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ENT Partners of Texas Blog

ENT Partners of Texas Blog

Feel Like Coughing When You Touch Your Ear Canal

Have you ever noticed that when you touch the entrance to one of your ear canals in just the right spot that it makes you want to cough? If so, you are one of the 2 – 16 % of people who have an active oto-respiratory reflex (O-RR) (also known as the  oto-pulmonary reflex). The (O-RR) consists of the cough reflex produced by direct mechanical stimulation of the deep portion of the posterior wall of the external auditory meatus ( Latin – a passage; in this case, the entrance to the ear canal). The sensation in this portion of the ear canal is carried by the auricular (pertaining to the external ear – the auricle) branch of the vagus (Latin – wandering) nerve. The vagus nerve, also known as the 10th cranial nerve, is the most important nerve that carries information from our thoracic (heart and lungs) and abdominal (stomach, intestines, etc) organs to our brain. The auricular branch of this nerve is also called Arnold’s nerve (Friedrich Arnold <8 January 1803 – 5 July 1890> was professor emeritus of anatomy and physiology at Heidelberg.).

An otolaryngologist will occasionally think of Friedrich and his nerve  as he tries to clean wax out of an ear in a patient who is unable to stay still due to coughing every time his posterior ear canal is touched. One may also see this occasionally in patient with hearing aid molds that stimulate the nerve and cause a tickle or an outright cough. I always check patients with a chronic cough to make certain that they do not have wax or a hair that may be stimulating the area.

In the cases in which the hearing aid may be triggering the cough or tickle, one may inject the canal with a local anesthetic to see if that controls the problem. If the injection works temporarily, a permanent success may be achieved by a small procedure in the operating room, elevating the skin of the canal and drilling the bone along the course of the nerve to disrupt its transmission.

I wonder what the teleological reason for the existence of this oto-respiratory reflex is? Why would we be programmed to cough when our external ear canal is stimulated?

I can think of two possible reasons:

  1. If, while we slept, a small creature (think cockroach here) started to explore that dark crevice known as our ear canal, perhaps the cough would awaken us and give us the opportunity to try to intervene.
  2. Perhaps it is God’s way of trying to get us to put that Q-tip down so that we don’t jam all of our wax deep into the canal, compelling our local ENT to go spelunking  to clean it out
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ENT Goes By Another Name

Ear, Nose, and Throat (ENT) is officially known by its Latin name otolaryngology. This is pronounced “oh/toe/lair/in/goll/oh/jee”. An alternative pronunciation of otolaryngology is “ear/nose/and/throat”.
Otolaryngology is the oldest medical specialty in the United States. An otolaryngologist from Kansas in 1896 called the initial meeting that in 1903 became the American Academy of  Ophthalmology  Oto-Laryngology. (At this time, the scope of practice included the care of the eye – ophthalmology.) Committees were formed to improve graduate education of its members and the American Board of Ophthalmology was formed in 1913 and the American Board of Otolaryngology in 1924. Now, if a physician wished to practice this type of medicine, he had to pass tests these boards provided, and become “board certified”. In 1978, after years of preparatory discussions, the specialty split into The American Academy ofOtolaryngology and the American Academy of Ophthalmology. (Occasionally, an older patient will incorrectly still refer to me as an “eye, ear, nose and throat” doctor). In 1980, the Academy changed its name to the American Academy of Otolaryngology – Head and Neck Surgery.
One of the most appealing aspects of being an ENT surgeon is the privilege of being involved in the entire medical journey of our patients. We meet them. We diagnose them. We treat them medically if appropriate. The majority of cases are handled in this manner and hopefully, we are successful. Sometimes, the condition does not call for medical therapy or perhaps medical therapy has been ineffective. Then, we operate.
You see, many people do not understand that when you visit an ENT, you are seeing a surgeon. Like every other surgical specialty (orthopedic, neuro-, urology, etc.), after four years of college and four years of medical school, ENT’s  completed a general surgical internship in which we learned how to care for a wide variety of surgical ailments. We had our turn at appendectomies, removal of gallbladders, amputations, care of burn victims, repair of hernias, etc. These surgical internships usually last for one year. This was the case for my business partner Frank Theilen M.D., who completed his general surgery internship in Galveston, Texas. Mine, however, was for two years, spent in UT Southwestern in Dallas, Texas.
After one’s internship, the ENT surgeon spends four years learning his craft concentrating solely on medical and surgical treatment of all of the medical conditions affecting the head and neck minus the eyes, brain, and certain problems of the cervical spine. After successfully completing one’s residency, one takes the board exam in Chicago and awaits the results. If you pass, you can start to work as a board certified  ENT OR choose to study one to three additional years in one of the specialty’s fellowships such as facial plastics, ear, voice, allergy, pediatric ENT, sleep apnea, oncology / head and neck surgery, or rhinology / sinus.
So, just a short 9-12 years after college, you too can call yourself an ENT.
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A Famous Song About ENT

Today, I’d like to highlight one of the great Ear, Nose, and Throat songs of all time.
I first heard Lou Carter’s “If I had a Nose Full of Nickles” on a Saturday morning driving home from a night on call at Parkland Hospital in Dallas somewhere around 1989. It was playing on KPBC, an “oldies”station which at that time was found at 1040 on the AM dial. It would take me a long time before I was able to secure a copy of the song and now I have the chance to share it with you.

Louis Carter was a jazz pianist for many years He performed under the name of Lou Carter with several big bands, including Jimmy Dorsey and Glenn Gray. He also appeared on national television, including the Perry Como show as Louie the Cabbie.



Here is some information on the singer from his son:


I’m Lou Carter’s son and I’m delighted that people are still enjoying my father’s music. He did indeed make three “cabbie” albums: Louie’s Love Songs, Louie Writes Again, and How Deep is Which Ocean? During that time, he made several appearances on the Perry Como Show. We actually still have a couple of the original scripts.

He also co-wrote, with Johnny Frigo and Herb Ellis, the jazz standard, “Detour Ahead” and another song, “I Told You I Love You, Now Get Out.” The former was recorded by everyone from Billie Holiday to Bill Evans; the latter was sung by Cybill Sheperd in an old Moonlighting episode.

Shortly after the Como appearances, he settled down and began a successful career writing and producing radio jingles. He would spend part of the week in his New York office writing and arranging and the rest of the week in the studio producing, playing piano and singing on the commercials. On occasion, my brother and I would accompany him to the studio. We’d see a parade of A-list musicians and singers — such as Ron Carter and Marlene Ver Planck — come through the door.

Throughout the years, he also regularly played jazz piano at local venues and was very much in demand. He would often fulfill requests to do a “cabbie” tune or two. He continued to play professionally well into his 80s.

Despite his accomplishments, he was a very humble man who always maintained a great sense of humor. I remember once when he was probably about 84 years old, he returned from a gig for which the audience was made up of people bussed in from retirement homes. When I asked him how it went, he said, “I gotta tell you John, senior citizens are just the worst!”


Louis Carter died Sept. 25, 2005 in Mountainside Hospital, Glen Ridge, NJ at the age of 87.

Lou, here’s hoping you finally have that nose full of nickels you so long desired.

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A Day in the Life of an ENT

Today, I’m sitting down to establish a blog covering various aspects of the Ear, Nose, and Throat (ENT) medical / surgical specialty, both in general, and also from the perspective of the physicians in the ENT Partners of Texas practice. Note the modifier “medical / surgical”. There is probably no other specialty that requires the combined skill and knowledge of both aspects of medicine as much as ENT. It is estimated that 60% of the patients that enter a general practitioner’s office have complaints dealing with the head and neck. This makes our specialty very challenging, but also keeps it very interesting, for you never know what particular problem lies behind that next door.

I thought it might be illustrative to give you a typical list of patients I might see during a routine morning in the office and a typical day in the operating room.

Here’s a typical Monday morning in my practice:

  1. 14 yr old male (M), follow-up (f/u) from tonsillectomy and adenoidectomy I performed last week
  2. 45 yr old female (F) initial snoring evaluation
  3. 2 yr old F 2 weeks f/u placement of ear tubes for recurrent ear infections
  4. 11 yr old M with very painful otitis externa (swimmer’s ear) not better on antibiotics from primary care physician (PCP)
  5. 69 yr old F with tinnitus (ringing in the ears)
  6. 34 yr old F with a thyroid nodule
  7. 34 yr old F with obesity who is scheduled for bariatric surgery (obesity surgery) who needs a sleep study and evaluation to make certain she does not have sleep apnea.
  8. 5 yr old F for 5 minute, routine 6 month f/u after tubes placed 18 months ago.
  9. 11 yr old M needs wax cleaned from ears.
  10. 26 yr old F f/u of sinus surgery 3 weeks earlier
  11. 8 yr old M failed a hearing test at school
  12. 52 yr old M for monthly f/u (8 months) after surgical removal of tonsil cancer followed by radiation
  13. 58 yr old M to discuss upcoming surgery for sleep apnea
  14. 19 yr old F with recurrent sinus infections

Normally Tuesday is surgery day. A typical surgery day would consist of the following:

  1. 4 yr old tonsillectomy / adenoidectomy (T&A)
  2. 6 yr old T&A
  3. 19 yr old T&A
  4. 45 yr old sinus surgery
  5. 52 yr old removal of small tongue cancer
  6. 54 yr old thyroidectomy with central neck dissection for cancer

As you can see, things are never boring.

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