CPAP Masks Causes Facial Changes With Time

CPAP is a machine that pushes air into a person while they are sleeping to treat obstructive sleep apnea, a medical condition where a person stops breathing multiple times throughout the night leading to all sorts of medical problems including increased risk of hypertension, stroke, peripheral vascular disease, heart attack, etc.

In order for this device to work, a mask must be worn while sleeping in order for the air to get pushed into the lungs.

It is considered the gold standard treatment for OSA.

However, a new study has found that prolonged use of CPAP masks lead to slight shifts in jaw and position of teeth along with other craniofacial changes. Previous studies have already reported midfacial hypoplasia in children using CPAP.

How long before such changes can occur in adults? In as little as 2 years.

Fortunately, there are other options beyond CPAP that can help minimize and possibly even cure OSA via surgical procedures.

Read a Businessweek article about this here.

Read the research here.

Reference:
Craniofacial changes after 2 years of nasal continuous positive airway pressure use in patients with obstructive sleep apnea. Chest. 2010 Oct;138(4):870-4. Epub 2010 Jul 8.

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Cat With Vocal Cord Condition Results In A Singing Voice

A reader forwarded this video (below) to me about a singing cat named Monster. This cat has a supposed "vocal cord condition" which causes operatic singing when yawning. Check it out!

Now personally, I can't really think of a vocal cord condition that would cause a more beautiful voice. Wish I could perform fiberoptic laryngoscopy on a "normal" cat and this cat to see what differences are present.

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Loud Noises Can Cause Heart Problems (Not Just Hearing Loss)!

According to a new study, people who work in noisy places for at least a year and a half could have triple the risk of a serious heart problem including a heart attack and severe chest pain compared to those who work in quiet environments. Of course, we all know such loud environment can also cause hearing loss.

6,000 people who were at least 20 years old and employed were surveyed from 1999 to 2004. Other heart risk factors including elevated Body Mass Index and smoking were statistically adjusted for.

Noisy occupations include not only welders, garage mechanics and forklift operators, but also dentists, construction workers, nursery school teachers and classical musicians.

Why would loud noises cause heart problems? It is felt that noisy environments typically are more stressful leading to higher levels of stress hormones which can contribute to heart problems. Still... quitting smoking and losing weight are more important to your heart health than avoiding noisy environments.

Read the research here.

Read a MSNBC article about this research here.

Reference:
Exposure to occupational noise and cardiovascular disease in the United States: the National Health and Nutrition Examination Survey 1999–2004. Occup Environ Med doi:10.1136/oem.2010.055269

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Fauquier ENT YouTube Channel Ranked As One of the Most Viewed In The World!

Today, it was with pleasant surprise that I was informed that our practice's YouTube channel has been ranked as one of the most viewed channels in the world!

In fact, our YouTube channel now has a ribbon with our ranking.

Yes... We are ranked #99 and nowhere even close to breaking the top 10... but still very cool and who knows in the future!

As of Oct 5, 2010, our channel has received 97,216,403 views.

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Sinus X-Rays Are Worthless

Oftentimes, I see patients come in with sinus x-rays with this or that finding. What many patients as well as physicians may not realize is that sinus x-rays are notoriously unreliable in determining whether sinus infection is present or not. Indeed, I NEVER order a sinus x-ray. Just how unreliable are sinus x-rays?

In adults, it may be literally a flip of the coin whether the sinus x-ray is providing a correct diagnosis compared with the gold standard CT sinus.

Depending on what study you look at, the specificity of a sinus x-ray hovers around 50% (how often it correctly states normal sinuses). Sensitivity is a little better at around 80% (how often it correctly detects actual sinusitis).

Several studies have concluded that sinus plain film x-rays are unreliable and no longer routinely indicated for the evaluation of nasal and paranasal sinus disease. When radiographic evaluation is indicated a limited CT series provides superior information.

Take home message?

Do not order a sinus x-ray when evaluating for sinus disease/sinusitis!!! Why bother ordering a test that is going to be wrong almost half the time?

(If a CT sinus comes back normal, the patient most definitely does NOT have acute or chronic sinusitis.)

Interestingly, sinus x-rays in kids (2+ years old) may be more reliable and in this sub-population, may be beneficial [Link]. But this study unfortunately did not include CT sinus scans to verify sinus x-ray findings. It should also be noted that sinus x-rays younger than 2 years old is also unreliable [Link].

Reference:
Radiographic evaluation for nasal dysfunction: computed tomography versus plain films. Head Neck. 11 (5), 405-9. 1989

Comparison of sinus x-rays with computed tomography scans in acute sinusitis. Acad Emerg Med. 1 (3), 235-9. 1994

Sinusitis and chronic cough in children. J Asthma Allergy 5:27-32. 2012.

Maxillary sinus radiographs in children with nonrespiratory complaints. Pediatrics. 1984;73(3):306–308.

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NPR on Endoscopic Sinus Surgery

NPR published a story on Oct 4, 2010 describing endoscopic sinus surgery using image guidance. The NPR story is actually quite balanced with accurate portrayal of what sinus surgery can or can't do.

Just like in the NPR story, our office performs the same high-definition endoscopic sinus surgery using BrainLAB image guidance (which provides the real-time 3-dimenstional guidance).

Prior to sinus surgery, a patient must fail medical management first (unless nasal masses like polyps are found) including allergy control.

Read the NPR story here.

Read more about sinus surgery here.

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New Video Uploaded on Earwax Removal Under the Microscope

Our office has produced a new video on earwax removal under a microscope that we have uploaded onto our YouTube Channel.

Click here to watch it or watch it below!

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