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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The Doctors TV Show Does the Mouth

The Doctors TV actually got something totally right!

Actually there are two segments here... One on the mouth followed by another on what happens when food/liquids go down the wrong way causing a reflexive cough.

Enjoy!

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Baby Shampoo Used to Treat Chronic Sinusitis

Yes... It's absolutely true! There's even research on this (limited).

The mixture ratio is 1/2 teaspoon of Johnsons No-Tears Baby Shampoo in 8 ounces of saltwater rinsed into the nose using a sinus rinse bottle can help with chronic sinusitis, especially when there's a lot of crusting present and to which all other therapies have failed to resolve.

The shampoo appears to work via several mechanisms theoretically:

1) It is directly toxic to germs
2) The soap action helps break apart crusting (similarly to the way detergent gets rid of mud from a kid's shirt in the washer)
3) The soap also helps break down and remove biofilms in the sinus cavities which tends to resist antibiotics and cause recurrent sinus infections (just like dishwasher fluid gets filmy food residue off plates)

For saline flushes, the NeilMed Sinus Rinse bottle is recommended for two reasons.

The black cap of the bottle is about 1 teaspoon... and the bottle itself is 8 ounces.

So, for the particularly difficult chronic sinusitis infection patient who has tons of crusting for which all other treatments have failed, the saltwater is made up as per routine using the NeilMed Sinus Rinse bottle, but than to also add 1/2 capful of the Johnson's No-Tears Baby Shampoo as well before use.

They are to flush their nose twice a day for a few weeks.

Reference:
Baby shampoo nasal irrigations for the symptomatic post-functional endoscopic sinus surgery patient. Am J Rhinol. 2008 Jan-Feb;22(1):34-7.

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Miscarriage During Pregnancy Is Murder Committed by the Mother (According to One Lawmaker)

I know... I know... I'm an ENT, so why am I doing a post on miscarriages? Well, I could not help myself given how outlandish this is... And I did put a picture of a pregnant woman who is smoking and smoking is an ENT problem!

In any case...

So most people in the United States would not bat an eye regarding how abortion can potentially be considered murder.

Most people also would agree with the idea of involuntary manslaughter if a person died due to acts of recklessness or criminal negligence committed by another individual.

Which now goes to the title of this post...

If miscarriage can be shown to be due to "recklessness" or "criminal negligence" of the mother committed against her unborn fetus, is that involuntary manslaughter? For example, if the mom decides to get up to go to the bathroom when told to be on bedrest and a miscarriage occurs, is that manslaughter?

Or what if an uninsured pregnant woman forgoes appropriate prenatal care or is caught smoking during pregnancy (reckless behavior) and miscarries, is that manslaughter?

Such actions can even potentially be considered voluntary manslaughter if it can be proven the mother deliberately committed acts that she knew may potentially by harmful to the fetus. Even if no harm ultimately came to the fetus, it could potentially be considered attempted "assault" and "battery" with the appropriate criminal charges dependent on the degree.

Well, Georgia State Rep. Bobby Franklin, a Republican from Marietta, Georgia, has introduced a 10-page bill (HB 1) earlier this year, that would criminalize miscarriages, making abortion and miscarriage ("prenatal murder" in the language of the bill) potentially punishable by death.

In essence, according to this bill, women who miscarry could become felons if they cannot prove that there was "no human involvement whatsoever in the causation" of their miscarriage. The burden of proof is on the mother.

Furthermore, the bill holds women responsible for protecting their fetuses from "the moment of conception" even though I do believe pregnancy tests aren't accurate until at least 3 weeks after conception.

Now, I'm not an obstetrician, but I do believe most miscarriages occur because the fetus is not developing normally from inherent factors and not external acts.

I'm not exactly sure how the State of Georgia will enforce this legislation if it passes (which I hope won't happen).

The USA is in the midst of spiraling healthcare costs due to defensive medicine being practice by doctors to prevent lawsuits against them. Now think about what would happen if this legislation passes...

Read news article about this here.

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Do Cell Phones Pose a Health Hazard? Do Cell Phone Companies Know About Them?

With all the recent news about increased glucose metabolism in the area of the brain in proximity to cell phone antennas (study abstract here), I thought it worth re-printing this blog article I wrote back in November 2010 regarding the possibility that cell phone makers may know more about health risks associated with cell phone use than they may be letting on. There's another blog article I wrote regarding what studies ARE already out there regarding risk of developing brain tumors that I felt worth re-printing below as well.

It is true that some people may find this recent research good news for some young people as it may be the only stimulation their brain gets (joking!), but it does bring some additional concerns that may merit limiting cell phone use as well as how it is used.

I quote (myself)...

Recently, there has been much speculation on whether cell phones pose a health risk.

What I find interesting is that the cell phone makers may actually know more about these risks than they are letting on or even have evidence for them.

If you look in the small print booklet that comes with your cell phone, cell phone makers state that phones should not be in contact with your body or skin and should be kept a certain distance away when in use or when carrying around. The picture of how the Verizon ad guy is using the cell phone is exactly how you are NOT supposed to use the cell phone (cell phone pressed against the face).

For example, in the iPhone 4 small print booklet that comes in the box with the phone, go to page 5 under the section "Exposure to Radio Frequency Energy." I quote:

"When using iPhone near your body for voice calls or for wireless data transmission over a cellular network, keep iPhone at least 15 mm (5/8 inch) away from the body, and only use carrying cases, belt clips, or holders that do not have metal parts and that maintain at least 15 mm (5/8 inch) separation between iPhone and the body."

Now, when I use a phone and answer a call, I have the phone right up against my ear just like the Verizon ad guy. I do not keep it 5/8 inch away from my ear/head.

Now why would a cell phone maker care whether the phone is right up against the ear (so you can hear better) or not unless there is some concern that there may be a danger due to proximity/contact?

Perhaps they are protecting themselves from any possible lawsuit that may occur in the future due to health problems that will occur with phone use over time?

Kind of reminds me of the tobacco industry who for years denied that smoking posed any health risk. Now we know better.

It would be ironic if Paul Marcarelli, the actor of the "Verizon Guy" character, develops a brain tumor due to cell phone use and sues the wireless industry just like the family of David McLean, the actor of the "Malboro Man," sued the tobacco industry for wrongful death when he developed and died from lung cancer caused by smoking.

Something to think about...

So are there studies out there suggesting that cell phones and wireless phones can lead to brain tumors like astrocytoma, malignant gliomas, and benign acoustic neuromas? Several studies published since 2009 containing long-term (10+ years) follow-up have lent support that it does.

The group at greatest risk for development of brain tumors have the following characteristics:

1) Use of cell/wireless phone younger than age 20 (the younger the age with first use, the worse the risk)
2) Use of cell/wireless phone for more than 10 years
3) The more hours of cellular phone use over time, the higher the risk of developing brain tumors
4) Risk higher with analog cell/wireless phones (instead of digital)
5) Risk higher with increased overall total exposure

By some estimates, subjects who used cell phones for at least 10 years had a 2.4-fold greater risk of developing a brain tumor.

Though unclear how exposure to a phone's microwave radiation leads to brain tumors, it is known that the cell signal is absorbed up to 2 inches into the adult skull. Even more worrisome is that the depth of penetration is even deeper in children.

The risk is not just to the brain, but even the parotid gland which sits just in front of the ear. In one study published in 2008 revealed an increased risk of parotid gland tumors with cell phone use. Also, contact allergy is another not uncommon risk with cell phone use.

Symptoms that a patient may exhibit that may suggest a brain tumor are subtle and include hearing loss or ringing of the ear on the same side the phone is used on.

It should be noted that all currently published results are based on retrospective studies and ideally, prospective studies will be required to provide more definitive results. However, that will take a long time and perseverance on both the researchers as well as the subjects since ideally, many of the study subjects should be children who are currently using cell phones (which it seems to be nearly all kids nowadays).

In any case, to be on the safe side, it is recommended to talk on speakerphone or use a wired headset (not wireless), or avoid altogether if at all possible, especially in children.

References:
Effects of cell phone radiofrequency signal exposure on brain glucose metabolism. JAMA. 2011 Feb 23;305(8):808-13.

Risk of Brain Tumors From Wireless Phone Use. Journal of Computer Assisted Tomography, 2010; 34 (6): 799 DOI: 10.1097/RCT.0b013e3181ed9b54

Cell phones and brain tumors: a review including the long-term epidemiologic data. Surg Neurol. 2009 Sep;72(3):205-14; discussion 214-5. Epub 2009 Mar 27.

Mobile phones, cordless phones and the risk for brain tumours. Int J Oncol. 2009 Jul;35(1):5-17.

Cell phone use and acoustic neuroma: the need for standardized questionnaires and access to industry data. Surg Neurol. 2009 Sep;72(3):216-22; discussion 222. Epub 2009 Mar 27.

Cellular phone use and risk of benign and malignant parotid gland tumors--a nationwide case-control study. Am J Epidemiol. 2008 Feb 15;167(4):457-67. Epub 2007 Dec 6.

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Diagnosing Smell and Taste Disorders

This article is reprinted with kind permission from Dr. Robert Henkin of the Smell and Taste Clinic located in Washington DC.

Answers to the Four Questions Required to Determine Cause of Smell and Taste Disorders: 

Question 1. DETECTION THRESHOLD – Can you detect the least concentrated stimulus from among three presented stimuli – two of which are either water (tastants) or neutral (odorants) and one of which is different?

This answer tells us of the presence and character of functioning taste and/or smell receptors. If this threshold number is higher (less sensitive) than normal then the patient requires more tastant or odorant than normal to stimulate taste and/or smell receptors. If the number is higher than normal then the patient has lost sensory receptor function due to some pathology.

Question 2. RECOGNITION THRESHOLD – Can you recognize correctly the different stimulus you just detected?

This answer tells us of the interaction between taste and/or smell receptors and the brain which processes this information. If the threshold number is higher (less sensitive) than normal then the patient requires more tastant or odorant than normal both to stimulate receptors and for the brain to process the sensory information correctly. This means that the patient has either lost sensory receptor sensitivity and/or has brain impairment which inhibits processing of the sensory stimulus due to some pathology.

Question 3. MAGNITUDE ESTIMATION – Can you judge the intensity of the correct recognition you just made using a scale from 0-100?

This answer tells us of the number of functioning taste and/or smell receptors. Taste and smell receptor activation involves a “field effect”; the larger the field, the more functioning receptors, the higher the magnitude estimation number. Thus, if the magnitude estimation number is lower than normal then the receptor number (taste and/or smell) is diminished and indicates pathology of the sensory system related to decreased receptor number.

Question 4. HEDONIC ESTIMATION – Can you judge the unpleasantness on a scale of -100 – 0, or pleasantness on a scale from 0 – +100, of the stimulus you just correctly recognized?

This answer tells us of the interaction between sensory receptor and the brain with respect to intensity of distortions of the sensory stimulus. This test uses a scale from 0 - −100 to indicate unpleasantness and a scale from 0 - +100 to indicate pleasantness. If a sweet tastant stimulus is considered unpleasant (e.g., -50% at a moderate concentration of sucrose, 300mM) then this response indicates a sensory distortion and thereby pathology of the taste system. Similarly, if the fruity odorant stimulus of amyl acetate is considered unpleasant (e.g., -50% at a moderate concentration of 10-1M) then the response indicates a sensory distortion and thereby pathology of the smell system.


By use of answers to these four questions it is possible to determine the nature and character of the pathology affecting taste and smell dysfunction. Answers to each of these questions are essential to determine this pathology.

These tests are used at The Taste and Smell Clinic in Washington, DC to determine the nature and character of sensory abnormalities of patients with taste and smell dysfunction. Only by use of this entire test battery can the nature and character of sensory dysfunction be determined. Simpler tests cannot fulfill this requirement.

Dr. Robert Henken
The Taste and Smell Clinic
Phone: (202) 364-4180

Reference:
An open label controlled trial of theophylline for treatment of patients with hyposmia. American Journal of the Medical Sciences. Vol. 337, pp. 396-406, 2009.

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New Video of Phlegmy Throat

In this video, the patient suffered from a severe phlegmy throat after suffering from a stroke. His secretions did not pass down to his stomach, but rather collected in his throat causing constant throat-clearing and coughing up clear phlegm.

As you can see in the video, there is a tremendous amount of mucus pooling present.

Treatment was geared toward improving his swallowing function so that his secretions would not collect in his throat.

If you are not sure what normal is supposed to look like, click here.

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