Fly Well: Stop touching your ear
Ear pain could signal something sinister
In the 2006 movie Casino Royale, James Bond tells his associate, with whom he is surreptitiously communicating, “stop touching your ear” as it will signal danger to the villain. My friend Nigel was touching his ear at lunch recently and I was similarly alarmed. At 48, he admitted to troubling earaches for three weeks, unimproved on antibiotics. I encouraged him to see a specialist. The diagnosis, as feared, was oropharyngeal cancer (OPC), a malignant growth at the back of the tongue, tonsils, or adjacent areas.
Cancer means cells are growing rapidly and in disordered fashion, destroying structures, spreading elsewhere, and—like the crab it is named for—nipping at all in reach. OPC strikes 1,000 people a week in the United States, impairing the ability to talk, chew, swallow, and breathe. Men are twice as likely to develop OPC. Although the cancer is vicious, with early diagnosis and swift treatment, 80 percent can survive. Poor oral hygiene; diets lacking fruit, vegetables, and Vitamin A; and chewing Asian betel nuts are contributory. Tobacco of any type can cause OPC, as may chronic marijuana use, and such cancers tend to have a worse prognosis, especially when patients also consume alcohol heavily. Human papilloma virus (HPV) infection is responsible for many less-aggressive cases. These sexually transmitted viruses are asymptomatic in most people as their immune system clears the invader. Of nearly 200 types of HPV, nine cause cancer of the female cervix, oropharynx, and other organs. One can test for infection, but cancer may not necessarily follow, and, as it can be dormant for years, infection does not mean a current partner has been unfaithful.
Symptoms may be vague, such as finding a lump or discolored area in the mouth, lips, or throat; having an unresolved mouth ulcer; bleeding; vocal changes; chronic sore throat; bad breath; ill-fitting dentures; loss of appetite or weight; or, as with my friend, enduring earache.
Diagnosis requires a detailed history; examination with a flexible telescope; taking biopsies; and scans including CT, MRI, PET, or ultrasound. This information helps “stage” OPC according to tumor size and location (“T”), presence of invaded lymph nodes (“N”), and whether the tumor has spread elsewhere (metastases or “M”). This TNM scale yields five stages, which will impact selected treatment as will the “grade” of cells meaning how “different” they are from host tissue.
Commando might refer to special forces soldiers, but in this case it’s COMbined Mandibulectomy And Neck Dissection Operation, major surgery sometimes needed to remove the jaw and much of the tongue. Robotic assistance or lasers can be used to limit the need for large incisions. The disease might require placing a breathing tube (tracheostomy) or feeding tube (gastrostomy).
Alternatively, radiation and chemotherapy are employed, requiring several weeks or months of treatment. Hair loss, diarrhea, and other symptoms might ensue and afterward, chronic dry mouth may persist. Additionally, one may need speech therapy to help restore swallowing and enunciation.
Given how serious the condition is, everyone should endeavor to avoid OPC. Screening can dramatically improve survival and is another reason to have a dental checkup twice a year. Immunization with HPV vaccines is a good idea and I concur with the directives to have children inoculated before they are sexually active. Current research does not show if there is a benefit for those over age 26 or already infected but it does make sense to me.
If diagnosed, self-ground immediately as cancer treatment is disqualifying until complete, with some exceptions.
For operations that require a medical certificate, after treatment is completed and there is “stabilized recovery” (30 to 60 days is suggested), records should be sent to the FAA for consideration of special issuance. One needs hospital admission history; an operative and pathology report; a detailed status report from treating physicians summarizing history, diagnosis, treatment, status, prognosis; and laboratory tests. If one has time left on an unexpired medical, records can go directly to the FAA. If the medical application has expired, a current MedXpress application and physical exam with the AME should follow. The examiner will defer application and airman then mails records directly to the FAA to be mated up with the electronically submitted application and assigned to workflow for review and decision. Review the general cancer guidelines online (www.aopa.org/pilot/general-cancer-guidelines) to become familiar with the records you will need.
Bond did not want his colleague touching his ear, but if you have symptoms please let a doctor touch yours to detect and eradicate any villains lurking within.
Related Articles
