{"id":156575,"date":"2023-06-22T14:14:14","date_gmt":"2023-06-22T12:14:14","guid":{"rendered":"https:\/\/www.erasmusmagazine.nl\/en\/?p=156575"},"modified":"2025-12-19T11:26:51","modified_gmt":"2025-12-19T10:26:51","slug":"ear-toilet","status":"publish","type":"post","link":"https:\/\/www.erasmusmagazine.nl\/en\/2023\/06\/22\/ear-toilet\/","title":{"rendered":"Ear toilet"},"content":{"rendered":"

Ideally, you want a single big, black-brown wad \u2013 one of those that you can suck up nicely and then crumbles into pieces, so you don\u2019t have to wipe the tube on gauze. Lovely. Unfortunately, such a wad often doesn\u2019t want to move. That means having to fish out the slimy stuff with an elongated metal hook, followed by a little more sucking. More irritating still is the membranous earwax, which you first have to suck up and then pull out. That can actually hurt.<\/p>\n

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\n\t\n\n<\/svg>\n<\/span>\n\tImage by:<\/span>\n\n\t\t\t\n\t\t\t\t\t\t\tLevien Willemse<\/a>, \t\t\t\t\t<\/span>\n\t\t\t\n\t\t\t\t\t\t\tPauline Wiersema<\/a>\t\t\t\t\t<\/span>\n\t<\/p>\n<\/figcaption><\/figure>

This makes the ear toilet one of the most prestigious weapons in the arsenal of an elective ear, nose and throat (ENT) intern. Regular interns aren\u2019t allowed to perform this procedure, just like I wasn\u2019t allowed to perform it six months ago.<\/p>\n

Becoming an elective intern means that, at long last, I\u2019m really entering the final phase of my studies. The elective medical internships are two internships of three weeks each, in which you can look for more depth in a specialisation of your choice before you start working as a doctor. They\u2019re meant to allow you to explore a bit more, as evidenced by the fact that I get 75 minutes per new patient, compared to the twenty minutes that medical residents get. Knowing that I\u2019ll have to take up the slack if I end up working there, twiddling my thumbs between my consultations feels like the calm before the storm.<\/p>\n

Anyway, being allowed to perform an ear toilet is fun, although of course the patient doesn\u2019t always agree. It\u2019s also a welcome change from the cerebral medicine minutiae: just getting some work done in between.<\/p>\n

Slightly further up the learning curve, and at least as much fun, is performing an endoscopy \u2013 that is, using a tube to examine the throat through the nose. The ideal thing about this is that you immediately know if someone\u2019s vocal cords are doing well, or if the pharyngeal tonsils are causing the ears to become blocked. Often, you can send the patient home after a single consultation, never to see them again.<\/p>\n

You can also perform an endoscopy for other things, by the way. For example, you can examine the eardrum through the ear, or examine abnormalities in the mouth. All tubular structures in the human body of about half a millimetre or larger, actually. Sounds great, right?<\/p>\n

Maybe I lost you at the words \u2018ear toilet\u2019. Snot, earwax, mucus, pus, blood: you need to have the stomach for them. Why choose such a slimy profession? Because it has become clear to me that you have to look not only at where your intellectual interests lie, but also at what your daily activities involve. ENT covers the things I like about medicine: clinical reasoning, performing treatments, coming up with your own diagnosis and thinking of creative, practical solutions. In the offing are unusual surgeries, from extremely finicky ossicle reconstructions to removing parts of the fibula to make a new jawbone. There\u2019s plenty of work during the day, but the shifts are quiet. Handover beckons as early as 16:30 every day.<\/p>\n

Aside from that, you just have to be able to stand the harsh hospital environment. The general practitioner with whom I did my GP internship told me to pay attention to the interactions between doctors and to always consider whether the learning environment was safe. If not, I\u2019d be running home with my tail between my legs. In that respect, I\u2019m kind of glad that I get to perform ear toilets for a while before I really get started.<\/p>\n\n\t

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