- The pharyngeal recess/Eustachian tube complex forms an acoustic passageway. [Journal Article]
- MHMed Hypotheses 2018; 121:112-122
- We propose that the complex formed by the Pharyngeal Recess and Eustachian Tube, acts as an acoustic passageway for sounds originating inside the body: sounds made by one's voice, breathing, masticat...
We propose that the complex formed by the Pharyngeal Recess and Eustachian Tube, acts as an acoustic passageway for sounds originating inside the body: sounds made by one's voice, breathing, mastication, one's heartbeats. The antagonistic effect of two sets of muscles, one innervated by the trigeminal nerve, the other by the vagal nerve and cervical plexus, enables the body to modulate transmission of sound via this passageway and hence modulate the awareness of body sounds. Impairment of this system can be due to local factors, such as adhesions over the pharyngeal recess or inflammation inside the pharyngeal recess and/or Eustachian tube; or to tensions of the muscles involved, related to other causes. Dysfunction of the system can lead to symptoms related to increased or decreased awareness of body sounds, such as autophony, hearing of pulsating sounds and clicks in the ear; sensory symptoms related to increased activation of the nerves such as fullness feeling in the ear, facial pain, burning mouth syndrome, globus pharyngeus, pharyngeal pain; and symptoms related to inappropriate muscular contraction such as masticatory and cervical muscle tensions, bruxism, and tension type headache. The functioning of this acoustic passageway is related to the concept of the Trigeminocervical complex. The concept of Vagocervical complex is proposed.
- Judicious antibiotic prescribing in ambulatory pediatrics: Communication is key. [Journal Article]
- CPCurr Probl Pediatr Adolesc Health Care 2018 Oct 30
- Children in outpatient clinics are prescribed over 15 million courses of unnecessary antibiotics annually. Clinicians have identified parent pressure for antibiotics, parent satisfaction, and time co...
Children in outpatient clinics are prescribed over 15 million courses of unnecessary antibiotics annually. Clinicians have identified parent pressure for antibiotics, parent satisfaction, and time constraints as the primary drivers of unnecessary antibiotic prescribing. Over the past decade, parents have become more aware that antibiotics only treat bacterial infections, yet continue to report an expectation for antibiotics in 50-65% of acute care visits. Parental expectations for antibiotics stem from parental concerns about symptom severity and a desire to alleviate symptoms. Clinicians can address parental concerns when they assess the severity of illness through a physical exam, provide a clear explanation for the symptoms, recommend ways to alleviate the symptoms, and provide council on when to be concerned. When clinicians fail to address parental concerns, parents are more likely to challenge the diagnosis or treatment recommendations, clinicians are more likely to perceive that parent as expecting an antibiotic, and antibiotics are significantly more likely to be prescribed. Parents that expect antibiotics are more likely to communicate using a 'candidate diagnosis' (e.g., "Johnny has strep throat.") and resist the diagnosis or treatment given. Clinicians can recognize these parental communication patterns and use specific communication practices shown to decrease unnecessary antibiotic prescribing. When parents expect antibiotics, clinicians should (1) review physical exam findings using 'no problem' commentary (e.g., "This ear is just a little red."), (2) deliver a specific diagnosis (e.g., avoid 'a virus'), (3) use a two-part negative/positive treatment recommendation (e.g., "On the one hand, antibiotics will not help. On the other hand, ibuprofen can help with pain."), and (4) provide a contingency plan. Clinicians should feel comfortable discussing the risks and benefits of antibiotics. Effective communication between parents and clinicians in outpatient clinics leads to more judicious antibiotic prescribing, higher parent satisfaction scores, and more efficient clinic visits.
- Challenging the Traditional Definition of a Difficult Intubation: What Is Difficult? [Journal Article]
- A&AAnesth Analg 2018 Oct 30
- Acute otitis externa because of negative pressure wound therapy applied over the head and ear canal for scalping treatment. [Case Reports]
- IWInt Wound J 2018 Oct 31
- Scalping is considered a complex wound with difficult treatment, requiring early surgical intervention, reconstructive plastic surgery, and a multidisciplinary team. The reconstruction of the scalp f...
Scalping is considered a complex wound with difficult treatment, requiring early surgical intervention, reconstructive plastic surgery, and a multidisciplinary team. The reconstruction of the scalp frequently requires a combination of therapies, including temporary coverage, such as negative pressure wound therapy (NPWT). Complications of NPWT, such as bleeding, infection, and pain, have been described. However, there is no report of acute otitis externa (AOE) because of NPWT. In this article, we present an unprecedented clinical case - a female patient who developed AOE after scalping treatment with NPWT applied over the head and ear canal. We consider that it may be a result of the direct physical action of subatmospheric pressure, the presence of dressing covering the external meatus, and alteration of the bacterial population.
- The Use of Battlefield Acupuncture Prior to Botulinum Toxin A Administration: A 2-Patient Case Series. [Journal Article]
- MAMed Acupunct 2018 Oct 01; 30(5):282-284
- Background: Botulinum toxin type A injection is a common and safe procedure used for the treatment of overactive muscles through local injection. This toxin inhibits the release of acetylcholine in t...
Background: Botulinum toxin type A injection is a common and safe procedure used for the treatment of overactive muscles through local injection. This toxin inhibits the release of acetylcholine in the neuromuscular junction. The benefits usually last only 3-6 months; thus, repeated injections are often required. The procedure, however, can be difficult if a patient's spasticity and pain prevents access to the muscles for injection or if a patient is anxious. Battlefield Acupuncture (BFA), a technique developed by Richard C. Niemtzow, MD, PhD, MPH, in 2001, is a form of auricular acupuncture using a very specific sequence of gold Aiguille semipermanente needles inserted into the ear. BFA can be very effective for reducing pain quickly, with few potential side-effects. Cases: BFA was performed prior to Botulinum toxin A injections on 2 patients who had either pain limitations or anxiety limitations during prior Botulinum toxin A injections. Case 1 was a 70-year-old male veteran with painful, right upper-extremity spasticity with hand contractures. Case 2 was a 69-year-old male veteran with spasticity who had anxiety related to his fear of needles. Results: Application of BFA prior to Botulinum toxin A injections enabled the 2 patients who either had pain limitations or anxiety limitations to tolerate the toxin injections much better. Conclusions: BFA is a safe and effective treatment option for rapid pain reduction, enabling Botulinum toxin A to be administered more easily to patients who have had pain or anxiety during prior injections.
- Bevacizumab for Hearing Preservation in Neurofibromatosis Type 2: Emphasis on Patient-Reported Outcomes and Toxicities. [Journal Article]
- OHOtolaryngol Head Neck Surg 2018 Oct 30; :194599818809085
- CONCLUSIONS: Bevacizumab treatment was followed by hearing improvement in 56% of patients, while decreased tumor volume was noted in 47%. These outcomes agree favorably with prior reported series. There were significant improvements in patient-reported outcomes that have not been described previously.
- Aromatase Derived Estradiol Within the Thalamus Modulates Pain Induced by Varicella Zoster Virus. [Journal Article]
- FIFront Integr Neurosci 2018; 12:46
- Herpes zoster or shingles is the result of varicella zoster virus (VZV) infection and often results in chronic pain that lasts for months after visible symptoms subside. Testosterone often attenuates...
Herpes zoster or shingles is the result of varicella zoster virus (VZV) infection and often results in chronic pain that lasts for months after visible symptoms subside. Testosterone often attenuates pain in males. Previous work demonstrates ovarian estrogen effects γ-aminobutyric acid (GABA) signaling in the thalamus, reducing pain but the role of testosterone within the thalamus is currently unknown. Because aromatase affects pain and is present in the thalamus we tested a hypothesis that testosterone converted to estrogen in the thalamus attenuates herpes zoster induced pain. To address this hypothesis, male Sprague-Dawley rats received whisker pad injection of either MeWo cells or MeWo cells containing VZV. To reduce aromatase derived estrogen in these animals we injected aromatase inhibitor letrozole systemically or infused it into the thalamus. To test if estrogen was working through the estrogen receptor (ER) agonist, 4, 4', 4″-(4-Propyl-[1H]-pyrazole-1,3,5-triyl)trisphenol (PPT) was infused concomitant with letrozole. Motivational and affective pain was measured after letrozole and/or PPT treatment. Vesicular GABA transporter (VGAT) is important in pain signaling. Because estrogen effects VGAT expression we measured its transcript and protein levels after letrozole treatment. Virus injection and letrozole significantly increased the pain response but thalamic infusion of PPT reduced zoster pain. Letrozole increased the number of thalamic neurons staining for phosphorylated ERK (pERK) but decreased VGAT expression. The results suggest in male rats aromatase derived estradiol interacts with the ER to increase VGAT expression and increase neuronal inhibition in the thalamus to attenuate VZV induced pain.
- Management of Great Auricular Neuralgia Confirmed by Electrophysiologic Examination: A Case Report. [Journal Article]
- JOJ Oral Facial Pain Headache 2018 Fall; 32(32):e53-e56
- The great auricular nerve (GAN) is a sensory branch of the cervical plexus originating from the C2 and C3 nerve roots that innervates the external ear, mandibular angle, and parotid gland. Since idio...
The great auricular nerve (GAN) is a sensory branch of the cervical plexus originating from the C2 and C3 nerve roots that innervates the external ear, mandibular angle, and parotid gland. Since idiopathic GAN neuralgia is a rare condition and branches of the GAN overlap with other cervical and cranial nerves, its diagnosis is challenging and can be confused with other facial neuralgias. This article describes the case of a 55-year-old woman with intractable unilateral periauricular and lateral head pain. No significant findings were found on cervical and brain imaging. At first, the patient was suspected to be suffering from trigeminal neuralgia or great occipital neuralgia; however, the symptoms persisted despite pharmacotherapy, cervical plexus and medial branch block, and repetitive transcranial magnetic stimulation. On the basis of an electrophysiologic examination, the patient was diagnosed as having GAN lesions. Pain subsided immediately after ultrasound-guided GAN block with local anesthetics and steroids. These findings indicate that electrophysiologic studies are helpful for accurately diagnosing patients with unclear pain in the periauricular and lateral head.
- Audiological and clinical outcomes of a transcutaneous bone conduction hearing implant: 6-month results from a multicenter study. [Journal Article]
- COClin Otolaryngol 2018 Oct 25
- CONCLUSIONS: The Baha Attract System provided a significant improvement in hearing performance and subjective benefit compared to the preoperative unaided condition (with the non-test ear blocked). Hearing performance of the Baha Attract was similar to a test situation with the same sound processor on a softband. A proportion of the patients reported numbness and pain/discomfort at the implant site during follow-up, especially during the first postoperative weeks. Based on the results of the current multicentre study, the Baha Attract can be considered as a treatment option for patients with the aforementioned hearing losses. Especially in the SSD patients a careful selection procedure is warranted. Therefore a pre-operative trial should be part of the decision making process before fitting a patient with the Baha Attract System. This article is protected by copyright. All rights reserved.
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- In Response. [Journal Article]
- A&AAnesth Analg 2018 Oct 19