Canker Sores

Canker sores or aphthous ulcers are small, painful, shallow ulcerations that occur on the soft tissues inside the mouth. Stress or tissue injury is believed to contribute to the development of canker sores, although the actual cause is unknown. Other possible factors include immune system dysfunction, vitamin deficiencies such as B-12, zinc, folic acid or iron, disease of the gastrointestinal tract, food allergies, or hormonal changes such as menstrual periods. There can also be a hereditary predisposition to developing these sores. They are not contagious and normally resolve without any intervention in 10-14 days.

Occasionally these sores can be recurrent or large and complex. For these cases there are several treatment options. Dr. Nasim Fazel makes the following recommendations.

• Topical therapy - Steroid compounds such as flucinonide (Lidex) or clobetasol gel for lesions which are easily within reach or dexamethasone (Decadron) elixir (0.5 mg/5ml) to swish around in the mouth for lesions that are in the back of the throat.
• Systemic therapy - Several immune system modifying medications may be used for the more severe cases. These include prednisone either in a short term therapy of 40-80 mg every day for 4-5 days or a long term dosing regimen with gradual taper; pentoxifylline (Trental) 400 mg three times a day for at least 3-6 months and usually for 1 year; colchicine 0.6 mg 2 to 3 times a day, dapsone 100-200 mg daily or azathioprine (Imuran) 50 mg twice daily for 2 weeks. Each of these medications has its own set of side effects which should be weighed against the benefits.
• Pain control therapy - Zilactin which is an over the counter gel, sucralfate(Carafate) to provide a protective coating over the ulcer, or viscous lidocaine 2% to be taken about 20 minutes before meals to reduce the discomfort while eating.

What ever option you chose, please don't do this.

Photo: courtesy of kidshealth.

Sinusitis - When to Start Antibiotics

How many times have you visited your doctor saying, " Doc I have a sinus infection - I need antibiotics". Looking at this picture, it's easy to understand why you would want to get the whole thing over with as quickly as possible. It's gnarly.

Chances are that you are one in the 30-35 million patients a year who develop acute bacterial sinusitis. Symptoms of this condition are severe pain and pressure in the face, forehead, and upper teeth as well as a purulent discharge that drains out of the nose and slips behind the throat causing a nasty taste and nausea. It can make it difficult to concentrate, work, or sleep.

"Quick give me the antibiotics now - I'm launching a project and can't afford to get sick." However, it turns out that once you have this condition there is a natural course that it follows. Antibiotics started before 7 days do not help expedite improvement. Antibiotics are beneficial only if the symptoms of the sinusitis have persisted beyond 7-12 days. Before 7 days, antibiotics do not offer an advantage in treatment. They may however, cause more side effects such as diarrhea, stomach upset and rashes which only compound the suffering.

There are measures other than antibiotics which may help resolve the sinusitis. These include taking decongestants or performing nasal irrigation.

So Googlers and non-Googlers alike, next time you call your doctor about your sinusitis symptoms please take into account as to how many days you have hosted the bug. Have you given the organism proper time to leave on its own terms? If yes, you should be better by 7 - 12 days. If not, then it may be time for an attack via pharmaceutical launches.

Reference: Title: Systematic Review of Antimicrobials for Acute Rhinosinusitis Authors: Michael C. Singer, MD, Richard M Rosenfeld, MD MPH, Stacie Schilling Jones MPH Date: Tuesday, September 18, 9:58 am - 10:06 am presented at the 2007 AAO-HNSF Annual Meeting & OTO EXPO.

Photo: courtesy of MayoFoundation.

iPods - Safe Tech Tips

This week is the Apple iPod's fifth year anniversary. I can't turn a corner without bumping into one of the 68 million people using this sleek MP3 player. It's a great device that provides music, keeps the peace between teens and adults, makes those long road trips tolerable, and keeps me sane when I travel. But how long and how loudly can you listen to an iPod safely?

A recent study was published that gives some guidelines for safe listening. The researchers, Cory Portnuff and Brian Fligor studied 5 MP3 players with 5 models of earphones with each player and with different types of music.

"Typical individuals can tolerate about two hours a day of a decibel unit known as 91-dBA before risking hearing loss, Portnuff said. The term dBA stands for "A-weighted decibels, a scale that takes into account that the human ear has different sensitivities to different frequency levels," he said".

The table below is their recommendation for maximum listening time with different earphones without damaging the hearing. **There was no difference in the genres of music or the MP3 players**. It's really all about volume control and how long you spend listening. Please note that these are just general guidelines. Some people have more sensitive ears than others.
Maximum Listening Time Per Day

% of Volume Control	Earbud	Isolator	Supra-Aural	stock earphones
10 - 50 %	No limit	No limit	No limit	No limit
60 %	No limit	14 hours	No limit	18 hours
70 %	6 hours	3.4 hours	20 hours	4.6 hours
80 %	1.5 hours	50 minutes	4.9 hours	1.2 hours
90 %	22 minutes	12 minutes	1.2 hours	18 minutes
100 %	5 minutes	3 minutes	18 minutes	5 minutes

Table 1. Maximum listening time per day using NIOSH damage-risk criteria. “Earbud” includes stock earphones and iPod In-ear earphones. “Isolator” includes Etymotic ER6i earphones and Shure E4c earphones. “Supra-Aural” includes Koss headphones that rest on top of the ear. ©2006 Cory D.F. Portnuff, B.S. and Brian J. Fligor, Sc.D.

Bottomline is that if you are going to listen to the MP3 player for an extended period of time then it seems safest to play it at a level of less than 70% of the volume. Above the 80% volume damage to the hearing could be done fairly rapidly. Similar findings were found in a study of personal stereo systems.

References: please see specific links.
Photo: courtesy of ipodlounge

Zinc Nasal Sprays and Loss of Smell

Zinc nasal sprays are over the counter products which are used for cold and flu symptoms. There have been studies which show that they may shorten the duration of cold symptoms. However, there are also anecdotal reports of a sudden loss of sense of smell (anosmia) and sense of taste after using this product.

I was reminded of this again today when a patient who had used the spray under the label Zicam reported that he suddenly felt a severe sharp burning sensation in his nose. Since then he has completely lost his sense of smell and therefore his sense of taste. This sudden burning sensation in the nose is assumed to be due to damage to the olfactory nerve and it may be permanent. The acuity of the symptom is also assumed to be more specific to the zinc than to the viral infection which can also lead to a loss of the sense of smell. Since the flu season is around the corner, you may want to consult your doctor before reaching for the zinc nasal sprays.

References: please see specific links.
Photo: courtesy of thedenverchannel

This week's object in the ear

I love this job. I can help people and hear stories that they wouldn't tell their best friends some times.
Today I saw a wonderful fellow who thought that he had paper in his ears.
He was good natured enough to giggle with me as I peered into the ear canal and tried to fish out the paper with out puncturing his ear drum. He was a little sheepish telling me his story, but who among us hasn't done some thing like this.
We successfully removed a large chunk of paper from each ear and concluded that the paper cover of a plastic straw is not an effective ear plug for diminishing the sound level while watching Mission Impossible III in the theatre. He gave me permission to pass this lesson to the bloggers. Moral of the story: don't put any thing smaller than your elbow in your ears, and yes that includes Q tips.

So what have you found or placed in an ear lately?

Photo courtesy of Medline.