Oral Exam Using a Finger

For a good physical exam, physicians use their senses (eyes, ears, nose) to detect disease processes that may not necessarily be obvious to a lay person. Beyond these obvious senses, fingers and hands are also utilized to feel for unusual bumps or masses that may not be obvious to the naked eye.

Take a neck mass for example. Neck masses may not be necessarily visible, but by feeling the neck, may become obvious. To use an analogy, a bowling ball under a mattress may not necessarily be obvious, but if you lay on the bed, would become painfully obvious.

Physicians also use the hands/fingers to examine areas that may not be visible... such as the unpleasant digital rectal exam (inserting a finger up a bung-hole) which is done to detect blood in the stool, rectal/anal cancers, anal muscular incompetence, etc.

However, I find it odd that the mouth is a body area that is not often "felt" around... physicians included.

A finger can appreciate unusual mouth pathology that may not necessarily be appreciated by looking alone. Furthermore, just like the rectal exam, a finger can appreciate base of tongue pathology that cannot be visualized by having a patient go "ah".

I truly feel that actor Michael Douglas would have been diagnosed with his base of tongue cancer much earlier if only a doctor stuck a finger and swept that back area of the tongue. One can "feel" cancer as it is rock hard and very tender. True... it may cause a person to gag, but for a cancer test, it's dirt cheap, fast, and reliable.

However, it does not just have to be areas of the mouth that can not be seen. Even for those ulcerations and bumps of the mouth that one can clearly visualize (or not), it does help to touch it. Is it hard? Soft? Ulcerated? Tender? Grooved? Papillated? Fungating? Rubber-like? Blottable?

Each characteristic provides information to achieve a more accurate diagnosis.

To an ENT way of thinking, if a doctor regularly performs a digital rectal exam, than one can certainly do the same thing at the other end. It's less invasive and provides just as much information.

Say "ah"!!!

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New Video on Esophageal Manometry and 24 Hour Multi-Channel pH and Impedance Testing

Our office has created a new video describing what a patient goes through when they undergo esophageal manometry as well as 24 hour multi-channel pH and impedance testing.

This test is often ordered when a patient is suspected to be suffering from reflux, whether acid or non-acid, or is possibly suffering from abnormal muscle activity of the esophagus.

Symptoms that a patient may experience that may lead to such testing include:

- phlegmy throat
- lump sensation in the throat
- chronic throat clearing
- chronic cough
- difficulty swallowing

Watch the video here!

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New Video Produced on Non-Sedated ABR/OAE Testing

Our office has produced a new video on non-sedated ABR/OAE hearing testing. Such testing traditionally required sedation as the patient was required to be absolutely still and quiet in order to obtain accurate test results. However, new technology now enables such testing to be performed without sedation. Furthermore, given the testing can be performed wirelessly, the patient can stand and walk around. Absolute quiet is also no longer necessary and the patient can actively play and even eat while testing is going on.

Read more about non-sedated ABR/OAE testing here.

Watch the video here.

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Can A Person Have Allergies Even if Allergy Testing Comes Back Negative?

YES!!! But how can that be?!! Well, here is the simplified answer. When allergy testing is performed whether by skin prick or blood testing (RAST), one is testing to certain specific proteins known to cause allergic reactions in majority but not all patients (these are called major allergen).

Patients need to remember that for a given allergy like CAT (or tree, mold, dust, etc)... there are millions of proteins (minor allergen) that have the potential to cause an allergic reaction in people. Allergy testing to cat ONLY tests for ONE of these proteins called Fel d1 as well as a few other minor allergens. As such, if a patient is CAT allergic, but not to the Fel d1 protein, then the allergy testing will come back normal!

Given this information, that's why skin testing is a bit more "accurate" when it comes to determining whether a patient has allergies or not as there are more "proteins" for a given allergen like CAT being tested than the blood test like RAST which STRICTLY tests for a single protein.

Of course, it is possible that a patient may TRULY not have any allergies. So, how can a person tell? Look at the total IgE serum levels. If it is high, than you most likely have allergies even if everything comes back negative.

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For $349, Test Your DNA for 100+ Hereditary Diseases

Image from Wikipedia

A company called Counsyl claims to be able to test an individual's DNA and determine the risk of passing on over 100 hereditary diseases to future offspring for $349 (or free with insurance). Such hereditary diseases they are able to test for include the commonly known cystic fibrosis to more rare conditions like Nijmegen Breakage Syndrome. The full list can be viewed here.

Though many of the diseases listed are associated with ear, nose, throat problems, the list unfortunately does not include hereditary hearing loss conditions.

To do the testing, all you need to do is get the kit mailed to your home, spit into their test tube, and send the kit back to the company.

Read more about this in the New York Times here.

Though this all sounds great, there are some potentially unforeseen implications one needs to consider prior to obtaining this test beyond the issues the NYT article brought up. If the testing comes back positive, one runs the risk of:

1) Having your health insurance dropped or premiums increased... not just for you, but for your offspring (pre-existing condition)
2) Businesses may not want to hire you as you would "cost" them more (missed days from work due to illness, etc)

Though insurance may cover the testing... not sure if you actually want the insurance company to pay and have them potentially find out the results, especially if positive.

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