Alopecia areata is a common autoimmune skin disease that causes hair loss, and the emotional toll can be devastating. Currently there is no cure, but the condition can be managed well, especially if treated early.
Alopecia Areata is an autoimmune skin disease that causes hair loss on your scalp, face, and sometimes other areas of the body. Your body’s immune system attacks the hair follicles, resulting in increased hair loss. The onset is often sudden, with clumps of hair being shed, and circular bald spots may form.
2. It’s common
About 7 million people in the United States— and 147 million people worldwide—are affected by alopecia areata.
3. It affects all kinds of people
People of all ages, both sexes, and all ethnic groups can develop alopecia areata. It often first appears during childhood and can be different for everyone who has it.
4. It’s complex
Alopecia areata is very complex, and may run in families. However, multiple factors, both genetic and environmental, are thought to trigger the disease. It is not just a matter of heredity.
5. There are three types of alopecia areata
alopecia areata (patchy)—one or more coin-sized patches on the skin or body
alopecia areata totalis—complete hair loss on the scalp
alopecia areata universalis—total hair loss on the scalp and body
6. Other forms of alopecia include:
Scarring alopecia: This includes frontal fibrosing alopecia (FFA), which is hair loss on the front and sides of the scalp and may also affect the eyebrows; lichen planopilaris (LPP), an uncommon condition producing smooth white patches of hair loss on the scalp that is slowly progressive; and central cicatricial centrifugal alopecia (CCCA), a unique form of scarring alopecia affecting mostly black women on the crown of the scalp
Male Pattern Baldness: Hair loss usually follows a pattern of receding hairline and hair thinning on the crown. It is related to your genes and male sex hormones.
There is no cure for alopecia areata, but it now is emerging as a manageable condition that doctors can treat effectively, which can allow you to grow back hair. Mount Sinai is also conducting studies in scarring alopecia conditions that induce hair regrowth.
“At the Alopecia Center of Excellence at Mount Sinai, we are conducting clinical trials offering our patients access to new therapies such as novel JAK inhibitors and other new treatments, many of which are not available anywhere else,” says Dr. Guttman.
To make an appointment to see one of our team of Alopecia Areata experts, call 212-241-HAIR or email alopecia@mountsinai.org
Suicide is a serious public health problem, one that affects a broad segment of the population, according to the Centers for Disease Control and Prevention. But it can be hard to talk about.
In fact, there is one suicide death every 11 minutes, and that does not reflect the number of attempts. The suicide rate had been rising dramatically prior to the pandemic, which is one reason why the federal government in July launched the 988 National Suicide & Crisis Lifeline, an upgraded hotline for those in crisis.
At the same time, it’s important to remember there are ways to mitigate the risk of suicide and specific things you can do if you are concerned about a friend of family member. In this Q&A, Marianne Goodman, MD, Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai, offers some guidance on this sensitive topic.
“If we can help people identify suicide risks, limit access to ways that they could die by suicide, and use the crisis services that are now much more available, including the national 988 hotline, we can make a big difference,” says Dr. Goodman, acting director of the Mental Illness Research, Education and Clinical Centers at the James J. Peters VA Medical Center in the Bronx, who also co-leads a new initiative to help concerned family members speak to veterans about safely storing firearms and reducing the risk of self-harm.
How serious is the problem of suicide in the United States?
Suicide is the 12th leading cause of death. There are about 130 suicide deaths every day, and that’s one about every 11 minutes. In 2020, almost 46,000 Americans died by suicide, and this is twice as many as those who die in homicides. There were also 1.2 million suicide attempts. White males account for about 70 percent of the suicide deaths, and firearms are involved in more than half of these deaths. Unfortunately, in the past 20 years, the age adjusted suicide rate has increased 30 percent. This is a national crisis prompting a tremendous amount of research and clinical programming developed to target this elevating rate of suicide.
Who is most at risk, and why?
Certain populations have a particularly heightened risk. These include those encountering chronic stressors such as the elderly, veterans, lesbian, gay, bisexual, transgender, and queer populations, those with debilitating physical and mental illness, and especially those with a previous suicide attempt. Other risk groups include people with acute stressors such as a recent job loss, having been stigmatized, victimized, or traumatized, or who have experienced financial or relationship problems. But there’s not an equal risk at all times. It turns out that the rate of suicide is higher on Mondays and lower on the weekends; rates are higher during the spring and summer and after midnight.
What are some of the most common causes of suicide and suicidal thinking?
Suicide and suicidal thinking is prompted by many factors. In addition to the known risk factors, suicidal symptoms can be triggered by intense feelings of failure, shame, and being a burden to others. A deep sense of isolation, helplessness, and hopelessness leads to the belief that taking one’s life is the only answer to the misery they are feeling. However, there are also protective factors that actually lower the risk of suicide. These include bolstering coping abilities, having a purpose and reason for living; possessing a strong cultural identity; and a connection to others. If we can increase our protective factors, it actually mitigates some of the risks.
There are growing concerns about suicide among younger people. Why is that?
There is a tremendous and growing concern about suicide in younger people. Suicide is now the second leading cause of death among people aged 15 to 24. The highest rate of suicide death in youth are American Indians and Alaska Natives, with about 23 deaths per 100,000 people. White youth are second with about six suicide deaths per 100,000 people. While these numbers are certainly concerning, there’s a lot of recent evidence that suggests that youth suicide is a growing problem. A recent study that looked at just the past year found that 20 percent of high school students reported serious thoughts of suicide, and 9 percent made an attempt. Those are astronomical numbers. It’s not just high school students at risk; other concerning emergency room data of pre-adolescent children 10 to 12 years old document an increase in suicidal ingestion of substances, up four and a half fold in the past two decades. Also, reports of firearm use in youth is the highest in the past 20 years. During the pandemic, there was an increase in firearm suicide deaths of about 2 percent in adults, but 15 percent in young people. So clearly life stressors are affecting youth, and it’s being expressed through suicidal expression.
What has been the impact of the pandemic?
Suicide rates peaked in 2018. During the pandemic, suicide rates actually declined 3 percent in 2020. Pandemic related decreases could be explained by the notion that people pull together during a crisis. Some stressors were lessened during the pandemic, such as no longer needing to endure long commutes to work. The pandemic did draw attention to the importance of mental health. So while the pandemic was stressful, some of those forces were mitigated with the suicide rate coming down since 2020.
Has the new 988 National Suicide Prevention Hotline helped?
The 988 hotline is the 911 for mental health crises. The national hotline, accessed through calling 988, now connects people to the National Suicide Prevention Lifeline. This lifeline then connects individuals to various resources, including the Veteran’s Crisis Line, and a network of more than 200 state and local call centers services through the U.S. Department of Health and Human Services. The Biden administration invested a tremendous amount of money into this infrastructure. In fact, funding increased from $24 million to $432 million to address our mental health and suicide crises. In the year before the hotline, there were about three million calls, chats, and text to these centers. That’s expected to double within the first year of the national hotline.
What are some signs that someone may be in need of help?
Suicide prevention is everybody’s responsibility. There are warning signs that signal that someone is struggling. These include a preoccupation with death, comments about feeling trapped or a burden to others, or suggesting that people would be better off without them. Look for reckless behavior and impulsivity, such as driving at high speeds or enhanced use of alcohol and mind-altering substances. Mood swings, irritability, and worsening anger are concerning signs, as are changes in behavior including pushing people away, turning off phones, excessive sleep, or inability to sleep.
What should you do if you are concerned about a loved one or friend?
If you are concerned about a loved one or a friend, it’s important to reach out to that person. Talk to them and listen carefully. Encourage them to tell you what’s going on. Ask some difficult questions, such as: Are they feeling so bad that they want to think about ending their life? Do they have a plan to end their life? Don’t pass judgment about what they’re saying. Just be there to hear what they have to say. It’s important to empathize with the pain that they are going through. Help them to connect to either friends or support. If they are in crisis, use the 988 hotline, or seek professional help in a local emergency room. It’s very important to reassure the person that that they will not feel this bad forever and that negative feelings do get better over time.
What resources are available?
There are tremendous resources available. You can call the 988 hotline line 24/7. There are many organizations that offer assistance, including the American Foundation for Suicide Prevention, which has a website with lots of information. Another website, Means Matter, offers information about the importance of restricting access to a means to die by suicide, such as firearms. The Suicide Prevention Resource Center is another valuable resource.
Why is the issue of firearms so important?
When firearms are used, more than 85 percent of suicide attempts end in death. All other methods average about a 2 percent likelihood of death. More than 50 percent of people who die by suicide use firearms. If we can limit access to firearms, especially for those who are vulnerable, during high-risk times, we can meaningfully bring down suicide death rates. Promoting safe storage of firearms, and involving family in these decisions, is key. Pulling a trigger can happen so quickly with firearms—that urge, that impulse, once it is acted upon, you can’t take it back.
The Food and Drug Administration (FDA) recently issued a rule that allows hearing aids to be available over-the-counter (OTC). This rule enables consumers who perceive themselves to have mild to moderate hearing loss to buy hearing aids from stores or online retailers without a medical exam or prescription.
This rule, which took effect October 17, is expected to make hearing aids more accessible to the public, but many questions remain unanswered: what does it mean to have perceived mild to moderate hearing loss; what can we expect from this new category of hearing aids; and how can audiologists and hearing specialists help even when there isn’t a need for a hearing exam to obtain these devices? Enrique Perez, MD, Assistant Professor of Otolaryngology at the New York Eye and Ear Infirmary of Mount Sinai, shares his thoughts on the FDA rule and the benefit OTC hearing aids can bring to consumers.
Who might benefit most from this new rule?
Older adults who have noticed they are struggling somewhat with hearing in their day-to-day activities would likely benefit the most. The rule applies to people age 18 and older with perceived mild to moderate hearing loss, which can be subjective to quantify without an exam. The OTC devices would likely be suitable for people without serious otologic (ear) disease, frequent discomfort in the ear, or ear infections.
What devices are covered under the rule?
The rule covers air conduction hearing aids, which mimic the way we naturally hear but deliver amplified sound to the inner ear. This is opposed to bone-anchored hearing aids, which require surgical implantation, or personal sound amplification products, which are not mean for impaired hearing but are intended for people with normal hearing to amplify sounds in certain situations.
It remains to be seen how OTC hearing aids will eventually be labeled, but it is important that the labels are comprehensive, to ensure that individuals are not misled. For example, an OTC label could point out that the product is different from a prescription hearing aid and that if you are not seeing a benefit, you should be evaluated by a specialist.
How might an audiologist help?
Hearing aids becoming available over the counter doesn’t necessarily mean there is no longer any need for an audiologist. As more people have access to hearing aids, we might start to see a big chunk of these people we might not ordinarily see in clinic.
Enrique Perez, MD
How can I tell if I might have mild to moderate hearing loss?
There are clearly defined levels of hearing loss, which are determined through hearing exams, known as audiograms, on the decibels individuals are able to hear. But without an actual audiogram, you would have to rely on subjective cues, Dr. Perez said.
Someone with mild hearing loss might be struggling to hear low rumbling sounds or people whispering or speaking in another room.
Moderate hearing loss could look like someone with difficulty hearing people talking at a low tone, or struggling to understand conversation in a quiet office.
People with mild or moderate hearing loss might also struggle to hear conversations in a noisy environment, like a busy restaurant.
A key takeaway: If you’re struggling to hear in your daily activities, you might have some form of hearing loss, and hearing aids could be suitable for you.
For example, someone might try an OTC hearing aid and notice it is not amplifying sounds the way it needs to. An audiologist in this situation might be able to classify the degree of hearing loss and point the patient to the right kind of device they need.
Audiologists specialize in managing prescription devices, adjusting to each patient’s condition. Hearing loss can be complex: some people have very good hearing in the low frequencies but poor hearing in high frequencies, and a specialist can account for those nuances.
A possible limiting factor of an OTC hearing aid could be comfort. Everyone’s opening of the ear canal can be quite different. Audiologists work with making ear molds to make the fit more secure and comfortable. However, it is not clear how billing would work for mold services at this point, especially regarding OTC devices.
What might the future of hearing aid access look like?
In the long term, I hope to see that as more OTC hearing devices enter the market, competition will drive down the price of the technology in general. Perhaps it could even reduce the prices of prescription hearing aids.
It’s sad to tell a patient that they could benefit from hearing aids, but because most insurances do not cover these devices, they are shut out. These devices are pretty expensive, even at wholesale prices. The cheapest ones could run around $800, and expensive ones could easily run north of $5,000. This is not pocket change for a retiree on fixed income.
There also has to be a system for consumers to try out and return OTC hearing aids, just as they can try on reading glasses at the pharmacy. Some dispensers of prescription hearing aids do 30- to 90-day trials; perhaps there’s some way OTC devices can have a similar return policy. Finally, as a physician, I want to see OTC hearing aids rolled out in a safe manner, with adequate patient education and labeling to ensure people don’t end up getting hurt. There needs to be proper education of when these devices are suitable and for what kind of patient.
When our voices changed as we became older, it was mostly a welcome sign we were becoming adults. But as we grow older, still more changes occur in our voices, and sometimes in ways that may make communication challenging. These changes may be signs of a condition called presbyphonia.
What is Presbyphonia?
As we age, we lose muscle mass, our mucous membranes thin and become drier, and we lose some of the coordination that we had in younger years. Some of these changes are due to physical inactivity.
Similar changes occur in the larynx and vocal cords, also called vocal folds, due in part to vocal inactivity that impact our ability to speak and be heard. The symptoms of presbyphonia include:
Reduced volume and projection of your voice
Reduced vocal endurance, meaning more fatigue or hoarseness when talking
Difficulty being heard in noisy situations, such as dining out
Scratchiness or roughness in your voice
Breathiness or weakness in your voice
A higher-pitched voice among men
A lower-pitched voice among women
Tremor or shakiness in your voice
According to one recent study, approximately one in three adults ages 60 and older in the United States have one or more of these difficulties, and it can have a significant negative impact on every aspect of our lives.
Olivia Boddicker, MA, CCC-SLP
“We tend to underestimate how important our voice is until we can’t rely on it anymore. Changes in our voice make it difficult for us to do the things we love, such as reading to our grandchildren, socializing with friends, or singing with a choir,” says Olivia Boddicker, MA, CCC-SLP, a voice-specialized speech language pathologist at the Grabscheid Voice and Swallowing Center of Mount Sinai.
“The changes related to presbyphonia are not necessarily dangerous, but they can affect our sense of identity and self-confidence, making it difficult to hold employment or socialize.”
How Presbyphonia is Diagnosed
Although these changes in the voice may be age related, they could be symptoms of a more serious issue. For that reason, it is important to consult a laryngologist and voice-specialized speech language pathologist to determine what is going on, rule out other causes, and start to address the problem.
The laryngologist will typically perform a complete examination of your head and neck, along with a specialized examination of the vocal cords/folds called stroboscopy. This is a simple test in which a small device called a laryngoscope is inserted in the mouth or nose to examine the larynx and assess the appearance, mobility, and vibrations of the vocal cord/folds. If the laryngologist sees that the vocal cords/folds are thin, stiffened, or have a gap between them when they close, the diagnosis is typically presbyphonia.
Click here to download a special brochure about the Grabscheid Voice and Swallowing Center
During evaluation, the speech language pathologist will also perform a stimulability test to see how much effort it takes for the vocal cords/folds to create different sounds. This test will help determine the best approach to treatment.
Treatments for Presbyphonia
After reviewing the stroboscopy exam with the laryngologist and speech language pathologist, patients can decide whether behavioral intervention or surgical intervention is appropriate. In many cases, behavioral intervention through voice therapy is one of the first recommendations for treating presbyphonia because it is non-invasive and proven to be effective in increasing voice-related quality of life.
Voice therapy for presbyphonia focuses on increasing projection, vocal endurance, and improving stability of the voice. Techniques and programs such as vocal function exercises, phonation resistance training exercises, and respiratory muscle strength training are designed to coordinate the muscles of breathing and the muscles in the voice box, resulting in the best voice with the least amount of effort.
This strength and conditioning through daily exercise is similar to physical therapy, though instead of lifting weights, you make sounds. One example is holding out “ah” at high pitches and low pitches to work the different muscles of the vocal cords/folds and larynx.
However it is not always so simple, as no one-size-fits-all program exists for every person experiencing age-related changes to the voice.
“It is important to work with a voice-specialized speech pathologist if you are diagnosed with presbyphonia because they can give you personalized insights on how to work with your voice and make improvements in a way that is sustainable,” Ms. Boddicker says.
In some patients, however, vocal coordination and strength training are not enough to restore the voice to acceptable levels. If vocal difficulties after attempted behavioral therapy continue to be a source of social withdrawal and significantly reduce the patient’s quality of life, then consideration should be given to surgical techniques to bulk up the vocal cords/folds.
Bulking up the vocal cords/folds through surgery, does not usually restore the voice completely, but usually increases the patient’s vocal volume and reduces their effort to produce that voice. This allows the patients to be heard so that they may continue to interact and remain social, says Mark Courey, MD, Professor of Otolaryngology-Head and Neck Surgery, and Director of the Grabscheid Voice and Swallowing Center.
The vocal cords/folds can be bulked up either by injecting fat or by implanting plastic or Gore-Tex strips beneath them to partially push them into a better position for talking so the patient does not need to work so hard.
Use It or Lose It
Perhaps the best approach to presbyphonia is a preventative one. Just as we exercise to keep our muscles strong and responsive, it is important to find opportunities to keep using our voices so that our larynx and vocal cords/folds do not weaken and make it difficult to speak. This can be challenging for older adults if there are fewer opportunities for daily interactions.
“Look for opportunities to increase your voice use through the day,” Ms. Boddicker says. “Read aloud to yourself, sing around the house for fun, call a couple of friends each day, or stay connected in your community. All these activities can help keep your voice more youthful.”
Ultimately, if you are experiencing any age-related voice changes that are making it hard to communicate or be heard, it is important to have an exam so that you know what is going on and can take action to protect and even restore a more youthful quality to your voice.
To make an appointment for your voice, call 212-241-9425 or email entpatientservices@mountsinai.org. For initial consults, you will need an appointment with both a laryngologist and a speech language pathologist.
For decades, there was no community transmission of polio in the United States. Though still rare, polio is back in the news.
The New York State Department of Health recently reported a case in Rockland County, and then the virus was found in the New York City sewer system.
For those with young children, the news about polio may be of special concern. Polio is highly infectious and life-threatening. Those who have received the routine polio vaccine series are protected. For young children, it’s important to check that everyone is up to date.
Here are five key takeaways from the experts at Mount Sinai.
Young children may be at risk.
Some families have not been able to stay up to date with the standard childhood immunizations due to the COVID-19 pandemic. This leaves many children at risk for vaccine-preventable diseases, such as polio. If your child is behind on vaccines for polio, varicella, and other conditions, schedule a doctor’s appointment soon. “It’s really important now that everybody check to make sure they are up to date with their vaccinations,” says Kristin Oliver, MD, MHS, a pediatrician and preventive medicine physician at the Mount Sinai Health System.
It’s important for parents to stay up to date on getting their children vaccinated. Health authorities recommend children get four doses of polio vaccine. They should get one dose at each of the following ages: 2 months old, 4 months old, 6 through 18 months old, and 4 through 6 years old. You can find out if you child has been vaccinated by checking with your doctor or checking the New York City Department of Health website.
Children who are in the middle of their vaccine series should complete the series as scheduled.
They do not need to receive earlier or additional doses. Children who have had one or two doses of polio vaccine in the past should get the remaining doses when they are due. It does not matter how long it has been since the earlier dose(s).
Most adults ages 18 and over living in the United States are presumed to be immune to poliovirus from previous routine childhood immunization.
Adults who know they have not been vaccinated for polio, should start the vaccination series as soon as possible.
Most people who get infected with poliovirus will not have any visible symptoms.
According to the Centers for Disease Control and Prevention, about one in four people will have flu-like symptoms that last from two to five days and then go away. A smaller number of people will develop more serious symptoms, such as meningitis, an infection of the brain or spinal cord. Paralysis occurs in about 1 out of 200 to 1 in 2,000 people, and can lead to permanent disability.
If you want to discuss your child’s vaccination status, schedule an appointment with your doctor through MyMountSinai, Find a Doctor, or by calling the office directly. For assistance finding a new physician call 1-800-MD-SINAI or search on our Find a Doctor platform.
Starting a new school year can be a very exciting time but also a stressful one for parents and students.
For parents with questions or concerns, here are some basic tips to help you and your kids prepare, and ensure everyone has a happy and successful year. These tips come from two experts, Kristin Oliver, MD, MHS, and Erica Brody, MD, both pediatricians at Mount Sinai Health System.
Schedule an annual checkup
It’s one of the best ways to ensure your children’s health and well-being. Making sure your children are up to date on all their vaccines can keep them from getting sick from serious diseases. This includes COVID-19 and flu vaccines for all school-age kids. Older children need their meningitis and HPV vaccines and booster shot for tetanus and whooping cough.
Wash up
A great way to prevent germs from spreading is to remind your kids about proper handwashing techniques and teach children to avoid touching their face.
Stick to a healthy diet and meal schedule
Most kids could use more vegetables, like spinach, broccoli, tomatoes, squash, or carrots, and less junk foods, such as chips, cookies, and candy bars. Lean proteins are also important, like grilled chicken or fish, shellfish, beans, nonfat Greek yogurt, and eggs. Try to limit junk food and sugary drinks to occasional treats. Breakfast is critical to boost our morning energy levels, and also get us hydrated to start the day. A lunch that includes a vegetable, a protein, and lots of water or milk, while also avoiding junk food and excessive carbs, is ideal. A regular meal schedule keeps our energy levels steady, while also helping to maintain healthy portion sizes. Skipping meals can make children irritable and less focused; eating too late may contribute to obesity and poor sleep schedules.
Develop sensible sleep habits
With a consistent and early bedtime, kids learn faster and feel happier. For younger kids, a regular routine is key, with softer lights and sounds around bedtime. For older kids, daily vigorous exercise earlier in the day will help them fall asleep more easily. For all kids: screen time should end at least an hour before bed, and the earlier they go to bed, the easier it will be for them to wake in the morning.
Stay active
Kids need a daily exercise routine. Even when they can’t get outside, an exercise video or family dance session can do the trick.
Manage anxiety and keep calm
Kids may have different worries than adults, but they’re no less real. Find time each day to check in, hear their feelings, and remind them they’re supported. If there’s lots of negative emotions, consider discussing it with your pediatrician.
