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Cochlear Implants

Description

Damage to the inner ear resulting in faulty transmission of auditory information to the brain is referred to as sensorineural hearing loss; damage which is often permanent. One of the more promising treatments is the cochlear implant, an electronic device that provides a sense of sound to people who would have little or no benefit from hearing aids.

A cochlear implant is surgically placed in the inner ear and activated by a device worn outside the ear. The implant functions similar to that of an artificial inner ear, taking over the job of the cochlea. The cochlea then translates sounds into electrical signals and sends them to the brain for interpretation. The implant directly stimulates the auditory nerve to send information to the brain.

The first research on cochlear implants began in the late 1950s when scientists began to experiment with ways to compensate for the damaged hair cells. Since then, cochlear implant technology has continually improved with approximately 70,000 people worldwide receiving implants, many of them children.

Although a cochlear implant does not restore normal hearing, it can dramatically improve the ability to hear and to understand speech. Benefits from the surgery vary from one individual to another, but most find that the implant allows them to handle such tasks as talking on the telephone. After a few months of wear, the user usually finds that other voices begin to sound more natural. For children, implants can help them acquire speech, language, and other essential developmental skills.

A cochlear implant is very different from a hearing aid, which amplifies sounds and delivers them to the ear canal. An implant does not make sounds louder. Instead, it compensates for damaged or nonworking parts of the inner ear, identifying useful sound information and translating this information into a form that the brain can understand.

Normally, the inner ear converts incoming vibrations from the middle ear into electrical impulses. The delicate hair cells stimulate the auditory nerve to send the electrical impulses to the brain. The brain recognizes the impulses as sound, unless the hair cells are damaged. In this case, they are unable to stimulate the auditory nerve. Although many nerve fibers may remain intact and can still transmit electrical impulses, these fibers are unresponsive because of the hair cell damage.

In people with mild or moderate hearing loss, sounds that are amplified by a hearing aid are converted into electrical impulses by the hair cells that are not damaged, in the same way that sounds are transmitted in a normal-hearing ear. But if there is profound sensorineural hearing loss, extensive hair cell damage prevents the ears from processing the auditory information, no matter how loud a hearing aid might amplify the sound.

Cochlear implants bypass the hair cells and stimulate the surviving nerve fibers in the cochlea. These fibers send electrical signals through the auditory nerve to the brain, allowing the perception of sound.

How Implants Function

Several different cochlear implant systems are available, but all work by identifying sounds in the environment electronically and sending the impulses to the brain. The implant is not a single unit but has both internal and external components. The external parts consist of a microphone, speech processor, transmitter, and connecting cords. The internal components are a receiver and electrodes.

These parts work together as follows:

• The microphone picks up sounds. It is located in a headset or case worn behind the ear, similar to a behind-the-ear hearing aid.
• A thin connecting cord carries sounds from the microphone to the speech processor, a small but powerful computer that digitally converts the sounds into coded electrical impulses. The coded impulses contain information about the frequency and loudness of sounds. Speech processors generally come in two styles. One is about the size of a pager and can be worn on a belt or in a pocket. The other is small enough to fit behind the ear and may be part of the same headset or case that contains the microphone.
• Coded impulses are sent to a transmitter, sometimes called a transmitting coil. A magnet holds the transmitter in place behind the ear, directly over the receiver that is implanted beneath the scalp.
• The transmitter relays the coded impulses as radio waves through the skin to the receiver. The receiver relays the signals to an array of electrodes threaded directly into the cochlea on a bundle of tiny wires.
• The electrodes stimulate nerve fibers in the cochlea that trigger the creation of electrical impulses. This information is sent to the auditory nerve and on to the brain for interpretation.

The process may sound complicated, but it all happens very quickly. The length of time between when the microphone picks up a sound to when the brain receives the information is just a few thousandths of a second. .

Criteria

Cochlear implants are not alternatives to hearing aids and help only those who cannot receive any benefit from hearing aids. Adults and children who are candidates for cochlear implants typically have severe to profound sensorineural hearing loss in both ears or have great difficulty understanding speech.

The best age for children is still being debated, but most who receive implants are between the ages of one and six. The younger the child at the time of implantation, the less delay there will be in the speech and language development – as long as there is appropriate therapy and education after the implantation.

Among adults, there is no upper age limit. Several studies have shown that people over the age of 65 can experience excellent results. The duration of hearing loss is the foremost predictor of any success with the implants: the shorter the duration, the better the results. The decision to receive an implant should be made only after talking to a cochlear implant audiologist and an experienced cochlear implant surgeon.

As well as having some degree of severe hearing loss, the best candidates for implants must have the following:

• Realistic expectations, that is, a clear understanding of the benefits and limitations of a cochlear implant;
• Willingness and ability to make a time commitment for the pre-implant evaluations and postsurgical follow-up services;
• Motivation, along with the support of family and friends to be a part of the hearing world.

Opposition

It may come as a surprise to know that many people in the deaf community strongly object to cochlear implants since many are often content in their unique culture. The deaf community usually includes a shared sign language, social customs and lifestyle, literature, art, and political, economic, and recreational organizations. However, not all people who are deaf participate in this culture and, for them, implants are a viable option.

For many in the deaf community, deafness is not regarded as a disorder to be altered. They have an especially negative reaction to implantation in children who are born deaf. Some parents have reported dealing with unfavourable comments and adverse reactions if they choose an implant for their child. However, some headway is being made in reconciling the two perspectives. Many are now recognizing the value of being fluent in both worlds – that is, continuing to use sign language and remaining part of the deaf culture while also participating in the larger hearing world.

Testing

The condition of the auditory nerve fibers will play a factor in the success of a cochlear implant. People with a greater number of functioning nerve fibers in the cochlea may benefit more from an implant. Although no test can determine the number or location of surviving fibers, such tests as magnetic resonance imaging (MRI) can indicate whether the cochlea can accommodate implant electrodes.

An otolaryngologist (ENT doctor), performs cochlear implant surgeries, although not all perform the procedure. Before proceeding with the implantation, several tests will be performed by an implant team, which includes an otolaryngologist and an audiologist. Tests will include:

• Otologic examination: An ENT will perform a medical exam involving the outer, middle, and inner ear to ensure that no active infection or any type of abnormality exists that would void the use of a cochlear implant. This exam will also determine if the patient can safely undergo general anesthsia.
• Imagery examinations: includes X-rays, CT scans (computerized tomography), and/or MRIs (magnetic resonance imagery) to see if the cochlea is suitable for inserting implant electrodes.
• Audiologic evaluation: includes extensive hearing tests to determine how much can be heard without a hearing aid. At the same time, hearing, speech, and language tests are conducted to establish a baseline of information for comparison with tests following implantation.
• Psychological examinations: will determine if the patient can cope with the implant. They will also examine issues that could affect adjustment to and satisfaction with an implant.

Once all the tests prove satisfactory, the surgery will be scheduled.

Surgical Procedure

Implant surgery is performed under general aneshetic and lasts from one to three hours. The procedure may also be done on an outpatient basis.

After anesthesia is administered, the surgeon will proceed as follows:

• An incision will be made behind the ear and a small depression in the skull behind the mastoid bone will be made. This will be where the receiver is placed.
• A second incision in the mastoid bone opens up the middle ear.
• A tiny hole is made in the cochlea and the electrodes are inserted.
• A few electronic tests are performed to make sure the device is functioning properly before the incisions are closed.

Bandages are usually removed a day or so after surgery. Complete healing takes about 4-6 weeks and, during this time, the implant will not be activated. Activation and programming will be done only after the surgical site heals completely.

Activating the Implant

When the healing process is complete, the patient returns to the cochlear specialist for the fitting of the external components and mapping the speech processor.

During the initial session, a headset or case containing the microphone is placed on the patient’s head and a transmitter is positioned on the side of the head. It is held in place by a magnet that couples with a magnet in the implanted receiver. The speech processor is connected to the microphone and to the audiologist’s computer.

One by one, implanted electrodes embedded in the cochlea are turned on. Each one carries a slightly different frequency and the patient will be asked to respond to the sound, indicating how loud it is. The audiologist uses these measurements to program the speech processor with special computer software. This processor is set to the appropriate levels of stimulation for each electrode.

After programming is complete, the speech processor is disconnected from the audiologist’s computer. Rechargeable or disposable batteries are inserted into the processor and the patient leaves with the whole system. It does take time to adjust, and each person has a different experience using the system.

Cost

Total costs for a cochlear implant, including evaluations, surgery, hospital fees, and all other fees and hardware, can range from $30,000 to $50,000. However, unlike hearing aids, cochlear implants are covered by most private insurance plans. In the U.S., Medicare, some state Medicaid programs, and Veterans Affairs provide partial coverage for cochlear implants. The implant specialist will be able to assist in determining the extent of a patient’s coverage.

http://www.innvista.com/health/ailments/earail/cochimpl.htm

Cochlear Implants, Surgical Technique

Introduction

Cochlear implantation has become a routine procedure in the United States and worldwide for the management of severe-to-profound sensorineural hearing loss. The decision to embark upon cochlear implantation is made either by the patient (if adult) or by the parents or caregivers of a child. The 60- to 75–minute procedure is well tolerated and routinely performed on an outpatient basis in both adults and children.

The team concept in cochlear implant evaluation allows for an exchange of information between the surgeon and other members of the implant and rehabilitation process, including audiologists, speech and language therapists, social workers, and psychologists. Typically, the patient is referred to a cochlear implant center, and initial contact is made. The patient may first be seen and identified as an implant candidate by an audiologist. Hence, a patient can enter the evaluation process in a number of different ways. Nonetheless, various issues are taken into consideration, including medical aspects of the patient's history, the audiologic evaluation, and radiographic studies.

An image depicting cochlear implant surgery can be seen below.

Postauricular incision for cochlear implant.

[ CLOSE WINDOW ]

Postauricular incision for cochlear implant.

Although the team evaluation concept is explained at greater length in the Indications section, it is notable because it allows for proper selection of patients, the continuous flow of pertinent dialogue, and the promotion of realistic expectations on the part of the patient and the patient's family.

The evaluation process used by the authors at the implant center at the Case Medical Center/University Hospitals of Cleveland and Rainbow Babies and Children's Hospital is summarized below. At the time of the medical evaluation, the patient's general medical history and issues regarding hearing loss are reviewed. A complete neuro-otologic and otolaryngologic examination is performed, and obvious conditions (eg, tympanic membrane perforation, chronic otitis media, congenital anomalies) are noted. The patient's history is reviewed to establish the potential etiology of the hearing loss. Audiologic tests are reviewed and repeated as necessary. Once the patient is deemed to be a potential cochlear implant candidate, the various cochlear implant options are discussed, and audiologic evaluation commences.

Typically, the audiologist measures the patient's hearing with and without hearing aids. Evaluation with pure-tone audiometry and auditory brainstem response (ABR) testing (in the case of children) is often performed. Otoacoustic emission (OAE) testing complements these studies; OAE results often indicate the need for a trial of newer and sometimes stronger hearing aids.

A CT scan is obtained to evaluate the status of the cochlea and to establish the presence of a patent (nonossified) cochlea or to identify a common cavity, Mondini dysplasia, enlarged vestibular aqueduct, or an ossified cochlea. In some cases, an MRI is used instead of the CT when questions exist regarding the presence of the eight nerve or severe ossification. In children and young adults, speech and language evaluation and educational placement discussions are performed next. Finally, a psychosocial evaluation is completed. Once a patient has been evaluated, a team meeting commences to recommend cochlear implantation advice. If the patient is cleared for cochlear implantation, the patient proceeds with preoperative medical clearance, chooses a cochlear implant device, and proceeds with surgery.

History of the Procedure

In 1957, Djourno and Eyries made the observation that activation of the auditory nerve with an electrified device provides auditory stimulation in a patient. This observation is considered the seminal observation that paved the way for modern cochlear implantation. In 1963, Doyle and Doyle's early experiments in scala tympani implantation preceded the first House/3M single-channel implant in 1972.¹ Multichannel devices introduced in 1984 have replaced single-channel devices by virtue of improved speech recognition capabilities. As of 2009, nearly 150,000 cochlear implants are estimated to have been performed worldwide, and approximately 7,000 procedures take place annually in the United States. Three US Food and Drug Administration (FDA)–approved multichannel devices are routinely used in the United States currently, including the Nucleus 5 cochlear implant system (Cochlear Corporation), the Clarion 90K (Advanced Bionics Corporation), and the Combi 40+ (MED-EL Corporation).

Problem

Severe-to-profound hearing loss, as evidenced by the lack of useful benefit from hearing aids, often determines one's candidacy for cochlear implantation. In children, this is confirmed via auditory testing and failure to develop basic auditory skills. In adults, candidates should receive limited or no benefit from appropriate hearing aids (ie, a score of 50% or less on sentence recognition tests in the best-aided listening situation).

Frequency

The incidence of congenital hearing loss varies by study. Niparko reviewed studies from the 1980s and 1990s and noted that one of the most carefully performed epidemiologic studies was that of Van Naarden et al, which noted an overall prevalence rate of serious hearing impairment of 1.1 cases per 1000 children aged 3-10 years.² By age 75 years, 360 of 1000 adults have a disabling hearing loss. According to the 1996 National Institute on Deafness and Other Communications Disorders survey, more than 28 million Americans are deaf or hearing impaired.³ This statistic may reach 40 million by the year 2020.

Etiology

Common etiologies of deafness that lead to consideration of cochlear implantation in pediatric patients include idiopathic, genetic, and acquired causes that result in congenital and delayed-onset hearing loss. Genetic hearing loss can be dominant or recessive. Infectious etiologies, including bacterial and postviral meningitis, can lead to severe hearing loss. Meningitis-related deafness has decreased with the routine use of the Haemophilus influenzae vaccine in children. Adult patients presenting for implantation include those with progressive hearing loss that began in childhood, viral-induced sudden hearing loss, ototoxicity, otosclerosis, Ménière disease, trauma, autoimmune conditions, presbycusis, and bacterial infections.

Pathophysiology

Typically, patients presenting with severe-to-profound deafness have had a direct or indirect injury to the organ of Corti, leading to degeneration or dysfunction of the hair cell system. Therefore, success of cochlear implantation depends on stimulation of surviving spiral ganglion neurons. The number of surviving neuron populations needed for successful implantation remains unclear. In 1991, Linthicum et al reported successful speech understanding in a patient who demonstrated less than 10% of the normal complement of neurons via a temporal bone study.⁴ Therefore, despite the wide range of surviving neurons present in various pathologic causes of deafness (10-70% of the normal 35,000-40,000 cells), most patients are likely potential implant candidates.

Presentation

In the past, children with hearing loss presented to the physician after their parents developed a concern about their child's lack of response to noise and voices. This may have brought the child to the attention of an otolaryngologist promptly (within a few weeks to months), or consultation may have been delayed up to a number of years. With the addition of universal infant screening, babies are identified at birth as having a hearing loss. The loss is confirmed and quantified with auditory brainstem testing, and, if profound, the patient is referred for cochlear implant evaluation. Children are fitted with hearing aids, and a decision to implant is based on progress or lack of language development and careful counseling of the family. If a child is clearly found to be an implant candidate, an earlier implantation results in superior hearing and speech outcomes.

Thus, implantation at age 12 months is now considered ideal, and, in some instances, implantation at an earlier age is performed. Adults with progressive loss that ultimately fails to be managed via amplification also may present for implant consideration. Patients are increasingly informed of the various options for cochlear implantation via the Internet and often have specific questions regarding different device options.

For excellent patient education resources, visit eMedicine's Ear, Nose, and Throat Center. Also, see eMedicine's patient education article Hearing Loss, as well as the eMedicine article.

Indications

The main indication for cochlear implantation is severe-to-profound hearing loss that is not adequately treated with standard hearing aids. The clinical conditions that lead to such an indication include various scenarios, as follows:

• Congenital hearing loss and prelingual deafness
• Acquired hearing loss and postlingual deafness
• Severe hearing loss that can be aided and that deteriorates to profound loss in childhood, adolescence, or adulthood (perilingual) and coexists with various degrees of language development

Generally, the candidacy for implantation is considered separately for adults and children. As outlined in the 1995 National Institutes of Health (NIH) consensus statement on cochlear implantation, adult candidacy is noted as being successful in postlingually deaf adults with severe-to-profound hearing loss with no speech perception benefit from hearing aids.⁵ In addition, the statement notes that "most marginally successful hearing aid users implanted with a cochlear implant will have improved speech perception performance." Medicare guidelines as of January 2005 allow for cochlear implantation in patients with 50% aided sentence discrimination scores and allow for 60% sentence scores in clinical trials. Clearly, the trend over time is that relaxed guidelines are better, and better cochlear implant performance and outcome have been demonstrated.

Prelingually deafened adults, although potentially suitable for cochlear implantation, must be counseled in regard to realistic expectations, as language and open-set speech discrimination outcomes are less predictable. A strong desire for oral communication is paramount for this group of patients

Children are considered candidates for cochlear implantation at age 12 months, and, because of meningitis-related deafness with progressive cochlear ossification, occasional earlier implantation is necessary. Investigations are ongoing into extending the age of early routine implantation to younger than 12 months. Audiologic criteria include severe-to-profound sensorineural hearing loss bilaterally and poor speech perception under best-aided conditions, with a failure to progress with hearing aids and an educational environment that stresses oral communication. The use of objective testing in this age group includes auditory brainstem response (ABR) testing and otoacoustic emission (OAE) testing in addition to trials of various auditory training programs, which are essential before cochlear implantation. For further discussion, see the eMedicine article Cochlear Implants, Indications.

Relevant Anatomy

The surgeon performing cochlear implant surgery must be experienced in otologic surgery and, ideally, some aspects of neurotologic surgery. Intimate knowledge of the relevant surgical anatomy of the mastoid cortex, retromastoid region, and posterior/middle cranial fossa dura is important in properly performing the approach to the facial recess and in properly creating an implant receiver well that provides low-profile placement of the internal device.

In addition, the relationship of the facial nerve, incus, chorda tympani, and the facial recess needs to be properly understood to safely perform the posterior tympanotomy to gain access to the middle ear. Once the facial recess has been opened, knowledge of the round window anatomy as it relates to normal or abnormal middle ear topography is vital. The ability to visualize the round window membrane by removing the bony round window niche is important for creating a proper cochleostomy. Variations in anatomy, ossification of the scala tympani, and various strategies of dealing with cerebrospinal fluid oozers and gushers should be anticipated.

Contraindications

Contraindications to cochlear implantation may include deafness due to lesions of the eighth cranial nerve or brain stem. In addition, chronic infections of the middle ear and mastoid cavity or tympanic membrane perforation can be contraindications. The absence of cochlear development as demonstrated on CT scans remains an absolute contraindication. Certain medical conditions that preclude cochlear implant surgery (eg, specific hematologic, pulmonary, and cardiac conditions) also may be contraindications. The lack of realistic expectations regarding the benefits of cochlear implantation and/or a lack of strong desire to develop enhanced oral communication skills poses a strong contraindication for implant surgery.

http://emedicine.medscape.com/article/857242-overview

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Allergies

Your eyes itch, your nose is running, you're sneezing, and you're covered in hives. It's allergy season again, and all you want to do is curl up into a ball of misery.

There has to be something you can do to feel better. After all, doctors seem to have a cure for everything, right? Not for allergies. But there are ways to relieve allergy symptoms or avoid getting the symptoms, even though you can't actually get rid of the allergies themselves.

What Are Allergies?

Allergies are abnormal immune system reactions to things that are typically harmless to most people. When you're allergic to something, your immune system mistakenly believes that this substance is harmful to your body. (Substances that cause allergic reactions, such as certain foods, dust, plant pollen, or medicines, are known as allergens.)

In an attempt to protect the body, the immune system produces IgE antibodies to that allergen. Those antibodies then cause certain cells in the body to release chemicals into the bloodstream, one of which is histamine (pronounced: his-tuh-meen).

The histamine then acts on the eyes, nose, throat, lungs, skin, or gastrointestinal tract and causes the symptoms of the allergic reaction. Future exposure to that same allergen will trigger this antibody response again. This means that every time you come into contact with that allergen, you'll have an allergic reaction.

Allergic reactions can be mild, like a runny nose, or they can be severe, like difficulty breathing. An asthma attack, for example, is often an allergic reaction to something that is breathed into the lungs by a person who is susceptible.

Some types of allergies produce multiple symptoms, and in rare cases, an allergic reaction can become very severe — this severe reaction is called anaphylaxis (pronounced: an-uh-fuh-lak-sis). Signs of anaphylaxis include difficulty breathing, difficulty swallowing, swelling of the lips, tongue, and throat or other parts of the body, and dizziness or loss of consciousness.

Anaphylaxis usually occurs minutes after exposure to a triggering substance, such as a peanut, but some reactions might be delayed by as long as 4 hours. Luckily, anaphylactic reactions don't occur often and can be treated successfully if proper medical procedures are followed.

Why Do People Get Allergies?

The tendency to develop allergies is often hereditary, which means it can be passed down through your genes. (Thanks a lot, Mom and Dad!) However, just because a parent or sibling has allergies doesn't mean you will definitely get them, too. A person usually doesn't inherit a particular allergy, just the likelihood of having allergies.

What Things Are People Are Allergic to?

Some of the most common allergens are:

Foods. Food allergies are most common in infants and often go away as people get older. Although some food allergies can be serious, many simply cause annoying symptoms like an itchy rash, a stuffy nose, and diarrhea. The foods that people are most commonly allergic to are milk and other dairy products, eggs, wheat, soy, peanuts and tree nuts, and seafood.

Insect bites and stings. The venom (poison) in insect bites and stings can cause allergic reactions, and can be severe and even cause an anaphylactic reaction in some people.

Airborne particles. Often called environmental allergens, these are the most common allergens. Examples of airborne particles that can cause allergies are dust mites (tiny bugs that live in house dust); mold spores; animal dander (flakes of scaly, dried skin, and dried saliva from your pets); and pollen from grass, ragweed, and trees.

Medicines. Antibiotics — medications used to treat infections — are the most common type of medicines that cause allergic reactions. Many other medicines, including over-the-counter medications (those you can buy without a prescription), also can cause allergic-type reactions.

Chemicals. Some cosmetics or laundry detergents can make people break out in an itchy rash (hives). Usually, this is because someone has a reaction to the chemicals in these products. Dyes, household cleaners, and pesticides used on lawns or plants also can cause allergic reactions in some people.

How Do Doctors Diagnose and Treat Allergies?

If your family doctor suspects you might have an allergy, he or she might refer you to an allergist (a doctor who specializes in allergy treatment) for further testing. The allergist will ask you about your own allergy symptoms (such as how often they occur and when) and about whether any family members have allergies. The allergist also will perform tests to confirm an allergy — these will depend on the type of allergy someone has and may include a skin test or blood test.

The most complete way to avoid allergic reactions is to stay away from the substances that cause them (called avoidance). Doctors can also treat some allergies using medications and allergy shots.

Avoidance

In some cases, like food allergies, avoiding the allergen is a life-saving necessity. That's because, unlike allergies to airborne particles that can be treated with shots or medications, the only way to treat food allergies is to avoid the allergen entirely. For example, people who are allergic to peanuts should avoid not only peanuts, but also any food that might contain even tiny traces of them.

Avoidance can help protect people against non-food or chemical allergens, too. In fact, for some people, eliminating exposure to an allergen is enough to prevent allergy symptoms and they don't need to take medicines or go through other allergy treatments.

Here are some things that can help you avoid airborne allergens:

• Keep family pets out of certain rooms, like your bedroom, and bathe them if necessary.
• Remove carpets or rugs from your room (hard floor surfaces don't collect dust as much as carpets do).
• Don't hang heavy drapes and get rid of other items that allow dust to accumulate.
• Clean frequently (if your allergy is severe, you may be able to get someone else to do your dirty work!)
• Use special covers to seal pillows and mattresses if you're allergic to dust mites.
• If you're allergic to pollen, keep windows closed when pollen season's at its peak, change your clothing after being outdoors — and don't mow lawns.
• If you're allergic to mold, avoid damp areas, such as basements, and keep bathrooms and other mold-prone areas clean and dry.

Medications

Medications such as pills or nasal sprays are often used to treat allergies. Although medications can control the allergy symptoms (such as sneezing, headaches, or a stuffy nose), they are not a cure and can't make the tendency to have allergic reactions go away. Many effective medications are available to treat common allergies, and your doctor can help you to identify those that work for you.

Another type of medication that some severely allergic people will need to have on hand is a shot of epinephrine (pronounced: eh-puh-neh-frin), a fast-acting medicine that can help offset an anaphylactic reaction. This medicine comes in an easy-to-carry container that looks like a pen. Epinephrine is available by prescription only. If you have a severe allergy and your doctor thinks you should carry it, he or she will give you instructions on how to use it.

Shots

Allergy shots are also referred to as allergen immunotherapy. By receiving injections of small amounts of an allergen, your body can gradually develop antibodies and undergo other immune system changes that help reduce the reaction to that allergen.

Immunotherapy is only recommended for specific allergies, such as allergies to things you might breathe in (like pollen, pet dander, or dust mites) or insect allergies. Immunotherapy doesn't help with some allergies, like food allergies.

Although many people find the thought of allergy shots unsettling, shots can be highly effective — and it doesn't take long to get used to them. Often, the longer someone receives allergy shots, the more they help the body build up antibodies that fight the allergies. Although the shots don't cure allergies, they do tend to raise a person's tolerance when exposed to the allergen, which means fewer or less severe symptoms.

If you're severely allergic to bites and stings, talk to a doctor about getting venom immunotherapy (shots) from an allergist.

Is It a Cold or Allergies?

If the spring and summer seasons leave you sneezing and wheezing, you might have allergies. Colds, on the other hand, are more likely to occur at any time (though they're more common in the colder months).

Colds and allergies produce similar symptoms, but colds usually last only a week or so. And although both may cause your nose and eyes to itch, colds and other viral infections can also cause a fever, aches and pains, and colored mucus. Cold symptoms often worsen as the days go on and then gradually improve, but allergies begin immediately after exposure to the offending allergen and last as long as that exposure continues.

If you're not sure whether your symptoms are caused by allergies or a cold, talk with your doctor.

Dealing With Allergies

So once you know you have allergies, how do you deal with them? First and foremost, try to avoid things you're allergic to!

If you have a food allergy, that means avoiding foods that trigger symptoms and learning how to read food labels to make sure you're not consuming even tiny amounts of allergens. People with environmental allergies should keep their house clean of dust and pet dander and watch the weather for days when pollen is high. Switching to perfume-free and dye-free detergents, cosmetics, and beauty products (you may see non-allergenic ingredients listed as hypoallergenic on product labels) also can help.

If you're taking medication, follow the directions carefully and make sure your regular doctor is aware of anything an allergist gives you (like shots or prescriptions). If you have a severe allergy, consider wearing a medical emergency ID (such as a MedicAlert bracelet), which will explain your allergy and who to contact in case of an emergency.

If you've been diagnosed with allergies, you have a lot of company. The National Institutes of Health (NIH) report that more than 50 million Americans are affected by allergic diseases. The good news is that doctors and scientists are working to better understand allergies, to improve treatment methods, and to possibly prevent allergies altogether.

To listen to the article visit http://kidshealth.org/teen/diseases_conditions/allergies_immune/allergies.html

All About Eczema

Rick was exhausted. Increased stress at school, home, and work had made him extremely tired. It also made his skin act up. Not again, he thought — not another eczema flare-up!

Eczema is a common skin problem. If you have eczema or think you might have it, here's how to deal with it.

Some Skin Facts

Your skin, which protects your organs, muscles, and bones and regulates your body temperature, can run into plenty of trouble. Acne occurs when your pores become clogged. But zits aren't the only skin problem you may encounter. Have you ever tried a new type of soap and developed an itchy rash? That reaction may just be eczema in action.

What Is Eczema?

Eczema (pronounced: ek-zeh-ma) is a group of skin conditions that cause skin to become red, irritated, itchy, and sometimes develop small, fluid-filled bumps that become moist and ooze.

There are many forms of eczema, but atopic (pronounced: ay-tah-pik) eczema is one of the most common and severe. Doctors don't know exactly what causes atopic eczema, also called atopic dermatitis (pronounced: der-muh-tie-tis), but they think it could be a difference in the way a person's immune system reacts to things. Skin allergies may be involved in some forms of eczema.

If you have eczema, you're probably not the only person you know who has it. Eczema isn't contagious like a cold, but most people with eczema have family members with the condition. Researchers think it's inherited or passed through the genes. In general, eczema is fairly common — approximately 1 in 10 people in the world will be affected by it at some point in their lives.

People with eczema also may have asthma and certain allergies, such as hay fever. For some, food allergies (such as allergies to cow's milk, soy, eggs, fish, or wheat) may bring on or worsen eczema. Allergies to animal dander, rough fabrics, and dust may also trigger the condition in some people.

Signs and Symptoms

It can be difficult to avoid all the triggers, or irritants, that may cause or worsen eczema flare-ups. In many people, the itchy patches of eczema usually appear where the elbow bends; on the backs of the knees, ankles, and wrists; and on the face, neck, and upper chest — although any part of the body can be affected.

In an eczema flare-up, skin may feel hot and itchy at first. Then, if the person scratches, the skin may become red, inflamed, or blistered. Some people who have eczema scratch their skin so much it becomes almost leathery in texture. Others find that their skin becomes extremely dry and scaly. Even though many people have eczema, the symptoms can vary quite a bit from person to person.

What Do Doctors Do?

If you think you have eczema, your best bet is to visit your doctor, who may refer you to a dermatologist (a doctor who specializes in treating skin). Diagnosing atopic eczema can be difficult because it may be confused with other skin conditions. For example, eczema can easily be confused with a skin condition called contact dermatitis, which happens when the skin comes in contact with an irritating substance like the perfume in a certain detergent.

In addition to a physical examination, a doctor will take your medical history by asking about any concerns and symptoms you have, your past health, your family's health, any medications you're taking, any allergies you may have, and other issues. Your doctor can also help identify things in your environment that may be contributing to your skin irritation. For example, if you started using a new shower gel or body lotion before the symptoms appeared, mention this to your doctor because a substance in the cream or lotion might be irritating your skin.

Emotional stress can also lead to eczema flare-ups, so your doctor might also ask you about any stress you're feeling at home, school, or work.

If you're diagnosed with eczema, your doctor might:

• prescribe medications to soothe the redness and irritation, such as creams or ointments that contain corticosteroids, or antihistamine pills
• recommend other medications to take internally if the eczema is really bad or you get it a lot

For some people with severe eczema, ultraviolet light therapy can help clear up the condition. Newer medications that change the way the skin's immune system reacts also may help.

If eczema doesn't respond to normal treatment, your doctor might do allergy testing to see if something else is triggering the condition, especially if you have asthma or seasonal allergies.

If you're tested for food allergies, you may be given certain foods (such as eggs, milk, soy, or nuts) and observed to see if the food causes an eczema flare-up. Food allergy testing also can be done by pricking the skin with an extract of the food substance and observing the reaction. But sometimes allergy testing can be misleading because someone may have an allergic reaction to a food that is not responsible for the eczema flare-up.

If you're tested for allergy to dyes or fragrances, a patch of the substance will be placed against your skin and you'll be monitored to see if skin irritation develops.

Can I Prevent Eczema?

Eczema can't be cured, but you can do plenty of things to prevent a flare-up. For facial eczema, wash gently with a nondrying facial cleanser or soap substitute, use a facial moisturizer that says noncomedogenic/oil-free, and apply only hypoallergenic makeup and sunscreens.

In addition, these tips may help:

• Avoid substances that stress your skin. Besides your known triggers, some things you may want to avoid include household cleaners, drying soaps, detergents, and scented lotions.
• Try to avoid hot water. Too much exposure to hot water or overuse of soaps or cleansers can dry out your skin, so take short warm — not hot — showers and baths and wear gloves if your hands will be in water for long periods of time. Be sure to gently and thoroughly pat your skin dry, as rubbing with a coarse towel will irritate the eczema. Also, it isn't the water that causes your skin to react; it's the water evaporating that's not captured in the skin.
• Say yes to cotton. Clothes made of scratchy fabric like wool can irritate your skin. Cotton clothes are a better bet.
• Moisturize! A fragrance-free moisturizer such as petroleum jelly will prevent your skin from becoming irritated and cracked.
• Don't scratch that itch. Even though it's difficult to resist, scratching your itch can worsen eczema and make it more difficult for the skin to heal because you can break the skin and bacteria can get in, causing an infection.
• Keep your cool. Sudden changes in temperature, sweating, and becoming overheated may cause your eczema to kick in.
• Take your meds. Follow your doctor's or dermatologist's directions and take your medication as directed.
• Unwind. Stress can aggravate eczema, so try to relax.

Dealing With Eczema

There's good news if you have eczema — it usually clears up before the age of 25. Until then, you can learn to tune in to what triggers eczema and manage the condition. For example, if you have eczema and can't wear certain types of makeup, find brands that are free of fragrances and dyes. Your dermatologist may be able to recommend some brands that are less likely to irritate your skin.

Your self-esteem doesn't have to suffer just because you have eczema, and neither does your social life! Getting involved in your school and extracurricular activities can be a great way to get your mind off the itch. If certain activities aggravate your eczema, such as playing soccer in the grass, suggest activities to your friends that won't harm your skin.

Even if sweat tends to aggravate your skin, it's still a good idea to exercise. Exercise is a great way to blow off stress — just try walking, bike riding, or another sport that keeps your skin cool and dry while you work out.

To listen to the article visit http://kidshealth.org/teen/diseases_conditions/allergies_immune/eczema.html