I am an ENT surgeon working in a German hospital. Ask me anything!

How do you cut through the thick bark hardened further by the betrayal of Saruman?

Sorry, what?

ENT Surgeon, as in Surgeon for ENTs (the tree things from Lord of the Rings)

Oh, I see. Our blades are forged with the lava of mount doom.

So does that technically also make you a tree surgeon?

General tree surgeon

This is a reference to the Ents in Lord of the Rings

I literally have a replica of Gandalf's sword on my wall in my office at home and didn't get that. Shame on me.

How do you balance work and personal needs as a young surgeon?

I always keep an eye on how many hours I worked that week and include them into an excel sheet that I update every week.

If I worked more than I had to, I demand days off to compensate for that. That is totally fine and a good employer will agree to that.

Ent doctor here in the US. Many ENTS Are generalists in the US, but the trend of sub-specialization has increased quite significantly among residents lately. Do you find that the same thing is happening in Germany?

In my opinion, that will be the future. If you specialize on something, you can treat your patients better. The ENT institutes of many university hospitals in Germany are specialized on some specific fields of ENT. So this trend is happening in Germany as well.

It does have one downside though: The more specialized doctors become in their respective few fields, the narrower their initial thoughts and processes become when treating patients which in extremely unfortunate cases can mean a missed diagnosis of a sickness or even wrong diagnosis and treatment.

Thankfully students still have to go through insanely massive amounts of general medical knowledge in their way to a doctorate.

That is true. In our department we have specialists for different specializations. So we can work together to sort things out.

I don't have a question, but just a general thank you.

I had no idea what ENT was until my son was born with severe congenital nasal pyriform stenosis. He couldn't sleep and was losing weight, so he was brought in for surgery at 2 months old.

It was an extremely harrowing time for my wife and I, but our surgeon was incredible. He was intelligent, focused, as well as caring and compassionate with us. It's been almost a year and I am still so overwhelmed by the medical process and specialty and effort that went into saving my son's life. Our surgeon truly taught my son to fight.

Thank you for being curious, thank you for specializing, thank you for (likely) saving lives.

You are welcome. I - like most of my colleagues - am always happy to be able to help.

I had my tonsils removed over 35 years ago and it was the best decision my parents made (Before that I would get so sick every year with swollen tonsils). Why are doctors reluctant to perform tonsillectomies these days?

We are performing tonsillectomies almost daily. At least in Germany many hospitals aren't doing them too often because you don't get much money for it when compared to more complexe surgeries.

Some ENT surgeons are doing the tonsillectomy as an outpatient surgery. However, since the surgery comes with some risks (e.g. postoperative bleeding which CAN be fatal) I would never recommend that to any patient. Our patients who get a tonsillectomy stay for 5 days so we can check the healing process everyday.

Yes, I gut mine removed as I was five years old.

I spilled that much blood, I can still remember it over three decay later.

To be honest I still remember the amount of ice cream I was allowed to eat, too.

Sometimes I think I still remember the removing of my tonsils. There was a strange sound like cutting through really thick fabric.

Fortunately tonsillectomy today is performed under general anesthesia. Can't imagine getting my tonsils removed while being awake, lol.

My dad (b 1930s) said his rural doctor would just pop out the tonsils with a loop like you use to castrate cattle back in the day.

I didn't ever really find out if he was serious or not....

Sounds like he was serious.

Hey, hi. Then I'll share this: got my tonsils removed while at the Bundeswehr. Was some time around '08, I think.
All I got was local anesthesia, and not a good one. Felt like I was in a SAW movie.

Sat there on the chair while the surgeon jammed his instruments into the back of my throat, over and over again. Saw the blood spurt out of my mouth and onto his apron. Will never forget the smell of burned flesh and the smoke curling up out of my gullet when he cauterized the wounds.

I think I might still be traumatized from that experience. 0/10, do not recommend.

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On the upside: haven't had tonsillitis since then and sore throats occur almost never.

I can't believe there are still ENT surgeons in Germany who perform tonsillectomy with only a local anesthesia...

F

Holy... 5 days?!

Danish ENT resident here. We regularly discharge patients a few hours post-surgery. They are thoroughly instructed to contact the department at any time of the day, should they bleed, and we have a doctor on call 24/7. Does 5 days really make sense?

Postoperative pain is a thing after tonsillectomy. Most patients who dismiss themself after surgery come back to us because they feel saver at our hospital.

isn't 5 days pretty excessive? that seems to be what you would have after a herniated disk or other rather complex surgeries. Doubt your patients appreciate that?

Most of our patients dislike that. But it's just for their own safety. And they can always decide to get the surgery done at another hospital.

How high is the bleed rate at your institution? As an Otolaryngology resident in the US I have a very hard time imagining the risk benefit ratio or NNT favoring this approach, particularly during a pandemic while much of your patient population is waiting on a vaccine. If the goal is to catch all bleeds while patient is in house, you are missing the portion who bleed on days 6-7.

To be honest, that also depends on the surgeon. I would say every 10th patient has postoperative bleeding. However, in most cases this bleeding is small and stops by itself. Postoperative bleeding that needs to be fixed surgically happens once every 2-3 months.

I find it odd how Reddit averts its eyes away from your comment that “you don’t get much money for it”. If you were an American doctor and said that, all hell would have broken loose.

I just try to be honest.

My tonsils are constantly hurting and filled with tonsil stones to the point where I feel like I need to stop talking after about 30 minutes. They're always a little bit inflamed. I try to be diligent on cleaning them and getting the tonsil stones out. Other than that, no tonsillitis symptoms. Should I see an ENT, or is this common?

If you are having pain, I would see an ENT. This isn't common and should be checked.

I believe, removing tonsils may have a negative impact on the immune system. Is that true?

I cried so much when I was five, my mother took me home again. :)

The tonsils are important for the training of our immune system. This is a thing in small children. Once you are older, you won't have any problems. Personally, I perform a tonsillotomy on children under the age of 6 (in that surgery the tonsils are reduced in size but not completely removed).

How would a patient detect bleeding that could be fatal? Or is it just fatal for those who bleed heavily and think it’s fine?

Either very long or very strong bleeding. Patients usually recognize that and call an ambulance (or the nurse if they are still in the hospital).

When will tinnitus be cured?

First we need to understand why patients develop tinnitus. We already know a few causes (cardiovascular problems, problems of the temporomandibular joint, ...) but in most patients we don't understand why they got tinnitus. Once we understand that, we can develop a treatment.

What are your experiences with Kevinism?

To be honest, I can laugh about jokes about the name Kevin. My best friend is regularly joking about me name. You shouldn't take yourself too seriously. And a good laughter doesn't hurt either.

And a good laughter doesn't hurt either

I thought that Germany humor is no laughing matter?

/s

We laugh from tie to time when nobody is watching us. Easier nowadays since you can't see us laughing behind the mask.

What's the weirdest thing you've pulled out of someone's nose?

An almond (patient was a 4 year old girl). You better ask me what the weirdest thing was that I pulled out of someone's nose.

That's what I did ask? Lol

Seems like I was typing too fast... I was talking about the ear... shame on me. Once an adult was putting a sliced onion into his ear. In Germany some people believe that putting sliced onion into a cotton cloth and putting that onto your ear helps against infections. He thought that it was even better if you put the onion into his ear. The result was a giant infection of the ear canal. Smart guy.

How much do you make? How much was education?

I'm making about 4800 € per month (however, my real income is like 60% of that because of taxes).

Education - including university - is somewhat free in Germany. You only pay a small amount per semester for going to university and if you can't pay that, you can get a loan. I am always surprised how expensive studying is in the US.

So your average monthly income is roughly 3000 as a head doctor of the ward in surgery? Seems rather low even for German standards

That's because I am an assistant physician (something like a junior resident). After 5 years on a certain field (like ENT) and after you pass a special exam you are a specialist on that field.

Ohhh, so you do have an attending doctor above you somewhat supervising that is full specialist? That's typically how it is for US medical residents before finishing training and becoming full independent specialist.

Yes, exactly. Everyday, one of our specialists is responsible for the OR. He also is able to help me out if I have any problems at the ward.

4800 Euros/month is around $69,000/year. That's really all you get paid? And ENT surgeon in the US probably makes around $380,000/year.

That's because I am an assistant physician (something like a junior resident). After 5 years on a certain field (like ENT) and after you pass a special exam you are a specialist on that field.

How many hours you average a week?

40 hours

I'm a teenager and your job is my actual dream job. But i'm also into research and studies to find new treatments and discovering new stuff as well. Do you think if i come to your lvl and becom a doctor can i also do research and stuff? Or this job requires so much time that my research dream portion would remain a dream? Sorry for the bad English tho :)

I actually had the same interests as you. I wasn't sure if I would prefer working in a hospital or working in a lab doing research. That's why I did my thesis (something similar to an MD PhD title) in a lab doing research on a topic related to cardiovasular physiology. That helped me to decide that I personally prefer working in a hospital.

If you like both equally you can always work in a university hospital. They even WANT you to do both. However, keep in mind that many of them require you to do your research in your free time. So you won't have to much time for yourself.

So you choose hospital over lab because u wouldn't have much time for yourself, Right? Or any other reason?

I was missing working with people. While in the lab if was often working alone. So I would only talk to people during lunch time or after work. While my time in the lab was great I just prefered to be able interact with people.

Wie oft darf (soll) man Döner essen?

Döner macht schöner. Eat as much as you like as long as there is garlic in it!

When I was 11 I lost my hearing in my left ear, the ENT that I saw theorised that it was due to a stomach bug that travelled up my system to damage the nerve in my ear. Have you ever heard of this happening to other people?

To be honest, I never heared of something like that. I am sorry.

I cannot hear on my left ear since I was 3 or 4 years old (now 32). I had a Blutschwamm that went away over time (probably by my 10th birthday), but they never found out what is actually wrong because I wouldn't lie still in the Röhre. Hearing tests back then indicated very little to no hearing and I should be wearing a hearing aid, but I don't like them.

Has there been any developments in research for these things? Could still be determined what caused this even after this long of a time has passed?

It probably isn't possible to find the cause of your hearing loss now. However, you might want look into: cochlear implant, sound bridge, bone bridge These might be options for you depending on the type of hearing loss. Make an appointment at a university hospital for that. Universitätsklinikum Würzburg is a really good hospital for that if you are able to travel.

Weird question but I’m struggling with constant pressure on my ears for a year now. I got checked several times and my head and my ears seem okay so it has to be some tension on my neck or jaw. Do you have any tips or exercises I could try out? Already have been to osteopathy and doing yoga regularly for my neck.

There is a connection between your nose and the ears. This connection is called the Eustachian tube. Air is able to get to your middle ear through this connection. If the Eustachian tube is too small or if the opening to the tube is blocked less air gets into your middle ear. That can lead to pressure on your ears, sometimes accompanied with hearing loss.

In other words: Get your nose checked.

Also: Practice the Valsalva maneuver every day every hour.

Hey Kevin, hope you and your family are doing okay and thank you so much for all your efforts towards fighting covid.

I live in India and I am looking forward to moving in Germany. Healthcare is one of the biggest questions. Do you think German Healthcare is better and more dependable??

One more question I have is how has your life changed after covid especially since you haven't been able to catch a break like a lot of other people have....

While our healthcare system has its problem it certainly is among the best in the world. Having an insurance is mandatory and if you can't pay for it you get it for basically free. The insurance covers a lot, especially all necessary treatments for life-threatening diseases (like cancer).

I mostly miss meeting with friends and having a good time with them. Meeting online just isn't a good replacement for that.

Do you prefer clinics or surgery ?

Probably surgery. It's just an amazing feeling. However, I would miss talking to patients if I would only do surgery.

Why is there one doctor for all 3 of those orifices?

I'm not the only doctor. All of os work at the ward, in the OR and in the doctor's office. We have a timetable which tells us where we are working at which time. I a the head doctor of the ward which means that I am responsible for the patients there and need to coordinate stuff.

I guess its because they are all connected.

I didn't understand your question at first. Sorry!

There are ENT surgeons who sub-specialize. However, since ear, nose and throat are connected, many diseases affect all of them. That's why it is one specialization.

I’ve had degenerative hearing loss since I was born. One reconstructive surgery to put the bones back together in my right ear. What sorts of things do you recommend to keep tinnitus in check or reduce it? It can be very overwhelming. Thank you for what you do.

Check out Tinnitracks. Many of my patients have good results with that.

I've had this issue in my right ear where ear wax seems to grow unnaturally fast compared to the left one. I need to get it washed atleast twice each year, that can't be good for my ear right? My current ent told me to just use ear drops on it on a regular basis. I'm pretty sure that isn't a permanent solution and I'm visiting another ent this weekend. And shockingly enough, look which post I've stumbled onto! Your 2 cents?

The amount of ear wax that your ears produce is highly variable from person to person. It also isn't uncommon that one ear produces more than the other. Actually, like every fourth of fifth person who visits our doctor's office comes to get his/her ears cleaned. Most of them come after 3-6 months. A professional cleaning of your ear canals isn't harmful and can prevent getting an infection of the ear canal due to too much ear wax.

If your ear is itching, you can try using 1-2 drops of organic olive oil every evening.

PS: Please don't use Q-tips or anything else do clean your ears yourself. I have seen so many injuries just because some people think it is a good idea to stick something into your ears.

Really? Don’t use q-tips at all? I’ve heard that a few times but can’t imagine going 2 days without q-tipping. What do you recommend? Only olive oil drops?

No Q-tips at all. Please. No. If your ear is itching, olive oil is enough (use high-quality oil without pesticides). Your ear is usually able to clean itself. If it can't, let an ENT clean it for you.

I'm having a difficult time understanding how olive oil is going to remove a small oily buildup in my ear. Are there are different types of earwax that olive oil works well for?

It can help if you procude very hard ear wax. It might soften your ear wax so your ear can clean itself more easily.

I normally use a large-ish syringe without needle with warm water, and the brown thing comes off rather easily (I do this in the shower). I assume regular tap water is not the absolute best for this, but it works... am I damaging my ear canals somehow?

If it works, it works. You should still see an ENT surgeon once a year. But you should be fine.

How can I get rid of tonsil stones?

Unfortunately there is no good method to prevent getting tonsil stones. They probably are a result of the accumulation of materal in the crypts of the tonsils.

You could try to remove them by using a Q-tip and pushing it against the tonsil stones. If that doesn't work, just visit an ENT surgeon as he can probably remove them for you.

If you are having significant bad breath because of them, removing the tonsils (tonsillectomy) might be an option. However, this comes with some risks that you should discuss with an ENT surgeon.

How often do you deal with hashimoto's disease and has it ever become serious that you had to remove the thyroid because of it?

At my hospitals thyreoidectomy is performed by the department of general surgery and not by us ENT surgeons. So I don't have much experience with thyreoid diseases.

How are you doing Kevin?

So far I am having a great day off. How are you doing?

Very well, thanks for asking!

:-)

Does Germany have universal healthcare? If so, do you feel that you make a wage that is commensurate with your skill and responsibilities?

We have universal healthcare. While I am happy with my wage, it is lower when compared to other countries.

What do you think of Euro countries putting a hold on the particular vaccine after a few negative reactions?

As I understand, from a statistical perspective, the dangers are still exceedingly small. Does that justify restricting vaccine supply to such a degree given the desperation of the broader demand?

I talked about that with my colleagues and we have mixed feelings about that. On one hand I can understand that they want to verify if the vaccine is really safe. On the other hand it is sending a really bad message to the people. Many already are afraid of getting vaccinated and this really won't help.

Personally, I don't think putting a hold on the AstraZeneca vaccine was a good idea. So far there is no proof that the vaccine caused the thrombosis. Additionally England - who afaik is the country which is using the vaccine the most - observed no significant side effects.

I am residing in Germany and it has become harder to breathe through the nose over the years. Using a facemask everyday makes me notice this especially. I must mouth breathe alot and always when going to sleep.

What is up? Is it Polyps in the nose? Should I consider a Septoplasty?

That can have several reasons. Polyposis is only one possible disease. You should see an ENT surgeon and maybe also get a CT scan of your nose. That helps to find the cause of your symptoms. And that is necessary to decide on a good treatment.

Do you see any connection between people with nose breathing issues/sleep apnoea and weight gain?

There probably is a connection. Some years ago we assumed that weight gain is a major risk factor for sleep apnoea. Today, science isn't too sure if this is right.

From my personal experience, most of my patients who have sleep apnoea are also obesive.

Do you need fluent Entish for your role? Or can you get by with a translator?

Fortunately the nurses at my ward can translate for me. I'm fine with simple phrases like "Hi!" and "Goodbye."

Do German people say “gesundheit” after someone sneezes or is that an American thing?

It is a German thing as well. It is considered polite to say "Gesundheit".

What do you think of Euro countries putting a hold on the particular vaccine after a few negative reactions?

As I understand, from a statistical perspective, the dangers are still exceedingly small. Does that justify restricting vaccine supply to such a degree given the desperation of the broader demand?

I talked about that with my colleagues and we have mixed feelings about that. On one hand I can understand that they want to verify if the vaccine is really safe. On the other hand it is sending a really bad message to the people. Many already are afraid of getting vaccinated and this really won't help.

Personally, I don't think putting a hold on the AstraZeneca vaccine was a good idea. So far there is no proof that the vaccine caused the thrombosis. Additionally England - who afaik is the country which is using the vaccine the most - observed no significant side effects.

I just copy-pasted my answer since somebody else already asked the same question.

What kind of surgeries do Ents usually need? Is it hard having to use a ladder every day because Treebeard et al are so tall? Does it get annoying trying to get their symptoms because they talk so slowly?

Fortunately, Ents are lieing on a table when we perform surgery on them. So we don't need a ladder.

They need to fill out a form before I see them. So I already know what their problems are. Saves a lot of time.

Is the removal of swollen/enlarged turbinates an effective treatment, or do patients usually don't report that they can breathe better after removal? Are there any cons to remove them?

Edit: I also have had a weird feeling at the back of my nose/throat since December. It's as if something is stuck in there. An ENT specialist checked it for me and found nothing. I still feel it though. What could be the possible causes?

1) You shouldn't remove the turbinates since they help to improve the air flow through your nose. However, you can reduce them. In fact, when doing nasal surgery in patients with problems breathing through the nose we almost always make the turbinates smaller. If done right, there is no major downside.

2) Hard to say something about that without checking myself. Maybe your nose is too dry. Try oil nasal spray.

Do you travel to forests like Fangorn to preform surgeries or is your hospital actually equipped to accommodate the Ents?

Our ward is very big. So we can accommodate the ENTS according to the standards of the National Ent Health Association (NEHA).

I lost my smell conpletely due to COVID about 2 months ago .. it has returned to about 40%. At what point do I give up on it healing all the way?

I wouldn't give up. It may take a lot of time. You can try to improve the process by using oil nasal sprays.

I'm using a saline spray, should I switch to oil? Also thank you!!!

You should try oil. Both are fine, but maybe oil is better for you. Trying it out won't hurt you.

How often after an hpv polyp is removed from the esophagus does it recur as cancer, and is there a correlation or increased risk with persons who have viral issues such as HS2 or EBV? Thank you.

We don't do too much cancer surgery (we are sending patients with cancer to the neariest university hospital). So, unfortunately, I don't have any personal experiences on that. I am sorry.

What's the latest you've seen someone have a full recovery from Sudden Hearing Loss?

I live in Berlin and lost my hearing in my left ear in December. The German doctors tell me there's hope for recovery up to 6 months, but the NIH website says it's a lost cause after 4 weeks.

Did you get any treatment so far? 6 months can be possible, but if your hearing hasn't change for 4 weeks, chances are low.

Oral cortisone for 10 days, then IV cortisone for a week, then 3 cortisone shots directly in the ear. No improvement after 3 months :(

Seems like the doctors did what they could. I feel sorry for you. However, hearing aids are really great nowadays. If your hearing is still not good after 6 months, give those a try!

Hello colleague! German internal medicine resident. In the city where I studied in, ENT residency was surprisingly competitive given that there was only one department and they had only few new residents per year. What's your view: How competitive is ENT for applicants who are geographically flexible?

I think it is better over here in Hessen. There are many hospitals with ENT deparments (I know of Frankfurt, Darmstadt, Hanau, Mainz, Marburg, Gießen, Rüsselsheim and Fulda) so it isn't too hard to isn't too hard to get a job.

Hi I’ve always had tinnitus. I had gromitts as a toddler. What I wanted to ask is about the sound. When I clench my jaw or move my jaw around, I can change the intensity of my left ears tinnitus and so I wondered if there is any research on this? I don’t feel it is from ear damage but maybe the nerve in jaw?

Diseases of the temporomandibular joint can cause tinnitus. You should see a orthodontist to check on that.

what newer advice would you give professional singers on voice care?

Don't use too much force. Some people use a lot of force when talking and singing. You can produce a loud voice without stressing your vocal chords too much. A speech therapist can help you with that.

How much do you make? How much was education?

About 4800 per month (because of taxes my real income is about 60% of that).

13 years of school, 6 years of university. Basically free expect a small fee for university (about 250 Euros per 6 months).

So I wear a CPAP and it has done wonders for me, and almost done with it in a few months.

Having said this I still can't breath at the same rate through both of my nostrils..almost like one is just getting a little less air. Now if I push my nose to one side it opens up the passages and I can breathe fine out of said nostril.

I've seen doctors and specialists and just getting tired of the constant tests and referrals and have a few that I give value to.

If I get the surgery where they break my nose and re-set it.. How painful is it? How long is the recovery time? Assume it's a general anaesthetic?

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Edit: The advice that I got from a doctor that I truly trust was lose weight and stop smoking (both of which I am doing quite well - totally done smoking and weight will take time). I assume that surgery should be the last and final option.

Congratulations for quitting smoking. I am sure you will also manage the weight loss!

The surgery sounds more painful than it is. Don't worry. But as you said, maybe you won't need it anyway.

Do you have any advice for Foreign doctors who wants to practice their profession in Germany?

The most difficult part probably is learning German as the language isn't easy. Maybe apply for an internship (for like 1 month) to see if you like it here. Most people can speak English, so you should be fine for the internship.

I snore like a monstertruck and wake myself up during the night. Is it a common thing to do surgery to fix really bad snoring?

Before thinking about surgery a full ENT examination and a sleep study should be done. In many cases, a surgery can fix (or at least reduce) your snoring habits. We perform that surgery regularly and most patients are happy with it.

Is there such a thing as permanently swollen tonsils? Like chronically?

Yes, tonsils can get too big chronically. For example that can happen, if you have a lot of infections of the tonsils. When tonsils are so big, that they are touching each other, they are called "kissing tonsils".