41. Treatment Of Hyperhidrosis (2) In all cases, gustatory sweating ceased within two days, gustatory sweatingmay also occur. Sympathectomy also results in cardiac sympathetic http://www.regence.com/trgmedpol/medicine/med79.html

Policies TRG Medical Policy TRG Dental Policy TRG Behavioral Health Policy Medicine Section - Treatment of Hyperhidrosis Topic: Treatment of Hyperhidrosis Date of Origin: Section: Medicine Policy No: Approved Date: Effective Date: Next Review Date: IMPORTANT REMINDER This Medical Policy has been developed through consideration of medical necessity, generally accepted standards of medical practice, and review of medical literature and government approval status. Benefit determinations should be based in all cases on the applicable contract language. To the extent there are any conflicts between these guidelines and the contract language, the contract language will control. The purpose of medical policy is to provide a guide to coverage. Medical Policy is not intended to dictate to providers how to practice medicine. Providers are expected to exercise their medical judgment in providing the most appropriate care. Description The consequences of hyperhidrosis are primarily psychosocial in nature. Excessive sweating may be socially embarrassing or may interfere with certain professions. For example, palmar hyperhidrosis may preclude art work, working with electrical components, or playing certain musical instruments. In addition, hyperhidrosis may lead to a need for several changes of clothing a day; excessive sweating may also result in staining of clothing or shoes.

42. Rosacea ETS Comments And Warnings For example, gustatory sweating was reported by 47% of 352 patients who were The incidence of gustatory sweating was lower (12 of 72 patients) in http://rosacea.ii.net/hl/26808.html

Rosacea Support Group Rosacea Support Group Rosacea Support Group From: Rdl000@_.com Date: Thu Apr 12, 2001 6:29 pm Subject: more comments and warnings on ETS Attached below is the publication I referred to earlier by Peter Drummond concerning the ETS procedure. BTW, I have corresponded with Peter concerning sns-mediated flushing (he has been very generous with his time - I'm truly indebted to him). One comment he made is that sns-mediated flushing is closely linked to sweating, ie if you don't exhibit heavy sweating, then it is unlikely that your blushing/flushing is sns-mediated. (My corrollary: in this case, it is unlikely that ETS will mitigate flushing symptoms). Here is exact text of his private comments to me: - I'd be surprised if you had a problem with sympathetic nerves in your face. Sympathetic vasodilators make the face flush when you need to lose body heat (e.g., after exercise) and during certain types of emotion (e.g., embarrassment and anger). There is a close link between sweating and flushing, so if your face isn't sweating as well as flushing it is unlikely to be a sympathetic nerve problem. Has anyone checked your blood levels of epinephrine when your face flushes? Epinephrine is secreted from the adrenal medulla into the bloodstream during sympathetic nervous system arousal and can induce facial flushing. Occasionally the cells proliferate and start to oversecrete. - I should add that others (possibly including Geoffrey) would disagree with this connection. Just goes to show how complex these issues are in that there is no consensus among experts. (BTW, much of what little I know about sns-mediated flushing I learned from Jen Sandwell on this board, who understands these issues much better than I ...) My net on ETS is that it is a mini-labotomy to your sympathetic nervous system, and easily is the most radical and controversial procedure for treatment of facial blushing. Another useful discussion, already mentioned in some recent posts, is whether ETS is only for social blushers or for people (like me) who flush for no real apparent reason. Rick =================== British Journal of Dermatology, 142, 194-195, 2000 CORRESPONDENCE A caution about surgical treatment for facial blushing Sir The fear of blushing can become so problematic that it limits the range of activities in which the blusher is willing to participate, and occasionally develops into full-blown social phobia. Recently, endoscopic transthoracic sympathicotomy has appeared in this journal' and elsewhere 2,3 as a solution for chronic blushing. Short-term results from this procedure were positive, 1-3 and few distressing side-effects were encountered. However, the benefits of surgery must be balanced against the risk of developing postsurgical complications, primarily compensatory sweating and pathological gustatory sweating and flushing. These conditions seem almost to be the rule rather than the exception. For example, gustatory sweating was reported by 47% of 352 patients who were followed up by questionnaire or clinical examination a median period of 16 years after endoscopic transthoracic sympathectomy for palmar hyperhidrosis. 4,5 In this series, patient satisfaction declined from 95.5% initially to 66.7% when patients were questioned many years after the operation.s In fact, compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction with the surgical outcome. The incidence of gustatory sweating was lower (12 of 72 patients) in another series, 6 but all patients except one suffered from compensatory sweating elsewhere in the body. Physiological assessment of gustatory sweating would probably have revealed a higher incidence than selfreporting in this study. Gustatory sweating takes time to develop: a patient who initially is satisfied with the surgical outcome may later regret having the operation when autonomic disturbances appear. Pathological gustatory sweating and flushing can develop after injury to preganglionic cervicothoracie sympathetic fibres, an unavoidable consequence of resecting that part of the sympathetic chain. The mechanism of this abnormal response is uncertain; conceivably, though, regeneration of injured salivatory fibres or collateral sprouting from nearby intact fibres creates aberrant connections between salivatory fibres and denervated vasomotor and sudomotor neurons in the superior cervical ganglion. 7 Commands to salivate would then be translated into commands to sweat and flush in the distribution of sympathetic denervation. Cross-innervation lower down in the stellate ganglion can also produce unusual and potentially distressing autonomic disturbances in the sympathetically denervated arm (e.g. piloerection while cating).8 Interrupting the sympathetic pathway to the face destroys the neural circuitry which controls flushing to heat and blushing to emotional events, 9 and may therefore alleviate anxiety about blushing. However, as inappropriate facial sweating and flushing while eating can be just as distressing as anxiety about blushing, most patients who opt for the surgical procedure may be little better off in the long term. At present there is very little evidence to show that those most likely to pursue surgical treatment for blushing actually blush more readily or intensely than other people. In fact, changes in facial blood flow during acute embarrassment seem to be unrelated to ratings of the self-reported frequency of blushing.10.11 On the other hand, self-consciousness and fear of blushing correlate well with subjective estimates of blushing frequency and intensity. 10" 1 In this respect blushing differs from palmar hyperhidrosis, the usual indication for endoscopic transthoracic sympathectomy; sweaty palms are far easier for the patient to detect than blushing, which often is just a worrying suspicion not substantiated by fact. If the source of the patient's problem is anxiety about blushing rather than blushing per se, anxiety would be a more appropriate target for treatment than permanently eliminating the normal regulation of facial blood flow and sweating. Cognitive-behavioural and drug therapies help patients with social phobia to control anxiety, 12 and should thus be considered the treatments of choice for patients with a fear of blushing. P.D.DRUMMOND School of Psychology, Murdoch University, South Street, Murdoch, Western Australia 6150 Rosacea Support Group

43. :: The Neurotoxin Institute :: gustatory sweating was completely abolished in approximately half of the patients gustatory sweating can occur in diabetic patients with neuropathy and http://www.neurotoxininstitute.com/ad_sd06.asp

SECRETORY DISORDERS 6. Clinical studies of BoNT in the treatment of palmar hyperhidrosis Studies of BoNT type A in palmar hyperhidrosis have been more limited and less consistent than those in axillary hyperhidrosis because of the difficulty in maintaining a consistent injection technique and a wider range of individual susceptibility to treatment. Additionally, palmar injections are frequently painful and may require use of a nerve block of the median and ulnar nerves (Naumann and Jost, 2004; Lowe et al, 2004; Cohen and Solish, 2003). Despite these considerations, a number of studies have demonstrated a positive effect of BoNT type A on palmar hyperhidrosis. The randomized controlled trials of BoNT type A in palmar hyperhidrosis are summarized in Table 3. Although each of these studies was small, the results suggest that BoNT type A can effectively treat palmar hyperhidrosis. However, BoNT type A is not yet approved for the treatment of palmar hyperhidrosis, and further studies are needed. Table 3. Randomized controlled trials of BoNT in palmar hyperhidrosis.

44. :: The Neurotoxin Institute :: Improvement of diabetic autonomic gustatory sweating by botulinum toxin type A.Neurology. 2002;5919711973. Saadia D, Voustianiouk A, Wang AK, http://www.neurotoxininstitute.com/ad_sd09.asp

SECRETORY DISORDERS 9. References and Further Reading Amir M, Arish A, Weinstein Y, Pfeffer M, Levy Y. Impairment in quality of life among patients seeking surgery for hyperhidrosis (excessive sweating): preliminary results. Isr J Psychiatry Relat Sci. Atkins JL, Butler PE. Hyperhidrosis: a review of current management. Plast Reconstr Surg. Baumann LS, Halem ML. Botulinum toxin-B and the management of hyperhidrosis. Clin Dermatol. Bentivoglio AR, Albanese A. Botulinum toxin in motor disorders. Curr Opin Neurol. Bhatia KP, M unchau A, Brown P. Botulinum toxin is a useful treatment in excessive drooling in saliva. J Neurol Neurosurg Psychiatry. Boroojerdi B, Ferbert A, Schwarz M, Herath H, Noth J. Botulinum toxin treatment of synkinesia and hyperlacrimation after facial palsy. J Neurol Neurosurg Psychiatry. Burgen AS, Dickens F, Zatman LJ. The action of botulinum toxin on the neuro-muscular junction. J Physiol Cohen JL, Solish N. Treatment of hyperhidrosis with botulinum toxin. Facial Plast Surg Clin North Am. Dressler D, Adib Saberi F, Benecke R. Botulinum toxin type B for treatment of axillar hyperhidrosis.

45. Arquivos De Neuro-Psiquiatria - Kuttner et al.18 described 19 patients with severe gustatory sweating following gustatory sweating and flushing after conservative parotidectomy. http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-282X2003000200017

46. Brazilian Dental Journal - The mechanism of postparotidectomy gustatory sweating (the Auriculotemporalsyndrome gustatory sweating due to misdirection of regenerated nerve http://www.scielo.br/scielo.php?pid=S0103-64402004000200014&script=sci_arttext&t

47. The Laryngoscope - UserLogin Several therapeutic approaches exist to treat gustatory sweating (Frey s Nineteen patients with severe gustatory sweating have been treated with BOTOX http://www.laryngoscope.com/pt/re/laryngoscope/fulltext.00005537-199803000-00013

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48. The Laryngoscope - UserLogin In 1859, Rouyer11 briefly described three cases of gustatory sweating. In the other two cases, gustatory sweating was attributed to parotitis, http://www.laryngoscope.com/pt/re/laryngoscope/fulltext.00005537-199909000-00021

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49. Redo Surgeries - Hyperhidrosis, Blushing gustatory sweating began 6 mo post op, hands are still warm and dry after first ETS, 6 months later gustatory sweating developed. 4 years after surgery, http://www.hyperhidrosis-usa.com/redos.html

Home Redo Surgeries - INTRODUCTION Missed Kuntz nerves are an important factor in recurrent symptoms prompting many of the 73 redo ETS surgeries Dr. Nielson has performed. Intact Kuntz nerves is the most common reason Dr. Nielson finds for persistent symptoms after a patient has undergone bilateral sympathectomy. Micro ETS vs Clamping Partial nerve regeneration has also been found in many redo surgeries by Dr. Nielson on patients who had a sympathectomy by another doctor. Much less commonly, persistent symptoms is due to mis-identifying the T3 as the T2 level and therefore leaving the T2 level completely untouched and free to carry sympathetic nerve signal to the fingers and face. Why have people come to you to have redo Micro ETS surgery? Some individuals have come to me with persistent symptoms (sweating for example) after having had ETS surgery performed by someone else. I have treated them with redo Micro ETS successfully and discharged them the same day despite undergoing a redo procedure. I have found the cause(s) to be hidden sympathetic nerve/ganglia under thick tissue making it easy to have been missed the first time, intact Kuntz sympathetic nerves crossing the second and/or third rib(s), and

50. Current Opinion In Otolaryngology & Head And Neck Surgery - UserLogin Management options for gustatory sweating (Frey syndrome) gustatory sweating (Freysyndrome) is a universal problem after surgery of the parotid region http://www.co-otolaryngology.com/pt/re/cooto/fulltext.00020840-200006000-00014.h

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51. Current Opinion In Otolaryngology & Head And Neck Surgery - Abstract: Volume 8(3 gustatory sweating (Frey syndrome) is a universal problem after surgery of theparotid region and might be encountered in a large number of pathology cases. http://www.co-otolaryngology.com/pt/re/cooto/abstract.00020840-200006000-00014.h

LWWOnline LOGIN eALERTS REGISTER ... Archive Management options for gustatory... ARTICLE LINKS: Fulltext PDF (2.45 M) Permissions Management options for gustatory sweating (Frey syndrome). Laccourreye, Laurent MD *; Gutierrez-Fonseca, Raimundo MD +; Laccourreye, Ollivier MD ++ Abstract: Gustatory sweating (Frey syndrome) is a universal problem after surgery of the parotid region and might be encountered in a large number of pathology cases. Numerous treatment techniques and options have been offered to manage this condition; however, none has met with universal acceptance. This article reviews the history, pathophysiology, incidence, prevention, and management options for gustatory sweating. Subscribe to RSS feed utrdc-pt02 Release 4.0

52. Article Abstracts - Media Library - LifeCell.com in the prevention of postparotidectomy gustatory sweating (Frey s Syndrome).INTRODUCTION gustatory sweating is a common postoperative problem and a http://www.lifecell.com/media/70/Article Abstracts/26

MEDIA LIBRARY CONTACT US Media Library SEARCH Press Releases Instructional Videos Article Abstracts Product Brochures ... Monographs Govindaraj S, Cohen M, Genden EM, Costantino PD, Urken ML. Laryngoscope. 2001 Nov;111(11 Pt 1):1993-8. Department of Otolaryngology, Mount Sinai Medical Center, New York, NY 10029, USA. . Access to and use of this Web Site is subject to these

53. Gustatory Sweating gustatory sweating emotions. All that is necessary of their browes, themPomegranates, to ever presumed such as animals, slavery was still something But the http://gustatory-sweating.pl.olkusz.pl/

gustatory sweating blue beehive wig alphabetical playstation 2 games list history of san bernardino california ps2 fellowship of the ring ... michigan history and constitution gustatory sweating

54. Thieme-connect - Artikel Im Volltext Ingesting highly spiced foods stimulates physiologic gustatory sweating in mostpeople. Aberrant gustatory sweating follows up to 73% of surgical http://www.thieme-connect.com/sample/htmlsmpl.html

Full Text Article Contact Us Semin Neurol 2003; 399-406 DOI: 10.1055/s-2004-817724 Disorders of Sweating William  P.  Cheshire  M.D.  , Roy  Freeman  M.B.    Ch.B.   Department of Neurology, Mayo Clinic, Jacksonville, Florida Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts ABSTRACT HYPERHIDROSIS Generalized Hyperhidrosis Focal Hyperhidrosis ... Top of Page ABSTRACT Top of Page KEYWORDS Hyperhidrosis - hypohidrosis - peripheral neuropathies - cholinergic antagonists - botulinum toxin - autoimmune diseases of the nervous system Eccrine gland sweating is the principal means of thermoregulatory heat dissipation in humans. If the body's internal temperature exceeds the hypothalamic set point, activation of a sympathetic reflex results in generalized sweating, vasodilatation, and hyperpnea.[ ] Evaporative heat loss thus maintains homeostasis by lowering core temperature to normal. The sweating pathway originates in the preoptic area of the anterior hypothalamus and descends uncrossed through the medial portion of the lateral funiculus of the brain stem to synapse upon preganglionic neurons in the intermediolateral column of the spinal cord.[

55. The History Of Gustatory Sweating: The Contributions Of Lucja Frey - Gustatory S gustatory sweating Parasympathetic innervation of cutaneous sympatheticreceptors; Localized facial sweating flushing with gustatory stimulation http://medinfo.ufl.edu/other/histmed/dunbar/slide3.html

i Gustatory Sweating Disruption of pathways subserved by the auriculotemporal (AT) nerve Misdirected growth of nerves Parasympathetic innervation of cutaneous sympathetic receptors

56. The History Of Gustatory Sweating: The Contributions Of Lucja Frey The History of gustatory sweating the Contributions of Lucja Frey RealAudiogustatory sweating RealAudio Auriculotemporal Nerve http://medinfo.ufl.edu/other/histmed/dunbar/

The History of Gustatory Sweating: the Contributions of Lucja Frey How to Use These Slides: This presentation has been enhanced using RealAudio. To hear the audio track you will need to install the RealPlayer available free from www.real.com . To start the program, click on the icon next to slide you wish to view. After a few moments the RealPlayer will begin the audio program at that point. You may also select any slide to view it without audio. Use the controls ( ) to move forward, backward, or return to this index. You may need to adjust the font size of your browser for optimal viewing. The History of Gustatory Sweating: the Contributions of Lucja Frey Objective Gustatory Sweating Auriculotemporal Nerve ... Special thanks and recognition Author: Erin Dunbar, MD / edunbar@ufl.edu Contact: BJ Strickland / STRICBJ@shands.ufl.edu Version: Produced by the Office of Medical Informatics 2001 by the University of Florida Location: http://medinfo.ufl.edu/other/histmed/dunbar/index.html Created: December 7, 2001 Modified: December 7, 2001

57. Linda Bartoshuk Q A Lee, TS (1954) Physiological gustatory sweating in a warm climate. Journal ofPhysiology, 124528542. q Why do dairy products stop the burning feeling http://www.pbs.org/safarchive/3_ask/archive/qna/3294_peppers.html

58. Blackwell Synergy - Cookie Absent Although these symptoms, sometimes referred to as gustatory sweating, Objective quantification of the gustatory sweating area was done by the starch http://www.blackwell-synergy.com/doi/abs/10.1046/j.0007-1323.2001.01982.x

Home An Error Occurred Setting Your User Cookie A cookie is a small amount of information that a web site copies onto your hard drive. Synergy uses cookies to improve performance by remembering that you are logged in when you go from page to page. If the cookie cannot be set correctly, then Synergy cannot determine whether you are logged in and a new session will be created for each page you visit. This slows the system down. Therefore, you must accept the Synergy cookie to use the system. What Gets Stored in a Cookie? Synergy only stores a session ID in the cookie, no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a web site to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. Please read our for more information about data collected on this site.

59. Blackwell Synergy - Cookie Absent He denied any gustatory sweating, hot flashes, wet flushes, or dysesthesias Botulinum toxoid in the management of gustatory sweating (Frey s syndrome) http://www.blackwell-synergy.com/doi/abs/10.1111/j.1524-4725.2004.30017.x

Home An Error Occurred Setting Your User Cookie A cookie is a small amount of information that a web site copies onto your hard drive. Synergy uses cookies to improve performance by remembering that you are logged in when you go from page to page. If the cookie cannot be set correctly, then Synergy cannot determine whether you are logged in and a new session will be created for each page you visit. This slows the system down. Therefore, you must accept the Synergy cookie to use the system. What Gets Stored in a Cookie? Synergy only stores a session ID in the cookie, no other information is captured. In general, only the information that you provide, or the choices you make while visiting a web site, can be stored in a cookie. For example, the site cannot determine your email name unless you choose to type it. Allowing a web site to create a cookie does not give that or any other site access to the rest of your computer, and only the site that created the cookie can read it. Please read our for more information about data collected on this site.

60. Hyperhidrosis, Sweaty Palms, Sweat, Excessive Sweat, Sweatypalms, Endoscopic, En A more rare side effect, gustatory sweating, which occurs in about 10% of gustatory sweating, a condition in which sweating increases while eating or http://users.rcn.com/szarnick/hidrosis.html

Welcome to Dr. Szarnicki's Hyperhidrosis Page Overview Symptoms Causes Treatment ... FAQ You may schedule a confidential appointment in my office to explain any topics or treatment options discussed on this page. Overview: Sweating is necessary to control body temperature during times of exercise and warm/hot surroundings. Sweating is regulated by the sympathetic nervous system. In 0.6 to 1.0% of the population, this system is revved-up and works at a very high level causing sweating to occur at inappropriate times in specific areas of the body. This condition is known as hyperhidrosis. Symptoms: Hyperhidrosis can occur in many different areas of the body. Most commonly, hyperhidrosis appears on the palms. In this case it is known as Palmar Hyperhidrosis. The condition isn't just limited to the hands. Hyperhidrosis is also a problem on the facial area, the soles of the feet and the armpits (axillae.) Severe facial blushing may coexist. Regardless of where it is located, hyperhidrosis presents an embarrasing problem to those afflicted with it. Shaking hands becomes uncomfortable, making business and day-to-day life a problem. Patients report that they are even embarrassed to hold the hands of those they love. Patients commonly suffer from various degrees of social phobia causing them to withdraw from normal activities. Hyperhidrosis is also not a temporary condition. Many people who suffer from it have suffered for many years, usually from adolescence. Also, hot or cold, the sweating is constant.

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