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November 19, 2017

How to do Home Balance Exercises for Treating Dizziness VIDEO

The home balance exercises described in the video may be helpful to resolve dizziness due to vestibular dysfunction that is NOT due to BPPV or Meniere's Disease which are treated differently. Vestibular dysfunction amenable to a home exercise regimen is typically determined based on VNG or ENG testing. Such exercises are helpful in select patients as it slowly challenges the inner ear balance system in such a way to make it work better. The analogy would be a young gymnast doing repetitive exercises to make their sense of balance supernormal in order perform amazing feats on the balance beam or a ballerina doing similar exercises to maintain perfect balance even though they are dancing on the tip of one toe. Needless to say, there is no "pill" that makes balance improve quickly. Drugs like meclizine may only temporarily help, but often makes balance WORSE in the long run. Read more about how drugs like meclizine work.

The human balance system is composed of 3 different systems working together to allow for dizzy-free movement.

• The eyes provide visual cues
• The inner ear balance system provides gyroscopic information
• Proprioception provides sense of position in space based on information provided from the muscles, tendons, and joints

What these exercises try to accomplish is to challenge and thereby improve the inner ear balance system in a graduated fashion by slowly taking away balance information provided by the eyes (by closing them) as well as proprioception (walking heel-to-toe). Although the first few exercises may be overly easy and simplistic, balance may be quite challenging by the end (exercise #10).

Keep in mind that such home exercises will NOT help with dizziness due to BPPV as well as Meniere's Disease. It only helps with stable vestibular dysfunction. To use an orthopedic analogy, BPPV is like a dislocated shoulder for which a single set of highly specific movements can "cure" the problem. Meniere's disease is analogous to severe muscle cramps (periods of absolute normalcy followed by extreme abnormality). Stable vestibular dysfunction is analagous to weak muscles for which working out in the gym regularly is required to make them stronger.

If you are not quite sure what type of dizziness you have, click here to try and figure it out.

The video below explains how the inner ear balance system works:

November 18, 2017

Toy Dolls with Hearing Aids and Even a Cochlear Implant

Lottie Doll with Cochlear Implant
A patient's mom recently informed me that toy companies are now making dolls that reflect the same disabilities that children may have triggered by the viral #justlikeme campaign. With respect to ENT, this mainly entails dolls with hearing aids and even a cochlear implant.

The most recent addition in 2017 is a Lottie Doll named Mia, a wildlife photographer who also happens to wear a left cochlear implant. Ideally, this doll should have been made with cochlear implants on both sides, mainly because most congenitally deaf children who would play with dolls would be deaf on both sides and not just one side. But given that this offering even exists, I guess one shouldn't complain.

This doll can be purchased on Amazon.

Dolls with hearing aids have been around for years. Build-A-Bear Workshops offer plush hearing aid accessories for any bears made in their stores. I tried to find a picture online that shows a bear wearing this hearing aid, but none are to be found. If any readers can post one???

Flaghouse toymaker also makes hearing aid accessories for their line of Just Like Me Dolls.

Flaghouse Just Like Me doll with hearing aid

The "high-end" doll company American Girl has also offered hearing aids through their Doll Hospital.
American Girl doll with Hearing Aid

November 17, 2017

Ear Pain Due to TMJ Video

Not infrequently, a patient presents to the ENT clinic with complaints of ear pain convinced there must be an ear infection. However, on exam, the ear itself appears completely normal!

What could be going on?

Often, the ear pain is actually not because of an ear problem, but due to a disorder of the temporo-mandibular joint otherwise known as TMJ. The pain gets referred to the ear.

This video demonstrates how the TMJ can cause ear pain.

Treatment typically entails soft diet, ibuprofen, and ice packs, but if the ear pain due to TMJ does not resolve, an appointment to see a dentist or oral surgeon is recommended.

And if you are lucky, there are dentists who specialize in TMJ disorders. In my area, these are the TMJ specialists I typically recommend:

Dr. Michael Singer in Bethesda, MD
Dr. Steven Guttenberg in Washington, DC

November 16, 2017

Deviated Septum Surgery (Septoplasty) Video

A new video has been uploaded to show how a deviated septum surgery or septoplasty is performed. Both 3D as well as 2D cross-sectional animations are shown.

November 11, 2017

Dr. Chang Quoted in Article on Stuffy Noses

Dr. Christopher Chang was quoted liberally in a article published on October 18, 2017 entitled "11 Reasons You Have a Stuffy Nose–and What to Do About It".

Dr. Chang was specifically quoted in the article describing allergies, anatomic factors, and nasal polyps as factors of causing nasal obstruction.

Read the article here!

November 10, 2017

Cartoon Showing What Surgery Day is Like from a Child's Perspective

Too often, parents expressed to me that online surgery videos like tonsillectomy and ear tubes were too "violent" for them to watch with their child. What is needed is a video that they can watch safely with their child that shows what will happen from a child's perspective, but rated G. No blood, no cuts, and no grossness included.

Due to such requested demand, I finally created two videos that can be considered "kid-safe" showing what surgery day will be like for them thru their eyes. The first video used "real-life" actors and can be watched here. The other is a cartoon animation as shown above.

I deliberately made the video generic enough such that it could apply to any type of pediatric surgery whether neck mass incision, tonsillectomy, adenoidectomy, ear tubes, or even hernia repair.

Check it out!

Overall, when it comes to medicine and surgery, free video offerings geared towards children are quite limited. Our office has recently started to make attempts to correct this deficiency.

Other child-safe ENT medical videos include:

• How Allergy Vials are Made for Allergy Shots
• Pediatric Hearing Testing

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VIDEO: How Does the Human Voicebox Work?