Ear wax

I think one of the most common questions I've heard ask of ENT physicians in general and especially Otologists (those in the ENT profession that just work on ears), is in regards to cerumen or ear wax.

To understand why we have it I'll explain...

1)God made us that way. Yes, it's absolutely incredible.

2)Some say it acts as a lubricant...I say, for what?

3) It's pH (scale of acidity or how basic), is slightly acidic. This is to keep the bugs (bacteria and fungus) at bay. Hence if too much of it is removed, you have a whole slew of problems popping up in those lil' canals.

So, the next question is how to deal with it.

Here is the list from least invasive to most invasive, and as long as there isn't a hole in the ear drum

1)Drop oil into the EAC (external auditory canal), these include Extra Virgin Olive oil, sweet oil, baby oil, mineral oil.

2)Wash it out in the shower

3)Don't use Q-tips, this over time shoves wax deep into the EAC causing an eventual impaction against the drum

4) Have your friendly neighborhood ENT doc pick, pull, scrape, wash it out on a yearly or so basis depending on the symptom accretion.

There are those with tiny ear canals...

Same as in previous steps 1-4.

5)Canalplasty-where the canal is opened wider surgically.

Those who produce lots and lots of it...

More often with steps 1-4

Dry ears...

Steroid cream works well here. Ask your doctor how often and for how long to use it. Also, there may be a fungal component to this. Lamasil drops usually work really well here as long as there isn't a hole in the drum.

Wet ears...

Skip the step #2

You can use 1/2 Acetic acid (vinegar) and 1/2 Everclear grain alcohol and put the drops in each ear after showers/bathing. This keeps the pH in the EAC balanced.

Last of all, DON'T USE EAR CANDLES! That is, unless you are into voodoo and that kind of jazz. Just look at Wikipedia for the explanation... or go to my super old post on the matter.

Why it gets dark?

When wax it produced down in the canal, it us almost clear. As it works it's way out the wax loses it's moisture and darkens to almost a black or very dark orange color. It is usually hard and crusty at this point.

Oh, the two faces with their "Transparency"

As physicians, we've been asked by the great B.O. and his thugs to be more transparent. What does this mean? It means that every physician in a group practice is obligated to switch their medical records to an electronic form so information can be more easily shared to other physicians. An idea of which sounds really really great. I've always felt this was what medicine with someday become several years ago.

The problems with this mandatory switch by 2012 are at least a couple. First, this lends to government care. And if you don't remember what B.O. said about your ENT surgery, and I paraphrase, "maybe a tonsillectomy isn't necessarily cost efficient. Because as surgeons we don't always have what's best for the patient as a top priority". Yeah, just read some of the current bills the Senate and House have proposed, and you will see who has YOU'RE interests at heart. It's laughable! Let's see you take the Hippocratic oath! And by the way, this "off the cuff" statement was so far from the truth, he has globally lost the faith and trust of the ENT physicians. See previous posting for details.

Second, it will take more time rather than less, (studies have shown this believe it or not), meaning less time for the patient, or less time for the physician to spend at home with his family (but who cares about the greedy doctors who just spent 11 to 13 post high school years studying to be part of the profession). On top of that, like my mother said, "Having a doctor type into a computer while talking to you makes the office visit so non-personable and disruptive". Some of this will have to be adjusted because lets face it, computers are the wave of the medical future.

So, we as physicians will inevitably become more transparent. What I want to know it WHY! WHY is the government so demanding of everyone else to be compliant, yet the rules of the game don't apply to themselves. It's like playing a made up game with a 5 year old! The rules change on a whim to accommodate them winning.

This article has the point I'm trying to make...

Don't you hate it when a politician says one thing when running for office and then does something else once elected! For example: In March 2008, then presidential candidate Obama promised the health care debate would be open and transparent saying: "I am going to do it all on C-SPAN so that the American people will know what's going on." (Town hall meeting, Lancaster, PA, 3/31/08) Fast forward to 2010 (and, if truth be told, all throughout 2009) and the Democrats are holding secret meetings to negotiate the health care reform bill - and they want to keep the cameras out. They want to keep us -- the American people-- from learning about their backroom deals and negotiations until after they are done- and we get to pay the price tag! In fact, on Tuesday, January 5, 2010, C-SPAN wrote a letter to congressional leaders asking that TV cameras be allowed to film negotiations to reconcile the House and Senate versions of the health care reform legislation. In what is a laughable response, House Speaker Nancy Pelosi (D-CA) defended Congress' work on the health care bill saying the process has displayed historic transparency. "There has never been a more open process for any legislation," Pelosi said - with a straight face - at a press conference. Senate Majority Leader Harry Reid's (D-NV) spokesman said that although he respects C-SPAN's "commitment to ensuring transparency," there is no plan to allow the network access to health care talks. President Obama has also been silent on the issue. They all know, and in fact the whole darn country knows, that this historic transparency is a big, bold, in-your-face lie. Sen. Ben Nelson's special deal to exempt Nebraska from paying its share of Medicare payments; Sen. Mary Landrieu's special $300 million "Louisiana Purchase"; $100 million for the University of Connecticut health care facility, and hundreds and hundreds of millions of dollars were all "backroom deals." We say to the Congress and White House: Stop your devious secret health care high jinks and let C-SPAN cover the meetings. No more secret sessions. No more sweetheart deals. The American people have a right to know. If you don't have anything to hide, then Let The Cameras In. Sincerely, Patients First Team