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:
- 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.
- 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
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”.
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.