Cleaning Of Ear Wax

Cleaning Of Ear Wax

Ok! We all know that ear digging feels Super “Shiok“!

Did you know that our ear canal is a self-cleaning organ, and dead skin, hair & earwax are constantly moving out from our ear canal?

The common use of cotton buds for cleaning ear wax tends to push wax deeper into the ear canal. This may lead to a complete obstruction in some patients.


What is Ear Wax (Cerumen)?

Ear Wax, also known as cerumen, functions as a natural barrier preventing physical damage to the external ear canal from water, insects, trauma, infection and other foreign bodies. It is composed of secretion from sebaceous and ceruminous glands in the ear canal and admixed with sloughed skin, normal skin flora, water and the occasional depilated hair.

Fun fact of the day:

The uppermost of the skin (skin epithelium) moves from the inner to the external part of the ear and serves to remove excess wax from the ear canal.

The concern arises when this innate system is hampered or insufficient.

Read: 5 Objects Found In the Ear Where they Should Not Belong!


What are the Causes for Earwax to Buildup?

1.) Obstruction/ Narrowing of the ear canal

  • Ear canal disease is one of the causes of the impedance of clearance of wax. Ear canal disease can be secondary to bone damage such as osteoma (benign bone growth); or skin conditions including infection of the external ear canal and eczema.
  • Ear canal that is tortuously narrowed either due to normal anatomical variations or repetitive injury and infections of the soft tissue ear canal has a higher risk of Ear Wax impaction.

2.) Ineffective ear-wax migration

  • The glands lining the ear canal shrinks as we progress with age. This produces more solid, less fluid-consisted wax. The wax clearance mechanism becomes inefficient.
  • The common use of cotton-tipped applicators (eg Cotton buds) tends to push wax deeper into the ear canal, this may lead to a complete obstruction in some patients.
  • Prolonged use of earplugs, hearing aids and swim moulds can potentially obstruct ear canal and contribute to the accumulation of ear wax.

3.) Excessive ear wax

  • Excess ear wax can occur as a result of injury to the ear canal or water retention.

Read: What are the causes of Swimming’s Ear Infection (Outer Ear Infection) 


Are There Any Symptoms?

Most people are asymptomatic (no symptoms displayed) despite the accumulation of wax in the ear.

In some, symptoms surface when wax becomes hardened and hard to remove.

Patients may experience ear painfeeling of pressure in the earhearing lossitchdizziness or ringing sound in the ear.


Who Will Benefit from Ear Wax Removal?

1.) Symptomatic patients

Patient with symptoms arising from wax accumulation who underwent wax removal experienced IMPROVED symptoms.

2.) Patients with an inability to express symptoms

This category of patients includes young children and patients with cognitive impairment. Ear Wax removal is advisable in these instances as its benefits in relation to hearing improvement has been well-evidenced.

3.) Asymptomatic patients

However, patients without symptoms are not advised to undergo routine Ear Wax removal as the Ear Wax mostly clears without intervention. Also, Ear Wax can serve as a protective layer.

Pearls of wisdom:

  • Consider consulting a doctor if you experience symptoms indicating excess wax such as troubled hearing, earache, ear block sensation or tinnitus.
  • Avoid attempts to remove Ear Wax using cotton bud sticks as this pushes the Ear Wax deeper into the canal leading causing further obstruction.
  • Excess ear wax can be managed by Ear Waxolytic ear drops, irrigation or manual extraction. A doctor will be able to advise on the appropriate method based on a patient’s medical history, expectation and preference.

What are the Ear Wax Removal Options?

1.) Cleaning Ear Wax by Cerumenolytic agents

Safe option in patients without infective, eardrum perforation, ear surgical histories. Unlike, other methods of ear wax removal, this is a convenient and effective option.

Patients who opt for this choice of treatment should follow-up with a doctor for examination as prolonged retention of cerumenolytic drops behind the Ear Wax can lead to irritation of the skin lining of the ear canal.

However, some patients have reported transient hearing loss, dizziness, ear pain, and external ear canal infection. It is advisable to use cerumenolytics not more than 3-5 times a day for this reason.

2.) Cleaning Ear Wax by Irrigation

Ear irrigation is one of the most widely used methods to remove Ear Wax. This involves using flushing of water to remove the build-up of ear wax. Under the gentle force of water, the ear wax is dislodged and flushed out from the ear. This procedure is not advisable for patients who have a history of the hole in the eardrum or ear infection.

A common side effect of ear irrigation is the retention of water behind any wax that was not completely removed. As a result, this might result in an infection of the ear canal. Irrigation may also lead to perforation of the eardrum, hearing loss, ear pain, giddiness and tinnitus.

3.) Manual Removal of Ear Wax

The procedure needs to be performed by an experienced clinician with appropriate equipment. Manual removal requires sufficient visualization with an otoscope or a binocular microscope.

Instruments used include curettes, forceps, hooks, suction. It is a preferred option for patients with perforation eardrum or patients at high risk of sustaining an ear infection.

Manual removal procedures are most effective for removing Ear Wax in the ear canal.

The method can be associated with ear pain, bleeding, laceration and perforation of the eardrum.

4.) Ear Toilet (Aural Toilet)

Toilet?! It is not as unglamorous as it sounds. Ear Toilet is an ear cleaning procedure using “micro-suction” or “mini-vacuum” tube to remove earwax in a safe manner.

With direct visualisation through a binocular microscope, this enables our doctors to clean the ear canal with greater precision and reduced patient discomfort.

This method allows 2-handed working which further minimizes the risks of human error.

5.) Ear Candling

This involves lighting one end of a hollow candle and putting the other end in the earEar candling is not FDA recommended for ear wax removal, as it is not safe and can cause injuries or burns.


If you are experiencing an Ear Infection or Excessive ear wax build up in your ears, it is highly recommended to visit a doctor at as soon as possible.

Our clinic provides Treatment for Ear Infection & Ear Toilet (Ear Wax Removal Singapore), you can email us at hello@dtapclinic.com or call us at +65 6962 7144.

What Are The Sign Symptoms & Nose Cancer

NPC stands for Nasopharyngeal Carcinoma. It is basically the most common form of cancer that arises from the back of the nose and it’s a silent killer. This is more common in Asian than in Western countries.
Over time, the tumour can grow, ulcerate and invade into nearby structures in your body, leading to nerve involvement. In its early stage, all these can occur without any symptoms. In the late stages, you might start to experience symptoms and these include:

  1. Block nose
  2. Headache
  3. Double vision
  4. Neck lumps
  5. Nose bleed
  6. Blood stained saliva
  7. Loss of hearing

RISKS FACTORS
There are various risk factors that you should be aware of.
The first is Age and Gender.
Nose cancer is more common in males and there is also a bimodal age presentation where occurrences peaked twice; once when the individual is in early adulthood and the second later in life.
The second is the presence of an infectious virus.
Studies have shown that the presence of EBV (also known as the Epstein – Barr Virus) has a positive correlation with Nose Cancer. As such, EBV antibodies and DNA are often tested for by performing simple blood tests in screening for Nose cancer.
The third is a lifestyle.
It is believed that smoking contributes to the risk of Nose cancer caused by the reactivation of EBV. Even though there is currently inconclusive evidence of this co-relation, smoking itself does cause many other diseases!
Another issue with lifestyle relates to our dietary practice. Consuming preserved foods – such as salted fish contains high levels of preservatives which increases risks of Nose cancer.
The last is Genetic Susceptibility.
Individuals with first-degree relatives that have been diagnosed with Nose cancer are also at a higher risk of being diagnosed with Nose cancer. While this is beyond your control, you can reduce your risk by limiting your exposure and watching your lifestyle.

What should you do?
As a starting point, you should undergo a physical health examination. A look into yours and your family’s medical history may also be of assistance.
If you do have a positive family history, you may consider doing a simple blood test to screen for Nose cancer. Studies have shown that there is a higher survival rate when Nose cancer is detected early.
Undergoing a non-fasting blood test is a fuss-free process and the report will usually be available within 3-5 working days. The doctors will advise you accordingly based on the results of the blood test.

If you like to know more about Nose Cancer & Nose Cancer Screening. Please call or visit Our Raffles Place Branch.
For more information, please email us at hello@dtapclinic.com.

How Do I Get Rid of My Ear Discomfort and Hear Better?

Have you ever felt the need to clean your ears with earbuds from the discomfort of ear wax accumulating inside your ear canal, or wonder where ear wax even comes from?
How do I get rid of this ear discomfort and hear better?
Look no further as we seek to clarify some of the doubts you face and possibly help you hear better.

What Exactly is Earwax?

It is an accumulation of dead skin from the ear canal, dirt and cerumen produced in the ear. Its purpose is to act as a protective barrier for the ear. Ordinarily, your ear should be capable of ‘self-cleansing’ by clearing the ear wax out of the ear canal.
However, problems arise when symptoms appear. Symptoms such as earache and discomfort, blocked ears, ringing sounds in the ear, difficulty in hearing in a noisier environment, ear discharge or even children not doing well in school because of hearing difficulties
 

What Can I Do About It ?

Sometimes because of many reasons, ‘ self-cleansing’ of the ear wax by the body isn’t effective due to the digging of the ears which pushes the ear wax further in, narrow ear canals or even previous ear surgery which affects the ear canal and ear wax that thicker and stickier

At home, people have tried using QTIPs to pick at the wax or even cotton buds. While this is successful sometimes, it is difficult to remove the chronic or thicker ear wax through this approach. It can also cause external ear infections when this QTIPs scratch the ear canals to cause an abrasion, and worse still if not careful it can cause a eardrum perforation (hole)!
Fret not, if in doubt, there are solutions such as ear toilet by your doctors. This is the removal of ear wax and relieving of patient’s discomfort. There are different methods of removal. By instrumentation under direct visualization to avoid damage to the surrounding ear canal and eardrum and lastly microsuction of ear wax which might be considered as one of the safer options.

Instrumentation and Microsuction (Ear Toliet)

While microsuction and instrumentation carry some inherent risks, this is a safe earwax removal procedures when used with direct visualization by your doctor.
This enables your doctor to clean the ear canal with greater precision and reduce patient discomfort whilst concurrently inspecting the ear canal and tympanic membrane (eardrum) in detail. As an ancillary benefit, this method allows 2-handed working which further minimizes the risks of human error.

Due to the increased precision and stability, microsuction is often used in situations where ear irrigation is inappropriate or for patients with a deficiency in the eardrum (eg hole in the ear) or having previous ear surgeries.
The alternative to this is ear syringing with water pushed into the ear, however, should not be done for any patients with an active ear infection or discharge, a previous hole in the eardrum, any surgery recently in the ears.

Who will benefit from the procedure?

  • Patients with ear infection will benefit as ear irrigation will not be safe in this group of patients;
  • Patient with build- up of ear wax causing symptoms;
  • Patient with anatomical variations of the ear canal;
  • Patient wearing hearing aids; and
  • Children who able to understand instructions and willing to cooperate.

 

What should be done before the procedure?

  • Instillation of Cerumwax softening agents (like olive oil) should be recommended.
  • Instillation of drops approximately 3 times a day 2-3 drops and to remain on the same side approx. 3– 5 mins after

 

What should be done after the procedure?

It is advised that a formal hearing evaluation is conducted after the wax removal procedure to ensure good hearing has been restored, especially in situations where a patient had suffered a loss of hearing before the procedure.
 

How long does the procedure take?

This clinic procedure usually takes between 15-20 minutes.

What else can this be done for?

  • Apart from wax, this can be used for removing foreign body.
  • Ear infection will also benefit from this form of ear toilet.
  • It enables the insertion of a soft medicated sponge for patients with severe ear infection.


We provide Earwax removal with Painless Microsuction at our Raffles Place Clinic. You can walk-in to our clinic at Raffles Place, or call us at +(65) 6962 7144 or drop us an email at hello@dtapclinic.com for an appointment.

Speak to one of our friendly doctors today if you would like to address your blocked ear discomfort symptoms! – ear wax removal singapore
Take Care!


Other Read:

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  4. New HPV Vaccine (Gardasil 9) – What You Need to Know
  5. The Top 7 Reason Men Undergo Circumcision
  6. The Causes of Swimmer’s Ear (Outer Ear Infection)
  7. 7 Myths & Facts about Erectile Dysfunction
  8. Nose Cancer & Nose Cancer Screening – What You Need to Know
  9. 7 Testosterone Boosting Foods that You Can Find in Supermarket 
  10. Genital Warts the Cauliflowe Like Lumps

What are the Causes of Swimmer's Ear or Outer Ear Infection?

(OTITIS EXTERNA aka Swimmer’s ear or Outer Ear Infection)
The external ear canal is the part of the ear that connects the outer ear to the eardrum. This outer ear infection takes place in the external ear canal and usually presents a sudden painful condition usually caused by bacterial infection, inflammation or sometimes fungal infection.
People who are predisposed to outer ear infection includes the young and adolescent group, people with skin conditions like eczema or psoriasis, and people with excessive ear wax production.

The natural defence mechanism of the ear canal

  • The narrow ear canal serve to reduce entry of contaminants
  • The sticky nature of the ear wax helps to maintain a harsh environment for bacteria, helping to trap fine debris and also repel water.

 

What are the Causes of Swimmer’s Ears or Outer Ear Infection?

A moist ear canal can serve as a reservoir for bacterial (most common cause) or fungal infection to seed on.
Other factors that contribute to outer ear infection:

  • Exposure to contaminated water, swimming pool or hot tubs
  • Contact with allergic or corrosive chemicals such as hair dye or spray
  • Excessive ear canal cleaning with cotton buds
  • Skin barrier impairment over the ear canal secondary to eczema/ psoriasis or abrasions secondary to scratching
  • Using ear canal devices such as earphones, hearing aids, diving caps
  • Complication from water irrigation during ear wax removal procedures

 
Concurrent infection which causes inflammation and swelling of the skin. This leads to obstruction, itch and scratching of the ear canal which will create further injury, thus worsening the condition.
 

What are the Signs and symptoms of Swimmer’s Ears or Outer Ear Infection?

  • Ear pain
  • Itch
  • Discharges from ear
  • The feeling of blocked ear
  • Reduced hearing

 
 

What are the treatments for Swimmer’s Ears or Outer Ear Infection?

The treatment goal is to control pain and treat the infection.

  • Careful cleaning of the ear canal using specialized equipment
  • Eardrops to reduce inflammation and hinder the growth of bacteria and fungus

 
With the removal of debris in the ear, this will facilitate the absorption of ear drops in the ear canal.
In addition, the doctor can place a sponge or wick in the canal if it is swollen. This will increase the delivery of ear drops into the ear canal.
 
How to take care of your ears?
It is important to avoid the ear canal from getting wet during treatment. Extra precautions should be taken while showering. Avoid swimming 7-10 days during infection is of great importance.
 
If you swim regularly, consider

  • Shake your ears dry after swimming
  • Blow dry the ears with low setting dryer held from a distance away
  • Use earplugs during swimming

 
Are there any Follow-ups?
A patient needs to be follow up 36-48 hours after treatment initiation to monitor symptoms. Sometimes, the ear may need cleansing again using specialized equipment by a doctor in addition to the installation of ear drops.
 
Most external ear infection improves within 7-10 days.
 
If you think you have outer ear infection, please speak to any of our friendly doctors at any of our clinics to discuss further, or drop us an email at hello@dtapclinic.com
 
 
 
 
 
 

Nose Cancer and Nose Cancer Screening

Nose Cancer and Nose Cancer Screening

What is Nose Cancer (Nasopharyngeal carcinoma)?

Nasopharyngeal carcinoma (NPC) is a cancer that arises from the back of the nasal cavity. It is more common in Asia than in Western countries.
 

What are the Signs and Symptoms of Nose Cancer?

What to look out for?
Common presenting complaints include:
• Block nose
• Headache
• Double vision
• Neck lumps and bumps
• Nosebleed
• Blood stained saliva
• Hearing loss
 
NPC can behave like a silent killer. One can be asymptomatic or showing no symptoms before experiencing symptoms.
Over time, the tumour can grow, ulcerate and invade into nearby structures leading to nerve involvement and other symptoms as stated above.
A tumour can also spread to distant spread to other parts of the body.

What are the risk factors for Nose Cancer?

Age and Gender
It is a cancer that is more common in males.
There is also a bimodal age presentation where occurrence peaks in younger and older adults.
Infective
Epstein – Barr virus (EBV) infection
The strong association between EBV infection and NPC is evident by anti-EBV antibody in the blood, an increased amount of EBV DNA levels in NPC tumour cells.
This is why EBV antibodies are used in the clinical setting for the screening of Nose cancer.
Human Papillomavirus (HPV) infection
The role of HPV in NPC is less clear-cut in comparison to EBV in NPC but studies have shown that there might be an association with Nose Cancer.
Lifestyle
Smoking
There is postulation that smoking contributes to risks of NPC by causing reactivation of EBV.
Even though there might not be sufficient evidence, smoking itself does cause many other diseases.
Dietary practice

  • Consuming preserved food which contains a high level of nitrosamines like salted fish, bacterial mutagens and EBV-reactivating substances is another risk of NPC.
  • Some traditional Chinese medical herbs intake can lead to reactivation of EBV. 

Genetic Susceptibility
NPC has been associated with certain genetic predisposition and risks of NPC is increased in patients with first-degree relatives with NPC.

Nose Cancer Screening

History and Physical Examination.
A thin camera also known as a flexible naso-endoscopy is useful for examination of the back of the nasal cavity and if needed, a tissue biopsy sample to be obtained at the same setting.
Future Tests include:
Blood Tests
A simple non-fasting screening blood test can be done to aid the detection of NPC.
Given the close association between EBV and NPC, laboratory blood tests like EBV viral DNA and EBV IgA serology tests can be performed in the screening of NPC for patients belonging in high risks groups.
Screening tests are recommended for patients who fall under the high risks group eg, those with positive family history.
However, studies have also shown that early NPC being an indolent killer due to its relatively asymptomatic nature, has a higher 5-year survival rate when detected at an early stage. (see reference below)
In addition, these tests can help to prognosticate treatment response and future recurrence of the same disease in patients diagnosed with NPC.
Radiological
Other imaging studies include magnetic resonance imaging (MRI) might be useful.

 

Treatment for Nose Cancer

Treatment options include radiotherapy, chemotherapy and surgery. Combined therapy of radiotherapy and chemotherapy together with surgery might be considered based on the location and extent of the lesion.
Nose Cancer Screening is available in our Dr Tan & Partners @Raffles Place in Singapore.
If you are interested in this service and wish to find out more, please call +65 6962 7144 or visit our clinic at our Raffles Place Branch or drop us an email at hello@dtapclinic.com


Reference:
1 ) Chan, K. C. A., Woo, J. K. S., King, A., Zee, B. C. Y., Lam, W. K. J., Chan, S. L., … Lo, Y. M. D. (2017). Analysis of Plasma Epstein–Barr Virus DNA to screen for nasopharyngeal cancer. New England Journal of Medicine,378(10), 973-973. doi:10.1056/nejmx180004
 

5 Objects Found In Ear Where It Should Not Belong!

#1 Impacted Earwax

The production of ear wax can be excessive in some people. This can happen when water gets trapped in the ear, or when the ear is injured or occurs for no particularly obvious reason.

#2 Small insects

A myriad of insects may reside temporarily in the external auditory canal.  Amongst all, small cockroaches are most commonly found in the ear canal as they prefer the warm, dark environment. A crawling and moving insect can be uncomfortable and may risk injuring the inner ear and the eardrum. Mineral oil is used to kill the insects before one attempting to remove it.

#3 Cotton bud

It is a common routine for some to attempt cleaning their ears using cotton buds. This can actually push the wax deeper into the ear instead of getting it out. As a consequence, leading to ear wax impaction, resulting to discomfort and decreased in hearing ability. Also, repetitive friction may cause skin tear in the ear causing bacteria to set in. This might result in an ear infection.

#4 Beads and plastic toys

This occurs in toddlers and children who place items in their ears out of curiosity.

via GIPHY

#5 Button Batteries

Button batteries can be found in toy or hearing aids. They can cause destruction to the ear canal because of electrical currents and pressure exerted by the battery in the small ear canal. There have been reports of injury to the eardrum and skin of the ear canal.

via GIPHY

Looking after your ears (Water Precaution)

It is imperative to keep water out of the ears and keeping them dry.  Water can be a vehicle for germs and bacteria growth when present in the ear canal. Interestingly, the worst water is bath water; even soap or shampoo water can potentially carry a large number of germs.
It is advisable for the below products when swimming or washing head and hair:

  • Cotton wool plug covered in Vaseline
  • Earplugs during swimming
  • Shower cap

via GIPHY
 

Tips for good ear care and prevention of ear infection

  • Keep the ears dry especially bathing or swimming.
  • Earplugs at all time during swimming. Earplugs need to be regularly cleaned and changed.
  • Keep ears dry after swimming
  • Dry the ears using a dry towel.
  • Avoid using cotton buds or sticking metal ear pick into your ears.
  • Regular cleaning and nightly removal of hearing aid
  • Clean the ears regularly by a doctor if you have excessive earwax

Who should be more concerned?
Preventive interventions should be considered in people with a recurrent ear infection or patients with a skin condition involving the ear.

Have You Heard of Ear Toliet?

Ear Toliet Procedure is using Instrumentation and Microsuction to Remove Ear Wax

While microsuction and instrumentation carries some inherent risks, this is one of the safest wax clearing procedure when used with direct visualization by the medical practitioner.
This enables the medical practitioner to clean the ear canal with greater precision and reduced patient discomfort whilst concurrently enabling the medical practitioner to inspect the ear canal and tympanic membrane are in detail.
As an ancillary benefit, this method allows 2-handed working which further minimizes the risks of human error.
Due to the increased precision and stability, microsuction is often used in situations where ear irrigation is inappropriate or for patients with a deficiency in the ear drum (eg hole in the ear) or having previous ear surgeries.

  • Patients with an ear infection will benefit as ear irrigation will not be safe in this group of patients
  • Patient with build- up of ear wax causing symptoms
  • Patient with anatomical variations of the ear canal
  • Patient wearing hearing aids
  • Children who able to understand instructions and willing to cooperate

The Ear Toliet (Ear Wax Removal) Procedure is only available in our Dr Tan & Partners @Raffles Place in Singapore.
If you are interested in this service and wish to find out more, please call +65 6962 7144 or visit our clinic at our Raffles Place Branch or drop us an email at hello@dtapclinic.com