Smoker's Kids Have More Ear Infections

Although not entirely new news... a new review paper which collated the results of 61 past studies has reaffirmed that smoking around kids increases their risk of ear infections dramatically.

Just how much?

Kids living with a smoker had a:

• 37 percent higher risk of ear infections and hearing problems
• 62 percent higher risk of ear problems if the household smoker was their mom
• 86 percent more likely to undergo ear surgery than kids without secondhand smoke exposure

Read a MSNBC story on this here.

So don't smoke for your own health as well as your kids' health!!!

Reference:
Parental Smoking and the Risk of Middle Ear Disease in Children. Arch Pediatr Adolesc Med. Published online September 5, 2011. doi:10.1001/archpediatrics.2011.158

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New Cartilage Can be Grown From Stem Cells Found in Adult Ears

Cartilage is found throughout the body giving shape to noses and ears and cushion for the joints. However when damaged, is not easily replaced which is why synthetic materials is often used to replace damaged cartilage.

However, Japanese scientists have grown new cartilage using stem cells found in the ear of all places. Specifically, the perichondrium which lines the cartilage of the ear. Perichondrium is also the layer under which a hematoma develops after ear trauma (ie wrestling) that can lead to cauliflower ear if left untreated.

The stem cells were isolated from the perichondrium and injected into mice where chunks of cartilage developed and remained still healthy after 10 months.

So rather than using artificial materials to reconstruct knees and noses, theoretically, stem cells can be retrieved from the patient's ear, injected into mice, cartilage grown and retrieved, and used to replace the damaged cartilage in the patient without worry of rejection.

Reference:
Reconstruction of human elastic cartilage by a CD44+ CD90+ stem cell in the ear perichondrium. DOI: 10.1073/pnas.1109767108

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"Ear Picking" - A Barber Shop Service Health Hazard?

It was only recently that I heard of "ear picking," a barber shop service that is apparently quite common in Asia and recently becoming more popular in the United States in cities with large Asian populations.

In essence, ear picking is when a variety of implements - scrapes, picks, and lights - is used within the ear canal.  Why is it popular among Asians? Mainly because of the type of earwax that is produced by Asians which is mainly dry and flaky which causes an itchy sensation. Ear picking helps remove some of this cornflake-like earwax as well as get the itch "scratched" and is apparently quite a pleasurable experience... like getting an itch on your back scratched. Caucasians have more peanut butter or wet type of earwax which is not amenable to "picking".

This unlicensed service is most often performed in barber shops and unfortunately has led to a number of ear related infections (eardrum perforations, fungal ear infections, bacterial ear infections, etc) as the tools are not sterilized in between customers.

If you want a "professional" type ear cleaning, see your local ENT. Itchy ears can be treated without resorting to ear canal instrumentation along with its risks of infection and eardrum perforations!

Read more about this phenomenon here.

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Novel Treatment for Glue Ear?

Glue ear is the layman's term for thick mucoid effusion of the middle ear, usually due to chronic ear infections.

The fluid itself is like maple syrup and usually treated with ear tube placement followed by suctioning as much of the fluid out as possible. However, given there is always some residual present, antibiotic ear drops with steroids is often prescribed.

Unfortunately, these patients are at higher risk of requiring repeated sets of tubes after the body spits them out.

Why?

Because of a phenomenon called biofilms... Think of it as teflon armour made of slime for infections. You can put antibiotics and steroids on it, but they kind of just slip off. Such biofilms make infections nearly 1000 times LESS susceptible to medications. In order to truly eradicate the biofilm (and underlying "hidden" infection), you either have to "scrape" it off which is not possible in the middle ear or use very high concentrations of antibiotics... much greater than that obtained using oral or IV antibiotics.

Though ear drops containing high concentrations of antibiotics are possible, the drops tend to come out of the ear just as easily as they go in preventing prolonged and enduring contact.

That's were the recent innovation comes in...

Scientists in England have developed a biodegradable antibiotic "pellet" that can be inserted into the middle ear during surgery where it will slowly release high concentrations of antibiotics to target any infections present (active or inactive) over 3 weeks continuously. Furthermore, the pellet contains N-acetylcysteine which effectively breaks apart the biofilm.

In essence, this pellet is like an armour-piercing bullet.

Of course, it is not available in the US yet... nor is it FDA approved.

Read more about this here.

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Xylitol (Natural Compound) to Prevent Recurrent Sinus and Ear Infections?

Image by Lauri Andler from Wikipedia

I only recently became aware of a natural sugar compound called "Xylitol" from a colleague's blog, BoogorDoctor, managed by Dr. Russell Faust. I certainly have never heard of it during medical school or surgical training.

This naturally-occurring sugar substitute apparently has all sorts of anti-bacterial as well as anti-fungal properties and has been known to doctors and scientists but hardly marketed or promoted in any fashion.

However, the importance of this compound is that it DOES appear to significantly decrease the incidence of ear infections and sinus infections when used regularly (in essence, xylitol mixed in with salt-water sprayed into the nose several times a day). See references below for links to research papers.

It's cheap, over-the-counter and at least from the studies I've reviewed, does seem to work. However, to be fair, it only works when given regularly even if healthy. If given when sick, it does not work (see this study). Also to be fair, there are some studies that suggest that xylitol does NOT work at all.

However, given there are minimal (if any) side effects and safe for kids, it is certainly something worth trying before surgical consideration, especially in children.

Why is this compound not more well-known?

Probably because it's cheap and therefore not a money-maker... which means not a lot of dollars goes into marketing the product whether directly to patients or doctors.

In any case, you can get it on Amazon.com here (or possibly at a local pharmacy).

I should also mention that Xlear is the only product series that uses the optimal concentration xylitol (others use only the bare minimum concentration to meet ingredient inclusion).




References:
A Story About a Sugar: The X-Factor. Blog by Dr. Faust

Xylitol as a prophylaxis for acute otitis media: systematic review. Int J Audiol. 2010 Oct;49(10):754-61.

A novel use of xylitol sugar in preventing acute otitis media. Pediatrics. 1998 Oct;102(4 Pt 1):879-84.

Xylitol chewing gum in prevention of acute otitis media: double blind randomised trial. BMJ. 1996 Nov 9;313(7066):1180-4.

Failure of xylitol given three times a day for preventing acute otitis media. Pediatr Infect Dis J. 2007 May;26(5):423-7.

Xylitol administered only during respiratory infections failed to prevent acute otitis media. Pediatrics. 2002 Feb;109(2):E19.

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Why Are You Looking in My Mouth When It's My Ear Hurting?

One June 20, 2011, NPR aired a great story about how a person may not "see" a person getting beat up on the side of a jogging path when they are focused on a task (pursuing another jogger)... even if they pass RIGHT BY THE FIGHT!!!

In fact, only a third of the subjects reported seeing this mock fight when the experiment was conducted at night. Even more surprisingly, broad daylight didn't improve the statistics (only 40% noticed the fight).

Though the situation and circumstances do not exactly correspond, there is a lesson to be learned here that applies to a medical visit.

As an ENT, I often see patients for a very specific complaint...

"My right ear hurts."
"I have a bad cough."

No matter what the complaint, unless it is for a specific task (there is earwax... can you remove it), I most always still do a complete ear, nose, and throat exam no matter the complaint.

Why???

Because often the symptoms are "the jogger" in the example above which is noticed to all exclusion when "the fight" is the more important event that should have been noticed.

Let's go to the examples stated above...

"My right ear hurts."

Though a patient may wonder why the heck I look in the mouth when their ear is the main complaint, it's mainly because there are other things that can cause ear pain... some of it life-threatening.

Tonsil cancer can cause ear pain (without any other symptoms) as well as a base of tongue abscess. Obviously, giving antibiotics to treat the right ear pain totally misses the fact that there was tonsil cancer that got missed or the tongue abscess which requires an emergency trip to the operating room followed by a few days in the intensive care unit.

"I have a bad cough."

This statement is pretty self-explanatory. Why bother looking in the ears??? A loose hair in the ear canal can cause a persistent dry cough. Why look in the nose if the cough is coming from the throat? Severe allergies and nasal polyps can lead to post-nasal drainage leading to a chronic cough. Why would an ENT than ask about my blood pressure medications? Because ACE inhibitors like lisinopril cause a chronic dry cough as a side effect.

The point being with these examples is that medical doctors are trained to not just focus in the exact symptom the patient is complaining of, but the entire picture. It doesn't do the patient any good if a doctor gets tunnel-visioned to the point where they don't notice what may be a very obvious thyroid mass or the large nasal polyp.

SO... next time you see a doctor for a specific complaint, humor us, and answer fully all questions about your medical history, surgical history, medications you are taking, and the physical exam we will perform on you... even if you are there for just a "simple" earache.

Read the NPR story here and the police beating that triggered this inattention experiment.

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Accurate Portrayal of Cauliflower Ear in "The Expendables"

In Fall of 2010, the movie "Expendables" directed by Sylvester Stallone was released to lukewarm reviews. A patient mentioned to me that though the plot was thin and the dialogue shallow, there was a scene where one of the actors (Randy Couture) accurately described his cauliflower ear.

On a side note, the actor's cauliflower ear is actually real. He was a professional mixed martial arts (MMA) and wrestler before getting into acting.

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Balloon Dilation For Treatment of Eustachian Tube Dysfunction

Eustachian tube dysfunction is a phenomenon whereby a person is unable to pop their ears to relieve symptoms of ear pressure, clogging, or fullness. It is much akin to the ear pressure a person experiences when flying, but at ground level. Traditionally, treatment of this condition involved medications like steroid nasal sprays and prednisone along with active valsalva. Once medical treatment has failed, ear tube placement has been the step of last resort.

However, a promising new treatment called eustachian tube balloon dilation has been described in March 2011 to address eustachian tube dysfunction at the source surgically rather than indirectly with tube placement across the eardrum. In essence, a balloon is inserted into the eustachian tube and than inflated thereby opening it up (the balloon is "popping" the ear for you). The balloon is than deflated and removed.

Dr. Dennis Poe in Boston, MA is the researcher who first described this technique in March 2011 and at this time, is not offered in many centers. Why? Mainly because of the cost of the balloon itself which is not covered by insurance. The material cost of the balloon is around $2000 or more. Compare this to the cost of a tube which is around $30 or less.

Reference:
Balloon Dilation of the Cartilaginous Eustachian Tube. Otolaryngol Head Neck Surg April 2011 vol. 144 no. 4 563-569

Balloon catheter dilatation of eustachian tube: a preliminary study. Otol Neurotol. 2012 Dec;33(9):1549-52. doi: 10.1097/MAO.0b013e31826a50c3.

Balloon Dilation of the Cartilaginous Portion of the Eustachian Tube. Otolaryngol Head Neck Surg. 2014 Apr 4;151(1):125-130. [Epub ahead of print]

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Ear Pain Due to Tooth... In the Ear Canal!

The Daily Mail published a story about a patient who suffered from right ear pain since the age of 14 that ultimately was found to be due to a tooth in the ear at the age of 47 years!

Removal of the tooth resolved his long-standing ear pain. It was also the last tooth to get removed as he had all his teeth inside his mouth removed years ago.

Based on the size, it is conjectured to be a baby mandibular front incisor.

My theory? Either he or some other kid put the tooth there and than forgot about it... It happens!

Read this interesting story here.

Read about other causes of ear pain here.

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Fauquier Hearing Aid and Hearing Testing Services Offered at Fauquier ENT

Even though our office has been offering hearing tests and hearing aid services in Fauquier County for over a decade, many people are still surprised when they learn they can get hearing tests, hearing aids, ear plugs, and other ear & hearing services in our office. The additional benefit is having a ENT specialist also present in the same office.

Furthermore, we offer a comprehensive suite of other related services including non-sedated ABR (auditory brainstem response) hearing testing to specialized custom ear plugs for hunters and musicians.

We evaluate all different ages from 1 day old infants to the 99 year old hearing impaired patient.

The full list of Fauquier Hearing services we provide include:

Comprehensive Hearing & Audiometric Evaluations

• Hearing Testing from Birth to Adult
• Newborn Hearing Screening and Follow-up
• Otoacoustic Emmission Testing (OAE)
• Auditory Brainstem Response Testing (ABR)
• Tone Burst Auditory Brainstem Response (TB-ABR)
• Bone Conduction ABR Auditory Brainstem Response (BC-ABR)
• Auditory Steady State Response (ASSR)
• Electrocochleography (ECoG)
• Central Auditory Processing Evaluations (CAPD)

Hearing Aid Services

• Hearing Aid Evaluations and Consultation
• Hearing Aid Dispensing
• Advanced Digital and Wireless Hearing Aid Technology
• Aural Rehabilitation Counseling
• Hearing Aid Service and Repair
• Hearing Aid Accessories and Batteries
• Resources for Parents of Deaf and Hard of Hearing Children

Balance Evaluations

• Electronystagmography (ENG)
• Vestibular Evoked Myogenic Potentials (VEMP) for Meniere's Disease
• Vestibular Rehabilitation Counseling
• Canalith Repositioning 

Hearing Conservation

• Custom Swim Plugs
• Custom Hearing Protection
• Musicians Filtered Earplugs
• Earplugs for Hunters
• Custom Earmolds for iPods, Cell phones, Headsets
• Assistive Listening Devices and Technology 

For more information, please go to our webpage here.

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Why Do We Have Earwax?

This question was addressed in today's Washington Post.

The question itself wasn't really addressed, but the article did contain good general information.

Read more about earwax here.

Read the Washington Post article here.

Watch a video of earwax being removed by an ENT specialist under the microscope:

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Patulous Eustachian Tube Video

In perhaps one of the most flagrant cases of patulous eustachian tube I've ever seen, the New England Journal of Medicine published a video showing the eardrum moving with respiration.

Normally, the eustachian tube (which extends from the back of the nose to the ear) is closed unless one pops the ears (like when flying in an airplane). As such, one does not normally see the eardrum moving to and fro with breathing.

Symptoms this poor patient with patulous eustachian tube may exhibit include hearing one's own breathing inside the ear as well as autophonia (hearing yourself talk in the ear). Symptoms improve transiently when the head is placed in a dependent position (head between the knees).

Treatment is very difficult. Some medical treatments that can be tried that often is ineffective include placement of ear tubes, SSKI (super-saturated potassium iodide), premarin drops, and reserpine. Perhaps the best treatment I've seen for Patulous Eustachian Tube is that provided by Dr. Dennis Poe at Massachusetts Eye and Ear Infirmary in Boston, MA. He performs a minimally invasive endoscopic insertion of a tiny catheter into the eustachian tube. The catheter is just the right size that one can still pop ears easily to prevent eustachian tube dysfunction, but large enough so that one does not suffer the symptoms of patulous eustachian tube.

The most common problem seen in the clinic regarding the eustachian tube is actually the complete OPPOSITE problem of patulous eustachian tube. It is eustachian tube dysfunction or the "clogged" ears whereby the ear feels full of pressure and one just is not able to pop the ears to release the pressure. In this situation, the eustachian tube stays closed, even when trying to pop the ears.

Check out the video below or here illustrating the problem with patulous eustachian tube.

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ENT Problem at the Biblical Wall of Jericho

Many people may be aware of the Sunday School story regarding the Wall of Jericho in the Bible. In this story, seven priests blew 7 trumpets of rams' horns resulting in the collapse of the wall of Jericho (Joshua 6:4-5) allowing the Israelites to conquer the city.

"4: And seven priests shall bear before the ark seven trumpets of rams' horns: and the seventh day ye shall compass the city seven times, and the priests shall blow with the trumpets. 5: And it shall come to pass, that when they make a long blast with the ram's horn, and when ye hear the sound of the trumpet, all the people shall shout with a great shout; and the wall of the city shall fall down flat, and the people shall ascend up every man straight before him."

Now... from an ENT standpoint, I can imagine the mayhem this weaponized horn sound must have caused not only to the wall of Jericho, but also to the surrounding soldiers and people.

Back than, city walls were constructed of brick and mud. It is entirely possible that a loud enough sound can certainly cause the collapse of this wall, but it would have to be very loud... at least 180dB (decibels) loud.
 
Just how loud is this sound? Well, a motorcycle is 100dB; a jet engine is 140dB. From a human ear standpoint, ear pain starts at 125dB. Permanent hearing loss due to ear tissue death occurs at 180dB... but before ear tissue death occurs, the eardrums will rupture at 160db.
 
Even if the Israelites wore ear plugs and ear muffs (like airplane workers do), it only decreases the sound intensity by 15-45dB. So, the rams' horn sound blast at 180dB would still result in the Israelite soldiers being exposed to 140dB of sound with its attendant ear pain and temporary threshold shift (temporary hearing loss).
 
So... though not expressly reported in the Bible, I'm sure not only did God supply the device causing the fall of Jericho's walls... but also appropriate ear & hearing protection for Joshua and his army.
 
In fact... even if the walls did not fall, its inhabitants certainly would be deaf from ruptured eardrums and hearing nerve death. And if Jericho's army is unable to talk and hear each other, its fighting effectiveness would be pretty much severely compromised.
 
Of note... the United States military utilizes weaponized acoustic devices that produce only 155dB.
 
Lung rupture and presumably embolism due to air blast occur at 200 decibels which can lead to death.
 
If you want to read more about acoustic weapons, click here which will probably provide more info than you ever wanted on this subject.

Of note, I can't take full credit for the idea of this blog post which is based on an episode on NPR Radiolab. The NPR Radiolab episode purely focused on the acoustic physics whereas I've taken the extra step of how it can cause health problems.

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ICD-10 Coding Primer for Otolaryngologists

If you are a physician... you probably already know what I am talking about...

ICD is the "International Statistical Classification of Diseases and Related Health Problems" used by physicians to code a given medical problem whenever a patient sees a doctor. This "code" is what is submitted to insurance companies along with medical charges.

Periodically, ICD undergoes an update and in the United States, it is about to undergo a MAJOR update come October 1, 2013 to version ICD-10-CM. The current ICD being used in the Unites States is ICD-9-CM.

What are these changes as it relates to otolaryngolgists?

First the basics:

Differences in organization & structure, code composition, and level of detail.
ICD-9-CM	ICD-10-CM
Consists of three to five characters First digit is numeric or alpha (E or V) Second, third, fourth, and fifth digits are numeric Always at least three digits Decimal placed after the first three characters	Consists of three to seven characters First digit is alpha All letters used except U Second and third digits are numeric Fourth, fifth, sixth, and seventh digits can be alpha or numeric Decimal placed after the first three characters

ICD-10-CM codes may consist of up to seven digits, with the seventh digit extensions representing visit encounter or sequelae for injuries and external causes.

ICD-9-CM Code Format	ICD-10-CM Code Format

SO... here are some examples of how the code changes from ICD-9-CM to ICD-10-CM:

Diagnosis	ICD-9-CM	ICD-10-CM
Right Earwax	380.4	H61.21
Left Earwax	380.4	H61.22
Bilateral Earwax	380.4	H61.23
Unspec Earwax	380.4	H61.20
Right Acute Otitis Externa	380.1	H60.311
Left Acute Otitis Externa	380.1	H60.312
Bilateral Acute Otitis Externa	380.1	H60.313
Unspec Acute Otitis Externa	380.1	H60.319

As you can see, what used to be a single code like 380.4 for earwax is now split into as many as 4 different codes based on side. Such increased specificity goes across the board for pretty much every diagnosis.

ICD-10-CM has numerous other new features allowing for a greater level of specificity and clinical detail.

• Combination codes for conditions and common symptoms or manifestations
• Combination codes for poisonings and external causes
• Added laterality
• Added extensions for episode of care
• Expanded codes (injury, postoperative complications)
• Expanded detail relevant to ambulatory and managed care encounters
• Changes in timeframes specified in certain codes
• External cause codes no longer a supplementary classification

ICD-10-CM also includes added standard definitions for two types of excludes notes. Excludes1 indicates not coded here. The code being excluded is never used with the code. The two conditions cannot occur together. For example, B06 Rubella [German measles] has an Excludes1 of congenital rubella (P35.0).

Excludes2 indicates not included here. The excluded condition is not part of the condition represented by the code. It is acceptable to use both codes together if the patient has both conditions. For example, J04.0, Acute laryngitis has an Excludes2 of chronic laryngitis (J37.0).

An additional feature is the expansion of codes for certain conditions like postoperative complication codes. Here's one if you accidentally leave behind a neuro paddy in the nose after sinus surgery causing nasal obstruction:

• T81.524 codes for "obstruction due to foreign body accidently left in body following endoscopic examination"

Code extensions (seventh character) have been added for injuries and external causes to identify the encounter: initial, subsequent, or sequela. The extensions are:

• A Initial encounter
• D Subsequent encounter
• S Sequelae

So that's a primer on how ICD-10-CM coding WILL affect otolaryngologists. A lot more time will be spent on coding than now.

The American Academy of Family Physicians has produced a superbill comparing ICD-9 and ICD-10. What took only 2 pages with ICD-9 will take up 9 pages once ICD-10 goes into effect. Sigh!

Click for ICD-9 and ICD-10 Superbill

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Will.i.am Suffers From Tinnitus

And yet another celebrity reports suffering from bad tinnitus or ringing of the ears. Black Eyed Peas' Will.i.am spoke with Britain's the Sun stating that the only time it doesn't bother him is when there's loud music. Read the news report here.

Prevention is by far the best way to avoid suffering from this debilitating condition. How does one prevent this problem? Protect your ears from loud noises!!! Wear ear plugs if loud noise exposure is unavoidable.

Unfortunately for Will.i.am who is a hip-hop star with the Black Eyed Peas, his tinnitus is likely due to loud noise exposure from his music... an unfortunate job hazard of his profession.

If you are a musician and loud noise exposure is unavoidable, get Musician's Ear Plugs through our office which can help reduce noise exposure while maintaining music fidelity.

If you already have tinnitus, click here for more info on treatment options.

Read the news report here.

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The PERFECTLY Shaped Human Ear

Well, that is according to the International Electrotechnical Commission (IEC). The "perfect" ear also known as IEC TR 60959, was "defined" in 1990 and is used to allow gadget manufacturers to standardise the acoustic performance of their headphones or cellphones. You can purchase this perfect ear here if you were so inclined.

Unfortunately, this perfect ear created in 1990 is actually not so perfect as it was defined using a series of 2D scans, taken at 2mm intervals. That meant individual manufacturers were left the subjective task of filling the gaps between adjacent scans. Consequently, there is variation between different models built to the standard.

Thanks to researchers at the National Physical Laboratory (NPL) in Teddington, UK, they have laser scanned a number of ears built to the IEC standard and used these to produce the definitive 3D model which will remove any ambiguity... and be even more perfect than it was before!

Before you ask, this perfect ear was developed through averaging many different peoples' ears.

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NPR: Injuries To Kids From Swallowed Disc Batteries Are No Joke... It Is An EMERGENCY!!!

In fact it is a STAT emergency... NPR published a story on Sept 20, 2010 regarding Chuck E. Cheese's recall of two toys (a light-up ring and glasses) due to a disc battery used to power them.

These disc batteries can be access by small children if they smash apart the toy. The Consumer Products Safety Commission says two kids have had problems with batteries; one swallowed it and the other stuck it up his nose.

The danger is that when a disc battery is inserted into a nose (for example), a localized electric current is created between the positive and negative poles of the battery within the nose. This electric current basically "electrocutes" the lining inside the nose leading to tissue damage and ultimately necrosis (tissue death) within an hour. The same applies even if the battery is swallowed or put into the ear canal.

Treatment is IMMEDIATE removal... as soon as possible. Regardless of the day or time. STAT...

In the last 10 years, 13 deaths related to swallowed batteries have been reported, 12 of which are due to disc batteries (20 millimeter lithium cells).

Small children should NEVER be able to access disc batteries.

Read the NPR story here.

Read about the recall itself here (also from NPR).

Reference:
Preventing Battery Ingestions: An Analysis of 8648 Cases Published online May 24, 2010
PEDIATRICS (doi:10.1542/peds.2009-3038)

A Review of Esophageal Disc Battery Ingestions and a Protocol for Management Arch Otolaryngol Head Neck Surg. 2010;136(9):866-871. doi:10.1001/archoto.2010.146

Images of the toys that have been recalled...

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Fauquier Hyperbaric Oxygen Chamber

On June 9, 2009, Fauquier Hospital opened a wound center that included two hyperbaric oxygen chambers. Hyperbaric oxygen, also known as HBO, has a long and close-knit history with ENT.

What hyperbaric oxygen treatment does, in a nutshell, is provide higher concentrations of oxygen to the bloodstream which allows for faster healing of chronic wounds as well as treatment of carbon monoxide poisoning and "the bends" when SCUBA diving.

The higher concentrations of oxygen is achieved by increasing the surrounding pressure of the patient with higher oxygen concentrations... it is simply not good enough to provide oxygen... it needs to be administered at elevated pressures too.

In order to achieve elevated pressures, the patient needs to be completely enclosed inside an airtight chamber while they "pump" oxygen in. Here's a couple views of the HBO chamber used in the Fauquier Wound Center. And yes... that's a TV on top... a single treatment lasts a few hours!

As the pressure increases, the patient needs to "pop" their ears constantly, much like if you were flying up in an airplane or diving into deep water.

If a patient is unable to pop their ears easily, ENT can surgically place ear tubes so that the patient doesn't have to pop their ears... the tubes pop the ears for the patient automatically!

It is not unusual that I get "urgent" same-day consults for barotrauma sustained during a HBO dive. Ear tubes get placed and the patient is able to immediately resume HBO treatments without delay!

Check out the Fauquier Wound Center here.

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Pulsatile Tinnitus Caused by Ear Tumor (Glomus Tympanicum)

The New England Journal of Medicine published a case report in June 2010 titled "Glomus Tympanicum" where a woman with a right pulsatile tinnitus is described. The pulsatile tinnitus was due to a tumor called glomus tympanicum.

The article includes a picture as well as video. If you watch the video carefully, you can actually "see" the pulsations.

The only way to treat this tumor is surgical excision by a neuro-otologic surgeon.

Read more about pulsatile tinnitus in general here.

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Can Earwax Be Made Into a Usable Candle?

Can you make a candle out of ear wax? Well according to a scene in the movie Shrek, it sure can. However, in reality, earwax can not produce a candle that's any good.

This "myth" was attempted to be reproduced by the friendly gang of Mythbusters (a serial show on Discovery Channel), episode 136 (air date: Dec 28, 2009).

Earwax was collected from Tory’s ears and ignited alongside paraffin and beeswax which are two common materials used for candles. The earwax burned with some sparking and sputtering. More earwax was collected from other members of the cast/crew as well as volunteers without much more improvement. In the end, they attributed this poor result to the fact that the earwax material did not melt as smoothly as the paraffin.

What Mythbusters may not have realized is that not all earwax are physically the same. Earwax comes in a multitude of different consistencies as well as moisture content. A better test would be to create an earwax candle trying out these different earwax types to see if it makes any difference.

Other interesting facts:

- I have a few patients who like to take the earwax I remove from their ear to feed their cat. Apparently, cats like to eat earwax!
- There are quite a number of patients who come every 3-6 months to get their earwax removed by me.
- Earwax have different odors. I do not make it a practice to smell them, but sometimes it can't be helped given I'm so close to the ear when removing it.

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