Hearing, Tinnitus, Balance, Blocked and Painful ears

Many patients come to our clinic to seek help for their hearing, balance and other ear problems. Our ENT doctors have a wealth of experience in looking after these patients, as they have each trained and worked at top tertiary ENT hospitals in the United Kingdom, Australia, North America and Singapore.

Hearing Loss

Hearing loss, if left untreated negatively impacts quality of life and is a major risk factor for cognitive decline. For our patients’ convenience, we provide in-house hearing evaluation in a specially-calibrated soundproof booth for optimal accuracy. Masking of air and bone conduction is performed during our in-house hearing tests to ensure accuracy, reliability and consistency of our test results.

To help us provide a personalised hearing management service, further hearing evaluation with speech audiometry including Speech in Noise test, Otoacoustic Emission (OAE), Auditory Brainstem Recording (ABR) and Auditory Steady State Response (ASSR); can be arranged for both adults and children. Together with our audiology partners, we provide full access to a wide range of different makes and types of hearing aids including the CROS device.

Fitting of hearing aids is only the beginning of the hearing treatment journey. Non usage or poor usage of hearing aids can occur due to inadequate patient education, expectation management and lack of good quality follow up. Hence, post hearing aid fitting, Aided Audiometry, Real Ear Measurements (REM), and Aural Rehabilitation will be co-ordinated with our audiology partners to enhance user satisfaction and compliance.

We also offer in-house assessment for cochlear and other hearing implants including osseo-integrated bone conduction hearing aids (BAHA or Bonebridge) and middle ear implants. From our experience working at top international implant centres, our doctors will carefully assess and guide you towards making the right decision for your hearing problem. Post implantation, we co-ordinate closely with our audiology partners for the initial switch-on, regular mapping and fine tuning of the cochlear and hearing implant.

Tinnitus & Sound Tolerance (Hypersensitivity) Disorders

We provide a comprehensive service for the assessment and treatment of Tinnitus and other sound intolerance or hypersensitivity disorders like Hyperacusis (reduced loudness intolerance), Phonophobia (fear and aversion to all noises) and Misophonia (fear and aversion to specific noises e.g. chewing noises). There can be overlap between these 3 conditions. Not infrequently, sound intolerance co-exists with both hearing loss and tinnitus.

For example, hyperacusis may be due to `recruitment – a phenomenon due to damage of the hearing hair cells (nerve sensory endings) in patients who already have hearing loss. This group of patients are likely to have tinnitus too. These patients face the paradoxical challenges of not being able to hear clearly; and yet experience intolerance and discomfort when amplification is provided. Patients with untreated migraine may also develop hyperacusis and phonophobia and they can be another challenging group of patients.

Hence an empathetic and thorough history taking is crucial, aided by specialised hearing questionnaires and `Patient Reported Outcome Measure’ (PROM) tools. Basic and advance hearing tests can provide valuable insight into patients’ real-world hearing capabilities. Uncomfortable Loudness Levels (ULLs), Extended High Frequency (EHF) Audiometry and Tinnitus Matching can be helpful for selected patients.

Specialised tinnitus rehabilitation including tinnitus masking strategies and masking devices can be offered to patients who have intrusive and disabling tinnitus. The use of advanced devices with targeted amplification and tinnitus masking function; carefully adjusted to the hearing needs and noise tolerance of each individual is an effective treatment strategy. One common reason why patients stop using hearing aids is the lack of awareness and screening for noise tolerance disorders.

Vertigo, Dizziness and Imbalance

We see a huge number of patients who suffer from Vertigo (disordered perception of movement including spinning and swaying sensation), Dizziness and Imbalance; and we take pride in our accurate diagnosis and successful treatment plans. Our ENT doctors are specially trained to undertake a detailed and thorough holistic assessment of the balance system, including the peripheral vestibular (inner ear) and central vestibular (brain) components; key to identifying the underlying cause.

Conditions that cause vertigo and dizziness includes Benign Paroxysmal Positional Vertigo (BPPV), Unilateral (e.g. vestibular neuronitis and labyrinthitis) and Bilateral (e.g. ear toxicity from chemotherapy or certain antibiotics) Vestibular Hypofunction syndromes, Meniere’s Disease, Vestibular Migraine, Persistent Postural Perceptual Dizziness (PPPD), Head Trauma (concussion & PTSD), Benign Paroxysmal Vertigo of Childhood (BPVC) and Autoimmune Inner Ear Disease (AIED).

It is crucial for the correct diagnosis to be made before the right treatment can be offered. A full range of balance examination can be carried out during your clinic visit and further evaluation with specialised vestibular tests (investigations) will be arranged where necessary. Our ENT doctors are also well-versed in performing particle-repositioning manoeuvres like the Epley, Gufoni and BBQ roll to treat the common and less common types of BPPV.

Through adopting a multi-disciplinary approach, we have developed the expertise and experience to manage patients with complex dizziness and vertigo. We collaborate closely with a team of vestibular audiologists for advance vestibular testing including the Video Head Impulse Test (VHIT), Vestibular Evoked Myogenic Potentials (VEMPs), Dynamic Visual Acuity and Subjective Visual Vertical. Our Vestibular Physiotherapist partners can offer advance vestibular rehabilitation incorporating individualised substitution, adaptation and habituation strategies. Patients with concurrent psychological co-morbidities will be offered the services of our partner psychologists.

Blocked, Painful & Wet Ears

The symptom of blocked and or painful ear are common caused by problems within the ear canals e.g. wax build-up, ear canal infection and foreign bodies, especially in children. Not uncommonly, blocked ear sensation may also be caused by dysfunction of the Eustachian Tube leading to negative pressure or even fluid collection in the middle ear (behind the ear drum). Our surgeons are able to perform complex ear clearance in the clinic to give our patients rapid relieve from their symptoms.

Patients may also experience discharge from their ears (wet ear) from burst ear drums and cholesteatoma, which is a far more serious condition. Our surgeons are skilled in complex ear operations including endoscopic and onlay tympanoplasty, osssiculoplasty, and mastoidectomy (both Canal Wall Down and Combined Approach Tympanoplasty) to give our patients safe, dry ears and with better hearing.