Doc, I've got a question

Ideally you should not need to clean your ears unless you are having difficulty hearing, feeling fullness in your ears, have ringing in your ears or if your ears are itching a lot. Ear wax is actually a natural lubricant made by your ears which helps to protect your inner ear from infection. It acts like a “self-cleaner” of sorts with its antibacterial advantages. Despite what many people believe, ear wax is actually produced in the outer third of the ear canal. This is the case so that the ear wax can provide its protective properties to the very fragile inner ear, and keep it out of the way of harm from bacteria and foreign bodies. This is why ENTs, or Ear, Nose and Throat physicians, strongly advise that patients do not put cotton-tipped applicators in the ear. When this is done, the ear wax is pushed in to the inner ear canal and can irritate or even perforate the ear drum, and make the ear more susceptible to infection. This is turn can cause temporary or even permanent damage to one’s hearing. Physical trauma and damage from infections can cause scarring on the ear drum, which can permanently impair your ability to hear.

That being said, there are some people who produce too much ear wax, which can in itself cause irritation of the inner ear. If you believe this to be the case, the first step I would recommend would be to visit your primary care physician so he or she can look inside your ear. A physician will be able to tell you if over-production of ear wax is the problem or if it may be something else, such as an infection causing you discomfort.

If it is found that there is too much wax in your inner ear, your physician may attempt to clean out your ears using warm water flushes, ear softening drops or using small tools to pluck out the pieces of wax without pushing it further in your ear. The physician then may suggest you use wax softening drops at home, or use a few drops of a natural softener such as mineral oil, baby oil or glycerin. These can all break down ear wax enough that it will fall out of your ear on its own. I cannot stress enough to never insert cotton-tipped applicators into your ears, for the aforementioned reasons. It is also not recommended to use ear candles to remove ear wax. There have been many instances of burning and perforation of the ear drum, or further obstruction with candle wax. If you have any further questions or concerns, do not hesitate your primary care physician.

What is the best way to deal with vertigo? Do you lay still or move around?

Vertigo is often described as a sense of dizziness or unsteadiness with the room spinning around you. Quite often vertigo is a transient feeling that comes and goes on its own within seconds or minutes. However it can persist for hours, depending on the cause of the vertigo. Since many people experience symptoms of unbalance, swaying, nausea and lightheadedness, in addition to other symptoms, it is often best to stay still until the spinning sensation resolves. This can help protect you from injuring yourself from a fall. There are many different causes of vertigo, ranging from infection, fluid build-up in your inner ear and displacement of crystals inside your ear to migraine headaches, medication side effects and head or neck injuries. If the vertigo persists for too long or recurs frequently, you should consider making an appointment with your primary care physician.

When should you do something about your teen’s acne? Should you just let it run its course?

Teen acne is unfortunately a very common factor of life during adolescence. However, this does not mean there is not a solution to this bothersome, and sometimes embarrassing, problem. In approaching this question, you should first determine the severity of your teen’s acne and how much emotional distress it is causing them, if any. First of all, there are two different types of acne: non-inflammatory and inflammatory. Non-inflammatory acne is also known as whiteheads and blackheads. Inflammatory acne consists more of nodules that may or may not have pustular material inside. Inflammatory acne also ranges in severity from mild to moderate to severe. The higher the severity, the more likely the acne is to cause scarring of the skin. Depending on the extent of the scarring, it can have long term physical and emotional sequelae. No matter the severity of the acne, if it is causing any emotional distress to the patient, treatment is recommended.

There are treatment options for every type of acne. If your teen has more of the non-inflammatory acne or mild inflammatory acne, you could start with trying an over the counter face wash and/or body wash that contains the ingredient benzoyl peroxide. If used regularly, this treatment could completely clear up the acne. If you have found that the over the counter washes are not doing the trick, or if the acne is more severe, you should consider paying a visit to your primary care physician. There are several prescription options for treating acne and your physician would be happy to discuss these options with you.

Is there a problem with a child chewing his fingernails? What should you do?

Nail biting is a common “bad habit” among children, similar to thumb sucking, nose picking and cuticle picking. According to the American Academy of Pediatrics (AAP), these habits tend to be self-comforting and tension reducing, and children are not often conscious of the habit. Although these actions tend to be quite bothersome to parents, they will not affect the development of the child significantly. Children will often outgrow the habit by the time they reach early school age, age six to eight years, when they become more perceptive of the awareness of their peers. Although some children may persist in the habit a few years longer, most will be habit-free by the time they reach adulthood. While it is always a parent’s impulse to fix things they see as wrong with their children, the AAP recommends that the best management of nail biting is to ignore the habit. If you call negative attention to the action, the child will in turn development more tension and thus will bite their nails more often. Another effective approach is positive reinforcement. When you have noticed an extended period of time during which your child has not been biting his or her nails, reward them. Although there may be times when the nail biting may cause mild bleeding, this will likely be a deterrent for the child to the behavior. If this does happen, be sure to encourage proper hand hygiene and apply bandages as needed to prevent infection. If you have any further questions regarding nail biting or similar habits in your child, please don’t hesitate to contact your primary care physician.

I’ve had a lump behind my ear, but I don’t notice any other problems. I don’t think it’s anything, but is it? Should I have it checked?

There are many kinds of lumps and bumps that we feel from time to time on our bodies. These lumps could be a wide variety of things, such as lymph nodes, fatty masses, clogged sweat glands or hair follicles or different kinds of tumors. Lumps behind the ear are most often lymph nodes. Lymph nodes are present throughout your body and their primary function is to help fight infection. It is normal for lymph nodes to enlarge when our bodies are infected with a viral, bacterial or fungal infection. If encounter with an infection of some sort, lymph can enlarge and can become somewhat tender. However, this enlargement should resolved within a few weeks after the infection has run its course or has been properly treated. If a lymph node remains enlarged beyond about 4 weeks, it is a good idea to have it evaluated by your primary care physician. Other reasons to have it checked out if it has been less than four weeks include if you’ve experienced unexplained weight loss, night sweat or persistent fevers, or if the lymph node is firm and seems to be fixed to the skin. Also if the lymph node is enlarged without any apparent cause or infection. These could all be signs that the enlargement could be due to a more serious event, such as cancer. Do keep in mind that even minor colds that one may see as insignificant can cause lymph node enlargement. Thus, depending on the time frame that this lump has been present and any other symptoms that may be present, it would likely be a good idea to be evaluated by your primary care physician.