Tonsils, meth, and wax

FYI: We've been yapping about tonsils over at Balls and Walnuts. Come see.

It never ceases to amaze me how many different questions I can get on ear wax. Here's another:

Q: I have a friend (and no it is not me that I'm referring to...since most of those statements tend to elude to such...) he is an addict and smokes methamphetamine regularly. For quite some time (at least a year) he has had a lot of ear discharge/wax buildup, etc., and is starting to have hearing probs. He regularly can be seen twisting a q-tip around his ear and is often taking his pinky finger, inserting and wriggling it around/up and down while tilting his head. He's also used peroxide wash and tried candling in the past. Where is he headed with this problem is what I'm wondering as I encourage him to visit my ENT but he has yet to do that. It is concerning me that he'll have permanent damage if he does not have matter looked at. As I know that the smoke inhalation of this drug tends to clog the ear air passage and creates an inverse suction of sorts.

I don't know what to say to facilitate a doc visit and was hoping to have some info to back potential damage he has/may have already incurred from letting it slide this long.

A: As much as I'd like to give you ammunition to get him off meth, I don't think ear wax, ear problems, or hearing loss is where it's at. For the last eight years, I have worked in a BIG methamphetamine area (the Pacific Northwest), and I haven't seen a single ear, nose, or throat patient with complications due to meth. Sorry!

He plainly has ear wax from hell, however, and would benefit from having an ENT clean out his ears. He can try using the over-the-counter wax removal products, but when it gets as bad as you describe, these kits can make matters worse.

D.

That purple stuff

Q: You're a hoot! Wish my ENT had as much personality. I try to make him laugh! Rarely works.

I am asking you this question as I neglected to ask him tonight. I had down wall Cholesteatoma surgery four years ago. I am scheduled for a mastoidectomy, tympanoplasty and meatoplasty next month. Between the surgery date and my schedule to fly ( short distance, one hour flight ) it is exactly one month. Would you give the okay to fly after only one month of the above procedures?

Also what is the purple stuff he puts in my ear. He said it was an ancient Chinese secret. Okay. He may be a little funny! '-)

Thank you!

A: Some definitions for those folks who haven't heard of these things.

The best definition for cholesteatoma is "skin growing where skin does not belong." Most commonly, we're talking about skin growing in the middle ear space. Skin is stupid; skin doesn't know any better than to make more skin. That's what skin does. And so you get this ever-growing ball of skin in a location where any mass can cause trouble (injury to the sense of hearing, or to the sense of balance, or to the facial nerve, or to the brain).

Mastoidectomy refers to an operation in which the surgeon drills out the mastoid bone (the bone behind/below the ear). In this case, it's done to eradicate the cholesteatoma. A canal wall down mastoidectomy is an operation in which the posterior wall of the ear canal is removed as part of the procedure. As a result, the patient will forever after have a large cavity as part of his ear canal (where before, he had a tube).

Tympanoplasty is an operation to fix the ear drum (and sometimes the middle ear bones); meatoplasty is an operation to enlarge the ear canal opening.

To answer your first question: I would say yes, it's okay to fly, but you really need to ask your ENT. There may be details specific to your situation which might result in a different answer. Also, different surgeons have different philosophies about after-care. Ask his nurse to ask him.

That purple stuff: it's a dye called gentian violet. It has antifungal properties. It also stains EVERYTHING, which is why I don't use it. Nasty, nasty stuff; I prefer to use antifungal foot powders (like Tinactin) or CSF powder (if I remember correctly: chloromycetin, sulfanilamide, and fungizone). If I used gentian violet, all my shirts would be purple. Or mostly purple.

Any more questions?

D.