Eustachian tube dysfunction due to a deviated septum?

Q:

Hi there,

I'm afraid I have a question for you which doesn't involve ear wax! Can a
deviated septum cause eustachian dysfunction?

A:

Interesting question. I had never thought about it. My knee-jerk reaction
is to say 'no,' because I can't immediately think of any mechanism
whereby septal deviation could cause ETD. But the more I think about it,
the more I can devise scenarios and think of things I can't completely
account for. So I would have to say 'maybe.'

The neat thing about this question is that it's empirically testable by
correlating rhinomanometry data (which measures nasal air flow) with
tympanometry data (which measures middle ear pressures -- a direct
measure of Eustachian tube function). Do this before and after
septoplasty and see if the improved airway results in an improved ET
function.

I just searched PubMed and found a relevant article here
and here. The first study found worsening of ET function soon after septoplasty,
with some improvement much later, but many patients showed no change in
ET function. The second study had a very brief abstract (and the main
paper is in French), so there's no telling what they demonstrated.

I would tend to agree with the conclusion suggested in the abstract of
that first paper: "We suggest that it [nasal surgery] may be useful in
cases with severe nasal pathology or chronic infection of the nose or
the nasopharynx, if this is accompanied by poor tubal function." In
other words, if the ENT doc feels the septal deviation is contributing
to sinus infection (for example), which in turn is contributing to ETD,
then septal surgery is indicated. Otherwise, don't bother.

Hope this helps!

D.

Radiofrequency uvulopalatoplasty for snoring

Yeah, you read that title right. Sometimes I feel motivated to make a public service announcement. Not often, but sometimes, and tonight's the night. And since the chances are pretty good you (or your spouse) snores, I figure I won't lose too many of you with a relatively serious post.

This first bit is for my malpractice insurance carrier:

I am NOT offering medical advice; I am merely providing information. Read the disclaimer. It has flashy things and animated buttons to keep you entertained.

Another note: my victim patient, Jeannie, has given me permission to use her images in these blog posts. Wasn't that nice?

Look, she's even smiling about it.

Follow me below the fold for a discussion of snoring, obstructive sleep apnea, and the use of radiofrequency uvulopalatoplasty to successfully treat snoring.

Read more »

A mucusy smorgasbord

Remember, if you need a question answered, send it to azureus at harborside dot com. And don't forget to see me at the blog and give me some love.

***

Heck, I don't even need to give you the letter on this next one. The answer is self-explanatory.

***

1. Itchy ears: if they're bothering you enough, consider asking your ENT for a prescription for Elocon (mometasone cream). The patient applies a thin layer to the ear canal openings once a day only as needed for itching. Works for most itchy ears. Caveat: some folks, and you may be one of them, have itching of the Eustachian tubes due to postnasal drainage. In that case, the only thing that will help is to treat the underlying nasal/sinus condition.

2. Tinnitus: currently, the only medication that seems to have any benefit is Zoloft, an antidepressant. Seems to help with tinnitus about 50% of the time. Not great odds, but better than nothing. (Be warned, though, that it occasionally makes tinnitus worse.) Masking is the old standby -- having some background noise in the room to distract your brain from its internal noise. But Zoloft is useful for folks who are getting loopy from the noise. I'm not sure how well this would work out with your Wellbutrin, though. Could be a problem.

3. For the mucus problem, the key interventions are (a) hydration (shoot for 64 ounces/day noncaffeinated, nonalcoholic beverages), (b) mucolytics such as guaifenesin (Mucinex, which is available OTC), (c) saline irrigation -- and nothing beats the NeilMed stuff, and (d) treatment of the underlying problem. Mucinex is the least important of those four things, hydration arguably is the most important.

4. Sometimes a person has nasal airway obstruction without any obvious source of obstruction. If that's the case, I check for nasal valve collapse. If this is the problem, lateral traction on the cheek greatly improves the airway. A Q-tip inserted into the nostril to "tent up" the ala ("wing" of the nostril) greatly improves the airway. If this is the case, there are two options: Breathe Right strips and surgery. There are a couple of approaches which bolster the nasal valve from within, essentially accomplishing internally what Breathe Right strips do externally.

5. It's very hard to say if your rhinitis and/or sinusitis has been managed with a sufficient level of aggression. There may be a role for oral antibiotics, antibiotic irrigation, antifungal irrigation, or nasal antihistamine spray (Astelin). Rarely, I use oral steroids (like Prednisone) which occasionally work better than nasal steroid sprays (like Flonase). Aggressive allergy management, either by avoidance or desensitization, may also be indicated. This part of the problem goes way beyond what I could accomplish for you in an email. I only wanted to point out that Flonase is a pretty wimpy first step at treating this problem, and there's a hell of a lot more that someone could do for you.

6. You may be wondering about obtaining a culture from the sinuses to find out what is causing the infection (if there is any infection). Nasal cultures are worthless, so the only way to get a worthwhile culture is by getting a surgical specimen. Since most of us leave surgery as a last resort, culturing the sinuses isn't much of an option. (ENTs can puncture into the sinus on an awake patient to get a valid culture, but it's REALLY unpleasant for the patient.)

This should give you plenty to discuss with your doctor.

D.

I'm back -- with boogers!

Hi folks. Sorry I haven't been updating this. I've been answering most people's emails -- more than half of them, anyway -- but I just haven't had the energy to post here.

If I'm true to form, I'll probably go a long time before posting again here. You're certainly welcome to email me (azureus at harborside dot com).

On to today's letter, which could be titled: TECHNICOLOR BOOGERS.

A brief history: I had extensive endoscopic sinus surgery done 8 days ago--all four sinus cavities were cleared out, turbinates resectioned, and windows were cut. My head had so many polyps they were either going to start going down my throat or out my nose. My CT Scan was completely grey in color, which concurred with my inability to breathe through my nose or smell. I've been back to the dr once, and he used the "sucker" and got a lot of mucous out of the way, and he is having me do saline sinus rinses multiple times a day now.

My question: What is all the junk coming out of my nose? Why the rainbow of color, size, thickness, and consistency? Today I have had clear, red/bloody, yellow-brown, and brown; sometimes like normal boogers and snot, and other times like really thick snot and mucous that has sat around too long. The one that shocked me that I'm really interested in was somewhat tissue-like...it was 1.5" long x 0.5" wide x 0.25" thick chunk of red, white, clear, and yellow, and it came out when I blew my nose. (Yes, I measured it) It was similar to the consistency of raw chicken fat or something equally gross. Then a few minutes later, I blew my nose again and the same sized and consistency chunk came out of the other nostril. I felt much better and finally felt like my nose was really cleared out after these came out, but I couldn't believe something that big and solid was in there. My doc said he didn't use packing, but I wonder if these two were really something natural or if it was a dissolvable packing type of thing? And is that an abnormal size chunk to come out...could I possibly blow out nasal tissue? What about the turbinate resection...could I have blown out cilia and membranes? Any thoughts? And, lastly, is there a record for having the largest boogers?

What struck me right away is that you had your operation only 8 days ago. Eight days is nothing in this business! Of course you're still producing wild mucus. I would expect it. Don't worry about blood-red, black, brown, or yellow. It's GREEN you need to beware, since that would indicate an infection.

But I'm jumping the gun. I should begin, first, with the usual disclaimer: such questions are always more appropriate for your doctor, rather than some dude who has never examined you and who doesn't know precisely what operation was done. My response is an unreliable guess based on the information you've provided me. An educated guess, perhaps, but still unreliable. You ought to talk to your doc about this, or at least share your concerns with his nurse.

Now, on to my thoughts in the matter:

Your doc might have used dissolvable packing. He's old school (I can tell, since you said he resected your turbinates and created windows -- if that means what I think it means, your doc is probably in his 50s or 60s), so to him, "packing" may mean "strip gauze." If he left any gelfoam in your sinus cavities, this stuff can come out looking like tissue.

Short answer: this early post-op, don't fret about anything except green mucus. Two other things which would prompt a call to the doctor: copious watery drainage, which could indicate a leak of cerebrospinal fluid, or signs of infection (facial pain, redness, fever, severe headache, stiff neck -- any of those).

Otherwise, keep irrigating like crazy and you should do well. Good luck.

D.

PS: the nasal and sinus cavities are HUGE. Much bigger than the nose on your face. There's plenty of room in there for enormous boogers.

That spinning sensation

Q: I am an aerialist (trapeze performer) and am currently dealing with what might be BPPV, Labyrinthitis, or something similar. I am 41 years old. My first experience with BPPV was about 2 1/2 years ago onset was a few days after I had hit my head. I ignored it for a while (it would improve and worsen randomly over the course of a few weeks) but when my work became dangerous I did se a ENT specialist who didn't suggest anything other than rest and Meclizine. Meclizine only worsened my condition. After a few weeks off the trapeze I returned to my usual activities and was fine.

About three months ago I experienced a slightly milder form of vertigo along with fullness in the ear, ear pain, popping and congestion. I saw my chiropractor who did an adjustment maneuver the day after which I was unable to walk my vision was so distorted. I could only focus if I was perfectly still. After 2 days in bed I felt better and slowly resumed activity. Mild vertigo symptoms came back in about a week, during which time my ear symptoms had worsened and I again saw my GP who prescribed Zythrimycin (sp?) - the medication and 2 days of rest and I was completely fine.

3 weeks ago I caught a cold, which caused severe headache and sinus pain after a week and a half I developed distortion in my vision causing dizziness when jumping. My doctor again prescribed Z-pack and I was improving and the dizziness receded. I curtailed trapeze activity but was able to do some aerial work. I was feeling much better dizziness wise, but still had severe headache and sinus pain. My doctor prescribed amoxiclav and flonase which I started on Tuesday morning. My sinuses began to clear, however I still had sinus pain and some facial swelling on the left. I was able to have one training session without dizziness. Later that day (Wednesday of this week) warming up for a performance I experienced positional vertigo, sweats, intestinal distress, and a metallic taste in my mouth. I got through my show and stopped taking the AmoxiClav. I have been doing the Brandt Daroff exercises and after a day of rest am only dizzy on the first set when I move to the right. I rested all day on Thursday and Friday. By end of Friday I was able to complete the BD exersize without vertigo, as well as fold forward and look up.

I saw my doctor Friday afternoon. He took an x-ray and determined that my right sinuses are still very infected and gave me Cefuroxime. He felt the dizziness was unrelated and that if it did nos subside he would refer me to an ENT. I took my first dose of Cefuroxime with dinner Friday evening. I began feeling itchy within a few hours. This morning Saturday my dizziness has worsened. I will be calling my doctor's office later today.

So, that is my history - now for the questions. Is there a reason why antibiotics would be making my vertigo worse? Is it possible to recover from a sinus infection without the use of antibiotics? Is it detrimental for me to be working out in a gym setting if I keep my head upright? I have 11 shows next week starting on Tuesday under contract, and I believe that I can compensate well if the vertigo doesn't worsen. However, I am not sure how to spend my next few days - resting completely, partial workouts? This set of shows were to be the last shows prior to my retirement (I am 41) - so they mean a lot to me. That said, I don't want to be an idiot.

Thank you so much for your time.

A: Before I address your questions, I think it's important we verify that we're talking about the same things.

BPPV: benign paroxysmal positional vertigo. (See also this link.) This has a number of unique features:

1. There is a true vertigo (sense of spinning) when the patient's head is in a particular position. Most commonly, this is provoked by rolling over in bed to one side or the other.

2. If you stay in that position, the vertigo always passes in under a minute.

3. While you are experiencing the vertigo, an observer would see your irises rotate several degrees, correct, the rotate again. Nystagmus is a repetitive eye movement; with BPPV, the nystagmus is called 'rotatory'. Other forms of vertigo show horizontal or vertical nystagmus depending on the motion of the irises. BPPV, to my knowledge, is the only condition which demonstrates rotatory nystagmus.

4. If you immediately go back into the offending position, the vertigo is either nonexistent or much less severe (so-called "fatiguability" -- the symptom "fatigues" with repetition).

5. When you first go into the offending position, there is often a delay of a second or two, sometimes a few seconds ("latency").

6. BPPV responds promptly to positional maneuvers. My favorite is the Epley maneuver, but there are others. With once daily repetition of the maneuvers, nearly all cases of BPPV will resolve in two to three days, assuming the correct maneuver is used. That's where your ENT comes in.

Fullness in the ear, popping, ear pain, and congestion are not associated with BPPV. These symptoms suggest a different problem -- perhaps Eustachian tube dysfunction, an acute ear infection, or possibly otitis media with effusion (fluid behind the ear drum). These problems sometimes improve with antibiotics or a variety of medications which treat the underlying problem, such as sinusitis, allergies, or other nasal/sinus inflammatory conditions. If medications don't help, the ENT can lance the ear drum or place a ventilation tube.

Labyrinthitis is a much more severe condition than anything we have discussed so far. Most cases are caused by viruses. (Bacterial labyrinthitis is a rare but devastating condition which usually leaves the patient with permanent balance and hearing disabilities.) The patient experiences severe vertigo worsened by any kind of motion, and, unlike BPPV, the vertigo can last for hours or days. Nausea and vomiting are common. Ringing in the ears and hearing loss are common. If there's no ringing or hearing loss, but the other symptoms are as I have described, then vestibular neuronitis should be considered.

Viral labyrinthitis and vestibular neuronitis are "self-limiting conditions", which means they improve spontaneously over the course of several days or weeks without any specific treatment.

BPPV, on the other hand, can persist for months unless the patient uses the correct positional maneuvers.

BPPV not uncommonly follows head trauma, labyrinthitis, vestibular neuronitis, or even an upper respiratory tract infection. Once you have it, you can make it go away with positional maneuvers, but it can return weeks, months, years later without warning. Positional maneuvers will again work, but there's no way to get rid of BPPV permanently.

On to your questions:

Is there a reason why antibiotics could make vertigo worse? Not usually. Only as a side effect of the medication (which is, of course, possible for any med, but I don't commonly see vertigo as a side effect of antibiotics).

Is it possible to recover from a sinus infection without the use of antibiotics? Yes. Untreated, most people will fight off a sinus infection. Antibiotics will shorten the duration of the illness (assuming we're talking about bacterial sinusitis) and will also help to prevent the progression of acute sinusitis into chronic sinusitis. One downside of NOT treating with antibiotics: the infection is more likely to turn chronic.

Is it detrimental for me to be working out in a gym setting if I keep my head upright? Assuming you are being safe in your workouts, I see no harm in this, and in fact, the workouts are probably a good thing. How else will you be able to judge if you are safe for performing?

How should you spend the next few days? Tough to say. If your heart is set on performing, you need to be working out, steadily increasing the intensity so that you can determine if you are safe to perform. Only you can make that judgment, by the way -- I doubt any doc could look you over and give you a 100% guarantee of safety. The thing to do, then, is whatever it takes for YOU to figure out if you're safe to perform.

I'm still not certain what it is that currently bothers you. That's where a visit to the ENT would come in handy, but at this time of year, I suspect getting in to the ENT would be difficult on such short notice. If your current problems are more Eustachian tube dysfunction-related, then medications (or possibly even minor surgical procedures, as I've noted above) could help. On the other hand, if your current trouble is more like BPPV, then positional maneuvers are the way to go. By the way, I can imagine situations where your stunts as an aerialist could undo the benefit of the maneuvers. You would know it right away . . . but I would hope you could find that out during your workouts, and not during a show!

Remember, safety is paramount . . . but I doubt I need to tell you that. You have many years ahead of you and I would hate to see you get injured.

Best of luck to you.

Tubes and adults don't always mix

Q: I had a bout of Mono last summer and one side effect was a viral infection in my middle ear . A drainage tube was inserted but results have been mixed. I have recovered my hearing in the affected ear for only about 6 weeks in the past 15 months and am about to have a new drainage tube installed.

I use an ear plug when bathing or swimming but it occasionally leaks. I have just been fitted for a molded plug.

My question is:

Could water seeping into the middle ear be the cause of my drainage tube being ineffective? If not, what could be causing my tube to be blocked?

P.S. I am -- years old and my ENT says that he has not seen my problem(s) other than in kids.


A: I'm intrigued by that PS. That must be an ENT who treats very few kids, since I am constantly seeing this sort of thing in adults.

There are several possibilities, and there's no way for me to know exactly what's happening with you. Here are the things which come to mind:

1. Yes, occasional water seepage into the middle ear could be enough to compromise tube function.

2. Even one episode of tube otorrhea (drainage of middle ear fluids through the tube) could be enough to clog the tube, making it nonfunctional.

3. Sometimes, the problem is neither middle ear fluid nor Eustachian tube dysfunction, but low frequency nerve deafness, which can masquerade as the other problems. This is something readily diagnosible by a hearing test.

4. Some middle ear mucosal diseases persist despite tube placement. In this case, you would continue to produce middle ear fluid and you would notice persistent leakage of fluid from the tube . . . unless the fluid is exceptionally thick. That's something your ENT should be able to notice when he examines your ear under the microscope.

5. Rarely, throat tumors can cause persistent Eustachian tube dysfunction. A fiberoptic examination of the throat is sometimes necessary.

6. Finally, and most troubling, I've found that some adults simply don't respond well to tubes even when all of our tests and exam findings indicate that the tube should work like a charm. They're simply unhappy with the tube and there's no good explanation for it.

Good luck!

D.

Those phantom smells

Q:

Love your blogs.

Thank you.

Okay, here's my question/situation. I occasionally get a bad smell in my nose - like all the air I'm breathing is tainted with cigarette smoke or burnt coffee. Sometimes I have to force myself to breathe through my nose when it's particularly bad. I start to breathe, then my nose rebels and I have to tell it please breathe. (I am not a mouth breather unless absolutely necessary.) When this happens, it lasts about a week or two, then goes away for months. This has been going on and off for at least several years. More than three, for sure.

I have a history of annual sinus infections - mostly in February, early March - and I'm asthmatic and allergic to everything it seems.

Is this worth a visit RIGHT NOW to a specialist, or should I bring this up at my next visit to my regular internist.

The most likely explanation for these phantom odors is, indeed, sinus infection. You may have a chronic sinus infection which flares periodically, either directly producing the odor or indirectly creating a phantom odor by irritating the olfactory nerves.

The worry with any phantom odor, however, is tumor -- a tumor anywhere near or on the olfactory nerves. These are uncommon (much less common than sinusitis) but, as you might imagine, they're a good deal more serious than sinus infection. These can, in fact, be brain tumors.

Phantom odors from a brain tumor would not tend to come and go, however. Typically, the odors would come and stay, possibly get worse, and the tumor could eventually knock out the sense of smell altogether.

It may sound like I'm trying to reassure you, but the other shoe still has to drop. In medicine, we say, "Never say never." In other words, just because something is (A) rare in the first place, and (B) unlikely to present in the manner you have described, doesn't mean you have zero chance of that worst case scenario.

I hope you'll understand that I can't directly advise you how fast to see a doctor. When I do answer those questions, I always answer them the same way ("See your doctor immediately!") because I have to cover my ass. BUT: it sounds like this is making you miserable, so if I were you, I would take care of it sooner rather than later. A consultation with an ENT, who will most likely order a sinus CT and may also examine your nose with an endoscope, would certainly be worthwhile.

Hope this helps!

D.

When is it more than a cold?

Miss Beff writes:

How long should I be stuffed up before thinking it's maybe not a cold and then going to the doctor? Three days? A week of snot sans relief? What?

She also points out that it has been aaaages since I updated. Sorry. Consider the comment section here to be an open thread -- ask away. And if I don't get back to you promptly, email me at azureus at harborside dot com with your questions.

Back to snot. In general, if it's a cold, you should be getting better within two to three weeks. But nothing is that simple. What's the chance it could be something else?

The most likely alternate possibility is sinus infection, allergy, or other forms of chronic rhinitis. Less likely: nasal polyps, and MUCH less likely, nasal/sinus tumors.

In children, you should also consider the possibility of enlarged adenoids, as this will cause nasal airway obstruction, too.

AND unilateral nasal airway obstruction in a child, typically with unilateral foul-smelling drainage, usually means?

Ding ding ding ding! Give a peanut and a popcorn kernel to the gal in the red blouse who correctly answered, "A nasal foreign body." You're head and shoulders above most primary care docs.

Back to the other possibilities. Let's take them one at a time. Bear in mind that colds are so common (hence common cold) you might have a cold AND one of these, okay?

Acute sinus infection

In addition to nasal congestion, expect to see discolored mucus (yellow, green, or occasionally more delightful colors. Brilliant orange, that was my personal favorite), facial pain, facial pressure, and an overall crappy feeling (malaise). Fever is uncommon in adults.

Chronic sinus infection

All of the above (for acute sinusitis) but the symptoms are usually less intense and more longstanding.

Nasal polyps

Polyps do not arise overnight. Generally, the patient gives a history of gradually increasing nasal congestion (over the course of months or years), recurrent sinusitis, and/or severe problems with nasal allergy. Which brings me to . . .

Allergic rhinitis

All the things you hear about in commercials. Congestion, sneezing, watery nasal drainage, itching of the eyes, nose, and throat, itching or pressure in the ears.

Tumors of the nasal cavities or sinuses

Awful, horrible things, usually. You don't want any part of this. Fortunately, these are rare, but a gradually progressive nasal airway obstruction always raises this possibility. What are the warning signs for nasal or sinus tumors?

• Change in vision (blurry vision, double vision)
• A bulge in the cheek, to the side of the nose, or in the brow line, often only apparent on comparison to old photographs
• Numbness on the cheek, teeth, lips, nose, or brow
• Loose maxillary teeth
• Blood-streaked nasal mucus in association with gradually progressive congestion on the same side
• Facial pain
  

I hope I'm not forgetting anything.

In the discussion of chronic nasal congestion, I'm skipping certain common things like septal deviation or chronic enlargement of the turbinates. Beth is, I think, more concerned with an acute process which seems to drag on longer than usual. For that, sinusitis and allergy would be my top two concerns.

I hope this helps!

***

By the way, over at Balls and Walnuts I have awarded my regular readers with a very special photo of ME. Me like you've never seen me before.

You've been warned.

D.

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.

Y'all can't get enough wax

I know, I know. It's been forever since I posted. Bad me.

Here's an all-too-common problem:

Q: Hi there. Ok, cracking up after googling "Ear wax medication" and reading your blog...as I just did like 4 ear candles on my poor husbands ear (which seemed to work, collecting a ton of wax & sand each time) but yet didn't remove the wax that we can see when we look in his ear.

Here is our issue - hope you can advise. My husband's ear (either from surfing or whatever) has a lot of hardened ear wax build up that can be seen with the naked eye. I can even send you a picture if you so desire. There is a hole about the size of a typed uppercase letter "O" that he has to hear out of in both ears. Frankly, I am tired of repeating myself! The wax is a very pale yellow and is pretty hard - it itches and all that fun stuff.

Are our only options to see an ENT? OR is there some sort of OTC meds that I can buy that will soften the wax and allow us to remove it with a q-tip? Trying to avoid paid medical intervention here, but we will do what it takes to get the man to hear again.

A: When it gets that packed, the best, safest, most reliable technique is removal by an ENT. If that's not an option (for financial reasons), you could try pre-treating with a few drops of warm oil (olive oil, for example), then, the next day, try using one of the over the counter wax removal kits. Your pharmacist can show you what I'm talking about. Your husband will be trying to flush the ears clear. I have to warn you, though, when it gets as bad as you describe, these do-it-yourself methods can make matters worse. If he fails to get the wax out, the wax will form a sludge which will take his hearing from bad to much worse. Not only that, but the plugged sensation is maddening.

Q-tips are a bad idea in this setting because he WILL push the wax deeper, causing pain and almost certain plugging. Don't do it.

D.

Earache my eye!

Q: Doug, can I ask an ear question?  I have an earache.  Sharp intermittent pains.  Hurts when I swallow.  (and greenish mucus from the nostril on that side, the side with a polyp ... I'll never be able to look you in the face after this revelation.  Allergies?

A: Bare minimum, you have a sinus infection on that side. That green yuck coming out of your nose? It's flowing down into your throat, too. On the way down, it passes by your Eustachian tube orifice. Any irritation of the ET orifice will be felt as a pain in the ear. The general term for this is "referred otalgia."

Infection can also ascend via the Eustachian tube, causing an outright ear infection. You don't mention hearing loss, so I'm going to guess you don't actually have an ear infection.

Allergies? Maybe, but that's not the whole story. Allergies won't give you green mucus -- but sinus infection will. You're gonna need an Rx.

D.