How do you talk so that teens will listen? Use the news.
Explore This IssueOctober 2019
Citing headlines can be one way to introduce a topic or help it sink in, said Nancy Young, MD, the Lillian S. Well Professor of Pediatric Otolaryngology at the Northwestern University Feinberg School of Medicine in Chicago. The risks of vaping, which is rampant among middle school and high school students according to a 2018 survey of 13,850 eighth, 10th, and 12th graders conducted by the National Institute on Drug Abuse (available at monitoringthefuture.org), were recently highlighted with reports this fall of several vaping-related deaths and hundreds of vaping related lung injuries.
To Dr. Young, recent news is a lead in to discussion about how to avoid practices such as vaping while patients may be seeing her for unrelated otolaryngology issues, she said. “As in, ‘While you are here, this is related to my specialty and this is in the news. It’s a dangerous thing.’” Similarly, discussing the importance of wearing helmets during biking, skateboarding, and related activities has gotten easier because there has been so much news about trauma, football, and concussions,” Dr. Young added. “You can say very little but can still reinforce that it’s important to protect your brain and use a helmet.” Such news makes the message “much more visceral,” instead of talking about things that will happen in the future. “It is difficult for many teens to imagine themselves as adults damaged by the choices they make today,” she said.
When patients come to otolaryngologists for issues such as earwax removal, ear infections, or sinusitis, it’s an opportunity to discuss effective generalized preventive health measures related to topics such as vaping, tobacco and cigarette use, healthy eating, and helmet use. Doing so in an open, rather than punitive, way, helps ensure that the message is heard.
Common Sense Coupled with Authority
Taking a common-sense approach to talking with teens can help solve problems that might seem more complex than they are. Pediatric and adolescent patients frequently come to Julie Wei, MD, division chief of otolaryngology and audiology at Nemours Children’s Hospital in Orlando and member of the ENTtoday editorial advisory board, because they are “tired” or have many complaints such as “sinus” problems or asthma and are taking multiple medications, she said. “Almost everyone is eating terribly,” she said. “I ask everyone what they eat and drink, and with teens, most don’t eat breakfast, and there’s no snack time in school,” she said. “They say ‘I don’t eat lunch at school because it’s gross,’ [and] it’s a rare one who goes to the salad bar. They are famished when they get home, and they eat everything in sight and drink Propel energy drinks. Then, they crash.” The trend starts around seventh grade when they decide they are not hungry and start skipping breakfast, she said.
“Once we clean up their diet, they become top performers. The ones who never come back, I can’t help them,” she said. “With teens, some you can’t engage. The ones who listen, they learn how to read food labels, and they learn that, ‘If you don’t take care of your body, it won’t take care of you.’ I also ask about, and encourage, physical activity.”
The approach works with parents, who are happy to hear otolaryngologists speak as impartial authorities. With teens, “I make them the center of the visit. In our clinic, we see patients from birth to age 18, so we get so used to talking to the mom of a five-year-old. We act like the 13-year-old is not there, but I’ve learned not to do that. I tell the kid they are old enough to speak, and the parent can add things as needed.”
Encouraging healthy eating is also a priority for John Carter, MD, the section head of pediatric otolaryngology at Ochsner Health Systems in New Orleans. “One of the biggest things I see is sleep apnea, where weight can be a contributing factor,” he said. His office has a healthy lifestyles clinic, with pediatric nutritionists to help teens reformulate their diets to get their weight down, he said. “As an otolaryngologist, when I’m talking about taking out tonsils and adenoids, if we get the patient’s weight down, the procedure will be more successful,” he said.
Some otolaryngologists appeal to teens’ interest in their appearances. “I talk to them about skin, and how sugars fuel inflammation and can lead to eczema,” Dr. Wei said. Since teens often shut down when warned of far-off dangers, such as cancer from smoking, Sujana Chandrasekhar, MD, a partner at ENT and Allergy Associates in New York City and a member of the ENTtoday editorial advisory board, talks to patients about how vaping, chewing tobacco, and smoking affect one’s looks. “Smoking will age you, and you will look significantly older than you are very quickly,” she said. “I also ask—if they have a lot of acne—if they are eating more greasy foods than they should be.” With the newest understanding of the high risks of vaping and the CDC warning, Dr. Chandrasekhar advises against all tobacco products but has zero tolerance for vaping. The key, she said, is to explain why, and allow teens to take responsibility for their own health.
Can You Hear Me Now?
When Dr. Chandrasekhar took her preteen daughter to see Taylor Swift’s 1989 concert in July 2015, the duo received light-up wristbands along with everyone else at the show. As the music pulsed, so too did the bracelets, which changed color and design with each song. But Dr. Chandrasekhar thought Swift could have distributed something better to her audience.
“She could have given out earplugs that cost about twenty cents a pair,” she said. “If concert venues gave away earplugs, the chances are overwhelming that people would use them. If you’re at a concert or a club, you can bring foam earplugs along in your pocket. By wearing them, you immediately cut down about 25 decibels of noise.”
Dr. Chandrasekhar, an avid music fan, said she has seen earplugs sold in other concert venues. “But if you’re a kid in college without a lot of money, you could go get a beer instead. Why would you buy earplugs?”
She counsels her patients about the importance of ear protection at live venues, in clubs, and while listening to recorded music individually through earbuds or headphones while at home, studying, or relaxing. Earplugs help prevent potential hearing loss, which may not be apparent until years or decades later.
“It’s easy to be a little proactive,” she said. “Stick a pair of earplugs or tissue in your pocket” before going out to a concert or club. “You don’t want to put in little bits of tissue paper in your ears, but you can wad up tissue and stick it in your ear if that’s all you have. Being cognizant of the potential damage makes even the cheapest earplugs helpful,” she said.
Sharing her love of music is one way that Dr. Chandrasekhar counsels her teen patients about how to prevent hearing loss from loud music exposure. “I think we have an obligation as otolaryngologists to be another voice that understands their desire to have fun and to listen to music, but also notes, ‘can you do that without putting your future at risk,’” said Dr. Chandrasekhar.
What’s New, Now
There are several famous musicians who have discussed their hearing loss and tinnitus from years of performing and creating live music, including giants such as Pete Townsend of The Who. But many teens today don’t recognize the names, said Dr. Chandrasekhar. “That used to be effective 10 to 15 years ago, but now, nobody young knows who Pete Townsend is,” she added. Citing younger musicians, such as Coldplay’s Chris Martin, or Bradley Cooper’s character from the film A Star Is Born, who have tinnitus, may better resonate with teens. “It’s important to convey that you value the things they value, and within that construct, how you can help them make choices that keep them as healthy as possible,” she said.
Doing so helps physicians better connect with their patients. “I try to stay up to date with current music and current topics because it’s helpful to be knowledgeable about what they are into, and it really disarms them in a visit,” said Dr. Carter. “If I had a three-year-old patient, I ask who their favorite Sesame Street character is. With a teen, I know about what artists, like Drake, are currently touring.”
Ultimately, otolaryngologists who are committed to reaching their teen patients are more likely to make a positive impact that lasts. “The hard part is to remember to do it,” said Dr. Young. “We are all so busy, and it’s usually not why the patients are there. We don’t usually see ourselves in the primary care business. You have to have really changed your mindset, and it has to be very purposeful.”
Cheryl Alkon is a freelance medical writer based in Massachusetts.