Black Hairy Tongue

Basically a bacterial

The name black hairy tongue may sound scary, but the condition is harmless. Black hairy tongue is caused by bacteria or fungi in the mouth, which make the tongue appear black and hairy. It’s easily remedied by good old-fashioned oral hygiene.

What Causes Black Hairy Tongue?
A black hairy tongue is caused by too much bacteria or yeast growth in the mouth. The bacteria build up on tiny rounded projections called papillae. These lie along the surface of the tongue. Instead of shedding as they normally do, the papillae start to grow and lengthen, creating hair-like projections. They can grow to 15 times their normal length.

Normally, the papillae are pinkish-white. But as they grow, pigments from food, drinks, and possibly the bacteria or yeast themselves get caught in the papillae, dyeing the tongue a color. Most often that color is black, hence the name. But the tongue can also turn brown, yellow, green, or a variety of other colors.

Certain lifestyle habits and conditions can make people more likely to develop black hairy tongue. They include:
poor oral hygiene
smoking tobacco
drinking a lot of coffee or tea
using antibiotics (which may disrupt the normal balance of bacteria in the mouth)
being dehydrated
taking medications that contain the chemical bismuth (such as Pepto-Bismol for upset stomach)
not producing enough saliva
regularly using mouthwash that contains peroxide, witch hazel, or menthol
getting radiation therapy to the head and neck
Black hairy tongue is more common in men, people who use intravenous drugs, and those who are HIV-positive.

What Are the Symptoms of Black Hairy Tongue?
Other than the appearance of the tongue, most people with black hairy tongue don’t have any symptoms or feel any discomfort. The exception is when there is too much growth of the yeast Candida albicans, which can cause a burning sensation on the tongue. This burning sensation is called glossopyrosis.

Some people complain of a tickling feeling in the back of the roof of the mouth, a metallic taste in their mouth, or nausea. In more severe cases, the condition may lead to a gagging feeling. Sometimes, food getting caught inside the extra-long papillae can cause bad breath.

How Is Black Hairy Tongue Treated?
Practicing good oral hygiene is the best way to treat black hairy tongue. Gently brush your teeth twice a day with a soft toothbrush. Also, brush your tongue. You can use a tongue scraper to make sure you’re thoroughly cleaning the area. Drink plenty of water throughout the day to help keep your mouth clean.

Other tips include:

If you smoke, quit.
Add more roughage to your diet. Soft foods won’t clean off the tongue effectively.
Call your doctor or dentist if the problem doesn’t get better on its own. Your doctor may prescribe antibiotics or an antifungal drug to get rid of the bacteria or yeast. Topical medications, such as tretinoin (Retin-A), are also sometimes prescribed. As a last resort, if the problem doesn’t improve, the papillae can be surgically clipped off with a laser or electrosurgery.

Grass Antigen Pill

FDA Approves Grastek, Merck’s Grass Allergy Pill; Joins Oralair In New Round Of Immunotherapies


The FDA’s approval of Merck’s Grastek ushers in a new era of grass allergy immunotherapy, as it’s the second medication to be approved for grass allergies this month. Merck

Spring is here, and it’s bringing seasonal allergies along with it. So it’s no surprise that a new round of allergy medications are getting approved by the Food and Drug Administration (FDA) — though they probably should have looked to an earlier release — the most recent of which is Merck’s Grastek, a sublingual — going under the tongue — pill for treating grass allergies.

Grastek is the second sublingual oral immunotherapy (SLIT) to be approved this month and the first of three that Merck plans to market, MedPage Today reported. Once placed under the tongue, it dissolves and super small doses of timothy grass extract are released into the body with the purpose of weaning a person’s allergies out of severity. Although it’s only made with the extract of timothy grass pollen, it’s cross reactive, and therefore can help treat other grass allergies as well, including sweet vernal, orchard, perennial rye, Kentucky blue, and red top.

Sebaceous Adenoma

230px-Sebaceous_adenoma_-_low_magSebaceous adenoma is a cutaneous condition characterized by a slow-growing tumour usually presenting as a pink, flesh-coloured, or yellow papule or nodule.

Sebaceous adenomas, in isolation, are not significant; however, they may be associated with Muir-Torre syndrome, a genetic condition that predisposes individuals to cancer.[3] Thus, identification of a sebaceous adenoma may be a life saver.

It is associated with tuberous sclerosis complex. The term adenoma sebaceum is a misnomer.


Trichilemmoma (also known as “tricholemmoma”) is a benign cutaneous neoplasm that shows differentiation toward cells of the outer root sheath.230px-SkinTumors-P6190341 The lesion is often seen in the face and neck region. Multifocal occurrence is associated with Cowden syndrome, in which hamartomatous intestinal polyposis is seen in conjunction with multiple tricholemmoma lesions.

Rhinoplasty Photography

The art and technology of photography can be overwhelming to the facial plastic surgeon. Photographic documentation of patients undergoing rhinoplasty is essential for patient consultation, perioperative planning, and postsurgical evaluation. Possession of a basic understanding of photographic principles, technique, equipment, as well as consideration regarding consistency of patient positioning is essential for producing the best photographic results. This article reviews the basic principles of photography and discusses their application to facial plastic surgery practice, and rhinoplasty in particular.

Post on Hiccups

What are hiccups?

Hiccups  occur when a spasm contracts the diaphragm, a large sheet of muscle that separates the chest cavity from the abdominal cavity. This spasm causes an intake of breath that is suddenly stopped by the closure of the vocal cords (glottis). This closure causes the characteristic “hiccup” sound.

What causes hiccups?

A very full stomach can cause bouts of hiccups that go away on their own. A full stomach can be caused by:

Eating too much food too quickly.
Drinking too much alcohol.
Swallowing too much air.
A sudden change in stomach temperature, such as drinking a hot beverage and then a cold beverage.
Emotional stress or excitement.
How long do hiccups last?

Hiccups usually stop within a few minutes to a few hours.

Hiccups that last longer than 48 hours are called persistent hiccups. Hiccups that last longer than a month are called intractable hiccups. While very rare, intractable hiccups can cause exhaustion, lack of sleep, and weight loss. Both persistent and intractable hiccups may be a sign of a more serious health problem and must be checked by a doctor.

There are many known causes of persistent or intractable hiccups, including:

Central nervous system problems, such as cancer, infections, stroke, or injury.
Problems with the chemical processes that take place in the body (metabolic problems), such as decreased kidney function or hyperventilation.
Irritation of the nerves in the head, neck, and chest (vagus or phrenic nerve).
Anesthesia or surgery.
Mental health problems.
How are hiccups treated?

Most bouts of hiccups go away on their own within a few minutes to a few hours and do not require any treatment.

Many home remedies are used to treat hiccups. Most of them involve increasing the level of carbon dioxide in the blood, which usually stops hiccups. Some of these remedies include:

Holding your breath and counting slowly to 10.
Breathing repeatedly into a paper bag for a limited period of time.
Quickly drinking a glass of cold water.
Eating a teaspoon of sugar or honey.
The treatment for persistent or intractable hiccups depends on the underlying cause of the hiccups and may range from medicine to acupuncture or hypnosis. Sometimes several treatments may be tried before persistent or intractable hiccups are controlled. If you have hiccups that last a few days or longer, your doctor may conduct tests to rule out a more serious problem.

Who is affected by hiccups?

Hiccups affect males more often than females. Hiccups occur in practically every human being, including babies and older adults.


Post on Helicobactor

Recently, pts. have become aware of the prevalance of H. pylori as a cause of ulcers and questioning why I don’t emperically tx. for it, rather than an initial trial of PPI’s. My response is that although H. pylori is present in >80% of ulcers, is has only been implicated as causative in ~20%. Plus, the potential risk of SE’s from triple therapy.

Blood test is easy. Unfortunately it detects antibodies, not infection. May remain positive for years even after eradication of infection. Detecting IgM vs. IgG is not always reliable.

Urea breath test and stool antigen test detect infection. As does biopsy for either rapid urease test or histology with special stains. Biopsy is most invasive, most expensive, and most accurate.

Keratosis Obturans Post

koKeratosis obturans and external auditory canal cholesteatoma (EACC) have previously been considered to represent the same disease process. However, review of the literature and our cases reveal these to be two different clinical and pathological processes. Keratosis obturans presents as hearing loss and usually acute, severe pain secondary to the accumulation of large plugs of desquamated keratin in the ear canal. External auditory canal cholesteatoma presents as otorrhea with a chronic, dull pain secondary to an invasion of squamous tissue into a localized area of periosteitis in the canal wall. The treatment previously recommended for both of these conditions has been conservative debridement of the external canal and application of topical medication. While this remains the treatment of choice for keratosis obturans, surgery may be required to eradicate EACC.


Unknown-1Actinomycosis occurs rarely in humans but rather frequently in cattle as a disease called lumpy jaw. This name refers to the large abscesses that grow on the head and neck of the infected animal. It can also affect swine, horses, and dogs, and less often wild animals and sheep.

Signs and symptoms

UnknownThe disease is characterised by the formation of painful abscesses in the mouth, lungs,[4][5] or gastrointestinal tract.[3] Actinomycosis abscesses grow larger as the disease progresses, often over months. In severe cases, they may penetrate the surrounding bone and muscle to the skin, where they break open and leak large amounts of pus, which often contains characteristic granules (sulphur granules). The purulent leakage via the sinus cavities contains “sulphur granules,” not actually sulphur-containing a11fig03but resembling such particles. These granules contain progeny bacteria. Sometimes there is difficulty in making the correct diagnosis. In addition to microbiological examinations magnetic resonance imaging and immunological blood analyses may also be helpful.
Actinomycosis is primarily caused by any of several members of the bacterial genus Actinomyces. These bacteria are generally anaerobes.[7] In animals, they normally live in the small spaces between the teeth and gums, causing infection only when they can multiply freely in anoxic environments. An affected human often has recently had dental work, poor oral hygiene, periodontal disease, radiation therapy, or trauma (broken jaw) causing local tissue damage to the oral mucosa, all of which predispose the person to developing actinomycosis. They are also normal commensals in the caecum; thus, abdominal actinomycosis can occur following removal of the appendix. The three most common sites of infection are decayed teeth, the lungs, and the intestines. It is important to note that actinomycosis does not occur in isolation from other bacteria. This infection depends on other bacteria (gram positive, gram negative, and cocci) to aid in invasion of tissue.
Actinomyces bacteria are generally sensitive to penicillin, which is frequently used to treat actinomycosis. In cases of penicillin allergy, doxycyclin is used. Sulfonamides such as sulfamethoxazole may be used as an alternative regimen at a total daily dosage of 2-4 grams. Response to therapy is slow and may take months.
There is a greater disease incidence in males between the ages of 20 and 60 years than in females.[8] Before antibiotic treatments became available, the incidence in the Netherlands and Germany was 1 per 100,000 people/year. Incidence in the U.S. in the 1970s was 1 per 300,000 people/year, while in Germany in 1984, it was estimated to be 1 per 40,000 people/year.[8] The use of intrauterine devices (IUDs) has increased incidence of genitourinary actinomycosis in females. Incidence of oral actinomycosis, which is harder to diagnose, has increased.
In 1877, pathologist Otto Bollinger described the presence of Actinomyces bovis in cattle, and shortly afterwards, James Israel discovered Actinomyces israelii in humans. In 1890, Eugen Bostroem isolated the causative organism from a culture of grain, grasses, and soil. After Bostroem’s discovery there was a general misconception that actinomycosis was a mycosis that affected individuals who chewed grass or straw. Violinist Joseph Joachim died of actinomycosis in 15 August 1907.

Post on Nasal Excellence


“One Doctor for One Nose”….

The Sinus and Allergy Center is focused exclusively on nasal, sinus, and allergy problems. We are board certified ear, nose, and throat surgeons. Dr. Todd had formal allergy training in his residency and obtained fellowship accreditation in allergy through the American Academy of Otolaryngic Allergy.  He performs a very high and consistent volume sinus and nasal surgery.

We offer state-of-the-art minimally invasive, image-guided sinus surgery, as well as unparalleled experience in rhinoplasty (plastic surgery of the nose) and nasal airway surgery.

We also offer comprehensive allergy testing and treatment, utilizing all the latest technology and techniques.

Our unique combination of skills, training, and experience allows the Sinus and Allergy Center to be the final consult for all your allergy, nasal, and sinus problems.

Sinus and Allergy