TSK: More than meets the ear
  • Nurse:Dr. Cranquis, I've decided that I just need to get over my fear of cleaning out ears, so if you have patients with plugged ears today, let me know and I'll do it.
  • Cranquis:Hey, I'm proud of you!
  • Nurse:I'm still nervous that I'll find a bug in someone's ear, but as long as it's just ear wax, I should be ok.
  • Cranquis:ok
  • (Time:passes)
  • Cranquis:Hey, Nurse, the patient in room 3 needs ear wax cleaned out of her ear.
  • Nurse:There's no bugs in it, are there?
  • Cranquis:Oh I doubt it, all I saw was wax when I looked in there.
  • Nurse:Ok.
  • (Nurse:enters room, door closes, starts flushing ear which, as it turns out, coincidentally has something hiding in the ear wax...)
  • Nurse:(muffled screaming through exam room door) OH MY GOD THERE'S A DEAD ANT IN HER EAR OH MY GOD OH MY GOD!
  • Cranquis:Oh crap, I'm never going to hear the end of this.

katherinemarty said:

What is the cheesy substance that builds up in the holes of pierced ears or ears with gauges? Is it analogous to earwax? My earlobes have been pierced for nearly 20 years and I'm still dealing with this weird crud, so I'm guessing it's some kind of natural by-product.

Haha, I know what you’re talking about - it’s not earwax (the glands that secrete cerumen are modified sweat glands present only in the inner ear canal), but a buildup of sweat and shed skin around the hole. You’ll probably see it much more often when you have earrings in, because the earring wires or posts make it much easier for that dead skin to build up. It’s kind of like when you have ick build up in your bellybutton when you don’t clean it out regularly - it’s just sweat and dead skin and dead bacteria.

An infected ear will actively ooze, probably hurt, and definitely be abnormal. But just having icky buildup crud is not weird - just make sure to take studs out often enough to clean the hole and posts, and make sure that cartilage piercings are thoroughly cleaned, even when they cant be taken out.

Also, don’t get a sword piercing. Those things get hella infected.


La cera de nuestro oídos, médicamente conocida como cerumen, es una sustancia molesta, pegajosa y, algunas veces, maloliente. Su composición es un tipo especial de cera y sebo (un tipo de aceite), además de por más de 40 sustancias diferentes, incluyendo células muertas de piel.

Puede ser húmeda o seca, lo cual está determinado genéticamente.

La cerca protege los oídos del agua, de los hongos y de muchos gérmenes. También hace que se peguen a ella el polvo y la suciedad que entra constantemente en los oídos.

Si tenéis demasiada cera, sin embargo, puede ser por una dieta demasiado baja en grasas, o porque os esmeráis demasiado en limpiaros los oídos: demasiada limpieza, irónicamente, genera más cera.

Y el uso de objetos rígidos para limpiaros puede provocar una perforación de tímpano, lo cual permitiría la entrada en el oído interno de peligrosas bacterias, hongos y virus.

Dice Joan-Liebmann Smith en su libro Escucha tu cuerpo:

Las personas de ascendencia europea y africana normalmente tienen en los oídos cera húmeda, pegajosa y de color marrón; las de procedencia nativa americana y asiática tienden a tener una cera seca, frágil y de color gris o beige. Las mujeres con cera húmeda parecen tener mayor riesgo de contraer cáncer de mama. De hecho, entre las mujeres japonesas que tienen la cera de los oídos húmeda, como los europeos, se dan más casos de cáncer de mama que entre las que la tienen seca, del tipo asiático.

Por cierto, lo de la limpieza natural de los oídos usando una vela hueca y aplicando la técnica denominada “ear coning” no es eficaz para limpiar la cera de los oídos: no sólo puede dañar el oído interno sino quemar el oído y la cara. Y cuantas más veces se haga, peor: queda depositada en el oído cera fundida procedente de la vela.

Deja de usar cotonito!

¿Por qué?
Es simple, al meter esta pequeña “cabeza” de algodón dentro de tu oído según tú para limpiarlo, pues no lo está haciendo, al revés! Produces más cerilla, al estar raspando con esto estimulas más a las glándulas del conducto auditivo a que se cree más cerilla, lo cuál llegará a ser un tapón de cerumén que seguiras metiendo más adentro de tu oído.

TSK: Dr. Cranquis pushes his nurse's buttons.
  • Nurse:Oh please oh please, don't tell me you want me to clean out that old guy's ears, I can't stand ear wax!
  • Cranquis:Oh no, don't worry, he doesn't need his ears cleaned out.
  • Nurse:(huge sigh of relief)
  • Cranquis:In fact, the reason his ears are itchy is because he's been keeping his ears TOO clean. So what I'd like you to do is dig some wax out of your OWN ears, and stuff it into his ears.
  • Cranquis:Merry Christmas! :)

Coloured scanning electron micrograph (SEM) of ear wax (brown) collected on cotton bud fibres (green). Ear wax forms in the ear canal, which runs between the outer ear and the ear drum. Ear wax, or cerumen, is produced by glands in the wall of the ear canal. It prevents the entry of bacteria and foreign objects that could damage the ear. Photo: Power And Syred/Science Photo Library

Right Ear Update 2K12

Got medication for “Swimmer’s Ear” and have been pumping that shit into my earhole for about a day now. I’d like to think it’s been working—swelling has diminished, pain has subsided. (I’ll probably continue to take it, just to be sure that I do away with an infection, in case I have one.) However, the hearing loss remained. So I went to CVS. And I found that nothing works better to return your hearing than a high-pressure bulb syringe, straight to the tympanic membrane, aimed 60 degrees above horizontal. After four or five tries, a big ol’ ball of brown-ass wax pops into the bathtub. I would post a picture, but it’s probably too graphic. Anyway, now I can hear REAL GOOD out of both ears, and this is one of the best days of my life. 

Day 4 of outreach- Mzuzu

Yesterday, I felt like God was asking me to pray for Gospel- he had shouldered the responsibility of driving 9 people all over northern Malawi and had worked full days in clinic with us. I got a chance to pray for him this morning- that was really cool.

Today’s clinic was a little more laid back. We went to a deaf school in Mzuzu to do assessments (I think less people come to the deaf schools than they do the hospitals when the hearing clinic does outreaches like these).

Same thing again today- case history, otoscopy, tymps, oaes, audiometry, ear mopping, and cerumen removal.

Again, lots of occluding cerumen and infections. At one point I said if refer most of these people to ENTs in the US for treatment by an ENT. Gospel told me that the only ENT in the entire country is in Blantyre- so they have to do a bit more management of these patients on their own (not distributing medications of course, but removing hard wax or giving patients debrox, cleaning ears, etc).

We finished our clinic around 3- Chico and I went to get lunch/dinner at a yummy restaurant.

Chico and I talked a bit about the future- she mentioned she’s kind of in a tough spot to dream about the future because she is a part of the first class of graduated audiologists in Malawi- there are a lot of things about the future that remain uncertain to her- where she will find a job, where she will live, etc. My heart has really been moved by these students- I greatly admire their passion for helping people and their courage in paving the way to be the first audiologists in Malawi. Right now, they are waiting for accreditation by the ministry of health (which is hard and is taking awhile). I really hope that the international community of audiologists can find a way to help forward this in Malawi and/or look after this first crop of audiologists in Malawi. These students all have colleges degrees and an additional 2 years or training in audiology. I think they are really fantastic clinicians and I sincerely hope to maintain these professional relationships (and friendships) in my career. I hope I see them at international conferences and doing amazing things for the profession of audiology I the years to come- these guys are rockstars.

Anyways, we were almost finished eating, we saw the truck pull in and then leave. We figured they’d be back in about 30 minutes to pick us up- so we waited near the road- it got dark, still they hadn’t come back for us. We started to worry maybe something happened to them. 3 hours later, they picked us up from the restraint and we headed to Kasungu. We got to Kasungu around 12:30 am (very very late)- and decided to stay at a place that was a bit more expensive (12,000 kwacha a night for double beds - about $30 per room. I guess most Malawians spend about 2,000 kwacha for a room - $5 per room).

When we asked for water to bathe in when we got there- but apparently the entire town was having an issue where people could get water. This guy put some standing water in a bucket and gave it to us to bathe in (it was cold).

Soon, we went to sleep- ready for our last day of outreach.

Day 3 of outreach- Rumphi

We woke up, ate a yummy breakfast and waded to Rumphi hospital- ready for work. People were lined up when we got there. I’m guessing we ended up seeing 60-70 patients that day.

Sadly, the method we discussed with the headmaster of EDS was not followed- things were a bit chaotic. One of the people from EDS just started pulling people from the line and taking case histories (no organization and who was doing what was discussed). So, I sat with her for the first couple, looked at the notes she took, and asked her to translate further questions I had. She continued taking case histories and the rest of us did otoscopy, tymps, oaes, audiometry, ear mopping, cerumen removal, and ear impressions (for hearing aids)- asking patients further questions about their history if necessary.

I got pretty good making earmold impressions with the impression gun! I also got some experience making instamolds (earmolds made instantly while you’re taking impressions).

I caught one malingerer- her thresholds were in the severe to profound range- so I did oaes, and they were present (meaning her hair cells in her inner ear are functioning properly and she has near-normal hearing).

And I got to see A LOT of different ear pathologies- many many people either had some sort of bacterial or fungal infection.

We finished close to sundown. Once everybody had been seen, we packed up our things and headed to Mzuzu.

When we got to our hostel, fletcher was afraid the shared bathroom would not be nice enough accommodations for me. It was late and we were tired- so I told him I was fine with it. Thankfully, the communal shower had a shower head- and got water came out of it! So while it looked a little dingy I was super grateful for a hot shower after a long days work.

Fungus and Chipicku Eclairs

Today I woke up and went to devotional this morning at the clinic. We first sang hymns in Chichewa and English. I was amazed at how well Malawians can sing different parts of the song and harmonize! I’ll record one of the songs so you can see what I mean- it’s truly amazing. Then Fletcher taught out of Exodus 34. He told me he is teaching again Friday- but encouraged me to take on leading devotional instead of him (so he wouldn’t have to go twice). I’m thinking about it, it could be cool!

Our first patient today had occluding cerumen in his right ear and a fungal infection in his left ear. We removed the wax in the right ear and we removed some of the fungus in the left ear using a currette and interestingly a syringe filled with water. I held a bowl underneath his ear. Alinana flushed out his ear canal with water a few times to get some of the fungus out (unfortunately I don’t have pictures). Then we took him to the ABC Clinic to see an ENT.

Erin and I then went with Elouise and Raphael to play on the playground. We’re all pretty great at the monkey bars.

We then had a missionary from the US, one of the leaders at Flood church, come in with an ear infection. We then took her over to the clinic to see the ENT.

I got to chat a bit with one of the audiology students. I asked her how she felt to as the first graduate from the ABC Hearing Clinic training program. She said at times it’s been hard (like right now they are trying to get accredited by the ministry of health in Malawi). But she said it requires a leap of faith, she sees that there are people that need help and she wants to help. I thought this was a really brave answer. With all of the students at ABC, I admire their perseverance as they get accreditation and find jobs as some of the first audiologists in Malawi. This is ground breaking stuff.

For lunch I went with some girls into town. We actually didn’t end up getting lunch haha- but we did get chipicku eclaires- one of Malawis few pleasures (a seasoned American living in Malawi claimed). It was true. We also got groceries at Chipicku (a supermarket) and got to look around some gift shops.

Then, for most of the afternoon at ABC we spent our time trying to program 2 pairs of Siemens hearing aids- and didn’t finish. I think we all felt like we were banging out heads against a wall. So tomorrow, we will program them in the morning (I hope they will let me drive :))

Then I came home and my new roommates, Barb and Katie, cooked me spaghetti!

And Katie got really excited about ‘melon’ for desert ;) haha

I moved my stuff and have been catching up on life since. I finally have wifi in my living space again! Whoot!!

My plan for the rest of this week is to see patients at ABC, spend time with friends, and hopefully go to the market (and use as much wifi as possible).

Next week Peter has organized a 4 day outreach in northern Malawi- which will be much more remote than it is here. We will be seeing kids at schools for the deaf.

When I get back, I’ll go with a friend (maybe a few friends) on a Safari in Zambia, then I’ll head home.

My time is flying! I’m bummed I won’t get to stay longer and know people better, but I’m also really grateful for the time I got to spend here :)