Thursday, October 29, 2009

Lend Me Your Ears

There are very few things in medicine that yield instantaneous results that please nearly everyone. The ones that do are usually quite simple.

Take the case of Mr. Barnes, who came in today unable to hear out of his left ear. He didn’t know why, but a single glance told me the whole story. Unknown to him, a swarm of honeybees had invaded his otic canal and constructed a very very very compact hive. It was dense, it was thick, and it was the color of the Big Mac Special Sauce when it’s had a chance to congeal a bit. (And for the record, I have eaten that.)

Most people don’t like the process of getting wax out of ears. It’s wet, repetitive work, an entry-level job serving as a rite of passage to doing more useful things such as taking rectal temperatures. However, I think its’ great fun. The trick is to dissolve away the wax just enough to create a small gap between the wall of the ear canal and plug. One you’ve got the hole, you irrigate the daylights out of the ear with warm water under high pressure (like generated by a squirt gun or a syringe with a plastic tip). If done right, the water flows through the gap and builds up pressure on the other side of the wax, and the cerumen (that’s the doctor cocktail party word for it, and why we can bill so much more than you) pops out whole for you to display to the astonished onlookers as the patient shouts out “I can HEAR! Thank the LORD!”

(The method also works with foreign bodies like pencil erasers. I know this because one of my other patients today was a young man who had just been named the “Most Inspirational” member of his high school class for his pastoral work. What he was inspired to do today was to place a pencil eraser on the sharp end of a pick-up stix and poke it in his ear to see what would happen. Using the above method, this popped out whole as well. I’ve been promised a “shout-out” in his next sermon. I’ll take all the heavenly points I can get…got a feeling I’m gonna need them someday.

This effect is even more dramatic when both ears are affected. Let me serve as an example. About two years ago I started to have trouble hearing. I had a feeling like both of my ears were blocked, and having had some sinus problems in the past I figured it was just a chronic buildup of fluid in the middle ear. But weeks went by and a continual diet of decongestants never seemed to help. To be honest, it wasn’t all bad. I’d go to meeting where I knew I was going to be asked some question that I couldn’t answer, and the “I’m sorry, can’t hear well, got an ear problem” excuse gave me some extra leeway to respond eloquently to a question other than the one asked. But I was trying to pull this off one morning with a pediatrician in attendance, and in calling my bluff he suggested that I drop by the office later that day.

So at noon I’m sitting in a chair in his office, looking up at happy elephant stickers perambulating across the ceiling, getting my ears hosed out with a high-pressure squirt gun by two nurses who are trying, but not succeeding, to stifle a snicker at the predicament of the State Health Director. I have to tell you that the sensation of the ears getting cleared out was really quite amazing…one moment you simply hear a low rumble of the water shooting against the wax, then a second later you hear the roar of a tsunami wailing on your eardrum, along with some nausea and dizziness induced by the water’s chill. (This is known as the caloric response, for those of you keeping score). And for the first moments I could hear everything…the whine of the neon lights, the hum of the air handling system, the traffic in the parking lot…all the noises we filter out during our daily life because they’re just too common. It was mind-numbing, one of those moments when you are simply overwhelmed in a way that defies description, like when you come over a hilltop to see an unexpectedly glorious valley below. It’s a very transient feeling, a few seconds at best, and then your mind readapts to it’s usual mode of work. I don’t know that I’d go out of my way to do it again…at least not with the ear wax…but definitely an experiential moment of note.

Speaking of ears (hahahahaha), one of the other instant cures is getting a live bug out of an ear. The best method to resolve this problem (translated as the funniest mode) is the Pedal Technique. You place the patient in a dark room, and shine a light into the ear canal. Just like cockroaches on your kitchen counter, the bug will run from the light. It exits the ear canal and the patient jumps up screaming. The cockroach falls to the floor and the physician steps on it. That’ll be $40.00, please.

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