In this era of accused #FakeNews and political bullying/manipulation of the media, many people have become cynical to what is reported in mainstream news. Some stories are too speculative, some can be unsupported, and others have too great of an editorial bias. As physicians, it is our hope that medical literature is different. Peer review is a time-honored process and is the antithesis to “fake news.” As scientists and physicians, we practice by a guiding principle of using evidence and clinical experience to shape the care of our patients. Even so, every now and then, a whimsical or sensational story comes through that raises our eyebrows.
One of my favorite posters from a Triological Society Sections meeting was a study testing the hypothesis that post-tonsillectomy bleeds more commonly occur during full moons, in red-headed children, in patterns of threes, or on Friday the 13th. The findings of the study were later published in The Laryngoscope, and I am happy to report that the researchers found no association between bleeds and the aforementioned conditions (Laryngoscope. 2004;114:2031–2033). Another favorite of mine: “Craniofacial Injuries Due to Golf Cart Trauma” (Otolaryngol Head Neck Surg. 2011;144:883–887). This was a case series looking at 68 (!) patients seen at a single site trauma center with injuries from golf carts. Sorry if I spoil the conclusion, but I don’t think it will be too shocking to hear that ejection and rollover were the most common mechanism of injury and alcohol was detected in nearly 60% of patients older than 16 years of age.
In this month’s edition of ENTtoday, we cover two stories that may appear sensational, but have scientific merit in their publications.
In “What Happened in Havana?” (p. 20), we review at events from the winter of 2017, when a number of CIA agents and diplomates began to complain of symptoms of intense head pressure, dizziness, and an inability to focus. What was once thought to be an isolated case grew to involve nearly two dozen Americans working in the American Embassy in Havana. What happened next reads as if it came straight from a paperback spy novel: The American and Cuban governments began a series of veiled accusations and denials, with Americans suspecting Cubans of employing an anti-spy practice or “neuro-weapon” and the Cubans denying the association. Michael Hoffer, MD, an otologist at the University of Miami who treated many of the patients, led a team that published a study detailing their vestibular findings in Laryngoscope Investigative Otolaryngology (December 12, 2018. doi: 10.1002/lio2.231). The authors describe the symptoms and objective findings of 25 American diplomates who became symptomatic. Putting aside the political angle of the story, Dr. Hoffer’s article is an important example of how objective testing is necessary to validate patient symptoms.
“Safe Nasal Irrigation,” one of our cover stories, looks at an example of how, at times, the objective evidence can be elusive, but our common sense and clinical acumen take over to protect our patients from harm. The passing of a 69-year-old Seattle woman from amoebic meningoencephalitis has been broadly covered on news networks. Although the source of the infection has not been proven, it is speculated that it came from the tap water she used in her neti pot for nasal irrigation (Int J Inf Dis. 2018;77:18–22). This report comes on the heels of previous case reports of similar amoebic infections linked to the use of saline nasal irrigations from untreated water sources. I agree with the sources interviewed in our article that, as important as nasal saline irrigations are in the treatment of rhinitis and sinusitis, we would be remiss as treating physicians to not emphasize the importance of using distilled or cooled boiled tap water.
I hope you enjoy this month’s issue, and I look forward to connecting next month. Until then, stay warm!