Pearls of Wisdom

I went to the dictionary and looked up the definition of “pearls of wisdom”. According to the online version of the old fashion Miriam Webster Dictionary the meaning of the phrase is “a wise word or statement“. In medicine we often try to pick up pearls from our colleagues. So this month I wanted to write about a few pearls for three common ENT issues, essentially what I tell patients in my office that over the years I have found to work.

Nose bleeds

Bleeding from the nose is common and mainly comes from the plate between the two nasal passages, the septum. Common causes are dry air, such as indoor heating or lower humidity as well as inflammation of nasal tissues from allergy or infection. Aspirin, or other blood thinners also contribute. If you have frequent nose bleeds please have available a bottle of Afrin type nasal spray. There are many brands of this decongestant spray, and they all have the active ingredient (in fine print) oxymetazoline. Often at the beginning of bleeding 2 to 3 sprays of Afrin on the side of the nose affected may be sufficient. Also, something like a paper towel piece can be rollled up, soaked with Afrin then gently placed into the side that’s bleeding. Press on the outside to hold it there for 10 minutes. One truth taught to me years ago is this. As long as there is any type of blood clot inside of the nose, bleeding will continue. Many people are afraid to blow their nose forcefully but it is essential if there are clots present. After blowing out any blood clots spray that side of the nose multiple times with Afrin. If bleeding persists repeat the same procedure of nose blowing and spray in five minutes, or use the soaked paper or cotton ball.

DO NOT lean or lay backwards and look up. All that does is get blood into your throat. You should lean forward and with your head down gently press the sides of your nostrils possibly over the Afrin soaked cotton or paper towel.  Also, I have never found it effective to put a cold spoon or ice cube or anything else under the upper lip. 

Ear pain

If you’re over 65 years old and you have ear pain it may not have anything to do with an ear infection. A large majority of people in this age group who come to my office because of concern or worry of an ear infection actually have pain coming from either the jaw joint or the neck. The front wall of the ear is the jaw joint. Just like a knee or shoulder joint the TMJ can have arthritis and muscle spasm, that your brain feels in your ear. Also sleeping on your side may force the mandible to one side and you can wake up with ear pain. Also, the upper two vertebra, C1 and C2 have nerves that go up to your ear as well as the back of the skull. If the nerve going to the ear from your neck is compressed or irritated you will have ear pain. Treatments for both the TMJ problems and neck problems can be heat massage and topical products such as Blue Emu, which are frequently found in most stores.

Best drops to dry ears

In 1979 at Bethesda Navy Hospital an older ear doctor teaching there showed me an old trick he had learned. The best ear drying liquid agent is alcohol, but not isopropyl or rubbing alcohol. The absolute best form is distilled grain alcohol, also known as ethyl alcohol, it is available in a form many may have drank in college, Everclear.  After swimming I recommend half Everclear and half white vinegar placed in ears. In a pinch just spraying Everclear with a spray bottle will also work and I do that frequently.  Word of warning, never use any type of alcohol if there is a hole in the eardrum or in kids with vent tubes. It will burn a lot and I don’t want to be blamed for that.