A Costly Mistake

Since 1984, twelve hotel guests cleaned their ear with a Q-tip, extracted it, noticed that the cotton had vanished, and called for a doctor.

These were stressful visits because I worried that the cotton might be too far inside to reach, and I don’t like poking with needle-nosed tweezers. Mostly, I was lucky, but one visit didn’t work out as planned.

“I don’t see anything,” I said after looking in the ear. The guest insisted that I must be in error. I looked again. Nothing that didn’t belong.

While he thought this over, I looked in the bathroom. On the floor near the sink lay a tiny ball of cotton.

He tried to laugh this off, but I could see his pain. I’d made the visit at the request of a housecall service that had already collected on his credit card, so there was no way I could give him a discount. It was an expensive mistake.

The Conundrum of Ear Pain

I hate forbidding guests from flying because of the ticket-change fee. The era when a doctor’s note impressed the airline is long gone. It still works for travel insurers, a good reason to buy a policy.

My problem arises most often with ear pain.

Cabin pressure at cruising altitude drops only about 25 percent from sea level, but that’s significant. If you bring a bag of potato chips you’ll notice that it swells like a balloon. Air in any closed space does the same. If you have gas, you’ll have more gas. If air in your middle ear can’t escape, the ear will feel stuffy and then painful. If pressure increases still more, it may blow a hole in the eardrum. This relieves the pain, and most small perforations heal in a few weeks, but we don’t like to encourage them.

The best preventative is a chemical nasal spray (Afrin, Dristan). As you sit in the plane before takeoff, spray generously, wait five minutes for it to work, and spray again. This should send the spray far up to reach the eustachian tube opening, the only connection between your middle ear and the outside world. Do the same before the plane begins its descent, an hour before landing.

Flying doesn’t cause ear infections, so if you felt fine before boarding, it’s OK to wait if your ear hurts after landing. Pain should improve after a few days. If you see a doctor, he’ll forbid you to fly.

It's Not an Ear Infection!

When I peered into the guest’s ear, the drum looked normal, so there was no middle-ear infection. When I pulled his earlobe, it hurt but not a great deal. In an external infection (swimmer’s ear), pulling is very painful.

Many adults with ear pain don’t have an infection (children are a different matter). I pressed a finger to his temple in front of the ear and asked him to open his mouth. That hurt badly. He had pain in the temperomandibular (jaw) joint.

The jaw joint is no different from the knee, ankle, or shoulder joint. You can injure it, or it can hurt for no obvious reason. This is common, but I can’t remember the last time someone complained of jaw pain. They tell me it’s an earache.

Flying with a middle-ear infection is a bad idea but no problem with jaw pain, so the diagnosis is good news, but guests are skeptical. Ear pain means an ear infection, and pain medicine lacks the cache of an antibiotic. Guests often make it clear that they’re not getting their money’s worth.