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September 15, 2017

Why do Old Men Have Big Ears?

Or, the better question is how fast does the ear grow as we age. Apparently this research topic was published in 1995 in the British Medical Journal.

The British researcher measured the ear length of 200 patients and discovered that not only do old men really did have big ears but also that ears grow about 2mm per decade after age 30.

This research won the 2017 Ig Prize for Anatomy.

Why do old men have big ears? BMJ. 1995 Dec 23-30;311(7021):1668.

September 12, 2017

Mediterranean Diet Works as Well as Medications in Reflux Treatment

Image courtesy of KEKO64

New York researchers have discovered that a modified Mediterranean diet worked as well as PPI medications in resolving LPR symptoms (laryngopharyngeal reflux) which include globus, chronic cough, phlegmy throat, constant throat-clearing, etc. The comparison study group that used PPI medications utilized esomeprazole (Nexium) twice daily or dexlansoprazole (Dexilant) daily.

In fact, the modified Mediterranean diet group had more patients feeling better (62.6%) than the medication group (54.1%). The symptoms also decreased more dramatically in the modified Mediterranean diet group (39.8%) than the medication group (27.2%).

Improvement typically occurred within 6 weeks.

Given there is a trend to avoid reflux medications due to side effects from long-term use, lifestyle changes are an integral part of any treatment regimen. This research provides welcome news for those wanting to avoid such medications.

So what is this modified Mediterranean diet for LPR symptom control? It is a diet rich in:

• fruits
• vegetables (tomatoes OK!)
• whole grains and nuts
• drink only alkaline water (pH more than 8)

BUT also to...

• near complete avoidance of dairy products (yogurt, ice cream, cheese, pudding, etc)
• near complete avoidance of meats including beef, chicken, fish, eggs and pork.
• avoid ALL caffeine (coffee, tea, chocolate)
• avoid ALL sodas
• avoid ALL greasy and fried food, spicy foods, fatty foods
• avoid ALL alcohol

Essentially, you need to become an alkaline water drinking vegetarian who cheats a little.
Keep in mind that although this diet appears to help with LPR symptoms significantly, it is unclear whether the improvement is specific to certain sub-groups (acid vs non-acid LPR vs both???). It is entirely possible that certain patient sub-groups may not benefit from this diet. More research is needed.

For those curious, the reason for the alkaline water beyond acid neutralization is that it inactivates pepsin, a stomach enzyme, which is thought to play a key role in ongoing mucosal damage independent of acid levels.  [more info]

A Comparison of Alkaline Water and Mediterranean Diet vs Proton Pump Inhibition for Treatment of Laryngopharyngeal Reflux. JAMA Otolaryngol Head Neck Surg. Published online September 7, 2017. doi:10.1001/jamaoto.2017.1454

August 17, 2017

Vitamin D Deficiency Associated with BPPV Occurrence and Recurrence

There is increasing evidence that Vitamin D deficiency may be a risk factor for BPPV as well as its recurrences. BPPV is a condition whereby a person may suffer from brief but severe vertiginous attacks with head position changes that occur due to displaced otoliths (calcium crystals) within the inner ear.

Although easy to treat with precisely defined head position maneuvers (, i.e. Epley maneuver for posterior canal BPPV), its occurrence let alone recurrence can be alarming for patients. Although viral infections as well as head trauma are known risk factors for BPPV, these afflictions are not something a patient has any voluntary control over. However, vitamin D deficiency has also emerged as another potential risk factor for BPPV and IS something that a patient may have some control over.

Only in the past few years, increasing number of research has been published showing that:

• Osteoporosis is associated with increased risk of BPPV. [link]
• There appears to be an association between BPPV and decreased serum vitamin D. [link]
• During months when Vitamin D levels are historically low (May), BPPV occurs/recurs more frequently whereas during months where Vitamin D levels are historically high (Sept), BPPV occurs/recurs less frequently. [link]
• Improvement of serum 25-hydroxyvitamin D3 levels with vitamin D supplementation is associated with substantial decrease in BPPV recurrences. [link]

The theory that explains Vitamin D's relationship to BPPV goes something like this... The matrix found within bone and otoconia are similar. Calcium is the main component of otoconia and Vitamin D is required for calcium regulation. Therefore, a correlation between Vitamin D and BPPV is theoretically possible by its effect on calcium.

SO... at least for an individual who has suffered from BPPV with osteoporosis and certainly for those who suffer from BPPV recurrences, it may be worthwhile to take Vitamin D supplementation especially if serum levels are low.

Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia. Ann Otol Rhinol Laryngol. 2003 Oct;112(10):885-9.

Osteoporosis as a risk factor for the recurrence of benign paroxysmal positional vertigo. Laryngoscope. 2013 Nov;123(11):2813-6. doi: 10.1002/lary.24099. Epub 2013 Apr 8.

Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013 Mar;260(3):832-8. doi: 10.1007/s00415-012-6712-2. Epub 2012 Oct 25.

Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016 Jun;43(3):237-41. doi: 10.1016/j.anl.2015.08.009. Epub 2015 Sep 16.

The Seasonal Variation of Benign Paroxysmal Positional Vertigo. Otol Neurotol. 2017 Aug 8. doi: 10.1097/MAO.0000000000001534. [Epub ahead of print]

August 11, 2017

Solar Eclipse 2017 in Virginia

Solar Eclipse on Aug 21, 2017
as would be seen in Virginia
To preface, this blog post has nothing to do with ENT... but given a total solar eclipse is such a rare event that will occur on August 21, 2017, I thought to post today... 10 days prior to the event to ensure as many people can enjoy viewing this spectacular astronomical event

FIRST, at least in Virginia, it will NOT be a total solar eclipse (which can only be seen in certain parts of the United States). It will be an 86% solar eclipse and will occur at 2:41PM. On the East Coast, a total solar eclipse will occur in South Carolina.

The maps below outlines the timetable throughout the United States and where a TOTAL solar eclipse can be seen.

After knowing the time for your location (click here to figure out the exact time for your location)...

NEXT, in order to fully appreciate the eclipse, you need to purchase specially filtered glasses so you don't damage your eyes when you look at it. Buy one now because they are already beginning to get sold out in many locations including Amazon... 3rd party sellers in Amazon still carry, but probably for not much longer.

Click HERE to find solar eclipse glasses for purchase!

August 08, 2017

Video Showing How Allergy Vials are Made for Allergy Shots

Our office has created a new video showing how allergy vials are made for patients undergoing allergy shots. Check it out!

There are essentially 3 steps:

Step 1:

Create graded dilutions of all allergic items (i.e., cats, dogs, trees, grasses, ragweed, etc). This is called the allergy board.

Step 2:

Based on allergy test results, the actual serum used to inject into patients is made. The more severe the allergy, the more dilute the initial concentration used. The more mild the allergy, the more concentrated the initial solution used.

Step 3:

Weekly allergy shot injections are performed. Over time, more and more concentrated serum is created for allergy injections (period known as buildup) until the maximum concentration of all the different allergies is used to create the serum. At this point, known as maintenance, allergy shots may continue for years until the patient becomes tolerant. Once tolerance is achieved, the patient is symptom free and is no longer considered allergic. Furthermore, the patient will no longer require any allergy medications.

August 05, 2017

Advanced Balance Exercises for Dizziness

There are basic balance exercises for dizzy patients who suffer from vestibular dysfunction which are safe even for a 90 years old... and than there are advanced balance exercises that will challenge even the healthiest 20 years old.

Here are some of the advanced balance exercises ballerinas and gymnasts perform in order to achieve a supernormal sense of balance that allow them to maintain perfect balance even under the most challenging of balancing situations.

The main point is that in order to resolve vestibular dizziness, vestibular rehabilitation through physical therapy is highly effective, but requires time and repetition that challenge and eventually strengthen the inner ear sense of balance, even if initially dysfunctional. This treatment strategy applies to the dizzy 90 years old as well as the 8 year old gymnast struggling on the balance beam.

Here's a lengthy YouTube video showing the balance exercises gymnasts perform to do well on the balance beam. Start watching from 3:40 minutes in.

Let's not forget about the ballerinas... Here are a few from Kathryn Boren, a member of the American Ballet Theater as part of the corps de ballet. These are all videos from her instagram's account. Click to play each of the videos.

A post shared by Kathryn Boren (@katieboren1) on

A post shared by Kathryn Boren (@katieboren1) on

A post shared by Kathryn Boren (@katieboren1) on

A post shared by Kathryn Boren (@katieboren1) on

A post shared by Kathryn Boren (@katieboren1) on

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