‘Friends, Romans, countrymen, lend me your ears’

Most of us probably remember this phrase from Shakespeare’s “Julius Caesar” from our high school English literature classes in which Mark Antony’s funeral oration about Caesar teaches us about the skills of oral presentation. However, these words can also introduce medical conditions which are very common and often poorly understood and treated. A recent clinical practice guideline issued by the American Academy of Otolaryngology contains an update for best practices for diagnosis and treatment of earwax (cerumen impaction). The report states that: “Excessive or impacted cerumen is present in 1 in 10 children, 1 in 20 adults, and more than one-third of the geriatric and (similar) populations…”

“Ear wax (cerumen) is a normal substance that the body produces to clean and protect the ears…” At times, the ears self-cleaning process may fail and partially or completely block the ear canal causing hearing loss and associated illnesses. Patients may think they can prevent or treat this condition by “cleaning out their ears with objects such as cotton swabs, paper clips, ear candles or any number of unimaginable things that could be inserted in the ear canal.” In my (CPM) experiences with this condition, I have seen serious complications result from “home cures…” Consult your family physician and staff to treat symptoms.

The practice guidelines from the Academy list several recommendations for physicians and patients to use in the general care of their ears:

• If any symptoms of ear and ear canal disease are present, be sure to initially have your ears examined to determine the source of the illness; ear pain, drainage, or bleeding are usually not related to cerumen;

• Don’t “over clean” your ears; “routine washing” is usually not necessary;

• Don’t insert anything smaller than your elbow into the ear canal (just like your mother …and grandmother… have told you);

• Avoid the use of ear candles; they are ineffective and can be dangerous;

• Do ask your physician and the staff about prophylactic ear hygiene at home; certain conditions may require observation and personal therapy.

It is generally felt that hearing is our most valuable sense. Both blind persons and deaf individuals usually report that they would rather be sightless than deaf. Although most of us gradually lose a portion of our hearing, usually in the high frequency ranges as we age, modern society and our medical care system have permitted our population to generally preserve its hearing abilities.

Another common and very important personal and public health problem related to our hearing abilities, especially as the summer months approach, is the challenge of noise-induced hearing loss.

The frequency of increasingly serious and prevalent noise-induced hearing loss has increased because the effects of environmental noise exposure are usually slowly developing and, ironically, are silent in their effect on the person’s hearing. Affected individuals often have irreversible hearing loss before they are aware of it and can begin to prevent further loss.

In a recent article on evaluating hearing loss, Dr. R.W. Danielson of Baylor University School of Medicine, described the warning signs of the presence of or the exposure to hazardous noise:

• You can’t hear someone three feet away from you

• You have pain in your ears after leaving a noisy area

• You hear ringing or buzzing (tinnitus) in your ears immediately after noise exposure

• You suddenly have difficulty understanding speech after noise exposure

Noise-induced hearing loss is preventable. All of us will develop some hearing loss with age, but in most cases we can enjoy normal hearing until age 60. However, long before that age range, preventative methods to protect our hearing should be instilled in our daily lives.

Alexander Graham Bell, the inventor of the telephone, was by family history and profession a teacher of the deaf in Scotland, Canada and America. His name is immortalized in the measuring unit for the strength of sounds called the decibel. Noise of a volume greater than 85 decibels (db) needs to be avoided. Significant sources of these loud noises (120+db) which we often encounter include: modern musical groups (“rock bands”); lawn mowers, personal music sources and ear “buds,” generators, shooting sports and recreational vehicles.

Noise damage to hearing is related to degree (number of decibels) and the length of exposure. Thus farmers, construction and factory workers, police, fire, and military personnel, and musical and other entertainers using amplification equipment should have their hearing monitored for safety and wear protective hearing equipment.

Hearing care professionals (audiologists) can evaluate environmental noise exposure and prescribe appropriate hearing protection such as ear plugs and muffs to protect one’s hearing — even when mowing the lawn.

Notably, at least 1/3 of hearing loss disease is preventable with hearing protection.

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