Earache historical posts June 1998

Re: Help - earache!!

Posted by GENE on June 01, 1998 at 15:38:57:

Dear Dr. Walt,

I am in no way trying to compete with you!
However, prior to visual inspection of ear drum I will never recommend to to pour the fluid in to the ear, since it may cause a harm. Majority of the described symptoms however indicate that it is OTTITIS EXTERNA.
The vinegar suppose to kill the fungi such as Asperillgus Niger usually associated with such symptoms.
The alcohol shall dsinfect the scar tissue, and remove the moisture created by water from vinegar.
Toy suggested also to keep the heat above the ear, I may differ with you for the following reasons.
First of all using steam from the cup could result in burning if a ho water will drip on to the ear, therefore for safety the ear shall be above. The second reson is that steam usually softeen the ear wax, and such with steam may fall down, if the ear is below the heat the wax may reenter deeper. To clean the excess wax from the ear one may use tepid water mixed with pottassium permanganate solution, or
mineral salt and flush the ear using "WATER PIK".

The AQUANAUTS solution is great !
However the oil is lighter than water and will quickly go to the surface. This may need ear plugs, which are not recomended for SCUBA DIVERS, since will not be able to decompress. I guess that you suggest that the oil will create the protective film within the ear, which may work very well. I assume that it is what you mean.
Some put just externally a clump of petroleum jelly, with out puting any inside ear canal. The jelly "clump" (corn size) will prevent water from getting inside due to viscosity.


Re: Help - earache!!

Posted by Walt Stoll on June 03, 1998 at 12:53:08:

In Reply to: Re: Help - earache!! posted by GENE on June 01, 1998 at 15:38:57:

Dear Gene,

I do not feel "competed".

I do, however, have a few observations about your note (with which I basically agree ).

The aquanaut program has prevented external otitis in a program which was on the verge of being cancelled 20 years ago. SO, apparently, it works. To my understanding, the oil only coats the ear canal and does not have anything to do with keeping water out of the ear---only protecting the skin in the canal. The alcohol is to adsorb any water not shaken out of the ear and help dry the canal skin. Since I learned about it, I have not had one case of recurrent swimmers' ear in my practice.

The steam from the cup of hot water is "too little. too late".
This is my opinion but I stand to be corrected by those who have seen this work. In MY experience, it takes at least 20 minutes of a high setting on a heating pad (with the ear up to facilitate venous drainage) to make a significant difference.

For the same reason as why scuba divers (of which I am one) cannot use ear plugs, the vaseline could not work as you have suggested. The water pressure would quickly force the vaseline plug into the eardrum where it would do no harm and might even protect the skin of the canal a bit (not as much as the mineral oil for the obvious reason that vaseline is easier to wash off with water than oil).

The water pik procedure is great so long as the drum is intact. Turned up high, it can tear the delicate skin of the canal AND if it hits the drum directly can actually rupture the drum. If one is reasonable with the pressure, it is a convenient & safe way to flush out impacted wax.

Also, remember, there are wax solvents at the drugstore that soften wax so it is easier to flush out. The ear naturally cleanses itself of wax SO LONG AS THE INDIVIDUAL NEVER PUTS ANYTHING INTO THE CANAL SMALLER THAN THE TIP OF THEIR PINKY. Q tips cause this mechanism to fail.

The reasons for this are anatomical & cannot be explained without pictures (at least by me). Trust me, q tips were NEVER designed to be used in the ear canal.

Notice in all TV advertisements, all pictures show the person using the q tip on the pinna (the external part of the ear that no one would buy q tips for). They do so because they know they would be sued for suggesting using q tips inside the canal----which, of course, is the only place people use the q tips they buy. Another racket!

Walt


The Dreaded Q-Tip Question....

Posted by trish on June 03, 1998 at 17:28:01:

Okay, Dr. Stoll. I'm sorry, but I can't handle the curiosity any longer! What's the scoop with the Q-Tip thing?

I ask because every morning, in the shower, I clean my ears out with shampoo, while I'm washing my hair. I shampoo up the outsides, and swish some foam into the ears, then I rinse them out when I rinse my hair out. THEN... and here's the scary part... I DRY THEM OUT WITH Q-TIPS! I insert the Q-Tip into my ear as far as is comfortable (some would say too far :-) !) and turn it a couple of times. I do this twice for each ear. This has been my habit for many years, every morning. When I saw an ENT a few years back, for clicking in my ears, he commented on how clean my ears looked - no waxy buildup! He diagnosed bad eustachian(sp?) tubes = too small.

Is this a very bad practice? What else should I do? I've seen you mention using alcohol to dry the ears, but it seems that would take a long time (I'm usually in a hurry in the AM), and since I have somewhat dry skin, I'd be worried that the alcohol would dry my skin out after awhile. Plus, I wouldn't feel comfortable in the winter here going out side with wet ears. I was prone to ear infections as a child, and my ears are very sensitive to the cold.

I'm sorry if I've opened a can of worms, but I just had to ask. Looking forward to a reply! Thanks much. :-)

trish


The Dreaded Q-Tip Question....GENERIC

Posted by Walt Stoll on June 05, 1998 at 11:13:56:

In Reply to: The Dreaded Q-Tip Question.... posted by trish on June 03, 1998 at 17:28:01:

Hi, Everybody!

I learned a valuable lesson with this one: If you want a response, make a mystery out of it & offer an inadequate explanation. Intimate that there IS an explanation but you will have trouble giving it (sigh).

First, the easy answer to why Q tips can cause a cough. ALL human beings are "hard wired" with the ear drum and the cough mechanism. No one knows why. However, this was demonstrated to all of us in medical school when we learned to look in ears. We were given a stiff hair to insert though the otoscope so it would touch the ear drum. In every case, the second the hair touched the drum the person felt the urge to cough. Remove the hair & the urge went away. If even one of the little coton fibers on th tip of the Q tip touches the ear drum, there will be a cough reflex.

I have seen people with a chronic cough that had been treated for years without resolution because the pulmonary specialist was too lazy to look in the ear. Just by washing out the ear (so I could see the drum) the cough disappeared (SOMETHING had been touching the drum)-----------one of the hazards of specialization by technicians who call themselves physicians.

Now the hard part that I really need a picture to explain---
you are just going to have to find a picture of the cutaway ear showing the entire external canal all the way from the drum to the outside. Visualize if you do not have a picture:

The eardrum is about 1/2 inch inside the outside surface of the skull bone that lines that part of the canal. The rest of the ear canal is lined by cartilege that wiggles when we use our jaw.

Inside our skull the canal is rigid & slopes down toward the INSIDE. Outside the bone, the canal slopes down toward the OUTSIDE. So long as we only put our fingers (elbows) into the canal, we are stopped by the bone from putting anything past the outside sloping part. Then the wax, that is there to clean the ear, just works its way out by our jaw moving the canal AND the fact that gravity is helping too.

If ANYTHING small enough to get past the bony edge is used (Q tip) it gets to the part that does NOT move with the jaw AND the slope is now toward the drum NOT to the outside.

If anyone has ever used a dust pan, they know that there is always a little heap of dust that measures the thickness of the pan, left when the pan is raised to empty. If you haven't used a dust pan, you are long past due (grin). ANYHOW, the Q tip leaves a little heap of wax at the extremity of its insertion. THEN, the wax has to build up to the top of that heap before it will continue to work itself out of the canal. Each time the Q tip is used, there is the potential of the pile getting deeper till the entire canal is blocked.

Obviously that doesn't happen to everyone (trish is a good example). However, it is the most common mechanism to explain the many people's problems with wax buildup requiring a visit to the doc to remove it. Of course, that person then thinks that, if they would just do a better job of "cleaning" their ears, they could avoid the doctor bill. This, without knowing the cause, results in the sale of more Q tips.

Neither the docs, nor the Q tip companies, are likely to kill this goose that lays the golden egg.

Those who use ear plugs to swim should get one of those little ear syringe kits from the drug store & follow the directions about once a month to get rid of the little "heap" that accumulates at the edge just like the Q tip causes and for the same reasons. Ear plugs are not a good idea. The problem with swimmers' ear is much better prevented with the aquanauts' protocol I mentioned earlier.

Hope this is clear to those dying for an explanation. You can see why I resisted doing this.

Namaste` Walt



Thanks so much for The Dreaded Q-Tip Answer

Posted by trish on June 05, 1998 at 13:35:40:

In Reply to: The Dreaded Q-Tip Question....GENERIC posted by Walt Stoll on June 05, 1998 at 11:13:56:

Dr. Stoll,

I'm sorry I made you go through all that - I'm just a curious sort by nature...It seems from what you said that I can continue my current morning ritual, since there's no reason to stop besides wax building up, which I'm not experiencing. Thank you very much for taking the time to explain!

trish


Re: Wash your ears with your elbows

Posted by Antonio Alvarez on June 03, 1998 at 22:09:50:

In Reply to: The Dreaded Q-Tip Question.... posted by trish on June 03, 1998 at 17:28:01:

Hello Trish & Dr. Stoll:

A "Good Doctor" from the old country one time told me that the best way to wash your ears was to use your elbows, i.e. never wash them because your body will do so naturally.

Dr. Stoll, was this good advice or was he full of ....

Take care,

Antonio


Me too!

Posted by Debbie on June 03, 1998 at 17:50:35:

In Reply to: The Dreaded Q-Tip Question.... posted by trish on June 03, 1998 at 17:28:01:

I too do the same thing, but every time I insert the q-tip as far as is comfortable, I start coughing! I don't know why, but it seems it must hit a nerve or something, because it makes the back of my throat close all up and I have a choking fit. But I have to clean them!!

Dr Stoll, what causes this??


Eyes, Ears, Nose & Throat

Posted by Greg on June 04, 1998 at 00:50:08:

In Reply to: Me too! posted by Debbie on June 03, 1998 at 17:50:35:

There is probably a good reason why they are linked together for specialists to work with. I loaded up "The Body 3D" software to take a look. I haven't zoomed in far enough, but it seems that there are nerve pathways in common, and what you are probably experiencing is nerve "crosstalk" where the signals from the ear are "jumping the tracks" to the throat nerves.

Hope this helps.



Re: Eyes, Ears, Nose & Throat

Posted by Debbie on June 04, 1998 at 09:51:42:

In Reply to: Eyes, Ears, Nose & Throat posted by Greg on June 04, 1998 at 00:50:08:

Really??? How weird. I thought they had to be connected somehow. This never happens to anyone else I know when they use q-tips. Wonder what I'm doing different...

Thanks!!!



Re: Eyes, Ears, Nose & Throat

Posted by Gerry on June 04, 1998 at 16:00:05:

In Reply to: Re: Eyes, Ears, Nose & Throat posted by Debbie on June 04, 1998 at 09:51:42:

Debbie, you should use a shorter Q-tip. Obviously it's going down your throat and tickling something. What I can't figure out is why it's not just coming out the other ear. Guess you're not blonde...

Hope you'all hav a sense of humor,
Gerry


Re: Eyes, Ears, Nose & Throat

Posted by Debbie on June 05, 1998 at 09:12:35:

In Reply to: Re: Eyes, Ears, Nose & Throat posted by Gerry on June 04, 1998 at 16:00:05:

Thank you for the laugh. *L* I needed it today. And yes I am blonde!



I tried the shorter ones, but I lost 'em....NMI :-)

Posted by trish on June 04, 1998 at 17:30:41:

In Reply to: Re: Eyes, Ears, Nose & Throat posted by Gerry on June 04, 1998 at 16:00:05:

No Message Inside


1998: May Jun

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