Ask an Ear, Nose Throat (ENT) Specialist: Dr Samuel Yeak from Mount Elizabeth Novena Hospital Singapore

dr. Samuel Yeak replied 2 years ago

If antibiotics don't help, it is probably not due to an infection. Acid reflux is definitely a possibility but there are many other reasons which should be looked at if you are not better. If you suspect acid reflux, you can take some acid reflux medication from the pharmacy first. Please see an ENT specialist once the COVID situation improves if you are still not better.

dr. Samuel Yeak replied 2 years ago

This sounds more like nasal allergy rather than sinusitis. We may have to look into the nose to make sure you don't have sinusitis. Usually nasal sprays and allergy medication will help. In the long run, allergy tests should be done to control the allergy better.

dr. Samuel Yeak replied 2 years ago

Throat pain may not be due to tonsillitis. We will need to look at the throat first. If the tonsils look big and infected, you may benefit from tonsillectomy.

dr. Samuel Yeak replied 2 years ago

It may only be ear wax and not an infection. If there is no pain or the child is not crying/holding the ear, you can observe to see if the discharge gradually stops. If not, you may have to see an ENT specialist.

dr. Samuel Yeak replied 2 years ago

Polyps in the nose should not be left untreated. However sometimes, this is wrongly diagnosed and may be just swelling of the turbinates (structures at the sides of the nose which help warm and humidify the air we breathe in). If you are having difficulty breathing, the polyps may be growing. The mucus may be due to sinus infection. Sinus infections can spread to the eye or the brain. The polyp may also be a tumour. A history of 10 years suggests that it was probably benign but 5% can become cancerous. This should definitely be looked at. Treatment will depend on the cause of the polyp.

dr. Samuel Yeak replied 2 years ago

The growth centre of the nose is at the nasal septum rather than the nasal bridge. Typically it stops growing at around 16 years old for boys and 14 years old for girls. Most ENT surgeons will advise against surgery on the nasal septum till after 18 years of age so that it will not affect the growth of the nose.

dr. Samuel Yeak replied 2 years ago

Yes, it sounds like this may be due to frequent swimming. Ear infections frequently occur in the tropics with swimming. This is partly because the swimming pool water may not be adequately chlorinated but also because of the warmth and humidity. You should get it looked at and treated before it gets worse. To prevent further infections, wear ear plugs when you swim. It is even better with a swimming cap which covers the ears.

dr. Samuel Yeak replied 2 years ago

We strongly advise against cleaning your own ears as it is very easy to injure yourself. It can also introduce infection. If it is just pain without hearing loss, discharge or bleeding, it should settle quickly with painkillers. If it does not settle or if you have hearing loss, discharge or bleeding, please see a specialist.

dr. Samuel Yeak replied 2 years ago

You probably have laryngo-pharyngeal reflux (LPR) which is due to acid coming up from your stomach into the throat (pharynx) and voice box (larynx). The acid in the throat causes pain and the acid in the voice box causes shortness of breath. Medication can be used to neutralise acids, reduce acid production, block acid production or increase motility of the upper gut. Antacids neutralise acid and provide quick relief but do not heal the gut damaged by acid. Medication to reduce acid production in the stomach are H2 receptor blockers like cimetidine (Tagamet) and ranitidine (Zantac) which have been around for a long time.

Nowadays, most doctors use medication to block acid production. These are proton pump inhibitors (PPI) like omeprazole (Losec), esomeprazole (Nexium), rabeprazole (Pariet), dexlansoprazole (Dexilant) etc. PPI's are generally considered stronger and have faster onset of action. Some patients may benefit from medicines to improve upper gut motility so that acid flows down and not up. An example is domperidone or Motilium.

It is also important to change your lifestyle. Avoid coffee, tea or alcohol, deep fried, oily and spicy foods. You should also avoid late night meals and should have an early light dinner. Taking a walk after dinner will help digestion. Sleeping with the head elevated may also help but please support your upper back and don't give yourself a neck ache!

dr. Samuel Yeak replied 2 years ago

Buzzing in the ear is also known as tinnitus. Unfortunately, it is a fairly non-specific symptom and can be due to problems in the external, middle or inner ear. External ear problems like ear wax or ear infection can be easily treated by cleaning the ears under the microscope. Middle ear problems are more difficult. We have to first rule out eustachian tube obstruction – this is a tube between the middle ear and the back of the nose (the nasopharynx). The problem is therefore usually in the nose or nasopharynx.

In the nose, common problems are nasal allergies, sinusitis, polyps and deviated nasal septum. In the nasopharynx, we need to make sure there is no growth obstructing the eustachian tube. Adenoids are common – lymphoid tissue at the back of the nose similar to tonsils which help us fight against germs. If there is one sided middle ear fluid, it is very important to make sure there is no cancerous growth as nasopharyngeal cancer (NPC) is very common in this part of the world and almost half of NPC patients see doctors for blockage or buzzing in one ear as the first presenting symptom.

Inner ear problems are the hardest to deal with. Hearing tests should be done to make sure there is no nerve damage. If there is, MRI scans may be needed to exclude a nerve tumour. Thankfully this is only seen in 3% of patients. For the vast majority, it is just due to ageing and degeneration. Medications to improve blood circulation as well as high dose vitamin B may help reduce tinnitus in these patients but it rarely goes away completely. If patients are very bothered, they can try various measures to cope with it.

Environmental sounds can sometimes help to mask the tinnitus but some may need to use tinnitus maskers which can be wearable devices or devices put at the bedside if it affects their sleep. Sleep medication may also help as tinnitus may affect sleep in these patients and lack of sleep worsens tinnitus.

dr. Samuel Yeak replied 2 years ago

Itchy and sore throat could be due to GERD. The sound you hear on touching your throat could be from inflammation in the throat arising from GERD as well. Please continue to take your GERD medication regularly. It may help to increase the dose of some medication. You should consult your doctor before increasing the dose. It is also important to change your lifestyle. Avoid coffee, tea or alcohol, deep fried, oily and spicy foods. You should also avoid late night meals and should have an early light dinner. Taking a walk after dinner will help digestion. Sleeping with the head elevated may also help.

Blocked nose is commonly due to allergies or infections. One sided obstruction is less common and could be due to a deviated or crooked nasal septum, the cartilage in the middle separating the two sides of the nose. One sided blockage could occasionally be due to a growth on that side of the nose. Again, you should see a doctor to determine the cause.

dr. Samuel Yeak replied 2 years ago

My main concern is whether there was damage to the recurrent laryngeal nerve during thyroid surgery. This is the nerve which supplies the vocal cords and travels through the bed of the thyroid gland and it is easily damaged during surgery. I have seen this before and patients have been wrongly diagnosed to have asthma after thyroid surgery!

When there is weakness or paralysis of the vocal cords and they are at or near the midline, voice may be normal but breathing may become difficult when she exerts herself. Endoscopy of the vocal cords would be necessary to look at the movement of the vocal cords.

Unfortunately, if she does have weakness or paralysis of the vocal cords, treatment is surgical and not with medication.

dr. Samuel Yeak replied 2 years ago

Unfortunately the symptoms you have described are very common after tonsillectomy. Pain typically peaks at 1 week and will get better after that. You should try to eat as normally as possible. Solid food helps to clean the wound and aids recovery. If you only take liquids and soft food, the wound can become dirtier and infected. It may become more painful and there is a risk of bleeding. Taking ice cream may help numb the pain. You should also take the painkillers prescribed for you after the surgery to help you eat normally, It usually gets much better in the second week. Please see your surgeon if pain gets worse or if you have bleeding.

dr. Samuel Yeak replied 2 years ago

These questions are tough to answer without an examination. Shortness of breath can be from the upper or lower respiratory tract. It is unusual for the nose to hurt or for the tongue to feel hot. Pain usually points to infection or a nerve problem. A hot tongue could be due to acid reflux from the stomach which can also cause shortness of breath. It can also be due to a nerve problem. Dental pain could again be due to sinus infection but could also be nerve pain. Mucus stuck in the throat can be due to postnasal drip from a sinus infection or acid reflux from the stomach. Reflux tends to be hot and can cause pain. You will need to be examined to rule out sinus infection and to look for evidence of acid reflux. These will need to be treated accordingly. If examination is normal, all your symptoms could be due to nerve problems (neuralgia) and we could try treating the nerve pain.