4
THE STRAITS TIMES
APRIL 1, 2010
DocTalk
Wet ear
at risk
Dr Stephen Lee
A
young man in his 20s came to my
clinic, clutching his ear in agony.
Meng (not his real name) was in
extreme distress. His brother, who was with
him, said that Meng had been swimming in
the sea around Sentosa three days earlier.
When he came home, his right ear felt
blocked and a little uncomfortable. But he
ignored the symptoms and went to sleep. By
morning, he felt pain in his ear.
A doctor at a nearby clinic gave him ear
drops, oral antibiotics and painkillers.
Initially he felt better, but over the
following two days, the right ear began to
throb and it swelled.
He continued with the medication but
when he woke up on the third morning, the
pain was so excruciating, tears welled in his
eyes. He could not chew and his right ear
felt hot and blocked.
I confirmed that he had a swollen right
ear canal. The walls of the ear canal were
touching. There was encrusted fluid around
the canal and the deeper ear canal or
eardrum could not be seen.
He clearly had a very bad outer ear
infection, medically known as Otitis
Externa. It is a common condition and
symptoms include blocked ear, fluid
discharge and sometimes hearing loss.
There may be discomfort or severe pain,
as in Meng’s case. This is because the skin
covering the ear canal is tight; it just takes
a little inflammation to cause great pain.
Often, the trigger is water or moisture
entering the ear. The resulting dampness
encourages the growth of bacteria.
For instance, cleaning the ear with a
cotton tip may cause minor abrasions. This
combination of a break in the skin lining
and moisture is a potent one resulting in
bacterial inflammation of the ear canal skin.
Apart from the possible abrasions, this
method of self-cleaning to remove wax
often pushes the ear wax deeper into the
ear.
Some people are prone to ear infections
because their ear canals are narrowed by
canal angulation.
ST ILLUSTRATION: ADAM LEE
Others have an allergic skin problem
called eczema of the ear canal where the
skin at the entrance to the ear canal or
deeper inside is scaly, flaky and itchy.
Those who have recently moved from a
drier temperate climate to a tropical climate
such as Singapore are often prone to
recurrent ear infections too.
Their ear canals have yet to acclimatise
and these individuals have to be even more
fastidious about keeping their ears dry.
As for Meng, I relieved his pain with a
strong painkiller, and about half an hour
later, I used a suction instrument to clear
his ear canal of secretion and debris.
After the cleaning procedure, I inserted a
tiny cylindrical sponge soaked with
antibiotic drops into his ear canal and
instructed him to use ear drops at home.
Without the sponge in place, Meng would
not have been able to deliver the ear drops
to the deeper swollen part of the ear canal.
He returned to my office two days later
with a big smile on his face.
I removed the sponge
from the ear canal and
confirmed that his eardrum
was intact and normal.
Swimming can cause
not only outer ear
infection but also middle
ear infection. This is
especially so for those
with a perforated
eardrum, or in kids who
have had ear tubes
placed in their
eardrums. These are
placed when they have
a problem of persistent
fluid accumulation in the
middle ear.
I am often asked what
measures swimmers should
take to minimise ear
infections. If you have a
recurrent outer ear infection
problem, you could dry the ear
by using swimmer's ear drops
which can be obtained over the
counter in pharmacies. These contain
alcohol and aid in the evaporation of
the moisture.
If the problem is due to an eardrum
perforation, then it is worthwhile to use ear
plugs to minimise the entry of water during
swimming. If the standard sized plugs are
unsuitable, you will have to get
custom-made ones from your doctor or a
hearing aid centre to fit to your ear canal
shape.
Ear related problems are common.
Another patient, Mary (not her real name),
suddenly lost her hearing.
She had gone to a hair salon to have her
hair washed. Water likely entered her ears
and was absorbed by the wax, resulting in
swelling and blockage.
She lived with her deaf grandmother and
feared she would be permanently deaf too.
To her great relief, she could hear again
after the impacted wax in her ears was
removed.
Most outer and middle ear afflictions can
be readily solved.
[email protected]
Dr Stephen Lee is an ear, nose and throat
surgeon and senior partner and consultant at
the ENT department at Raffles Hospital. He has
published more than 20 articles locally and
internationally and authored three textbooks.