Physical Examination: Adolescent Male

Puberty: Adolescent Male

Physical Examination: Adolescent Male | Johns Hopkins Medicine

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The teenage years are also called adolescence. During this time, teens will see the greatest amount of growth in height and weight. Adolescence is a time for growth spurts and puberty changes.

A teenager may grow several inches in several months followed by a period of very slow growth. Then they may have another growth spurt. Changes with puberty may happen slowly. Or several changes may occur at the same time.

It's important to remember that these changes will happen differently for each teen. Some teens may experience these signs of maturity sooner or later than others. And being smaller or bigger than other boys is normal. Each child goes through puberty at their own pace. 

What changes will happen during puberty?

Sexual and other physical maturation that happens during puberty result from hormonal changes.

In boys, it's hard to know exactly when puberty is coming. There are changes that happen, but they occur slowly over a period of time rather than as a single event. 

There are certain stages of development that boys go through when developing secondary sex characteristics. Here is a brief overview of the changes that happen:

  • In boys, the first puberty change is the enlargement of the scrotum and testes. At this point, the penis does not enlarge.
  • As the testes and scrotum continue to grow, the penis grows.
  • The first growth of pubic hair produces long, soft hair that is only in a small area around the genitals.
  • This hair then becomes darker and coarser as it continues to spread.
  • The pubic hair eventually looks adult hair, but in a smaller area. It may spread to the thighs and sometimes up the stomach.

The following changes may also happen to a boy as he goes through puberty:

  • Body size will increase. Sometimes the feet, arms, legs, and hands may grow faster than the rest of the body. This may cause a teen to feel clumsy.
  • Some boys may get some swelling in the breast area. This is a result of the hormonal changes that are happening. This is common among teenage boys and is often a short-term or temporary condition. Talk with your son's healthcare provider if this is a concern.
  • Voice changes may happen, as the voice gets deeper. Sometimes the voice may “crack” during this time. This is a temporary condition and will improve over time.
  • Hair will start to grow in the genital area. Boys will also have hair growth on their face, under their arms, and on their legs.
  • As the puberty hormones increase, teens may have an increase in oily skin and sweating. This is a normal part of growing. It's important to wash daily, including the face. Acne may develop.
  • As the penis enlarges, the teen boy may begin to have erections. This is when the penis becomes hard and erect because it is filled with blood. This is due to hormonal changes and may happen when the boy fantasizes about sexual things. Or it may happen for no reason at all. This is normal.
  • During puberty, a boy's body also begins making sperm. Semen, which is made up of sperm and other body fluids, may be released during an erection. This is called ejaculation. Sometimes this may happen while the teen is sleeping. This is called a wet dream (nocturnal emission). This is a normal part of puberty. Once sperm is made and ejaculation happens, teen boys who have sex can get someone pregnant. 

What does my teen understand?

The teen years bring many changes—not only physically, but also mentally and socially. During these years, teens increase their ability to think abstractly and eventually to make plans and set long-term goals. Each child may progress at different rates, and show a different view of the world. In general, the following are some of the abilities you may see in your teenager:

  • Developing the ability to think abstractly
  • Concerned with philosophy, politics, and social issues
  • Thinking long-term
  • Setting goals
  • Comparing himself to his peers

Your teen's relationships with others

As your teenager begins to struggle for independence and control, many changes may happen. Here are some of the issues that your teen may experience during these years:

  • He wants independence from parents.
  • Peer influence and acceptance is very important.
  • Peer relationships become very important.
  • He may be in love.
  • He may have long-term commitments in relationships.

Source: https://www.hopkinsmedicine.org/health/wellness-and-prevention/puberty-adolescent-male

Johns Hopkins and Bloomberg Philanthropies, with New York State, Launch Online Course to Train Army of Contact Tracers to Slow Spread of COVID-19

Physical Examination: Adolescent Male | Johns Hopkins Medicine

Newswise — With the urgent need to limit the spread of COVID-19, the Johns Hopkins Bloomberg School of Public Health, with Bloomberg Philanthropies, today launched a free online course to help train a new cadre of contact tracers to reach and assist people exposed to the virus. Taking and passing this course will be a requirement for thousands of contact tracers being hired by the state of New York to fight the pandemic.

The new course, “COVID-19 Contact Tracing,” highlights how contact tracing is a key component of a public health strategy to slow the spread of COVID-19 without large-scale shutdowns and stay-at-home orders.

Through presentations by expert faculty and role plays, the course teaches the basics of interviewing people diagnosed with COVID-19, finding their close contacts who might have been exposed, and providing them advice and support for self-quarantine.

Contact tracing is a public health practice that has been successful in breaking the chain of transmission of other infectious diseases, including measles and tuberculosis.

New York Gov. Andrew M. Cuomo and Michael R. Bloomberg, founder of Bloomberg Philanthropies and former three-term mayor of New York City, recently announced an initiative to develop a large-scale contact tracing program in New York state.

 The program will include a baseline of 30 contact tracers for every 100,000 residents in the state and will utilize additional tracers the projected number of cases in each region.

The program is expected to have 6,400 to 17,000 tracers statewide depending on the projected number of cases.

Bloomberg Philanthropies is supporting the state Department of Health with recruiting and interviewing applicants, and the Johns Hopkins Bloomberg School has developed this online curriculum to train candidates.

Vital Strategies’ initiative Resolve to Save Lives will provide technical and operational advising to New York state health department staff.

 The program will serve as an important resource to gather best practices and as a model that can be replicated across the nation.

“Contact tracing allows us to communicate with people infected with COVID-19, identify those who may have been exposed, and provide all of them with guidance to limit the spread of the disease,” said Bloomberg.

“This new training course, which we’re making available online for free, will teach contact tracers how to do this work effectively—and help cities and states across the nation undertake these critical efforts.

“Testing and tracing are critical to our reopening plan, and New York is leading the nation on both fronts.

We’re testing more than any other state and now we’re working with Bloomberg Philanthropies and Johns Hopkins to quickly build an army of tracers for our contact tracing program that can serve as a model for the rest of the nation,” said Governor Cuomo.

“This innovative online training course is a key component of our program that will provide tracers with the tools to effectively trace COVID-19 cases at the scale we need to fight this pandemic.”

A recent report from the Johns Hopkins Center for Health Security at the Bloomberg School estimated that the current situation in the United States requires a new workforce of at least 100,000 contact tracers to limit the spread of COVID-19 and begin to reopen the economy.

To support the effort, the Johns Hopkins Bloomberg School of Public Health has developed the contact tracing course that is available for registration on the Coursera platform starting Monday, May 11, 2020.

It is open to anyone in the world, whether they are interested in becoming a contact tracer or just want to understand the process. Applicants in New York state will be invited to take the course after their application is reviewed and they pass an initial interview.

The interview, followed by taking the course and passing the final assessment within 72 hours, will be required to be hired into the New York state program.

“Controlling the spread of COVID-19 will require the hiring and training of a public health workforce in record time,” said Joshua M. Sharfstein, MD, vice dean for Public Health and Community Engagement at the Bloomberg School.

“This introductory course provides a strong foundation in the core concepts of contact tracing, from how to talk to people about COVID-19 to key ethical principles.”

The lead instructor of the course is Emily Gurley, PhD, an infectious disease epidemiologist at the Bloomberg School.

Among other contributors to the class is Bloomberg School senior research associate Tolbert Nyenswah, LLB, MPH, who was the incident commander for the response to the Ebola outbreak in Liberia.

The contact tracing course, which takes six hours to complete, is divided into five sections or “modules.” The course covers:

  1. Basic information on the virus and COVID-19, including symptoms of infection and how the virus is transmitted;
  2. Fundamentals of contact tracing, such as how to define a case, identify their contacts, and calculate how long a contact should isolate;
  3. Steps involved in investigating cases and tracing their contacts, including simulated scenes performed by professional actors who illustrate potential interactions that tracers may experience with infected individuals and their contacts;
  4. Ethics of contact tracing, including balancing privacy and public health considerations, and examples of basic technology tools that can facilitate contact tracing, such as using text messaging for check-ins and reminders;
  5. Skills for effective communications in the tracing process, such as what it means to be an “active listener” and how to deal with common challenges that arise when investigating cases.

“We hope the excellent content and easy accessibility of this virtual training program can contribute to achieving the speed and scale required to get the New York State program up and running,” said Kelly Henning, MD, who leads the Bloomberg Philanthropies Public Health program. “We believe it also can be useful for health departments around the country and around the world eager to aggressively expand contact tracing.”

 “The Bloomberg School of Public Health has been at the forefront of the fight against COVID-19 since the beginning, helping leaders and the public understand and respond to this pandemic with the best available science and evidence,” said Ellen J.

MacKenzie, PhD, ScM, dean of the Johns Hopkins Bloomberg School of Public Health. “Massive contact tracing is a critical component of our recovery.

We are thrilled to bring our deep expertise on this important public health practice, as well as our experience in industry-leading online teaching, to the training and curriculum for this groundbreaking effort.”

# # #

Source: https://www.newswise.com/articles/johns-hopkins-and-bloomberg-philanthropies-with-new-york-state-launch-online-course-to-train-army-of-contact-tracers-to-slow-spread-of-covid-19

Medical Mystery: How Can Some People Hear Their Own Eyeballs Move?

Physical Examination: Adolescent Male | Johns Hopkins Medicine

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It sounds something an Edgar Allan Poe tale of horror.

* A man becomes agitated by strange sounds only to find that they are emanating from inside his own body—his heart, his pulse, the very movement of his eyes in their sockets.

Yet superior canal dehiscence syndrome (SCDS) is a very real affliction caused by a small hole in the bone covering part of the inner ear. Such a breach results in distortion of hearing and, often, impaired balance.

The human ear consists of three parts. The outer ear includes the ear lobe and external auditory canal, which funnels sound waves toward the eardrum (or tympanic membrane) allowing it to vibrate.

The middle ear converts sound waves that vibrate the eardrum into mechanical vibrations for the cochlea, the hearing part of the inner ear.

This area, however, also includes of a system of three fluid-filled semicircular canals in each ear—superior, posterior and horizontal—responsible for giving the brain information about angular motion of the head. SCDS can occur when some part of the bone protecting the superior semicircular canal is missing.

Whereas it is difficult to know exactly how prevalent SCDS is, several reported cases define how it impacts the lives of those suffering from the disorder.

Stephen Mabbutt, a 57-year-old Englishman who suffered from SCDS for six years, described “hearing his eyes scratching sandpaper every time they moved in their sockets.

” He returned to work earlier this month after successful surgery to plug a pin-size hole in the bone covering the semicircular superior canal in one of his ears.

Toby Spencer, a 41-year-old IT professional from Skowhegan, Maine, described similar symptoms as Mabbutt as well as the feeling that loud noises made him feel as though he was losing his balance. Spencer had surgery in April to correct the problem. [Read more about inner ear ailments and remedies: “Regaining Balance with Bionic Ears”]

Musician Adrian McLeish suffered from the disorder for more than two decades, even having to give up his livelihood playing the French horn, before in 2008 seeing Lloyd Minor, provost and senior vice president for academic affairs at Johns Hopkins University in Baltimore. McLeish sought out Minor, a professor of otolaryngology—head and neck surgery—because he is the lead author on the study in 1998 providing the first description of SCDS in Archives of Otolaryngology—Head & Neck Surgery.

McLeish described (video) not only hearing a buzzing, distorted version of his own voice but also being able to feel the vibrations of the sound whenever he spoke.

Essentially, the missing piece of bone in McLeish's left ear was allowing the superior semicircular canal to respond to sound and pressure in abnormal ways. It was enough for the canal to act as an amplifier for every sound in his body.

McLeish's horror story came to a happy ending soon after meeting with Minor, who corrected the problem and allowed the musician to resume his career.

Scientific American spoke with Minor about the nature of SCDS, the toll it takes on those who suffer from it and why it's best to plug (rather than cover up) such an opening.

[An edited transcript of the interview follows.]

What is superior canal dehiscence syndrome (SCDS)?

Superior canal dehiscence syndrome is a disorder caused by an opening in the bone that should cover the inner ear's top balance canal (called the superior semicircular canal). The inner ear consists of a bony labyrinth that has two parts: the cochlea, which enables us to hear, and the vestibular labyrinth, which enables us to keep our balance. Located within the labyrinth are three semicircular canals that act as angular accelerometers for the head. When these are working properly, they allow us to maintain a steady gaze and keep images stable on our retinas even when our heads are moving.

The inner ear is a closed system surrounded and protected by the petrous portion of the temporal bone. In superior canal dehiscence, a portion of the bone covering the superior balance canal is missing. Without this bone, the membranous canal is exposed to the overlying dura mater membrane of the brain's temporal lobe.

Mechanical stimuli such as sound and pressure can then cause motion of the fluid in the membranous canal resulting in abnormal neural activity from the sensory receptor cells associated with the canal.

This can lead to hearing loss, abnormal eye movements and a sudden sensation of movement (vertigo) as a result of loud noises or pressure, such as coughing or sneezing.

How were you able to first identify SCDS?

It was a study of the eye movements. The eye movements of this disorder, which is evoked by sound and pressure, are quite distinctive. Because the superior semicircular canal is affected, the eye movement is typically vertical-torsional, meaning the eye closest to the affected ear will twitch in a direction up and away from that ear (toward the middle of the face) in response to loud noises or by stimuli that change middle ear or intracranial pressure (such as coughing, sneezing or straining).

Can someone be born with SCDS or is this something that afflicts people only later in life?

Our hypothesis is that about 1 or 2 percent of the population fails to develop a normal thickness of bone overlying the superior canal. If you have a normal thickness of bone, which is about 0.6 or 0.7 millimeter covering the superior canal, that's very unly to ever erode. If you started out with 0.1 or 0.2 millimeter of bone, yes, that can be eroded over time for a number of reasons: pressure from the temporal lobe sitting on top of it, changes in intracranial pressure or maybe by trauma. The median age of onset is in the early 40s, and it does tend to affect men and women equally. But you rarely see it in kids. That suggests that the opening probably doesn't develop until later in life.

*Editor's Note (7/30/13): The misspelling of Edgar Allan Poe's name has been corrected.

Does SCDS worsen over time if it is not treated?

In many cases, it will stay at a certain level, although it's hard to predict. That very first patient I identified with this disorder back in 1995—whose eye movements were so profound in response to sound that I could see just on the exam that there was something wrong with the superior canal—has elected never to have treatment. His most disturbing symptom was loud noises caused his eyes to move, so he's avoided loud noises. Other people are more disturbed by the disorder. Some people develop eye movements that follow the rhythm of their pulse, and that's extraordinarily disturbing because you're constantly sensing motion. Another thing that's disturbing to people is hearing their own voice, this sense of autophony. Even a conversational voice reverberates and is uncomfortably loud, causing them to feel motion. The range of symptoms is quite diverse, so therapy has to be tailored to the individual.

Do people get this in both ears?

In about one third of cases it's bilateral when diagnosed. Usually there's a more symptomatic ear, and we treat that ear first (although some have opted to have both ears treated, but not at the same time). In the minority, both ears appear to be equally affected.

How is this treated?

The way we have treated this disorder is to mechanically inactivate the balance canal, to plug it with fascia (the covering of muscle) and tiny chips of bone taken from the patient. It's a tiny structure, so you need only the smallest amount of fascia and chips. We've used canal plugging with success. Bone cement is often used to cover the canal after it is plugged. You'd think that if the problem was the covering being missing, why not just replace the covering? In principle that sounds great. In practice, however, we found that function in the canal is often diminished before surgery, and replacing the covering itself may lead to inactivation of the canal anyway. A person can function perfectly fine with five balance canals, so we believe the best treatment is to plug the canal. We can selectively inactivate one balance canal without affecting the other balance canals. Superior canal plugging is a procedure that usually takes about four hours and requires patients to be in the hospital for a couple of days. I had worked with that canal-plugging technique in a lot of my basic research, so I was comfortable with it as a surgical technique.

Are there preventative measures that can be taken or tests that determine whether a person is at risk for SCDS?

There are screening tests that can be done. We've seen people in their teens and 20s that have this disorder. If someone is having symptoms that are suggestive of superior canal dehiscence, then the evaluation begins with a physical exam to determine if any of the distinctive signs eye movements evoked by sound or pressure are present. A vestibular evoked myogenic potential test (a neurophysiological assessment technique to inspect the function of organs in the inner ear) can also show abnormalities characteristic of SCDS. A high-resolution CT scan can also be performed to look at the temporal bones for dehiscence.

You mentioned that 1 or 2 percent of the population could be at risk for SCDS. Do you know how many people are afflicted with this disorder?

Experience with this is relatively new. When we started out, we thought, well, this is probably quite rare. We don't have enough data to give an actual number of people afflicted with the disorder, you can just see from the papers and the cases being reported that it may not be all that rare.

Why are we hearing more about SCDS recently?

It's being better recognized because it's been in the medical literature now. Most major ear centers in the world now have experience with it and are comfortable making the diagnosis. It's also a gratifying diagnosis to make, because you can do something about it. The symptoms seem bizarre—I mean, hearing your eyes move. The first patient referred to me was referred by a psychiatrist because his symptoms were so bizarre that it was clear that something was going on. It's a neat story—there's good science in it and an effective treatment once you've made a definitive diagnosis, and the outcomes tend to be very good. It's the kind of thing you'd to see more of in medical science: Start out with a mystery, come up with an explanation, develop the right screening tests to make the diagnosis, and then come up with an effective treatment.

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Source: https://www.scientificamerican.com/article/superior-canal-dehiscence-syndrome/

Piscataway Johns Hopkins Treatment Centers – EHP Treatment Centers and Rehab Piscataway, Middlesex County, New Jersey – Johns Hopkins Treatment Programs Piscataway

Physical Examination: Adolescent Male | Johns Hopkins Medicine

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Source: https://www.psychologytoday.com/us/treatment-rehab/johns-hopkins/nj/piscataway