Dr Broker lectures to American Academy of Otolaryngology on Pediatric Sub-Certification

Dr Broker was asked to speak at the Board of Governors of the American Academy of Otolaryngology on the topic of sub-certification and its effect on the field of general otolaryngology. As a Board Certified Pediatric Otolaryngologist, Dr Broker has decades of experience caring for children. And yet, the American Society of Pediatric Otolaryngology (ASPO) is asking for a new certification that would change the credentials of the 10,000 or so active Pediatric Otolaryngologists like Dr Broker in the United States. ASPO would like to take the name "Pediatric Otolaryngologist" for themselves and thus eliminate the ability of general ENT doctors to use the term. But this would be inaccurate and detrimental to patient care.

What's In a Name?

The members of ASPO, who can be found at pediatric hospitals, have specialized training in very unusual pediatric ENT problems, such as congenital defects and pediatric head and neck cancer. General Otolaryngologists, like the ones found in your local community, have specialized training in common pediatric ENT problems such as chronic tonsil infections, ear disease, chronic cough, and allergy and are Board Certified Pediatric Otolaryngologists by the American Academy of Otolaryngology (AAO). Understanding the difference between the two groups is hard for pediatricians, let alone parents. So its clear that the AAO has a big public relations task cut out for itself. But limiting the use of the term "pediatric otolaryngologist" to one group would be dishonest.

The "father" of the ASPO group, Dr Charles Bluestone, defined their work as "caring for common problems in unusual children and uncommon problems in healthy children". Its a mouth-full. But its probably the best way to distinguish the ASPO doctors from the general ENT's.

In the end, there seemed to be general agreement from the Board of Governors that a more appropriate distinction would be "Pediatric Otolaryngologist for Common Problems" to refer to community ENT doctors who care for tonsils, throats, and ears. Thus the ENT doctors at pediatric hospitals would be called "Pediatric Otolaryngologists for Uncommon Problems" referring to their work with congenital defects and cancer.

On a separate but related note, the Board of Governors received Dr Broker's proposal favorably to promote the AAO's policy against "Itinerant Surgery". Itinerant surgery is the practice of surgeons going far away from their home base to operate and leaving the patients without adequate post-operative care. Sometimes this is done for disaster relief, like after the Haiti earthquake. But in those cases, every effort is made to get local doctors to agree to care for the post-operative patients and to give them training. This type of care is felt to be justified because the local doctors do not have the necessary surgical expertise.

But Itinerant Surgery has become a common practice of pediatric hospitals in the United States today as they look to make more money. They set up outpatient surgery centers far from their home base and are not available after-hours to provide emergence care locally, even for patients who have life-threatening bleeding after surgery. They make no attempt to arrange for local doctors to accept their post-operative patients in case of an emergency and simply tell the patients to "go to the local emergency room" if they have a problem. With local Board Certified Pediatric Otolaryngologists for Common Problems in abundance in these areas, the pediatric hospitals cannot argue that their surgery centers are providing care that is otherwise unavailable. And thus they are violating the AAO's policy against itinerant surgery. The policy is very clear, this practice is condemned by the AAO.

Hopefully, Dr Broker's lecture will spur an effort to stop the practice of itinerant surgery by pediatric hospitals. We'll keep you posted.

We are Board Certified Pediatric Otolaryngologists
http://www.entandallergyspecialists.com/

Cochlear implants cure deaf children

Toddler with cochlear implant performing hearing tasks.

In an earlier post I discussed how cochlear implants in deaf children can help them develop normal language and learning abilities as well as increase their IQ test scores.

New research shows that universal newborn hearing screening laws passed so far in many states (including Pennsylvania)work to catch about two-thirds of children who lose their hearing or are born deaf at a much earlier age and thus allow earlier treatment. This is important because of the critical window of language development that the brain goes through in the first 3 years of life. If this window is missed, many children never catch up to their peers.

But the research also shows that one third of cochlear implant patients passed their newborn screening tests demonstrating that these patients lost their hearing at a later time. Thus we need to adjust our screening so that it occurs periodically, probably at yearly check-up exams, to catch those with delayed onset hearing loss within the first 3 years of life.

Read the research at http://bit.ly/e3jRBp

We donated the equipment and daily services to create Pennsylvania's first universal newborn hearing screening program at Phoenixville Hospital at no charge to patients before it was the law. We have been testing newborn and children's hearing with this technology for over a decade and are experts in pediatric hearing loss.

Check out our Pediatric Ear Nose & Throat Doctors.
http://www.entandallergyspecialists.com/

Manchester United Star w Throat Cancer

Former football (soccer) star turned coach Bryan Robson has vocal cord (throat) cancer.

From the optimistic statements made by his Ear, Nose and Throat doctor it seems the cancer is at the earliest stage (stage one) which is the most curable. The British Otolaryngologist, "Mr." Mike Dikes (across the pond they call surgeons "Mr" and not "Dr"), may have been caught up in the spotlight when he exclaimed, "If God were going to give you cancer, you would choose throat cancer." - presumably because the cure rates are high (up to 98% if caught early). But the treatment has the potential for real side effects; radiation can leave the throat very dry with firm skin while surgery will leave permanent hoarseness. Still, with modern techniques these side effects are minimized.

Mr Dikes also erred when he states that throat cancer is mostly caused by smoking and drinking; not anymore. The number one cause of throat and mouth cancer has shifted to the HPV virus, probably due to decreases in tobacco use and changes in sexual practices.

Read the statement from Manchester United at http://yhoo.it/edQ3Sb.

Read more about this topic at Throat Cancer Doctor.
www.ENTandAllergySpecialists.com

Pediatric Ear, Nose & Throat doctors at ENT and Allergy Specialists

At ENT and Allergy Specialists our Board Certified Pediatric Otolaryngologists are experts in disorders that affect children including chronic ear and tonsil infections, allergy, and sleep apnea. We offer the most innovative treatments available for children including sublingual immunotherapy (at-home allergy drops under the tongue to eliminate allergies, prevent asthma, and avoid office visits for shots), computerized hearing evaluations for any age, even newborns, and minimally invasive surgical techniques such as intracapsular tonsillectomies which offer faster recovery and less pain.

At our Pediatric Surgical Facilities, our Anesthesiologists and staff are pediatric trained and certified as well offering the best possible perioperative care.

There is no longer a need to wait weeks or months to see a pediatric ENT doctor from a distant pediatric hospital who is only in town for a few hours. Come see the superior quality care you'll get from local Board Certified Pediatric Ear, Nose & Throat doctors, available 24 hours a day, at ENT and Allergy Specialists.

Our pediatric Ear, Nose & Throat doctors see patients in Phoenixville, Bryn Mawr, Pottstown, Exton/Lionville, and Roxborough/Philadelphia.

Peanut allergy gene found

Researchers have found that a gene already known to be associated with allergy and ezcema is linked to 20% of peanut allergy sufferers. The gene makes a substance called fillagren which is involved in creating an effective barrier between skin and the outside world. Its thought that a defect in the gene allows substances into the skin which sets off allergic reactions. Since only 20% of peanut allergy sufferers have this defect, it seems that there are several ways to develop a peanut allergy.

We are food allergy, peanut allergy and environmental allergy doctors. Pediatric Ear, Nose and Throat doctors, Pediatric Allergists, and adult ENT doctors and allergists all under one roof.

www.ENTandAllergySpecialists.com

Read more about peanut allergy gene at http://bit.ly/gdMVfv

Can wind turbines, infrasound make you sick?

Massachusetts governor Duval Patrick has pledged to install 2000 megawatts of wind energy in his state in an effort to increase environmentally-friendly energy production. But residents of one Cape Cod town have been bitterly complaining of negative health effects from their local wind turbine including tinnitus and sleep deprivation, dizziness and nausea.

The local residents complain that the wind turbine emits "infra-sound", or a low-frequency sound, that is not supposed to be in the human range of hearing but many claim that they can still hear. Those people feel that this sound is the source of their health problems.

The ear is the organ effected by infrasound and there are several theories how this happens. One is that some people may be able to hear infrasound, but more likely, it is felt by the balance organ in the ear, called the labyrinth. This part of the ear normally functions on lower frequencies than the hearing part of the ear, the cochlea. The low-frequencies that affect the labyrinth are not typically delivered via sound or air vibrations, but usually by motion of the head which shakes the fluid in this organ to produce low-frequency energy. That energy tells your brain how fast and which way your head is moving. As in many dizziness disorders, if the stimulis is presented to the ear in an unfamiliar way, such as with infrasound or being on a rollercoaster, the brain gets confused and can experience a whole range of discomforts from vertigo, to tinnitus, to nausea. Its this phenomena that is thought to give people the queezy feeling that a house is haunted and recently was used on purpose by the movie Paranormal Activity to give the audience a sense of uneasiness during the scary scenes (the movie makers actually delivered infrasound through the speakers).

Infrasound has been recognized as a work-place hazard in industry for many years and its mitigation is an occupational safety concern. Makers of wind turbines are aware of the problem and claim that the newer models no longer make this infrasound. Currently, there are no regulations that govern the production of infrasound by wind turbines.


References;

See the PBS video on this story at http://bit.ly/eU7s78

Responses of the ear to low frequency sounds, infrasound and wind turbines.
Salt AN, Hullar TE.
Hear Res; 2010 Sep 1 ; 268(1-2):12-21. http://bit.ly/gzvBVj

Effects of infrasound on cell proliferation in the dentate gyrus of adult rats.
Liu J, Lin T, Yan X, Jiang W, Shi M, Ye R, Rao Z, Zhao G.
Neuroreport; 2010 Jun 2 ; 21(8):585-9. http://bit.ly/hf2riu

Involvement of microglial cells in infrasonic noise-induced stress via upregulated expression of corticotrophin releasing hormone type 1 receptor.
Du F, Yin L, Shi M, Cheng H, Xu X, Liu Z, Zhang G, Wu Z, Feng G, Zhao G.
Neuroscience; 2010 May 19 ; 167(3):909-19. http://bit.ly/gWcIpT

[Occupational health in factory workers engaged into iron quartzite enrichment, prophylactic measures].
Boranova NA, Rushkevich OP, Lutsenko LA.
Med Tr Prom Ekol; 2009 ; (8):34-7. http://bit.ly/i9hXkb

Tuning and sensitivity of the human vestibular system to low-frequency vibration.
Todd NP, Rosengren SM, Colebatch JG.
Neurosci Lett; 2008 Oct 17 ; 444(1):36-41. http://bit.ly/eUZhHv

Impact of infrasound on the human cochlea.
Hensel J, Scholz G, Hurttig U, Mrowinski D, Janssen T.
Hear Res; 2007 Nov ; 233(1-2):67-76.
http://bit.ly/etBnPd

Wikipedia explanation on infrasound w many good references;
http://en.wikipedia.org/wiki/Infrasound

How wind turbines make infrasound and may effect health; http://science.howstuffworks.com/environmental/green-science/wind-turbines-health.htm


We are hearing and balance doctors and provide treatment for dizziness, tinnitus, hearing loss, and other effects of infrasound.
http://www.entandallergyspecialists.com/

Phil Collins re-thinks quitting music

Seems Phil Collin's spokes people didn't like the interview he gave claiming he was quitting music. They did note he's suffered from tinnitus and back pain as a result of playing the drums, but noted that he has no intention of quitting music.

That's not what it sounded like in his original interview.

Read the new statement from his publicist at http://bit.ly/eKN8Co

www.ENTandAllergySpecialists.com

Second-hand smoke bad for kids and fetus

A new extensive review of the medical literature, called a meta-analysis (1), shows that second-hand smoke is harmful to children before they are born as well as after.

We've known for some time that second-hand smoke increases childhood diseases like ear infections, allergy and asthma. The new study shows that it also increases the rate of birth defects and still births.

Some studies have suggested that second-hand smoke is as harmful as actually smoking (2). Every day in our practice, we see the detrimental effects of tobacco use; from allergy, lung disease and chronic sinus infection, to cancer of the head and neck, mouth, throat, and voice box. So the best advice is; stay away from smoke, period.

We offer treatment for allergy, asthma, sinusitis, and treatment for cancer of the mouth, throat, and head and neck.
www.ENTandAllergySpecialists.com

References;

1) Leonardi-Bee J, et al "Secondhand Smoke and Adverse Fetal Outcomes in Nonsmoking Pregnant Women: A Meta-analysis" Pediatrics 2011;127 http://bit.ly/g9yZS9

2) Smoking, second-hand smoke and cotinine levels in a subset of EPIC cohort.
Cancer Epidemiol Biomarkers Prev; 2011 Feb 25 . http://bit.ly/dQm0RA

FDA removes hundreds of cold/cough/allergy medicines from the market

The FDA announced that they have removed over 500 prescription cold, cough, and allergy medicines from the market because they haven't gone through the proper approval process.

But many of these medications have been around for decades and have been used without any significant reports of adverse effects. Some of those medications include; Chlorpheniramine, Entex, Rondec, Bromhist pediatric syrup, Bromfed, and Rynatan pediatric suspension.

In many cases of combination medications, the medications themselves are not in question, just whether or not the combination will work as advertised. Its still perfectly fine with the FDA for doctors to prescribe those medicines separately for the patient to use at the same time.

So do these medications really need to be pulled off the market? You decide and leave a comment to let us know what you think.

Read the list of medicines removed by the FDA at http://1.usa.gov/fXbMzV

We provide treatment for allergy, colds, cough, nasal congestion, and sinusitis.
www.ENTandAllergySpecialists.com

Phil Collins quits music, cites hearing loss

Phil Collins told a reporter that he's quitting the music biz at 60 due to a variety of ailments. Chief among them hearing loss from the all noise and back pain from playing the drums. He also said he didn't think anyone would miss him, which is just silly.

He's not alone getting hearing loss from all the noise. Researchers note a dramatic increase in hearing loss due to personal music devices like iPods.

IPods have an option under "settings" that let's you limit how loud it will get. You should set it for your kids. A good rule of thumb to prevent hearing loss from personal music players is that if someone standing next to you can hear the music while the buds are in your ears, its too loud.

But if you do lose your hearing, we carry all the different types of hearing aids to help you out!

www.ENTandAllergySpecialists.com

Read the Phil Collins story at http://bit.ly/gj0nUU

Is it safe to fly with an infant?

As a pediatric ear, nose, and throat doctor I'm often asked this question. Flying with a child older than 6 weeks old, and in good health, is usually not a problem. Its ideal to just avoid flying in newborns, but its not always possible.

The quick answer to whether or not its safe for an infant to fly is; it depends. The ultimate answer will be up to your pediatrician who should examine the baby before flying. Here's some important factors to consider;

The baby's age; the baby's doctor may discourage unnecessary air travel during the first six weeks after birth, when he would be especially vulnerable to the germs that circulate in an airplane's enclosed cabin.

The baby's ears; Cabin pressure changes during a flight causes temporary changes in middle ear pressure, which can trigger ear pain, fluid and/or an infection. To help equalize the pressure in the baby's ears, encourage him to suck on a bottle or pacifier during takeoff and landing. The sucking motion pulls on the eustachen tubes and promotes drainage of ear fluid into the throat. If the baby has an ear infection or upper respiratory tract infection, air travel may be uncomfortable. The biggest concern is that children younger than 6 weeks old are more vulnerable to meningitis from ear infections. Before travel, the pediatrician should examine the baby. In some cases, the doctor may suggest postponing the flight.

The baby's breathing; Research suggests that irregular breathing is more common in low-oxygen environments like pressurized airplane cabins. Although this temporary situation doesn't seem to pose problems for otherwise healthy babies, the pediatrician may recommend supplemental oxygen if he has an underlying respiratory condition.

The baby's safety seat; Most infant car seats are certified for air travel. Although airlines typically allow infants to ride on a caregiver's lap during flight, the American Academy of Pediatrics and the Federal Aviation Administration recommend that infants ride in properly secured safety seats. Its also good to avoid lying completely flat during take off and landing, and instead have the head slightly elevated over the stomach, to avoid reflux which can get into the ears through the eustachen tubes and cause an ear infection. If the baby is in the safety seat during these times, he won't be lying flat.

Be prepared to feed the baby during the flight. Baby formula, baby food, expressed breast milk, juice and water are allowed on board in reasonable quantities, according to the Transportation Security Administration. You can also take the baby out of his safety seat for nursing or just to get a break when the crew approves moving throughout the cabin.

We are pediatric ear, nose and throat doctors.

www.ENTandAllergySpecialists.com

Reference;
http://www.mayoclinic.com/health/air-travel-with-infant/HQ00197

Training tired doctors is like tired parents; somtimes its just unavoidable, but they still need to do their job.

A new survey published in the Mayo Clinic Procedings asked residency directors what they thought of recent proposed limits in residency hours. Essentially, they said they felt the limits would harm education and ultimately patient care.

The problem with limits on residency work hours is that its like trying to fit a square peg into a round hole. Patient care is not a job that one can effectively stop at the end of a shift and hand off, like flying an airplane (the analogy used by most lawmakers). Rather, patient care is more like parenting; your job isn't done until all the tasks are finished regardless of the hours and sometimes you just have to function when you're tired.

The biggest flaws in the concept of limiting residency training hours is that it eliminates the need to learn efficiency and it diminishes the sense of ownership. If all the tasks are not done at the end of the shift, residents just go home and leave it to someone else. But in the real world after residency, doctors don't have someone to pass on their patients to. Just like parents, the job isn't done until its done. And a good doctor, just like a good parent, isn't going to leave an important job to someone else. That sense of ownership and responsibility is vital to patient care.

That does not mean that doctors shouldn't know their limits and when they're too tired to get something done. But that knowledge used to be an important part of residency training too. There was always a method in residency that a tired resident could get coverage while they got some rest. But now the concern is that we've eliminated an important part of real-world training.

Read the survey at http://bit.ly/foNhXA

http://www.entandallergyspecialists.com/

Men should get the HPV cancer vaccine same as women.

The lump on the left vocal cord is a papilloma caused by HPV.

A new report in the medical journal Lancet calls for men to get the Human Papilloma Virus (HPV) vaccine just like already recommended for women to protect against HPV-related cancers in the genitals, mouth and throat. In an earlier post I discussed the findings that changes in sexual practices have made oral sex, and kissing, the leading cause of mouth and throat cancer.

Researchers looked at HPV infection in males and found that half of all men contract it at some time and that the average infection can last up to 52 months (4 years and 4 months) before the body can clear the infection. The more sexual partners, the higher the risk of HPV infection. In the US, there are 7600 cases of HPV-related cancers of the penis, anus, mouth or throat every year.

Gardisil is the vaccine that protects against HPV infection. It is recommended to be given to boys before they have any sexual contact to be the most effective. It can be given as early as 9 years of age.

Read the research article in the Lancet at http://bit.ly/fNS6Oe

The Centers for Disease Control (CDC) has a fact sheet about HPV and can be read at http://bit.ly/fN9irS.

We are mouth and throat cancer doctors.
http://www.entandallergyspecialists.com/

World's smallest custom hearing aids

Now available at ENT and Allergy Specialists, the Otolens from Starkey. It is custom made for each patient to fit deep in the ear canal, deeper than the usual "completely in canal" aid, to become invisible. Its unique hearing technology gives patients the best hearing experience possible with less feedback or background noise than a regular hearing aid and a device that cannot be seen in the ear.

We do not recommend the Lyric hearing aid because we find that most patients want an aid that they can take in and out or change the batteries on their own like the Otolens.  The Lyric must be installed in the ear by the hearing aid provider which requires frequent return visits to the office to adjust the aid and get a fresh power charge.

Come visit us to learn more about invisible hearing aids.

www.ENTandAllergySpecialists.com