All posts by Richard Saint Cyr MD

Ear Wax: What Works Best?

Every once in a while, children and adults feel a lot of pressure or pain in their ears, and thick wax clogs their ear canal and needs to be removed. Doctors can try to scoop or rinse it out, but many over-the-counter drops can soften it up. But which one works best? This was reviewed by the Cochrane group, the world’s leading reviewer of evidence-based medicine. Their perhaps unsurprising finding was that none of the major drops worked much better than the other; even water-based or saline-based drops worked. However, they weren’t too happy with the overall quality of the studies they reviewed in their literature search. Here’s their “plain language summary” from their review (Ear drops for the removal of ear wax):

Using ear drops to remove impacted ear wax is better than no treatment, but no particular sort of drops can be recommended over any other. Impacted ear wax is one of the most common reasons that people visit their general practitioners (family doctors) with ear problems, as it can cause reduced hearing, discomfort, and sometimes pain and dizziness. Ear drops (either oil- or water-based) are often prescribed to clear the wax or to aid subsequent ear syringing if necessary. The review of trials found that ear drops (of any sort) can help to remove ear wax, but that water and saline drops appear to be as good as more costly commercial products. The quality of the trials was generally low, however, and more research is needed.

The Bottom Line?

You should certainly try some type of wax softener before coming to the doctor, who would probably prescribe something just as effective as an OTC product. For more information, you can read this patient handout from American Family Physician.

By the way, you should never routinely use cotton swabs to clean your ears! There’s no need at all to routinely clean your ear canal, as mother nature does it just fine. I see many patients who have outer ear infections, and most have a story of routinely cleaning their ears with something, usually Q-tips. Remember that earwax is normal and protective; daily messing around in your ear canal sets you up for infections as well as risks of puncturing your eardrum.

Air Pollution: Do Your Schools Have Action Plans?

Air pollution is a growing problem in many urban areas. Many people may not realize that over the last five years there is a lot of new research proving more serious health effects at lower levels than we had previously thought. The danger is especially acute in children, whose lungs are not fully formed and therefore more vulnerable. Now, there’s a great new review as well as a patient handout to explain the basics. It’s from my specialty’s Journal of the American Family Physician. Their recently published review (Outdoor Air Pollutants and Patient Health) describes the main culprits of air pollution.

It also discusses the US EPA’s Air Quality Index as well as action plan. Notice how the recommendation states how levels over 200 are “very unhealthy” and that “everyone should avoid all physical activity outdoors“. How many of us do that? Does your school have an air pollution action plan? The action plan is below:

Food Allergy in Kids: Are We Over-Diagnosing?

Food allergies in children, as a diagnosis, are more common than before. But are we over-diagnosing? The main issue is that the tests we perform, especially the blood tests for allergens, may show a positive “in vitro” allergy but “in vivo”, AKA in real life, there may not be a clinically significant allergy.

This growing issue is discussed in the always excellent Wall Street Journal Health Section (When Is Your Kid’s Food Allergy Really a Food Allergy?). One of their good quotes:

“Are these blood tests being overused? Possibly. Misinterpreted? Absolutely,” says Robert Wood, director of Pediatric Allergy and Immunology at Johns Hopkins Hospital, who is part of a task force writing guidelines for diagnosing and managing food allergies. “A lot of these kids truly have food allergies, just not to all the foods that they are being told they have allergies to.”

A national sampling from 2005-2006, which also included blood tests, found that 9% of U.S. children had a sensitivity to peanuts, 7% to egg; 12% to milk and 5% to shrimp. But experts believe that only about one-tenth of those children will actually have allergic reactions to those foods. Even the true rate of fatal reactions to food allergies is hard to gauge: Estimates range from as low as five to as high as 200 per year.

Here’s an excellent graph from the article:

The bottom line?

Many children do have serious food allergies, but perhaps they should be evaluated more frequently, if possible, by an allergist who can also perform allergy skin tests or a food challenge.

Vitamin D: Miracle or Hype?

Just a couple weeks ago I posted an article discussing the trendiness of vitamin D. Since then, there is even more press about this; last week I reported how sales of vitamin D are jumping. Now, the New York Times also reviews the literature, with a cautionary note (The Miracle of Vitamin D: Sound Science, or Hype?).

The crux of the article is that indeed there is a lot of recent information that vitamin D supplements can help decrease cancers and heart disease — among those with documented blood-level deficiency in vitamin D. What is less clear is whether the entire population would benefit from a high-dose supplement. In other words, if your blood levels are normal, there is yet not a lot of evidence that a supplement would help. A good quote:

“What we know is that there are a lot of people who are vitamin D deficient based on estimates from national surveys,” said Dr. Michal L. Melamed, assistant professor of medicine at Albert Einstein College of Medicine in the Bronx. “But we don’t know what happens when the curve shifts to the other end. There probably is a risk to having too much vitamin D in the system.”

I think that perhaps the best approach is to see if you first have a deficiency, which many do. In that case, there’s clear evidence that a supplement of 1,000-2,000 IU a day wiill benefit. As for the rest of use, we will have to wait for better studies — which will take many years to finish. In the meantime? I’m still personally debating whether I should start myself on extra doses…

Air Quality: Games For Kids

It’s a bit, um, difficult to make air pollution a cool subject for kids. Even my recent slide show on air pollution left a few high-schoolers eyes glazed. Fortunately, I spread out a couple fun internet games to perk up the group. Fun and educational! Throw in free and you have an instant hour or two of kid-distractions.

The best collection is from the U.S. EPA:

Does anyone have other good links? Please share in the comment section below.

Deafness in Children: Cochlear Implants Really Work

People may not realize that there have been amazing advances in technology that can help deaf children hear again. It’s called a cochlear implant, a surgical implant that amplifies sound waves directly into a child’s brain — and allows them to hear again.

A study in the current Otolaryngology, discussed in the New York Times (Vital Signs), had post-surgery children fill out a quality-of-life questionnaire; this group experienced “quality of life similar to that of normal-hearing peers”. That’s a wonderful result!

You can read more about this exciting technology from the U.S. National Instititute on Deafness and Other Communication Disorders.