For a while I worked as a junior doctor in the specialty ear, nose and throat (ENT). it was always the ears that caused the most trouble. as a non-specialist I never dealt with anything complicated or surgical, although I loved going to theatre to watch operations. most ENT involves tight manoeuvring in confined spaces; grommet surgery, in particular, takes dexterity, although it is a straightforward procedure.
Grommets are designed to treat recurrent glue ear, which is a build-up of viscous fluid in the middle ear. the “glue” hampers the free movement of the auditory bones, preventing sound from conducting properly and causing deafness. the idea of the grommet is not to drain out the fluid, but rather to allow air to circulate, enabling the ear to regulate itself. In grommet surgery, the surgeon first makes a tiny perforation in the eardrum. then she picks up the tiny plastic grommet. as soon as it enters the ear canal – and so the range of the operating microscope – it appears enormous, like a gigantic piece of penne. the rest of the operation consists of poking and anchoring the grommet into the puncture hole: a process which either takes seconds or extends over several fraught minutes.
But I spent most of my time outside of theatres, and with the outer parts of ears. I never knew how much trouble your ears could get into until I did ENT; and almost all of it was self-inflicted. First there were the foreign bodies – children with beads, chewing gum, pen lids and Barbie accessories stuck in their ears. having discovered this challenging new orifice, they rarely limited themselves to a single item or, in fact, a single ear. it is difficult to communicate with someone who has Tic Tacs in both ears.
With older patients the main problem was earrings. each clinic would bring an emotional teenager. On going to take her earring out, she could no longer find the butterfly catch at the back. Alas, it hadn’t fallen off, but instead had buried itself under the skin at the back of the earlobe. To get it out you need to make a tiny incision and then dig a little; you’re basically removing a curly splinter.
Two things made it difficult: the back of the ear is an awkward place to work, and the patient was frequently terrified, weeping as they climbed on the couch and weeping louder at the idea of a local anaesthetic. I could never work out how they’d got pierced in the first place. One boy with piercings in both ears, one eyebrow and his tongue asked if we could cover up the instrument trolley. People are much more comfortable when the person with the sharp tool is not a doctor (unless it’s a dentist, of course).
When the more ambitious piercings go wrong the result can be terrible. One night I was called to A&E to see a man who, the A&E doctor said, “had lost half his ear”. People do occasionally lose bits of ear, usually in fights; I’d got used to seeing tooth marks in cartilage, and dramatic haematomas (when the ear is bashed it can bleed under the skin and swell up to an alarming size: it is important to drain and reshape it quickly, to avoid a cauliflower).
I pulled back the cubicle curtain to find a 21-year-old man sitting on the bed. His girlfriend was holding his hand. it was true: he had exactly half a right ear.
The top half was perfect; the bottom had disintegrated into two hanging threads. for a moment I couldn’t make sense of what had happened, until I saw his other ear, which still wore an enormous pendulous bolt-shaped earring. “It tore,” he said. “Please, please, tell me you can mend it.” he started to cry.
Sophie Harrison is a hospital doctor in South Yorkshire