“Huuu…snort!…..huummm…gasp!” Your snoring echoes and booms through the night—much to the agony of the person being kept awake beside you. Our ENT doctor would like to remind us that: Apart from affecting the sleep of our families and housemates, snoring could also have a big impact on our health, so we must be on guard when it comes to obstructive sleep apnea.

What is OSA?

Obstructive sleep apnea (OSA) is the most common form of sleep apnea. It occurs when the upper respiratory tract becomes blocked, making breathing more shallow or stop, repetitively interrupting sleep. In serious cases this could happen 30 or more times per hour and lead to high blood pressure, heart attacks, brain problems, or increased risk of accidents.

What are the symptoms?

•  Snoring (most common symptom)

•  Fatigue or feeling tired during the day

•  Headaches in the morning

•  Dry mouth or sore throat when you wake up due to breathing through the mouth

•  Restlessness, screaming, sleep talking, convulsing, hearing sounds, having hallucinations, or sleep walking while asleep

•  Sexual dysfunction

•  Night sweats

•  Trouble concentrating, forgetfulness, and depression

•  Waking up suffocating or gasping due to difficulty breathing

Who gets it?

OSA is more common in males above 30. People who may be more likely to have OSA are those who may:

•  Be obese or overweight with a BMI of >25

•  Have a thick neck

•  Have small airways in their nose, throat, or mouth

•  Have enlarged tonsils

•  Have a large tongue

•  Smoke

•  Have diabetes

•  Have high blood pressure

•  Be at risk of heart failure or stroke

•  Use long-term sleep medicine

•  Upper respiratory tract inflammation

How is it diagnosed?

You can have your sleep monitored by wearing a device known as a polysomnography (PSG) as you sleep. Once finished, it will generate a diagnostic report. Your doctor will interpret the results to see if you have OSA. Standard diagnosis includes oxygen saturation, thoracic motion, and nasal airflow. Complex diagnosis may include ECG, EEG, or EMG.

How is it treated?

•  Life intervention and avoiding working too strenuously

•  Using a ventilator applying continuous positive airway pressure (CPAP)

•  Surgery in some cases

Treatment can significantly improve sleep quality and reduce the possibility of complications associated with cardiovascular disease and diabetes.

How can it be prevented?

Sore throats are common. A sore throat is often a throat infection or pharyngitis.

Sore throats are usually caused by 2 types of germs—viruses and bacteria. Most sore throats are caused by viruses. Only 10% of sore throats are caused by bacteria. 

You or your child has seen the doctor and is likely to have a sore throat caused by a virus.

Do I need antibiotics?

If your sore throat is caused by a virus, you do not need antibiotics. A sore throat caused by viral infection gets better on its own with at-home care, usually within five to ten days.

What medicines will my doctor give me? 

Your doctor will most likely give you medication and lozenges to relieve your throat pain or discomfort. Depending on your symptoms, doctor may also give you medicines to relieve running nose and cough.

What about alternative remedies?

There are limited evidences on what works and what does not for common alternative remedies. Some of these remedies may not be safe. Check with your doctor before using them.

What are the things I can do at home to feel better?

DOs

•      Get plenty of sleep and avoid talking

•      Drink plenty of fluids to keep your throat moist. This helps with swallowing and prevents dehydration

•      Drink soothing beverages and eat soft foods

•      Gargle with salt water several times a day to help relieve throat pain

•      Add moisture to the air in your home. Use a cool-mist humidifier or vaporizer. Be sure to clean it daily

DON'Ts

•      Avoid spicy foods or acidic foods that irritate your throat

•      Avoid smoking or secondhand smoke

How much salt should I put in my salt water gargle?

About 1/4 to 1/2 a teaspoon (1.5 to 3.0 g) of salt in one cup (250 ml) of warm water.

When can I return to work? When can my child return to school?

You can resume your usual activities as soon as you feel better. Wear a mask if the air pollution is bad to prevent further throat discomfort.

How can I avoid getting a sore throat again?

Reduce your chance of having a viral infection by exercising regularly and eating healthily.

Also practice good hand washing habits, washing your hands with soap and water to prevent the spread of infection.

When should I see my doctor again?

Please contact your doctor if your sore throat does not improve within two days or if you have a fever. 

Also contact your doctor if you have the following symptoms: 

•      Difficulty swallowing

•      Drooling (especially for children)

•      Trouble talking or opening your mouth

•      Hoarseness lasting more than two weeks

•      Body aches, joint pain, or earache

•      Skin rash

•      Nausea or vomiting

•      Constant sleepiness or tiredness

•      Increased thirst or dry and sticky mouth with less urine than usual (one wet diaper or void in six hours) or total lack of tears when crying

When do I need to go to the hospital or emergency department?

Call the ambulance or go to the nearest hospital right away if you have: 

•      Chest pain

•      Difficulty breathing

•      Shortness of breath

With reference to www.uptodate.com

When the middle section of the ear gets infected, it causes an ear infection just behind the eardrum, known as acute otitis media. This is a common problem in children. Middle ear infections often occur after a common cold, the flu, or nose and throat infection.  

When you or your child has a middle ear infection, swelling occurs and fluid forms just behind the eardrum. This may cause you pain, fever, drainage from your ear, and sometimes difficulty in hearing. Middle ear infections keeps usually clear up without long-term effects/problems. 

What medicines will my doctor give me? 

Depending on your age and severity of the infection, your doctor will decide if you need antibiotics. It is important that you complete the course of antibiotics as instructed.

Your doctor may also give you medications to relieve your pain and reduce your fever.

What can I do at home to feel better?

DOs

•      Keep your ears dry

DON'Ts

•      Do not use cotton swabs to scratch or poke your ears

•      Avoid blowing your nose forcefully

•      Avoid activities that will worsen your symptoms such as diving or swimming

When can I return to work? When can my child return to school?

You can resume your normal activities once the pain and fever have subsided. 

How do I prevent middle ear infection?

Reduce your exposure to the common cold or upper respiratory infections. Keep up-to-date with pneumococcal and influenza vaccinations. Stay in a smoke-free environment whenever possible. Your doctor may decide to give you a low dose of antibiotics if your middle ear infections keeps occurring 3 or more infections in 6 months.

When should I see my doctor again?

Please contact your doctor if you have: 

•      No improvement within 24 to 48 hours

•      Worsening of pain or fever

•      Increase in ear drainage

•      Increased difficulty in hearing. For children – lesser response to surrounding noise

•      For children – decreased activity or lack of appetite

We recommend children who are younger than 2 years old or at the age where they are learning to speak have a follow-up ear exam 2 to 3 months after being treated. This follow-up exam reduces the risk of your child delaying his/her speech development. If necessary, your doctor may refer you or your child to see an Ear, Nose and Throat (ENT) specialist.

Allergic rhinitis (AR) is caused by small airborne particles that behave as allergens in our nasal passages. These allergens provoke an allergic reaction and our body produces substances that cause swelling and congestion (inflammation). When this happens, it is known as rhinitis. AR often runs in families.

The usual symptoms are an itchy runny nose and sneezing. Sometimes, the mucus from the nose will run down the back of your throat (postnasal drip). For some, the symptoms go beyond the nasal passages and affect the eyes, ears, throat, and even sleep.

AR can be seasonal (occurring during specific seasons) or year-round. Seasonal AR allergens include pollens from trees, grasses, and weeds. Year-round AR allergens include dust mites, cockroaches, animal dander, etc. For some people. this becomes a lifelong condition that waxes and wanes over time.

What medicines will my doctor give me? 

Your doctor will provide you with devices you can use to rinse your nose. Besides helping to clean the insides of the nose, this helps to get rid of pollen and other allergens.

Your doctor may also give you some steroid nose sprays. They help to lessen the swelling in the nose, nasal congestion, and post-nasal drip. It can take up to days and weeks before they work. They are only effective if you take them daily.

Your doctor may also give you some antihistamines and decongestants to help with itching, sneezing, and runny nose symptoms. We advise that you do not use the decongestants more than instructed by your doctor, as overuse will sometimes make your symptoms worse.

If required, your doctor may refer you to an Ear, Nose and Throat (ENT) specialist or offer you other treatments such as allergy shots or pills.

What can I do at home to feel better?

DOs

•      Rinse your nose 

•      Take medications as instructed to control your symptoms

DON'Ts

•      Avoid allergens that will make you feel worse (including cats or dogs)

•      Don't be around freshly cut grass or raked leaves

•      Don't smoke and avoid second hand smoke

How do I prevent allergic rhinitis?

If you get symptoms at the same time every year, talk with your doctor. Some people can prevent symptoms by starting their medications 1 to 2 weeks before that time of the year.

When can I return to work? When can my child return to school?

You can resume your normal activities once you feel better. It is important to know if the environment has allergens that will make you feel worse. If so, please avoid them and rest at home until you feel well.

When should I see my doctor again?

Please contact your doctor if you have: 

•      Fever

•      Ear or sinus pain, or a headache

•      Worsening symptoms even after treatment

•      Pain or bleeding from inside your nose 

•      Blood when you cough

What is earwax?

Earwax, also called cerumen, is soft yellow wax. It is produced by glands inside your ear canals. Earwax works with tiny hairs inside the ear to keep out dirt, water and other foreign matter that could cause damage to your inner ear.

Should you clean the wax out of your ears?

In most cases, earwax takes care of itself. A small amount of earwax regularly makes its way to the outer ear where it dries up and flakes off or is washed away when you take a shower.

Can earwax cause a problem?

Usually earwax does its job without causing any problems, but sometimes too much earwax builds up and can block the ear canal. This can cause pain, interfere with your hearing, and cause ringing in the ear or dizziness.

What causes earwax buildup?

Some people are just born with narrow or winding ear canals that make it hard for earwax to wend its way out. People with very dry skin may produce hard, dry earwax that moves less smoothly from the inner to the outer ear.

A bad cold or an ear infection can cause tissue to swell up, narrowing the ear canal and keeping earwax stuck inside. People who wear hearing aids, earplugs or use cotton swabs (Q-tips) to clean their ears can push earwax back into the ear canal, causing build-up. And, finally, as we get older, the glands in theears weaken, producing less-oily, drier earwax that is more likely to get stuck inside the ear.

How can I tell if I have earwax buildup?

Earaches, hearing problems, ringing in the ears and sometimes dizziness may be signs of earwax buildup - and a variety of other medical conditions. These symptoms do not necessarily mean that you have earwax buildup. The only way to know for sure is to ask your doctor to look into your ear canal.

What can I do at home to remove excess earwax?

As long as you do not have tubes in your ears or a perforated eardrum, you may try to gently remove excess earwax on your own. Do not use cotton swabs to clean your ears. Never use anything else - like a paper clip or a bobby pin - to clean your ears. Doing so may push the earwax back into the ear canal, making your problems worse.

Instead, try one of these safer methods:

1.      Use an eyedropper to place a few drops of baby oil, mineral oil, glycerin or hydrogen peroxide in your ear canal twice a day for no more than four or five days. This will soften the wax

2.      Use a bulb syringe to gently squirt lukewarm water into your ear canal. Don’t squeeze the bulb too hard, and don’t force the syringe deep into the canal. Tip your head to allow the water to drain out. When finished, dry yourouter ear with a towel or a hand-held hair dryer

 You may need to repeat these wax-softening and irrigation procedures several times before the excess earwax falls out. If your symptoms do not improve after a few treatments, see your doctor.

Can the doctor remove excess earwax for me?

Your doctor can scoop out excess wax with a small, curved curette or ‘spoon,’ or rinse out excess wax with a gentle spray of warm water from a water pick or rubber syringe. If the wax is very hard, your doctor may prescribe eardrops to soften the wax for a few days before you return to the office to have it removed. Sometimes the eardrops alone are enough to loosen up earwax so it comes out on its own.

If earwax buildup is a recurring problem, your doctor may recommend putting a drop or two of mineral oil in the affected ear once a week to help keep the wax from hardening and building up.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

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What is benign paroxysmal positional vertigo?

Vertigo is the sudden sensation that you are unsteady or that your surroundings are moving. Benign paroxysmal positional vertigo (also called BPPV) is the most common kind of vertigo.

BPPV is an inner ear problem that causes you to suddenly feel dizzy when you move your head in a certain direction, lie down from an upright position, turn over in bed, or sit up in the morning.Moving your head to look up can also make you feel dizzy.

Although BPPV can be bothersome, it is rarely a serious problem. Episodes of BPPV are usually short, lasting less than a minute, and the problem tends to come and go. In some cases, BPPV goes away by itself with little or no treatment.

What causes BPPV?

Your inner ear contains tiny calcium particles that help you keep your balance. Normally, these particles are distributed evenly in the inner ear's three canals. When you move your head, the calcium particles stimulate nerve cells inside the canals. These cells send your brain a signal telling it what direction your head is moving.

However, these calcium particles can break loose and clump together in one of the ear's canals. When this happens, the nerve cells tell your brain that your head has moved more than it actually has. This incorrect signal results in vertigo. In most cases, BPPV is something that happens as part of aging. It can also occur after a blow to your head or, less often, as a result of a virus that infects your ear.

How does my clinician know I have BPPV?

Your clinician may suspect BPPV if you feel dizzy when you move your head certain ways. Your clinician will do a physical exam, ask you some questions, and review your medical history. If there is doubt about what is causing your dizziness, your clinician may order one or more tests to rule out more serious problems.

What can I do to cope with BPPV symptoms?

•      Get out of bed slowly. Sit on the edge of the bed for a minute before standing up

•      Be careful when you bend to pick something up or when you raise your head back to get something from an upper cabinet. Make these movements slowly

•      Sit or lie down right away whenever you feel dizzy

•      Be careful when getting up from lying back at the dentist's office, beauty parlor or barbershop, or during activities such as yoga or massage

How is BPPV treated?

Your clinician may recommend some simple head movements that you can do at home. These movements, called the Brandt-Daroff exercise, can help move the calcium particles in the canals in your inner ear. This easy exercise can stop the symptoms and may keep the dizziness from coming back.

How to Do the Brandt-Daroff Exercise

1.   Sit on the edge of a bed or sofa with your legs hanging over the side. Sit near the middle so that you can lie down in either direction

2.    Quickly lie down onto your right side, resting your right ear on the bed or sofa, looking straight ahead. Hold this position for 30 seconds (or until any dizziness passes, whichever is longer)

3.   Return to the up right position and look straight ahead. Hold this position for 30 seconds

4.    Quickly lie down onto your left side, resting your left ear on the bed or sofa, looking straight ahead. Hold the position for 30 seconds or until any dizziness passes

5.   Return to the upright position and look straight ahead for 30 seconds

These steps make up one 'set' of the Brandt-Daroff exercise. Do 5 repetitions of this set.It should take about 10 minutes.

 Try to do 2 or 3 exercise sessions a day for 10 days to 2 weeks. You can do one exercise session in the morning, another at lunchtime, and/or one before you go to bed. If your symptoms go away after one week of doing these exercises, you can cut back to 2 repetitions 3 or 4 times a week for the next week.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

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developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

Answer the following questions, circling Y for yes and N for no.

Y         N          Do I have a problem hearing on the telephone?

Y         N          Do I have trouble hearing when there is noise in the background?

Y         N          Is it hard for me to follow a conversation when two or more people talk at once?

Y         N          Do I have to strain to understand a conversation?

Y         N          Do many people I talk to seem to mumble (or not speak clearly)?

Y         N          Do I misunderstand what others are saying and respond inappropriately?

Y         N          Do I often ask people to repeat themselves?

Y         N          Do I have trouble understanding the speech of women and children?

Y         N          Do people complain that I turn the TV volume up too high?

Y         N          Do I hear a ringing, roaring, or hissing sound a lot?

Y         N          Do some sounds seem too loud?

If you answer"Yes" to 3 or more of these questions, you may have significant hearing loss. Ask your primary care doctor whether you should see aspecialist.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What is a hearing aid?

A hearing aid is an electronic, battery-operated device that amplifies and changes sound to help you hear better.

How do I know if I need a hearing aid?

The best way to find out if you need a hearing aid is to see a specialist called an audiologist. An audiologist is a licensed professional who will perform tests to find out what kind of hearing loss you have and whether hearing aids can help you. Your doctor can recommend an audiologist and help set up an appointment for you.

Because some hearing loss develops from medical problems, your doctor may also refer you to an otolaryngologist (an ear, nose and throat doctor). If you have ear pain, drainage, sudden hearing loss or dizziness, it is especially important that you see an otolaryngologist.

How do hearing aids work?

Every hearing aid contains a microphone to pick up sound around you, an amplifier to make sound louder, and a receiver to deliver the sound to your ear. All hearing aids run on batteries. Some have extra features. Among the most popular features are adapters that make it easier to hear on the telephone, directional microphones that help you separate sounds coming from in front of you from sounds coming from behind you or beside you, and feedback cancellation that prevents the aid from squeaking.

What are the different kinds of hearing aids? 

There are five basic styles of hearing aids:

•       Completely-in-the-canal hearing aids

These aids fit completely into the ear canal. They are the smallest aids available and therefore the least noticeable. However, because they are so small, the parts of these hearing aids (such as the volume control and batteries) can be hard to see and adjust.

•       In the canal hearing aids

These hearing aids fit partly in the ear canal, but not as deeply as the completely-in­the-canal aid. They include features that won't fit on completely-in-the-canal aids such as feedback cancellation and volume control.

•       Half-shell hearing aids

A smaller version of the in-the-canal hearing aid, the half shell fills the lower portion of the bowl-shaped part of your outer ear. It fits better in smaller ears and has the cosmetic advantage of being small.

•       In-the-ear hearing aids

Also called full shell, these hearing aids fill most of the bowl-shaped area of your outer ear. They are more visible than in the-canal aids and may pick up wind noise, but are generally easier to insert in the ear. Batteries last longer and these hearing aids are easier to handle than smaller aids. Although they are more visible, they still have the cosmetic advantage of fitting inside the ear.

•       Behind-the-ear hearing aids

All parts are contained in a plastic case that hooks over the top and rests behind the ear. The case is connected to an ear mold, which fits into the ear. These are the bulkiest hearing aids but many people find them easiest to use. Behind-the-ear hearing aids are less bulky and more comfortable than they were even a few years ago. Because they can amplify sound more than other hearing aid styles, they are often the best choice for people with severe hearing loss.

What does digital technology mean?

Most hearing aids today contain a computer chip that can be programmed for different listening environments such as quiet conversation in your home, noisy situations like a restaurant, or large areas like a theater. Many aids now use ‘digitized sound processing’ to convert sound waves into a computerized code. With this technology, the hearing aid can analyze sounds and make automatic adjustments to help you hear better as you move from one environment to another.

What are directional microphones?

Though no hearing aid can completely ‘remove’ background noise, directional microphones are the best technology available to help sort out speech from background noise. These microphones are designed to amplify sounds directly in front of the user more than the sounds to the back and sides of the user. So, in a crowded restaurant, the hearing aid will amplify the voice of the person you are looking at more than the voices at tables behind and around you.

How much do hearing aids cost?

Hearing aid costs vary according to styles and electronic features. Prices range starts from thousands to ten thousands of Chinese currency. Itis important to shop carefully. You can purchase them at pharmacy or medical equipment stores, discounts may apply.

Here are a few tips:

•       Buy from a professional audiologist or hearing aid specialist

•       Bring a friend along to help you make the decision

•       Ask about add-on features. Don’t be pressured into buying extras you don’t need

•       Get a contract in writing that includes a trial period and follow-up visits

Price is an important factor, of course, but it should not be the only thing you think about when you are choosing a hearing aid. Buying a reliable product can save repair costs and the frustration of a hearing aid that doesn’t work well.

Will my health insurance pay any of the costs of acquiring a hearing aid?

Some health insurers cover the costs of hearing tests, a hearing aid evaluation, and partial or even full coverage of a hearing aid. Check with your health insurance plan to find out exactly what your policy covers. 

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine

What is a ruptured eardrum?

A ruptured eardrum is a tear or a hole in your eardrum (also called the tympanic membrane). The eardrum is a thin membrane that separates your ear canal from your middle ear. This membrane vibrates when sound waves strike it, starting the process of converting sound waves into nerve impulses that travel to your brain. The membrane also acts as a shield, protecting your inner ear from bacteria and debris.

What causes a ruptured eardrum?

Causes include:

•   Middle ear infection(otitis media). The pressure of fluid in your middle ear can cause your eardrum to rupture

•   Changes in air pressure (barotraumas). Flying in an airplane or diving can cause a build up of pressure on your ear, resulting in a ruptured eardrum

•   Foreign objects in your ear. Small objects such as a cotton swab or a bobby pin pushed too far into your ear canal can rupture your eardrum

•   Loud, sudden noise. A sudden, extremely loud noise, such as from an explosion or a firearm, can rupture your eardrum.

How will the doctor treat this problem?

In most cases, a ruptured eardrum heals on its own within a few weeks to a few months. Your doctor will want to see you regularly while your eardrum is healing to make sure everything is going well. The most important thing you can do is to keep your ear dry during the healing process. Here are some things you can do at home to help your eardrum heal and to stay comfortable while it is healing:

•   Keep your ear dry. Place a cotton ball with Vaseline in your ear when showering, bathing or washing your hair

•   Do not clean your ears while the eardrum is healing

•   Do not go swimming until the doctor tells you that the ruptured eardrum has healed completely

•   Avoid blowing your nose. The pressure created when blowing your nose can damage a healing eardrum

•   Use over-the-counter pain relievers to ease ear pain. Some choices are aspirin, Advil, Motrin or Aleve. Ask your doctor what’s best for you. Antibiotics are generally used to treat a ruptured eardrum only when an ear infection caused the problem

Will my hearing return to normal?

Any hearing loss you suffer should go away once the tear or hole in your eardrum has healed. To be sure your hearing has returned to normal, your doctor may recommend that you make an appointment for a hearing evaluation once the rupture has completely healed.

What if my eardrum doesn't heal?

In most cases, a ruptured eardrum will heal without any special treatment. If your eardrum doesn't heal within three months, your doctor may refer you to a specialist to talk about treatment, including surgery.

This document is intended to provide health related information so that you may be better informed. It is not a substitute for your care team's medical advice and should not be relied upon for treatment for specific medical conditions.

© 2017 The General HospitalCorporation.

Primary Care OfficelnSite

developed by the MGH Laboratory of Computer Science and Division of General Internal Medicine