Tuesday, September 26, 2006

All Ears

Fellow bloggers, lend me your ears.

I can probably attribute a substantial percent of my lifetime income to ears (although I have never done the math). In pediatrics, otitis media (middle ear infection) is a staple for office visits during the winter, and otitis externa (swimmer's ear) is a frequent reason for visits during the summer. So I have spent a substantial amount of time (probably several weeks) of my life looking in people's ears - especially children.

Over the years, I have made several observations. First I have noted that people tend to be very apologetic about the wax in their ears. I am not certain why this is the case, as it is a natural condition to have wax in the ears, in fact the absence of wax can cause problems (I once heard that wax keeps bugs out of people's ears, but I could not verify it). People often say something like, "I'm sorry about my ears. I didn't get to clean them out." What are they thinking? Do they really think I am offended by the sight of wax? I got some understanding of why people apologize in this situation when I went to get my teeth cleaned and found myself apologizing for the tartar on my teeth. Same thing.

Second, there are a number of odd things I have discovered in ears. Kids tend to put things in their ears and never tell people about it. I have found beads, breakfast cereal, and other assorted small objects in the ear canal. One older gentleman had a toothpick in his ear that he did not know about. The worst thing is when cockroaches get in ears. I usually get my nurse to irrigate ears, but with roaches I just do it without telling her as she has a strong aversion to these critters (as we say in Georgia). Roaches enjoy the warm and dark atmosphere, but can't back out well and so usually die (maybe the wax kills them).

One of the most important skills for a pediatrician is to clean wax out of ears. This is an acquired skill that you perfect over years of practice. Since otitis media is a common problem, it is important to get a good look at the eardrum. We use a tool called a "cerumen spoon" - cerumen is the fancy-schmancy name for earwax - and dig wax out of the ear. Sometimes this is an easy task (easier for adults than children), but sometimes it is a high-decibel experience which leaves both parent and pediatrician physically and emotionally exhausted. Occasionally the ear canal is very sensitive and bleeds when you clean it. I hate it when this happens, because it is hard to explain to parents why you caused the child to bleed from their ear. An interesting phenomenon which happens when you clean some people's ears, they have a strong need to cough. This is a phenomenon called Arnold's Reflex, caused by a branch of the vagus nerve going to the external ear canal. Why it decided to be this way is a mystery to me, but Dr. Arnold has to be happy because let him go down in posterity (I always felt sorry for Dr. Cowper). As an aside, one of the causes of chronic cough is earwax or a hair on the eardrum - due to our dear friend Dr. Arnold.

I generally don't mind cleaning out people's ears (even the children). When you get a "Mother Load" of wax out of someones ear, I have found the most common thing for people to say is, "Good Lord," followed closely by "Oh my God." I am not sure why wax brings out the religious side of people. Perhaps Dr. Arnold can explain that too. One thing I will never do is to clean out my own kids' ears. I did that once when they were young and it was terrible to have my wife watching with great suspicion as I subjected my son to external ear torture. I have never done that again.

Finally, I have found that I have made a progression over the years I have practiced as to what I say when I look in ears. Probably one in two adult patients (or parents of teenagers) say "can you see through to the other side?" when I look in the ear. I have resorted to saying "No, the spider webs are getting in the way." For young children, telling them you see something in the ear is a well-used way to get them to cooperate. Over the past 12 years I have made a progression of what I tell kids I see:
  1. I started out seeing Barney in the ears - Even thought I detest this character almost as much as Precious Moments (that's saying something!), I found it was quite popular for a time. After a while, thankfully, the popularity of this fingernails-on-a-blackboard character waned and I no longer had to profane the air with his name.
  2. Then I started saying I saw birdies or butterflies in the ears. This worked well with girls, but the boys just sneered.
  3. I have tried multiple other characters, such as Dora, the Wiggles, and Sponge Bob (I never did stoop so low as to do Telletubbies), but their acceptance was never as wide as "He who should not be named" - the dinosaur thing.
  4. My most popular ear finding is to say there is food in their ear. I have started saying I see peanut butter in the first ear, and another food in the second (usually macaroni and cheese or spaghetti and meatballs). This works up to older ages as well as the younger kids. They think it is absurd to have peanut butter in their ears. I ask them if they put it in there or if it squished out when they were eating. I get a lot of belly laughs from that.
I would love to hear any other interesting foreign body stories (keep it to the ears, please - no GI or GYN stories! I would also like to hear any other successful ear inhabitants used to calm the nervous child.

Just for my good friend Clark Bartram, I found a couple of interesting sites on the homeopathic and chiropractic treatment of ear problems. Simply astounding.