Singapore surgeon explains why ears are like aeroplane engines

SINGAPORE - Dr Low Wong Kein, 52, was such a good marksman in secondary school that he was runner-up in a national rifle shooting competition. His steady hands have served him well in ear, nose and throat microsurgery.

The consultant ENT surgeon at Novena ENT - Head & Neck Surgery Specialist Centre at Mount Elizabeth Novena Hospital inserted the first paediatric cochlear implant here in 1998. This bypasses damaged parts of the ear to stimulate the auditory nerve.

In 1999, he chaired a Health Ministry committee, which found that congenital hearing loss that was treated late would result in poor speech and language development.

He then co-directed a national newborn hearing screening programme in 2001, aimed at early detection of hearing problems. Such screening is now standard here.

To promote early intervention, he spearheaded a national cochlear implant programme.

He headed the ENT department of Singapore General Hospital from 1998 to 2005, and was director of its Centre for Hearing and Ear Implants from 2004 till last year, when he left for private practice.

The president of the Singapore Association for the Deaf is married to DrStephanie Lim, the chief listening and spoken language specialist in the same clinic. They do not have children.

I sub-specialise in ear disorders because...

They are common and medical intervention can often help patients.

Eight to 10 per cent of people here experience hearing loss, which becomes more prevalent with an ageing population. Furthermore, hearing may be affected by excessive noise and the young are increasingly exposed to leisure-related noise.

The ears are fascinating because...

They allow for communication over distances, for sensing danger and balance and, in some species, to determine their surroundings.

The mammalian ear, perhaps the most complex of the sensing organs, is made up of dozens of parts and thousands of pieces that must all work together to perceive sounds.

One little known fact about treating ear conditions is...

Recent studies have suggested that acupuncture may have an effect on cochlear hair cells that detect sounds in the inner ear.

I argued in a letter published recently in the international Journal Of Alternative & Complementary Medicine that acupuncture may, therefore, have a complementary role to standard medical treatment in the early stages of sudden hearing loss.

This is when one's cochlear hair cells abruptly become sick without any apparent cause.

If I were to give an analogy for what I do, I would be...

A flight engineer overseeing the maintenance of the engines of an aeroplane, which are normally mounted on its wings. For a smooth journey, engines on both sides have to be in good working condition.

Likewise, the ears are meant to operate as a pair. A person with defective balance function in one ear can probably still walk steadily on flat ground in a brightly lit room. However, he is likely to trip and fall when walking on uneven ground in a dark environment.

This is why whenever I do surgery on one ear, I take the function of the other ear into account.

A typical day for me would...

Have me wake up at 5.30am and leave for work by about 6am.

On the way, my wife and I normally stop for breakfast. I try to eat healthily by having noodles in soup, rather than fried ones, and black coffee without sugar or cream.

I find early morning the best time to avoid traffic jams and to get some administrative work done before seeing patients.

I conduct thorough assessments for each patient and explain and discuss conditions in detail. Every fortnight, I teach residents at SGH.

In the evenings, my wife and I enjoy Chinese drama on television. I use the opportunity to improve my command of Mandarin.

On weekends, I go for evening jogs if the weather permits. After the jog, I will reflect on what I did that week and how I could have done better.

I have come across all types of cases...

Including a five-month-old boy with profound hearing loss in both ears, who did not benefit from hearing aids.

His parents decided to fit him with cochlear implants in both ears so that he could have the chance for normal speech and language development.

I once treated an 82-year-old man who had also lost his hearing in both ears. He too opted for bilateral cochlear implants as he wanted to appreciate the sermons in church.

Good hearing is always valuable, but its value may differ at different stages in life.

I love patients who are...

Highly motivated to do well in life, despite their hearing disability.

People who get my goat are...

Those who feign illness for personal gain. I once assessed a construction worker for workman's compensation, when he claimed he had lost his hearing after an accident.

Behavioural hearing testing based on subjective self-responses suggested he had severe hearing loss, yet he could respond well to verbal commands during the medical consultation. This prompted further investigations using objective testing. I found his hearing to be normal.

I do not enjoy dealing with this ugly side of medicine.

Things that make me smile are...

Being rewarded for hard work, such as having a research paper accepted for publication in a scientific journal.

I also enjoy sharing my research findings and experience through publications and presentations. I have held more than 200 lectures and had more than 70 publications.

It breaks my heart when...

Patients are deprived of effective medical care just because they cannot afford it.

Fortunately, after a Health Ministry-funded national cochlear implant programme was set up, cochlear implants were made available to needy Singaporeans at subsidised rates.

I would not trade places for the world because...

I have helped shape the way hearing loss is being managed here and the hearing-impaired now integrate better into mainstream society.

My best tip is...

For people to demonstrate a little more understanding and patience towards hearing-impaired patients.

This will go a long way to minimise the psychological and emotional stress that they often experience.

The public often fails to realise that even the best hearing technology is far from perfect and that the hearing-impaired still face various challenges in communication.

joanchew@sph.com.sg


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