MWH Services Otolaryngology

Call us at 6931 2000 should you need any of the following services

1. General Ear, Nose and Throat Services
   – Audiology (Middle & Inner Ear Tests)
   – Loss of hearing and balance
   – Disorders of paranasal sinuses
   – Headache with paranasal sinus involvement
   – Nasal Infection
   – Nasal Obstruction and deviated septum
   – Nosebleeds (Epistaxis)
   – Nasal Polyps
   – Voice and other throat problems (Hoarseness, choking, swallowing difficulties)
   – ENT related operations
2. Paediatric ENT
   – Childhood Ear, Nose and Throat disorders
3. Head and Neck Screening
   – Head and Neck cancer, particularly nasopharyngeal cancer
4. Allergy Testing
   – Food Allergy Testing & Aeroallergen
5. Sleep Study
   – Snoring and Sleep apnoea
6. Industrial Screening
   – ENT assessment for licensing of Divers, Pilots and Laser Operations

1. Adults

• Nasal endoscopy
• Voice Strobe voice evaluation
• Radio Frequency of Inferior Turbinates
• Nasal Clearance
• Ear wax cleaning under microscope and suction
• Steroid Injection to Tympanic Membrane
• Ultrasound guided Thyroid Biopsy
• Allergy Blood Test
• Swabs for Lab Test
• Stitches removal

2. Pediatrics

• All general pediatrics cases
• Adenoidectomy
• Tonsillectomy
• Grommet tube insertion
• Airway management
• Head and Neck surgery including biopsy & thyroid / salivary gland surgery
• Pinnaplasty / otoplasty
• Protruding ears
• Hearing restoration and repair
• Nose-Pediatrics sinus surgery, snoring / sleep apnea surgery

Condition:
Hearing loss occurs in adults and children and may be caused by common conditions such as impacted earwax, ear infections, foreign bodies, eardrum perforations (ruptured eardrums) and fluid trapped behind the eardrum (glue ear) after a bad cold. Longstanding ear disease such as destructive skin cysts and abnormal fixation of the ear bones may also cause hearing loss. In addition, many adults experience hearing difficulty as they grow older. Hearing loss can severely affect a person’s quality of life. Not all types of hearing loss may be helped by hearing aids or standard surgery.  Sometimes, the hearing is so poor that only the option of hearing implants remains.

Treatment:
Our skilled team can perform surgeries such as grommets (ventilation tubes), myringoplasty (eardrum repair), ossiculoplasty and stapedotomy (reconstruction of ear bones) to treat the conditions.

Hearing implants are also a reliable modern solution to today’s hearing problems and can considerably improve quality of life for those with hearing loss. These include bone conduction hearing devices (Bone Anchored Hearing Aids BAHA and Bonebridge) and cochlear implants. More than 300,000 cochlear implants have been performed worldwide since 1985, with overall good results in most cases.

Cochlear implants are surgically implanted devices which stimulate the inner ear (cochlea) with electrical signals. These are converted into sound signals by the brain to allow the patient to hear again. The surgery may be done as a day procedure, but patients often prefer to stay in hospital overnight and go home the next day. The cochlear implant is usually switched on 2-3 weeks after surgery. Specialised speech therapy is then conducted over the next few months to help the patient learn to use his new cochlear implant.

Other types of hearing implants e.g. BAHA, Bonebridge, Vibrant Soundbridge, may be suitable to manage different types of severe to profound hearing loss.

Detection:
It is extremely important to screen for your condition as it can optimise recovery and rule out more serious conditions like inner ear or brain tumours.

Difficulty in hearing should always be investigated thoroughly with a full history and examination. Let us perform a hearing test (audiogram) to determine the type of hearing loss that you may be suffering from. Reach us at 6391 8000 for a hearing test.

Condition:
The most common lumps or swellings are enlarged lymph nodes. These can be caused by bacterial or viral infections, cancer (malignancy), or other rare causes. Swollen salivary glands under the jaw may be caused by infection or cancer. Lumps in the muscles of the neck are caused by injury or torticollis.

There are many causes of lumps in the neck. The most common lumps or swellings are enlarged lymph nodes. These can be caused by bacterial or viral infections, cancer (malignancy), or other rare causes.

Swollen salivary glands under the jaw may be caused by infection or cancer. Lumps in the muscles of the neck are caused by injury or torticollis. These lumps are often at the front of the neck. Lumps in the skin or just below the skin are often caused by cysts, such as sebaceous cysts.

The thyroid gland may also produce swelling or one or more lumps. This can be due to thyroid disease or cancer. Most cancers of the thyroid gland grow very slowly.

As adults age, the likelihood of the lump being a cancer increases. This is noticed in people who smoke or drink a lot of alcohol. Most lumps in adults are not cancers.

Treatment:
Thyroid disease or cancer are cured with surgery, even if they have been present for several years. Come to us to check for any presence of lumps. Whether you are young or old. Neck lumps in children are mostly caused by infections that can be treated. Early treatment should be done to prevent complications or the spread of an infection.

Condition:
Nasal allergy (Allergic Rhinitis, AR) is a common condition affecting both the young and the old. It is the most common immunological disease affecting mankind. The prevalence of allergic rhinitis is about 40% in Singapore. House-dust mite and house-dust (fecal matter of the house-dust mite) is the most common cause of aero-allergenic AR in Singapore.

Rhinitis, by definition, is an inflammation of the lining of the nasal passage (mucosa). It presents with nasal discharge (runny nose), itching, sneezing and nasal blockage or congestion. Rhinitis can be caused by a variety of factors, allergy being one. It can also be non-allergic, infective or a combination of factors.

Allergic rhinitis is a risk factor for asthma and affects the control of asthma as well. A combination of the two conditions increases the cost of managing both. AR in early childhood is a risk factor for future development of asthma in adult life. Approximately 80% of patients with asthma report symptoms of rhinitis and vice-versa.

AR is associated with other ‘allergy’ states (i.e. atopy) such as eczema and food allergy. AR also affects the eyes (conjunctivitis), reduces the sense of smell (hyposmia), affects the middle ear and potentially reduces hearing, irritates the throat and can affect the voice box.

Middle ear inflammation and swelling of the adenoids (lymphoid tissue found at the back of the nose) may be associated with AR too. Occupational rhinitis i.e. rhinitis caused by airborne substances in the work environment affecting the nasal lining can affect the individuals primarily or affect predisposing asthma and potentially even cause it.

Detection:
Examination of the ear, nose and throat looking for signs of AR includes looking for an ‘allergic salute’ – a horizontal nasal crease across the front of the nose above the tip, and dark circle around the eyes due to pooling of blood around the eyes (i.e. shiners).

Inspection of the front of the nasal passages (anterior rhinoscopy) looking at the health of the nasal lining, any swelling of the side walls of the nose (turbinates) and deviation in the nasal partition (septum) will be documented.

We can perform nasal endoscopy for adults and young children at our specialist centre. The examination allows for visualization of the back of the nose and throat. Other conditions that may affect the nose such as infections, polyps and adenoidal swellings are easily picked up on nasendocopy.

The mainstay of diagnostic testing in subjects with AR are tests that assess a type of immunoglobulin in the skin or blood serum. These molecules (i.e. immunoglobulins) are effectively antibodies that are produced by a specific type of cell as part of the body’s immune system.  The allergen-specific immunoglobulin is called IgE. Skin prick tests (SPT) are a routine and involve the pricking /scratching of the skin while inserting a purified sample of the known allergen. A positive SPT does not always mean that the individual is allergic to a particular allergen – up to 15% of individuals who do not exhibit any AR. Serum (blood) tests are more specific and serum specific IgE can be tailored according to the profile and possible exposure of the patient.

Call us at 6931 8000 to arrange an allergy blood test or swab test .

Treatment:
Allergic rhinitis in Singapore is predominantly due to house dust mite allergy. While seasonal allergens are more easily avoided and do not affect the patient throughout the year, the house dust mite allergy sufferer has a greater challenge facing him or her given the practical challenges of reducing exposure.

Antihistamines: These drugs that stop the release of histamine, which is secreted by cells found in the nose, throat and eye. These drugs can be administered orally, as nasal sprays or eye drops. The older generation antihistamines causes more ‘central’ effects such as drowsiness. The newer ‘2^nd’ generation antihistamines are longer acting and have a less sedating effect. Antihistamines are the first line treatment for mild to moderate symptoms of AR. The topical intranasal compounds have been shown to help with faster onset of action.

Corticosteroids: This class of drugs is the cornerstone of the anti-inflammatory treatment in AR and are administered intranasally as sprays. They are suitable in children and adults depending on the preparation and manufacturer’s recommendations. They reduce nasal congestion and have a much better effect in comparison to other therapeutic groups such as the antihistamines. Intranasal steroids (INS) can take several hours to take effect and clinical improvement can take a few days with even a fortnight for maximal effect. Unlike their oral counterparts, the newer INS have much lower to negligible absorption into the bloodstream thus reducing systemic side effects (low bioavailability). As such, they are also used in children.

INS can cause mild insomnia and can raise the intraocular pressure in glaucoma patients. They are ideal in patients with moderate to severe symptoms and can be used in conjunction with antihistamines. Combination treatments where a topical antihistamine and INS are mixed have been shown to help all nasal symptoms of AR in addition to ocular complaints.

Nasal decongestants: These reduces the swelling of the nasal lining temporarily. They work much faster than INS and may be tempting to use in the long term given their immediate effect. However, it is not recommended for long term use given the rebound nasal congestion after. A three-to five-day course (maximum) is recommended. Another class of drugs known as the anti-leukotrienes have been used with some success in asthma and AR sufferers. They are well tolerated but do not have the same effect in managing inflammation as the INS. Another class of drugs which may help in watery discharge, the anti-cholinergics (e.g. ipratropium bromide) can be used in combination with INS when necessary. Finally, cromoglycates, a class of drugs that aim to prevent histamine release from sensitized cells can help in mild AR and used as eyedrops for ocular symptoms.

Immunotherapy: This form of therapy aims to re-educate and ‘calm-down’ the immune response by habituation and development of ‘tolerance’ to an allergen. Subcutaneous immunotherapy (SCIT) involves the incremental injections of purified allergen under the skin over a period in a controlled manner and setting. This process can take up 3-5 years with 4-6 weekly injection. Access to emergency resuscitation facilities are imperative however given the risks of anaphylaxis (severe life-threatening allergic reaction). Sublingual Immunotherapy (SLIT) involves placing a tablet or drops of purified allergen under the tongue. It is generally well tolerated and has been effective for grass pollen and house dust mite. Besides side-effects such as oral irritation and mouth swelling, it is safe and can be administered by the patient at home. In summary, immunotherapy is the only treatment that has the capability to modify the immunological course of AR and has been shown to reduce or obviate the need for INS and other treatments.

Surgery: Given that AR is primarily an immune mediated condition, the role of surgery is limited to dealing with anatomical issues such as a deviated septum, inferior turbinate hypertrophy, concomitant chronic rhinosinusitis and in so doing help with more efficient drug delivery.

Condition:
Some parents may notice that their young children snore during their sleep. Snoring is not harmful, but it may be a sign of underlying obstructive sleep apnoea (OSA), especially if the snoring is associated with frequent pauses in breathing, waking episodes at night or increased effort made by the child to breathe at night. Sometimes, bedwetting at night may be a more subtle sign that the child is suffering from an element of OSA. Other discreet signs of OSA to watch out for include changes in the child’s behaviour and attention deficits, which may also be noticed by the child’s teachers at school.

OSA in children is different from OSA in adults. In a normal and otherwise healthy child, OSA is commonly caused by large tonsils and adenoids at the back of the nose and throat, which are made up of lymphoid tissue (part of the immune system). Reassuringly though, surgical removal of the tonsils and adenoids to treat OSA in children does not affect the child’s immune system. In many children, the tonsil and adenoid tissue begins to shrink by itself around the age of 7 so that by the time they reach puberty or young adulthood, most of them will no longer have large tonsils or adenoids.

Detection:
Sleep studies are usually reserved for children with other health issues or underlying syndromes or if the diagnosis of OSA remains unclear.

Sometimes, nasal issues like allergic rhinitis (sensitive lining of the nose which may cause sneezing, itching, blocked nose, runny nose as a reaction to e.g. house dust mite) may lead to snoring in children.  Nasal allergy may cause swelling and enlargement of the soft tissue inside the nose.

Treatment:
In children, we always try medication to treat first and only consider surgery if necessary. Our nasal endoscopy is suitable for young children and our skilled specialist is trained in pediatrics ENT to treat your child’s conditions. Call us for an appointment to see our specialist at 6931 8000.

Condition:
In children, ear problems are quite common and may present with ear pain, ear blockage or ear discharge.  One of the most common problems is due to impacted earwax which may form a small plug inside the ear and cause the sensation of blocked ear and some mild hearing loss. Earwax is made up of skin cells shed from the ear canal and has protective properties as it contains natural oils to coat the ear canal skin. One simple advice to avoid ear infections is to stop digging one’s ears and to keep the ears dry e.g. at shower time.  The ear is usually a self-cleaning device as the skin lining the ear inside tends to migrate outwards to move most wax away from the inside. Sometimes, earwax gets trapped inside due to the type and nature of wax, and shape of the ear canal.

After a bad cold or flu, children (and adults) may sometimes get fluid building up behind their eardrums as the nose is connected to both ears by pressure tubes (Eustachian tubes). If this fluid becomes infected, then the child (or adult) may develop an ear infection which can lead to eardrum perforations (“holes”) to cause ear discharge (liquid leaking out of the ear) and hearing loss.

Another risk factor for buildup of eardrum fluid and infections may be due to excess soft tissue growing behind the nose (adenoids). Having large adenoids is relatively common in young children and may also lead to snoring and trouble breathing at night.

Treatment:
A few drops of clean olive oil applied inside the ears helps to soften the wax and make it easier to flow out on its own. If this does not work, then bring your child to visit our Ear Nose Throat specialist and we can help clean up the trapped wax and any infected debris with special tools under the microscope. Call us at 6931 8000 if you think you need help.

After careful cleaning of the ear, eardrops are prescribed to treat the infection fully. In eardrum infections, we may prescribe a course of oral antibiotics.  Eardrum perforations which do not heal by themselves may need to be repaired with surgery to prevent further infection.

• Head and Neck Cancer
• Hearing Loss
• Tinnitus
• Rhinosinusitis
• Sleep-disordered breathing and snoring
• Snoring and Obstructive Sleep Apnoea (OSA)
• Swallowing Difficulties
• Voice Examination
• Voice Disorders
  • Acute and Chronic Laryngitis
  • Muscle Tension Dysphonia
  • Vocal Fold Paralysis
  • Vocal Nodules, Polyps, Cysts and Tumours