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One of the Top Reason for Visiting a Doctor

Ear, nose, and throat complaints, such as allergies, ear infections, sinusitis, and sore throats.

Diseases and disorders of the head and neck, particularly the ear, nose, and throat (ENT), are treated by ENT physicians. Thus, we didn’t want to miss an opportunity to sit down with Dr. Lim Kean Meng, Consultant ENT Surgeon of Columbia Asia Hospital Klang for a quick pick of his expertise on the common issues faced by patients especially at the primary care level on medical conditions relating to the ear.

InfoMed: Hearing loss in the aging population, your comments?
Dr. LKM: Age-related hearing loss (presbycusis) is the loss of hearing that gradually occurs as we grow older. It is one of the most common conditions affecting elderly adults. Approximately one in three people in the United States between the ages of 65 and 74 have hearing loss, and nearly half of those older than 75 have difficulty hearing. Having trouble hearing can make it hard to respond to warnings, hear phones, doorbells, and smoke alarms. Hearing loss can also make it hard to enjoy talking with family and friends, leading to feelings of isolation. The age-related hearing loss most often occurs in both ears, affecting them equally. Because the loss is gradual, you may not realize that you’ve lost some of your ability to hear. There are many causes of age-related hearing loss. Most commonly, it arises from changes in the inner ear (cochlear), but it can also result from changes in the middle ear, or from complex changes along the nerve pathways from the ear to the brain.

Conditions that are more common in older people, such as high blood pressure or diabetes, can contribute to hearing loss. Medications that are toxic to the sensory cells in your ears (for example, some chemotherapy drugs) can also cause hearing loss. Rarely, the age-related hearing loss can be caused by abnormalities of the outer ear or middle ear. Such abnormalities may include reduced function of the tympanic membrane (the eardrum) or reduced function of the three tiny bones in the middle ear that carry sound waves from the tympanic membrane to the inner ear. Older people who experience hearing loss have a combination of both age-related hearing loss and noise-induced hearing loss.

InfoMed: What is a peripheral hearing loss?
Dr. LKM:There are two major categories of hearing loss:

1. Central hearing loss involves problems with central auditory nerve and processing information in the brain.
2. Peripheral hearing loss refers to problems within the ear structures. There are three types of peripheral hearing loss:

• Conductive hearing loss which occurs when the transmission of sound through the external or middle ear is blocked. Sometimes this type of hearing loss is caused by physical abnormalities that are present from birth. More commonly, it begins during childhood as the result of middle ear infections. Other causes include perforation of the eardrum, impacted earwax or objects in the ear canal.
• Sensorineural hearing loss involves problems with the transmission of sound information from hair cells in the inner ear (cochlear) to the nerve that sends sound information to the brain. Sensorineural hearing loss can be present at birth. Or it can occur later in life. Causes include prolonged exposure to loud noise, infection, severe head injury, toxic medications and some rare inherited diseases.
• Mixed hearing loss is both conductive and sensorineural.

InfoMed: What is vertigo?
Dr. LKM: Vertigo is a type of dizziness that the patient has a false feeling of their surroundings is spinning and is usually associated with nausea, vomiting and loss of balance. It can last for few minutes or hours. In most cases, there is a medical condition that causes vertigo. However, sometimes the cause is unknown.

InfoMed: What is Meniere’s disease?
Dr. LKM: Meniere’s disease, also called endolymphatic hydrops, is a disorder of the inner ear where the endolymphatic system is distended with endolymph. It can affect anyone at any age, but it most commonly begins between the ages of 40 and 60.

Usually, the disease is unilateral, but the other ear may be affected after a few years. The disease is named after a French doctor called Prosper Meniere who first described the disease in the 1860s.

InfoMed: The relationship of vertigo with Meniere’s disease.
Dr. LKM: Meniere’s disease is characterized by vertigo, sensorineural hearing loss, tinnitus and ear fullness. An attack of vertigo may last from 20 minutes to several hours. The average is 2 to 4 hours. Many people feel quite sleepy after an attack. Slight unsteadiness may last a day or so after an attack – sometimes longer. The symptoms can vary from person to person and from time to time in the same person. It is thought that a build-up of fluid in the labyrinth from time to time causes the symptoms. The build-up of fluid may increase the pressure and cause swelling of the labyrinth.

InfoMed: How can we prevent Meniere’s disease?
Dr. LKM: The treatment during an acute attack is a short course of vestibular sedative medicines such as prochlorperazine or cinnarizine and bed rest. For prevention and reduce attacks, medicines like betahistine, diuretics and vasodilators. Betahistine is thought to increase the blood flow around the inner ear. This may reduce the amount of fluid inside the labyrinth and prevent symptoms from developing. If you take betahistine every day, it is unlikely to stop all attacks, but it may reduce the number and/or severity of attacks. It does not work in all cases. A trial for 6-12 months of taking betahistine may be advised to see if it helps to reduce symptoms. Others measure like low salt diet, regular exercise, reduce stress, stop smoking and reduce intake of caffeine, tea and alcohol may improve the control. If medical treatment fails to control the attack, other options will be intratympanic gentamycin therapy, Meniett device or surgery into the inner ear.

InfoMed: The importance of physiotherapy for those having Meniere’s disease or vertigo?
Dr. LKM: Physiotherapy like vestibular rehabilitation therapy (VRT) can help with recovery by promoting brain compensation. This occurs because the brain learns to use other senses (vision and somatosensory, i.e., body sense) to substitute for the deficient vestibular system. The goal of VRT is to use a problem-oriented approach to promote compensation. This is achieved by customizing exercises to address each person’s specific problem.

InfoMed: Is vertigo related to migraine headaches?
Dr. LKM: Yes. There is a type of migraine called vestibular migraine that causes recurring episodes of vertigo together with migraine headache and lasts between minutes to hours. It may affect up to one in a hundred people. The dizziness that you get with a vestibular migraine is not an aura. It occurs at the same time as a headache.

InfoMed: How serious is cerumen impaction or earwax which is a naturally occurring substance?
Dr. LKM: A plug of earwax is not a serious problem, more a nuisance. You only need to remove earwax if it is causing symptoms such as ear block, reduce hearing or pain. A doctor can look into the ear canal and confirm a plug of earwax has formed. Earwax may also need to be removed for the fitting of a hearing aid, or if a doctor needs to examine your eardrum.

InfoMed: Is it safe to clean our earwax regularly at home?
Dr. LKM: No need. Our ears have its own cleaning mechanism to push the ear wax outward. So do not try to clean the ear canal with cotton wool buds, etc. This can make things worse, as you will push some earwax deeper inside. It may also cause an ear infection. Let the ear clean itself.

InfoMed: What is the health burden of cerumen impaction?
Dr. LKM: Earwax is a build-up of dead cells, hair, foreign material such as dust, and cerumen. Cerumen is the natural wax produced by glands in the ear. It forms a protective coating of the skin in the ear canal. Small amounts are made all the time. Flakes or crusts of earwax break off and fall out of the ear from time to time.

The quantity of earwax made varies greatly from person to person. Some people form plugs of earwax in their ear canal. This may cause a feeling of fullness and dulled hearing. It can feel uncomfortable. A hard plug of earwax can also sometimes cause ‘ringing in the ear’ (tinnitus) or even a mild type of dizziness (vertigo).A doctor can look into the ear canal and confirm a plug of earwax has formed. A plug of earwax is not a serious problem, more a nuisance.

InfoMed: Does the presence of cerumen impaction directly contribute to hearing loss?
Dr. LKM: Yes. Some people form plugs of earwax in their ear canal and cause a feeling of blockage and hearing loss. A doctor can look into the ear canal and confirm a cerumen impaction.

InfoMed: What is proper ear hygiene to prevent cerumen impaction?
Dr. LKM: Some people are troubled by a repeated build-up of earwax and cause impaction. In this situation, to prevent earwax building up and forming a plug, some doctors recommend using ear drops regularly – for example, olive oil ear drops. However, there is no clear research evidence to guide on this issue. For example, it is not clear how often the drops should be used – from daily, to once a fortnight. It is also not clear if regular use of ear drops does prevent earwax from building up. However, if you are troubled by regular plugs of earwax, you may wish to try using ear drops on a regular basis to see if this prevents the problem.

InfoMed: Many of us use cotton-tipped swabs to remove earwax. Your comments?
Dr. LKM: NO. This can make things worse, as you will push some earwax deeper inside. It may also cause an ear infection. Let the ear clean itself.

InfoMed: Whom can I see to clean my ears?
Dr. LKM: A doctor can look into the ear canal and confirm a plug of earwax has formed. An ENT specialist clinic has the machine to do a suction clearance of impacted ear wax with the guide of ear microscope to prevent injury to the ear canal and eardrum.


WHO 10 Facts about Deafness (WHO Media, updated April 2017)

There are 360 million people in the world with disabling hearing lossThis is over 5% of the world’s population – 32 million of these people are children. Disabling hearing loss is defined as:

·       Adults (15 years and older): hearing loss greater than 40 decibels (dB) in the better hearing ear;

·       Children (0 – 14 years of age): hearing loss greater than 30 dB in the better hearing ear.

Unaddressed hearing loss poses an annual global cost of 750 billion international dollarsThere are significant costs associated with the impacts of unaddressed hearing loss. These include health sector costs, costs of educational support, loss of productivity and societal costs. Interventions to address hearing loss including prevention, screening and provision of hearing devices are cost-effective.
32 million children have disabling hearing lossUp to five out of every 1,000 babies may be born with hearing loss or acquire it soon after birth. Hearing loss can have a significant impact on a child’s development and educational achievements. Early identification of such hearing loss followed by prompt and suitable interventions can help to ensure that children with deafness and hearing loss enjoy equal opportunities in society.
Chronic ear infections are a leading cause of hearing lossOver 30% of hearing loss in children is caused by diseases such as measles, mumps, rubella, meningitis and ear infections. It is estimated that up to 330 million people suffer from chronic ear infections (chronic otitis media, i.e., COM) globally. When left untreated, COM leads to hearing loss and can cause life-threatening complications and mortality. COM is preventable and can be managed effectively through medical and surgical interventions.
Nearly 1 out of every 3 people over 65 years are affected by disabling hearing lossLeft untreated, hearing loss can lead to exclusion from communication and can contribute to feelings of loneliness, frustration and social isolation. Hearing loss in the elderly is also linked with early cognitive decline and dementia. Age-related hearing loss can be managed effectively through a variety of means, including hearing aids.
Noise is a major avoidable cause of hearing lossIt is estimated that 1.1 billion people (aged between 12-35 years) are at risk of developing hearing loss due to noise exposure in recreational settings such as concerts and sporting events and through the use of personal music devices. Regular exposure to loud sounds for prolonged periods poses a serious threat of irreversible hearing loss. This is largely preventable through raising awareness of risks, legislation and following safe listening practices.
Hearing loss can be caused by occupational noise and the use of ototoxic medicationsIn many places occupational noise, such as loud sounds of machinery and explosions, has become the most compensated occupational hazard. This can be largely prevented through improved awareness and use of personal protective devices. Some commonly used medicines (such as aminoglycosides and certain anti-malarial medicines) can also lead to irreversible hearing loss. Ototoxicity, a drug’s property of being toxic to the ear, can be prevented through awareness among health care providers and by the rational use of drugs.
People with hearing loss can benefit from devices such as hearing aids and cochlear implantsCurrent production of hearing aids meets less than 10% of the global need, and in developing countries, less than 3%. It is estimated that there are 72 million people who could potentially benefit from the use of a hearing device.
Sign language and captioning services facilitate communication with deaf and hard of hearing peopleDeaf often use sign language as a means of communication. Family members, medical professionals, teachers and employers should be encouraged to learn signs/sign language in order to facilitate communication with deaf people. Use of loop systems in classrooms and public places, as well as provision of captions on audio-visual media, are important for improving accessibility of communication for people with hearing loss.
60% of childhood hearing loss is preventable through public health actionsStrategies for prevention of hearing loss include:

  • Strengthen maternal and child healthcare programmes including immunization
  • Implement infant and school-based hearing screening
  • Train healthcare professionals in hearing care
  • Make hearing devices and communication therapies accessible
  • Regulate and monitor the use of ototoxic medicines and environmental noise
  • Raise awareness to promote hearing care and reduce stigma

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