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| Dr. Joel Aronowitz |
Dr. Joel Aronowitz - "Well,
greetings everyone, and welcome back to Aronowitzland. Wanted to do, maybe, a
little more entertaining reaction video. Are trying to handle this little tail
that's going, and it doesn't seem like whatever creature's attached to the tail
would fit inside of somebody's external auditory canal. I mean, basically, a
cockroach of a moderate size doesn't fit into your external auditory canal.
Small bugs do, and that's relatively common to have small bugs crawl into
someone's ear when they're in tropical climates, especially because the ear is
dark and warm, and so the insect will be attracted. But it's this kind of a
creature that looks like some type of reptile. I think it's highly unlikely
that whatever animal is connected to that tail is so small it could fit
completely inside somebody's ear canal.
Now, the next thing we notice is that these
fellows, they're using little sharp, fine tweezers or pickups. The steel looks
kind of grayish and doesn't really look medical grade. That tells me right away
this is probably not in an ENT office or an emergency room, where you typically
handle this kind of problem.
Now, you notice that this tail is moving
pretty rapidly, and they can never seem to get a hold of it, and it takes them
a long time to solidly get a hold of it. You should know that they are being
judicious in the sense that they don't pull the animal apart. I watched another
one of these videos that I'm sure wasn't real. It was supposedly the head of a
snake coming out, a little tiny snake coming out of somebody's ear and, number
one, there's no way that the snake would get in tail first, and the snake couldn't
crawl from one side to the other, and it had to come out the other side. But
the people trying to pull it out basically tore the snake apart. You don't want
to kill the creature in trying to pull it out and fragment it, and then be left
with a partial biologic foreign body.
We should understand that a foreign body
that's inorganic, like a stone, let's say, or a piece of glass, is in a whole
other category than something that is originally organic. In other words, it's
biologic. It was a plant or it was part of an animal, that sort of thing,
because those living things, even when they're dead, the outside of the cells
contain a fuzzy protein. These are the HLA proteins, for example, in humans
that identify those cells as that specific individual, and that's how your body
knows to attack those things on an immune basis. If it's a foreign body that's
just chemically inert, like a piece of glass, let's say, the body just forms
fibrous tissue around it, and you don't have a robust immune response unless
that foreign body provides anitis for infection. So inorganic foreign bodies,
those are well tolerated and really depend on the physical and chemical
characteristics of that foreign body more than anything, whereas a biologic
foreign body, or organic foreign body, somebody else's tissue, a plant's
tissue, that sort of thing, even when it's dead, will elicit a robust immune
response and will continue to until that foreign body is somehow expelled from
the body or walled off in a sequestered area.
Dr. Joel
Aronowitz - Okay, so you can see at the end the video just kind of peters
out, and we don't get any satisfaction of seeing the entire critter; there we
don't see any relief on the face of the individual who's got something stuck in
their ear. And it just kind of ends. All flop around, but you should understand
for the reasons I've given that this is a bogus video, I believe, and it's
highly unlikely that anybody would possibly get such a large critter in their
ear on their own account. So let's talk, though, about how medically to deal
with a living foreign body in the external auditory canal.
So, this is the external auditory canal, this
is the pinna—vera, the external ear. There's a lot of cool little parts to it:
the lobule, the helix, the antihelical fold, the conchal bowl, the tragus here.
The embryology of the ear is very interesting because the brachial clefts of an
embryo will fold in on themselves and we have little grooves and hillocks that,
through a very complicated pattern of folding, resorption, and growth of cells,
becomes this beautiful external ear. And the other one interesting fact about
the ear I'll point out from a biologic standpoint is when you see a little bump
on the outer part of the ear here, and some people will have a bigger bump and
even a pointiness, that's called Darwin's tubercle. And it represents the
atavistic remnant, that is the remnant of an ear that is tall and skinny, like
let's say a dog's ear or a rabbit's ear. Rabbits here and then our ear flattens
out and becomes rounded as it grows, but we're left with this little tiny hint
of what could have been. And I think I've got one here somewhere if you look
carefully you can see a little bump there. So that's called Darwin’s tubercle
as a reminder of our atavistic past embryologically.
Now let's talk about the treatment of living
creatures in the external auditory canal. So let's say someone presents to you
as a medical provider, or you're a mom or a dad, and a small child has a bug in
their ear and they can feel it crawling around and everybody's going nuts, and
it's a terribly unpleasant. It's very scary, and you know what to do, what to
do. So let's say you're out in the woods and someone wakes up in the middle of
the night. Your eight-year-old wakes up in the middle of the night and has a
bug in their ear. So, and it's obvious what it is because there's nothing else
that feels like a bug in your ear crawling around than a bug in your ear. First
thing you want to do is, you, you want to always have a little mineral oil.
Mineral oil is great for a lot of different things. It's good for constipation;
it's good for this problem. So basically all you need to do is first kill this
insect, and insects breathe through little tracheals in their skin because
they're so small. They don't have a trachea like we do and a whole respiratory
system. They breathe directly through their skin through their exoskeleton
that's made of chitin. Little tiny tubes connected to the outside, and they go
directly into the body of that insect and provide oxygen directly to the cells
that way, through diffusion, without a need for the insect to actually inhale,
exhale. It doesn't really have lungs or gills or anything. What we do is engulf
that insect with oil, and it will go around those little tracheal, those little
tubules, and block them, and within minutes that insect will be dead.
Now, once the insect is dead, and the way you
do that is basically by putting that child, that individual, on their side, put
the head over, pour the oil in, and just keep it there so it doesn't run out
right away, and within a very short period of time, one minute, two minutes,
three minutes, it will, the insect within a very short period of time, one
minute, two minutes, three minutes, it will—the insect will stop moving, give
that person immediate relief. Then, you can find a tweezer somewhere, make a tweezer
out of a little piece of metal, a paper clip or something like that if you have
to, and you can retrieve that insect intact from the ear. And, even if you turn
the head to the side and let the oil pour out, the insect will probably pour
out intact with the oil.
What you don't want to do is be too aggressive
or rough and fragment the insect, and then you don't know if you got the insect
out. And if you use a Q-tip, you may actually pack it further in the way you
would the way an old cannon works, and you put the gunpowder and you put the
shell and you pack it with a ramrod. You don't want to use a Q-tip in that way.
You want to be able to draw that little insect
out intact and look at it and see, 'Okay, I've got all the legs, and I've got
both of the wings, or four wings if it's that kind of an insect.' But you want
to make sure you've got all the parts.
Then, you can use a little gauze or Kleenex,
something that absorbs the oil out of the ear, and Bob's your uncle—you're
done, and everybody can go back to bed.
So, I hope you enjoyed that little bit of
information in that reaction video, and I hope you didn't find that too gross
watching the tail flop back and forth. I thought it was kind of funny. More
later from a runner, I would say.
If you have any comments, questions, something
you'd like me to address, leave it in the comments below. I'll try to get to
it. Like me to address? Leave it in the comments below. Like me to address?
Leave it in the comments below. I'll try to get to it." – Dr.
Joel Aronowitz
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