy Your Nose!

On Oct 14, 2010, there was a story out of England about a hairdresser whose nose slowly collapsed due to damage sustained from breathing in hair clippings for 35 years.

Apparently, over a period of 20 years, the small hair clippings slowly caused damage to her septum to the point it caused a perforation. The perforation than led to infection which further weakened her nose structure to the point it started to collapse... a type of nasal deformity called a saddle nose.

Of course, it just wasn't her septum that was affected, but also her sinuses leading to persistent headaches, nasal congestion/obstruction.

Read the story here.

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Cocaine As A Medically Approved Medication

Many people are already aware that marijuana is now legal in some states in the US with a medical prescription.

What many people may not realize is that cocaine is also used in medical care, especially in the ENT world.

Cocaine is one of the most potent anesthetic AND vasoconstrictor. These two characteristics make it an ideal medication for use during sinus surgery as well as any nasal procedure where bleeding and pain may be an issue.

Many physicians will use cocaine to help stop nosebleeds (I do not).

Many surgeons use cocaine during sinus surgery to minimize post-operative pain as well as minimize intra-operative bleeding. Use of cocaine also significantly decreases risk of nosebleeds after sinus surgery as well as minimize need for nasal packing.

Cocaine when used for illegal recreational purposes by snorting puts a person at risk for septal perforation due to its vasoconstrictor properties. In essence, the cocaine puts a chemical tourniquet on the blood supply to the septum leading to mucosal necrosis and eventual perforation. Afrin does the same thing, but on a much smaller scale.

Before anybody asks... Cocaine is NEVER prescribed to a patient. It is only ever used in a hospital/office setting and heavily controlled under lock and key. (It is never used in our office.)

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Nasal Surgery Helps With Snoring

Researchers have found that surgery to improve nasal breathing in setting of nasal obstruction, congestion, and/or resistance can also help with snoring.

Depending on the study, surgical relief of nasal obstruction improves snoring in a range from 35% to as high as 86%. Unfortunately, complete CURE (ie, no snoring whatsoever) is less likely occurring in <15% of patients. What are the possible nasal surgeries one can undergo to relieve nasal obstruction and potentially achieve snoring improvement? They include:

• Septoplasty
• Adenoidectomy
• Turbinate Reduction
• Sinus Surgery

Reference:
Nasal Surgery for Snoring in Patients With Obstructive Sleep Apnea Laryngoscope. 118:354-359, 2008.

Can Snoring Relief After Nasal Surgery be Predicted. Clin Otolaryngol 19:41-44, 1994

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Intra-Nasal Cooling System Effectively Chills Brain After Cardiac Arrest

In a study in this month's Circulation, a new nasopharyngeal device was used to initiate cerebral cooling during cardiac arrest. This device, called RhinoChill made by BeneChill cools the major vascular structures of the brain thereby improving neurological outcome.

Use of this device was found to increase survival over CPR alone by 27% and a 26% increase in neurologically intact survival.

Reference:
Intra-Arrest Transnasal Evaporative Cooling. A Randomized, Prehospital, Multicenter Study (PRINCE: Pre-ROSC IntraNasal Cooling Effectiveness). Published Online on August 2, 2010.

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New Webpage on Large Adenoids: Symptoms and Treatment

A new webpage has been created on problems associated with large adenoids and how it can be treated.

Large adenoids cause all sorts of symptoms that may be confused for other etiologies including:

• Nasal obstruction
• Nasal congestion
• Nasal sounding speech
• Runny nose (rhinitis)
• Snotty nose
• Colored drainage
• Allergy like symptoms
• Ear pain, clogging, stuffiness
• Cough
• Post-nasal drainage

Correction of the large adenoids (medications or surgery) may eliminate all these symptoms!

Click here to read more about this as well as to watch videos on this subject.

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Vaginal Premarin Cream for Recurrent Nosebleeds?

It is an old trick of the trade where a physician may prescribe vaginal premarin cream to treat recurrent nosebleeds.

The premarin cream (just as it does when placed vaginally) causes the nasal mucosa lining to thicken thereby "burying" the superficial blood vessels that are often the culprits for recurrent nosebleeds. Application is by rubbing the cream 2-3X per day to the anterior wall of the nasal septum (Kiesselbach's plexus) where 90% of nosebleed sources are located.

Understandably, males may be reluctant to be prescribed this medication due to the small (but temporary) risk of breast enlargement given the very small amount that can be systemically absorbed (based on vaginal studies, less than 20 pg/ml).

Furthermore, given there are other good options for treating nosebleeds including nasal emollients, cauterization, and packing, this option is mainly for females who are scared to death of nasal cauterization/packing when other more conservative treatment fails.

Though I wish I can provide a few good references... there aren't any. It is considered general knowledge. The only one I was able to find is:

Mehriz A, Weber DR. Estrogen therapy for recurrent epistaxis: case histories and literature review. Hosp Pharm. 1999;34:1057-1064.

The vast majority of research on use of premarin cream for recurrent nosebleeds is actually for treating individuals suffering from Hereditary Haemorrhagic Telangiectasia (HHT), also known as Osler-Weber-Rendu Syndrome.

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New Webpage on Rhinitis Medicamentosa (Nasal Decongestant Spray Addiction)

A new webpage has been created and uploaded to our website on rhinitis medicamentosa, a devastating sinus/nasal condition with symptoms of severe chronic obstruction/congestion. This condition occurs when over-the-counter nasal decongestant sprays are used more frequently (every 12 hours) and longer (3-5 days) than directed.

Such nasal decongestant sprays include the common and popular Afrin and Zicam nasal sprays. These sprays contain one of these active ingredients: phenylephrine, neo-synephrine, oxymetazoline, and xylometazoline.

This condition has also been portrayed in the New York Times and the article can be read here.

Check out the webpage here.

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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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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 well as what happens when the voice doesn't sound normal here.

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