TV Show HOUSE Exploring ENT Problems

I must clarify that I never really like TV show House for reasons explained here... but patients who love watching House have alerted me to some episodes this season that touched on ENT problems.

So... here goes...

Episode 21 (Season 8): Holding On
Diagnosis: Persistent Stapedial Artery

19 years old cheerleader was admitted after suffering from dizziness, massive nosebleed, and auditory hallucinations. It was ultimately determined that he was suffering from a persistent stapedial artery.

This artery is a congenital defect of the inner ear that should have obliterated during fetal development. However, if persistent, is typically found going through the stapes bone of the middle ear.

It CAN cause symptoms of dizziness as the pulsations of the artery can transmit through the stapes footplate and into the vestibule via the oval window. It can also cause auditory hallucinations by pressing against the nearby temporal lobe as well as a nosebleed. If the artery ruptures, it can only drain through the eustachian tube and out the nose.

However, if the patient presented to the ER with nosebleed and dizziness, a complete physical exam would have been performed and a clearly seen blood-filled middle ear cavity (hemotympanum) would have been seen that even a medical student would have found. That would have indicated an ear issue causing both the dizziness and nosebleed. Also, the patient would have complained of hearing loss with blood in the ear.

From that point, the differential diagnosis is actually quite small and would have been obtained relatively easily.

Episode 17 (Season 8): We Need The Eggs

Diagnosis: Amoebic Meningitis

35 years old man admitted to House’s service after he is discovered crying blood. He later develops light sensitivity, vomiting, and a stiff neck.

After suspecting meningitis, it was discovered that he was using a Neti Pot and was using tap water rather than distilled or sterilized water in order to perform saline flushes. The water happened to contain an amoeba (likely Naegleria fowleri) which caused an amoebic infection of the brain.  The culprit organism Naegleria fowleri causes a life-threatening encephalitis after passing thru the nose and up into the brain where the organism eats neurons for food.

Such brain infections have been recently reported in the news and can be prevented by using water that is boiled, distilled, or filtered.

Fortunately, it is rare.

Amoeba Deaths from Neti-Pot Use and How to Minimize Risk

In the past few weeks, there have been numerous stories about the 2nd death in Louisiana from Neti-Pot use leading to an amoeba infection of the brain. The culprit organism Naegleria fowleri causes a life-threatening encephalitis after passing thru the nose and up into the brain where the organism eats neurons for food.

As such, recommendations have been issued to use water as instructed with the Neti-Pot packaging... water should be boiled, distilled, or filtered.

However, before the millions of people who may have elected to simply use tap-water change their daily routine, consider that more commonly, swimming in warm lakes or rivers causes 2-3 amoeba related deaths per year... and swimming in and of itself leads to thousands of drownings per year. So far, there have been only TWO amoeba-related deaths linked with Neti-Pot usage that we know of so far.

In any case, lets talk about boiled, distilled, or filtered water and what a Neti-Pot user can do to keep their daily routine simple. After all, it is so simple to simply fill the container with running tap-water. The additional step to keep things safe can become annoying.

Boiled Water: Naegleria fowleri can not survive in temperatures above 47°C. As such, by boiling water, you guarantee death if any are present in the water.

Save time by boiling a large amount of water and storing in 1+ gallon containers for daily use.

Distilled Water: By definition, distillation involves boiling the water and then condensing the steam into a clean container. It's a slow process, but it not only kills any micro-organisms much like simple boiling does, but also removes any inorganic "impurities" that may be harmful like mercury as well as beneficial minerals including calcium, magnesium, and sodium. Distillation does not discriminate.

It is not feasible for most individuals to set up a home water distillation process just so they can use the Neti-Pot. Though can get expensive over the years, save time by purchasing large volumes of distilled water to have at home. But, there are portable water distilling machines you can purchase as well.

Filtered Water: Water that is filtered is cleaned by means of a fine physical barrier, a chemical process or a biological process. In most homes, filtered water is almost universally achieved by a physical barrier. There are numerous vendors out there that sell devices to filter the water including Pur Water and Brita.

Save time by purchasing a faucet attachment that automatically filters water into your Neti-Pot when you need it.