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Please don't attempt auto-turbinectomy at home

Geoff wonders whether he's getting through to his nostril obsessed patient

Geoff wonders whether he's getting through to his nostril obsessed patient

Like many people else I quite like Dali's works, especially his "Persistence of Memory". I wonder, though, if he ever tackled "persistence of false ideas"? Perhaps this is more in Freud's line.

For example, once upon a time I was listening to some music and my friend said, "Did you know this song is about Jesus?" So we skipped back a track on the CD, listened carefully, and established that given the song's robust sexual content it was highly unlikely to be about Jesus.

About a year later the song came on the radio and my friend turned to me and said, in all innocence and certainty, "Did you know that this track is actually about Jesus?"

So I was in surgery this week and a middle-aged woman came to me complaining of frequent nose bleeds. I got up close and personal with my scope, looked, and commented "Well, the inner lining certainly does look quite bruised and bloody."

She was amazed, and went on to explain why. "I keep my nose and nostrils very clean, doctor." And it turns out that once or twice a day she does a deep cavity clean with a cotton bud.

Trying to mute my horror I said as plainly as I could, "Right, job 1 is to stop doing that." Five minutes in to my long and fascinating discourse on nasal hygiene and Little's Area she interrupted me.

As if we were starting all over again she said she couldn't believe the repeated bleeding given what a good job she did cleansing her nose, frequently digging out surprisingly large bits of muck.

I then established that she had self-examined and caught sight of her turbinates (she really did have quite big nostrils). Predictably, she had probed these extensively, convinced that they out not to be there.

I modified my lecture with clever diagrams to include this aspect of the anatomy with the strict instruction to LEAVE THEM ALONE.

You can guess where this is going: one of the last things she said before leaving "So, I'll just keep it clean, right?" This was followed by an invitation to drop in at her perfume shop. I was flabbergasted, but at least it explained her obsession with her nose.

"Dear Dr. Tipper, we are writing to let you know that we have just performed a combined neurosurgical/ENT procedure to remove impacted cotton buds from your patient's sphenoid sinus. She mentioned you in her last words before she went under the anaesthetic. She said that you had encouraged her to attempt auto-turbinectomy and that if she met resistance she was to simply push harder. The GMC will be in touch shortly."

Geoff Tipper

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