Q: My 27-year-old son's hearing is less sharp on one side, compared to the other ear.
He consulted a general practitioner who told him it was a result of ear wax.
He was not satisfied with the diagnosis as he recalled during his primary school days, there was a hearing test and he was referred to the children's clinic where a "gunshot wash" was given to him.
He wants to know where he can go for the same type of treatment that he had received as a child.
A : The human ear is designed to be self-cleaning, where ear wax (also called cerumen) migrates out of the external ear canal and onto the skin of the external ear (pinna).
However, in certain circumstances, the ear wax does not get cleared out. Instead, it accumulates in the ear canal. This occurs more frequently when the external ear canal is crooked or narrow, such that the wax is unable to migrate out of the ear canal easily.
This also occurs when the ear wax is particularly hard and dry, and builds up rapidly.
When the ear wax is unable to migrate out, it tends to become impacted in the external ear canal.
Impacted ear wax is one of the most common causes of decreased hearing.
This can develop suddenly in the case of a sudden expansion of the ear wax after a swim, for instance.
The hearing loss can also develop slowly over several months, in which the ear wax slowly builds up in the external ear canal and completely occludes it.
There are several ways to dislodge and remove ear wax.
The "gunshot wash" method is known as ear syringing. Water is pushed rapidly and syringed into the ear canal to dislodge the ear wax.
This is available in certain general practice clinics as well as at ear, nose and throat specialist clinics.
There may be a few problems with this method.
The first problem is that it is a "blind" procedure, as the ear canal is not visualised during this procedure. This may lead to inadvertent damage to the ear drum or ear canal.
In some patients who have a hole in the ear drum (tympanic membrane perforation), water flushed will also enter the middle ear and predispose them to infection.
Lastly, the water may also lead to rapid expansion of the ear wax, which may aggravate the impaction.
The safer way to remove ear wax is to have it removed professionally by an ear, nose and throat surgeon, who directly visualises the external ear canal with a microscope while removing the ear wax with a suction apparatus or various microscopic instruments.
As the surgeon is able to see the ear canal during the procedure, accidental damage to the ear drum and external ear canal can be avoided.
In your son's case, where he had a hearing test and was subsequently referred to a children's clinic during his primary school days, it would be important to determine if the hearing loss was really due to the impacted ear wax or some other reason.
There are numerous causes of hearing loss, including problems in the external ear, middle ear and the inner ear.
It would therefore be a good idea to consult an ear, nose and throat specialist if the hearing loss persists despite clearing out the ear wax.
By DR BARRIE TANHead, consultant and director at the Centre for Hearing & Ear Implants at the department of otolaryngology at Singapore General Hospital
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