21 January 2026

Beware the hubris of doctors

Peering into Alan’s ear, I failed to spot the reason for his depression

Alan’s left ear was driving him crazy. For five years he’d been plagued by strange symptoms. The skin there felt odd: numb when he scratched or pinched it, yet paradoxically hypersensitive, with sudden lancinating pains that would take his breath away. And he could tell there was something in there – the ear felt periodically blocked and full, his hearing muffled like he was underwater – except that any time a doctor examined him, Alan was told there was nothing wrong.

He’d tried endless drops to clear the blockage and had flushed it any number of times. “Sometimes I just feel like ramming a pencil in there, anything to get rid of it.” As he talked, he repeatedly rubbed and jabbed at the offending ear. His wife kept laying a hand on his arm, trying to soothe his distress. Attempting to catch up on half a decade of history in a single appointment is a tall order, but Alan’s GP was away and he had come to me in desperation. I steeled myself to run late.

His notes contained multiple letters from an ENT specialist, professing himself unable to explain Alan’s symptoms. Examination was perplexingly normal: aside from some scattered scabs where Alan had worried away at the skin, there was nothing to find. But when I mapped out the area of distorted sensation, it involved not just the ear but the side of his scalp and the skin overlying his jaw as well.

I called up a dermatome map on my computer and showed them the graphical representation of the territory supplied by the mandibular branch of the trigeminal nerve. It exactly matched. “I’ve never seen anything like this before,” I admitted, “but I think it must be a nerve problem, a neuropathy.”

“That’s what the psychiatrist wondered, last time I saw him,” Alan said. Living with intrusive symptoms that no one seemed able to explain had taken an inexorable toll on his mental health. He’d become profoundly depressed and anxious and had been off work for more than a year as a result.

I did more research later that day. The clincher was the underwater sensation. The mandibular branch controls a tiny muscle that tenses the eardrum to protect it when there is especially loud noise; when it malfunctions, it creates exactly the blocked feeling that was driving Alan to distraction. The usual cause of trigeminal neuropathy is trauma, and sure enough Alan had sustained a head injury in 2020 before his ear problems had kicked off. I started him on a medication that I hoped would damp down the aberrant nerve sensations and emailed him the paper I’d found describing the condition so he could digest the information in his own time.

I briefed Alan’s GP on my findings when he returned from leave, and I kept an eye on Alan’s notes, expecting to learn of improvement now the mystery had been solved. Understanding what troublesome symptoms do and do not mean can be powerfully therapeutic.

Except things got worse. The medication I’d started him on proved ineffective and a further ENT consultation was similarly fruitless, and Alan ended up being admitted to the psychiatric ward with severe agitated depression. While noting Alan’s obsession with his ear symptoms, the psychiatrist’s focus was instead on his disturbed mental state. He commenced Alan on potent antipsychotics and charted his steady resolution, such that by the time of discharge Alan was hardly bothered about his ear at all.

Reflecting, I can see this was principally a case of my own hubris. Making a rare diagnosis can give any doctor a warm, self-satisfied glow, and it had made perfect sense to me that Alan would have been distraught by the years spent as a medical mystery. My pride in puzzling out the underlying cause had blinded me to the bigger picture. Depression and anxiety will hugely magnify any physical symptom, and I had failed to appreciate that Alan’s obsessive ruminations over his ear were actually a sign of how far it had consumed his mind and soul.

[Further reading: Britain’s youth are living in Nick Clegg’s shadow]