Top 10 Medical Myths in ENT Practice – June 2015

When you have been in medical practice as long as I, you tend to hear the same stories repeatedly. In general, the patient population is becoming better informed and educated, as most take the time to research their ailments, available treatments, etc. There are a few classic misconceptions, however, that come up over and over. I will list my top 10 of these, but I’m sure I could share another 10 with you in months to come.

Myth #1: Over-the-counter medications are safer than prescription drugs: The regulatory agencies that oversee drug safety are much tougher on prescription products than those sold over-the-counter (OTC) with regards to their safety. What makes OTC drugs so dangerous is the misconception that they must be relatively safe if they do not require a prescription. Without going into an exhaustive list of dangerous OTC medications, I suggest patients use them only if they discuss with the pharmacist possible risks and side effects, or their physician recommends them.

Myth #2: Vitamins and Supplements are beneficial and safe as a rule: There is very good evidence now that there is virtually no health benefit to the vast majority of vitamins and supplements. There are unusual special occasions (using CoQ 10 supplement if you take a “statin” for cholesterol, etc) in which a supplement is beneficial, but in general, the vitamin and supplement industry is a multi-billion dollar hoax that has been likened to the old “snake oil” salesmen of the Old West.

In addition, there are some vitamins and supplements that are hazardous and even toxic when used by certain individuals. There is a long list of supplements that should NEVER be taken before a procedure or surgery, as they cause abnormal clotting and their use can provoke surgical hemorrhage.

Myth #3: Cotton swabs (O-tips) are useful and safe to use for ear cleaning: I probably see at least two patients every single day that have, in some way, damaged their ears through Q-tip use. At the very least, Q-tips pack wax down deep against the eardrum, along with fibers of cotton that together create a tight blockage. Swabs can tear eardrums, cause ear canal infection and skin irritation. Q-tip use by many patients becomes a temporarily pleasurable habit that may have serious repercussions.

Myth #4: Surgery should always be the last resort: There are certainly situations in which it is preferable to avoid surgery, but there are as many situations when it should be considered over use of medications. Chronic infections, tumors and malignancies, obstructions to breathing, if treated passively for an extended period of time, can weaken and harm an individual, and put them at increased, occasionally life-threatening risk. There are many disorders I see (chronic tonsillitis, chronic sinusitis, chronic otitis) in which medication treatment is futile, leading to a long, expensive, disabling situation that would have been managed more effectively by offering patients surgical intervention up front.

Myth #5: Ear Candles remove earwax and are safe to use: Some researchers who have too much time on their hands have proven what, to most of us, is common sense—that the use of ear candles accomplishes nothing good, and can be very dangerous. The debris that accumulates in the candle is not wax that has been removed, and seems to be nothing more than the combustion product of the candle itself. In my practice, I have seen injuries from ear candles ranging from burns to the side of the face and ear, burned hair and skin, to burns through the eardrum, deposits of molten wax against the drum that I have to dig out under the microscope.

Myth #6: Laser surgery is always superior to convention surgery techniques: While laser technology is useful for many procedures we perform, including microscopic work around the vocal cords, removal of skin pigments and lesions and certain middle ear operations, there is no evidence whatsoever that it is better than conventional techniques for the vast majority of surgeries we perform. The term “laser” is used successfully as a marketing tool to entice the non-medical public into believing it is more gentle and refined. As a matter of example, laser tonsillectomy has been shown to result in more pain, and longer healing than conventional surgery. The laser, after all, creates a burned and raw surface that may take weeks to heal in.

Myth #7: Nosebleeds can be helped by throwing the head backward, or placing ice on the back of the neck: During a nosebleed, throwing one’s head back will only allow the blood to drain into the throat and airway, causing choking and swallowing of blood. Ice applied to the neck has no effect on nasal bleeding. The proper acute care of a nosebleed includes placing a cotton ball soaked in Afrin LA nasal spray into the nose and pinching it gently closed, and holding the head slightly tilted forward so excess blood can drain forward.

Myth #8: Tinnitus (ear ringing) is curable: Despite what is promised on radio and TV ads, there is no cure for tinnitus. There are, however, many unscrupulous professionals who are happy to take your money and promise you a solution. There are a number of management techniques for this malady including avoidance of nerve stimulants (caffeine), avoidance of loud noise (acoustic trauma), biofeedback, relaxation techniques, and “masking” (pleasant music or noise in restful environment that “distracts” your brain from the incessant ringing) that are very useful.

Myth #9: Whispering is safe voice use during laryngitis: When the vocal cords are injured from infection (laryngitis), overuse (edema) or surgical procedures, and the voice is hoarse or raspy, it is no safer to whisper that to speak in a normal tone of voice. The key to voice recovery is to limit vocal use altogether, and avoid vocal abuse (screaming), coughing and throat clearing. In fact, we believe that whispering in this situation can damage the vocal cords compared to gentle use of normal voice.

Myth #10: Physicians are Wealthy: Although doctors do earn a good living, they struggle like everyone to save and build wealthy for a variety of reasons. To begin with, we don’t begin earning money until we are in our early 30’s or later, as training continues often 10 years or more after college graduation. Most of us had to pay back huge loans we incurred during our education. Although the cost of healthcare for all of us is going up, our salaries as physicians are going down markedly, and we have to hire more and more personnel to fight with insurance companies to collect our discounted reimbursements. Lastly, physicians generally have poor business sense, make bad investments and struggle to build enough wealth and assets to retire in a timely fashion. (Fortunately for me, I enjoy my work so much I never want to retire!)

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