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					           Geographic Tongue

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                   001049.htm
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• Geographic tongue: Glossitis areata
  exfolviativa - a condition of the tongue
  marked by numerous denuded patches on
  the dorsal surface coalescing into freeform
  shapes similar to the geographic areas on
  a map. Denuded areas may persist for
  more than a month.
• Glossitis - an inflammation of the tongue
• Alternative names :Patches on the
  tongue; Tongue - patchy; Benign migratory
  glossitis
• One of the most common medical conditions of
  the tongue. Parents usually are the ones to
  notice several large, red, slightly depressed,
  unusually smooth patches on the surface of their
  child's tongue -- when nothing was there hours
  before. Often the red areas are bordered with
  distinct white bands. The sharp borders of these
  irregularly shaped lesions give the surface of the
  tongue the appearance of a map, perhaps a
  map of a group of uncharted islands. The rather
  dramatic appearance of geographic tongue
  looks to many like a burn, or like some kind of
  nasty infection. In geographic tongue, the filiform
  papillae are missing in the reddish areas and are
  overcrowded in the gray-white borders.
                 Incidence
• The exact prevalence varies widely from study
  to study, but at any given time, somewhere
  between 0.1 percent and 14.3 percent of
  otherwise healthy people have it.
                     Etiology
• The specific cause of geographic tongue is unknown,
  although allergies may be involved. Other causes may
  include irritation from hot or spicy foods, alcohol, or
  tobacco.
• We still do not know exactly what causes geographic
  tongue, but we do know that it strongly tends to run in
  families (Oral Surgery, Oral Medicine, and Oral
  Pathology, Nov 1976). Geographic tongue has polygenic
  inheritance -- it is associated with several different
  genes. We also know that it is associated with a number
  of other genetic medical conditions. It has been most
  closely linked to psoriasis, and is notably more common
  in those who have psoriasis (British Journal of
  Dermatology, Sep 1996). The two conditions have been
  linked to the same gene and are probably produced in
  the same manner; nevertheless the great majority of
  those with geographic tongue do not go on to develop
  psoriasis.
• Geographic tongue is also significantly more common in
  people who are sensitive to the environment -- those
  with allergies, eczema, and/or asthma (Oral Surgery,
  Oral Medicine, and Oral Pathology, Aug 1984).
• It is also four times more common in those with diabetes
  (Oral Surgery, Oral Medicine, and Oral Pathology, Jan
  1987). But a great many conditions are more common in
  those with diabetes, and geographic tongue has never
  been noted as an early warning of diabetes.
• In young women with geographic tongue who are also
  taking oral contraceptives, the geographic tongue is
  worst on day 17 of the cycle (British Dental Journal, Aug
  1991). This suggests that hormone levels probably play
  a role. Perhaps there is even some truth to the unproven
  belief that stress can trigger geographic tongue.
• Weaker links have been reported to anemia, seborrhea,
  and eating spicy foods.
• Most people with geographic tongue are
  otherwise healthy. The condition is usually
  entirely painless. While it can produce a burning
  sensation in the mouth, this is very rare in
  children. If there is any pain or burning, this
  usually can be successfully controlled with
  antihistamines (Pediatric Dentistry, Nov 1992).
• There is no loss of the sense of taste (hurrah for
  the glorious sense of taste!), nor is there any
  loss of the dexterity of the tongue. There is,
  however, a measurable decrease in the tongue's
  sense of touch. This was studied by carefully
  assessing response to mechanical vibration
  (Journal of Laryngology and Otology, Mar 1984).
• Symptoms
• a map-like appearance to the surface of the
  tongue
• smooth, beefy red patches and lesions on the
  tongue
• patches that change location from day to day
• soreness and burning pain (in some cases)
• Signs and tests Your doctor will usually
  diagnose this condition based on an
  examination of your tongue. Tests are usually
  not necessary.
              Treatment
• No treatment is currently recommended,
  however, for this benign, self-limited
  condition.
• Geographic tongue heals spontaneously.
  The individual lesions often heal at the
  same time new ones are forming,
  changing the appearance of the tongue
  over hours or days. This gives rise to the
  appearance that the map is migrating
  across the face of the tongue. Thus,
  geographic tongue is also called benign
  migratory glossitis. Although benign, this
  condition may last for months -- or even
  longer -- and often recurs.
• The same pattern holds true for the rare,
  but real variation -- geographic lip.
               Prevention
• Avoid irritating your tongue with hot or
  spicy food, alcohol, or tobacco if you are
  prone to this condition
             Tinnitus
             MelinePlus
   American Tinnitus Assocsiation
Taber’s Cyclopedic Medical Dictionary
• Tinnitus: the perception of noise in the ears or head
  when no external sound is present. sound in the ear.
• People hear whooshing or ringing or tinkling or buzzing
  or chirping or pulsing.

• Tinnitus (ringing in the ears) is a common problem,
  affecting about 17% of the general population around the
  world (44 million people in the USA). It causes significant
  suffering in about 4% of the general population (10
  million in the USA). Typically patients are told "to learn to
  live with it." The development of a neurophysiological
  model of tinnitus (Jastreboff, P.J. Phantom auditory
  perception (tinnitus): mechanisms of generation and
  perception. Neurosci.Res.:221-254, 1990)
                    Etiology
• Found in certain diseases of the exterior, middle
  or inner ear.
• Etiology: may be caused by impacted cerumen,
  myringitis, otitis media, labyrinthitis, Ménière’s
  symptom complex, otosclerosis, or hysteria
• The most common cause is damage to the
  auditory cells in the inner ear. This is due to age-
  related hearing loss or exposure to very loud
  noises.
• It may also follow prolonged treatment with
  drugs such as quinine and salicylates,
  including aspirin; more than 200
  medications can cause tinnitus
• Injury to the head or neck
• Stiffening of the bones in the middle ear
• Tumors in the brain or ears
• Can also be due to sound of blood flow in
  hypertension – objective tinnitus
                Treatment
• Depends on cause:
  – Stop medications
  – Remove ear wax or treat infection
  – Treat tumor or blood vessel problems
  – Damage to hearing cells cannot be cured:
     • Treatments may include hearing aids or
       maskers
     • Some medications (also have side effects)
     • Tinnitus retraining therapy