The Pursuit of Earwax - Waxaholics

Credit: Brian Sanders

If have written about this subject many times in the past, and those of you who frequent WebMD's ENT Board know my stance. Nearly every week, someone is writing about a self-inflicted Q-tip injury. In my clinic practice, evaluating eardrum injuries and the management of excessive earwax is a daily occurrence.

For centuries, people have been obsessed with their earwax. As a collector of antique medical devices, I periodically find ear spoons. I would love to include one of them in my collection, but most are way too expensive; often made of wood or ivory and dating back a few hundred years. An interesting one had a toothpick on one side and an ear spoon on the other. It hung on a little chain around your neck so that it would be readily available.

Many years ago, I was traveling in Japan. A young girl was passing out free samples of something. It turned out that it was a disposable, plastic ear spoon; not unlike the antique ones that I covet. In the U.S., ear spoons would not be sold due to liability issues. Why? For one, they could rupture the eardrum and the manufacturer would be sued. We are stuck with using Q-tips. However, don't discount the Japanese just yet. Read on.

The company that makes Q-tips clearly states that Q-tips are NOT to be inserted in the ear - an important, legal disclaimer. I am sure that most Q-tip users bide by this important advice. During the 1950's, condoms were sold "for the prevention of disease," but the label could not list for the prevention of pregnancy. Advertising contraceptive devices were not legal. (This is probably the first time in history that Q-tips and condoms appeared in the same paragraph.)

One of the most ridiculous quackery devices out there is the ear candle. Not only can you burn yourself, or catch the house on fire, there is absolutely no evidence that this thing cures anything. There is not enough suction created by a lit, wax tube to suck out a feather, yet people believe it will suck out impurities from your body. Yes, pouring some hot wax in your ear may meld with your own wax, but with what risk? I know that I am going to get a lot of responses about this from ear candle devotes - the waxaholics. I even had the pleasure of meeting someone in my own town that has a brisk business of making and selling ear candles. I chose not to tell him what I do for a living.

The pursuit of earwax is becoming big business. I am embarrassed to say that it cost way over a hundred dollars for me to remove earwax in our clinic; this is the office visit plus the cost for the surgery (give me a break!). Since I am a salaried employee, I have absolutely no control over the cost of my services (unless I "forget" to write it down on the billing sheet). Granted, it does take time and skill to remove some seriously-impacted earwax, but I feel that charge is a bit excessive in most cases. If I use an ear curette (a wire loop), it is considered surgery (a waxectomy?). If I just use a syringe of warm water to wash out the ear, this procedure is not a billable event.

My WebMD moderator called my attention to a new device marketed in Japan called the Coden Ear Scope TV. I tried for years to develop an inexpensive camera that would mount to a standard otoscope so people could look inside their own ears, but engineering is not my forte. Standard web cameras are inexpensive, but they are not of medical quality. Home otoscopes are not expensive either, but the light source is often not optimal. There are fiberoptic medical-quality cameras for this purpose that cost several hundred to more than a thousand dollars. It is unlikely that even the most obsessed waxaholic would shell out this kind of money, so my hat goes off to the Japanese for marketing an affordable product. This ear camera costs about $350.00, or about 3 trips to my office to have me look in your ear. Wax on. Wax off.

Being able to see your own earwax is only half the battle. Once you discover that you do have a wax impaction, you have to have a safe and effective way of removing it. This Japanese device has one of those quasi-dangerous ear spoons on the end. If you are blessed with the steady hand of surgeon or diamond-cutter, you may be able to dig it out yourself, however, you could get a great video of yourself puncturing your eardrum. You could post it on You Tube.

Speaking of You Tube, there are numerous videos on this popular site related to earwax. I would suggest that you not eat before you watch them. In some, the foul language is not appropriate for children or other human beings. I did like the one in India, where you can pay an entrepreneurial man a small pittance to clean out your ears. My guess is that he is not an otolaryngologist.

I have done everything that I can to help vindicate the reputation of earwax. I tout its medical benefit for protecting the sensitive ear canal from water and infection. I preach endlessly about the dangerous of Q-tips and self attempts to remove it with bobby pins and paper clips. These efforts have fallen on deaf ears (Ha!).

Yes, earwax is not the most pleasant bodily substance on this planet. It falls somewhere between that stuff that collects in the corner of your eyes and a booger. Out of context, a can of car or fine furniture wax would look equally as disgusting, but think of the protection that it offers. I ask you (again), not to judge earwax by its appearance or unfair reputation.

Unless it is completely occluding your ear canal and interfering with your hearing, earwax is best left alone. The shape and angle of the ear canal, coupled with our 98.6 degree body heat allows earwax to come out naturally. Simply shower it away, or wipe it out with a wash cloth. Do NOT go mining for it.

Related Topics:

• 5 Summertime Tips for Healthy Ears
• A-Z Guide: Earwax

Technorati Tags: earwax, ear candle, ear injury, health and wellness

Ten Tips to Keep Your Teens Summer-Safe

Several years ago, my PA wife and I worked for the county Child Protection Center. Our job was to perform evidentiary medical examinations on children and teenagers that were sexually-abused or raped. We would dread the summer months, especially the weekends, since this was the High Season for teenage sexual situations. It would not be unusual to be called out to perform a half dozen rape examinations on a summer weekend.

The summer social scene is very exciting: No school, relaxed rules, and ample free time. There are frequent parties, sleep-overs, outings, concerts, and camping trips. Parents work during the day, often leaving teens to watch younger siblings.

Some parents will go on vacation and leave teenagers for a week or more with an easy-going grandmother or with one of their friends. Many older teens are even left alone when parents go on short trips or overnighters. Even when I was a teenager, a house without parents was an automatic party. I spent many Sundays helping to shampoo spilled beer out of my friend's carpet before the parents came back, or trying to replace guppies and goldfish in the aquarium that were systematically swallowed during out-of-control drinking games.

We quickly discovered that throw pillows do not cover up stains or cigarette burns. As soon as parents would come home, the phone would ring. It would be the neighbors ratting on us. Before I graduated high school, two of my best friends were killed in car accidents involving alcohol.

Young teenage girls (age 12-15) are too young to work, can't drive, and like to hang out at swimming pools, water parks, amusement parks, shopping malls, etc. with other teenagers. They are also proud of their new, rapidly-changing bodies and are not afraid to show them off. Coupled by their inexperience with the opposite sex, questionable judgment, and their inherent naivete about the dangers around them, they often get themselves into very dangerous situations. Teenagers are risk-takers savant and the summer months bring it out in full force.

Younger teenage girls are frequent victims of sexual crimes during the summer months. Teenage girls will meet a "guy" (usually older) and be easily convinced to take a ride in his new car. They typically lie about their true ages, as do the perpetrators. We found that teenage sexual crimes and alcohol use went hand in hand. Teenage girls quickly succumb to the effects of alcohol or recreational drugs. Date rapes are much more likely when teens are drunk. It is essential that parents keep the lines of communication painfully open in the event that your teen has been sexually abused or becomes a victim of a date rape. Immediate medical attention and prompt psychological support is paramount.

Underage drinking is rampant. When our son was caught with beer hidden in his car, he refuses to this day to reveal the source. He is now thirty-two years old and has his own teenage daughter. We suspected a convenience store in the neighborhood, but were never able to prove it. The bottom line is that he did not have any problems buying alcohol or cigarettes. Marijuana, speed (methamphetamines), LSD, Ectasy, etc. could simply be bought at school or concerts. Statistics show that teens who begin to drink before the age of 15 are FOUR TIMES more likely to develop alcohol dependency.

Just because teenagers look like adults, in no way implies that they are adults-in-training. They are still children; emotionally and intellectually. Remember that. Parents, wanting to be their friends and be known as "cool parents" frequently provide alcohol at quasi-supervised parties. Talk about mixed messages! Recently, a local Mom was arrested for providing alcohol to teenagers, and having sex with two of them. She was one of those "cool" Moms.

Alcohol and injuries are other inseparable pairs. Although I no longer work for the Child Protection Center, I am patching up injured kids every day. This week, I sutured the head of a teenage boy who cracked it on a tree limb trying for new heights on the trampoline. I put on a half-dozen upper arm casts last week from a variety of risk-taking behaviors (some involving alcohol). And, my PA wife who runs the Teen Clinic, is booked weeks in advance for birth control visits. Since I tend to see many of the teenage boys in our practice, I have ordered an impressive share of sexually transmitted disease tests since the beginning of June.

Ten Tips for Frightened Parents of Teenagers:

1. Don't relax the rules. If anything, take 'em up a notch. And, don't be surprised when the rules are stretched or broken.


2. Make consequences clear... and make 'em harsh. Write them down and get your teenagers to sign it. Seal the bond of trust with a hug.


3. Supervise Your kids. Your teenager has plenty of friends; you need to be their PARENT. Be prepared and expect to be unpopular from time to time.


4. Openly discuss alcohol use and abuse. Make it clear that teenage drinking is illegal and dangerous. As a parent, if you drink at home, do so responsibly and count your beers. Lock up your liquor. Make sure your vodka hasn't mysteriously changed to water./li>
   
5. Ask questions. Stay involved. Teenagers need and deserve a certain amount of privacy in their lives, but that does not imply parents should stop parenting.


6. Check and double-check teenage party plans. Talk to those supervising parents. Do not hesitate to make surprised visits. Embarrassing your teenager is your privilege and right.


7. Make sure your rules are not ambiguous. Teenagers are famous for being vague or "changing plans" at the last minute. If there is a loophole in the rules, a teenager will jump through.


8. If you are going out of town, do not leave teens unsupervised overnight. Even responsible teenagers get into big trouble when the supervisory distance increases.


9. Follow through with your consequences. Your primary mission is to keep your teenager safe and on the right road to responsible adulthood.


10. It's okay to say NO.

Related Topics:

• 10 Parenting Tips for Raising Teenagers
• WebMD Video: Summer Education Camps

Technorati Tags: advice, tips, health and wellness, summer, parenting, teenagers

Happy Father's Day

I received my first Father's Day card today, from my daughter. It was very nice and she never forgets. It is those few well-chosen words and those thoughts that made my day.

Recently, I started organizing her old videos from thirty years ago so that I can transfer them to DVDs. I was proud to own one of the first RCA video cameras (black and white) for my first-generation VCR. It was a great machine and had such features as "on and off." The blank video tapes cost $30.00, so I used them sparingly. Believe it or not, I still have that old camera ($300.00). The camera was not cordless, so all of those early videos were taken within ten feet (the length of the video cable) of a fifty pound VCR and television set. It had a sight, but not a viewfinder, so many of those shots have part of her head missing. I had to turn off the TV to keep her from watching herself. To look back nearly thirty years and see that little face; to hear her voice; to hear her constantly coughing (she was in daycare!), is wonderful. Even if those tapes burned up in a fire, those memories are burned into my heart.

During most of my early childhood, my father was ill. He had lung cancer. I suspect this is why there are so few pictures of me as an infant. He was the only one that could work the camera. Like me, my father was an amateur photographer. There were many pictures of my older brother (eight years older), since he also had his own darkroom. During the war (before I was born), my father worked in the shipyards of Baltimore. In order to supplement his salary as a welder, he sold girlie photos. He bought the negatives from a catalogue and printed them in the basement. There are not many people who can proudly say that their father helped support the family by selling pornography.

When I came along in 1951, my father already had a time bomb ticking in his lungs. One of his jobs in the shipyards was to fireproof various areas with asbestos. Coupled with his two-pack-a-day cigarette habit, he developed lung cancer and died before his 39th birthday. I was in kindergarten.

Children have very few accurate memories before the age of five, but I do remember my father. He was a good hugger. I remember standing on the front seat of the car as he drove. In those days, cars did not have seat belts and dangerous practices like standing on the front seat were sort of ignored. I remember our last Christmas. And, I remember him lying in his hospital bed that took up one of our two bedrooms. In the last month before be died, I was sent to live with my Uncle Joe. I came home on the day of his funeral.

I remember his funeral like it happened yesterday. As a matter of fact, I once allowed myself to be hypnotized in front of an audience at a medical seminar. Thinking that I was going to be one of those resistant subjects that could not (or would not) be hypnotized, I volunteered. I was wrong. I have no idea how long I was under hypnosis, but I woke up crying. I had re-lived my father's funeral so vividly that I could smell the flowers. It was unbelievable, and so disturbing that I had to call my older brother to confirm what I had just "seen." He was accurate to the "T."

I didn't have many years with my father, but I do remember him. I only have a few pictures of my father, but I gave them to my son so he would know what his grandfather looked like. I wanted to post one of them today, but I had to settle for one of me at about age 3-4. Nice pants, huh?

All fathers really want on Father's Day is to be remembered. A card, a phone call, or a visit is always appreciated. No flowers, please. Ties are optional.

Now... go call your Dad.

Related Topics:

• WebMD Video: Celebrating Dad
• Father's Day Advice for Dad

Technorati Tags: Fathers Day, dad, health and wellness

Plane Truth - Infectious Disease Exposure When Traveling

Andrew Speaker had things to do and places to go. He had a European honeymoon trip planned. He also had tuberculosis. And, not just the plain 'ol, garden variety tuberculosis that has been killing people for millennia...this was one of the new super-bugs. Mr. Speaker, an Atlanta personal injury attorney, had XDR TB - Extensively Drug-Resistant Tuberculosis.

Whether he fully grasped the public health consequences of his worldwide odyssey is debatable, but more than 600 people were exposed during his transatlantic flights and probably countless more on the ground in France, Eastern Europe, Canada, and the U.S.

Public Health officials started spin doctoring. "We told him not to travel."

"No, you said it was "not recommended" that I travel. I'm sorry." (Don't you just love attorney logic?)

Not since Typhoid Mary was put in prison in New York to keep her from working clandestinely in restaurants, has there been such public health uproar. While quarantine policies are in place, they are woefully antiquated, inadequate, and toothless. If we can keep one person from spreading his germs around the planet, how in the world are we going to deal with a major pandemic, like the bird flu? I can see it now. People dying right and left with bird flu. Entire communities quarantined...sort of.

Mr. Speaker flew into Canada and drove across the U.S. border in New York. Although his passport clearly was flagged, the border agent (now, former border agent) let him in. Oh, well, at least he wasn't carrying a dirty bomb. Yes, he was. There is nothing more "dirty" than a mindless person freely-sharing a drug-resistant organism.

I wonder where Mr. Speaker contracted his drug-resistant tuberculosis. Was it from one of his personal-injury clients or some stranger? I find it very interesting that Mr. Speaker's father-in-law, Robert Cooksey, is a research microbiologist for the CDC's Division of Tuberculosis Elimination! I am definitely going to lose some sleep over that bizarre coincidence.

Some Centers for Disease Control experts are now saying that he was not "that contagious," although it is well-known that tuberculosis can be easily spread through the air, or by freshly-contaminated fomites, such as someone coughing on a surface. Apparently, Mr. Speaker was not hacking and spitting up bloody-phlegm, but I still would not want to share a seat with him or use the bathroom after him. Airline air filters (75% of planes have them now) or not, I would still not be a happy traveler if he were my seat-mate. An air filter is not going to stop an airborne loogie!

Mr. Speaker may actually be liable for any health-related injuries if one of those 600 contacts come down with his rare form of tuberculosis. Victims of disease, like herpes or HIV, have successfully sued their contacts in the past. Even if these potential victims do not develop a positive tuberculosis test over the next few months, they have been inconvenienced by having to be tested and certainly frightened. Statistically, exposure to in infectious disease, even this one, in no way implies that you will get it. Hopefully, all of these people will be fine.

Since 9/11, people have been carefully scrutinizing their fellow-travelers. In the past, all we were worried about was sitting next to an extremely obese person encroaching into our seat space, or someone that was overly-talkative, or hygiene-challenged. Sure, we have to eyeball anyone that looks suspicious, but now we are going to go crazy when someone is coughing.

Several years ago, one of my PA colleagues was exposed to drug-resistant tuberculosis by a patient in California's Central Valley. By the time it was determined this person had TB, the patient was sitting (and coughing) in a crowded waiting room for an hour. Infectious Disease: The Gift that Keeps on Giving.

Tuberculosis is not high on my fears, but as a medical provider who works in another of those "Dirty Places," I get a tuberculosis skin test every year. Fortunately, they have always been negative. It is not that I am germophobic, but I am very germ-o-conscious, especially when I have to fly. Airlines have definitely cut corners on the cleaning crew. All they do now is empty the (obvious) trash. They do not have time to disinfect those scary tray tables, and I serious doubt that the bathrooms are really disinfected between flights. I won't use those blankets or pillows, either. It is bad enough sitting in those cloth seats. I know that if I tried to fly with a Hazmat (hazardous material) suit, gloves, and an OR mask, I would be adversely profiled. However, I may get a seat by myself and will likely sail right through customs.

Related Topics:

• Tuberculosis: 17 Questions and Answers
• WebMD Video: Travel Danger

Technorati Tags: TB, XDR TB, extensively drug-resistant tuberculosis, Andrew Speaker, travel, health and wellness