Sinus versus migraine headaches

How can we distinguish between a true sinus headache versus a migraine headache?
This is a major diagnostic dilemma which has been a concern and interest of mine for many decades. The recent medical literature is beginning to finally address this common long-term dilemma.
A recent review in the International Forum of Allergy and Rhinology has confirmed the approach we have followed. Treatment will follow a precise and targeted fashion. The work up should include not only a history, careful physical examination, and nasal endoscopy, but also CT scans with high suspicion for a diagnosis of migraine headache. In the absence of finding sinusitis. attention towards a neurological cause should be pursued.


Although alcohol and tobacco use account for majority of patients with squamous cell carcinoma of the head and neck, HPV is now recognized as a major factor in the development of the majority of head neck squamous cell carcinoma’s of the oropharynx in North America and Europe. It is expected that the incidence will surpass the incidence of cervical cancer by 2020. Alcohol and tobacco usage have been associated with increased incidence of HPV unrelated head and neck squamous cell carcinoma. HPV tumor status has been associated with favorable prognosis in terms of treatment and survival.though it is associated with a favorable initial response to therapy approximately 30% of patients well unfortunately experience we currents. It is too early to determine the definite value of HPV vaccination initiatives in terms of oro-pharyngeal cancer.


What is the best treatment for vocal disorders of aging (presbyphonia)?

As the American population is aging, the incidence of vocal disorders has been estimated between 12 and 35%. A recent medical series of patients older than 65 years of age reveals that vocal complaints are commonly due to vocal cord bowing, where the observed findings by the ENT doctor includes vocal fold atrophy, with an increased space or gap between the vocal folds as they close. Other specific mucous membrane findings have also been observed. With the physical property changes in vocal fold anatomy as well function, the classic bowing of the vocal folds is noted with a classic change in the quality of our voices as we age.
Speech therapy and voice therapy remain the hallmark of initial treatment for those patients who are concerned. There are newer surgical options for the occasional patient who does require a more improved quality-of-life . This includes injection of the vocal folds and surgical procedures to medialize the vocal folds
There is a recent article in the journal Laryngoscope of 2014 highlighting the algorithm for care of the aging voice.

Tonsil size and sleep apnea

A recent medical study was done to determine whether the size of children’s tonsils can predict the severity of their obstructive sleep apnea. Children were evaluated at a university center and their tonsil sizes were graded between 2 and 4+. The study results indicate that regardless of the size of the tonsils there was significant improvement after tonsil surgery. Interestingly, tonsil size did not correlate with the preoperative severity of the children’s sleep apnea, even when adenoid enlargement was factored into the analysis.

Sleep apnea and weight loss

There has been much discussion and research about the effect of weight loss on sleep apnea.

Body mass index is a scientific formula for a measurement of weight relative to height. Greater than 70% of individuals with obstructive sleep apnea have a body mass index greater than 25.

Weight loss reduction is an important part of management of sleep apnea. Many studies over the past 30 years have demonstrated that sleep apnea severity can be improved with weight reduction.

Although there are no cures for obstructive sleep apnea, weight reduction and further research on more accurate metrics for weight reduction will allow us to treat more sleep apnea patients more successfully.

App for drug shortages

Have you heard about drug shortages in the United States? In March 2015 the FDA launched a new mobile device app to allow the public to access information on current drug shortages in the US. The app, drug shortages, allows users to identify the status of the particular drug by generic or brand name or by its’ therapeutic category. The app also allows the public to report a suspected shortage to the FDA.
The app, which is free, is available for iPhone and Android devices.

Is snoring more than a nuisance?

Is snoring more than a nuisance?

A recent study in the Journal Laryngoscope 2015, volume 125, pages 2413- 2416, noted snoring in approximately 53% of respondents with more males likely to report snoring than females. Snoring, as expected, increased with increasing BMI (body mass index = increased weight).The study indicates that snorers were more likely to report falling asleep while driving, having a diagnosis of coronary artery disease, having had a depressive disorder, and having poor quality of sleep.
Though snoring is considered to be an annoyance, the self reported study indicates that there are significant negative sleep pattern behaviors, including decreased sleep time, failure to obtain enough sleep as well as higher incidence of certain medical illnesses in patients who are snoring.

More on tinnitus

Tinnitus accounts for billions of dollars in Veterans Administration disability claims each year.
In 2014 it was the number one cause for such disability claims according to the VA annual benefits report of 2013.
Because nobody dies from tinnitus it has received little attention until now.
Functional magnetic resonance imaging testing has allowed researchers to evaluate new regions of the brain that may become active when stimulated with tinnitus.
These areas include the amygdala, the reticular formation, and the hippocampus.
Targeted therapy according to Dr. Salvi appears promising. Drugs need to be selected very carefully for the multiple etiologies that have been implicated in tinnitus. With new research modalities the future appears promising.


Tinnitus is the perception of sound when there is no external stimulus. Research to treat and control tinnitus has been very difficult. It is due to many etiologies which has made research and treatment challenging. The disease can be due to pathology involving the outer middle or inner ear as well as the brain. A recent study by an international team of researchers has focused on the issue of how patients can hear sounds after the nerve connection between the ear and brain has been severed because of disease. How can a person hear phantom sounds in this situation. It would be impossible ? The researchers have noted that in fact there are several interconnected brain structures which upto now are not felt to be involved with tinnitus. The neural areas include the amygdala and the reticular formation. These are arousal centers of the brain. This may well explain why so many patients with tinnitus feel depressed anxious or under stress during active periods of disease.

There are several investigational drugs targeting neurotransmitters in these regions. In phase 2 and phase 3 studies they seem to be promising for the long anticipated treatments for tinnitus.

Obstructive sleep apnea

The primary treatment for obstructive sleep apnea is CPAP. Despite efforts to improve compliance only 40 to 60% continue to use CPAP on a long-term basis. Hypoglossal nerve stimulation is now being pursued as an alternative therapy in the treatment of obstructive sleep apnea according to a recent review in a 2015 issue of Laryngoscope magazine. Sleep endoscopy can indicate that specific subset of patients who may benefit from hypoglossal nerve surgery and potentially avoid the use of CPAP. The studies are in their infancy but the results are looking very promising in this subset of patients where the obstruction is at the tongue area.