Dr Brenda Sim, Consultant from the Department of Otorhinolaryngology - Head ＆ Neck Surgery at Singapore General Hospital (SGH), answers your questions on ear disorders.
Listen up! Your ears are more important than you think.
The ear has three main parts - outer, middle and inner.
Did you know one of the middle ear bones, called the stapes, is the smallest bone in our body?
And yet, together with two other middle ear bones (ossicles) it plays a very important role to conduct sound from the outer ear to the cochlea, which is part of the inner ear, and these signals then get transmitted to the brain.
However,
the inner ear is not only responsible for hearing. It also houses the balance organs - the semicircular canals, as well as the utricle and saccule. The balance organs detect rotational movements, gravity and back-and-forth movements of the head.
As such, our ears are essential in our daily lives, be it in interacting with our friends and family, or keeping our balance. Any disorder of the ear can cause much discomfort and impact the quality of our life.
Commonly encountered symptoms of ear conditions include:
About Dr Brenda Sim
Dr Brenda Sim is from the Department of Otorhinolaryngology - Head and Neck Surgery in Singapore General Hospital (SGH). She completed her training in Otorhinolaryngology in Singapore and has a subspecialty interest in hearing and balance disorders.
Questions and answers on ear disorders
1. Question by cloverqueen
I have this ringing sound in my ear for quite a long time. It doesnt really seem to go away and i'm pretty used to it by now. Except when the surrounding is quiet or during night time, then the sound will be more obvious. Should I be concern with it and when should I see a doctor about it? Thanks.
Answer by Dr Brenda Sim
Hi!
Thank you for your question. What you are describing is known as “tinnitus”.
Tinnitus is when you experience ringing or other noises in one or both of your ears. It isn’t caused by a sound externally and cannot be heard by others.
Tinnitus usually occurs due to an underlying cause. Common causes include ear infection or blockage, age-related hearing loss, noise-induced hearing loss, previous injury to ears/ head and neck region, previous use of medications that can affect the inner ear, etc. Less common causes include, Meniere’s disease (where there is repeated episodes of dizziness, tinnitus and hearing loss that fluctuates), eustachian tube dysfunction, changes to the tiny bones in the ear (otosclerosis), muscle spasms in the middle ear, temporomandibular joint disorders, tumours along the hearing or balance nerves, blood vessel disorders etc.
Many patients will also similarly experience that it becomes louder in a quiet environment, and that is because the environmental white noise no longer drowns out the tinnitus.
One should see a doctor if:
The tinnitus is following an upper respiratory tract infection and does not get better within a week or two
Tinnitus is associated with dizziness or hearing loss
Tinnitus is one sided
You are experiencing anxiety or depression as a result of the tinnitus
2. Question by Wangtc
Dear Dr
Any cure for tinnitus? I am 64 & I had it for about 40 yrs.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Treatment for tinnitus depends on the underlying cause. Have you had the tinnitus evaluated? It is best to ensure that there is no underlying diagnosis resulting in the tinnitus.
Some examples of treatment would include:
Treatment of ear infection or removal of wax if you have infection or wax causing blockage of the ear canal
Hearing aids, if the tinnitus is a result of age-related or noise-induced hearing loss.
Changing any medications that is the culprit of the tinnitus
Oftentimes, tinnitus cannot be “cured”. However, there are certain measures that you can employ to make it less noticeable. Oftentimes, most patients would learn to ignore it and go on to lead very normal lives. Measures include:
Ensuring you have enriched environmental noises (i.e. not have too quiet a room) – opening the window to allow environmental noises into your room. Fans, air conditioners produce white noise as well and help to reduce tinnitus symptoms
Use of a white noise machine – these produce sounds such as falling rain, ocean waves etc and are effective
Use of a tinnitus masker (worn like a hearing aid, and produces a continuous white noise so as to suppress the tinnitus)
If the tinnitus has caused significant disturbance and distress in your lives, counselling in the form tinnitus retraining therapy or cognitive behavioural therapy will help. If one is so distressed with the tinnitus that it causes suicidal ideation, please seek help immediately be it with your Family Physician or via the Emergency Department.
3. Question by Smurf
I feel my inner ears are watery. When I insert a scroll tissue paper, it comes out wet. Sometimes it caused like I have a blocked ear.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Just to be clear on the terminology, the ear is divided into three parts – external, middle and inner. From what you have described, it seems that you are having infection of the ear canal. The ear canal is part of the external ear, and correspondingly, infection of the ear canal is known as otitis externa. (It is unlikely the inner ears as inner ears is very deep in and comprises of the cochlea which is the hearing organ, as well as the balance organs, and can only be reached surgically!)
Most common reasons why the ear canal can get infected is through frequent instrumentation (ear digging with cotton buds, metal ear digger, and even a rolled up tissue paper) and swimming (as dirty water gets into the ear canal). The debris formed in the ear canal then causes blockage to the ear.
Other symptoms for otitis externa other than ear discharge and ear blockage could include ear pain and ear itch. If so, I would suggest that you seek medical attention to get it evaluated so that the appropriate ear drops can be prescribed to you.
4. Question by Grachel
Hi Dr Brenda,
I have been having giddiness for many years. When lying down on bed I will feel super giddy and results me not able to sleep throughout the night. Sometimes will feel pressure in my head. What should I do? As this has affected my life.
Answer by Dr Brenda Sim
What you have described sounds like you are experiencing episodic giddiness. Giddiness is a complex topic. It may be from a central cause (brain) or a peripheral cause (not a brain cause). More questions needs to be asked to determine what is the cause of the giddiness.
The two most common causes of episodic giddiness are benign paroxysmal positional vertigo (BPPV) and vestibular migraine. Usually by asking you a series of questions, we would be able to help determine the cause of your symptoms.
BPPV is caused by loose crystals in your balance organs that are floating around each time you turn your head in a particular direction. This then results in vertigo. We can do certain repositioning manoeuvres in the clinic to help you. Thankfully BPPV is self resolving (typically in a few weeks) as the loose crystals eventually gets absorbed by the body. If it is persistent, please do seek medical attention.
Vestibular migraine is a variant of migraine and is one of the more common causes of episodic giddiness. You describe your head having pressure. Do you have migraine now or in the past? Any family members have migraine as well? Are there any known triggers to your giddy episodes – such as lack of sleep, certain foods like cheese/ wines/ MSG etc? It is important to avoid those triggers. If these giddy episodes happen frequently, pls do seek medical attention and the doctor can discuss with you if any preventive medications can be prescribed.
If at any point you are experiencing giddiness with concurrent weakness / numbness / slurring of speech/ severe headaches etc. – please do seek medical attention immediately as it may be a sign or stroke.
It would be best to see a doctor so that we can ask you more questions to determine the cause of your symptoms and treat you accordingly.
5. Question by Hissing Sound
How to reduce tinnitus? Does tinnitus damage the brain?
How to prevent nose dripping mucus when eating?
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Oftentimes, tinnitus cannot be “cured”. However, there are certain measures that you can employ to make it less noticeable. Oftentimes, most patients would learn to ignore it and go on to lead very normal lives. Measures include:
Ensuring you have enriched environmental noises (i.e. not have too quiet a room) – opening the window to allow environmental noises into your room. Fans, air conditioners produce white noise as well and help to reduce tinnitus symptoms
Use of a white noise machine – these produce sounds such as falling rain, ocean waves etc and are effective
Use of a tinnitus masker (worn like a hearing aid, and produces a continuous white noise so as to suppress the tinnitus)
If the tinnitus has caused significant disturbance and distress in your lives, counselling in the form tinnitus retraining therapy or cognitive behavioural therapy will help. If one is so distressed with the tinnitus that it causes suicidal ideation, please seek help immediately be it with your Family Physician or via the Emergency Department.
And rest assured, no, tinnitus does not damage our brain.
As for your second question, having runny nose while eating is known as gustatory rhinitis. The runny nose is often more pronounced when eating spicy or temperature hot foods. This is because a nerve called the trigeminal nerve gets stimulated while eating and this in turn causes the runny nose.
Management of this problem would be to avoid eating trigger foods. Nasal sprays and antihistamines would also help.
6. Question by kooscorp
Dr Sim, may I know how come sometimes after I exercise, my ears get blocked (they are okay before I exercise)? The blocked ears only go away, say like half a day later.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
What you describe sounds like you have a patulous eustachian tube. The eustachian tube connect the middle ear to the back of the nose and the main functions are with equalizing pressure and with draining the middle ear secretions to the back of the nose.
In patulous eustachian tube, the eustachian tube is abnormally patent. The symptoms of blocked ear sensation and autophony (hearing your own voice echoing in your ears) very often worsens during exercise. It improves with certain manoeuvres such as lying down on your back.
In some cases, patulous eustachian tube happens after significant weight loss, but in majority of cases, it can happen without a known precipitating cause.
Management options include observing and seeing if it resolves on its own. Sometimes, estrogen nose drops may be prescribed. Sometimes injection of fillers to the eustachian tube opening in the back of the nose may also be considered. This will be discussed with you in the clinic.
Nevertheless, as the symptom of blocked ear also occurs in many other conditions, if it is persistent do consider getting a referral to ENT for a check of your ears, your hearing and possibly an nasoendoscope to ensure there are no pathologies at the back of the nose where the eustachian tube opens to.
7. Question by Noabunny5
I have a history of sinusitis and ear infection. Recently, when I went swimming, after awhile, my ear would feel painful. The pain will leave after I stop swimming. Why is that so? Is it still safe for me to go swimming? Sometimes, my hearing will feel blocked too. My nose is also perpetually blocked in one side.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
There is an inherent risk in getting otitis externa (or infection of the ear canals) with swimming as the pool water is dirty. The debris in the ear can then cause ear blockage. Another reason for ear blockage would be – when swimming pool water enters the ear canal, it may expand the wax and cause one to feel ear blockage. Perhaps you could consider using ear plugs to prevent the swimming pool water from entering your ears.
As for your blocked nose, yes allergic rhinitis may cause it. Other symptoms of allergic rhinitis can be runny nose, sneezing and itch. Allergen avoidance and use of nasal sprays can help.
There are overlap of symptoms for rhinitis and sinusitis. If you experience discoloured nasal discharge (often yellow or green), smell disturbance, or facial pressure or pain, it may be a symptom of sinusitis. This is often self-resolving. But sometimes you may require antibiotics. If it does not resolve with antibiotics, then surgery may be required.
Structural changes in the nose such as a deviated nasal septum or swelling of the turbinates, as well as nasal polyps may also cause nasal blockage.
Do check in with your usual GP and they can better advise you on the next steps to take.
8. Question by VicCKK
From my various doctors visits, it appears private clinic Dr. does not use the same procedure when clearing hard ear waxes. May I know what is the MOH acceptable method to remove hard ear wax to ensure no harm effect to sensitive ear drum?
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Generally speaking, the ear is self-cleaning. The ear wax in the ear canal provides a protective film, acts as a lubricant, and also has anti-bacterial properties. As such, there is no need for routine cleaning of the ear. In fact, sometimes frequent instrumentation of the ear pushes the wax deeper in. This not only prevents migration of the wax outside but can also cause the wax in the ear canal to be hard and impacted and may start to cause problems. Common symptoms includes ear blockage, hearing loss, tinnitus.
Treatment of ear wax can include use of topical drops like olive oil and docusate sodium to soften the wax. These can commonly be bought over the counter and the symptoms generally resolve within a few days.
To my understanding, some GP clinics also do offer ear syringing.
In the ENT clinic, we have the benefit of having a microscope and specialised instruments to either do micro suctioning or removal of the ear wax.
9. Question by A Lim
Hi Dr!
I would like to ask why my left ear often has popping / crackling sound after I yawn. Is it related to blocked nose? Thank you!
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Further questions need to be asked about your symptoms to determine the cause of what you are experiencing. There may be 2 possible causes:
a) Eustachian tube dysfunction.
The eustachian tube is a tube that connects the middle ear to the back of the nose. They act to equalise air pressure and also to drain fluid from the middle ear to the back of the nose. In eustachian tube dysfunction, the tube blocked.
The most common underlying cause is that of rhinitis (inflammation of the nose). This may be due to allergies (allergic rhinitis) or from an upper respiratory tract infection (infective rhinitis).
Common symptoms of eustachian tube dysfunction include: blocked ear sensation, hearing loss, tinnitus. Crackling/popping sound may be due to accumulation of fluid in the middle ear.
Thankfully, most times, eustachian tube dysfunction resolves on its own. Doing Valsalva manoeuvre (the act of popping your ears as you would when your ear gets blocked during air travel) often helps as it opens up the tubes.
However, sometimes, if persistent, medications are required. They include nasal sprays, anti-histamines and decongestants. For very persistent eustachian tube dysfunction, other treatment options include balloon tuboplasty (a balloon is introduced to the eustachian tube through the nose and inflated) or a grommet tube insertion (small tube placed in the ear drum to help equalise the air).
b) Temporomandibular joint dysfunction
The temporomandibular joint is an important joint very near the ear that is involved with chewing and opening/closing of your jaw. In TMJ dysfunction, the joint and its associated muscles and ligaments become inflamed or irritated. This happens most commonly due to wear and tear of the joint. Certain habits like chewing on hard nuts or bruxism (grinding teeth during sleep) may hasten the wear and tear of the joint.
Very often, you will get pain especially on chewing hard foods. You may also get a clicking sound when you open your mouth widely – this is most likely due to the possible dislocation of the joint when you open your mouth wide.
Pain killers can help, as with eating a diet comprised of soft food. If you do make an appointment with the ENT clinic, we will help to check to make sure that there are no other reasons why you are having an ear pain. You would also benefit from getting an opinion from our (SingHealth) dental colleagues.
10. Question by Iris
Dear Dr Sim,
I have been suffering from ear pain, itch and sometimes ear block sensation for more than a year. Doctors at polyclinic was unable to treat me and so I was referred to ENT specialist. But specialist was unable to treat me too. So, I went to a private Ear Specialist and doctor used a magnifying glass (I guess) and then told me that she needed to remove the bacteria and fungi inside that had caused the pain.
My pain has been relieved but till now I am still experiencing terrible itch and scaly & dry skin in my ear.
Please advise what can be done to solve this problem. Thank you.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
It must have been a relief to have the infection treated. Sometimes, if patients continue to experience itch even after the infection of the ear canal has resolved, it could be due to dermatitis (or eczema) of the ear canal skin. Please do avoid the urge to dig the ear to relief the itch as it can precipitate an infection. Instead what you can do is to gently massage the tragus to relief the itch.
Sometimes, over-the-counter olive oil drops for the ear can be used to relieve any itch or discomfort. However, if the symptoms persist, please do seek medical help and the doctor may also prescribe steroid ear drops for you for the eczema of the ear canal skin.
11. Question by Anne
Hi Dr,
Last Thursday I had vertigo attack twice. Once before dinner and another at night. I felt dizzy, all around me spinning and then vomited each time. I am feeling fine now however I still have this feeling of ear block sensation. Will this ear block feeling go away after applying ear drops? What should I do?
Answer by Dr Brenda Sim
Hi! Thank you for your question.
There are many causes of episodic giddiness. How long does each episode last? You mentioned you have feeling of blocked ear sensation – does the sensation of blocked ear and hearing loss come together with the giddy episodes? Do you have fluctuating hearing loss? One of the possible causes would be Meniere’s disease – but it is rare. There are treatment options for Meniere’s disease – including oral medications (like vasodilators, diuretics, etc) intratympanic injections and even surgeries.
As for whether ear drops may help with the blocked ear sensation – it may not if it was not a problem like ear canal infection or blockage from ear wax in the first place.
The treatment the giddiness really depends on the underlying cause. I think it is best you go for a proper medical consult to determine the cause of your symptoms and have a personalised treatment plan.
12. Question by Sophia
Hello Dr,
I started using hearing aids from 2019. Today I feel my hearing has deteriorated considerably. With hearing aids on I can't make out what people are saying (most of the time). Can this be treated?
My other question is - does buildup of ear-wax cause hearing loss? I have asked a doctor before to check my ears but was told they were clear. Can ear-wax be deep in the ear canal that can only be seen with a special instrument and which can clean out the ear canal?
My last question - I sometimes feel giddy whilst standing up & feel like I'm swaying. What is wrong?
I am 76 years old. Thank you.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
To answer your first question, there are two possible reasons why you cannot hear others despite putting the hearing aids on. Firstly, it could be because of further deterioration of your hearing. Secondly, it could be because the hearing aids are no longer working – please do check with the audiologist / vendor whom you bought the hearing aids from to see if they can optimize your hearing aids.
As for your second question, yes, wax impacted ear wax can cause hearing loss as it prevents sound from conducting effectively to the ear drum and middle ear bones to the hearing organ. Doctors in both GP clinics and ENT clinics may use an otoscope to check the ears.
Lastly, more needs to be asked before I can determine the cause of your giddiness. Do you mean that you get light-headed after standing up from a lying or sitting down position? That is known as postural giddiness. It may be related to your blood pressure. I would advise you to check in with your usual GP.
13. Question by AG
Dear Dr Brenda Sim,
I suddenly had frequent vertigo attacks recently, two within 2 days and after 5 days. I suspect it has to do with my block ear sensation or other imbalances in my system. Is there a cure? How should I treat this problem? Just to inform I had CVT nine years ago and taking Pradaxa an anticoagulant daily.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
I assume CVT means cerebral venous thrombosis and that you are taking an anticoagulant. It is not uncommon to experience dizziness post-stroke. Have you informed the neurologist that you are on follow up with and what are the doctor’s comments?
There are many causes of episodic giddiness. How long does each episode last? Does the sensation of blocked ear and hearing loss come together with the giddy episodes? Do you have fluctuating hearing loss? One of the possible causes would be Meniere’s disease – but it is rare. There are treatment options for Meniere’s disease – including oral medications (like vasodilators, diuretics, etc) intratympanic injections and even surgeries.
The treatment the giddiness really depends on the underlying cause. As you seem to have quite a complex medical history, I think it is best you go for a proper medical consult to determine the cause of your symptoms and have a personalised treatment plan.
14. Question by Vincent
Dear Dr Brenda Sim,
As per your Q&A forum, I have tinnitus and will appreciate your reply for the following queries:
a) What causes tinnitus?
b) Will tinnitus cause loss of hearing, deafness or any other ear issues?
c) If I take a Sleep Apnea Test and if tinnitus affects my deep sleep pattern, how will this show up in the test results?
Thank you!
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Tinnitus usually occurs due to an underlying cause. Common causes include ear infection or blockage, age-related hearing loss, noise-induced hearing loss, previous injury to ears/ head and neck region, previous use of medications that can affect the inner ear, etc. Less common causes include, Meniere’s disease (where there is repeated episodes of dizziness, tinnitus and hearing loss that fluctuates), eustachian tube dysfunction, changes to the tiny bones in the ear (otosclerosis), muscle spasms in the middle ear, temporomandibular joint disorders, tumours along the hearing or balance nerves, blood vessel disorders etc.
To answer your second question, tinnitus does not cause hearing loss, but rather, it is a symptom of underlying hearing loss or other ear conditions, such as middle ear effusion, etc.
You are right in that if your sleep is poor or disrupted due to any reason including tinnitus, it can affect your sleep study result as sleep efficiency will be poor and this may affect the accuracy of the sleep apnoea test result. There are too many fine points to discuss this here and I hope you will have a meaningful discussion with the doctor who will be going through the sleep study result with you.
15. Question by Winston Jr
Dear Dr,
I have an issue with my right ear as there is a constant ringing sound. Can I have your advice on this?
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Sometimes, a constant ringing sound (tinnitus) may be the caused by impacted wax, ear infection or middle ear infection. It may also be the first sign of hearing loss. Do you also have any other symptoms like blocked ear sensation, ear pain or ear discharge? Any nasal symptoms as well?
I would advise you to see a doctor to have your ears and hearing checked to ensure that this is not a serious issue.
16. Question by Lekoon
Hi Dr,
My teen daughter always has blocked ear with some pain on and off since young and according to a doc it's because her ear canel is narrow and she has wet ear wax. So she has to apply ear spray to help remove the wax. I am concern if this can be done throughout her life. She has had her ear wax removed a few times but the problem will come back a few months later.
Kindly help to advise. Thanks!
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Yes, it is alright to use olive oil to help with wax clearance regularly to prevent wax built up.
Generally speaking, the ear is self-cleaning. Meaning to say, there is no need to regularly clean out the wax. However, some people, for example those with previous ear surgeries like mastoidectomies, or those with narrow ear canals from whatever underlying cause, may need frequent cleaning at a medical facility.
Be sure not to dig the ears, as frequent instrumentation of the ear pushes the wax deeper in. This not only prevents migration of the wax outside but can also cause the wax in the ear canal to be hard and impacted and may start to cause problems such as secondary infection or hearing loss.
17. Question by daniel
Hi Dr,
I tend to get dizzy once I tilt my head to the right. Is it a sign of vertigo? If so, can it be cured?
Answer by Dr Brenda Sim
Hi!
Thank you for your question.
To be clear on terminology, "vertigo" is a symptom (i.e. what you experience) – it is a sensation that either you or your environment is moving when it is actually not.
There are many underlying cases of vertigo. It may be broadly divided into central (brain) causes, vs. peripheral (non-brain) causes. The most common ear cause of vertigo that ENT doctors see in our clinic would be benign paroxysmal positional vertigo (BPPV). BPPV is caused by loose crystals in your balance organs that are floating around each time you turn your head in a particular direction. This then results in vertigo. We can do certain repositioning manoeuvres in the clinic to help you. Thankfully BPPV is self resolving (typically in a few weeks) as the loose crystals eventually gets absorbed by the body.
Dizziness is a complex issue. More questions need to be asked in order to determine the cause of your dizziness. I would highly encourage you to seek medical advice.
18. Question by stewart
Hi Doctor,
I have this condition Patulous Eustachian tube issue for both side of my ears. The ear passage is always open and started 2 years already. Very irritating and my quality of life has reduced tremendously. I can hear my breathing. But the only time when it is PERFECTLY normal is when I woke up from bed. Swallow saliva and the hearing is very normal. After 2 minutes when I walk straight or I should say upright position the condition returns. At times I feel there is a pressure beneath the cochlea (my own estimation of the location). I did the injection to close the tube but no use at all. Normally how is the remedy for this type of situation?
Answer by Dr Brenda Sim
Hi! Thank you for your question.
For the benefit of other readers, the eustachian tube connects the middle ear to the back of the nose and the main functions are with equalizing pressure and with draining the middle ear secretions to the back of the nose.
In patulous eustachian tube, the eustachian tube is abnormally patent (i.e. open). The symptoms of blocked ear sensation and autophony (hearing your own voice echoing in your ears) very often worsens during exercise. It improves with certain manoeuvres such as lying down on your back (which explains why you are alright when lying down, but symptoms are worse when in upright position).
In some cases, patulous eustachian tube happens after significant weight loss, but in majority of cases, it can happen without a known precipitating cause.
I see that you have already had fillers injection to the eustachian tube opening. While it may work for some people, it did not for you. That is understandably frustrating.
Other simple measures like keeping adequately hydrated, and lying down occasionally during the day would help. As would using saline nasal sprays.
Medications would include estrogen nose drops as well – have you discussed that with your doctor?
Other measures would also include applying a paper patch onto your ear drum.
In very many cases, the symptoms of patulous eustachian tube will eventually resolve on its own, and I wish that it will too for you.
19. Question by kellyn9
Hi Dr,
My 17-year-old daughter occasionally gets dizzy spells. Is there any linkage to her low iron blood count or is it due to others reasons?
Answer by Dr Brenda Sim
Hi! Thank you very much for your question.
Yes, a low red cell count (also known as
anaemia) can cause giddiness. Has the reason for the low red cell count been evaluated? If not, I would strongly suggest seeking medical attention for it.
20. Question by KKLim
Dear Dr,
I have tinnitus in both ears. I read about the condition online and found research that a possible cause could be weak or damaged auditory cortex in the brain. I have several questions:
1) Is this true?
2) Will tinnitus go away on its own? I read of cases of patients who said their tinnitus disappeared after several weeks, and in several cases, after a year or longer.
3) Will taking supplements strengthen or nourish the auditory cortex and thereby clear up tinnitus?
4) Is gingseng proven to nourish the auditory cortex?
Thank you.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
There are many theories as to why tinnitus happens. So far there is no single theory that can explain the mechanism of tinnitus, in part due to the diverse nature of it.
Regardless, tinnitus usually occurs due to an underlying cause. Common causes include ear infection or blockage, age-related hearing loss, noise-induced hearing loss, previous injury to ears/ head and neck region, previous use of medications that can affect the inner ear, etc. Less common causes include, Meniere’s disease (where there is repeated episodes of dizziness, tinnitus and hearing loss that fluctuates), eustachian tube dysfunction, changes to the tiny bones in the ear (otosclerosis), muscle spasms in the middle ear, temporomandibular joint disorders, tumours along the hearing or balance nerves, blood vessel disorders etc.
For most patients, the tinnitus will improve over time. However, a minority of patients may need additional help, be it with medications/supplements (we prescribe our patients with gingko and vit B), tinnitus maskers or counseling.
21. Question by limnl2002
Hi Dr Brenda Sim,
Is there a cure for blocked ear sensation? Thanks.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
It really depends on the cause of the blocked ear sensation. External ear conditions like ear infection or wax accumulation in the ear canal can cause blocked ear sensation. Treatment of the infection and removal of the wax respectively can help.
Many middle ear conditions can also cause blocked ear sensation. If it is due to a middle ear fluid within the middle ear, then generally speaking, I would highly recommend for a nasoendoscopy to be done to ensure there is no growth at the back of the nose. If it is from a recent upper respiratory tract infection, it generally resolves on its own. But some people may require steroid nasal sprays +/- a course of antibiotics. If it does not get better after some time, then a small procedure called myringotomy (in which a small cut is made in the ear drum to drain the fluid) and tube insertion may be necessary.
Additionally, eustachian tube problems can also cause blocked ear sensation.
Since "blocked ear" is such a broad topic with many possible underlying causes, it is best to seek medical attention for it so that it can be properly evaluated.
22. Question by Desmond
Hi Dr Brenda,
I got blocking ear on the left ear for since 2017 till now. I went to SGH ENT for almost 2 years in 2017 but could not solve the problems, so I switched to CGH ENT till now.
My blocking ear give me a lot of discomfort all these years could you advise with many thanks.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Understand that you have already visited an ENT doctor for the problem. What was the possible underlying diagnoses that was discussed with you?
For chronic ear blockage problems, very often it is due to some eustachian tube dysfunction. Unfortunately this condition may be hard to treat in some patients.
Do you have underlying nasal allergies? If so, use of nasal steroid sprays would help. Decongestants can also help but decongestants must not be used on a long term basis.
It helps greatly to "pop your ears" (as you could when you want to equalise the air pressure in your ears when you sit on a plane) a few times a day. What this does is to open up the eustachian tube so that you can equalise the middle ear pressure.
For very persistent eustachian tube dysfunction, other treatment options include balloon tuboplasty (a balloon is introduced to the eustachian tube through the nose and inflated) or a grommet tube insertion (small tube placed in the ear drum to help equalise the air).
23. Question by Chng
Dear Dr Brenda Sim,
I'm asking on behalf of my Mrs who is suffering from dizziness and imbalance:
(1) What causes the dizziness and imbalance?
(2) Are there any treatment and cure?
(3) How can she manage the dizziness and imbalance
(4) Since these symptoms can also be from central, i.e. brain causes, or maybe from eye problems, i.e. blurring vision, how can she confirm the actual cause?
Thank you.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Dizziness is a broad and wide topic. Unfortunately I am not sure that I can determine the cause of your wife’s symptoms through this platform alone. Dizziness can be broadly classified into: vertigo (sensation that either you or your environment is moving when it is actually not), pre syncope (the feeling of almost-fainting), disequilibrium (examples would be the feeling of walking on clouds, a feeling of floating sensation etc), and light headedness.
Systems that can cause dizziness would include central causes (brain), cardiac (heart) problems, inner ear causes, and even chronic medical conditions (e.g. anaemia, thyroid conditions, psychiatric conditions etc.).
Only with thorough evaluation through asking you questions, examining you and possibly some investigations can we determine the cause of you giddiness. It is only after determining the cause can we advise the appropriate treatment and management.
24. Question by Henry
Dear Dr,
What is your understanding on the progress of the use of stem cell therapy to recover hearing loss? I read this article recently:
https://www.labiotech.eu/in-depth/stem-cell-therapy-hearing-disorders/
I understand that hearing loss will lead to cognitive decline and lead to dementia. Kindly advise.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Stem cell therapy for hearing loss remains in the research phase. I am hopeful that it may be applied in the context of hearing loss in the future.
You are right that hearing loss can not only lead to cognitive decline and dementia, it can also cause social isolation as someone with hearing loss finds it harder and harder to communicate with others. Additionally, one must also think about the safety aspect of not being able to hear well (e.g. not being able to hear an oncoming vehicle when walking on the side of the road).
For this reason, we are very happy to see those with hearing loss and give a personalized treatment plan for each one of our patients.
If during the evaluation, you are diagnosed with a condition that requires surgery (e.g. ear drum perforation, cholesteatoma, otosclerosis etc.), the surgical details will be discussed with you in our clinic.
However, the most common cause of hearing loss that we see in our clinic is age-related hearing loss. For most of these patients, hearing aids would help. Hearing aids help by amplifying sounds so that they may be detected by the damaged hearing organ (cochlea).
If however, the hearing loss is so profound that hearing aids are no longer useful and effective, cochlear implant would be an option. Cochlear implant involves a surgery in which an electrode is implanted into the cochlear. Electrical signals then directly stimulate the hearing nerve, which then sends signals to the brain.
After cochlear implant surgery, one would need to undergo therapy sessions to be able to learn to interpret these new signals. After some months, most patients with cochlear implant make considerable improvements in understanding speech.
25. Question by CK
Dear Dr Brenda Sim,
I have a blocked ear, clicking sounds and echo (sometimes) when I talk. Have went for tests and my hearing has dropped. The Dr diagnosed as eustachian tube dysfunction.
May I know how to address this problem? Do certain exercise like blowing with closed nostrils help? Is there any way to correct this issue other than surgery?
Thank you.
Answer by Dr Brenda Sim
Hi! Thank you for your question. It does sound like eustachian tube dysfunction.
Thankfully, most times, eustachian tube dysfunction resolves on its own. Doing Valsalva manoeuvre (the act of popping your ears as you would when your ear gets blocked during air travel) often helps as it opens up the tubes.
However, sometimes, if persistent, medications are required. They include nasal sprays, anti-histamines and decongestants. For very persistent eustachian tube dysfunction, other treatment options include balloon tuboplasty (a balloon is introduced to the eustachian tube through the nose and inflated) or a grommet tube insertion (small tube placed in the ear drum to help equalise the pressure).
26. Question by Billie
Dear Dr Brenda Sim,
I am having imbalance issue. My questions are:
a) How to tell if my imbalance issue is caused by ear disorder or weakness of my leg.
b) I have been applying olive oil for ear wax on both ears once a week for a few years. It is ok to do it for long term?
Pls advise. Thank you.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Unfortunately, it is a bit hard to differentiate imbalance caused by ear disorder versus that caused by weakness of your legs through this platform. It is best you go to a doctor to get it evaluated.
There are many inner ear disorders that may cause vertigo (sensation that you or the environment is moving when it is not) and disequilibrium (e.g. the feeling of walking on clouds etc), and it is often associated with nausea and vomiting. Sometimes, inner ear disorders can also imbalance associated with hearing loss or ringing of the ears (tinnitus). These are symptoms that would point towards more of an inner ear disorder rather than leg weakness, as leg weakness would not cause such symptoms.
As for your second question, yes it is alright to use olive oil periodically to prevent wax build up in your ears.
27. Question by oasis
Hi Dr Brenda Sim, I have 2 queries:
a) How to get rid of water in the ears
b) Why do my right ear gets block almost every morning after I wake up but will clear up by mid-morning.
Thank you.
Answer by Dr Brenda Sim
Hi, thank you for your question.
Do you mean how do you get rid of water in your ears should they accidentally get in during a shower or during swimming? If it does happen, quickly tilt you head so that any excess water can flow out of your ear canal. Thereafter, you may stand in front of the fan to blow it dry. Alternatively, you may use the "cool" function of your hair dryers to gently blow towards the direction of the ear canal as well.
As for your second question, I wonder if you have allergic rhinitis (sensitive nose)? Often people with sensitive noses have blocked nose and runny nose, especially in the morning. And that is because most patients with allergic rhinitis in Singapore are allergic to house dust mites. So after exposure to the dust mites (which are most commonly in your pillows and bed sheets) the whole night, most patients will experience symptoms in the morning.
The eustachian tube (which connects the back of the nose to the middle ear), which is part of the upper airway tract, would also be implicated in allergic rhinitis. It could cause swelling, and therefore the eustachian tube cannot perform its function of equalizing the pressure in your middle ear, hence causing one to experience blocked ear.
28. Question by Wendra
Dear Dr Brenda Sim,
I am 47 years this year and I have been occasionally feeling floating sensation (imbalance) issue since 2017. Did the stroke MRI brain scan in 2017, result was okay. Doctor did the epley maneuver and gave betahistine 24mg but did not completely cure the floating sensation. It still come and go. Last year 2022, I had more frequent giddiness and floating sensation. Feeling like standing on the soft ground when walking. Also positional change e.g. up and down, or fast movement will make me feel imbalance. It was not vertigo spinning sensation.
I did another brain MRI stroke scanning and MRI cervical spine in Aug 2022, results are acceptable and the giddiness/ imbalance was not caused by brain / neck issue.
I occasionally had ringing in my ears and also block ears (suddenly weak in hearing for a moment). I went to see ENT from 2022 to March 2023 and did the necessary test e.g. Pure Tone Audiometry, Tympanometry, videonystagmography (VNG), Vestibular Evoked Myogenic, Physiotherapy Assessment, Video Hear Impulse Test (HIT). All the ENT tests are consider acceptable. But I still having imbalance issue.
Appreciate if you can advise what is another possible cause and how to treat my imbalance issue.
Thank you very much.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
You sound like you have recurrent episodes of giddiness. Did you have frequent headaches or migraine now or in the past? Did you have a problem of motion sickness in your childhood?
How about the triggers? It would be good to identify what triggers these episodes of disequilibrium.
One of the most common causes of recurrent episodes of giddiness would be vestibular migraine. To put it simply, it is a variant of migraine which can cause giddiness/ imbalance rather than headaches. But there is a diagnostic criteria.
Common triggers would include lack of sleep, physical tiredness, consumption of cheeses/ wines / MSG, exposure to bright lights/ loud sounds etc. There are too many to list. But importantly, do try to identify what triggers your giddy episodes. Keeping a diary helps so that when you next see a doctor, the doctor would be better able to help you.
29. Question by Ellie
Hi Dr Sim,
I would like to understand how is tinnitus actually diagnosed, and is it more common in people with anaemia and postural dizziness?
I have been experiencing a sound in my right ear for a few years now, I wouldn't describe it as "ringing" but more like gentle waves crashing on the shore. It used to go away after a short while, but recently it has gotten more pronounced (especially in very quiet environments) and persistent. I've gone for ear irrigation but there was no ear wax. I'm concerned about the extent and costs of tests involved to diagnose tinnitus (or other ear issues). Thank you.
Answer by Dr Brenda Sim
Hi! Thank you for your question.
Tinnitus usually occurs due to an underlying cause. Common causes include ear infection or blockage, age-related hearing loss, noise-induced hearing loss, previous injury to ears/ head and neck region, previous use of medications that can affect the inner ear, etc. Less common causes include, Meniere’s disease (where there is repeated episodes of dizziness, tinnitus and hearing loss that fluctuates), eustachian tube dysfunction, changes to the tiny bones in the ear (otosclerosis), muscle spasms in the middle ear, temporomandibular joint disorders, tumours along the hearing or balance nerves, blood vessel disorders etc.
If your tinnitus had worsened in the recent past, it would be good to come to the ENT clinic to do an audiogram to check your hearing. Depending on whether or not you have hearing loss, and also considering the pattern of hearing loss, we would then advise you if any scans are necessary.
30. Question by Irene
Dear Dr Sim,
I started having tinnitus on left ear in July 2021 and had an MRI in Nov 2021 but no growth found. Diagnosed with mild to moderate hearing losses.
Shortly after MRI, I began to feel pressure on the right ear. It doesn't clear when I yawn or swallow. A doctor did scope in nose and said the right side is a bit blocked and I was given Nasal Spray to try.
After 1.5 months, it doesn't seem to help relieve the pressure. Now I'm having a second tinnitus sound, a high shrill sound on the right (much like when in a jungle). The left ear's tinnitus sound is still there, but comparative not so high pitch and more bearable.
I would like to ask if there is anything could be done for my right ear pressure and the high pitch tinnitus sound. Are there any further diagnostic tests that I should go for? Thanks.
Answer by Dr Brenda Sim
Hi. Thank you for your question.
The right ear pressure you are experiencing is likely eustachian tube dysfunction.
The eustachian tube is a tube that connects the middle ear to the back of the nose. They act to equalise air pressure and also to drain fluid from the middle ear to the back of the nose. In eustachian tube dysfunction, the tube blocked.
The most common underlying cause is that of rhinitis (inflammation of the nose). This may be due to allergies (allergic rhinitis) or from an upper respiratory tract infection (infective rhinitis). Less commonly it may from a tumour or growth in the back of the nose, blocking the eustachian tube. I am glad that your doctor has already done a scope and it was normal.
Common symptoms of eustachian tube dysfunction include: blocked ear sensation, hearing loss, tinnitus. Crackling/ popping sound may be due to accumulation of fluid in the middle ear. It would be good to do an audiogram in the ENT clinic as well.
Thankfully, most times, eustachian tube dysfunction resolves on its own. Doing Valsalva manoeuvre (the act of popping your ears as you would when your ear gets blocked during air travel) often helps as it opens up the tubes.
However, sometimes, if persistent, medications are required. They include nasal sprays, anti-histamines and decongestants. For very persistent eustachian tube dysfunction, other treatment options include balloon tuboplasty (a balloon is introduced to the eustachian tube through the nose and inflated) or a grommet tube insertion (small tube placed in the ear drum to help equalise the air).
Ref: I23
