22 August 2023

An interesting story about earwax and the human microbiome

I recently chatted with a cousin who is a physician in Florida.  He told me about a patient in their clinic system who for years had been plagued by chronic otitis externa (inflammation of the ear canal; "swimmer's ear").  
Otitis externa may be acute (lasting less than six weeks) or chronic (lasting more than three months). Acute cases are typically due to bacterial infection, and chronic cases are often due to allergies and autoimmune disorders. The most common cause of Otitis externa is bacterial. Risk factors for acute cases include swimming, minor trauma from cleaning, using hearing aids and ear plugs, and other skin problems, such as psoriasis and dermatitis. People with diabetes are at risk of a severe form of malignant otitis externa. Diagnosis is based on the signs and symptoms. Culturing the ear canal may be useful in chronic or severe cases.
This patient had received multiple courses of conventional therapy (cleaning, eardrops, antibiotics etc) with no resolution of the process.  Then one day he returned to clinic in total remission - asymptomatic and with a normal otoscopic exam.  When he was asked what recent treatment had worked, he replied that he had taken some earwax from his "good ear" and placed it in his "bad ear."  After that, the inflammation had subsided and then resolved.  

This is an anecdotal case report, from a series of n=1, and as far as I know is unpublished, but it is clearly suggestive of the importance of the individual's microbioime.  Of note, this event occurred many years before even the concept of the human microbiome had been understood or published.  The patient figured this out on his own.

The best single longread about the human microbiome is probably this one at the National Library of Medicine.

5 comments:

  1. There are many more anecdotes of such effect.

    However, from a scientific point of view, the microbiome is so staggeringly enormous and complex that's gonna take a while to sort out what's going on there.

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  2. Fecal transplants for weight loss are coming!

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  3. Yes, but they might find therapeutic biome value of some kind in using fecal transplants in the ear. It's possible. One time years ago I was talking about advertising tricks with friends Eleanor and Mitch. Elly came up with a campaign for a personal hygiene product to solve the social problem of "that place behind your ears that smells so bad." This might be that product.

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  4. It is also suggestive of randomness at work, the power of the anecdote, the birth of an urban legend and that physicians are not automatically scientists.

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    1. It is also suggestive of randomness at work

      An anecdote is not data. That is true. But the number of such anecdotes that's around, strongly suggests that there is more at work than randomness. We just don't know what. Yet. Big difference.

      Science can be excruciatingly slow. Note that gravity waves were predicted about a century before they were actually measured.

      To give an idea of the enormity of the microbiome, consider that we've been able to 'read' DNA for a decade or two, and yet we haven't fully understood the human DNA - there are huge strings of base pairs that we have no idea what they're for.

      Now consider that the microbiome contains a near infinity of unidentified microorganisms, all with their own DNA that would need to be read and understood before we can do something with it.

      The quantities we're talking about are wholly unsuitable for the current abilities of big data science even with AI. It'll take a while before we get a handle on this. But we'll get there. It just takes time and effort.

      This is why you should support basic science.

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