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April 27, 2017

Is Eating Your Boogers Really Good for You?

On 4/26/17, a variety of media sources reported that a scientific study claimed that eating your own boogers is healthy for you. Given the sensational headlines and pertinent ENT topic, I decided to investigate this claim further and actually read the study that was quoted as the scientific source.

To preface, NOWHERE in the quoted research study was the claim made that one should eat, chew, or ingest any nasal secretions, boogers, snot-rockets, or any other nasal secretions whether wet or dried up crusties to prevent infections.

What the research paper DID report was that biologic "mucus" DOES have health benefits in preventing bacteria from potentially causing cavities.

Rather than killing bacteria, the mucus acts as a physical barrier to prevent bacteria from attaching and harming the dental enamel. Similarly, it is felt that such mucus barriers may help prevent germs from causing infectious diseases in the gastrointestinal and respiratory tract.

The scientific study conducted at MIT, focused on the mucus protein MUC5B which is principally produced by the salivary (spit) glands, namely the submandibular and sublingual glands. NOT the nose.

To reiterate, NOWHERE in the study was the claim made that nasal secretions produced this mucus protein and as such, one should eat nasal boogers to prevent infections.

It seems somebody saw the word "mucus" in this fairly dense research paper and erroneously equated that to "snot" which people can mistakenly assume is only produced in the nose... aka, boogers.

Just goes to show how good, legitimate scientific papers can be twisted and distorted totally out of context into sensational and incorrect conclusions that make good scientists and their work look ridiculous and demean what it means to be an expert who is trying to do some real good.

You can read the full research paper here. What do you think? Did the media accurately interpret this paper? Read some media articles here.

Salivary mucins protect surfaces from colonization by cariogenic bacteria. Appl Environ Microbiol. 2015 Jan;81(1):332-8. doi: 10.1128/AEM.02573-14. Epub 2014 Oct 24.

April 24, 2017

How Much Better are Antibiotic Ear Drops Compared to Oral Antibiotics?

Antibiotic ear drops deliver vastly higher amounts of antibiotics compared to oral and even IV antibiotics. There is no comparison. It is literally 300 times better than oral antibiotics. The catch is that the ear drops need to get down to where the infection is in order to work, whether into the ear canal (if dealing with otitis externa or swimmer's ear) or through a hole or tube in the eardrum (if dealing with otitis media).

For example, two of the most common ear drops prescribed are 0.3% ofloxacin (Floxin) drops and Ciprodex which both contain 3000 mcg/ml of antibiotics. Cortisporin drops contain 3500 mcg/ml of antibiotic.

Compare these middle ear concentrations with that found with oral antibiotics after ingestion.

• Amoxicillin with an oral dose of 90 mg/kg resulted in middle ear concentration of 6-10 mcg/ml
• Cefuroxime at 500mg resulted in 2-4 mcg/ml
• Clarithromycin at 500mg resulted in 2-5 mcg/ml

Even IV antibiotics deliver lower concentrations of antibiotics compared to the ear drops:

• Ceftriaxone (35 mcg/ml)

However, oral antibiotics may still be helpful in those situations where the ear drops may have trouble penetrating to the source of the ear infection. Such situations include when the ear drainage is so copious that the ear drops are not getting down to the middle ear effectively, even with tragal pumping. As such, in these situations, a few days of oral antibiotics in combination with ear drops may work better than either oral or ear drops by itself.

Beyond concentration, there are other advantages of topical ear drops over oral antibiotics including avoidance of systemic side effects, especially nausea and diarrhea as well as much lower risk of multi-drug resistance infections.

In order to maximize antibiotic ear drop effectiveness,

• Remove as much of the ear drainage as possible prior to ear drop usage (typically, one can roll up a corner of a tissue and stick in the ear canal to soak up as much drainage as possible)
• Perform tragal pumping after ear drop administration to try and "push" the ear drops as deeply into the ear canal as possible. Tragal pumping is performed by pressing the tragus against the opening of the ear canal repeatedly several times.
• Should the ear canal be swollen shut as found in swimmer's ear or otitis externa, place an ear wick (a small sponge) first so that any ear drops placed can be wicked down past the swollen ear canal skin. Occasionally, a single dose of steroids can be very helpful to reduce the ear canal swelling (and pain) quickly.

Ototopical Antibiotics. Medscape 11/29/16.

Clinical and pharmacokinetic basis for the antimicrobial treatment of acute otitis media. Otolaryngol Clin North Am. 1991 Aug;24(4):859-75.

The chinchilla microdialysis model for the study of antibiotic distribution to middle ear fluid. AAPS J. 2006 Feb 3;8(1):E41-7.

Microdialysis studies of the distribution of antibiotics into chinchilla middle ear fluid. Pharmacotherapy. 2005 Dec;25(12 Pt 2):140S-145S.

April 20, 2017

Can Ear Drops Increase Risk of Eardrum Perforation?

With ear tube placement, there is a baseline 2-10% risk that a persistent hole in the eardrum will occur after the tubes come out. However, a study came out in April 2017 suggesting that commonly used antibiotic ear drops to treat ear infections when ear tubes are present may increase the risk of such persistent eardrum perforations after the tubes come out (post-TT TMP).

Specifically, antibiotic ear drops belonging to the fluoroquinolone class is associated with an increased risk of persistent eardrum perforation (post-TT TMP) compared to aminoglycoside class of antibiotics. Fluoroquinolone antibiotics include ofloxacin and ciprofloxacin with or without steroids. Aminoglycoside antibiotics typically include cortisporin or neomycin with steroids.

The next big question is how much higher is the risk of post-TT TMP with use of fluoroquinolone ear drops?

Based on this retrospective cohort study, the adjusted hazard risk was 1.61. Broken down, the adjusted hazard risk was 1.49 for ofloxaxin, 1.94 for ciprofloxacin with hydrocortisone, and 2.00 for ciprofloxacin with dexamethasone. (Value of 1.00 means no additional risk.)

These adjusted hazard risks are based on raw data showing 11 post-TT TMP per 10,000 patient years for non-fluoroquinolone exposure versus 17 post-TT TMP per 10,000 patient years in those exposed to fluoroquinolone antibiotic ear drops.

10,000 patient years is the total sum of observed time during which the incidence of post-TT TMP is observed. For example, if 100 patients are followed for 2 years, that would be 200 patient-years of follow-up.

So, if one were to hypothetically smush together all the patients into a single individual who lived for 10,000 years, use of fluoroquinolone ear drops would occur 6 more instances than one who did not use this type of antibiotic ear drops. (17 per 10,000 person years minus 11 per 10,000 person years.)

So although it does appear that the risk of post-TT TMP is present with fluoroquinolone antibiotic ear drop usage, the additional risk is not large by any stretch of the imagination and the impact on its use for a given single patient is really quite small overall and should not dissuade from its use.

Quinolone Ear Drops After Tympanostomy Tubes and the Risk of Eardrum Perforation: A Retrospective Cohort Study. Clin Infect Dis. 2017 Apr 15;64(8):1052-1058. doi: 10.1093/cid/cix032.

Meta-analysis of tympanostomy tube sequelae. Otolaryngol Head Neck Surg. 2001 Apr;124(4):374-80.

Factors related to persisting perforations after ventilation tube insertion. Int J Pediatr Otorhinolaryngol. 2016 Feb;81:29-32. doi: 10.1016/j.ijporl.2015.11.028. Epub 2015 Dec 7.

April 14, 2017

Video of the Human Voicebox in Action!

In honor of World Voice Day on April 16, 2017, I have created a new video showing how the voicebox is examined using a fiberoptic endoscope threaded through the nose. I created the first version of this video back in 2007 and given better and newer technology, I have decided to do a refresh including more info and examples. Of course, the video and audio quality is also way better compared to a decade ago. Check it out!

April 07, 2017

Wax Removal of Nasal Hair

Screenshot of video by Sepi Balini
Makeup artist and vlogger Sepi Balini posted a video on instagram showing her nasal hair being removed by waxing.


She's made of tough stuff as most individuals would have at least shed a tear given the nose is extremely sensitive, even with pulling just one nostril hair out. Watch the video here.

However, this is NOT a good idea and I certainly hope is not something that picks up in popularity whether male or female.

Although nasal hair does contribute to air filtration by preventing debris from getting into the nose, the greater concern is infection of the hair follicles. Although an infected hair follicle hurts no matter where it occurs, it is particularly painful in the nasal region. Given the nasal location, one can argue that it is more likely here than other locations given how often air passes through this opening along with germs. Other nasal skin conditions that may also result include:

  • nasal crusting
  • ulcers
  • pimples
  • scabbing
  • skin cracking
  • abscess

Staph in particular likes to hang out among the nasal hair. In very rare cases, an infection in this region of the face (called the "Triangle of Death"), can lead to infection of the brain. Click here for more information on how this may happen.

If you want to remove nasal hair, it is best to trim the hair out with nose hair clippers or a scissor.

April 03, 2017

Increased Risk of Thyroid Cancer From Frequent Use of Disinfectants

Yale researchers have reported that regular exposure to biocides including disinfectants (such as doctors, dentists, nurses, etc) doubles the risk of thyroid cancer. This findings was determined through a population-based case-control study involving 462 thyroid cancer cases in Connecticut collected 2010-2011.

Over the past decade, there has been an increased incidence of thyroid cancer every year and this report may explain part of this alarming trend along with possible over-diagnosis as ultrasound technology and pathology technique has improved. At least in the United States, the average annual increase in the incidence of thyroid cancer is 5%.

Biocide products include not only disinfectants, but also any product capable of deodorizing, sterilizing, sanitizing, and / or killing micro-organisms including bactericides, algicides, fungicides, germicides, and preservatives.

For example, the active ingredient in many "anti-bacterial" soap used in households contains triclosan, a suspected biocide. This biocide is also suspected of causing other types of cancers.

Animal studies have suggested that biocides can trigger thyroid cancer by altering thyroid hormone production. For example, triclosan which is widely found in antibacterial soap is known to decrease serum T3 and T4 thyroid hormones. Drinking water disinfectants including chlorine has also been found to reduce T4 thyroid hormones in animals.

Interestingly, pesticide exposure did not show this same increased risk of thyroid cancer. Pesticides are defined as substances capable of killing some form of organism that is deemed undesirable including insecticides, herbicides, rodenticides, fungicides, molluscicides, and nematodicides.

Obviously, further evaluation is mandated to elucidate the relationship between thyroid cancer and biocide usage. In particular, which exact biocide chemical(s) is/are responsible for this increase given biocides encompass a wide range of chemicals.

Also, there is NO evidence to show that anti-bacterial soap is more effective than regular soap in preventing illnesses. As such, at least for the lay-public, it is recommended to avoid anti-bacterial soap containing any type biocide chemicals and stick with regular soap. Of course for healthcare professionals, we may be out of luck because pretty much any product used to disinfect, clean, sterilize, etc contains biocides. What's worse is that healthcare professionals are exposed to biocides multiple times every day.

Hand-sanitizers should also be avoided, especially if it contains biocides. Triclosan (mentioned above) can quickly absorb through the skin and enter the bloodstream exerting its potentially deleterious effects. If hand-sanitizers are used, ethanol should be the only active ingredient and it MUST be present at concentrations above 60%, otherwise it will be ineffective at killing germs.

Occupational exposure to pesticides and other biocides and risk of thyroid cancer. Occup Environ Med 2017; published online 2/15/17.

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