Through the Otoscope
Michael J. Rensink, is a member of ENT Associates of San Diego, and has been a practicing ENT specialist for more than 35 years. Special thanks to MedRx for lending Dr. Rensink a video otoscope to capture the images in this article. Thoughts about something you've read here? Write to us at HJ@wolterskluwer.com.
You may have heard the old saying, “Never put anything smaller than your elbow in your ear.” Unfortunately, not many of our patients take this guidance to heart, and in turn do serious harm by placing cotton-tipped applicators such as Q-Tips, hairpins, and other inappropriate tools in their outer and middle ear. A look at the damage that results from such practices will help you and your patients better understand why this saying is so important.
One patient attempting to clean her ears created a contusion of the ear canal. (Figure 1.) She reported some discomfort in the ear, but was unaware that she had inflicted damage to herself. When we took a photograph of her ear, she was surprised at the blood in the ear canal. After looking at the photographs, she asked us to get her husband from the waiting room to show him the photos. He was also guilty of using Q-Tips.
Another patient made two lacerations in her ear canal by using a hairpin to clean and scratch her ear. (Figure 2.) She explained that her ear was itchy and the hairpin was the first thing she could find that would reach the itch. (Paperclips have been used in a similar manner.) The patient experienced some pain when the event happened and became concerned. She eventually came to see me when the pain continued.
Yet another patient severely traumatized her tympanic membrane when she pushed a cotton-tipped applicator through the membrane, perforating the covering and disturbing the middle ear structures. (Figure 3.) When I saw the patient a couple of days after the event, her ear was full of blood, and she had a large conductive (possibly permanent) hearing loss due to the damage to the middle ear ossicles. I am currently treating this patient by cleaning her ears periodically, and I hope to rehabilitate the ear.
We all know that using cotton-tipped applicators is dangerous, yet we deceive ourselves into believing that only “dummies” make these kinds of mistakes. On the contrary, these accidents could happen to anyone. When I asked the patient with traumatized membrane how it happened, she said that she had been using Q-Tips for many years to clean her ears and she had no idea that this degree of problem could happen. She was simply cleaning her ear in a confined space, and when she turned, her elbow hit the wall, jamming the Q-tip into her ear. I have seen a similar injury where the stapes was driven into the vestibule of the inner ear, causing severe dizziness and immediate and ultimately permanent hearing loss to that ear, despite almost immediate surgery to try to correct the problem.
Doing something dangerous for many years creates complacency and a degree of false security. Most times we don't believe that we will suffer horrific consequences from everyday accidents that we hear about, yet as a professional in a busy medical practice, I can tell you that I often see patients who do. So a word to the wise here: “Don't put anything smaller than your elbow in your ear.” And tell your patients the same.