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ENT Partners of Texas Blog

ENT Partners of Texas Blog

A Quick Bit on Oral Cancer

Once a year, Dr Theilen and I participate in a Men’s Health Fair at Baylor Medical Center in Irving (Highway 183 and MacArthur). We typically will see between 100-200 men, screening them for any oral / head and neck cancer. I thought it might be instructive to go over some of the common signs and symptoms of oral head and neck cancer.

  • A lump or sore that does not heal
  • A sore throat that does not go away
  • Persistent swollen glands (lymph nodes) in the neck
  • A lump or mass in the neck
  • Difficulty swallowing (dysphagia)
  • Difficulty moving your jaw or tongue
  • A change or hoarseness in the voice
  • White or red patches on the gums, tongue, or lining of the mouth
  • Changes in denture fit
  • Unexplained facial pain or persistent pain in the ear
  • Loss of smell
  • A bloody nasal discharger or coughing up blood
  • Persistent nasal congestion that does not improve

Though these all may point to cancer, they also may be less serious conditions. A doctor or dentist should check any of these symptoms.

I recently spoke of actor Michael Douglas’ case of tongue cancer for Baylor which you can view by clicking here.

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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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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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