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why you shouldn't use cotton buds to clean your ears

21/2/2022

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1. It’s unnecessary
The ear is self-cleaning. No routine maintenance is required. If you’re inserting swabs into your ears to remove earwax or prevent its build-up, think again. Earwax is produced within the ear canal and naturally migrates from deeper inside to outside. There are exceptions, of course. Some people make more than the average amount of earwax, and for others (especially older adults) it becomes harder and drier than usual. Even in these situations, inserting a swab inside the ear is not the answer. 


2. It may be harmful
Inserting a cotton tipped swab (or anything else) into the ear can damage the ear canal or eardrum, or push earwax further into the canal, making it harder to remove. This may cause a feeling of pressure in the ear and hearing loss. Even worse, clumps of earwax pushed down near the eardrum can lead to ear infection, pain or ear blockage.

3. Earwax is not a sign of poor hygiene
Earwax — the medical term is "cerumen" — is there for a reason. 
  • It is a natural moisturizer, preventing the skin inside the ear from becoming too dry.
  • It traps dirt and dust before they can reach deep into the canal.
  • It absorbs dead skin cells and debris.
  • It prevents bacteria and other infectious organisms from reaching the ear drum.
Some people make more earwax, while others make less. The makeup of earwax varies depending on ethnicity, age, environment, and even diet. The presence of earwax is not a reflection of uncleanliness; in fact, it’s a sign of normal, healthy ears.
 
What to do about "cerumenosis"
Build-up of earwax can cause symptoms. This is called "cerumenosis" or impacted wax. Over-the-counter ear drops that can soften earwax and allow it to exit the ear more easily (with gentle irrigation, such as during a shower) can be used. Or an ENT specialist can look inside your ear and use instruments specifically designed to remove earwax.

​In conclusion . . .
There’s a reason the makers of cotton-tipped swabs put this warning on their packaging: "Do not insert swab into ear canal. Entering the ear canal could cause injury." But, it still goes on. Perhaps it’s just too tempting or satisfying. Perhaps no one reads the labels of the products they use. Or maybe the myths about earwax are too ingrained to be easily dispelled by facts. Whatever the reasons, now you know to stop putting cotton-tipped swabs into your ears. And that also goes for unfolded paper clips, pen caps, or whatever else you’ve been using!
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My child is snoring. Should I be worried?

29/4/2021

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Sleep is vital for childhood development, so it’s no surprise that many parents are concerned if their child snores. If the snoring only happens occasionally, there is no need to worry. But if it is frequent or severe, then it may mean that your child has obstructive sleep apnoea. The effects of this on a child can include disturbed sleep, poor daytime behaviour and difficulty learning at school. So if you are worried about your child's snoring, you should make an appointment to see an ENT specialist as soon as possible.
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What is obstructive sleep apnoea?
Obstructive sleep apnoea (OSA) is when a child briefly stops breathing while sleeping. It happens because of a blockage in the upper airway. The pause in breathing may occur many times in a night, disrupting the child’s sleep. The condition is most commonly found in children ages 3 to 6.
What are the symptoms of OSA in kids?
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During sleep, you might notice the following:
  • Snoring
  • Frequent awakenings from sleep
  • Restless tossing and turning
  • Mouth breathing
  • Choking or coughing during sleep
  • Noticeable pauses in breathing often with a ‘snort’
  • Bed-wetting
​​​During the day, you might notice the following:
  • Tiredness
  • Falling asleep in school or napping at unusual times
  • Attention problems or poor performance in school
  • Hyperactivity and other behavioural problems
  • Personality changes such as being moody, cranky or irritable
  • Headaches, especially in the morning, upon waking
​So why does OSA in children matter?
Over time, sleep apnoea can have significant effects on your child. Fatigue can lead to poor concentration and the inability to function during the day. This leads to poor school performance. It can also cause hyperactivity and mood swings.
Due to reduced oxygen intake through the night, children can experience growth or developmental delays in severe cases. Paediatric sleep apnoea is also associated with heart problems, high blood pressure and childhood obesity, and can have an impact on brain function and intelligence.
What is the treatment of paediatric obstructive sleep apnoea?
Treatment will depend on your child’s symptoms, age, and general health. An overnight sleep study is often conducted to find out how severe the condition is.
The treatment for OSA is based on the cause. It may include:
  • Surgery to remove enlarged tonsils and adenoids (known as adenotonsillectomy). This is the most common treatment for moderate or severe OSA.
  • Intranasal steroid sprays may help children with mild obstructive sleep apnea caused by swelling of the lining of the nose (chronic rhinitis) or enlarged adenoids.
  • Leukotriene receptor antagonists (e.g. montelukast) have also been found to be useful in mild OSA.
  • Staying away from second-hand smoke, indoor pollutants, and allergens is important for children who have chronic rhinitis.
  • Weight loss may help if your child is overweight.
  • Continuous positive airway pressure (CPAP). This is a machine that delivers a steady stream of air (via  special mask) to keep the child's airway open. Some children may have trouble getting used to the mask.
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Do I have a cold, or is it sinusitis?

2/12/2020

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​Sneezing and a runny nose are annoying symptoms of the common cold. But when you have pain and pressure, there is a good chance you have a sinus infection. When your sinuses are blocked, pressure builds up inside them. This can make your face sensitive to touch, especially around your nose and eyes. You might notice that leaning forward or moving your head causes the pain and pressure to worsen. If this happens, it is time to see your friendly Singapore ENT doctor and sinus specialist! 
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What are the symptoms of sinusitis?
  • pain, swelling and tenderness around your cheeks, eyes or forehead
  • a blocked nose
  • a reduced sense of smell
  • green or yellow mucus from your nose
  • a sinus headache
  • a high temperature
  • pain in your teeth
  • bad breath ​​
How long does a sinus infection last?
There are two main types of sinus infections, acute and chronic.

Acute sinusitis

Acute sinus infections come on suddenly. They can be caused by a virus or bacteria. An acute sinus infection caused by a virus is the most common type of a sinus infection, and it typically clears up on its own. It can take up to four weeks to recover completely, but your symptoms will begin to clear up after about seven days.
An acute sinus infection caused by bacteria lingers longer and will likely need medical treatment to heal. Symptoms of a bacterial sinus infection can last for ten days or more, but go away quickly once you get treatment.
 
Chronic sinusitis
A chronic sinus infection is an infection that lasts long-term, usually for 12 weeks or longer. They can be caused by bacterial infections that aren’t treated or fungal infections. Chronic sinus infections are more complicated to treat, and they won’t go away on their own.
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Tips to avoid sinus infections
  1. Wash your hands frequently.
  2. Keep the nose moist with nasal saline sprays (the microscopic hairs inside the nose work more effectively in a moist environment).
  3. Keep your allergies under control.
  4. Avoid nasal irritants such as pollution or smoke.
  5. Irrigate your sinuses on a regular basis with a saline sinus wash (ideally at least once a day).
  6. Try to avoid taking oral antibiotics or steroids unless you really need them, as both will affect the natural good bacteria (biome) that lives in the sinuses and allows bad bacteria to proliferate.
  7. If you do need antibiotics then take oral probiotics, in order to replenish the natural biome of the sinuses.
  8. Persistent nasal congestion can decrease airflow to the sinuses and may also block the outflow of the sinuses. If you have a badly deviated septum or a hole in your septum, getting that repaired will help prevent infection.
  9. Swim in salt water pools as they are less irritating to the nasal and sinus mucosa, and produce much less inflammation when compared to chlorinated pools.
  10. Try to maintain a healthy lifestyle and maintain a strong immune system because other illnesses, such as a viral cold or flu, can cause a bacterial sinus infection to occur.
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Eustachian Tube Dysfunction

22/8/2020

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We've all had that feeling of blocked ears on a flight. Usually it will clear easily by blowing the nose or swallowing. But what happens if it doesn't clear? This is when you should see an ENT doctor to try and relieve the blockage. Persistent ear block can lead to pain or even hearing loss. The following article explains a little more about the what might be causing the problem and how best to treat it.​
What is the Eustachian tube?
The Eustachian tube is a cartilaginous and bony tube providing a connection between the back of the nose (nasopharynx) and the middle ear. At rest, the Eustachian tube is closed, but it opens when you swallow, yawn or sneeze. It can also be opened forcefully by raising pressure in your nasopharynx by blowing your nose and “popping” your ears. When the Eustachian tube opens, it allows the equalising of pressure between the external environment and the middle ear by allowing a small amount of air to pass through.​
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The Eustachian tube connects the middle ear to the nasopharynx
What are the symptoms of Eustachian tube dysfunction?
When the Eustachian tube does not work very well, a number of different symptoms can occur. These include:
Ear block
​Pain
Feeling of fullness in the ear
Ringing in the ears (tinnitus)
Difficulty hearing
Dizziness or balance problems​
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Eustachian tube dysfunction can lead to pain in the ears
​What causes Eustachian tube dysfunction?
The main causes of Eustachian tube dysfunction are conditions that lead to swelling in the nose and nasopharynx. These include upper respiratory tract infections, allergy, pollution, and smoking. Other triggers include extreme pressure changes that occur when flying or SCUBA diving, and temporomandibular joint (TMJ) disorders. 

How is Eustachian tube dysfunction treated?
Firstly, it is important to see an ENT doctor to exclude other common causes which often produce similar symptoms (e.g. impacted ear wax, outer or middle ear infection, sudden sensorineural hearing loss, or ear drum perforation).
Once these other causes have been excluded, the ENT specialist will usually try medication to reduce the swelling which is the causing the blockage of the Eustachian tube. These include nasal decongestants (e.g. Afrin, Iliadin), topical nasal steroid sprays (e.g. Avamys, Nasonex) and antihistamines with decongestants (e.g. Telfast-D, Zyrtec-D).


If the medication doesn’t work, then the patient can consider a procedure in order to relive the symptoms. A small cut in the ear drum can be done under local anaesthetic (myringotomy). If this helps, then a small tube (grommet) can be inserted to keep the hole open. This has several disadvantages, however. In Singapore (because of the humidity), the risk of an ear infection is high – this is more likely if the patient swims regularly. It also cannot be used if the patient is a SCUBA diver.

​A promising new treatment – first described in 2011 and only available in Singapore in the last 6 years - is to use a high-pressure balloon to widen the cartilaginous Eustachian tube. Known as Balloon Dilation of the Eustachian tube or Balloon Eustachian Tuboplasty, this simple procedure restores normal tube function and can reduce or resolve the patient’s symptoms. It is usually performed under a short general anaesthetic in day surgery; however, it is increasingly being offered under local anaesthetic. During the operation, a probe is inserted into the affected Eustachian tube and a special balloon is inflated to a set diameter at high pressure (10 bar). You can see a video of the procedure here. Complications from the procedure are rare and the recovery is very quick.
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Balloon dilation of the Eustachian tube is a promising new treatment
9 Comments

House Dust Mite Allergy

19/8/2020

5 Comments

 
If you see an ENT doctor in Singapore with a blocked nose or sinus infection, he or she will often consider allergy as an underlying risk factor. The commonest allergy in Singapore is house dust mite allergy. About 80% of the adult population in Singapore has evidence of house dust mite allergy (IgE antibodies) but only half (roughly 40%) will develop symptoms of allergic rhinitis (swelling of the nasal lining).​
Avoiding exposure to dust mites is the best strategy for controlling dust mite allergy. While you can't completely eliminate dust mites from your home, you can significantly reduce their number.​
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​This ten-point plan will help reduce dust mites in your home.
  1. Use allergen-proof bed covers. Keep your mattress and pillows in dust-proof or allergen-blocking covers. These covers, made of tightly woven fabric, prevent dust mites from colonising or escaping from the mattress or pillows. Encase box springs in allergen-proof covers.
  2. Wash bedding weekly. Wash all sheets, blankets, pillowcases, and bed-covers in hot water that is at least 60C to kill dust mites and remove allergens. If bedding can't be washed hot, put the items in the dryer for at least 15 minutes at a temperature above 60C to kill the mites. Then wash and dry the bedding to remove the allergens. Freezing non-washable items for 24 hours also can kill dust mites, but this won't remove the allergens.
  3. Keep humidity low. Maintain a relative humidity below 70% in your home. A dehumidifier or air conditioner can help keep humidity low, and a hygrometer (available at hardware stores) can measure humidity levels.
  4. Choose bedding wisely. Avoid bed-covers that trap dust easily and are difficult to clean frequently.
  5. Buy washable stuffed toys. Wash them often in hot water and dry thoroughly. Also, keep stuffed toys off beds.
  6. Remove dust. Use a damp or oiled mop or rag rather than dry materials to clean up dust. This prevents dust from becoming airborne and resettling.
  7. Vacuum regularly. Vacuuming carpeting and upholstered furniture removes surface dust — but vacuuming isn't effective at removing most dust mites and dust mite allergens. Use a vacuum cleaner with a double-layered micro-filter bag or a high-efficiency particulate air (HEPA) filter to help decrease house-dust emissions from the cleaner. If your allergies are severe, stay out of the area being vacuumed while someone else does the work. Wait about two hours before going back in the vacuumed room.
  8. Cut clutter. If it collects dust, it also collects dust mites. Remove knickknacks, tabletop ornaments, books, magazines, and newspapers from your bedroom.
  9. Remove carpeting and other dust mite habitats. Carpeting provides a comfortable habitat for dust mites. This is especially true if carpeting is over concrete, which holds moisture easily and provides a humid environment for mites. If possible, replace wall-to-wall bedroom carpeting with tile, wood, linoleum, or vinyl flooring. Consider replacing other dust-collecting furnishings in bedrooms, such as upholstered furniture, non-washable curtains, and horizontal blinds.
  10. Install a high-efficiency media filter in your furnace and air conditioning unit. Look for a filter with a Minimum Efficiency Reporting Value (MERV) of 11 or 12 and leave the fan on to create a whole house air filter. Be sure to change the filter every three months.
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    Welcome to Dr Chris' blog page

    In this blog, Singapore ENT Specialist and Head & Neck Surgeon, Dr. Chris Hobbs, will share useful information about the ENT conditions that you may be suffering from.

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