Miley Cyrus "I Cut My Uvula"! ...NOT!

I was recently made aware of this video Miley Cyrus made in January 2009 when she reported that she cut her uvula (according to a nurse) after swallowing a slippery piece of chicken causing her voice to sound quite hoarse. Watch the video here:



However, based on how her voice sounds, I seriously doubt that her hoarseness is due to a cut uvula. When the uvula gets cut, or swollen, or gets injured one way or another, it would cause her voice to sound muffled... NOT raspy like her voice sounds. Though it is possible that her uvula may have been injured, it certainly is not the cause of her poor vocal quality.

Rather, I suspect that her voice sounds bad the way it does due to a vocal cord injury. Often, when people swallow a piece of food (like a chicken) that either gets stuck or goes the wrong way, the person automatically coughs severely in order to expel it.

If the cough is severe enough, it'll cause traumatic injury to the vocal cord resulting in a hoarse voice. The injury itself may not be that bad (usually a mild vocal cord submucosal hemorrhage), but the voice does sound bad. Here are two mild examples of laryngitis due to blood accumulation here and here. A more severe example of traumatic laryngitis can be found here.

In this situation, if the person persists and tries (forces) to talk and sound normal in a setting where the vocal cord is injured, compensatory behavior sets in whereby the vocal quality will fluctuate and go in and out as Miley's voice does in the video (listen to an audio of another patient with this problem here). This condition is called "compensatory muscle tension dysphonia," and in her case, secondary to acute traumatic laryngitis.

This diagnosis can be confirmed on fiberoptic laryngoscopy. Treatment is high dose steroids that will bring the swelling down as well as strict voice rest for a few days (depending on severity of the injury). Resolution of her voice would be expected within 1 week with this treatment. Voice therapy may be required, though usually not.

Read more about traumatic laryngitis here.

Read more about muscle tension dysphonia here.

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New Video on Uvula Excision for Snoring (and Other Problems)

Our office has created a new video on how a uvulectomy (or uvula excision) is performed to treat not only snoring, but chronic cough, throat-clearing, and even gagging due to an extremely long uvula.

Though the procedure can be performed awake without sedation in adult patients without a severe gag reflex, for those with a bad gag reflex, it must be performed under general anesthesia as shown in this video.

For more info on this procedure, click here.

Check it out here!

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Xyzal and Clarinex Generics Now Available

Xyzal and Clarinex are both anti-histamines used to treat allergies. Both medications are now available as generics by prescription since December 2010. The active ingredient for both xyzal and clarinex are the active stereoisomer of the over-the-counter zyrtec and claritin respectively.

In other words, zyrtec and claritin available over-the-counter contain the same active ingredient found in xyzal and clarinex, but in an "un-purified" state. Still confused? Read this article which probably contains more information than you ever wanted on this subject.

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Non-Sedated ABR & OAE Now Offered at Fauquier ENT

What is ABR/OAE? ABR (Auditory Brainstem Response) as well as OAE (Oto-Acoustic Emission) are specialized hearing tests that can evaluate whether a child/infant/newborn can hear without requiring them to respond.

These tests are completely non-invasive. Just like an EKG measures a heart's electrical activity using little stickers, ABR/OAE testing checks out the electrical activity from the ear to the brain. Special stickers on the head enable us to "see" whether the brain "hears" any sounds introduced into the ear.

If the ABR/OAE testing comes back normal, rest assured your child's hearing in both ears is normal.

Specifically, OAE is performed by placing an earpiece and playing clicks into the ear. The machine than listens for an echo which indicates that the ear "heard" the clicks.

ABR is performed just like an OAE, but special leads are placed behind the ear and forehead which measures brainwaves (just like an EEG or an EKG) to see if the brain "hear" the clicks produced by the testing machine. There are several different types of ABR (regular, tone burst, bone conduction, ASSR) depending on the age of testing and reason for the testing.

Traditionally, ABR/OAE testing required sedation in order to obtain accurate and reliable results as any muscle activity can lead to false reports. Furthermore, there are a lot of wires going from the patient to the equipment and as such required the patient to stay still. In the case of infants/children, this mandated general anesthesia in a hospital operating room.

Fortunately, new technology that our office possesses eliminates the need for such sedation and still obtain accurate ABR/OAE test results. Our office uses Vivosonic Integrity which incorporates wireless technology and the use of an in-situ bio-amplifier which amplifies biologic electrical activity at the ear source thereby reducing interference from environmental electric, magnetic, and RF field-induced noises. This also dramatically reduces artifacts which result from other muscular and ocular electrical activity.

What does this all mean for a patient?

It means that an ABR/OAE can be obtained in our office on a child/infant who is actively moving and playing around, eating food, chewing gum... all without being attached to wires. No sedation. No medications. No needles. No pain.

Click here for more info.

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Tonsillectomy Causes Obesity?

MSNBC published a story on Feb 1, 2011 regarding a new study suggesting a link between childhood obesity and tonsillectomy.

What they found was a greater than expected weight gain in both normal weight and overweight children after tonsillectomy over a 6-12 month period of time. In one study, the average body mass index of the kids increased by about 7 percent. In another analysis of 249 children, 50 to 75 percent of kids had weight gain after surgery. While most weight gain happened in the first year after surgery, scientists don't know definitively whether it levels off after that.

What is unclear about this research is whether this common surgery to remove tonsils is contributing to the nationwide "epidemic" of obesity.

Several theories have been proposed:

1) One reason why tonsillectomy is performed is because of difficulty breathing. In this scenario, more calories are expended on trying to breath. After tonsillectomy, all the energy expended on breathing is now being used to gain weight instead.

2) Having difficulty swallowing food due to large tonsils may prevent children from eating very much. In this scenario, after tonsillectomy, the child can now eat without problems leading to eating more and gaining weight.

3) In young and school-age children there's evidence of both a weight gain and a "growth spurt" after tonsillectomy that may be triggered by higher levels of growth factors.

One needs to be careful and realize that this study does NOT prove cause and effect. It suggests a possible association and the only way to know for sure if this common surgery actually causes obesity is to perform a double-blinded, placebo-controlled, prospective study... or at the very least, a prospective study (given it will be near-impossible to have a placebo group and be double-blinded... after all, you can just look to know if the tonsils were removed or not). What will likely end up being true is the fact that obesity is due to a number of factors of which tonsillectomy may play one possible role in certain pediatric populations. In the end, more study is needed.

Regardless of the cause, perhaps the best advice for parents is to have tonsillectomy done for their child only if it is absolutely necessary and if done, keep an eye on how much they are eating and to encourage healthy eating habits.

Read the MSNBC report here.

Reference:
Pending in Feb 2011 Issue of Otolaryngology-Head & Neck Surgery

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The Doctors TV Show Does Surgery for Obstructive Sleep Apnea

The Doctors TV show at some point in the past (not sure when), did a segment on surgery used to treat obstructive sleep apnea. The surgery portrayed was UPPP (uvulopalatopharyngoplasty). Dr. Brian Weeks, the featured otolaryngologist, removed the tonsils and uvula followed by suturing the cut mucosa to reposition the soft tissues of the patient's throat.

This operation is a basic surgical method addressing obstructive sleep apnea. However, prior to considering surgical treatment, I typically recommend trial of CPAP for 3 months.

Some things to keep in mind is that obstructive sleep apnea is often due to multiple levels of obstruction. UPPP only addresses mouth-level problems. Other sleep apnea surgery options need to be considered when obstruction exists at other levels including the back of tongue (below the mouth level). Base of tongue reduction helps in this situation.

Watch the video of the TV show here. Watch the video our office produced on this surgery here.

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New Video on UPPP Surgery to Treat Sleep Apnea (Uvulopalatopharyngoplasty)

A new video has been created and uploaded onto our YouTube channel showing how a UPPP (uvulopalatopharyngoplasty) sleep apnea surgery is performed. This surgery is commonly performed to try and improve or even cure obstructive sleep apnea in adults. This surgery rarely is performed in kids.

Read more about UPPP here. More info about obstructive sleep apnea can be found here.

Another operation used to treat obstructive sleep apnea in adults along with UPPP is base of tongue reduction. Read about this operation here as well as watch the video here.

Watch the video here.

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