Tuesday, August 4, 2009

Kudos for the Articulating Curette!

Score another one for the Articulating Curette!

This blog is about my wife’s practice. She’s a family practice physician and the director of one of the family practice residency programs here in Toledo. She also sees patients, and a significant number of them are older individuals. The other day she saw a woman who was complaining of impacted cerumen, a common problem in the geriatric population. The poor woman was so impacted that she had really diminished hearing in both ears. The problem had been going on for some time, and no one had been successful in removing the impacted wax.

Enter the Articulating Safe Ear Curette. As my wife tells it, when she examined the woman with the otoscope, all she could see was a tiny sliver of an opening at the edge of a very large wax plug. She was able to slip the head of the Articulating Curette through that tiny opening past the plug. Once she was past the wax plug, she slid her fingers to flex the tip of the curette and was able to pull the entire hard wax plug from the woman’s ear canal. The patient was thrilled with the results and so happy she could finally hear again. My wife’s comments: “The Articulating Curette rocks!”

If any of you have experiences with the Articulating Curette, or with any of our Safe Ear Curettes or Lighted Ear Curettes, I would be interested in hearing them.

Until next time.

--James Huttner M.D

Tuesday, July 14, 2009

Removing A Foreign Body From The Nose

Hi again.

One of the most fun things (in my admittedly strange opinion) in practice is removing foreign objects from noses, ears, etc. Kids manage to put the wierdest things in any orifice they can find and get to-- usually ears and noses. I've removed beads, buttons, erasers, bugs, an LED, foam rubber, a doll's eye, and Barbie earrings (two of them, one after the other from the same nostril!). Parents are usually freaked by the occurence, and incredibly relieved afterwards. The kids, of course, could care less-- until you go to remove the object.

There are, of course, real concerns about foreign bodies in the nose. Aspiration of the object into the lungs can occur, causing respiratory compromise. Its important at the outset to take precautions to minimize the chance of that happening. First, DON'T lay the patients down until you've examined them to ensure that there is no airway compromise. Listen for wheezing or "whistling" over the anterior chest, signs that there may be an object in the airway. (I noted this on one child who on bronchoscopy was found to have aspirated a small plastic ring from an artificial flower.)

Then, do your exam to identify the location of the object with the child sitting upright on the parent's lap. Be sure to check BOTH nares, even if the history suggests only one side. Once you have confirmed the presence of the object, prepare everything you need to retrieve it-- lighting, tools, etc.-- before you position the child Often, you can do this by restraining the child on the parent's lap, though sometimes you have to lay them down.

In this case, the foreign object was a small rubber nose from a toy animal that the child had placed in his nose. My partner tried to retrieve it with tweezers, but was unsuccessful. The object was far back in the nose, and wedged against the side of the nostril (a not uncommon finding). This made it difficult to get the forceps on both sides of the object for a good grip, so she couldn't pull it out.

So she called me in to help. After I examined the nose, I had an "Aha!" moment. I went and got one of our new Articulating Safe Ear Curettes. This curette has a moveable tip that is flexed by simply sliding your fingers against each other.

I restrained the child lying down, with his arms straight over his head and having mom hold his elbows against the sides of his head to keep it from moving. (A great technique, by the way.) Then I simply slipped the Articulating Curette past the object, flexed the tip, and pulled it straight out of the nose! Success!! The whole process took about a minute, with no trauma or sedation, and two very happy people afterwards. (Three, if you count my partner.)

Try the Articulating Safe Ear Curette for nasal foreign bodies, or for ear curettage in general. Also, let me know of your experiences (and tips) for removing foreign bodies in kids.

Till next time.

Dr. James Huttner

Thursday, June 25, 2009

Ear Tubes

Hi. It's gotten pretty hot in Toledo-- summer is definately here! Most of our office visits these days are for pre-school and general well care physicals. Quite a few of these children have tympanostomy tubes in place, or a history of prior tube placement. One of the known complications of ear tubes is perforation of the TM. These usually heal up with time, but it's important to follow them to ensure that that happens. Obstructing wax can keep you from getting a good look, so even in these well kids I will try to remove enough wax to get a complete look at the ear drum to document the presence of tubes or a perforation. Also, the Lighted Ear Curette is great for easily removing extruded tubes that are just sitting in the ear canal.

Let me know of your experiences with the Lighted Ear Curette, or any of our Safe Ear Curettes.

--Jim Huttner

Tuesday, June 9, 2009

Swimmer's Ear

Hi, again. Toledo has finally warmed up enough to have kids hit the swimming pools, and with that we're seeing an increase in the number of otitis externa, or "swimmer's ear", cases.

We think of ear curettage as used mostly for removing stubborn, hard wax that obstructs the ear canal. But don't forget its usefulness in the diagnosis and treatment of swimmer's ear. Most experts agree that its important to remove the pus and debris in the affected ear canal to allow antibiotic ear drops to reach the infection site. For this, I find the FlexLoop and VersaLoop Safe Ear Curettes very effective. They seem to grab that gooey mess to let me drag it out of the canal, and their flexibility allows me to be extra gentle when curetting in a tender, infected ear canal.

Once I've cleared the bulk of the purulent drainage I have the choice of inserting an ear wick, or just administering antibiotic drops. Either way, I know that the drops are reaching the site of the infection instead of just sitting on top of the pus.

Let me know if you have experiences with curettage and otitis externa, or any other interesting cases you run into.

Dr. Huttner

Monday, May 18, 2009

Summer seems like its almost here! In my peds office, we're seeing fewer patients overall, but still a fair number of viral infections and ear infections, especially in the little kids. For those infants who come in with complaints of "he won't sleep" or "fussy" and "fever and runny nose", its important to separate the treatable conditions from the viremias and teething issues. To do that you've GOT to visualize the ear drum adequately to rule out or in otitis.

For the little kids, my best tip is to do everything with the child held on mom's shoulder. Mom should be backed up against the table for support, and she holds the child in the "L" formed by her shoulder and neck. The babies turn their heads out-ward automatically. I use the heel of my hand to immobilize the child's head (or at least keep them from turning), and my thumb and finger to extend the ear and straighten the ear canal. If there's wax, I like the white FlexLoop or lighted VersaLoop, depending on the size of the ear canal and how well I can see. Usually I can remove enough wax to make my diagnosis in a relatively quick and painless fashion. Being able to confidently tell the parent that there's NOT an infection because you got a good look at the ear drum is worth its weight in suckers!

Any tips you have for examining kids (or adults) and ear wax removal would be appreciated by all.

Till then.

James Huttner MD

Tuesday, May 12, 2009

Another week here at Bionix. We're now on twitter, so you can follow us there--it'll get busier during the fall tradeshow season-- or on my blog.

The folks in sales and marketing just got back from Primed West. We had an amazing turnout at the show, and some great response to our products. One device that generated lots of interest was our OtoClear Safe Irrigation System. The OtoClear was developed in response to those of you who have the need to irrigate patient's ears in your practice, but were tired of the need to tie up a room and a nurse for forever, and the pain and mess associated with the old style metal ear syringes. Many of you have tried alternative devices and techniques-- a syringe and angiocath, the Waterpik, etc. Sometimes they work, more often they don't, and they still can cause pain and create a mess.

So we created the OtoClear tip. This thing works great! I use it in my office, and I can clear impacted wax in just a few minutes. I use body temperature tap water (I don't use peroxide, but you could), and drape the patient with a towel to prevent drips. The patient holds the catch basin, and I hold and manipulate the OtoClear. Whichever water delivery system you like best is what you should use.

The portable Waterpik is great for impactions, and has the fastest and greatest volume of water delivery. This unit is perfect for larger volume facilities. A drawback is that the noise it creates can bother some patients. The Spray Wash bottle is quieter, has a large reservoir volume, and is very convenient and easy to use. It’s a cost-effective option for those offices that perform only a few irrigation procedures each week

Each tip is single patient use, and this prevents cross-contamination. Contraindications are standard-- known perforation or tubes, active infection, etc. Complications are rare, and the safety of the system is unparalleled. We did an early study with Children's Hospital of Pittsburgh, and you can view it at http://www.bionix.com/Images/OtoClearStudy.pdf .

There's more on irrigation on our web site at https://www.bionix.com, and on our "Curettage and Irrigation" video (under the "New Web Videos" heading). Check it out.

More soon.

--James Huttner MD

Tuesday, May 5, 2009


To all, greetings.

My name is Jim Huttner, and I developed the first Bionix Safe Ear Curette when I was a resident, some 27 years ago. Since then, I've been a practicing pediatrician as well as being the "in house" inventor of ear curettes for Bionix Medical Technologies. Most of the ear curette designs came about as a result of problems of ear wax removal encountered by physicians in their practices. We would meet them at national meetings--AAP, AAFP, PRI-Med's, etc.-- and they would discuss how they liked or disliked one curette or the other, noting that they were great for soft wax, but not stiff enough for hard wax, or too large to curette through the otoscope speculum, things like that. So I would go back, and with the help of our engineering staff would develop the next curette in the Safe Ear Curette line. (It helped a great deal that I was able to test out our new designs on my pediatric patients.)

We used that same kind of input/feedback to create the Lighted Ear Curette, bringing illumination and visualization to what used to be a blind procedure. And we also created the OtoClear Safe Irrigation System in response to the expressed need for a better way to irrigate cerumen from ears, one that would work safely and effectively on all patients.

Over the coming weeks and months, I will be writing about some of the challenges and experiences I've had removing wax (and other objects) from kids ears. I invite you to write and post your experiences, as well. Hopefully, we'll all learn better techniques for dealing with this common problem--wax impaction/obstruction-- and maybe some of those discussions will lead to the next new innovation in cerumen removal.

I'll look forward to reading your posts.

--James Huttner MD