Breathing Easier with the Help of K. Hovnanian Childrens Hospital

Dr. Samuel Engel, MD, MPH

Ryan Dunckley, 3, of Whiting was a constant worry to his parents. Born with a congenital condition called laryngomalacia, Ryan had an underdeveloped voice box that lacked structural support.

But when he developed a strange breathing problem that wouldn't go away, his mother, Karen, grew concerned. "His breathing sounded like a motor boat, especially when he was exerting himself or sleeping at night," she says.

She videotaped the noises and brought him to Mary Mitskavich, MD, a board certified otolaryngologist affiliated with Jersey Shore University Medical Center.

Because the majority of children outgrow laryngomalacia by age 2, Dr. Mitskavich at first took a watchful approach. But Ryan was slow to crawl, walk, and talk, and his breathing became more labored. At the next appointment, Dr. Mitskavich, introduced her new colleague in the practice, Samuel Engel, MD, MPH a pediatric otolaryngologist at K. Hovnanian Children's Hospital at Jersey Shore University Medical Center.

Dr. Engel, who has a special interest in pediatric airway obstruction, recommended a sleep study to make sure Ryan's breathing was not stopping during sleep, which is an associated condition called sleep apnea. The study was done in an overnight sleep lab, close to Ryan's home in Brick, at Ocean Medical Center.

After determining that Ryan did not have sleep apnea, Dr. Engel recommended surgery known as supraglottoplasty to fix the breathing problem. "I endoscopically corrected the structure of his voice box, which had collapsed," Dr. Engel explains. "The entire surgery was performed transorally so there are no scars. At the same time, Ryan had his adenoids removed and ear tubes placed for recurrent ear infections."

Ryan spent one night in the hospital before going home. As a precaution, he stayed in the pediatric intensive care unit. "The nurses and staff there are so friendly," Karen recalls. "We weren't as severe a case as the other children in the unit that night, but we go the same care. I swear it was just about the next day when Ryan started running around at home. His life changed right there."

Ryan's follow-up care involves speech therapy, but he's "a big, happy, healthy kid," Karen says. "And I can't say enough about Dr. Engel. He is just such a nice guy and talks in a way you understand. He made Ryan very comfortable, too." -Ryan Younger

Toys on Santa's Naughty List

With the holidays upon us, you are probably wondering what gifts to give the little ones. How about the gift of hearing? Each day, a child's ears are bombarded with loud and possibly damaging sounds; why continue that assault by giving a loud toy?

For the last 12 years, Minnesota's Sight and Hearing Association and the University of Minnesota, have teamed up to purchase and test readily available toys for potentially dangerous sound levels. This year, 15 out of 19 tested toys were deemed loud enough to damage precious hearing in 15 minutes. The top offender? Iron Man Mobile Headquarters Action vehicle by Jada Toys, Inc., which came in at a whopping 119.5 dBA! You must realize that a lawn mower produces about 90 dBA of noise and anything over 100dBA poses hearing risk in 15 minutes. Second and third place offenders go to the Fischer Price Learning Letters Mailbox (113.9 dBA) and Sesame Street Help Along Sing a Song (112.1 dBA), respectively.

How do you know if a toy is too loud for children? Try it out. Hold a toy next to your ear and give it a go. If you find yourself flinching at the sound, it is too loud. Noises can be harmful at all ages. However, a child's ears are more fragile due to the smaller size of the ear canal and the increased sound pressure placed upon the eardrum.

Take the time to inspect the toys children already have. If the toys are too loud, control the volume by taking out the batteries and putting packing tape over the speaker to muffle sounds, replace toys with less noisy toys, or restrict use to outside play areas.

Remember to enjoy your holiday season and protect the ones you love!

Candice E. Ortiz, AuD, CCC-A, FAAA

Audiologist

Coastal Hearing and Balance Center

3700 Rt 33

Neptune, NJ 07753

http://www.coastalhearing.com/

Medications and Their Effect on Hearing

Medications that can damage the ear, resulting in hearing loss and/or balance disorders are considered ototoxic. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) Literally, ototoxic means “ear poison.” There are over 100 known ototoxic prescription and over-the-counter medications on the market today. (Mudd, Edmunds, Glatz, Campbell, & Rybak, 2008) These include, but are not limited to, medicines used to treat serious bacterial infections, cancers, and heart disease.
What are the Effects of Ototoxic Medications?
The first sign of ototoxicity is most often ringing in the ears (tinnitus). Permanent, high frequency hearing loss may also occur. Although uncommon, hearing loss as a result of ototoxic medications may be temporary. The hearing loss often remains unnoticed by a person until speech understanding is affected.
In addition to hearing loss, a person may also experience a loss of balance and the feeling of bouncing vision from the medication. These side effects are often temporary as the human body can learn to adapt to theses deficits. (Guthrie, 2008)
Who is affected by Ototoxic Medications?
Use of ototoxic medications can have serious affects on its users’ quality of life. Not being able to hear conversation, or perhaps always feeling dizzy, may cause a person to stop participating in their usual activities. Therefore, it is important that the pros and cons be weighed before the start of a treatment plan.
All people who take ototoxic medications should be aware of its side effects. However, there are those who are at greater risk than others. Infants who are born prematurely are at a greater risk of ototoxicity than adults when taking medications known as aminoglycosides, which treat serious bacterial infections. Children are also at a greater risk for ototoxicity when using cisplatin (a drug used to treat cancer). (Garcia, Martinez, Agusti, Mencia, & Asenjo, 2001)
The elderly, those with kidney disorders, people who already have hearing loss, those who have previously used ototoxic medications, those using multiple ototoxic medications at one time, and those who have genes linked to ototoxic weakness, are also at a higher risk for experiencing ototoxic effects than others. (Garcia et al., 2001; Mudd et al., 2008; Vasquez & Mattucci, 2003)
The “who” is not the only factor to consider when thinking of vulnerability to ototoxic medications. The “how”is also important. The way that medications are delivered can play a role in severity of ototoxic effects. For example, medications put directly into the blood stream by intravenous injection may be more severe than those applied by liquid drops on the eardrum. (Guthrie, 2008)
Can a person protect themselves against ototoxicity?
There is a lot of research being done to develop ways of protecting a person from ototoxic medications. Animal experimentation shows promising results. However, the extent that the animal study results extend to humans is unknown at this time and human studies have not yet been performed. Therefore no protective strategy has been formally approved. (Guthrie, 2008)
What should a person do if they are going to begin using an ototoxic medication?
Monitoring the hearing and balance systems are very important. By thorough monitoring, if a change occurs, adjustments can be made by the doctor to try to save as much hearing and/or balance as possible. Adjustments in treatment can include, but are not limited to, changing the dose, the schedule of treatment, a switch to a less ototoxic medication, or possibly stopping the treatment temporarily. (Vasquez & Mattucci, 2003)
Prior to starting the treatment plan, a baseline evaluation should be conducted which includes a conventional hearing test, high frequency hearing test, word recognition test, otoacoustic emission test, and an electronystagmography or videonystagmography test when possible. Throughout the course of treatment, weekly tests should be performed consisting of at least conventional and high frequency hearing tests and the otoacoustic emission test. Post-treatment tests should also be performed as reactions to the drugs make not take affect right away and cannot be predicted. (Vasquez & Mattucci, 2003)
What can be done when treatment has ended and a person has hearing loss and/or balance problems?
Unfortunately, even with careful monitoring, ototoxic effects may be unavoidable as the primary concern is the treatment of the disease which requires the drug in the first place. If a person is left with tinnitus, hearing loss, imbalance, and/or dizziness, an audiologist can work to develop a rehabilitation plan. This plan may include lessons on better hearing strategies, hearing aids, and/or balance therapy.
If you suspect that you may have, or had, problems related to ototoxic medications, please feel free to make an appointment with our team of physicians and audiologists at Coastal Ear, Nose and Throat.

Coastal Hearing and Balance Center

3700 Route 33

Neptune, NJ 07753

www.coastalhearing.com

(732) 280-7855

Dr. Mitskavich Receives Patient Choice Award

8-3-2009

Mary Mitskavich, MD
3700 Route 33
Ste 101
Neptune, NJ, 07753-3206

Dear Dr. Mitskavich:
You chose to become a physician in order to help people, and made it your life’s work.
It’s a vitally important job, not an easy one, and carries heavy responsibilities balanced by the intangible rewards of the good you do.
Well, those intangible rewards just got a little more tangible.

We are proud to let you know that you have recently been honored by your patients with a Patients’ Choice recognition.

This honor reflects the difference you’ve made in these people’s lives through the exceptionally high praise granted to you by your patients.

Every month, more than 40,000 patients across the U.S. provide online feedback about their experiences with their doctors. They rate various components such as bedside manner, doctor-patient face time, degree of follow-up, courtesy of office staff, and overall opinions.

Over the course of 2008, these reviews have totaled hundreds of thousands patient opinions. While physicians generally receive positive reviews from their patients, only a select few receive uniformly rave reviews across the board. Of those that receive rave reviews, only physicians like yourself-- with near perfect scores - have been voted by their patients for this honor.

In fact, of the nation’s 720,000 active physicians, less than 5% were accorded this honor by their patients in 2008.

You are, indeed, the Patients’ Choice; one of the physicians most highly regarded by their patients.

This notation of your distinction as a Patients’ Choice physician will be prominently displayed in your Profile on a broad collection of web sites, including Vitals.com, RightHealth.com, Google.com, and a variety of Managed Care sites. These web sites are viewed by more than 150,000 people on a daily basis.

Congratulations once again on this outstanding distinction.

Sincerely,


Erika Boyer
Vice President, Consumer Research

The “Patients’ Choice” award is tabulated byMDx Medical, Inc.
MDx Medical, Inc. 1200 Wall Street West, Lyndhurst, NJ 07071 T. 201.459,6264 F. 201.438.4555

Dr. Sean Houston Receives Patient's Choice Award

8-3-2009

Sean D Houston, MD
3700 Route 33
Ste 101
Neptune, NJ, 07753-3206
Dear Dr. Houston:
You chose to become a physician in order to help people, and made it your life’s work.
It’s a vitally important job, not an easy one, and carries heavy responsibilities balanced by the intangible rewards of the good you do.
Well, those intangible rewards just got a little more tangible.

We are proud to let you know that you have recently been honored by your patients with a Patients’ Choice recognition.

This honor reflects the difference you’ve made in these people’s lives through the exceptionally high praise granted to you by your patients.

Every month, more than 40,000 patients across the U.S. provide online feedback about their experiences with their doctors. They rate various components such as bedside manner, doctor-patient face time, degree of follow-up, courtesy of office staff, and overall opinions.

Over the course of 2008, these reviews have totaled hundreds of thousands patient opinions. While physicians generally receive positive reviews from their patients, only a select few receive uniformly rave reviews across the board. Of those that receive rave reviews, only physicians like yourself-- with near perfect scores - have been voted by their patients for this honor.

In fact, of the nation’s 720,000 active physicians, less than 5% were accorded this honor by their patients in 2008.

You are, indeed, the Patients’ Choice; one of the physicians most highly regarded by their patients.

This notation of your distinction as a Patients’ Choice physician will be prominently displayed in your Profile on a broad collection of web sites, including Vitals.com, RightHealth.com, Google.com, and a variety of Managed Care sites. These web sites are viewed by more than 150,000 people on a daily basis.

Congratulations once again on this outstanding distinction.

Sincerely,


Erika Boyer
Vice President, Consumer Research

The “Patients’ Choice” award is tabulated byMDx Medical, Inc.
MDx Medical, Inc. 1200 Wall Street West, Lyndhurst, NJ 07071 T. 201.459,6264 F. 201.438.4555

Tobacco and Children

From the desk of Samuel Engel, MD, MPH
www.coastalhearing.com
732-280-7855

Ear, Nose, and Throat Doctors Warn of the
Many Dangers of Exposing Children to Cigarette Smoke

NEPTUNE, NJ — Despite how far the U.S. has come in its ongoing fight to help people avoid the dangers of cigarettes and smokeless tobac­co products, millions of children are still at risk for being exposed to the dangers of secondhand and “third-hand smoke” that can cause a num­ber of health problems such as head and neck cancer, upper respiratory tract disorders, tooth decay, and behavioral issues. Coastal Ear, Nose and Throat reinforces the need for public aware­ness the dangers to children of tobacco smoke.

The term “third-hand smoke” is a relatively new phrase that describes the chemical contam­inants from cigarette smoke that remain in the air and on surfaces even after the cigarette is extinguished. These chemicals linger for a long period of time and can be reabsorbed into the body if inhaled or ingested.

A recent study in the medical journal Pediatrics found that of adults surveyed, the impact of third-hand smoke is less well known to the public than other smoking-related risks. Since the term is so new, the researchers asked people if they agreed with the statement that “breathing air in a room today where people smoked yesterday can harm the health of infants and children.” Only 65 percent of nonsmokers and 43 percent of smokers agreed with that statement.

Secondhand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by a smoker. Also known as environ­mental tobacco smoke (ETS), it can be recog­nized easily by its distinctive odor. ETS contam­inates the air and is retained in clothing, curtains and furniture. Beyond being unpleasant, annoy­ing, and irritating to the eyes and nose, ETS represents a dangerous health hazard. Over 4,000 different chemicals have been identified in ETS, and at least 43 of these chemicals cause cancer.

Furthermore, on average, children are exposed to more secondhand smoke than non­smoking adults. Coastal Ear, Nose and Throat warns parents and caregivers that exposing chil­dren to any kind of tobacco smoke is dangerous to their health and could result in immediate health problems like triggering an asthma attack, to long-term issues like tooth decay and chronic ear infections that can lead to hearing loss if left untreated.

Dr. Samuel Engel of Coastal Ear, Nose and Throat recommends the following ways to help limit a child’s exposure to tobacco smoke:
First, and most importantly, if you do smoke, stop. Consult your physician for help, if needed. There are many new resources available to help you quit from medications to support groups.

Consider a home/car smoking ban. Do not allow anyone to smoke anywhere in your home or at any time in your car. Studies have shown that parents who enforce a no-smoking ban at home are less likely to have teens who experi­ment with cigarettes.

Finally, if you used to allow regular smoking in your home, consider replacing low-cost items like throw pillows, area rugs, and curtains. For items like couches and rugs, consider a thor­ough steam cleaning which can help reduce the amount of dangerous particles, pollutants, and allergens that are trapped in their fibers.

The American Academy of Otolaryngology - Head and Neck Surgery (AAO­HNS), seeks to advise parents and caregivers that ear, nose, and throat disorders remain among the primary reasons children and adoles­cents visit a physician.
For more information on kids’ ear, nose, and throat health, visit our website at www.coastalhearing.com/.

Sean Houston, MD

Sean Houston, MD

Dr. Sean Houston received his undergraduate degree in Biology from Georgetown University and his Medical Doctorate from the Georgetown School of Medicine. He completed his internship and residency at the University of Pittsburgh.

Dr. Houston is a contributing author to a textbook entitled Decision Making in Ear, Nose and Throat Disorders and has been a featured speaker at the Academy of Otolaryngology, Head and Neck Surgery Annual Conference.

In 2007, Dr. Houston was voted by his peers as one of New Jersey Monthly's Top Doctors. He serves as a Clinical Instructor for the Residency Program at Jersey Shore University Medical Center.

Dr. Houston is Board Certified to treat both adult and pediatric Otolaryngology patients.

Samuel Engel, MD

Samuel Engel, M.D., M.P.H.

Dr. Samuel Engel graduated Summa Cum Laude from Rutgers University. He received his master's degree in Public Health from the UMDNJ-School of Public Health and his medical degree from UMDNJ-Robert Wood Johnson Medical School of Public Health and his medical degree from UMDNJ-Robert Wood Johnson Medical School where he received the Academic Achievement Award and was inducted into Alpha Omega Alpha Medical Honor Society.

Dr. Engel completed his internship and residency in Otolaryngology at the Washington University School of Medicine. He completed his fellowship in Pediatric Otolaryngology at Children's National Medical Center, one of only six Pediatric Otolaryngology programs that are accredited by the Accreditation Council for Graduate Medical Education.

Dr. Engel is chief of Pediatric Otolaryngology at Jersey Shore University Medical Center and the K. Hovnanian Children's Hospital. He specializes in all aspects of Pediatric Otolaryngology, with particular interest in pediatric airway disorders and obstructive sleep apnea, adenotonsillar diseases, otitis media, neck masses in children, pediatric sinusitis and pediatric voice disorders.

Mary Mitskavich, MD

Mary Mitskavich, MD

Founder, Coastal Ear, Nose and Throat

Dr. Mary Mitskavich is the founder of Coastal Ear, Nose and Throat, LLC and is the managing partner. She received her undergraduate degree in Pharmacy from Duquesne University, graduating Summa Cum Laude as the class Valedictorian. She worked as a registered Pharmacist until deciding to pursue a career in medicine.

Dr. Mitskavich completed medical school, internship and residency at the University of Pittsburgh where she was elected to the Alpha Omega Alpha Honor Society. Dr. Mitskavich has had multiple scientific publications and presentations at national meetings. Grant money was awarded to fund her clinical research.

Currently, Dr. Mitskavich serves as a clinical instructor at Jersey Shore University Medical Center. She serves on the management committee of the Center for Advanced Surgery and Pain Management. She was on the Board of Directors of Meridian Ambulatory Care, Inc. She was recently selected to participate in the Meridian Physician Leadership Program. In 2007, Dr. Mitskavich was voted by her peers as one of New Jersey Monthly's Top Doctors.

Dr. Mitskavich is Board Certified in Pediatric and Adult Otolaryngology. She specializes in Balloon Sinuplasty, a less invasive endoscopic sinus surgery. You can see her interviewed on our Balloon Sinuplasty video.

www.coastalhearing.com

sbmccorry@coastalhearing.com

Coastal Ear, Nose and Throat Urges Area Residents to Listen Up in a Down Economy
and Address Hearing Loss During Better Hearing and Speech Month

Neptune, May 1, 2009—May 1 marks the start of Better Hearing and Speech Month, a month dedicated to educating consumers about the need to assure that their hearing is healthy. This year, Coastal Ear, Nose and Throat is joining with the Better Hearing Institute (BHI) to educate Americans on how hearing health affects job security, performance, and employment opportunities. Coastal Ear, Nose and Throat is encouraging people of all ages who are either seeking employment or who want to protect their jobs to make sure that unaddressed hearing loss doesn’t pose a barrier to employment success. BHI is offering an online hearing test where people can quickly and confidentially assess if they need a comprehensive hearing check by Coastal’s hearing professionals. Please visit our website at http://www.coastalhearing.com/ under helpful links to take the Better Hearing Institute hearing test.
“Never before has good hearing been so important,” says Suzanne McCorry, an audiologist in Neptune. “Hearing your best can be a smart job security strategy in a tough job market. How an employee is perceived by employers is effected by how he or she hears. Job candidates need to sound sharp during an interview. And employees who aren’t sure what an employer is asking can’t answer their best.”
According to the International Listening Association (ILA), listening is one of the top skills employers seek in entry-level employees and in those being promoted. Individual performance in an organization is found to be directly related to listening ability or perceived listening effectiveness.
When people with even mild hearing loss use hearing aids, they improve their job performance, increase their earning potential, enhance their communication skills, improve their professional and interpersonal relationships, stave off depression, and better their quality of life.
According to a BHI national study—“Impact of Hearing Loss on Household Income"—Americans with unaddressed hearing loss make less money than people with normal hearing. The study found that wearing a hearing aid reduces the amount of income lost. Specifically, untreated hearing loss negatively affects household income, on average, up to $23,000 per year depending on the degree of hearing loss. The use of hearing aids mitigates those negative effects by about 50 percent.

“Treating hearing loss early is no longer an option,” says Sergei Kochkin, PhD, Executive Director of BHI. “It is a career imperative. Great workplace communication is critical to both job performance and to getting a job. Great communication starts with great listening. And great listening starts with the ability to hear. We urge everyone to take that first, most critical step to ensuring career success by visiting http://www.hearingcheck.org/. Do it today.“
# # #
Suzanne McCorry is Director of Audiology at Coastal Ear, Nose and Throat in Neptune, NJ, and can be contacted at 732-280-7855; sbmccorry@coastalhearing.com; http://www.coastalhearing.com/