ENT

RECENT POSTS

Q-Tips: How Can Something That Feels So Good Be So Wrong?

Notice the warning. (Carey Goldberg/WBUR)

Notice the warning. (Carey Goldberg/WBUR)

Sure, yes, I knew that the ear is an erogenous zone. But never did I expect that a quick, news-you-can-use post about the dangers of sticking Q-tips into that zone would draw an outpouring of “Noooooo! Q-tipping is one of life’s great ecstasies!”

Nor did I know that Q-tip use is apparently a frequent issue of spousal disagreement, as e-mailed responses like this suggest: “Sending this to the habitual Q-tip abuser in my home,” and “My husband LOVES q-tips, he uses them far more often than I’m sure any doctor would say is healthy.”

That quick post — Why You Really, Truly, Should Not Put Q-Tips Into Your Ears — has enjoyed regular resurgences onto the WBUR.org top 10 since it went up in November, to the point that it seemed worthwhile to revisit the theme, draw some lessons, and seek a reality check on some of the claims in the comments.

Dr. Steven Rauch (Courtesy MEEI)

Dr. Steven Rauch (Courtesy MEEI)

I spoke with Dr. Steven D. Rauch, professor of Otology (ears) and Laryngology (throats) at Harvard Medical School and associate chief for education and academic affairs of the Otolaryngology department at the Mass. Eye and Ear Infirmary. But before I get to his sage comments on Q-tips, here’s the main pearl he shared:

“Q-tips aside, If someone develops new onset of a blocked feeling in the ear — like the feeling of water in the ear when you get out of the shower — most of the time it’s harmless and it goes away in minutes or hours. But if you develop an acutely blocked ear and it does not clear that day, it should be checked. It could be sudden deafness, which strikes one person in 5,000 every year — so about 500 people in Metro Boston a year — and is an emergency because there’s a short time window in which to treat it, within a couple of weeks. After that, it’s untreatable.”

“If your ear blocks up suddenly or you realize that one ear is blocked, here’s the test you should perform: Hum. Just hmmmmmmmmmmm. And if you hear your voice louder in the blocked ear, the bad ear, there’s nothing to worry about. But if you hear it louder in the good, unblocked ear, that’s bad. That’s when we worry you have sudden deafness.”

Nobody knows exactly what causes this sudden deafness, Dr. Rauch said, but it’s nerve damage that is potentially reversible if treated with steroids within two to four weeks. Often, he said, patients wait to see if the symptoms improve, and try to clean out their ears, and try cold medications, and by the time a specialist sees the ear it’s three months out and too late to treat. So remember, he said, “that little humming test is the simplest, low-tech thing to do, but if you’re not sure, have an ear, nose and throat specialist look at your ear.”

End of public service message. Now for Q-tips. Dr. Rauch, lightly edited:

“The topics that came up in the post’s comments range across the whole gamut of all the things anybody ever says about ear wax. Back in the 19th century and early 20th century, there were a lot of medical papers on ear wax. All the indications were that it kills bacteria and moisturizes the ear canal and protects it from particulate debris, so it’s good for you. People who don’t make enough ear wax are miserable because their ears are itchy and dry all the time.

By and large, ears are self-cleaning. If you leave your ears alone, they’ll leave you alone.

The ear canal is only about an inch long from the external world to the drum, and the wax forms only at the outer edge. The skin of the ear canal migrates outward like a conveyor belt and pushes the wax out, so by and large, ears are self-cleaning. If you leave your ears alone, they’ll leave you alone. In some cases, because of the shape of the canal or the consistency of the wax, you need someone to clean it, but routinely, that’s not the case, and you’re thwarting the normal conveyor belt mechanics when you plow the stuff down into the deep part of the canal.

There was some discussion in the comments about touching your ear drum, but that is unlikely, because the distance to it is three times the length of the Q-tip cotton ball, and it’s intensely painful to touch. No one can tolerate that. When we’re cleaning an ear and accidentally touch the drum, the patient goes right through the roof. So no one commenting on the pleasurable aspects of Q-tips is going that deep — it would be intensely painful.

So let’s talk first about all these pleasure responses. I was amazed by the flood of responses from people defending the exquisite pleasure of ear-cleaning… Continue reading

Ear, Nose and Throat Docs Weigh In On Controversial Test

Doctors raise questions about the appropriate use of a nasal scope

Last week, WBUR’s Martha Bebinger wrote a story about doctors at Beth Israel Deaconess Medical Center who, for the first time, got access to a list of prices for common tests and procedures. The piece triggered a minor uprising among some ENT specialists, who offered impassioned comments on the story. Martha explains the controversy:

One primary care doctor, David Ives, the medical director of Affiliated Physicians Group, the largest group of private doctors that admits patients to Beth Israel, reacted to the price of a nasal endoscopy and said he thinks the procedure is used too often when a physical exam would suffice.

This comment angered many Ear, Nose and Throat specialists who say the development and use of this scope is one of the most important diagnostic tools in their field in recent history. Before filing the story, I searched for medical literature comparing either the cost effectiveness or the outcomes of a nasal endoscopy vs. a physical exam. I didn’t find anything. I did not call a representative of the American Academy of Otolaryngology for their views on nasal endoscopy. We offer that now.

Wendy Stern is the chair elect of the Public Relations committee for the American Academy of Otolaryngology/Head and Neck Surgery, a former president of the Massachusetts Society of Otolaryngology. Dr. Stern says nasal endoscopy allows the physician to look for signs of bacterial infection, structural changes, polyps or tumors that would not be visible without this tool.

Not using it, “could be harmful or even deadly in the event a patient had cancer,” says Stern. Using the scope appropriately “often helps reduce the need for antibiotics or other unnecessary medication,” continues Stern and can “reduce overall medical costs and the costs of sick days and time out of work.” Continue reading