Ask a Ear Nose Throat (ENT) Specialist: Dr Barrie Tan from Gleneagles Hospital Singapore

dr. Barrie Tan replied 2 years ago

Hi, it would be important to do a Nasoendoscopy to look at the back of your nose. This is a camera attached to a small flexible tube that can be inserted into the nose. This is to evaluate if there are any growths or swellings in the back of your nose that may be blocking or pressing on the openings of the Eustachian Tubes (the natural ventilation path of the ear that connects to the back of the nose). Usually middle ear infections arise from bacteria that go up the Eustachian Tubes to the middle ear space. Problems with the function of the Eustachian tubes may predispose to middle ear infections. Besides antibiotics, nasal decongestant medications are usually also prescribed to ensure that the mucus from the front of the nose does not drip back and block the opening of the eustachian tubes.

As for white fluid coming out of your ear, that would be unusual in a purely middle ear infection unless there is a hole in the ear drum. When that happens the fluid in the middle ear will leak out through the hole into the external ear canal. In such a situation, I would advise you to start some antibiotic ear drops to your affected ear for at least 1 week to treat the infection. When the infection settles, you should have an examination of the ear drum to see if there is a ear drum perforation (hole). If there is one, you should consider undergoing a surgery to repair the hole when the ear is dry, to prevent a future ear infection.

dr. Barrie Tan replied 2 years ago

I would suggest that you undergo a Nasoendoscopy to evaluate your nose and also the deeper portions of your throat. This will allow us to visualise any problems that may arise from the nose that may cause a chronic cough like chronic sinusitis with a constant post nasal drip (backdrip of mucus at the back of the nose). Also other causes such as laryngopharyngeal reflux, where the stomach juice and acids reflux into the throat, can be seen with evidence of swellings and redness of certain portions of your throat. The treatment would depend on the diagnosis made after the Nasoendoscopy. Most times, treatment would begin with some medications, before surgeries may be advised for certain conditions.

dr. Barrie Tan replied 2 years ago

The main problems of your nose is nasal obstruction from what sounds like possible Inferior Turbinate hypertrophy or general swelling of the nasal tissues from underlying allergic rhinitis since you are better when you are not exposed to dusty environments. There are permanent solutions to breathing difficulties from such nasal obstruction. They basically involve shrinking the swollen tissues and correcting any other structural deformities of the nose like deviated nasal septums. This will require an examination with a nasoendoscopy first to look for the sites of nasal obstruction before deciding on what types of surgeries are required. The main types of surgery include the following:

1. Endoscopic Inferior Turbinectomy or Turbinoplasty: This involves resecting (cutting away) or trimming of the inferior turbinates which are the tissues located along the side walls of the nose inside. They are often swollen in underlying allergic rhinitis. They occupy significant space in the nasal cavity and after reduction or removal, there is a much larger available space in the nasal cavity to breathe

2. Septoplasty: To correct any deviation of the nasal septum. That would allow the air entry in the ear to be equal on both sides after surgery.

3. Radiofrequency reduction of the Inferior Turbinates: This is similar in intention to a Inferior Turbinoplasty but serves to reduce size of the front 1/3 of the inferior turbinates on both sides. This will result again in more space available in the nasal cavity.

dr. Barrie Tan replied 2 years ago

Hi, Gastric Acid reflux can definitely cause the symptoms that you have mentioned. As such, the treatment of acid gastric reflux would include the following:

1. medications to reduce the stomach acid production
2. Lifestyle changes: Avoid certain foods like citrus fruits, chocolate, coffee, tea, fatty and fried foods, garlic and onions, mint flavoring, highly spiced foods. tomato based foods. To sleep with at least 1 firm pillow to elevate the neck slightly. To avoid going to sleep with a full stomach. Best to allow at least 3 hours interval for the stomach to empty from the last meal before bedtime.
3. If the reflux is very severe, it is necessary to have an evaluation of the esophagous and stomach by a gastroenterologist for any predisposing cause for the reflux.

dr. Barrie Tan replied 2 years ago

Yes, there is a chance that an unrepaired hole in the ear drum will lead to future middle ear infections and a widening of the ear drum perforation. If you are in good health and under 65 years old, it would be best to undergo a surgery to repair the ear drum perforation as the chance of future infections of the middle ear through entry of bacteria via the perforation, is high.

dr. Barrie Tan replied 2 years ago

It is important to complete a Nasoendoscopic examination of the nasal cavity and the openings of the paranasal sinuses. The treatment will depend on the underlying problems seen. These can range for excessive mucus production from allergies, to polyps to sinusitis infections. The treatment methods vary for each and may start with medications first before considering various types of surgery.

dr. Barrie Tan replied 2 years ago

There could be several reasons why it hurts, itches and bleeds. There could be small polyp or growth in the inside of the nostril that is traumatised whenever you insert anything into the nose. There could be an infection of the nose and this is aggravated by introducing anything into the nose. I would suggest that you get a review by an ENT doctor who can do a nasoendoscopy. This would allow the doctor visualise the entire nasal cavity to determine if there is any such problem

dr. Barrie Tan replied 2 years ago

The ringing in the ears are probably what is commonly known as Tinnitus. Usually this condition is not debilitating. But for some it is very disturbing. It is important to perform a Pure Tone Audiogram to ensure that there is no associated hearing loss on the left ear. If there is, then certain investigations such as an MRI scan of the Internal Acoustic Meatus (MRI IAM) should be performed to ensure there are no sinister causes like a tumour in the brainstem pressing on the hearing nerve. Most times, tinnitus tends to fade into the background after a few months. For those in which the tinnitus does not subside, there are various therapies such as masking therapy, the use of hearing aids, acupuncture as well as some medications that may be of some benefit to a few patients. However, there is no one universal treatment that is effective for all patients with tinnitus and oftentimes there may be a need to trial these different therapies to see which one works for you.

dr. Barrie Tan replied 2 years ago

The ringing in the ears are probably what is commonly known as Tinnitus. Usually this condition is not debilitating. But for some it is very disturbing. It is important to perform a Pure Tone Audiogram to ensure that there is no associated hearing loss on the left ear. If there is, then certain investigations such as an MRI scan of the Internal Acoustic Meatus (MRI IAM) should be performed to ensure there are no sinister causes like a tumour in the brainstem pressing on the hearing nerve. Most times, tinnitus tends to fade into the background after a few months. For those in which the tinnitus does not subside, there are various therapies such as masking therapy, the use of hearing aids, acupuncture as well as some medications that may be of some benefit to a few patients. However, there is no one universal treatment that is effective for all patients with tinnitus and oftentimes there may be a need to trial these different therapies to see which one works for you.

dr. Barrie Tan replied 2 years ago

The ringing in the ears are probably what is commonly known as Tinnitus. Usually this condition is not debilitating. But for some it is very disturbing. It is important to perform a Pure Tone Audiogram to ensure that there is no associated hearing loss on the left ear. If there is, then certain investigations such as an MRI scan of the Internal Acoustic Meatus (MRI IAM) should be performed to ensure there are no sinister causes like a tumour in the brainstem pressing on the hearing nerve. Most times, tinnitus tends to fade into the background after a few months. For those in which the tinnitus does not subside, there are various therapies such as masking therapy, the use of hearing aids, acupuncture as well as some medications that may be of some benefit to a few patients. However, there is no one universal treatment that is effective for all patients with tinnitus and oftentimes there may be a need to trial these different therapies to see which one works for you.

dr. Barrie Tan replied 2 years ago

It is difficult to say what that white lump inside the ear is now. However, if there is still yellow fluid coming out together with blood stains, we may have to assume that there is an infection.If so then you should see an ENT surgeon for cleaning of the ear canal under a microscope and administer some topical antibiotic ear drops. There may also be a need to take some oral antibiotics.

dr. Barrie Tan replied 2 years ago

There could be several reasons for your symptoms. It would be necessary to do a complete examination of your throat with a Flexible Nasoendoscopy. This allows the ENT surgeon to visualise your larynx (voice box), tongue base and the openings to your esophagous. A common problem detected on this scope would be evidence of laryngopharyngeal reflux, which is where the stomach juice comes up to the throat and causes irritation. This often happens at night when you lie down to sleep as there is no more gravity to help keep the stomach contents down as compared to during the daytime when you are upright in position most of the time. We would be able to see swelling around the back part of your voice box on the nasoscope. Treatment would include some changes to your lifestyle and also some medications. Other causes include inflammation of the voice box (Laryngitis) and also some infections of the lower airway like Bronchitis. Treatment would probably include some oral antibiotics in these situations.

dr. Barrie Tan replied 2 years ago

It sounds like the diving accident may have damaged your ear drum and possibly your inner ear. The hole in the ear drum will then predispose to frequent middle ear infections as bacteria will often get into the middle ear through the hole in the ear drum. These ear infections then lead to infected liquid leaking out from the ear. The buzzing sound is what we term as "Tinnitus" and may have resulted in some damage to the inner ear from the high pressures in the middle ear when diving previously. You should see an ENT Surgeon and consider a surgery to repair the hole in the ear drum if there is one, as there is a significant chance of repeated infections that may cause further damage to the ear.

dr. Barrie Tan replied 2 years ago

You should see an ENT doctor instead to remove the stuck cotton. They will have the necessary equipment (Microscopes and special forceps) to visualise and remove it safely. Generally it is safe to leave the cotton stuck for a while as it does not lead to infections quickly but it is best to eventually have it removed as it will block the ear and cause some mild hearing loss as well as trap more of the wax inside.

dr. Barrie Tan replied 2 years ago

It depends on the problem that you are facing with the tonsils. Medicines are usually antibiotics which can help to treat the underlying tonsil infection and should be used for an acute infection (Acute tonsillitis). If the Acute tonsillitis is frequent (more than 3 times a year for 2 consecutive years), then you should undergo a surgery called tonsillectomy, which is the removal of the tonsils. Other common problems of the tonsils include having very large tonsils that obstruct the airway during sleep (Obstructive Sleep Apnea) especially in children. The cure for this is also to undergo a Tonsillectomy.

dr. Barrie Tan replied 2 years ago

Certain antibiotic ear drops can be used when there is a hole in the ear drum as they are safe to the inner and middle ear and does not cause side effects of damage to the inner ear, especially to the hearing. However, certain eardrops should be avoided if there is a hole in the ear drum as they have toxicity to the inner ear. So it depends on the ear drop that you are using, particularly the type of antibiotic that is being used in the ear drop.

dr. Barrie Tan replied 2 years ago

This sounds like some pus like fluid coming out of your left nose. The most common cause would be due to an infection of the paranasal sinuses, called sinusitis. You should see an ENT doctor and have an examination of your nose through a Nasoendoscopy. You may require treatment with oral antibiotics and other oral and topical medications to the nose if there really is clinical evidence of sinusitis.

dr. Barrie Tan replied 2 years ago

Any hard lump on the side of the neck needs to be properly examined and investigated. Many possible tissues when enlarged can cause such lumps and swellings. Since this lump is felt more prominently when you swallow, it most probably is arising from the thyroid gland. So you may very well have a thyroid nodule. This will need to be further investigated with ultrasound investigations, fine needle aspiration cytology (putting in a needle to extract some cells from the nodule for examination) and thyroid hormone blood tests. Thyroid nodules can be either benign or malignant (cancerous) so they should be evaluated properly. If it is a malignant nodule, it would be considered dangerous and surgery and further therapy would be necessary.

dr. Barrie Tan replied 2 years ago

Since it changes with position, this may be due to differences in the blood flow through your nose tissues when you stand up versus when you lie down. This may happen as part of a normal variant, or it may be that you have some form of rhinitis, or sensitivity of the nose tissues, most probably Vaso-motor rhinitis. This leads to swelling of the nose tissues. Treatment depends on how severely you feel you are affected by the nasal obstruction and can range from medications to various types of nasal surgery.

dr. Barrie Tan replied 2 years ago

I would advise you to seek medical treatment immediately. There is a strong possibility that there is an infection of the cartilage of the ear where the ear is pierced and the soft tissue may very likely swell further and completely embed and cover the ear stud over time. Infections of the cartilage portion of the ear are very serious infections and these need to be treated aggressively with removal of the ear stud and antibiotics. Poorly treated cartilage infections of the ear may lead to long term deformity of the ear. As such if your infection do not resolve with oral antibiotics, then you may need to have the ear stud removed and be admitted for intravenous antibiotics.

dr. Barrie Tan replied 2 years ago

The most common reason for clear discharge from the ear is an infection of the external or middle ear. Besides oral antibiotics, you should have a course of topical antibiotic ear drops as these can deliver the antibiotics in much higher concentrations to the ear.

dr. Barrie Tan replied 2 years ago

If the boil persists despite oral and topical antibiotic ear drops, then you may require a minor surgery to drain the infection or abscess in the ear. This may be done under local anesthesia or general anesthesia depending on how severe the boil or abscess is.

dr. Barrie Tan replied 2 years ago

Most ENT surgeons would be able to perform a septoplasty to correct the deviated nasal septum, and there are some ENT surgeons who can perform an operation called Septorhinoplasty to correct both the internal deviation of the septum as well as the external form and look of the nose. However, please check that your ENT surgeon has been trained to perform this septorhinoplasty operation as not all ENTs have experience performing this operation.

dr. Barrie Tan replied 2 years ago

There may be several reasons for the various symptoms that you have described. The only symptom that is truly due to ENT condition is that your left ear rings, which is known as tinnitus. I would suggest that you have a complete ENT examination including an otoscopy to look at the ears as well as a hearing test to evaluate the possible reason for your tinnitus. As for your other symptoms, I would recommend you see a general practitioner who can perform some examinations and a general review to determine which specialists you may need to seek an opinion regarding your symptoms.

dr. Barrie Tan replied 2 years ago

The most likely reason is that you have some form of allergic rhinitis, probably to house dustmites. These house dustmites are present in your bedsheets and therefore after a whole night of exposure to them when you sleep, you wake up with an oversensitive nose and these symptoms. During the day, the symptoms eventually subside since you are not exposed to the same allergens.

dr. Barrie Tan replied 2 years ago

It is difficult to diagnose what the disease is based on the description you have made. However, there is a condition where there is a small hole seen just near the top of the external ear in front of the ear cartilage, called a pre-auricular sinus. This is a congenital condition where there is a small tract that leads from the skin surface into the tissues under the skin. This often traps dirt and bacteria and sometimes they get swollen and infected. If it is swollen, painful or discharging pus, please do go see a doctor to start on a course of oral antibiotics. Eventually the main treatment for an infected pre-auricular sinus is to undergo a small operation to remove it so as to prevent a recurrence of the infection.