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All About Ears – Blog Series Part 1 – No More Tubes

We all come into this world with certain gifts.  My gift revealed itself early on.  I can remember being in the 8th or 9th grade and my mother brought home one of her students whose earring back had imbedded itself into her earlobe.  We lived in a rural area in the Midwest where people didn’t have a whole lot of extra resources.

I took a look at the ear and instinctively cleaned her earlobe, numbered it with ice, sterilized and threaded a regular sewing needle, then stuck the needle into her earlobe until I could loop it through the back of the earring, and pulled out the earring back.  This girl never made a peep during the whole procedure, there were no calls to her parents, no consent forms signed, no plastic gloves, and only common sense (something I’m not accused of having a lot of!).   I have done that earring back retrieval only a couple of times since then and I must admit, it was much easier as a teenager.  I had no hesitation, didn’t think about…or know what could go wrong, didn’t know about scarring, infection, lawyers, or any other risks that we doctors now hold like a cloak around usNeither my mother nor I thought anything odd about said “operation”, nor did we speak of it again until recently.  My entire childhood was filled with similar situations.  I was removing splinters, dissecting frogs, and filleting fish any chance I got.  I used to spend hours canoeing along the bank of our pond fishing & catching bull frogs to use as my next science experiment.  And to think now I can barely kill a bug on an absolute rare occasion!

The ears have consistently held a fascination for me.  Clear as a bell, I can remember the moment in my human physiology class that I learned about the otolith.  My professor went on…..“The otolith is the sense organ in the middle ear that tells us where we are in space, our equilibrium and our balance.  If this sense organ it is not working, pilots cannot fly & it’s the reason we feel dizzy and off balance when drinking alcohol.”  It consists of tiny hair cells attached to a gelatinous membrane, which contains little tiny “rocks” of calcium carbonate.  When these rocks move as our head moves, they tug on the hair cells.  This stimulates the vestibular nerve and let’s us know where our body is in space.  I was in love with the otolith.  Yes, I said it, in love.

This fascination just barely scratches the surface of all things that fascinate me about the ear.  We also have 3 tiny little bones in the hollow space of the middle part of the ear, the hammer (malleolus), the anvil (incus), and the stirrup (stapes).  The malleolus transfers sound/vibrations from the eardrum through these three bones and into the fluid of the inner ear where it is converted to impulses that are passed along to the brain via the auditory nerve.  There are even incredible systems built in to account for things like rock concerts.  If the noise moving through the system is too loud, the noise induced reflex of the middle ear kicks in, contracts the middle ear muscles, and dampens the sound conduction.

Understanding this fine tuned system and appreciating these details….You can imagine my shock when I first learned about ear tubes.  WHAT?!  A TUBE IS INSERTED INTO THE EAR DRUM?!  HOW?  WHY?  HOW COULD THIS DELICATELY BALANCED SYSTEM  STILL WORK WHEN THERE IS AN ARTIFICIAL HOLE PLACED IN THE AIR TIGHT DRUM THAT TRANSMITS THE SOUND WAVES?

This didn’t make any sense to me, but at the time, I was fresh out of residency and it was all I could do to keep my head above water in the reality of the US medical system.  What I thought my life as a doctor would be versus what my life was turning out to be.  I left the office nearly every day feeling like I had been clubbed and that someone had taken a straw and sucked the life out of me.  Needless to say, I dropped my crusade to figure out why in the world we were putting tubes in so many kids eardrums and continued to play my part as a cog in the wheel of medicine.  And if kids had persistent ear infections that my prescribed antibiotics could not take care of I referred them to have ear tubes.  And of course hand in hand with ear tubes go adenoids and tonsils.  If I had a dime for every time a parent said to me, the doctor said if we are putting tubes in the ears, we may as well go ahead and take out the adenoids.  And inevitably, 9 months later when the ear tubes fell out, the ear nose and throat doctor would put in a 2nd set of tubes, and just for good measure, yank out the tonsils as well.

I know this last statement will send waves through the medical community and I will say, there are many many cases where removing the tonsils and adenoids and placing ear tubes are the very best things we can do for a child, especially if they have sleep apnea or if their hearing is being compromised by their recurrent ear infections.  Sleep apnea can affect everything from the immune system to energy during the day and the ability to pay attention in school.  What I am saying is this; these surgeries are at times, absolutely crucial, however, in my opinion, we do them far more often than needed because we continue to feed our children food that not only inflames their little bodies, but it is in fact suppressing their immune systems.  This makes them more susceptible to infection and other issues.

To be continued…..

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