Parents usually gush over a newborn's cute little fingers, toes, nose and ears as they get to know their baby. Lindsey and Michael were no exception when they welcomed their daughter, Adelyn, in March.

The couple, along with big sister, McKenzie, were thrilled with her arrival and admired her personality and features.

"She is a very laid back, sweet baby, and she looks like mom," says Lindsey proudly.

While in the hospital, the St. Michael, Minnesota, couple noticed that Adelyn's right ear looked different than her left.

"The top cartilage of her ear was cupped," says Lindsey. "It was almost completely folded over."

Concerned, Lindsey asked her local health care team about Adelyn's ear.

"They told me that it might bounce back, but I was worried," she recalls. "I started Googling options and found the EarWell website and Dr. Pearson. I set up an appointment right away."

The appointment was with Susan Pearson, M.D., a pediatric otolaryngologist and head and neck surgeon, also called an ear, nose and throat physician, at Mayo Clinic Health System in Mankato, Minnesota. She has special training in the surgical and nonsurgical correction of ear deformities. One nonsurgical option, called EarWell, uses a plastic mold to reshape the ear within the first weeks of life.

"While about 25% of babies will have an ear deformity, 70% will not improve over time or even worsen," says Dr. Pearson. "The good news is that 90% to 95% of these cases will improve with ear molding."

During treatment, a plastic mold is placed over the newborn's ear and held in place with double-sided tape. The procedure is pain-free, and newborns can hear normally through the mold. It is worn continually for two to six weeks, depending on the severity of the deformity and how soon in life it was placed.

Dr. Pearson explains that time is of the essence with ear molding treatment.

"The window for excellent results is quite narrow. During the first month of life, a baby's ear cartilage is flexible due to the maternal estrogen levels in the baby," she says. "The estrogen levels decrease after this time, and the ear cartilage begins to stiffen. Early placement of the mold reshapes the ear while it is malleable."

Adelyn was 1½ weeks old during her first visit with Dr. Pearson, who confirmed the cupped ear deformity and answered the couple's questions.

"Dr. Pearson said she was a good candidate for ear molding. She was very informative and took the time to explain everything," says Lindsey.

The couple decided to try the treatment for Adelyn.

"Her parents were very proactive and wonderful to work with," says Dr. Pearson. "They had done their research prior to coming to the clinic and were very educated about the molds."

A mold was placed on Adelyn's right ear while she was awake in the clinic that day. After that, the family made the nearly three-hour drive to Mankato for weekly follow-up appointments.

"We couldn't really tell at first if it was working. The way the mold covered her ear, it was hard to see," says Lindsey. "But after the first appointment, her ear seemed to stand up more."

Lindsey and Michael say that Adelyn wasn't bothered by the mold, and its presence didn't change her feeding or sleeping. Bathing was the only thing they needed to approach differently during the weeks of her treatment.

"We had to work together to keep the mold on right," says Lindsey. "We needed four hands during bath time, but there were no other issues."

After three weeks, Dr. Pearson removed the mold in the clinic. The cartilage on her right ear was no longer cupped and is now symmetrical with her left ear. Adelyn's ear should need no further treatment.

"It was painless, and it works. Her ear looks great," says Michael. "There is no difference in looks between her ears now."

Dr. Pearson explains that with this treatment, Adelyn avoided a future invasive ear surgery, called an otoplasty.

"It is an extensive, invasive surgery to correct an ear deformity. Often, the results are not as natural as they are with molding," she says. "The surgery is done when a child is around 5 to 6 years of age and takes between 60 and 90 minutes per ear."

Avoiding this surgery was a relief for Lindsey and Michael.

"I thought that surgery might have been her only option and that we would be referred to Ear, Nose and Throat later," says Lindsey. "It's important for parents to be informed early on and don't wait for their children's ears to bounce back."

Dr. Pearson agrees and stresses that Adelyn's good results were possible because of early treatment.

"With this treatment, it's important to get into the clinic as soon as possible," she says. "The sooner we place the molds, the greater the outcome."

Editor's note: Last names were withheld in this story at the family's request.

The post Mold reshapes baby Adelyn’s ‘different’ ear appeared first on Mayo Clinic News Network.

Wax has many uses, ranging from crayons and adhesives to polishes and candles. It also helps to protect and lubricate your ears.

Cerumen, commonly called earwax, is found in the ear canal. It's made up of several components.

The ear canal is lined with small hairs and glands. Earwax is made up of secretions from these glands, skin cells that have sloughed off, hairs that have shed and usual bacteria that lives on the skin's surface.

Earwax has many jobs. It moisturizes the fragile ear canal skin, and prevents dry and itchy ears. It also protects the ear canal skin from infection, and traps dust and other foreign particles. It has antibacterial properties to protect your ears from unhealthy bacteria. Finally, its water-repelling features prevent water damage to the ear canal and eardrum.

How to clean your ears

The ears are self-cleaning for most people. Earwax migrates from deeper in the ear canal to the ear canal opening via different mechanisms, including normal skin migration pattern and movement of the jaw joint. These mechanism help push earwax outward toward the ear canal opening. Once it arrives, it falls out or is washed away.

You don't need to take extra steps to keep your ears clean. Just wash your hair regularly and gently dry your ear canal opening with a towel.

Clinical removal of earwax

Some people produce an excessive amount of earwax. This can be due to various causes. Other people have issues with wax blockage because they put items into their ears, thus embedding the wax deeper into the ear canal.

Talk with your health care team if you have concerns about your earwax or concerns that you may have a wax blockage. They can remove excess wax in the clinic using a small instrument called a curette, or suction or other specialized methods.

Hydrogen peroxide drops

Your health care team may recommend that you use hydrogen peroxide drops in your ears. Hydrogen peroxide is a cerumenolytic. This means that it softens, loosens, dissolves and breaks down earwax.

This treatment should only be completed under the guidance or at the direction of a health care professional who will direct you on proper use, including the number of drops and length of time. It is likely your health care team will want you to return to the clinic after completing the treatment course to make sure that any remaining earwax is cleared and perform an ear exam.

Hydrogen peroxide drops should not be attempted in people who have a history of recurrent ear infections, holes in eardrums or prior ear surgeries. It can cause harm and pain in these cases.

Keep items out of the ears

Never attempt to dig out excess or hard earwax using a paper clip, Q-tip or another small object. These instruments can push the earwax deeper into the ear canal, which can cause an earwax impaction.

Q-tips and other small objects can traumatize the fragile ear canal skin and lead to infection and bleeding. They also can disrupt the tiny hairs that protect your ear canal skin. Finally, Q-tips contribute to single-use plastic waste, which is yet another great reason to avoid them.

Fareeda Hussain, M.D., is an otolaryngologist and head and neck surgeon in Albert Lea and Austin, Minnesota.

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• Home Remedies: Listen up about earwax
• Mayo Clinic Q and A: Ear infections after swimming

The post The scoop on earwax appeared first on Mayo Clinic News Network.

Editor's note: This story was written by patient Marge Cabanski.

I am Marge Cabanski, and at 74 years old in November 2020, I began experiencing eye irritation. It was diagnosed as Graves' disease. Though I had had my thyroid irradiated in 2017, an autoimmune reaction within my body led to a further diagnosis of severe thyroid eye disease.

By May 2021, my eyesight had deteriorated to the extent that I couldn't drive, read or identify colors, and the simplest of life's daily tasks had become difficult. I felt that I was going blind.

Treatment with my local ophthalmologist and appointments with several endocrinologists were not helping. My primary care physician suggested that I consider Mayo Clinic in Rochester, Minnesota, for treatment.

My first visit to Mayo was a full day of testing, and meeting one on one with what became my Mayo team: Endocrinologist Dr. Marius Stan, Ophthalmologists Dr. Lilly Wagner, Dr. Erick Bothun and Dr. Ahmed Sheikh, and Otolaryngologist ― Head and Neck Surgeons, Drs. Janalee Stokken and Linda Yin.

Their approach was to test for what they knew would be helpful in diagnosing and treating my thyroid eye disease, meeting with me one on one, answering all my questions and concerns, and coming up with a plan. As I got to know my team, my confidence grew, and the knowledge I gained was empowering.

The initial treatments with high doses of steroids had no effect in calming my thyroid eye disease. My eyes were bulging, and they were swollen and inflamed. My blurred vision, which was already bad, worsened. I had double vision and significant pain, and I was frightened.

During a return visit several weeks after my initial visit, I met with my Mayo team. Ultimately, I chose to have orbital decompression surgery.

Drs. Stokken and Yin performed the delicate three-hour surgery at Mayo Clinic Hospital ― Rochester, Saint Marys Campus. Several hours after the surgery, my eyesight was restored. It was like a miracle, making me able to immediately read an eye chart and identify colors. And although my double vision was not eliminated, I have been able to read, drive and enjoy all that life has to offer.

I will return to see Dr. Wagner for a checkup in the spring. I will schedule a surgery to realign my eyes to eliminate the double vision. I hope to return to hiking on uneven ground and kayaking, and the active lifestyle I so enjoy.

My lasting impression of Mayo Clinic is how coordinated my team worked for me and how caring each doctor was in presenting me with all the information I needed to confidently make decisions. I am so thankful I found Mayo Clinic.

The post Sharing Mayo Clinic: An eye on the future appeared first on Mayo Clinic News Network.

Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma is a long complicated-sounding term for throat cancer. Specifically, cancer in the top of the throat, an area that starts at the far back of your tongue and includes your tonsils.

This type of cancer is difficult to diagnose, often discovered as only a small mass in the neck, and with no pain or other symptoms. Mayo Clinic researchers examine the barriers to timely diagnosis in a new study in Otolaryngology–Head and Neck Surgery. Lead author Emily Karp, M.D., an otolaryngology surgical resident at Mayo Clinic says they found that patients would often have a neck mass for weeks or even months before they came in to have it checked out.

"These delays in diagnosis lead to delays in treatment decisions," says Dr. Karp. "And of course, we always want to get to a correct diagnosis and personalized treatment plan for our patients as quickly as possible."

The researchers examined the records of 703 patients diagnosed with oropharynx cancer who had received treatment between 2006 and 2016 at Mayo Clinic in Rochester, Minnesota. This research was supported in part by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The center is embedded in Mayo's medical practice and works hand-in-hand with the Practice to identify ways to improve outcomes, enhance experience, and increase value for patients, in short, to transform the practice of medicine.

"We confirmed that on average it was nearly five months from symptom onset to final cancer diagnosis," says Dr. Karp.

Delays in diagnosis can be connected to patient characteristics. For example, in the most recent study, investigators found delays occurred more commonly among patients who identified as a current smoker, while retirees generally were diagnosed more quickly. Delays in diagnosis can also be the result of the patient's health care path. For example, the researchers noted that patients who saw two or more providers before diagnosis took longer to get the correct diagnosis and start treatment. At the same time, antibiotic therapy — while not recommended in practice guidelines for adults with a neck mass — seemed to lead to a quicker diagnosis. The researchers speculated in the paper that this was "likely attributed to the patient being connected with a provider who developed a heightened sense of concern beyond a benign physical exam and initiated close follow-up on that patient's care."

"We see many patients in Rochester with oropharynx cancer, many of whom come from the Midwest," says Kathryn Van Abel, M.D., an otolaryngologist at Mayo Clinic and the study's senior author. "We also are fortunate to serve patients from across the U.S. and from other countries. While we cannot generalize the results of our study beyond our actual patient population, HPV-associated oropharynx cancer is a worldwide epidemic, with a significant global impact."

Dr. Van Abel says in raising awareness of signs and symptoms of oropharynx cancer, she hopes to shorten the length of time to diagnosis, and therefore to treatment.

"It is important to recognize the emotional cost and increase in patient anxiety related to a delay in any diagnosis that patient experiences, especially for a cancer related diagnosis," says Dr. Van Abel. "There are financial costs to testing and treatments associated with a delayed diagnosis as well. While we did not see a difference in cancer outcomes in this study, patients with long delays did present with a larger burden or stage of disease.”

Both Drs. Karp and Van Abel agree that being vaccinated against HPV infections is a good place for almost anyone to start.

“Often our patients ask what they can do to prevent this in the future. In addition to eating a healthy diet, getting the recommended exercise, practicing safe sex, and avoiding tobacco products, I always recommend that they reach out to all of their family members who are candidates for the HPV vaccine and strongly recommend it to them. It is the best way to prevent anyone else from developing this cancer," says Dr. Van Abel.

Vaccinate to prevent cancer

According to the Centers for Disease Control and Prevention, almost all cervical cancer is caused by HPV. It also causes cancers of the vulva, vagina, penis, anus and as much as 60-70% of oropharynx cancers. HPV-associated oropharynx cancer is most often diagnosed in men but, Dr. Karp says, "We strongly recommend the HPV vaccine for everyone who is eligible."

The original HPV vaccine protects against several strains of the virus, including HPV-16, which is the most common cause of throat cancer, she says. The newer version protects against nine strains: protecting patients against the two common wart causing strains as well as seven cancer causing strains. Remarking on the delay between symptoms and diagnosis for throat cancer, Dr. Karp thinks part of the disconnect in is the extended periods of time involved, as well as lack of public understanding. Almost all people from age 9 through 26, and even many as old as age 45 may get the HPV vaccine. Conversely, it only takes one viral exposure — of the wrong kind of HPV — to result in a cancerous growth developing years, or even decades, later.

"We know there is an increased risk of developing HPV associated oropharynx cancer with younger age of sexual debut, increased number of sexual partners, and increased number of oral sexual partners," says Dr. Karp. "However, nearly 100% of sexually active (current or ever) adults have been exposed to the virus. Whether you have one partner or more, and no matter the type of sexual activity engaged in, the risks can be substantially reduced by getting vaccinated."

Educate to find and treat

In addition to hoping for an increase in awareness among patients of the signs of oropharynx cancer, Dr. Van Abel believes this study's findings will help her colleagues as well.

"This research gives us data to be able to educate primary, urgent, and emergent care providers," she says. "We know from our study, these are the providers who see these patients first and need to have high suspicion for cancer in an adult patient with a new neck mass, especially one with no other symptoms such as fever or malaise, and even more importantly, in one that has been present for two weeks or more."

The American Academy of Otolaryngology has published clinical practice guidelines for treatment of a persistent neck mass in adults. Dr. Van Abel says that these guidelines, combined with Mayo's new research, are providing important tools for education.

"Our department has taken action through Grand Rounds presentations, discussions with community providers, and online education materials such as podcasts and YouTube videos. These are small steps toward improving public awareness of the disease," Dr. Van Abel says. She adds that these research findings are made possible by Mayo's unique approach to medical care.

"We have a multidisciplinary Oropharynx Cancer Clinic that has been specifically designed to meet the needs of oropharynx cancer patients," she says. "Through the work of this multidisciplinary clinic we are able see patients in a very efficient manner and expedite their care. This has been an amazing platform for effective and efficient clinical trials to determine risk factors for the disease, study ways to minimize toxicities of treatment, and investigate biomarkers that may be able to screen for oropharynx cancer. "

###

The post Yes, that little lump or funny bump on your neck could be cancer, best to find out now appeared first on Mayo Clinic News Network.

The COVID-19 virus spreads through respiratory droplets. This means treating patients who have diseases or injuries involving the ears, nose or throat, or the head and neck, requires particular precautions.

"COVID-19 taught us all to be more nimble," says Dr. Devyani Lal, a Mayo Clinic otolaryngologist and head and neck surgeon. She says the COVID-19 pandemic required Mayo Clinic's Department of Otolaryngology to pivot quickly and require that patients be tested for COVID-19 before appointments.

In this Mayo Clinic Q&A podcast, Dr. Lal explains more about COVID-19 safety measures that have been implemented and encourages not to delay treatment. She also details how extensive the otolaryngology practice is at Mayo Clinic.

Watch: Dr. Lal discusses COVID-19 safety protocols and treatment for otolaryngology patients.

Read the full transcript.

____________________________________

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

Information in this post was accurate at the time of its posting. Due to the fluid nature of the COVID-19 pandemic, scientific understanding, along with guidelines and recommendations, may have changed since the original publication date. 

For more information and all your COVID-19 coverage, go to the Mayo Clinic News Network and mayoclinic.org.

Learn more about tracking COVID-19 and COVID-19 trends.

The post Mayo Clinic Q&A podcast: Protection protocols involving ear, nose and throat patients during COVID-19 appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Minetta Liu, a medical oncologist at Mayo Clinic, will break down the latest results of the Mayo Clinic National Health Check Up. Also on the program, Dr. Myra Wick, a medical geneticist at Mayo Clinic, will explain the latest advances in prenatal screening. And Dr. Karthik Balakrishnan, an otolaryngologist at Mayo Clinic, will discuss treatment for pediatric ear, nose and throat problems.

To hear the program, find an affiliate in your area.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: National Health Checkup appeared first on Mayo Clinic News Network.

On the next Mayo Clinic Radio program, Dr. Minetta Liu, a medical oncologist at Mayo Clinic, will break down the latest results of the Mayo Clinic National Health Check Up. Also on the program, Dr. Myra Wick, a medical geneticist at Mayo Clinic, will explain the latest advances in prenatal screening. And Dr. Karthik Balakrishnan, an otolaryngologist at Mayo Clinic, will discuss treatment for pediatric ear, nose and throat problems.

To hear the program, find an affiliate in your area.

Miss the show?  Here's your Mayo Clinic Radio podcast.

Follow #MayoClinicRadio, and tweet your questions.

Mayo Clinic Radio is on iHeartRadio.

Mayo Clinic Radio produces a weekly one-hour radio program highlighting health and medical information from Mayo Clinic.

Access archived shows.

The post Mayo Clinic Radio: National Health Checkup / advances in prenatal screening / pediatric ear, nose and throat problems appeared first on Mayo Clinic News Network.

When Becky Loar injured her voice, she was alarmed by the prospect of not being able to sing. But her care team at Mayo Clinic provided Becky with the treatment she needed to hit the high notes once again.

When Becky Loar entered a recording studio in July 2016, it was the culmination of a goal the Vero Beach, Florida, native had almost given up hope of achieving.

A voice injury had threatened to sideline Becky's music career. "I realized I was hoarse all the time. Then one day I was vocalizing, and it just wasn't there. I knew in my gut something was wrong," Becky says. "Singing is all I've ever known and done, and all I want to do."

Thanks to the specialty care provided by Mayo Clinic laryngologist Amy Rutt, D.O., and the rest of Becky's care team at Mayo Clinic's Florida campus, Becky was able to regain her voice. She recently released an album titled "How Can I Keep From Singing," which includes a dedication to her Mayo Clinic care team in the liner notes.

An overloaded voice

Becky grew up with a love of music, singing in the church choir as a child. She went on to earn degrees in voice and opera performance, and then delight audiences across the country with timeless classics like Handel's "Messiah," Bach's "Magnificat," and Mozart's "Exsultate, Jubilate."

Eventually Becky married, became a mom and started teaching music at two universities in Jacksonville, Florida. She also recorded and released a five-track album of contemporary Christian music and was excited about the possibility of a second.

But that ambition was placed in limbo when Becky began to have problems with her voice. It began when Becky's son was diagnosed with a hearing impairment. She admits she struggled with communication at first.

"I realized I was consistently hoarse all the time. Then one day I was vocalizing, and it just wasn't there. I knew in my gut something was wrong." — Becky Loar

"As his hearing loss progressed, I think my speaking voice got louder and louder, and my mom voice took over," she says. "I thought if I just talked louder, he would hear me better. But that was the catalyst for the strain on my voice."

One evening in late 2015, Becky called out to her son that it was bath time, unaware that he'd removed his hearing aids. When he didn't answer, Becky raised her voice. Then she heard a pop.

She decided she needed to have her voice checked.

A melodious team

Becky met with an ear, nose and throat specialist near her home who simply told her to rest her voice. After a week of not speaking, Becky still wasn't feeling right and sought a second and third opinion.

"Issues that singers face are different than typical speech problems," Becky says. "As a singer and a voice teacher, I'm hyperaware of what's going on with my voice. I wanted someone who was skilled in all aspects of voice."

She felt at ease when she met with Dr. Rutt at Mayo Clinic. A laryngologist, Dr. Rutt specializes in disorders of the larynx — also known as the voice box.

"She was not your normal ear, nose and throat doctor," says Becky, noting Dr. Rutt's experience in music. "I liked her style. And I liked that she had a whole team of people to work with me."

"I trusted Dr. Rutt and her team. I knew I was in good hands." — Becky Loar

Dr. Rutt found that Becky had a polyp on one of her vocal cords (sometimes called vocal folds).

She advised Becky to undergo surgery to remove it. Though some polyps may heal on their own, they usually require many months to do so. If left untreated, there was a possibility that the polyp could get worse. Or another polyp, called a reactive lesion, could form on the opposite vocal cord. But Becky dreaded the prospect of surgery.

"I wondered what it was going to feel like," says Becky. "How would it be? Was I still going to be able to sing? It was terrifying."

A strong comeback

Despite her concerns, Becky opted to go through with the surgery. She recalls the fear subsiding as she lay on the operating table before the anesthesia took over.

"I trusted Dr. Rutt and her team," she says. "I knew I was in good hands."

When she awoke, the polyp had been removed. After one week of complete voice rest and six weeks without singing, Becky began voice rehabilitation with Stacey Menton, a Mayo Clinic speech language pathologist who is also a singing voice therapist.

"Stacey is unique. Being a singing voice specialist and an opera singer, I trusted everything going into a therapy session with her," Becky says. "I knew she would guide me properly."

The day she was allowed to sing again, Becky was pleasantly surprised. Although her voice wasn't as strong as it had been before surgery because the vocal muscles still needed time to strengthen, she could definitely sing.

"It was so satisfying to record this album because had I not had the surgery, I wouldn't be able to sing again." — Becky Loar

"I began vocalizing, and when I hit a high C, it was there!" she says. "I was excited because I had just started therapy and the muscles had to relearn what they were trained to do, but it was there."

Soon Becky was back to teaching, and she began planning her return trip to the recording studio.

"I was so nervous before I went to Nashville. I went to see Dr. Rutt to make sure it was OK to do this recording and that I wasn't going to hurt myself," Becky says. "Dr. Rutt, the whole team, was very encouraging to me."

The recording was a success, and now Becky is looking forward to a future filled with more music.

"It was so satisfying to record this album because had I not had the surgery, I wouldn't be able to sing again," says Becky, who is planning an album of Christmas songs and wants to pursue a doctorate in music. "Mayo Clinic is simply the only place in the region that can fix and rehabilitate a singing voice."

HELPFUL LINKS

• Learn more about voice disorders.
• Read about voice disorder care at Mayo Clinic.
• Explore Mayo Clinic's Florida campus.
• Request an appointment.

The post Working in Harmony to Keep a Musician Singing appeared first on Mayo Clinic News Network.

When Heather Spaniol woke up from the first of many surgeries to rid her body of a life-threatening infection that was decimating her tissues, the gratitude she felt toward the Mayo Clinic surgeons who’d saved her life was so strong, she didn’t even register how much trauma her body had sustained.

“I think I was in shock. I was like, ‘You’re all so great! I just appreciate everything you’re doing. It’s fine,’” says Heather, a mother of two from Rochester, Minnesota. It was June 2014, and she'd lost a major nerve and most of her right shoulder muscle, in addition to epidermal tissue on the back and front of her right side, to necrotizing fasciitis.

When Heather regained her senses, she realized the scope of the damage. She couldn’t move her right arm, and she lacked sensation on the front and back of her right side. She had a long journey ahead of her, but she was on the road to recovery.

To help in her healing, Heather embraced both traditional treatments and complementary therapies. Today, although she’s still dealing with repercussions from her illness and surgeries, Heather’s recovery is going strong.

Spared by circumstance

 The days leading up to Heather’s first surgery turned into a nightmare scenario that began with a seemingly innocuous scrape on her knuckle during a game of tag with her kids. At first, her only symptoms were a swollen joint and a scratch. Then Heather’s neck began aching four days after the incident. The next day, the pain intensified, her neck became stiff and she developed a fever. A day later, immobilized with pain, Heather was hospitalized at Mayo Clinic’s Rochester campus. Her white blood cell count measured more than double what is considered normal.

Heather is convinced that if she’d not been examined by Mayo Clinic infectious diseases physician Mark Enzler, M.D., she would not have survived.

In the hospital, a member of Heather’s care team outlined the edges of the infection on her neck with a marker. By the time Dr. Enzler saw her later the same day, the infection had spread beyond those margins. He believed the appearance of her skin, the severe pain and the progression of the infection were all hallmarks of necrotizing fasciitis.

After finishing his infectious disease training at Mayo Clinic School of Medicine, Dr. Enzler had practiced in Chicago for seven years. During that time, he treated a number of people who had necrotizing fasciitis, often photographing them to use for teaching purposes.

“It’s one of those cases in medicine where the clock is ticking. Waiting until the next day is not a good plan.” — Mark Enzler, M.D.

“He came in and knew instantly that I had necrotizing fasciitis,” Heather says.

Necrotizing fasciitis is rare. Only 1 in 100,000 individuals develop it each year. This infection can be caused by a normally harmless streptococcal bacterium that lives on the surface of the skin and inside the body. It sometimes causes strep throat. Necrotizing fasciitis may lead to serious medical concerns, including the need to amputate involved extremities. In 14 to 30 percent of those who develop the infection, it may be fatal.

“This infection develops in the fascial plane between the fat and muscle layers, where it’s like a bacterial superhighway. It can spread rapidly in any direction,” Dr. Enzler says. “The only way to stem that spread is to remove the dead and infected tissue. When we catch it early, it’s important to surgically explore the affected tissue, wash out the fascial area and remove any dead tissue, which could include skin, fat or even muscle. If the infection involves an extremity, there may be a need to amputate.

“When necrotizing fasciitis involves the central body, it gets scary. If it occurs in the neck region, you can’t amputate. Necrotizing fasciitis is one of those conditions in medicine where the clock is ticking. Waiting until the next day is not a good plan.”

A race against the clock

Dr. Enzler was confident of Heather’s diagnosis, but it could only be confirmed through surgery. He consulted with a surgeon in Mayo Clinic’s Department of Otolaryngology, who agreed to operate on Heather that day. Early in the evening, Dr. Enzler received a call from the surgical team. His suspicion of necrotizing fasciitis was correct.

After opening Heather’s neck and back and seeing the extent of the necrotic tissue, the surgical team called in Mayo Clinic ENT surgeon Daniel Price, M.D., who had experience operating on patients with the infection.

“It can be hard to know the extent of necrotizing fasciitis from the imaging and the exam because of the way it travels,” Dr. Price says. “You always have to expect the person might be in for a fairly extensive operation.”

The goal of the surgery is to remove all nonviable tissue. The surgeon takes out any tissue that looks abnormal and doesn’t bleed when cut. Getting rid of all the affected tissue is usually done over the course of multiple operations, so the surgeons can identify the areas of tissue that are healing, as well as those that show signs of the infection spreading.

Heather had four surgeries in five days to remove dead and infected tissue. Two days after Heather's last surgery, Dr. Price’s team examined her under anesthesia and found no further evidence of the infection. But she required several additional operations over the next three months to close the large wound on her back and neck from the area where tissue was removed.

“It can be hard to know the extent of necrotizing fasciitis from the imaging and the exam because of the way it travels. You always have to expect the person might be in for a fairly extensive operation.” — Daniel Price, M.D.

Skin and muscle weren’t the only tissues taken out during the procedures. Heather’s surgical team, which included spinal and thoracic surgeons, also removed dead nerves.

“Most of those nerves were sensory nerves — the nerves that give us a sense of touch,” Dr. Price says. “But one was her accessory nerve, which is an important nerve that allows us to raise our arms above our shoulders. When we removed a segment of infected nerve, we tagged the nerve ends with the hope that we would later be able to repair it once the infection had been treated. Unfortunately, when it came time to consider repair, we were not able to.”

When Heather awoke from that surgery, she says she was oblivious to what had happened.

“My family was really somber,” says Heather. “Dr. Price and his team came in to tell me that during the surgery, the dead tissue was quite extensive. They told me I lost a lot of muscle and a lot of tissue and a major nerve in my arm.”

Heather said she was informed that she would never again be able to raise her arm over her head.

“He was so sorry that they couldn’t save that specific nerve in me. But I was so happy to be alive that it didn’t register in my mind that I would be limited in anything in life,” Heather says. “I was just so grateful; I wasn’t hearing what he was saying.”

Recovery and regrowth

After her surgeries, Heather completed dozens of sessions in a hyperbaric oxygen chamber to encourage growth of her tissues. Following her discharge from the hospital, Heather also practiced exercises prescribed to her by her physical therapist.

But a turning point came when Heather visited Mayo Clinic’s Integrative Medicine Department. There, she tried the traditional Chinese medicine therapy of cupping to help her regain feeling and motion in tissues that were thought to be destroyed.

“Since I’ve done the cupping, my range of motion is insane,” she says. “Before, I had zero range of motion. Now I can move my arm up, not backward or to the side, but I can go forward. I can lift something out of the cupboard if it’s just above my head. I can feel, especially in my back, pressure pushing on my skin, which I didn’t have before.”

“Last summer I was able to swim with my kids. Swimming is something my kids love, and this has given me enough range to stay afloat. That was huge progress to me.” — Heather Spaniol

It’s been two years since Heather began cupping treatments, and she continues to gain benefits from them, increasing strength and function in her arm and shoulder.

“Last summer I was able to swim with my kids,” Heather says. “Swimming is something my kids love, and this has given me enough range to stay afloat. That was huge progress to me.”

The gratitude Heather feels about her recovery is an extension of the appreciation she has toward simply surviving the devastating infection.

“It makes you live a different life, a better life,” she says. “You are more grateful for what you have, and everything else doesn’t matter.”

HELPFUL LINKS:

• Learn more about skin infections such as necrotizing fasciitis
• Read more about cupping.
• Explore Mayo Clinic’s Center for Integrative Medicine and Health
• Request an appointment.

The post Keen Eye and Quick Action Save Rochester Mom From Life-Threatening Infection appeared first on Mayo Clinic News Network.

In this Mayo Clinic Minute, Dr. Karthik Balakrishnan, a Mayo Clinic otorhinolaryngologist, explains why you are likely doing more harm than good when you ignore this recommendation from the American Academy of Otolaryngology. Jeff Olsen reports.

Watch: The Mayo Clinic Minute

https://youtu.be/O1ZJInvpq-g

Journalists: Broadcast-quality video pkg (0:59) is in the downloads. Read the script. 

The post Mayo Clinic Minute: Stop cleaning your ears appeared first on Mayo Clinic News Network.