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Ear, Nose & Throat Associates |
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 | July 2006 Articles:
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July 2006 News Archives
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July 11: Slime-Like Substance Blamed for Chronic Ear Infections, HealthDay News
TUESDAY, July 11 (HealthDay News) -- If your young child has an ear infection that won't go away, he may be struggling with a slime-like substance in the middle ear that experts call bacterial "biofilm."
This biofilm makes it harder for antibiotics to do their jobs, leading to long-lasting ailments. Bacteria appear to be hiding in this usually protective slimy film in kids with chronic middle ear infections, a new study found.
The discovery isn't going to lead to any new treatments right away, but they may eventually help doctors get a better handle on one of the plagues of childhood. Ear infections, in fact, are the most common illnesses that bring children to doctors.
"It's a particularly big disadvantage to working moms," said study co-author Dr. J. Christopher Post, director of pediatric otolaryngology at Allegheny General Hospital, in Pittsburgh. "It really compromises a woman's ability to participate in the workforce."
Ear infections are so common in kids -- affecting eight or nine of every 10 children -- because the developing middle ear sometimes cannot fully drain fluid, said Dr. Craig Derkay, a professor of otolaryngology and pediatrics at Eastern Virginia Medical School, in Norfolk. Also, the immune system in a child isn't fully developed and can't tackle infections, he added.
Over-prescribing of antibiotics, meanwhile, has made matters worse by helping ear-infection germs develop immunity to existing drugs, he said.
Post and his colleagues in Pittsburgh and Wisconsin studied mucosal tissue from the middle ears of 50 children with chronic ear infections. Some of the children got ear infections repeatedly, while others continually suffered from fluid in their ears.
All the children were scheduled to undergo operations to install drainage tubes in their ears.
The researchers found evidence of mucosal biofilms in 46 of the 50 children. They didn't find any biofilms in another group of eight healthy children and adults whose ears were studied as they underwent cochlear implant operations for hearing loss.
The findings are published in the July 12 issue of the Journal of the American Medical Association.
Biofilms are very common in nature, Post said, such as the slime you might find on rocks next to a pond. "It's like a little city of bacteria," he said, in which germs communicate with each other and are well-protected against the outside world.
The new research suggests that treating chronic ear infections with antibiotics is "not helpful," Post said, adding that "biofilms by their nature are very resistant to antibiotics."
Instead, researchers must find another approach that either gets rid of biofilms or stunts their growth, perhaps by flooding the ear with "good bacteria," Post said. That approach is known as probiotics.
For now, the research is "just sort of an explanation as to why not all children are responding to these antibiotics" and need to have drainage tubes put in, said Derkay.
More information
Learn more about ear infections from the U.S. National Institute on Deafness and other Communication Disorders.
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July 11: Two Distinct Types of Vocal Cord Dysfunction Identified, Newswise
Two distinct phenotypes of vocal cord dysfunction (VCD) - an involuntary functional disorder during inspiration often misdiagnosed as asthma - were identified in a long-term study published in the current issue of Annals of Allergy, Asthma & Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI).
Investigators at the Pediatric Allergy and Pulmonary Division at the University of Iowa College of Medicine in Iowa City, Iowa, conducted a retrospective medical record review of 49 patients seen in the clinic who were diagnosed as having VCD. During the 13-year period, they observed two distinct clinical phenotypes: one group had VCD triggered only by exercise and the second group had spontaneous onset of symptoms not caused by exercise.
Devang R. Doshi, M.D., and Miles M. Weinberger, M.D., observed that speech therapy, the currently accepted preferred intervention, was recommended for all patients in the spontaneous VCD group. For patients with exercised-induced symptoms, seven were prescribed a metered-dose inhaler containing a short-acting anticholinergic agent, and the remainder received no treatment.
Authors noted that the diagnosis of VCD was based on "direct laryngoscopy, reversible inspiratory airflow obstruction with spirometry during observed symptoms, or a convincing history of episodic inspiratory stridor that was rapid in onset and rapidly reversible in the absence of any other findings."
The symptoms of VCD can be mistaken for asthma because both can include labored breathing, an inspiratory noise often described as wheezing, chest tightening and shortness of breath. In VCD the symptoms are a result of an abnormal closing of the vocal cords rather than inflammation of the airways, as in asthma.
Of the 49 patients in the original study population, 41 had previously been diagnosed as having asthma as a cause of their symptoms before the diagnosis of VCD was established. Asthma was confirmed as a comorbidity in 12 of those patients.
The study also demonstrated that once diagnosed the long-term outcome of VCD is quite good. From the results of a structured telephone interview in 28 of the children and adolescents, the authors reported a complete absence of symptoms in 26 of the 28 contacted patients, at times ranging from one week to five years after the diagnosis.
"The positive outcomes data underscore that VCD appears to be a self-limited disorder once the diagnosis is made," wrote guest editorial author Michael O'Connell, M.D., of the University of Colorado Health Sciences Center in Aurora, Co. "This should energize us to encourage our colleagues in allergy-immunology and primary care to learn the characteristic presentations of this disorder so that the diagnosis can be made without delay."
Patient information on allergic diseases including asthma is available by calling the ACAAI toll free number at (800) 842-7777 or visiting its Web site at www.acaai.org.
The American College of Allergy, Asthma and Immunology (ACAAI) is a professional medical organization headquartered in Arlington Heights, Ill., that promotes excellence in the practice of the subspecialty of allergy and immunology. The College, comprising more than 5,000 allergists-immunologists and related health care professionals, fosters a culture of collaboration and congeniality in which its members work together and with others toward the common goals of patient care, education, advocacy and research.
Citations:
DR Doshi, MM Weinberger. Long-term outcome of vocal cord dysfunction. Ann Allergy Asthma Immunol 2006;96:794-799.
M Connell. Guest Editorial: Vocal cord dysfunction: ready for prime-time? Ann Allergy Asthma Immunol 2006;96:762-763.
Annals of Allergy, Asthma & Immunology is online at http://www.annallergy.org.
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July 12: Ban on smoking in cars with children present was needed, The Daily Advertiser
The evidence of harm done to children by secondhand smoke is strong enough to fully justify the passage of House Bill 1010 in the recent session of the legislature.
The bill, which Gov. Kathleen Blanco has now signed into law, bans smoking in cars or trucks with children present.
Starting Saturday, police will issue tickets to people smoking in a vehicle carrying kids aged 12 and under. Violators will face fines up to $150 or a minimum of 24 hours of community service.
The threats to children from environmental tobacco smoke (ETS) are numerous, according to organizations such as the American Lung Association, and lesser-known health organizations such as the American Academy of Otolaryngology.
The academy notes in one of its publications that at least 43 chemicals found in secondhand smoke are known to cause cancer.
While ETS is dangerous to all people, the organization says, it is particularly dangerous to children because it can damage developing organs.
The American Lung Association says exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It has the potential for increasing both the frequency and severity of childhood asthma attacks.
Ordinarily, discussions of secondhand smoke center on the potential for causing cancer. It can have numerous other consequences for children, such as aggravating sinusitis, rhinitis and cystic fibrosis.
Chronic respiratory problems such as cough and postnasal drip also can help increase the number of children's colds and sore throats.
In children under 2 years, the American Lung Association says, ETS exposure increases the likelihood of bronchitis and pneumonia.
A 1992 study by the Environmental Protection Agency says ETS causes 150,000 to 300,000 lower respiratory tract infections each year in infants and children under 18 months of age. These illnesses result in as many as 15,000 hospitalizations.
The effect of ETS on the ears of children probably comes as a surprise to many people.
According to several leading health organizations, exposure to ETS increases the number of ear infections a child will experience and the duration of the illness.
These are some of the threats to children listed in publications of such health organizations as the American Cancer Society, the Environmental Protection Agency, the National Safety Council, the American Lung Association, the American Academy of Otolaryngology and others.
Each threat is a strong justification for the passage of House Bill 1010. We commend the state government for adding a measure of protection for Louisiana's children.
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July 14: Earlier Is Better for Cochlear Implants, HealthDay News
The earlier deaf infants or toddlers receive a cochlear implant, the better their speech by the time they're three and a half years old, a U.S. study finds.
A cochlear implant senses sound and sends electrical signals to an internal component that stimulates the hearing nerves in the inner ear.
Researchers from the Washington University School of Medicine in St. Louis and from the Southwestern Medical School at the University of Texas in Dallas tested the spoken language skills of 76 children, all 42 months old, who had cochlear implants.
The results of the spoken language tests were compared to the length of time each child had had his or her cochlear implant. The study found an association between longer implant time and richer vocabulary, longer, more complex sentences, and more frequent use of irregular words.
The findings were published in the June issue of Ear and Hearing.
"Kids with residual hearing can get some help from hearing aids, but cochlear implants give a tremendous hearing advantage over hearing aids -- the implants provide more sound information," study co-author Johanna Grant Nicholas, a research associate professor of otolaryngology at the university's School of Medicine, said in a prepared statement.
"For example, high-frequency sounds are magnified more with cochlear implants, so kids can hear 's' sounds and 'ed' endings better. So, they tend to catch on to plurals and verb tenses faster," Nicholas said.
In this study, many of the children who received cochlear implants at the youngest ages had nearly the same spoken language skills as children with normal hearing, she noted.
More information
The U.S. National Institute on Deafness and Other Communication Disorders has more about cochlear implants.
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July 17: New test for Esophageal Reflux, Consumer Health Daily
A new test for esophageal reflux disease developed by a Wake Forest University Health Science in Winston-Salem, N.C., might be used in a doctor's office.
The test detects the presence of human pepsin 3b in a patient's saliva. It was developed by Dr. Jamie Koufman, then professor of otolaryngology at Wake Forest University School of Medicine and director of the Center for Voice Disorders. She is now director of the Voice Institute of New York.
"Most people associate heartburn with excess stomach acid, but it is the digestive enzyme pepsin (and not acid) bathing the lower area of the esophagus that causes the damage," said Koufman. "For patients with severe esophagitis, the tissue in the esophagus is literally being self-digested."
Besides helping to diagnose gastroesophageal reflux disease, or GERD, detecting pepsin in saliva should also help diagnose laryngopharyngeal reflux disease, the backflow of stomach contents into the throat, according to Koufman.
"Laryngopharyngeal reflux disease is even more difficult to diagnose than GERD. Scientific evidence points to aerosolized pepsin being drawn into the respiratory system as a common culprit of chronic cough, asthma and even sinusitis."
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July 18: A Pain in the Ear, The Washington Post
As many parents are painfully aware, ear infections are the most common reason for kids' doctor visits, antibiotics prescriptions and surgery. For kids with chronic middle-ear infections, antibiotics often don't work. Now experts know why. A long-lasting slimy bacterial barrier called a biofilm is the cause of many such infections, confirmed a study in last week's Journal of the American Medical Association; biofilms are 1,000 times more resistant to antibiotics than free-floating bacteria.
Slime Attack Researchers from the Children's Hospital of Wisconsin in Milwaukee examined biopsies of ear tissue from 50 children getting tubes inserted for chronic ear infections and eight children getting cochlear ear implants. The researchers found biofilms in 92 percent of the children with chronic ear infections but none in the children getting cochlear implants. Lead investigator Garth Ehrlich, executive director of the Center for Genomic Sciences at Allegheny General Hospital in Pittsburgh, said the study proves that recurrent ear infections are often not the result of reinfection, as doctors previously thought.
Hold the Meds Richard Rosenfeld, director of pediatric otolaryngology at Long Island Hospital in Brooklyn and an expert on ear infections, said antibiotics will cure children who have occasional ear infections -- especially those that are accompanied by a fever and a bulging eardrum. But those who have six to 12 ear infections by age 1 or 2 most likely have biofilms that antibiotics won't kill and that can live in a child's inner ear for years. Routine antibiotics also won't help kids who have persistent fluid in their ears.
"What this study supports is that if you've got a child who has got bad ear problems, frequent, more aggressive, stronger antibiotics are not the answer," Rosenfeld said. For persistent infections and fluid in the ear, doctors advise getting tubes surgically placed in children's ears; left untreated, chronic infections can lead to hearing loss and speech problems.
-- Elizabeth Agnvall
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July 24: Tonsillectomy improves children's behavior, WABC New York
It may seem unlikely, but surgery to remove a child's tonsils may actually help kids with behavioral problems. A recent study shows children who have their tonsils out are significantly more likely to improve in both behavioral and sleep problems than children who do not have the surgery.
Seven's On Call with Dr. Jay Adlersberg
While the University of Michigan Health System researchers say their findings do not yet suggest tonsillectomy as a cure for ADHD, they note there is a growing body of evidence indicating children with inattention, hyperactivity, or daytime sleepiness may benefit from a tonsillectomy.
Previously, the procedure was performed on more than a million children a year, now, however, it is performed on a few hundred thousand a year. The surgery is usually done to remove enlarged tonsils and adenoids that block the flow of air, making it difficult to breathe. The procedure is also commonly performed in children who suffer from repeated ear and throat infections. Nearly all children who undergo the surgery also suffer from symptoms of sleep apnea.
Among the children in the study, 22 were diagnosed ADHD at the start of the study. Eleven of those children no longer met the criteria for diagnosis one year after having the tonsillectomy. This, say researchers, suggests there is a connection between sleep and breathing problems and ADHD.
Researchers believe interruptions in sleep, such as those caused by obstructive sleep apnea, cause the brain to wake up, often without the person being aware of it. These interruptions in sleep are believed to affect behavior during the day.
Based on their findings, researchers suggest parents of a child who snores or has other nighttime breathing problems have their child evaluated for sleep problems and perhaps consider a tonsillectomy. They urge parents of children with behavioral problems to heed this advice.
Future studies are expected to look at brain activity and sleep problems.
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July 25: Nasal rinsing technique eases sinusitis, Reuters Health
Nasal irrigation, a traditional therapy that has been shown to help people with chronic sinus problems, can be easily learned with a 30-minute group training session, a new study shows.
Patients in the study also reported a sense of "empowerment" because they could use and adjust the technique effectively on their own rather than requiring multiple doctor visits and prescriptions, Dr. David Rabago of the University of Wisconsin at Madison and colleagues report.
Used for thousands of years in the Ayurvedic and Yogic traditions, nasal irrigation involves rinsing the nasal cavity with a saline solution to get rid of mucus that may contain allergens or infectious agents.
Rabago and colleagues had previously reported that a six-month trial of nasal irrigation in patients with chronic stuffy nose (rhinitis) and sinusitis reduced symptoms and medication use and improved quality of life. In the current study, Rabago and his team surveyed 28 patients who participated in the study about their experience.
The patients found that barriers to learning the technique included fear of having liquid in the nasal cavity, initial discomfort and mild side effects, the need to learn how to perform nasal irrigation effectively, and the need to set aside time for nasal irrigation, Rabago and his team report in the Annals of Family Medicine.
However, participants said that the 30-minute group sessions in which they learned to perform the technique -- especially "coached practice" -- helped them to overcome these misgivings.
They also reported incorporating nasal irrigation into their existing daily hygiene routine, using warm water, and making adjustments to the salt content and schedule to ease discomfort.
"This ability to manage their own treatment likely contributed to the reported sense of empowerment and personal control of their chronic symptoms, further enabling continued use," Rabago and his colleagues write.
They also comment that they were surprised by the "passion and drama" of many of the patients' reports of how using the technique eased their symptoms and improved their quality of life.
SOURCE: Annals of Family Medicine, July/August 2006.
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July 26: Smoke adds surgery risks for children, study says, Detroit Free Press
Children who live with smokers have been found to be at risk for a variety of health problems in even the best of circumstances. Now a new study finds that if the children happen to need surgery, they may be at even greater risk.
Researchers from Harvard University report that children exposed to secondhand smoke experienced more breathing problems under general anesthesia. The study, which is in the current journal Otolaryngology -- Head and Neck Surgery, was conducted by Dr. Dwight Jones of Children's Hospital Boston and Dr. Neil Bhattacharyya of Brigham and Women's Hospital in Boston.
The study looked at more than 400 children being operated on. Before the surgery, the patients' families were given general health surveys, which included questions about smoke exposure. About 40% of the children had been exposed to secondhand smoke, and they were much more likely to experience problems such as airway constrictions, the study found.
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July 27: New Treatment Offers Hope For Head And Neck Cancer, (WJZ) Baltimore, MD
Two experimental vaccines could someday extend life and improve the quality of it for people with head and neck cancer.
Head and neck cancers include those of the throat, mouth, voice box, sinuses and skin. They can be hard to treat and have a high risk of recurrence.
Healthwatch Reporter Kellye Lynn spoke to patients who suffer from the disease, and to the University of Maryland doctors testing the vaccines that could help them live longer.
This year about 40,000 people in the United States will learn they have head and neck cancer.
Lisa Harrigan got the diagnosis in 1999. Now, the cancer that started in her throat has spread to other parts of her body.
"This is my last chance because I've had everything. There's not much more you can do," Harrigan told Healthwatch Reporter Kellye Lynn.
A scan of Lisa's brain shows a mass which doctors say cannot be treated by existing therapies.
Her only hope is an experimental therapy being tested at the University of Maryland Medical Center. The vaccine, which is in its first phase of testing, is designed to stimulate the body's immune response against cancer.
It works by targeting the proteins linked to Squamos Cell Carcinoma, the most common form of oral cancer.
"It's a way to try to turn on the immune response so it recognizes the tumor but not the tissues around the tumor," said Doctor Scot Strome, who is testing the vaccines.
Patients receive four shots at monthly intervals. And Lisa says she felt better after the first infection. "I'm still here and I'm still alive and I thank God for that," she said.
People who smoke are six times more likely to develop head and neck cancer. Alcohol intake and sun exposure also increase risk.
Researchers are still recruiting patients for the study. For more information on how you can participate in the study call 1-800-492-5538, 410-328-2473
Kellye Lynn
Reporting
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