Hearing loss is a common condition, but when it occurs suddenly, it can be alarming and distressing. Sudden Hearing Loss (SHL) is typically defined as a rapid onset of hearing impairment over a period of 72 hours or less. It is crucial to seek immediate medical attention as early intervention improves the chances of recovery. Causes of Sudden Hearing Loss Sudden hearing loss can be classified into conductive and sensorineural types: 1. Conductive Hearing Loss Conductive hearing loss occurs when sound waves cannot reach the inner ear due to obstructions or abnormalities in the outer or middle ear. Causes include: Earwax impaction: Excessive earwax can block the ear canal, preventing sound from reaching the eardrum. This is a common and reversible cause of hearing loss that can be treated with ear irrigation or microsuction. Acute otitis media (middle ear infection): Infections in the middle ear cause fluid buildup behind the eardrum, leading to temporary hearing loss. If untreated, chronic infections can result in persistent conductive hearing loss Otosclerosis: A hereditary condition where abnormal bone growth in the middle ear interferes with sound transmission. It typically affects the stapes bone and can lead to progressive hearing loss, often requiring surgical treatment. Barotrauma: Sudden changes in pressure (e.g., during air travel or diving) can damage the eardrum or middle ear structures, causing temporary or permanent hearing impairment. In the following clinical photographs B to F show various presentations of barotrauma to the ear. A is normal ear drum. Tympanic membrane perforation (e.g., due to earbud use or trauma): Inserting objects like cotton swabs or earbuds too deeply into the ear canal can rupture the eardrum, resulting in sudden hearing loss. In most cases, the perforation heals spontaneously, but larger defects may require surgical repair. Cholesteatoma: An abnormal skin growth in the middle ear that can erode bones and lead to conductive hearing loss. It often requires surgical removal to prevent complications. Ossicular chain disruption due to trauma: Direct trauma to the head or ear can dislocate the ossicles (tiny bones in the middle ear), leading to significant hearing loss. Surgical intervention may be needed. 2. Sensorineural Hearing Loss (SNHL) Sensorineural hearing loss results from damage to the inner ear (cochlea) or auditory nerve pathways. Causes include: Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL): A sudden loss of hearing with no identifiable cause, often presumed to be viral or immune-mediated. Prompt treatment with corticosteroids is crucial for recovery. Viral infections (e.g., herpes simplex virus, cytomegalovirus): Certain viral infections can damage the cochlear nerve or hair cells, leading to permanent hearing impairment. Reactivation of latent viruses may also contribute to sudden hearing loss. Bacterial infections (e.g., syphilis, Lyme disease, meningitis): Bacterial infections affecting the inner ear or nervous system can lead to irreversible sensorineural hearing loss. Early antibiotic treatment is essential. Ototoxic drugs (e.g., aminoglycosides, cisplatin, loop diuretics): Some medications can damage the hair cells in the cochlea, causing progressive or sudden hearing loss. Monitoring drug levels and using alternative medications when possible is recommended. Autoimmune inner ear disease: An immune-mediated attack on the inner ear structures can cause fluctuating or progressive sensorineural hearing loss, often requiring immunosuppressive therapy. Meniere’s disease: Characterized by episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness, this disorder is associated with excess fluid in the inner ear. Acoustic neuroma (vestibular schwannoma): A benign tumour on the vestibulocochlear nerve that can cause unilateral hearing loss, tinnitus, and balance issues. MRI is essential for diagnosis. Vascular events (e.g., microvascular ischemia, stroke): Reduced blood supply to the cochlea or auditory nerve can result in sudden hearing loss. Cardiovascular risk factors should be assessed. Trauma (e.g., temporal bone fractures, barotrauma): Blunt force injuries or rapid pressure changes can damage inner ear structures, leading to permanent hearing loss.   Consultation and Diagnosis Initial Assessment Detailed history (onset, associated symptoms like vertigo, tinnitus, or aural fullness) Physical examination Otoscopy and ear microscopy: To assess the ear canal, tympanic membrane integrity, and signs of infection or trauma. Ear endoscopy: Provides a detailed view of the external and middle ear structures. Tuning fork tests (Rinne and Weber tests): Helps differentiate conductive from sensorineural hearing loss. Nasal endoscopy: Evaluates Eustachian tube function and detects nasopharyngeal tumours affecting the auditory pathway. Audiological Investigations Pure Tone Audiometry (PTA): Confirms sensorineural vs. conductive hearing loss. Speech Audiometry: Assesses speech recognition and comprehension at different volume levels, helping to differentiate sensorineural from conductive hearing loss. Tympanometry: Measures middle ear pressure and eardrum mobility, aiding in the diagnosis of conditions such as otitis media, Eustachian tube dysfunction, or ossicular chain abnormalities. Otoacoustic Emissions (OAE): Assesses cochlear hair cell function. Auditory Brainstem Response (ABR): Rules out retrocochlear pathology (e.g., acoustic neuroma). Radiological and Laboratory Investigations MRI with contrast (gold standard): Detects acoustic neuroma, demyelinating disease, or vascular abnormalities CT scan (if trauma or cholesteatoma is suspected). Blood tests: Complete Blood Count (CBC): Checks for infections or haematological abnormalities. Erythrocyte Sedimentation Rate (ESR) & C-reactive Protein (CRP): Evaluates for inflammatory or autoimmune conditions. Autoimmune Panel (ANA, RF, antiphospholipid antibodies, ANCA): Assesses for autoimmune inner ear disease. Viral Serology (HSV, CMV, HIV, EBV, VZV, syphilis serology): Screens for infectious causes. Thrombophilia Screen (Protein C, Protein S, Antithrombin III, Factor V Leiden mutation, Homocysteine levels): Identifies vascular aetiologies. Metabolic Panel (Glucose, Lipid profile, Thyroid function tests, Vitamin B12): Rules out metabolic contributions. Treatment of Sudden sensorineural Hearing Loss (SSNHL) Systemic Corticosteroids (First-line Treatment) Prednisolone 1 mg/kg/day (max 60 mg/day) for 7–14 days with a tapering dose. Studies support corticosteroids as the primary therapy for ISSNHL. Intratympanic Steroid Injection (ITSI) Indications: Poor response to oral steroids, contraindications to systemic corticosteroids, or as an adjunct therapy with oral steroids. Procedure: Direct delivery of dexamethasone (4-10 mg/mL) into the middle ear, absorbed through the round window. Evidence: ITSI has been shown to be effective as a salvage therapy with better hearing recovery. Hyperbaric Oxygen Therapy (HBOT) Mechanism: Increases oxygen delivery to the cochlea, promoting hair cell recovery. Protocol: 10–20 sessions of 90–120 minutes at 2.0–2.5 ATA pressure. Evidence: HBOT

Restoring Ear Health | Addressing Eardrum Perforations WHAT IS THE EARDRUM?   The eardrum, also known as the tympanic membrane, is a vital component of the ear, acting as a barrier and a resonator to transmit sound waves from the outer wear to the middle ear.  When damaged or perforated, it can lead to hearing loss, infections, and discomfort.  For those experiencing these complications, myringoplasty offers a restorative solution, improving both ear function and quality of life. WHAT CAUSES EARDRUM PERFORATION? Eardrum perforation can result from several factors: – Acute Ear Infection: Acute ear infections can burst the eardrum, leading to holes or perforations. Chronic Ear Infection: Chronic ear infections can erode the eardrum, leading to holes or perforations – Injury or Trauma: Direct impact, sharp objects, or sudden pressure changes (e.g., explosions, diving, or air travel) can damage the eardrum. – Sudden Loud Noises: Exposure to very loud sounds can cause the eardrum to rupture. – Medical Interventions: Certain procedures, such as the insertion of ventilation tubes, may occasionally lead to perforations. Minor perforations may heal independently, but larger or symptomatic perforations typically require surgical repair through myringoplasty. WHY IS MYRINGOPLASTY NEEDED? Myringoplasty is recommended for those with symptomatic eardrum perforations, offering benefits such as: – Improved Hearing: Repairing the eardrum can significantly restore hearing affected by the perforation. – Reduced Infections: The intact eardrum provides a barrier to bacteria and prevents water entry, reducing the risk of recurrent ear infections. – Enhanced Ear Health: Restoring the eardrum’s integrity promotes overall ear health and can alleviate ear discomfort and pain.  ALTERNATIVE TREATMENTS While myringoplasty provides a permanent solution, some may opt for non-surgical alternatives to manage symptoms temporarily: – Ear Protection: Preventing water from entering the ear (e.g., with earplugs) can reduce infection risk in perforated ears. – Antibiotic Ear Drops: For those with infections, antibiotic ear drops can help manage symptoms. – Hearing Aids: Temporary amplification devices may help with hearing loss associated with eardrum perforation. These alternatives, however, do not resolve the structural issue of the perforation. CONSEQUENCES OF NOT HAVING A MYRINGOPLASTY Choosing not to repair an eardrum perforation when indicated can lead to ongoing issues: – Persistent Hearing Loss: Without repair, hearing may remain compromised. – Frequent Infections: An open eardrum increases susceptibility to infections, especially with water exposure. – Chronic Ear Discomfort: Ongoing symptoms such as pain or ear discharge can impact quality of life. CONSULTATION PROCESS AND PRE-OPERATIVE ASSESSMENT – Consultation Process: Initial consultation includes a detailed history, examination, and hearing tests.  Dr. Sandeep will discuss symptoms, goals, and expectations. – Pre-Operative Assessment: Prior to surgery, additional evaluations may include ear endoscopy, nasal endoscopy, hearing tests and sometimes ear imaging (CT scan if needed) to assess ear structure. UNDERSTANDING THE MYRINGOPLASTY SURGICAL PROCESS Myringoplasty is a surgical procedure designed to repair a perforated (hole) eardrum, also known as the tympanic membrane.  This surgery is typically performed under either general anesthesia (where you are asleep) or local anesthesia (where only the ear area is numbed).  Your doctor will discuss the most suitable type of anesthesia for you before the surgery. BEFORE SURGERY 1.Preparing for Surgery: You may be advised to stop taking certain medications that could increase the risk of bleeding, such as aspirin or anti-inflammatory drugs, vitamin E and herbal medications.  It is also essential to avoid food and drink for several hours before the procedure if you are receiving general anesthesia. Day of Surgery: On the day of the procedure, you will arrive at the hospital or clinic. A nurse will guide you through pre-operative preparations, such as changing into a surgical gown. If you are feeling nervous, please know our team is here to support you every step of the way. THE MYRINGOPLASTY PROCEDURE 1. Accessing the Eardrum – Ear Canal Approach: For smaller perforations, Dr. Sandeep may access the eardrum directly through the ear canal.  Endoscopic techniques may be used in suitable patients. – Incision in front of the ear: For small posteriorly placed perforations, a small incision may be made at the junction between the top of front part of the ear and the cheek to reach the ear drum. – Incision Behind the Ear: For larger perforations or if better access is needed, a small incision may be made behind the ear to reach the eardrum. 2. Grafting Material A small piece of tissue, often taken from an area close to the ear (like a muscle sheath called the temporalis fascia or covering of the cartilage of the ear – tragal perichondrium), is used as a graft to patch the hole in the eardrum.  This tissue will help close the perforation and eventually heal to become part of the new eardrum. 3. Placing the Graft The graft is carefully positioned to cover the hole in the eardrum.  It is typically held in place with absorbable packing material that supports it as it heals.  This packing dissolves over time, so it does not need to be removed. 4. Closing Incisions (if any) If an incision was made behind the ear, it will be closed with sutures.  These sutures are usually dissolvable and will not need to be removed. If non-dissolvable sutures are used, they will be removed after one week. 5. Completion The entire procedure usually takes about 1 to 2 hours, depending on the extent of the repair needed.  Afterward, you will be taken to a recovery area to be monitored as you wake up from anesthesia. AFTER SURGERY: WHAT TO EXPECT 1. Recovery Room: You will spend some time in the recovery room, where our team will monitor you to ensure you are comfortable and stable after anesthesia. Going Home: Myringoplasty is usually an outpatient procedure, which means you can go home the same day. However, you will need someone to drive your home, as you may feel drowsy or tired from the anesthesia. Pain and Discomfort: You might experience mild pain or discomfort in your ear, which can be managed with prescribed pain medications. It

MIDDLE EAR INFECTIONS Middle ear infections, also known as otitis media, are a common ailment that can affect individuals of all ages, although they are particularly prevalent among children. The symptoms of a middle ear infection can range from mild to severe and may include ear pain, fever, and hearing difficulties. Recognising the debilitating impact such conditions can have on a patient’s quality of life, Dr Sandeep prioritises prompt and accurate diagnosis. ACUTE OTITIS MEDIA (AOM) Acute Otitis Media (AOM) is a type of middle ear infection that is characterised by the sudden onset of symptoms such as ear pain, fever, and sometimes hearing loss. It is a condition primarily affecting the middle ear, which is the air-filled space located behind the eardrum that contains the tiny vibrating bones of the ear. AOM is most commonly caused by bacterial or viral infections and is particularly prevalent among children, although it can occur at any age. Clinical Features In AOM, the middle ear becomes inflamed and filled with pus or fluid due to an infection. The following are common symptoms: Severe ear pain Fever Irritability or fussiness (commonly observed in children) Hearing difficulties Fluid drainage from the ear How It Differs from Otitis Media with Effusion It’s important to distinguish AOM from Otitis Media with Effusion (OME), another type of middle ear condition. While AOM is an active infection with symptoms like pain and fever, OME is a condition where fluid remains trapped in the middle ear but without the acute symptoms of infection. OME often follows an episode of AOM but can also occur independently. DIAGNOSIS At The ENT Clinic, Dr Sandeep Uppal takes a meticulous approach to the diagnosis of Acute Otitis Media (AOM). Understanding that accurate diagnosis is the cornerstone of effective treatment, our team employs a multi-faceted methodology: Clinical Interview The first step often involves a detailed clinical interview where the patient or the caregivers are asked about the onset, duration, and nature of symptoms. Questions may include: When did the ear pain start? Are there any accompanying symptoms like fever or hearing loss? Is there a history of upper respiratory infections or allergies? Otoscopic Examination An otoscope, a medical device equipped with a light and a magnifying lens, is used to closely examine the ear canal and eardrum. The team looks for: Redness and inflammation of the eardrum Presence of fluid or pus behind the eardrum Eardrum immobility Any perforation or rupture of the eardrum Tympanometry This diagnostic test measures the movement of the eardrum in response to air pressure changes. Lack of normal eardrum movement usually indicates the presence of fluid in the middle ear, which is a hallmark of AOM. Pneumatic Otoscopy This advanced form of otoscopy allows the practitioner to not only visualise the eardrum but also to assess its mobility by blowing a small puff of air into the ear canal. Reduced or absent movement of the eardrum suggests fluid accumulation and middle ear infection. Audiometry In cases where hearing loss is reported or suspected, an audiometric test might be conducted to assess the extent of hearing impairment. Microbiological Tests Although less common in routine practice for AOM, swabs for microbiological culture may be taken in recurrent or persistent cases to identify the specific bacterial or viral pathogen responsible for the infection. Through a combination of these diagnostic tools and methods, we aim to provide a comprehensive and accurate diagnosis of Acute Otitis Media. This thorough diagnostic process is essential for devising an effective treatment plan tailored to the needs of each individual patient. TREATMENT At The ENT Clinic, Dr Sandeep and his team are adept at offering evidence-based treatments for Acute Otitis Media (AOM), customising the approach based on the severity of the condition, the age of the patient, and any accompanying medical concerns. Here’s a closer look at their treatment modalities: Antibiotic Therapy For bacterial AOM, antibiotics are often the first line of treatment. The choice of antibiotic may vary based on the suspected causative agent and the patient’s medical history. Pain Management Symptomatic relief is crucial in managing AOM, especially in the initial stages when pain can be intense. Analgesics such as paracetamol or ibuprofen are commonly prescribed for pain and fever. Observation In certain cases, especially when the infection is suspected to be viral or when symptoms are mild, a “watchful waiting” approach may be adopted. This involves monitoring symptoms closely for 48 to 72 hours and initiating antibiotic treatment only if there is no improvement. Myringotomy In severe or recurrent cases of AOM where fluid accumulation is significant, a surgical procedure known as myringotomy may be considered. This involves making a small incision in the eardrum to allow drainage of the trapped fluid. Tympanostomy Tubes For chronic or recurrent AOM, the insertion of tympanostomy tubes (also known as grommets) may be recommended. These tubes help to equalise pressure and allow fluid to drain from the middle ear, thereby reducing the frequency of infections. Adjunct Treatments In some cases, adjunct treatments like decongestants or antihistamines may be recommended, especially if the patient has concurrent issues like allergies or sinusitis that could be exacerbating the condition. Follow-up and Monitoring We place a strong emphasis on follow-up care to monitor the patient’s response to treatment. This often involves another otoscopic examination and possibly repeat tympanometry to confirm that the infection and any fluid accumulation have resolved. Potential Complications of Acute Otitis Media Through a comprehensive and individualised treatment plan, Dr Sandeep Uppal and his team at The ENT Clinic aim to manage Acute Otitis Media effectively, alleviating symptoms and preventing complications. Our experienced team are well aware of the potential complications that can arise from untreated or inadequately managed Acute Otitis Media (AOM). Their focus on thorough diagnosis and effective treatment is geared towards minimising these risks. Here are some complications associated with AOM: Hearing Loss One of the most immediate complications of untreated AOM is temporary hearing loss. The accumulation of fluid in the middle ear can impede

UNDERSTANDING CHOLESTEATOMA Cholesteatoma is a serious condition of the ear where a collection of skin cells and other debris forms a cyst in the middle ear. This blog delves into the intricacies of cholesteatoma, its symptoms, causes, and treatment options, with expert insights from Dr Sandeep Uppal and his team at The ENT Clinic. WHAT IS CHOLESTEATOMA? in an abnormal location – the middle ear behind the eardrum. Although non-cancerous, it can cause damage by expanding and eroding important structures within the ear, including the tiny bones necessary for hearing. The infection can also spread into important surrounding structures like the inner ear, facial nerve, and brain, leading to serious complications. SYMPTOMS OF CHOLESTEATOMA Symptoms can vary but commonly include: Ear Discharge: A persistent or intermittent discharge may indicate the presence of a cholesteatoma. Hearing Loss: Conductive hearing loss is frequently associated with this condition. Rarely the inner ear may be affected leading to sensorineural hearing loss. Ear Pain: Pain or discomfort may be experienced, although it’s less common. Odour: An unpleasant smell from the ear discharge is often reported. Vertigo or Tinnitus: In cases where the inner ear is affected, symptoms may extend to dizziness or ringing in the ears. CAUSES OF CHOLESTEATOMA The development of a cholesteatoma can be due to a variety of reasons, such as: Eustachian Tube Dysfunction: Leads to negative pressure and can draw skin into the middle ear. Chronic Ear Infections: Repeated infections can contribute to its formation. Tympanic Membrane Perforations: Holes in the eardrum can allow skin to enter the middle ear space. Genetic Factors: There may be a predisposition in some individuals towards this condition. DIAGNOSING CHOLESTEATOMA Dr. Sandeep Uppal emphasizes the importance of a comprehensive approach to diagnose cholesteatoma, which often includes: Clinical Evaluation: A thorough assessment and detailed history are key initial steps. Otoscopic Examination: Visualization of the ear canal and eardrum to look for signs of cholesteatoma. Audiometric Testing: Evaluating the extent of hearing loss. CT Imaging: In complicated cases, a CT scan provides detailed images of the ear structures. TREATMENT OPTIONS The management of cholesteatoma often requires a multifaceted approach: Ear Cleaning: To remove debris and allow for effective medication application. Medications: Topical and systemic antibiotics are used to manage infection. Surgery: Procedures such as tympanoplasty or mastoidectomy may be necessary to remove the cholesteatoma and repair any damage. POTENTIAL COMPLICATIONS If left untreated, cholesteatoma can lead to: Destruction of Middle Ear Structures: Causing significant hearing loss. Mastoiditis: Infection spreading to the mastoid bone and lead to abscess formation in adjacent structures. Facial Nerve Paralysis: Due to nerve involvement. Intracranial Complications: Such as meningitis or brain abscess, which are medical emergencies. THE IMPACT OF CHOLESTEATOMA Beyond physical symptoms, cholesteatoma can affect quality of life, leading to psychosocial issues and impacting education and employment. TAKE ACTION AGAINST CHOLEASTEATOMA Early detection and treatment are critical in managing cholesteatoma. Dr Sandeep Uppal’s team is dedicated to providing comprehensive care and education to prevent and treat this condition. If you suspect symptoms of cholesteatoma or have concerns about your ear health, schedule an appointment with our clinic today. Don’t let ear problems escalate – proactive care is key to maintaining your hearing health. Dr Sandeep has thirty-three years of experience in dealing with Chronic ear infection and has treated hundreds of patients with this condition successfully.

UNLOCKING THE MYSTERY OF MÉNIÈRE’S DISEASE Meniere’s Disease is a complex and often misunderstood inner ear disorder that affects the vestibular system, which is responsible for maintaining balance and spatial orientation. Characterized by episodes of vertigo, tinnitus (ringing in the ears), hearing loss, and a feeling of fullness or pressure in the ear, Meniere’s Disease can significantly impact the quality of life of those affected. CAUSES OF MÉNIÈRE’S DISEASE The exact cause of Meniere’s Disease remains unclear, but it is believed to be related to an abnormal volume or composition of fluid in the inner ear. This imbalance in inner ear fluid can disrupt the signals sent from the inner ear to the brain, leading to the symptoms of Meniere’s Disease. Several factors may contribute to this imbalance, including: AUTOIMMUNE RESPONSES The body’s immune system mistakenly attacks healthy cells in the inner ear. VIRAL INFECTIONS Past viral infections might trigger inflammatory responses affecting the inner ear. GENETIC PREDISPOSITION Family history may increase the risk of developing Meniere’s disease. STRESS Emotional stress is known to exacerbate symptoms. DIETARY HABITS Certain dietary factors, such as high salt intake, can affect fluid retention, impacting inner ear fluid dynamics. CLINICAL PROGRESSION Meniere’s Disease progresses in stages, each with its own set of symptoms: EARLY STAGE Characterized by sudden and unpredictable episodes of vertigo, fluctuating hearing loss, tinnitus, and ear fullness. These episodes can last from 20 minutes to several hours. MIDDLE STAGE Vertigo episodes may become less severe and less frequent, but hearing loss and tinnitus may worsen. Periods of remission are common. LATE STAGE In the final stage, hearing loss may become permanent, and tinnitus may continue. However, vertigo episodes tend to become less frequent and may stop altogether. DIAGNOSIS Diagnosing Meniere’s Disease involves a comprehensive evaluation by a healthcare professional, typically an otolaryngologist (ear, nose, and throat specialist) or an audiologist. Diagnosis is based on the characteristic pattern of symptoms, hearing tests, and, sometimes, balance tests. Tests may include: Hearing Tests: To assess the degree of hearing loss. Balance Tests: To evaluate the inner ear’s function and balance. MRI or CT scans: To exclude other possible causes of the symptoms, such as a brain tumour or multiple sclerosis. MANAGING MENIERE’S DISEASE While there is no cure for Meniere’s Disease, several management strategies can help control symptoms and improve quality of life. These include: DIETARY CHANGES Reducing salt intake can help regulate fluid levels in the body and potentially reduce the severity of symptoms. MEDICATIONS Diuretics may be prescribed to manage fluid retention, and anti-vertigo medications can help control episodes of dizziness. THERAPY Vestibular rehabilitation therapy can help improve balance and reduce the impact of vertigo. STRESS MANAGEMENT Techniques like meditation, yoga, and counselling can help manage stress, which may trigger or worsen symptoms. SURGERY In severe cases where medical management is not effective, surgical options such as endolymphatic sac decompression or vestibular nerve section may be considered. FIND YOUR BALANCE AGAIN If you or someone you love is experiencing symptoms suggestive of Meniere’s Disease, don’t wait to seek help. Early diagnosis and management are key to controlling symptoms and maintaining a high quality of life. Remember, you’re not alone in this journey—support and treatment options are available to help you find your balance again. “Take Back Control: Navigate Meniere’s with Confidence and Support!” Make an appointment to see Dr Sandeep through our appointment booking system or contact us through WhatsApp.

A GUIDE TO BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV) Benign paroxysmal positional vertigo (BPPV) is a prevalent inner ear disorder characterized by short, intense episodes of vertigo or dizziness triggered by changes in the head’s position. This condition occurs due to the displacement of calcium carbonate crystals, known as otoconia, within the semi-circular canals of the inner ear. The movement of these crystals disrupts the normal fluid flow within the canals, sending incorrect signals to the brain about the body’s position and causing the sensation of spinning. CAUSES OF BPPV BPPV is primarily caused by the dislocation of otoconia from their usual position in the utricle, leading to their accumulation in one of the semi-circular canals. This displacement can result from: Minor Head Injuries Even a slight bump or knock to the head can dislodge these crystals. Degeneration of the Vestibular System Natural aging processes can contribute to the detachment of otoconia. Other Factors Conditions like inner ear infection or prolonged positioning on the back (such as during dental procedures or hair salon visits) can also trigger BPPV. TYPES OF BPPV AND INDIVIDUAL TREATMENTS BPPV is classified based on the affected canal and the location of the crystals within it. The two primary types are: CANALITHIASIS In this most common type, the crystals freely move in the fluid of the canal, causing brief vertigo when the head’s position changes. The Epley manoeuvre is the primary treatment, effectively relocating the dislodged crystals to the utricle, where they no longer cause symptoms. CUPULOLITHIASIS Here, crystals adhere to the cupula of a semi-circular canal, making it sensitive to gravity changes. The Semont manoeuvre or Liberatory manoeuvre can dislodge the crystals from the cupula, providing relief from vertigo. MANAGING BPPV BPPV symptoms can be distressing, but the condition is manageable with the right approach. Diagnosis involves specific positional tests like the Dix-Hallpike test, performed by a healthcare professional to confirm BPPV and its type. TYPES OF BPPV AND THEIR TREATMENTS BPPV is classified based on the affected semi-circular canal and whether the crystals are free-floating or attached to a specific part of the canal. POSTERIOR CANAL BPPV This is the most common form, where crystals accumulate in the posterior semi-circular canal. The Epley manoeuvre is the preferred treatment, designed to guide the crystals out of the canal and back into the utricle, where they can no longer cause vertigo. This manoeuvre involves a series of specific head and body movements performed by a trained healthcare provider and can also be taught to patients to perform at home. HORIZONTAL (LATERAL) CANAL BPPV In this type, crystals affect the horizontal canal. The Lempert Roll manoeuvre (or barbecue rotation) is often used, involving rotating the patient’s body along with their head around a horizontal axis to move the crystals out of the horizontal canal. ANTERIOR CANAL BPPV This rare form affects the anterior canal and is more challenging to treat due to the canal’s position. A modified version of the Epley manoeuvre, targeting the anterior canal, may be attempted, though its effectiveness varies. SYMPTOMS AND DIAGNOSIS BPPV symptoms include vertigo, nausea, and, less commonly, vomiting, triggered by specific head movements. Diagnosis typically involves the Dix-Hallpike test for posterior canal BPPV or the supine roll test for horizontal canal BPPV, aiming to elicit vertigo and observe the induced nystagmus. PROGNOSIS AND MANAGEMENT While BPPV can recur, it’s not considered a serious condition and often resolves within one to two weeks with proper treatment. Lifestyle modifications and precautions can help manage and reduce the risk of recurrence. These include avoiding sudden head movements that have previously triggered episodes and, in some cases, using prophylactic manoeuvres periodically. CONCLUSION BPPV is a manageable condition that affects a significant portion of the population, especially among older adults. Understanding the different types of BPPV and their specific treatments allows for targeted management, offering relief from the distressing symptoms of vertigo. If you experience symptoms of BPPV, seeking prompt medical advice is crucial for accurate diagnosis and appropriate treatment. With the right care, most individuals can lead a normal, vertigo-free life. REGAIN YOUR BALANCE: TAKE THE FIRST STEP AGAINST BPPV TODAY! If you’re experiencing sudden, brief episodes of dizziness or spinning with head movements, don’t let BPPV take over your life. Understanding the causes and types of BPPV is the first step toward effective management. Consult a healthcare professional who can offer a precise diagnosis and tailored treatment plan, including manoeuvres like the Epley or Semont, which you might also learn to perform at home safely. Remember, while BPPV can recur, it’s highly treatable. Most individuals find significant relief or complete resolution of symptoms with proper treatment. Don’t ignore your symptoms; take action today to reclaim your balance and well-being. Make an appointment with Dr Sandeep through our appointment booking service or contact us via WhatsApp.

TYMPANIC MEMBRANE PERFORATION (HOLE IN THE EARDRUM) Clinical photograph showing normal tympanic membrane The tympanic membrane is commonly referred to as the eardrum. A perforation in the tympanic membrane is often known as a ruptured or punctured eardrum. Clinical photographs showing perforated ear drums. CAUSES TRAUMA Clinical photograph showing perforation ofthe eardrum caused by injury due to ear bud Impact to the ear, perhaps from a slap or the insertion of a foreign object like a cotton bud or hair pin. INFECTIONS Severe middle ear infections can lead to pus build up behind the ear drum,  the pressure of the pus causes the ear drum to rupture. Normal ear drum Image of an inflamed and bulging ear drum due topus accumulation in the middle ear behind the ear drum. BAROTRAUMA Pressure changes, commonly experienced in air travel or diving. ACOUSTIC TRAUMA Exposure to extremely loud noises. PREVIOUS SURGERIES Ear surgeries can sometimes result in perforation. SYMPTOMS HEARING LOSS The conductive hearing loss is due to poor conduction of sound through the tympanic membrane, it is often temporary but can be permanent. Hearing test showing poor hearing in theleft ear (Blue squares) due to hole in the ear drum PAIN The conductive hearing loss is due to poor conduction of sound through the tympanic membrane, it is often temporary but can be permanent. Sharp, intense pain commonly occurs at the time of rupture, either due to trauma or as a sequelae of Acute otitis media. EAR DISCHARGE Fluid or pus may drain from the affected ear. TINNITUS A ringing or buzzing noise in the ear. VERTIGO Dizziness or imbalance may occur. BLEEDING Blood may also be present due to traumatic perforation. DIAGNOSIS Diagnosing a tympanic membrane perforation is a meticulous process that Dr Sandeep Uppal and his team at The ENT Clinic carry out with utmost care. Here are the typical steps involved: INITIAL CONSULTATION Patient History: The team starts by taking a detailed medical history, focusing on any incidents that could have led to the perforation, such as trauma or infections. Symptom Review: Symptoms like pain, hearing loss, discharge, and bleeding are discussed to assess the severity and duration of the condition. PHYSICAL EXAMINATION Otoscopy Using an otoscope, the team examines the ear canal and the eardrum to assess the size, location, and severity of the perforation. Microscopic Examination Dr Sandeep  also uses the microscope to check for signs of infection, discharge, or other abnormalities in the ear. SPECIALISED TESTS Audiometry A comprehensive hearing test is performed to evaluate the extent of hearing loss. This helps in understanding the impact of the perforation on auditory function. Tympanometry This test measures the movement of the eardrum and the air pressure in the middle ear, providing valuable information on the condition of the eardrum and middle ear. CT Scan In complex or severe cases, a computed tomography (CT) scan of the ear may be recommended to get a detailed view of the middle ear, mastoid, inner ear structures and any signs of complications. Culture Test If an infection is suspected, a sample of the ear discharge may be taken for culture to identify the causative bacteria or fungi. Consultation and Treatment Planning Dr Sandeep Uppal and his team will review all the findings and discuss them with the patient. Based on the diagnosis, an individualised treatment plan is then formulated, which is crucial for the effective management of tympanic membrane perforation. TREATMENT Observation The approach of observation, often termed “watchful waiting,” is one of the initial treatment pathways. Many minor perforations of the tympanic membrane due to trauma or acute otitis media have the ability to heal spontaneously over time, typically within a few weeks. Observation allows for a more personalised treatment plan. If the perforation doesn’t heal naturally or worsens, more aggressive treatments like surgical closure can be employed later. The decision to observe a tympanic membrane perforation is a measured one, rooted in both medical and practical considerations. During the observation period, patients are generally advised to keep the ear dry and to avoid inserting anything into the ear canal. Follow-up appointments are scheduled for re-evaluation, and treatment plans may be adjusted based on the healing progress and symptomatology. Antibiotics Antibiotic ear drops or systemic antibiotics may be employed to fight off infection. Surgery For severe cases, myringoplasty or tympanoplasty may be advised to graft tissue onto the perforation to repair it . Audiological Support Hearing aids may be used during the recovery period. COMPLICATIONS OF UNTREATED PERFORATIONS Failure to promptly address a perforated eardrum can result in complications such as: CHRONIC OTITIS MEDIA Persistent infection in the middle ear. Learn more about chronic middle ear infections here>> CHOLESTEATOMA FORMATION Growth of a skin cyst in the middle ear. Learn more about cholesteatoma>> PERMANENT HEARING LOSS The longer the perforation remains untreated, the greater the risk of permanent hearing loss. TINNITUS Persistent ringing or buzzing in the ear may become chronic. Learn more about tinnitus here>> STEP TOWARDS HEALING EAR DRUM PERFORATIONS! A hole in the ear drum can be a silent troublemaker, but it doesn’t have to stay that way. Dr Sandeep Uppal and the team at The ENT Clinic are your partners in patching things up. With our deep understanding and personalized care plans, we’re all about fixing those tiny tears in a way that’s just right for you or your child. Don’t ignore a perforated ear drum. Let Dr Sandeep and our experts take a look and tailor a treatment that’s music to your ears. Contact us at The ENT Clinic for care that brings harmony back to your hearing! Act now by scheduling an appointment through our appointment scheduling page or connecting with us via WhatsApp.

TINNITUS AND ITS MANAGEMENT Tinnitus is a condition characterized by the perception of noise or ringing in the ears when no external sound is present. It can manifest as ringing, buzzing, hissing, whistling, swooshing, or clicking. Tinnitus isn’t a disease itself — it’s a symptom of an underlying condition, such as age-related hearing loss, ear injury, or a circulatory system disorder. For those experiencing tinnitus, it can range from a minor nuisance to a significant issue that affects daily activities and quality of life. While there’s no cure for chronic tinnitus, there are various ways to manage the condition. Read more about tinnitus>> DIAGNOSIS For patients presenting with tinnitus, particularly unilateral tinnitus (occurring in one ear), Dr Sandeep Uppal and his team at The ENT Clinic consider the possibility of a tumour as an underlying cause. A meticulous medical history and a thorough physical examination are the cornerstones of effective diagnosis. MEDICAL HISTORY Type of Tinnitus Determining whether the tinnitus is pulsatile or non-pulsatile, and whether it’s occurring in one or both ears, is critical for understanding the possible underlying cause. Onset and Duration The team will inquire about how suddenly or gradually the tinnitus started, as sudden onset could point to different causes than a gradual onset. Associated Symptoms Questions about other symptoms like hearing loss, vertigo, or imbalance can give clues about the nature of a possible tumour. Previous ENT Problems A history of ear infections, surgeries, or other ENT issues may be relevant. Family History A family history of tinnitus, hearing loss, or benign tumours like acoustic neuroma could be significant. Medication History Some medications are ototoxic and can exacerbate tinnitus or even contribute to tumour growth. Lifestyle and Occupational Factors Exposure to loud noises, smoking, or alcohol use can be pertinent information. PHYSICAL EXAMINATION Otoscopy Examination of the ear canal and eardrum to rule out simpler causes like earwax impaction, infection and middle ear conditions like cholesteatoma. Neck and Jaw Examination Palpation of the neck and jaw areas can sometimes reveal abnormal masses that might be causing tinnitus. Hearing Tests Pure-tone audiometry is performed to determine any hearing loss, which often accompanies tumours like acoustic neuroma. Tympanometry This test evaluates the function of the middle ear, providing insights into pressure changes behind the eardrum. Blood Pressure High blood pressure can cause or exacerbate tinnitus, so it’s a standard part of the physical exam. Vestibular Tests If there are symptoms of dizziness or imbalance, tests may be performed to evaluate the vestibular system. Auscultation In cases of suspected vascular tumours, a stethoscope might be used to listen for abnormal blood flow in the neck or temporal area. Throat examination This helps to confirm palatal myoclonus. For suspected tumours, additional diagnostic tests like MRI or CT scans are typically ordered. In some cases, a biopsy may be recommended. Angiography is used for vascular tumours to understand the blood supply to the tumour. Through a detailed medical history and comprehensive physical examination, Dr Sandeep Uppal and his team at The ENT Clinic aim to diagnose the underlying causes of tinnitus, including tumours. Their commitment to thorough evaluation ensures that each patient receives the most effective and individualised care possible. MEDICAL MANAGEMENT OF TINNITUS Tinnitus can be a debilitating condition that significantly impacts a person’s quality of life. While there is no definitive cure, various medical management strategies can help alleviate the symptoms. PHARMACOLOGICAL TREATMENT Vasodilators Drugs like Ginkgo Biloba, a herbal remedy, is occasionally used. Corticosteroids Oral or injectable forms may be used in cases of sudden-onset tinnitus, often associated with hearing loss or an inflammatory condition. Intratympanic Injections Steroid injections directly into the ear are sometimes considered for severe tinnitus, although this is generally a second-line treatment. Botulinum Toxin Injections Antidepressants Medications like Amitriptyline or Nortriptyline are sometimes prescribed for tinnitus, particularly if depression or anxiety co-exist. Antianxiety Medications Benzodiazepines like Clonazepam can sometimes be used on a short-term basis to alleviate tinnitus. NON-PHARMACOLOGICAL TREATMENT Sound Therapy White noise machines, tinnitus maskers, or hearing aids with a masking function can help drown out the tinnitus sound. Cognitive Behavioural Therapy (CBT) This psychological treatment aims to change the way a person thinks about their tinnitus so that it becomes less bothersome. Biofeedback and Neurofeedback These therapies teach patients how to control physiological functions that may exacerbate tinnitus. Tinnitus Retraining Therapy (TRT) This involves a combination of sound therapy and counselling to help people become less aware of their tinnitus. Mindfulness and Relaxation Techniques Methods like deep breathing, progressive muscle relaxation, and mindfulness meditation can help manage the stress and anxiety associated with tinnitus. MONITORING AND FOLLOW-UP Regular Audiology Tests To monitor any changes in hearing levels or tinnitus intensity. Medication Reviews To adjust dosages or switch medications based on efficacy and side effects. Lifestyle Counselling Advice on avoiding triggers like loud noises, and managing stress and diet to reduce tinnitus symptoms. Patient Education Providing comprehensive information on tinnitus management, including the use of hearing protection and stress management techniques. SURGICAL MANAGEMENT OF TINNITUS While medical management is often the first line of treatment for tinnitus, surgical intervention may be considered in certain cases. TUMOURS Microsurgical removal is performed for benign tumours like acoustic neuromas and glomus tumours. CHRONIC EAR INFECTIONS Persistent middle ear infections and cholesteatoma that contribute to tinnitus may require surgical intervention. Tympano-mastoid surgery to remove infected tissue and improve drainage may be performed. OTOSCLEROSIS This is a bone growth disorder in the middle ear which can cause tinnitus and may be treated surgically. Stapedotomy/Stapedectomy, a surgical procedure to replace the stapes bone in the middle ear can be performed. EUSTACHIAN TUBE DYSFUNCTION Eustachian Tube Balloon Dilation, a minimally invasive procedure where a balloon is inserted into the Eustachian tube and inflated to improve function of the eustachian tube. VASCULAR CONDITIONS Abnormal blood vessels causing pulsatile tinnitus may require surgical correction. Glomus tumours of the middle ear and carotid body tumours fall in this category. Endovascular surgery techniques such as coiling, or embolization may be used.

OUTER EAR INFECTIONS Outer ear infections, or swimmer’s ear, can turn fun in the sun into a real ear-bummer. They happen when water gets trapped in the ear canal, making it the perfect place for germs to throw a party. TYPES Acute External Otitis (Swimmer’s Ear): Inflammation or infection in the ear canal. Chronic External Otitis: Long-lasting inflammation or infection in the ear canal. CAUSES BACTERIAL INFECTIONS Pseudomonas aeruginosa and Staphylococcus aureus are commonly involved. FUNGAL INFECTIONS (OTOMYCOSIS) Candida albican infection of the ear canal Aspergillus niger infection of the ear canal Candida and Aspergillus species are common culprits, causing ear canal infection in Singapore. ENVIRONMENTAL FACTORS Excessive moisture or minor trauma to the ear canal can trigger infection. These infections are common in swimmers and those who dig their ears with cotton buds or other instruments. MANAGEMENT EAR CLEANING To remove any debris or discharge. Ear toilet under a microscope is a pivotal procedure in treating ear infections. It enables targeted removal of infected material and debris, reducing the bacterial/fungal load while minimizing risk of trauma to sensitive ear structures, including the eardrum. It also facilitates accurate sample collection for microbiological analysis, aiding in targeted antibiotic therapy. TOPICAL ANTIBIOTICS OR ANTIFUNGALS Topical antibiotics or antifungals in the form of ear drops and creams are often the first line of treatment for outer ear infections. Dr Sandeep Uppal and his team at The ENT Clinic frequently prescribe these as they directly target the underlying microorganisms, offering rapid relief from symptoms. Ear drops are generally easier to administer, while creams may provide a longer-lasting effect on the affected area. Both forms are effective in eradicating the infection when used as directed. PAIN MANAGEMENT Over-the-counter analgesics or stronger medications are used where necessary. COMPLICATIONS Complications arising from untreated or improperly managed outer ear infections are a concern that Dr Sandeep Uppal and his team at The ENT Clinic take seriously. Here are some key complications associated with outer ear infections: Cellulitis: The infection may spread to adjacent skin and soft tissue, requiring more aggressive treatment, such as intravenous antibiotics. Chronic External Otitis: Persistent infections can lead to a chronic state, increasing the risk of further complications and often requiring long-term treatment. Stenosis: Repeated or chronic infections can result in a narrowing of the ear canal, potentially affecting hearing and making future treatments more challenging. Abscess Formation: Pockets of pus may develop, requiring drainage and more intensive antibiotic therapy. Malignant Otitis Externa: Though rare, this severe form of outer ear infection can spread to the bones and cartilage at the base of the skull, requiring immediate medical intervention. This is more likely to happen in patients who have uncontrolled diabetes mellitus or are immunocompromised. Hearing Loss: While usually temporary, untreated outer ear infections can sometimes result in conductive hearing loss. Dr Sandeep Uppal and his team are adept at identifying the signs of these complications early, thanks to their meticulous diagnostic approach, thereby enabling timely and effective interventions. GOODBYE EARACHES! Is the splash of summer fun leaving you or your little one with an itchy or aching ear? We’re here to help you and your child hear without any ouches. No more ear pain means more fun talking and playing. We’re all about keeping ears feeling good and working great. Don’t let swimmer’s ear dampen your spirits or silence your conversations. Our team is all about more than just quick fixes—we aim to ensure everyone enjoys the full symphony of sounds life has to offer, without any interruptions.