Blog

Subscribe via RSS

Tonsillectomy in children

Wednesday, October 26, 2011

A multidisciplinary clinical practice guideline, "Tonsillectomy in Children" would be reported in the recent issue of Otolaryngology Head and Neck Surgery (watch for a new cover and publisher in that issue of the journal). The new guideline provides evidence-based recommendations on the pre-, intra-, and postoperative care and management of children aged 1 to 18 years under consideration for tonsillectomy. Additionally, this guideline is intended for all clinicians in any setting who care for these patients. This guideline also addresses practice variation in medicine and the significant public health implications of tonsillectomy. 



Tonsillectomy in children

Tonsillectomy is one of the most common surgical procedures in the United States, with over 530,000 procedures performed annually in children under 15 years old. Tonsillectomy is defined as a surgical procedure (performed with or without adenoidectomy) that completely removes the tonsil, including its capsule, by dissecting the peritonsillar space between the tonsil capsule and the muscular wall. Depending on the context in which it is used, the term may indicate tonsillectomy with adenoidectomy, particularly in relation to sleep-disordered breathing. 

"Over half a million tonsillectomies are done every year in the United States," said Richard M. Rosenfeld, MD, MPH, journal guideline author and consultant. "The tonsillectomy guideline will empower doctors and parents to make the best decisions, resulting in safer surgery and improved quality of life for children who suffer from large or infected tonsils". 

The primary purpose of this guideline is to provide clinicians with evidence-based guidance in identifying children who are the best candidates for tonsillectomy. Secondary objectives are to optimize the perioperative management of children undergoing tonsillectomy; emphasize the need for assessment and intervention in special populations; improve counseling and education for families of who are considering tonsillectomy for their child; highlight the management options for patients with modifying factors; and to reduce inappropriate or unnecessary variations in care. 

(0) Comments | (0) Trackback | Permalink

Low-pitch Treatment For Tinnitus

Wednesday, October 26, 2011


Low-pitch Treatment For Tinnitus

For those who pumped up the volume one too a number of times, UC Irvine scientists may have found a therapy for the hearing damage loud music can cause. 

Fan-Gang Zeng and his colleagues have identified an effective way to treat the symptoms of tinnitus, a form of hearing damage typically marked by high-pitched ringing that torments more than 60 million Americans. A low-pitched sound, the scientists discovered, applied by a simple MP3 player suppressed and provided temporary relief from the high-pitch ringing tone linked to the disorder. 

Tinnitus is caused by injury, infection or the repeated bombast of loud sound, and can appear in one or both ears. It's no coincidence that a number of rock musicians, and their fans, suffer from it. Eventhough known for its high-pitched ringing, tinnitus is an internal noise that varies in its pitch and frequency. Some therapys exist, but none are consistently effective. 

Zeng presented his study Feb. 13 at the Middle Winter Research Conference for Otolaryngology in Denver. 

"Tinnitus is one of the most common hearing disorders in the world, but very little is understood about why it occurs or how to treat it," said Zeng, a professor of otolaryngology, biomedical engineering, cognitive sciences, and anatomy and neurobiology. "We are very pleased and surprised by the success of this treatment, and hopefully with further testing it will provide needed relief to the millions who suffer from tinnitus". 

As director of the speech and hearing lab at UCI, Zeng and his team made their discovery while addressing the severe tinnitus of a research subject. The patient uses a cochlear implant to address a constant mid-ranged pitched sound in his injured right ear accented by the periodic piercing of a high-pitched ringing sound ranging between 4,000 and 8,000 hertz in frequency. 

At first, Zeng thought of treating the tinnitus with a high-pitched sound, a method called masking that is sometimes used in tinnitus treatment attempts. But he ruled out that option because of the severity of the patient's tinnitus, so an opposite approach was explored, which provided unexpectedly effective results. 

After making a number of adjustments, the scientists created a low-pitched, pulsing sound - described as a "calming, pleasant tone" of 40 to 100 hertz of frequency - which, when applied to the patient through a regular MP3 player, suppressed the high-pitched ringing after about 90 seconds and provided what the patient described as a high-level of continued relief. 

Zeng's patient programs the low-pitched sound through his cochlear implant, and Zeng is currently studying how to apply this therapy for people who do not use any hearing-aid devices. Since a cochlear implant replaces the damaged mechanism in the ear that stimulates the auditory nerve, Zeng believes that a properly pitched acoustic sound will have the same effect on tinnitus for someone who does not use a hearing device. Dr. Hamid Djalilian, a UCI doctor who treats hearing disorders, points out that a custom sound can be created for the patients, who then can download it into their personal MP3 player and use it when they need relief. 

"The therapy, though, does not represent a cure," Zeng said. "This low-pitch therapeutic approach is only effective while being applied to the ear, after which the ringing can return. But it underscores the need to customize stimulation for tinnitus suppression and suggests that balanced stimulation, rather than masking, is the brain mechanism underlying this surprising finding". 

Qing Tang, Jeff Carroll, Andrew Dimitrijevic and Dr. Arnold Starr of UCI; Leonid Litvak of Advanced Bionics Corp.; and Jannine Larkin and Dr. Nikolas H. Blevins at Stanford University took part in the study, which was supported by the National Institutes of Health. 

(0) Comments | (0) Trackback | Permalink