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  • Partial Irrigator Bibliography with Abstracts
    increased after two weeks of one or two times a day irrigation using the Pulsatile irrigator with the nasal attachment Rhinitis Allergy Principles and Practice 3rd edition Middleton E CV Mosby Company Ch 17 1988 All forms of allergy rhinitis are benefitted by saline irrigation with the Pulsatile irrigator and nasal attachment Medical Management of Rhinitis Fadal R English Otolaryngology 1996 Vol 2 Ch 13 The principal benefits from saline irrigation are shown to include 1 Augments mucociliary flow 2 Liquefies tenacious mucus 3 Soothes irritated tissues 4 Removes crusts and microforeign bodies 5 Augments tissue repair 6 Reduces forceful noseblowing 7 Improves olfaction Atrophic Rhinitis deSouza F M Chapter 14N English Otolaryngology 1996 The Pulsatile irrigator dental irrigation device with the nasal irrigator tip is shown to increase the efficiency of saline nasal douches Atrophic Rhinitis Goodman Wilfred S Otolaryngology Vol 2 Ch 14 1984 Atrophic rhinitis varies in severity and is difficult to cure Pulsatile irrigation is recommended for symptomatic relief and treatment Chronic Rhinitis a Practical Approach to Diagnosis and Treatment Zeigler R Shatz M Part 2 Treatment Immunology Allergy Practice 1982 4 3 pp 26 36 Good allergy management is shown to include irrigation for removal of offending particles in order to restore normal ciliary flow Atrophic Rhinitis deSouza F M Chapter 14N English Otolaryngology 1996 The Pulsatile irrigator dental irrigation device with the nasal irrigator tip has increased the efficiency of saline nasal douches Asthma Sinusitis and Bronchial Asthma Slavin RG J Allergy and Clinical Immunol 66 250 257 1980 Slavin presents three mechanisms re sinusitis causing asthma Clearing sinusitis is important in asthma Allergies and Asthma for Dummies by William E Berger MD use a Pulsatile irrigator with nasal attachment to irrigate with warm saline solution to relieve pressure and congestion in your nasal passages Allergy Inhibition Of The Seasonal Ige Encrease To Dactylis Glomerata By Daily Saline Nasal Sinus Irrigation During The Grass Pollen Season Journal of Allergy and Clinical Immunology In press Pulsatile irrigation works for allergy by removing the IgE so that the pollen doesn t cause symptoms Allergies and Asthma for Dummies by William E Berger MD see above in Asthma Current Review of Allergic Diseases 2001 edited by Michael A Kaliner Pulsatile Irrigation is recommended for nasal problems Prospects for ancillary treatment of rhinosinusitis in the 1990 s Zeiger RS J Allergy Clin Immunol 1992 90 478 495 Recommends pulsatile irrigation to reduce or eliminate allergy symptoms Post Operative Care Perioperative Care in Functional Endoscopic Sinus Surgery Sonkens JW Miller R J Highlilghts of the Instructional Course Ed Lucente editor Chapter 24 pp267 277 Pulsatile irrigation should be done 1 to 3 times a day postoperatively until no further benefit is achieved Endoscopic Paranasal Sinus Surgery Rice D Ravens Press 1993 Pulsatile irrigation before sinus surgery is recommended to reduce infection and after surgery to restore ciliary function and reduce patient s symptoms Rhinoplasty Edited by Rolin K Daniel M D 1993 Chapter 2 by Geroge Meredith Four days after nasal surgery start to use the Pulsatile Irrigator Almost all patients find the cleaning provided by pulsatile irrigation a great source of comfort It significantly improves mucociliary transport in the first few weeks postoperatively Evaluation of methods of Sinus Nasal Irrigation Irrigation Post Sinus Surgery Cenjor C Gutierrez R Congress of Spanish Society of Otolaryngology and Cervical Facial Pathology Las Palmas de Gran canaria 12 16 Octubre de 1998 Pulsatile Irrigation is the preferred method of treatment after endoscopic surgery Highly accepted by patients Fungus Infection Effect of anti fungal nasal lavage with amphotericin B on nasal polyposis Ricchetti A Landis BN Maffioli A Giger R Zeng C Lacroix JS J Laryngol Otol 2002 Apr 116 4 261 3 Rhinology Unit Department of Otorhinolaryngology Head and Neck Surgery Geneva University Hospital Switzerland Recent studies have suggested that allergic fungal rhino sinusitis could be involved in the development of nasal polyposis The aim of this study was to evaluate the response of anti fungal nasal lavages Patients performed nasal lavage with 20 ml of a one per one thousand amphotericin B suspension in each nostril twice a day for four weeks In addition all patients continued their saline nasal lavage and their conventional topical corticosteroid spray This study included 74 patients with a mean age of 46 years range from 19 to 73 Before anti fungal treatment the distribution of nasal polyposis according to Malm was 13 patients in stage I 17 5 per cent 48 patients in stage II 65 per cent and 13 patients in stage III 17 5 per cent After anti fungal nasal lavages the total disappearance of nasal polyposis was observed in 29 patients 39 per cent Eight patients were stage I 21 stage II and none stage III In patients who have had previous endoscopic polypectomy and functional endoscopic sinus surgery total disappearance of nasal polyposis was seen in 24 patients 47 per cent Hyper reactivity to fungal organisms could be one of the mechanisms underlying the development of nasal polyposis A direct effect of amphotericin B suspension on the integrity of the cell membrane of the polyps epithelium could not be excluded Effects of Aspergilis fumigatus and Alternaria on human ciliated epithelium in vitro Cody DT 2 nd Mcaffrey TV Kern E Laryngoscope 1997 Nov 107 1511 4 Nasal cilia are inhibited by toxins from Fungi Inhibition of the cilia can reduce the effectiveness of natural healing Cystic Fibrosis Management Of Sinusitis In Cystic Fibrosis Moss RB King W Arch Otolaryngol Head Neck Surg 1995 1 21 566 572 Stresses the use of pulsatile irrigator with nasal adaptor for home use Recommends antibiotic irrigation of sinuses Pulsatile irrigator Irrigation with Nasal Adaptor is used for CF Cystic Fibrosis Currents Volume 11 No 4 Method For Rapid Evaluation Of Topical Of Topically Applied Agents To Cystic Fibrosis Wine JJ King W Lewiston NJ Am J Physiol 1991261 Lung Cell Mol Physiol 5 L21 8 L221 Pulsatile isinus irrigation makes an ideal vehicle for local

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  • Ears
    sound is used as the tinnitus Coleus The advantage of this masker is the price we are using a single tape and the portable tape players every household with a child already owns Another is that the volume is easily adjusted And socially so many people nowadays work and play with a Walkman c type instrument that many patients prefer this to the standard masking device in the ear If the masking is needed for periods longer than 30 minutes the tape can be rewound Nerve Enhancement In another group of patients this same tape device can be used as a type of biofeedback device to reduce tinnitus I call this nerve enhancement Here the user places the tape sound into the unaffected ear again using a single ear piece and rests in a comfortable chair It is best to be fully relaxed Now he adjusts the tape volume of the tinnitus sound so that it is LOWER than in the affected ear He than suggests that the body match the volume of tinnitus of the affected ear with that of the tape player Ideally the body SEES what to do and proceeds to reduce the volume in the affected ear Over time the volume is reduced until the patient is asymptomatic What the actual physiology of this method is is unknown But then similar processes take place in Biofeedback the hand is warmed or cooled by showing the subject a reading on a dial of minute temperature changes People learn to change temperature heart rate brain waves when they see the readings on the dial and are instructed to tell the body to change the temperature or the brain wave And remember rats can do the biofeedback changes as well as humans which demonstrates that the body does the work independent of intelligence Reinforcement Reinforcement is one of the most important factors that bring patients to my office for tinnitus symptoms In a reinforcement cycle the more it itches the more you scratch the more the anxiety the more it itches Whether this involves contact lenses that result in spasm of the eye muscles or the itch or the dentures that don t fit well anxiety can reinforce and make the symptoms much worse This is particularly true in tinnitus when the annoyance or worry may cause tight muscles and reduced circulation and increased awareness of the tinnitus and then more tinnitus more worry and so on When I published the first article on using biofeedback for tinnitus in 1975 Grossan 1975 I described the benefits of breaking the reinforcement cycle Performing nerve enhancement does this because in the relaxed state muscle relaxation that is anxiety is reduced and the reinforcement cycle can be broken But experience has shown that an additional factor is at work here By showing the body what to do right reducing the tinnitus volume the body proceeds to do it My patients are instructed to do this process 15 minutes a day The relaxation instructions are the same as in my 1976 article Grossan 1976 Breathe in at the count of 4 and out at the count of 6 As you exhale let that be a signal to relax your entire body Or progressively relax from the feet the legs etc to finally the jaw Or visualize a relaxed scene Science has shown that you cannot have anxiety if your muscles are fully relaxed And you reduce or eliminate the need for drugs Relaxation Excercises The tape of the individual tinnitus sound can be prepared by the audiologist or my office can prepare them for you by having the audiologist perform a tinnitus match test and then sending us the results The same tape can be used for masking or for the enhancement It is necessary to use a single ear piece in the affected ear for masking and in the normal or unaffected ear for nerve enhancement Sometimes the major benefit of this tape is that the patient can take charge of his own treatment using either the enhancement or the masking Indeed Dr Murai describes having the patient measure his own tinnitus and masking effect A nice introduction to Biofeedback is given in the pages of LifeMatters Click Here to return to the top of this document Back to The On Line ENT Consultant Home Page Dizziness and Vertigo Dizziness Vertigo and Their Causes Dizziness and Vertigo are terms that are sometimes used interchangeably by lay persons but they terms have clearly different meanings for doctors Vertigo is the sensation of moving either you feel like you are moving or the room feels like it is moving This often occurs when the fluid in the inner ear called the labyrinth is affected Dizziness on the other hand is any sensation of unsteadiness or feeling faint or difficulty in walking and can have many causes Physicians sometimes have to work hard to get the patient to properly convey what they are feeling you can be dizzy from getting up out of bed too fast Here the blood hasn t had a chance to catch up with your brain any part of the balance circuit may not be getting enough blood This can make you dizzy and faint Any blow to the head even a severe whiplash can cause some swelling in the circuits and make balancing a problem We can do a test called Electronystagmography and tell if the neck is a causal factor or if it is Benign Positional Vertigo Balance Keeping one s balance is a highly complex activity Balance consists of four elements Your eyes can tell you which way is up In the inner ear are three water tubes called semicircular canals Picture of ear at http www teleport com Veda gallery html They go in 3 different directions Think of them as a carpenter s ruler with a bubble The bubble goes up when you tilt your head One canal or bubble system is for forward and back

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  • Clearing Your Ears
    is equalized Many people reccomend swallowing or blowing while holding your nose to clear your ears if you have trouble That s because your sinuses are connected to your eustachian tube When your sinuses are blocked or irritated your eustachian tubes can become blocked as well This is why sinus medication can help you clear your ears I promise this is true it is not that I don t know my nose from my ear Antihistamines Chlophenarimine Entex ternafdine Seldane will help and you should take these with you if you have to fly with a cold or allergies If you have a lot of trouble clearing your ears all the time try this Practice Divers LEARN to clear their ears with practice we are simply conscious of the part of our body that opens the Eustacian tubes like other people are conscious of their fingers Try to clear your ears a few times every now and again by blowing gently while holding your nose Go ahead and try the old standbys chewing gum and holding your nose and blowing These usually work if you keep at it FOR THE DIVER Same for you only more important since failure to

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  • Drug Treatment for Sudden Hearing Loss Reported
    not only reduce damage to auditory tissues and reduce hearing loss due to noise and chemical insult but in some cases to actually reverse it Now the American BioHealth Group LLC of San Diego CA has signed an exclusive license with the United States Navy to bring this new treatment to the market Under the terms of the license American BioHealth Group will conduct clinical research product development and have an exclusive license to market the new compound It will be the first pharmaceutical product in the marketplace targeted at specific hearing loss The compound is not yet available to the public We are still involved in intensive testing and development says David Karlman of American BioHealth Our target date for getting this to the public is 2007 Bone jarring noise generated by machinery gunshots jet engines and rock concerts destroys hearing and hearing loss costs the Veterans Administration over 300 million a year on disability compensation and treatment for hearing loss the single largest disability expenditure it has The auditory receptors in the cochlea are what actually hear sound says Commander David Street who oversees the research on the treatment at ONR These are connected to nerve cells and they in turn are connected to the brain If we are able to repair and re grow injured or damaged auditory hair cells inside the cochlea then some hearing may be restored Dr Kopke is quick to point out that older long standing hearing loss due to noise or chemical exposure probably will not be helped by the new drug We are trying to prevent hearing loss by bolstering the inner ear s antioxidant defenses making the ear more resistant to noise or toxins or infection Dr Kopke says And we re also exploring strategies to regenerate the inner ear

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  • Throat Problems
    tube into the middle ear When the lower 1 3 of the throat is infected you may be hoarse because the larynx is swollen and can t function see Laryngitis or hoarseness Many people get hoarse because they gargle with a sore throat which is like rubbing your eyes when they are infected When you feel a sore throat coming on aspirin chewing gum any flavor is recommended Ice drinks are best when there is swelling or pain The throat is especially painful when the uvula the part that hangs down the middle of the throat from the soft palate swells The uvula can also swell as an allergic reaction just as the eye or nose can Ice is good as well as an antihistamine Sometimes crackers or tostados can scratch the uvula and cause swelling Swelling of the uvula doesn t serve any useful purpose The uvula functions to rise up when you swallow to keep food from going up into the nose Infection can come here as well as to the tonsils or the back of the throat except that swelling of the uvula is quite frightening because of fear it will obstruct the air way It rarely does but it feel like it With a sore throat the uvula is often involved Gargling will cause it to swell Drinking very hot fluids will swell the uvula as well causing discomfort Warm drinks help the throat heal and ice drinks take the pain down Do both Swelling of the throat for whatever cause is helped by ice drinks and proteolytic enzyme tablets with papin and bromelain make sure you use a formula with calibrated enzyme activity one three times a day dissolved in the mouth between the cheeks and the gums In the emergency room the doctor may give a cortisone or similar injection If your throat stays sore and you feel real sick all over you do need to be checked If you have trouble opening your mouth and your voice sounds like you have a potato in it you may have a serious throat abscess and this is a must see the doctor condition If you get frequent sore throats and frequent hoarseness you should try pulsatile throat irrigation on a daily basis This washes away surface bacteria and massages the area so that fresh blood comes in and stale old blood leaves Many patients are frightened when they see white spots on the tonsils This is perfectly O K These are the dead white cells and dead bacteria that accumulate in the holes of the tonsils called crypts Here the tonsils are just doing their job If breath odor is a problem see above Click Here to return to the top of this document Asthma or Ventricular Dysphonia This is an uncommon condition that few persons would ask me about The reason for including ventricular dysphonia here is that when this is misdiagnosed the results can be tragic and ruin a person s life This

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  • Laryngitis
    if the pain follows flying or scuba diving It is very important to look for a a combination of papain and bromelain and b a calibrated enzyme activity of one million units of bromelain from pineapple and a half million units of papain from papaya Be careful of using enzyme tablets which do not list the enzyme activity you can t be sure if you re getting the right amount and most have insignificant activity Hoarseness develops because the cold or sore throat gets to the larynx and causes the vocal cords to swell It gets worse because we try to speak in spite of the swelling or if people speak incorrectly The more relaxed your neck muscles the less chance for hoarseness Frequent hoarseness may be caused by tight neck muscles Make sure your head is not turned when you talk Speaking from bed may be a factor I have my singers do an exercise in the shower with the water directed onto back of the neck gently turn the neck as if to see who is standing behind you Alternate sides and continue for 3 minutes If performed daily this will help to keep these muscles relaxed Teachers

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  • Vocal Survival Techniques For Singers Who Abuse And Overuse Their Voices
    6 Excessive tension of the extrinsic neck muscles jaw and face 7 Persistent throat clearing 8 Tickle in the throat 9 The appearance of restlessness or nervousness 10 A wrinkled forehead 11 Loss of voice IV Causes and manifestations of vocal dysfunction in the speaking voice Incorrect habitual optimal pitch and glottal initiation of sound So that you can use this information let s discuss these two areas One of the most damaging vocal behavior I know is speaking at the incorrect optimal pitch usually too low Vocal Fry More women than men have this problem A soprano with vocal problems may have a speaking pitch around C or D below middle C When I vocalize them in this area they claim it is too low but that is where they are speaking This causes register interference discrepancy usually affecting bridging between registers and seriously affecting the ability to sing in the upper voice There can be little hope of successfully rehabilitating the singing voice until the optimal pitch is raised appropriately Learn your correct optimal pitch and use it all the time If your voice is gravelly and hoarse it is probably too low When the optimal pitch is used the quality of the voice is clear and does not tire as quickly Not very scientific but a way to find your approximate optimal pitch is to hum sliding upward until the voice is clear This will be close to the optimal pitch Become aware of that approximate pitch and continue to speak there never allowing the voice to gradually anchor on the very low damaging pitches When speaking the voice pitch encompasses a range of a fifth or more but the optimal pitch is the most frequently used pitch Begin by using mainly head voice for speaking it may sound childlike to you The phrasing must be legato sustained and well supported using no excessive force or pressure Until the voice is healthy do not use your projected performing voice Glottal initiation of words and phrases is another surefire way to finish off your voice It occurs when the delivery is staccato breaks after almost every word and is disjointed not legato The louder the voice the harder the folds collide the higher the pitch the more frequently the folds slam together In glottal initiation of words or phrases glottal attack the glottis closes firmly before breath pressure is applied To make a sound the folds must explode open against muscular resistance causing great muscular tension and vocal fatigue Glottal Initiation of words or phrases is quite common among speakers whose speaking pitch is too low and those with voice disorders The damage to the folds causes trauma irritation and swelling Hard fast glottal attacks for 20 minutes may cause hemorrhaging of the vocal folds and even 24 hours of complete voice silence may not repair the damage Unfortunately most habitual voice abusers cannot be persuaded to rest the voice until they can hardly croak To correct this

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  • Vocal Survival Techniques For Singers Who Abuse And Overuse Their Voices
    plenty of liquids so that your throat membranes are not dry Remember for a beautiful sound and correct resonation of the voice the mucus membranes of the nose and mouth must be moist Don t save Entertainer s Secret for times when you are desperate dry or just before a performance Use it often during the day particularly if your mouth is dry or you have reflux and vocal fatigue Researchers at Thomas Jefferson Medical College in Philadelphia provoked heartburn by feeding the volunteers a meal that was high in fats The patients were then asked to lie down on either their left or right sides and the esophageal acid levels were measured for four hours Those patients who rested on their right sides experienced reflux for 200 minutes while the left siders experienced approximately 100 minutes half the amount Gastroenterologist Dr Donald Castell said Lying on the right side may un crimp the esophagus where it enters the stomach making it easier for stomach acids to enter These findings are valid whether induced by fat consumption caffeine alcohol spicy foods or acid foods so try sleeping on your left side more often Treatment of reflux can be relatively simple depending on the cause and severity of your condition Your self discipline and adherence to the Reflux Regimen listed below can in many cases eliminate or reduce the symptoms of reflux Try the regimen for a week if not free of symptoms consult your physician immediately If it is indeed reflux medications may be required The most common medications recommended by physicians are antacids Four over the counter medications are Gaviscon my preference Maalox Mylanta and Gelusil Diet restrictions and antacids may be sufficient to relieve symptoms of mild reflux however physicians may recommend taking antacids in conjunction with other medications Some medications prescribed which suppress production of stomach acid are Zantac ranitidine Tagamet cimetidine Pepcid famotidine Axid nizatidine and Prilosec omeprazole Note Recently researchers have advised carefully monitoring anyone taking Propulsid It sometimes causes incontinence particularly women Complete Vocal Rest For A Few Days May Be Required depending on the severity of your symptoms Then you must limit vocal use particularly when speaking until the reflux improves When beginning to rehabilitate the voice use easy humming exercises and lip trills Vocalize quietly in the middle range Remember medications alone may not probably will not solve your problems Singers and professional voice users with even mild reflux must raise the head of their beds and follow the diet in order to gain optimal vocal improvement with or without medications The Loeding Reflx Regimen 1 ELEVATE THE HEAD OF THE BED at least 4 6 inches on wood blocks DO NOT SUBSTITUTE MORE PILLOWS This only aggravates the condition Put the blocks under the legs of the bed allowing gravity to keep the acid from reaching the vocal folds 2 DO NOT LIE DOWN for at least three hours after eating Gravity makes it easier for the liquids and foods to

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