EIC Social Media Team
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We’ve known for some years that antibiotics don’t help most bronchitis cases and other respiratory problems, like sinusitis. In fact, taking antibiotics isn’t as effective for treating bacterial sinusitis as is widely believed. The American Academy of Otolaryngology—Head and Neck Surgery Foundation says antibiotics fare only slightly better than waiting for the infection to go away on its own. This scant improvement is most likely not worth taking antibiotics. Yet over-prescribing antibiotics persists—even when they don’t help and can even hurt — a study says.
A new study published last month in the American Journal of Managed Care reports that particularly with urgent care, primary care and emergency departments, clinicians seldom follow evidence-based care guidelines for the treatment of common sinusitis. The study criticizes several clinical practices such as over-prescribing antibiotics and over-ordering CT scans.
From the report, only 29 percent of adult acute sinusitis encounters followed accepted clinical guidelines for the prescription of antibiotics, according to the Kaiser Permanente study. And they found the ordering of CT scans more likely in emergency room visits, resulting in expensive imaging tests.
Sinusitis strikes nearly 31 million Americans per year, according to the American Academy of Family Physicians, costing around $3 billion because of tests and procedures, outpatient and emergency department visits, and medication. It is one of the most prescribed conditions for which antibiotics are used, but national clinical guidelines state that antibiotics should only be used when it lasts more than seven days.
Providers may be going against what is suggested by current guidelines, the researchers suggest, resulting in unacceptable standards of care. From the study, antibiotics were prescribed in 89.2 percent of the 152,774 EHR encounters. Nearly 50 percent of these encounters were with patients having symptoms for fewer than seven days.
Granted, each recorded visit entails a different set of symptoms with unique circumstances, especially for those presenting the most urgent and severe symptoms. But from the study, over 75% of the cases took place at the primary care providers’ offices. This number is much too high, considering that most patients were given antibiotics when they had only exhibited symptoms for less than 7 days. We understand the importance of immediate relief, but it’s the long-term harm that should be overriding our decisions.
Despite the frequency of acute sinusitis cases, treatment and prescription habits have not been closely monitored. “A clear understanding of current practices requires awareness of how acute sinusitis is treated in different acute care settings,” say the researchers, from Kaiser Permanente’s large, integrated Southern California system.
This study points to how we as healthcare providers need to better understand and coordinate acute care services in order to achieve the triple crown of health care: that is, improving the patient-care experience, the overall population’s health, and reducing healthcare costs.
The age-old problem of over-prescribing antibiotics may be partly due to the difficulty in differentiating bacterial sinusitis infections from the more common viral ones. To help clinicians identify patients who are likely to benefit from antibiotics for acute sinusitis, the most pragmatic and evidence-based approach is to focus on the patient’s length of symptoms.
The National Sleep Foundation estimates that over 18 million Americans suffer from the condition of obstructive sleep apnea (OSA). Yet much misinformation continues to complicate the lives of those with this sleep-related condition because it is largely underdiagnosed.
To further worsen matters, the American Journal of Epidemiology reports that OSA is on the rise. Since OSA is underdiagnosed, those who most need treatment do not receive help nor proper care. Might someone you know have sleep apnea? This is a serious question that most people overlook, because sleeping disorders are often overlooked. Let’s take a look at three personal stories about how OSA was misdiagnosed, and how these three comments will shed much insight about this misunderstood condition, and how important it is to get treatment as soon as possible.
- Sleep apnea may be inherited. Case in point: Adam Amdur, 41, of Sarasota, Florida, believes he’s had sleep apnea since childhood, but was not diagnosed until he was 35. He learned that inherited physical features may exist with his children, such as an enlarge tongue base or enlarged tonsils, and that these features may put his own daughter at risk, which it did. He says that understanding this condition allowed him to get early treatment for his daughter, whom he believed would suffer “years of slow incremental decline—physically and mentally.
Remember, up to 4% of children have sleep apnea, according to the American Sleep Apnea Association. “Absolutely, it can be hereditary,” says Shalini Paruthi, MD, a fellow of the American Academy of Sleep Medicine and director of the Pediatric Sleep and Research Center at SSM Cardinal Glennon Children’s Medical Center in St. Louis.Snoring is not always harmless.
- Snoring can be more serious than you think.“Lots of people joke about snoring,” says Robin Simon, 51, of Chicago. Simon learned how serious after sharing a hotel room with a friend while on vacation in Italy; her snoring was so loud and strong that her friend believed it was unusually loud and asked Simon to get it checked. Simon did and learned she had sleep apnea.
Women have sleep apnea, too. Ask Tracy Nasca, 61, who wishes more people realized that women can have this common disorder. It took doctors 14 years to diagnose her sleep apnea because, in part, of her gender. It was once commonly believed that women didn’t suffer from OSA
- Many people mistakenly assume OSA is a man’s disease, Dr. Paruthi says. But about 4 percent of men, and 2 percent of women, in the US have sleep apnea, according to the World Congress on Sleep Medicine. It’s very common for bed partners or family members to say someone is snoring loudly and chronically, or choking or gasping during sleep. That’s often how doctors discover sleep apnea, Paruthi says.
Sleep apnea should never be ignored. “I wish people knew that sleep apnea never gets better if left untreated. It only gets worse,” Nasca says. Untreated obstructive sleep apnea can cause serious health problems such as diabetes, high blood pressure, heart disease, and weight gain. Furthermore, complications can also include daytime fatigue which is known to affect everything from workplace productivity to car accidents on the freeway, and could further cause your partner to become sleep-deprived. In short, snoring issues should not be ignored nor taken lightly.
For kids going into surgery, if you suspect a sleep-related disorder, then you should consider a sleep-disorder screening questionnaire. The latest AANA (American Association of Nurse Anesthetists) Journal mentions how anesthesia professionals can identify children with sleep-disordered breathing (SDB) before undergoing a general anesthetic.
According to the article (2015) “Snoring, Trouble Breathing, Un-Refreshed (STBUR) Screening Questionnaire to Reduce Perioperative Respiratory Adverse Events in Pediatric Surgical Patients: A Quality Improvement Project,” one of the main challenges of addressing SDB in children is similar to the one for adults: That is, there is a lack of awareness of the risks involved with this condition before having surgery.
Leading the report, Karrey L. Terry, CRNA, DNP, says, “Parents are often unaware of the potential problems related to their child’s snoring. Recognition of this condition is of utmost importance, as children have died after routine tonsillectomies after receiving too much pain medication.”
Anesthesia professionals are in a unique position to uncover SDB because it becomes more evident how patients breathe before going under. In addition to these professionals having knowledge of a patient’s breathing patterns, Certified Registered Nurse Anesthetists (CRNAs) are in a perfect position to reveal undiagnosed SDB prior to surgery. For both professionals, it is essential for them to head off any breathing complications during anesthesia.
One possible complication has to do with general anesthesia suppressing the upper airway muscle activity, which may impair breathing by allowing the airway to close. Anesthesia thus may decrease arterial oxygen saturation.
The STBUR questionnaire provides 5 questions in order to identify SDB prior to surgery. It is vital that the anesthesiologist identify any “at risk” children of this condition because of possible complications. According to the article, the likelihood of developing a perioperative respiratory adverse event (PRAE) increases three-fold when 3 STBUR symptoms are present, and 10-fold when all 5 symptoms are present.
Therefore it is crucial to include the STBUR questionnaire in the pre-anesthesia interview in order to detect a sleep-related disorder. This serves to raise awareness of potential risks, and allows anesthesia professionals to modify their airway passage and anesthesia plans toward safer practices.
A few months ago, Royal Philips, a Dutch diversified technology company known for its healthcare reports, released the “Sleep: A Global Perspective” report. This report is the first in a series of studies about the sleeping trends and habits taken from a survey of nearly 8,000 people across 10 different countries.
The report revealed three key factors affecting sleep: worrying about work, finances, and the economy. Sleep is a fundamental human process, and is recognized globally as essential to health and well-being, yet most people do not take the necessary steps to improve it.
“Over the past few years, many surveys have focused on the negative impact that technology and mobile devices can have on sleep, but our report confirmed that the global factors impacting people’s sleep are much more varied and complex,” says Teofilo Lee-Chiong, MD, chief medical liaison, Philips, in a release. “And, while it’s refreshing to see people around the world equally valuing sleep as critical to their overall health, there’s clearly more that people can be doing to ensure they’re on a path to a better night’s sleep.”
Of the 7,817 people surveyed in the US, Brazil, the UK, France, the Netherlands, Germany, China, Japan, South Korea, and Australia, 96% responded saying sleep was very important; 57% admitted their sleep should be improved; and only 17% consistently slept well.
In addition to these questions, 6% of respondents claimed to have obstructive sleep apnea (OSA). That makes 100 million people globally suffering from this disorder. In the US, an estimated 10 million people have this condition with 80% of patients remaining undiagnosed, which suggests a substantial number of people may benefit from proper screening, diagnosis, and treatment of obstructive sleep apnea. To make matters worse, only around 1-2% of those with OSA receive treatment.
Interestingly, a list of 12 key factors surveyed overall health and well-being, including family, work, school, social life, and intimacy with a partner. From the list, sleep ranked the highest in importance at 87%. Close behind it at 84% was money/financial security. Another survey of 13 factors asked respondents what kept them up at night: 25% answered with financial/economic issues. Surprisingly, 67% of respondents said their mobile phones were in reach, but only 21% remarked that technology was a sleep disrupter.
“Our report indicates how psychological factors can impact sleep, and how those factors can change depending on the times in which we live,” says Dr. Mark Aloia, senior director of global clinical research, Philips. “Combating stress is critical to a good night’s sleep, but the toughest part for people is often just getting motivated to make changes. These data further demonstrate that sleep needs to be viewed and treated holistically, with both technology and lifestyle solutions that work together to promote better health.”
How Might You Take Sleep More Seriously?
The first step to improving your health often begins with investigating an underlying problem. If lack of sleep is yours, then it could be a sleep disorder. Globally speaking, sleep disorders are not uncommon. The more serious problem of obstructive sleep apnea may affect over 100 million people globally. OSA is often mis- or undiagnosed here in the US as it is in other countries. If you feel you’re at risk for sleep apnea symptoms, talk to your doctor about seeing an Ear, Nose and Throat specialist, trained in obstructive sleep apnea.
Besides understanding and being aware of potential sleep disorders, it is important to develop behaviors that improve your sleep. Yet in this economy, it’s no surprise that financial and economic issues creep into our sleep—they’ve been life stressors for some time—but let’s take notice of how minor life changes, like exercise, can balance the body and mind for a good night’s rest that we all deserve so much.
A growing body of research has pointed to some common problems found among western societies: That allergies, asthma and chronic sinus problems are increasing. Although the research is not conclusive, some researchers suspect one main reason for these growing problems is the “hygiene hypothesis,” also called the “cleanliness hypothesis.” This theory states that a lack of early childhood exposure to infectious organisms such as those found in gut flora, probiotics or common parasites increases the chances of allergic diseases because the immune system is naturally suppressed. In other words, the immune system’s tolerance is weakened because it hasn’t been exposed to certain bacteria and parasites that it should have at an earlier age.
Some of the microorganisms that many allergy and asthma suffers have not adapted to are allergens. People who are not routinely exposed to some allergens can develop allergies, particularly as children. When they are later exposed to an allergen, the body misidentifies the foreign substance as dangerous and then reacts with hives or other allergy symptoms.
There are many detractors of this hypothesis. But did you know that allergies and asthma are uncommon in developing or underdeveloped countries yet are increasing in developed countries?
Furthermore on increased allergies, research has shown that severe allergies are connected to chronic sinus problems and asthma. The connection to all these conditions has to do with the inflammation in the airways, which is similar in the nose and sinuses or in the lungs.
What can we do to prevent these conditions from progressing or causing greater severity in the other conditions? There is growing evidence that early management of allergies or sinus inflammation can reduce the risk of developing asthma. Immunotherapy (allergy shots, or now sublingual drops or tablets) in allergic and asthma-prone children has been shown in a couple of studies to reduce developing asthma and reducing asthma attacks.
According to Dr. Michael S. Benninger, “Sinus surgery may also be preventative in some people.” In a recently presented paper at the American Rhinologic Society’s spring meeting, researchers suggested people who underwent sinus surgery had lowered the severity of and even prevented their asthma from occurring.
Other interesting results from the paper include:
- Allergy patients with chronic sinusitis were at a higher risk of developing asthma than those with no allergies.
- Early surgical treatment (less than two years after a sinusitis diagnosis) resulted in less long-term asthma than in those who had surgery later (four to five years after a sinusitis diagnosis).
Sinuses affect the lungs and vice versa. What may cause inflammation in the sinuses may do so also in the lungs, especially for those with allergies. For those with allergies and chronic sinusitis, keeping the sinuses under control helps the lungs, and keeping the lungs under control helps the sinuses. Aggressive treatment, whether with allergy immunotherapy or sinus surgery, may help reduce the risk of developing a worse airway disease, like asthma.
What all this means is that we might be recommending surgery and immunotherapy earlier in order to relieve later symptoms.
One final though before you slather your children’s hands in antimicrobial gel: sometimes a little dirt is good for a little while. Of course, this doesn’t mean they should wash their hands regularly; it means we don’t have to be overly cautious with a little dirt sometimes because it might reduce the development of asthma and severe sinus problems.
The Centers for Disease Control and Prevention estimate 50-70 million US adults have sleep or wakefulness disorder, and the root cause of these disorders for most is snoring. Many of these snorers have a serious sleep disorder called Obstructive Sleep Apnea (OSA). Snoring is one of the most common symptoms associated with mild obstructive sleep apnea, and is caused by soft tissues vibrating and obstructing the pharynx during sleep. However, most people who snore do not have OSA.
For both those who are just heavy snorers (called primary) and those who have mild OSA, a Brazilian study published recently has found exercises of the oropharyngeal, mouth and tongue significantly reduce the frequency of snoring by 36%. This study was published on the Online First section of CHEST, a journal published by the American College of Chest Physicians.
For the past 20 years, a number of nonsurgical treatments for snoring have been available such as avoiding alcohol, painkillers, sleeping on the back, and weight loss. Surgeries may include treatment for nasal problems, tissue reduction of the palate and upper airway. To add something so simple like mouth and tongue exercises should come as a great relief for those with mild OSA and primary snoring problems. These exercises in conjunction with other treatments should also help on a case-by-case basis.
According to the study, below are the exercises they recommended.
- Push the tip of your tongue against the roof of the mouth and slide it backward and forward;
- Suck the tongue upward against the roof of the mouth, and press the tongue against the roof of the mouth;
- Push back of your tongue against the bottom of the mouth at the same time keeping the tip of the tongue in contact with the bottom, front teeth.
- Elevate the back of the roof of the mouth and uvula while saying the vowel “A.”
“This study demonstrates a promising, noninvasive treatment for large populations suffering from snoring, the snorers and their bed partners, that are largely omitted from research and treatment,” said Barbara Phillips, MD, FCCP, President-Designate, American College of Chest Physicians, and Medical Director, Sleep Laboratory at the University of Kentucky College of Medicine.
To be honest, noninvasive approaches are always the first choice for patients with mild obstructive sleep apnea, and for those who snore, which are a lot of patients, this will be welcome news.
University of New South Wales (UNSW) researchers have answered the enduring question of how the brain processes hearing between our ears, which is essential for localizing sound, hearing in noisy conditions and protecting us from noise damage. This study should get many hearing specialists excited.
The landmark animal study also provides new insight into hearing loss and is likely to improve cochlear implants and hearing aids. A cochlear implant is a surgically implanted electronic hearing device that helps amplify sound for a profoundly deaf person or for someone with severe hearing.
The reason for cochlear implants is that they provide hearing to nearly deaf persons who have damaged sensory hair cells in their cochleas. In these patients, the implants provide enough hearing in order to understand speech. However, the quality of sound differs from natural hearing, because the brain receives less natural sound information to interpret it. Yet the implants offer enough for the patient to hear and understand speech and environmental sounds.
UNSW Professor Gary Housley, senior author of the research paper, said his team’s primary aim was to understand the biological process behind the ‘olivocochlear’ hearing control reflex. The professor added, “The balance of hearing between the ears and how we discriminate between sounds versus noise is dependent upon this neural reflex that links the cochlea of each ear via the brain’s auditory control centre.
The key to this finding is that the researchers were able to fully understand how the olivocochlear reflex works. Professor Housley stated, “When sound intensity increases, the olivocochlear reflex turns down the ‘cochlear amplifier’ to dynamically balance the input of each ear for optimal hearing, sound localisation and to protect hearing.”
Another important aspect of this study found that the cochlear’s outer hair cells, which amplify sound vibrations, also provide the sensory signal to the brain for dynamic feedback control of sound amplification, through a small group of auditory nerve/sensory fibers that were previously misunderstood.
The researchers, using mice, discovered how the olivocochlear reflex in each ear communicates with the cochlear auditory sensory fibers, and this feedback loop allows the brain to balance sound in the environment.
Professor’s Housley’s team further speculated that hearing loss humans experience from old age may be related to the gradual breakdown of these sensory fibers connected to the outer hair cells.
“A major limitation of hearing aids and cochlear implants is their inability to work in tandem and support good hearing in noisy conditions,” Professor Housley also added. “The ultimate goal is for cochlear implants in both ears to communicate with each other so that the brain can receive the most accurate soundscape possible.” This research helps hearing specialists improve cochlear implant devices so that we can create a more natural and effective learning device for those with hearing loss.
According to researchers at Ben-Gurion University of the Negev (BGU), they have developed an innovative approach to testing sleep quality using their new breath sound analysis (BSA). This is less expensive and invasive than current polysomnography (PSG) technology, which has been the gold standard as a sleep apnea test. The study has been published on PLOS Online.
“One of the main goals of sleep medicine today is to improve early diagnosis and treatment of the ‘flood’ ” of subjects presenting with sleep disorders,” says Prof. Yaniv Zigel Ph.D., head of the Biomedical Signal Processing Research Lab in BGU’s Department of Biomedical Engineering.
Prof. Zigel added, “We’ve developed a non-contact ‘breathing sound analysis’ algorithm that provides a reliable estimation of whole-night sleep evaluation for detection of sleep quality, snoring severity and Obstructive Sleep Apnea (OSA). It has the potential to reduce the cost and management of sleep disorders compared to PSG, the current standard of treatment, and could be used at home.”
Generally, the most accurate sleep apnea test has been the polysomnograph (PSG). PSG requires a night’s sleep at a sleep center, and subjects are connected to several kinds of equipment that monitor the heart rate, eye, leg and arm movement, breathing patterns, sleep patterns, and brain patterns. The data is processed and must be interpreted by a sleep specialist in order to reveal insights about sleep/wake states and many aspects of physiology. This procedure is time-consuming and costly.
After comparing the two studies, there were only minor average differences in the measurements between PSG and BSA. The researchers measured 150,000 individual time segments (epochs). From these segments, the BSA proved to be 83.3% accurate with 92.2% sensitivity measuring sleep as sleep. These percentages are high. “The results showed that sleep/wake activity and sleep quality parameters can be reliably estimated solely using breathing sound analysis,” says Prof. Ariel Tarasiuk of BGU’s Department of Physiology and head of the Sleep-Wake Disorders Unit, at Soroka University MedicalCenter.”
For obstructive sleep apnea specialists, there has been a shortage of new and accurate tests. This study highlights the potential–and much needed accuracy–of this innovative approach to measure sleep in research and clinical circumstances. Although there are already many advances with at-home evaluations, this technology clearly points to a more improved sleep apnea test for home studies.
Sleep insufficiency may be caused by many societal factors such as 24/7 access to technology and work schedules, but sleep disorders such as insomnia or obstructive sleep apnea also play an important role. The Centers for Disease Control and Prevention estimate 50-70 million US adults have sleep or wakefulness disorder. Such disorders affect our productivity, car accidents and risky behaviors, and they contribute to diabetes, cardiovascular disease and depression.
Researchers from Boston Children’s Hospital and Merck have discovered a way to collect data that represent sleep disorder symptoms by looking at the way people use Twitter. The researchers have created “digital phenotypes” that reflect behavior of someone with insomnia or another sleep disorder. A “digital phenotype” is simply an observable characteristic influenced by genetics or environment.
The research team used publically available data from Twitter to create a virtual test group of 896 active Twitter users whose tweets contained sleep-related words such as “can’t sleep,” “insomnia,” or hashtags #cantsleep, #teamnosleep, or the names of common sleep aids or medications. They then compared data from that test group to those of a second group of 934 users who did not tweet using sleep-related terms. From these tweets, researchers were able to discover larger populations with some sort of sleep disorder.
The use of big data in healthcare has been increasingly effective in predicting diseases, treating them and even curing some. So it’s no surprise that this study was published in the Journal of Medical Internet Research. This timely study is one of the first to look at links between social media use and sleep disorders.
Another interesting aspect of this study is they were able to assess sentiments expressed in users’ tweets—the tweets were hints that patients with sleep disorders may be at a greater risk for psychosocial issues.
Historically, research on sleep disorders has relied on survey methods. Someone calling you and asking you a list questions would be an example. Such methods are expensive, time intensive and often do not represent the larger U.S. population.
John S. Brownstein, who directs the hospital’s Computational Epidemiology Group, said: “We wanted to see if we could use new forms of online data, such as Twitter, to characterize the sleep disordered individual and possibly uncover new, previously-undescribed populations of patients suffering sleep problems.”
“These findings are preliminary and observational only, and need to be studied further,” Brownstein cautioned. “But they suggest that social media can be a useful addition to our toolkit for studying the patient experience and behavioral epidemiology of sleep disorders.”
Sleep disorders are increasingly affecting society, and besides insomnia, one underdiagnosed disorder is sleep apnea. From this study, there is hope that we’ll be able to help more people who suffer from this treatable condition too.
Nearly 37 million Americans suffer from sinusitis each year. Some of these people will have chronic sinusitis, a common condition in which the cavities around the nasal passages become inflamed and swollen—lasting anywhere from 10 days to 8 weeks.
For most people who suffer stuffy noses and sinus pressure from head colds, their experience is at most uncomfortable because these symptoms last a few days. But for a few others, these symptoms don’t go away within few days. For those with chronic sinusitis, these symptoms may drag on for weeks, and in the worst cases, even months. Fortunately, scientists have stumbled upon a potentially new and effective therapy that might address one of the underlying factors associated with managing chronic sinusitis.
The researchers of a recent study developed a simple method to make molecules called low-molecular-weight, arginine-rich peptides from an already-approved drug compound called protamine. Peptides are a type of amino acid and can create antibodies to boost the body’s immune system. In the lab tests, researchers increased nitric oxide production in mouse immune cells and cells that line airways, making them a good candidate for further development of antibodies to boost the immune system.
Nitric oxide (NO) plays a critical role in your body’s immune system. Scientists found that that a peptide molecule from protamine plays an important role as an antimicrobial agent that helps prevent sinus infections. One reason people have chronic sinusitis is that low levels of NO are lodged in the nasal passages. The NO has been linked to trigger and exacerbate this condition in just small amounts. As you recall, sinusitis may make breathing through your nose difficult and can also lead to facial pain and headaches. One therapeutic approach could involve boosting NO levels, and for Mark E. Meyerhoff and colleagues, they want to further test the possibilities of NO improving chronic sinusitis in adults.
Addressing underlying factors that contribute and improve chronic sinusitis are keys to improving this condition.