Talking About Tonsils

Talking About Tonsils

 April 27, 2022   Return

Words Lim Teck Choon

When most people think about the immune system, they envision white blood cells rushing in the bloodstream to eliminate potentially harmful foreign microorganisms such as bacteria and viruses. Some will also associate lymph nodes with the immune system. There is another often underappreciated component to the immune system: two roundish lumps at the back of the throat known as the tonsils.

ENTirety with

Professor Dato’ Paduka Dr Balwant Singh Gendeh

Consultant Ear, Nose & Throat Surgeon

Pantai Hospital Kuala Lumpur

The First Line Of Defense Against Infections

The tonsils we commonly think of are called the palatine tonsils. Prof Dr Balwant explains that these are the fleshy tissues located one at each side at the back of our throat or pharynx.

There are also other types of tonsils in our body, all located around the pharynx:

The pharyngeal tonsil, or adenoids, is a mass of tissue located on the roof of the space at the back of the throat (nasopharynx). The adenoids play a role in the immune system during childhood. They shrink as we age and eventually disappear during adulthood.

A pair of tubal tonsils (sometimes called Gerlach’s tonsils) are located on each side of the location where the auditory tube opens into the nasopharynx.

A pair of lingual tonsils are located on the back part of the tongue, one at each side.

These tonsil tissues are arranged to form what is called the Waldeyer’s tonsillar ring. This ring acts as the first ring of defense against infections by microorganisms that find their way in through the nose and mouth.

The tissues in the tonsils are similar to that found in lymph nodes. Like lymph nodes, tonsils can swell in size in the presence of infections.

Hence, our tonsils can serve as an indicator as to whether there is an infection happening in our body. “Tonsils are very necessary for children up to their teenage years,” Prof Dr Balwant reiterates. Hence, the current recommendation among many healthcare professionals these days is to keep the tonsils for as long as possible.

However, swollen tonsils due to infection can also be a painful bother. This condition, called tonsillitis, is ironically the main reason why many people had their tonsils removed in the past – a classic case of shooting the messenger for the bad news!

Heinrich Wilhelm Gottfried von Waldeyer-Hartz was an early 20th century anatomist and lecturer from Germany. He was the first person to detail the structure and function of lymphatic tissue in the neck and throat region, hence the naming of the tonsillar ring after him.

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Tonsillitis: The Good & The Pain

Each time we breathe and eat, we are also inviting all kinds of microorganisms into our body. Some bacteria and viruses may be harmful, and often, because the throat is their first “pit stop”, that region becomes infected.

During an infection by bacteria or viruses, the tonsils sometimes become swollen, with white spots often seen on them. This condition is called tonsillitis, and the swollen tonsils are often accompanied by sore throat and fever.

6 Facts about Tonsillitis

  1. It can happen at any age, but it commonly affects children from preschool (kindergarten) to mid-teens.

This is because tonsillitis is contagious, and children are frequently exposed to the bacteria and viruses responsible for tonsillitis while playing and mingling with one another at school. The frequent contact is also the reason why children may also experience recurrent tonsillitis.

However, Prof Dr Balwant advises adults who experience recurrent tonsillitis, especially those 30 years old and above, to visit an ENT specialist – the recurrent tonsillitis may be a sign of a more serious problem that needs medical attention.

  1. The symptoms of mild tonsillitis – pain, swollen tonsils, fever – usually resolve themselves within a week or so.

However, some viruses and bacteria may cause more serious problems if left to their own devices. For example, the Streptococcus family of bacteria can give rise to strep throat once they infect the tonsils. If left untreated, there is a chance that the infection can advance to affect the blood and the urinary tract.

Therefore, it is advisable to consult a doctor if the tonsillitis is persistent despite us having received treatment over a period of time.

  1. Other reasons to see an ENT specialist:
  • The tonsils have swollen to an extent that we experience breathing or swallowing difficulties.
  • There are swollen lymph nodes at the sides of our neck.
  • Tonsillitis is usually accompanied by high fever (over 39ºC).
  1. Mild tonsillitis can be treated with antibiotics (if it is caused by bacteria) and plenty of rest.

Prof Dr Balwant also recommends drinking plenty of fluids and gargling with salt water. Lozenges and warm tea mixed with honey can be helpful in providing relief. The doctor may also prescribe pain relief medications if the pain is especially bothersome.

  1. While healthcare professionals recommend keeping the tonsils, surgical removal or tonsillectomy is sometimes necessary.

It may be the ideal solution for people who experience persistent, long-term tonsillitis or frequently recurrent tonsillitis. It is also recommended when other conventional treatments do not work.

  1. Tonsillectomy may also be necessary if the infection has spread deeper into surrounding throat tissue. This condition, called tonsillar cellulitis, will lead to pus formation in the affected areas. When this occurs, the ENT surgeon will attempt to drain the pus while prescribing antibiotics if bacteria is responsible for the infection. If these efforts fail to yield the desired results, Prof Dr Balwant points out that the infected tonsils may need to be removed at a later date.

Other Tonsil Troubles

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Stones In The Tonsils?

The surface of our tonsils isn’t smooth. In fact, there are various crevice-like pockets called crypts. According to Prof Dr Balwant, when bacteria, dead cells, mucus and other substances become trapped in these crypts, they can form soft aggregates that may eventually harden to become tonsil stones.

Symptoms. It is possible for some people to have tonsil stones without realizing this, as these stones may be small and do not cause any discomfort. If the stones grow to larger sizes, however, they may cause the tonsils to swell and give rise to bad breath, discomfort and issues associated with enlarged tonsils (such as difficulties in breathing and swallowing). Ear pain and ongoing cough may also be seen in some people. 

Treatment. Prof Dr Balwant reveals that for smaller tonsil stones, gargling with salt water after every meal may help to dislodge these stones and to reduce bad breath. Antibiotics may be prescribed when necessary to reduce the number of bacteria in the tonsils that contribute to stone formation. For more severe cases, the ENT specialist can remove the stones using a technique called cryptolysis. If all else fails to yield the desired result, tonsillectomy may be necessary.

Tonsil Cancer

Cancer can also develop in the tonsils. Like most cancers, we have not identified the precise causes, but it has been linked to smoking and the human papilloma virus (HPV). People who smoke or have HPV infection tend to have a higher risk of developing tonsil cancer. It can occur at any age, but the risk also increases with age.

Prof Dr Balwant adds that when cancer develops, usually only one tonsil is involved.

HPV is most commonly transmitted through oral, vaginal and anal intercourse, and people infected with HPV may not show any symptoms. Fortunately, HPV vaccines are available to protect against infection by the virus.

Symptoms. The early symptoms of tonsil cancer may be mistaken as those for strep throat, hence it may be worth visiting an ENT specialist when someone 30 years old and above has persistent, non-healing sore throat.

Other symptoms can include:

  • One tonsil noticeably larger than the other
  • Difficulties and/or pain when chewing, swallowing and speaking
  • Blood in the saliva
  • Swelling in the neck
  • Severe ear pain
  • Unintentional weight loss

Treatment. Early stage cancer treatment includes surgical removal of the affected tonsil followed by radiation therapy to kill any remaining cancer cells present in the region. For more advanced cancer, chemotherapy will also be included as part of the treatment regime, and more advanced surgery may also be necessary. Like most cancers, better treatment outcome is more likely if the cancer is detected at an early stage. HT

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Dental Care: Brushing Up On The Basics

Dental Care: Brushing Up On The Basics

 April 27, 2022   Return

WORDS Hannah May-Lee Wong

Dr Lau Lake Koon

Implant & Aesthetic Dentist

 

World Oral Health Day falls on March 20th every year. The global awareness day highlights the importance of keeping good oral hygiene and reminds us that oral health comprises a big part of every individual’s wellbeing. Yearly, the World Dental Federation (FDI) focuses on a specific theme and this year, it’s “Say Ahh: Act on Mouth Health”. The campaign aims to encourage everyone to walk the talk, and actively take measures to improve their oral health.

Anyone remember the Academy Award winning movie Cast Away (2000) starring Tom Hanks? It talks about a FedEx employee who was on-board a plane that crashed into the sea. Although he survived, he was “cast away” to an uninhabited island. Before he got on the ill-fated plane, he was suffering a bad toothache and kept putting off going to the dentist to get it checked. As a result, he was left on an island with no dentist and was forced to extract his tooth himself (ouch!). Let’s not be that character. We don’t have to wait for a toothache to pay our dentists a visit. Beyond that, we should also diligently care for our teeth and encourage our children to do the same.

This World Oral Health Day, HealthToday chats with friendly local dentist, Dr Lau Lake Koon, as he graciously answers a series of frequently asked questions:

We’re curious to know, how would you as a dentist define good oral health?

The human mouth, just like the gut and other parts of the body, contains good and bad bacteria. A balance of these good and bad bacteria maintains healthy functioning of the body. Good oral health to me is defined by maintaining an optimum number of good bacteria against bad bacteria in the mouth. This can only be attained through practicing good oral hygiene, having a healthy diet and having a healthy body.

Your dentist, through your regular check-ups, should be able to identify any dental issues that may exist, treat them and educate you on how to care for your teeth. That said, it is important that you as a patient consistently practice good oral hygiene and carry out whatever that was prescribed to you by your dentist. Frequent visits to the dentist will catch existing problems in the early stages. This is a good thing because as the saying goes, prevention is better than cure.

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We often hear dental experts telling us we don’t brush our teeth long enough for us to get a good clean. How long should we brush our teeth for, and how often?

Brushing your teeth, the proper way for approximately two minutes each time should be enough to keep the teeth clean. There are many ways of brushing your teeth and your dentist will show you what’s best for you. Generally, I recommend brushing with the Bass technique, which includes brushing under the gumline with the toothbrush at a 45-degree tilt.1 That said, I rarely advise my patients to brush for longer. In fact, the more common problems I see daily arise from:

  1. Not flossing
  2. Not brushing at night before sleeping
  3. Not brushing correctly

It is during our sleep that our mouths have a warm, stable environment that goes uninterrupted for hours. This kind of environment is most suitable for bacterial growth. If there are food debris and bacteria in the mouth, bacteria will grow exponentially. This can increase the risk of developing cavities and the formation of tartar (plaque that stays and hardens on your teeth) which leads to gum disease.2

The most important advice I give to patients is to brush their teeth at night, right before sleeping. It’s a simple procedure that will go a long way in keeping teeth healthy. It is recommended to brush twice a day: in the morning and at night before sleeping.

Are electric toothbrushes better than normal toothbrushes?

With the advent of stronger formulated toothpaste brands, more awareness on oral care, better oral care techniques and better designed toothbrushes, it is not necessary to use an electric toothbrush.

In my practice, there are two extreme groups of patients:

The first group consists of those who do not take care of their teeth at all and require lots of education to change their habits. In these cases, I would need to resolve all their dental issues, restore dental functioning and aesthetic, and rehabilitate the patient, for them to take care of their teeth effectively in the future. This group would benefit from using an electric toothbrush.

The second group consists of those who are experts in their oral care regime. They use the latest electric toothbrushes despite not really needing them. In some cases, the over-brushing can cause the tooth enamel (the hard, outer layer of the teeth) to be worn out and cause sensitive teeth. These people should stop using electric toothbrushes.

In summary, electric toothbrushes should be reserved for those who are unable to care for their teeth (for example, those with Parkinson’s disease or are handicapped), those with very bad dental conditions or those who have severe stains from smoking or drinking tea, coffee or wine. In most cases, a normal toothbrush is more than enough to keep your teeth clean. It is important to check with your dentist what’s most suitable for you.

How often should we pay our dentists a visit?

It is recommended that a person with no outstanding dental issues visits the dentist every 6 months.

Cavities and gum disease are quite common among us. What causes them and how do we prevent them?

Cavities are mostly caused by taking sweet food or drinks. But one must understand, it is the frequency or exposure time to the sweet items, and not the amount consumed, that causes cavities.

For example, a person who drinks two cups of coffee in 15 minutes every morning will have much less incidences of dental caries (tooth decay) compared to a person who drinks one cup of coffee over a four-hour period every morning.

Gum disease is caused by a gradual build-up of plaque and tartar on the tooth surfaces. If these are left long enough, it causes gum infection. Gum bleeding is a sign of gum infection. This is also the main cause of gum recession and shaky teeth in one’s old age.

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Why do some people have sensitive teeth and what are the best ways of dealing with it?

Besides over-brushing with an electric toothbrush or using overly strong formulated toothpaste, gum recession (from gum disease) and cavities can also cause sensitivity. The best thing to do is to make an appointment for a dental check-up as soon as possible.

Let’s talk about teeth whitening. Do whitening toothpastes work? What is the most effective way of whitening our teeth to look good?

Whitening toothpaste is an example of stronger formulated toothpaste brands. They contain higher levels of abrasive particles. They are more effective in removing stains and debris on the teeth. However, on a clean tooth surface, whitening toothpastes will not make teeth get whiter. On a stained and dirty tooth, whitening toothpastes will be more effective in removing the stains, thus the teeth look cleaner — NOT whiter.

Professional whitening done by dentists use approved chemicals with or without laser and they do not cause long-term side effects. These whiten the teeth beyond their original colour.

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What can we do to avoid bad breath?

Most bad breath is caused by ineffective brushing techniques, not flossing, not brushing the tongue and indigestion issues. If the mouth still harbours large numbers of bacteria or rotting foodstuff, it will smell.

How about food? Is staying away from sugary food really the key to having good teeth?

Everything is about moderation. As I tell my patients, you must enjoy your life! But how you enjoy your cup of coffee or wine is important. Finish your coffee within 20 mins to reduce exposure time. Try to limit yourselves to a max of 2 sweet drinks a day, preferably during meal times so that your teeth can recover in-between meals. After a night of having wine, remember to brush your teeth before sleeping — don’t let the strong wine stains linger and bind onto the teeth surfaces. Overall, if you take care of your teeth, you can enjoy them for a much longer time.

How about caring for children’s teeth? Is it different from an adult’s oral hygiene routine?

It is important to instil good oral hygiene habits from young. I often start coaching parents about oral care for children, even before the baby is born. My advice:

After birth: It is important to gently wipe your baby’s gums with a clean wet cloth after every milk feeding.

6 months: The first front teeth will appear when the baby is approximately 6 months old. You should continue wiping with a clean wet cloth until the age of 1 to 1.5 years old. Make sure your children understand that they must have their teeth cleaned by their parents before sleeping every night and upon waking up every morning.

1.5 to 2 years old: Parents can start using small baby toothbrushes to brush their children’s teeth. Parents should brush for their children first, then let their children practice brushing after. This should go on until the child is 7 years of age. After that, continuous supervision should be sufficient. Non-fluoride toothpaste brands should be used until the child does not swallow toothpaste anymore (usually by 7 years of age). Parents should bring their children for dental check-ups every six months, as there are many changes happening in a growing child’s teeth.

References:

  1. https://www.colgate.com/en-us/oral-health/basics/brushing-and-flossing/3-tooth-brushing-techniques-that-get-the-job-done
  2. https://www.webmd.com/oral-health/guide/tartar-dental-calculus-overview#1

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Cervical Cancer Elimination Receives a Boost with ROSE

Cervical Cancer Elimination Receives a Boost with ROSE

 April 27, 2022   Return

WORDS PANK JIT SIN

A multinational effort by stakeholders from University of Malaya (UM) and VCS Foundation Australia has resulted in an innovative approach to reduce and eliminate cervical cancer in Malaysia. Known as Removing Obstacles to cervical ScrEening (ROSE), the pilot programme integrates self-sampling, human papillomavirus (HPV) testing and e-health technology to improve cervical cancer screening uptake among Malaysian women.

According to Professor Woo Yin Ling, consultant obstetrician and gynaecologist at UM, who helmed the pilot programme, ROSE integrates “self-sampling, HPV testing and e-health technology to enhance every woman’s personal journey of maintaining good cervical health.”

“At its heart, ROSE is driven by empathy for the screening experience of women. ROSE embodies safety, privacy and dignity through self-sampling, encouraging more women to willingly participate in screening in a timely manner,” says Prof Woo. 

The HPV test accompanying ROSE is evidence-based and highly accurate, thus providing greater reassurance to the women tested. The diagnostic accuracy also allows for less frequent testing over a woman’s lifetime. Prof Woo reveals that it was the e-health component of ROSE that makes it unique and powerful. The programme utilizes mobile technology and VCS Foundation’s canSCREEN®, a population health management platform that enables healthcare professionals to track the progress of every woman screened through their lifetime regardless of whether they did it in a government or private setting.

The programme provides a welcome safety net to ensure women are screened at recommended intervals and followed up accordingly.

“It also allows optimization of health resources by preventing duplication of services while establishing a powerful resource to monitor our progress towards eliminating cervical cancer as a nation,” says Prof Woo.

Evidence for ROSE comes from a multi-sectoral collaborative effort, which was established to conduct the screening study. The pilot project took place in five MOH clinics in 2018 and involved 4,188 women. It was supported by academia, government, corporate, non-profit organizations, as well as private sponsors.

The pilot project found that 99% of the participants preferred the self-sampling method of ROSE, suggesting that Malaysian women would generally find this new approach to screening more acceptable.  Abnormal test results were detected in 5% of the women screened, and three cases of cancer were diagnosed and had the appropriate follow up. The mobile technology and e-health facilitated comprehensive follow through of the ‘screening to treatment’ pathway in the women.

 “The studies also found a high level of engagement with the ROSE model among participating healthcare professionals. They were very encouraged by its potential to increase the uptake of cervical cancer screening by women attending the clinics while not burdening the healthcare staff with additional administrative workload,” says Prof Woo.

Thus, the findings suggest that ROSE is the right way ahead in strengthening the national cervical cancer screening programme.

ROSE’s potential to change the landscape of cervical cancer has been recognized by WHO, Union for International Cancer Control, International Papillomavirus Society, U.S. National Cancer Institute and International Federation of Gynecology and Obstetrics. Dr Tedros Adhanom, Director-General of WHO, wrote in to endorse the women-centred approach of ROSE and said Malaysia is well on its way of meeting WHO’s target of screening and managing 80% of women aged between 35 and 45 by 2030.

Malaysia is the first country in the world to implement a programme such as ROSE, which incorporates self-sampling, HPV DNA-testing, and a digital platform that securely monitors the entire screening journey of women through an integrated platform.

The launch of ROSE and signing of Memorandum of Understanding between UM and VCS Foundation was also attended by Professor Dato’ Dr Adeeba Kamarulzaman, Dean of the Faculty of Medicine, UM, Dato’ Seri Dr Wan Azizah Wan Ismail, Deputy Prime Minister of Malaysia, Datuk Seri Dr Dzulkefly Ahmad, Minister of Health and Hannah Yeoh, Deputy Minister of Women, Family and Community Development. HT

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Cancer: Are You Aware?

Cancer: Are You Aware?

 April 27, 2022   Return

WORDS PANK JIT SIN

World Cancer Day 2019 is celebrated on 4th February every year and many activities are carried out around the world in conjunction with this day.

This year’s theme for World Cancer Day is ‘I Am and I Will’ which is an empowering call to action to everyone to embrace personal commitment towards reducing the impact of cancer for themselves, their loved ones and the rest of the world.

Our Ministry of Health came out with a factsheet for healthcare providers (but there are some key messages everyone should take away from it) and it address five key issues namely:

  1. Awareness and correct understanding
  2. Screening for cancer
  3. Prevention and risk reduction
  4. Mental and emotional impact
  5. Saving lives and saving money

Explanation:

    1. Improve awareness and knowledge about early signs and symptoms of cancer. Awareness and accurate information can help with earlier diagnosis, thus earlier treatment and a possible cure in certain cancers. Make informed choices about one’s health and dispel ignorance and misconceptions about cancer ie, exercising, avoidance of smoking and processed foods, etc.

 

    1. Early screening will detect cancer and precancerous lesions and those that can be effectively screened include breast, cervical, colorectal and oral cancers. All four screening services are provided by the MOH at public health clinics throughout the country.

 

    1. Prevention and risk reduction. At least 30% to 50% of cancers are preventable, which means everyone can reduce their risk of developing cancer by avoiding cigarettes and alcohol; exercising and eating healthy; and vaccination (for human papillomavirus and hepatitis B).

 

    1. The mental and emotional impact of cancer goes beyond the physical aspect as it affects the mental and emotional wellbeing of the patient and loved ones. Patients and their caregivers should be encouraged to participate actively in the decisions about their care and treatment plan.  

 

  1. Saving lives and saving money. Cancer patients and their families often encounter a double-whammy of sorts on their finances. Cancer treatment itself can take up the entire savings and insurance expenditure. Additionally, the patient may not be able to work, confounding the problem at hand. Therefore, it is best to avoid cancer where possible, treat early otherwise and prevent a catastrophic financial situation for the family. HT

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ACK! Why am I suddenly allergic to prawns?

ACK! Why am I suddenly allergic to prawns?

 April 27, 2022   Return

WORDS PANK JIT SIN

Can adults develop allergies? A little while ago, the smarties at HealthToday were discussing about allergies and the topic of adult onset allergies came up. A few of us were afflicted by allergies that developed in adulthood and post pregnancy. That got us intrigued and we went snooping around for further information. Beyond searching for literature on adult onset allergies, we also spoke to Dr Kent Woo, a prominent allergist and immunologist at Gleneagles KL.

We tend to think of allergies as something that develops during childhood and stays with us for life. It is rare to hear someone growing out of their allergies without any medical interference. These allergies include asthma, eczema, allergic rhinitis, hay fever and food allergies.

According to Dr Woo, adult onset allergy technically means a newly developed allergy during adulthood as opposed to childhood. He said: “Allergy can develop during all stages in life. However, it is more common to develop food allergies as a child and medication allergies as an adult.” Dr Woo notes an interesting observation in his practice—an increase in allergic contact dermatitis towards cosmetics in menopausal women. He postulates it could be caused by hormonal changes causing the allergen sensitization to previously tolerated cosmetics.

Regarding treatment, Dr Woo said treatment towards all forms of allergy is primarily avoidance. Medication allergy is a little different and one can opt for desensitization therapy. According to the American Academy of Allergy, Asthma and Immunology (AAAI), drug desensitization or induction of drug tolerance, is “a method of safely administering a medication to a patient who is allergic to it.” The procedure is done by administering an extremely small dose of the medication to the patient. This dose is increased slowly at regular intervals until the full dose is achieved. Once the drug is discontinued, the patient returns to his or her previous allergic state.

In the case of aeroallergens such as dust, pollen or spores, a treatment called allergen specific immunotherapy can be done. The treatment is a disease-modifying therapy which is useful in treating allergic rhinitis and conjunctivitis, allergic asthma and insect hypersensitivity.

It is very important that any treatment involving allergies be carried out by a doctor or specialist, specifically an allergist, as there is a risk of developing anaphylactic (life-threatening) reaction to the medication or treatment.  An allergist will be able to tailor a plan specific to your allergies.

How common is adult onset allergy?

While we like to believe that allergies often afflict the young, the truth is allergies can develop during all stages in life. A rather recent research looking at adult-onset food allergy claims that 5% of adults and 8% of children are affected by food allergies.

A separate survey carried out in the US comes up with an even more alarming figure—almost one quarter of adults reported developing adult onset food allergy while about 55% noted they had childhood onset food allergies. The study, which was carried out on over 40,000 adults revealed that the most common allergies reported by adults were shellfish, milk, wheat, tree nut and soy, in that order. The researchers were taken aback by the number of shellfish allergies and it was noted that a substantial number of them ended up in the emergency department due to anaphylactic reactions.

Nobody really knows why someone can be perfectly fine with a type of food and suddenly develop allergy to it later in life.

Does ethnicity affect my risk?

Apparently, one’s ethnicity determines the risk of developing certain types of allergies. Asians, Hispanics and persons of African descent are at higher risk of developing shellfish and peanut allergy than Caucasians.

Another observation from the survey was that being female and getting older puts one at increased risk of developing adult onset food allergy.

Some people may not recognize they have a food allergy and believe they are merely intolerant to it, thus not seeking help. We all know someone who avoids certain foods because it makes them queasy or it gives them tummy aches.

If consuming a type of food always seems to bring you discomfort or trigger other symptoms, perhaps you might want to consider the possibility of it being a food allergy. So, with that in mind, what foods do you avoid? What foods make you feel unwell? Could it be food allergy? We’ll leave you with that thought, but at least now you know better and can look for treatment if necessary. HT

References:
1. American Academy of Allergy, Asthma and Immunology. What is drug desensitization? Retrieved from https://www.aaaai.org/conditions-and-treatments/library/allergy-library/drug-desensitization.

2. Warren C., et al. (2018). Prevalence, severity, and distribution of adult-onset food allergy. J Ann Allergy Asthma Immunol;121:S1–S17.

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Taking Control Of Our Fertility

Taking Control Of Our Fertility

 April 27, 2022   Return

WORDS LIM TECK CHOON

Imagine being able to focus on building our career and achieving financial stability without having to worry that time may be running out when it comes to having a family. Perhaps life can be like a romantic movie or novel, and maybe we can wait until we can find that special someone without hearing the biological clock ticking away in our head.

Thanks to advances in fertility methods and technology, we now have options to gain some semblance of control over our fertility (within realistic limits, of course). This month, fertility specialist Dr Agilan Arjunan invites us to take a closer look at these options.

How Long Can A Woman Wait To Have A Baby?

WOMAN’S HEALTH AND FERTILITY WITH

Dr Agilan Arjunan

Consultant Gynaecologist & Fertility Specialist

KL Fertility & Gynaecology Centre

 

When it comes to fertility, the biological clock is quite real. Dr Agilan shares that:

  • A woman’s most fertile period is usually between the ages of 20-25.
  • Her fertility begins to decline after the age of 25 (more steeply after the age of 35), often when she is finally ready to settle down and start a family.

 

Why Is There Even A Biological Clock In The First Place?

While a man’s testicles continuously produce sperm over time, a woman is born with all her eggs already produced, to be released over time during each menstrual cycle.

This means that she has a limited number of eggs that can be used to conceive a child throughout her reproductive years. As we can see from Figure A, a woman has 100% of her eggs at birth,but the number decreases over time. By the time she is 30, she has approximately 10% of her eggs remaining, and the number continues to decline until she experiences menopause, after which she is no longer able to conceive a child.

It’s Not Just The Number That Counts, It’s Also The Quality.

Dr Agilan explains that age doesn’t just affect the number of eggs available for a successful conception. The quality of the eggs is affected too.

“The good quality eggs are often released during a woman’s most fertile age,” he elaborates. As the years pass, there is a higher risk for an egg to contain abnormal genetic material or develop into an abnormal embryo. This is why the risk of having a child with genetic disorders such as Down’s syndrome increases when a woman has a child at a later age (especially after 40).

There Are Other Factors That Also Affect A Woman’s Fertility.

Some of these include:

  • Being obese or overweight has been linked to abnormal periods and ovulation as well as reduced chances of successful pregnancy.
  • Diet and lifestyle may also contribute to reduced chances of conception.
  • Other possible factors that can affect fertility include the presence of pollutants and/or toxins in the environment and stress.

In-Vitro Fertilization Or IVF Can Solve All These Issues, Right?

Sadly, no. No matter how advanced IVF technology may be, it still requires the woman’s eggs. If she has low numbers of eggs, and there are few good quality eggs available, the chances of a successful IVF will be impacted significantly.

Fortunately, there is a way to freeze a woman’s eggs, obtained when she is younger and hence more fertile, which can then be used for IVF when she is at a later, less fertile age.

The Deep Freeze

Dr Agilan shares that, in the past, egg freezing was an option offered to women who were about to undergo cancer treatment. It still is, but with recent improvements being made to the technology, egg freezing is now also an option for women who wish to preserve their younger eggs for later use.

What Has Been Improved About Egg Freezing?

Dr Agilan shares that egg freezing experienced a surge in use after the development of a technique called vitrification. This process allows the egg to be very rapidly frozen in liquid nitrogen. This method greatly reduces the formation of ice crystals that can damage the eggs – a problem that plagued egg freezing prior to the development of the vitrification technique.

Dr Agilan further elaborates that the entire process may take about two weeks, which shouldn’t be too much of a disruption to a busy woman’s routine. He adds that the fertility specialist will try to accommodate the client’s schedule as much as possible.

So, How Much Is It?

The cost may vary from one fertility centre to another. Aside from the usual fees for consultation, injections, medications and the egg harvesting procedure, the fertility centre will charge a fee for the storage of the eggs. If the client has any concerns about the cost, the matter can be discussed with the fertility specialist.

Technology Has Allowed The Freezing Process To Have A Lower Risk Of Egg Spoilage. Hence, Egg Freezing Is Now A More Viable Option To Preserve A Woman’s Fertility.

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What Is The Procedure Like?

  1. Let’s talk about it first. Like most consultations, the fertility specialist will explain the procedure clearly and thoroughly to the client first. Dr Agilan adds that this is a good opportunity for the client to voice any concerns she may have.
  2. Let’s find out how many eggs are there. The fertility specialist may frst conduct a pre-screening test to obtain an idea of how many eggs the client has left (or her ovarian reserve). The knowledge will allow the fertility specialist to determine whether egg freezing is suitable for the client and, if yes, how many eggs would likely be harvested per cycle. Dr Agilan shares that the fertility specialist usually aims to collect about 10 to 12 eggs.

  3. Let’s get the ovaries to work. Once the client is ready, the fertility specialist will offer some injections to stimulate her ovaries into producing a large number of eggs.

  4. Let’s collect the eggs. When the time is right, the fertility specialist will put the client under deep sedation and harvest the eggs using a needle. An ultrasound will be used to help guide the fertility specialist.

  5. Let’s freeze the eggs. The harvested eggs will then be frozen in liquid nitrogen using the vitrifcation process.They will be stored in a safe and clean temperature-regulated area within the fertility centre.

Still Have Concerns? Dr Agilan Dishes Further About Egg Freezing.

How Long Can The Eggs Keep?

The eggs can keep for a considerable length of time so long as they are stored under the right conditions. According to Dr Agilan, the fertility centre typically agree to store a batch of eggs for 5 years.

Can The Fertility Specialist Guarantee The Success Rate When The Eggs Are Used In IVF?

No. Egg freezing serves to preserve a woman’s eggs at a younger age for future use. It doesn’t improve the quality of the eggs or increase the odds of success when these eggs are used in IVF.

What Happens If The Frozen Eggs Are Damaged Or Lost?

When a client agrees to have her eggs frozen at a fertility centre, she will be given a consent form to sign. Details such as accountability will be stated clearly on the form, and the client should read it carefully to make sure that the terms are agreeable before signing on the dotted line.

Details may vary from one fertility centre to another, but usually, the fertility centre cannot be held accountable if the eggs were damaged or missing due to unforeseeable or unpreventable incidents. These include events considered as ‘acts of God’, such as natural disasters. The fertility centre, however, can be held accountable for errors caused by carelessness or negligence.

What Happens If The Fertility Specialist Retires Or Transfers To Another Fertility Centre? Or, If The Fertility Centre Closes Down?

Ethical and responsible fertility centres have contingency plans for issues such as closure. Typically, clients will be notified in advance, and these fertility centres would have made arrangements with another one to take in the frozen eggs.

In the event of a transfer or retirement of a preferred fertility specialist, the fertility centre will be happy to continue the existing arrangement or, if the client prefers not to, help facilitate the efforts to transfer the frozen eggs to a fertility centre of the client’s choice. HT

Hey, how come only women need to plan their fertility? How about the men?

Don’t shoot the messenger, but biology isn’t big on equality of the sexes. Unlike women, men continue to produce sperm cells throughout their reproductive period, and hence there is usually no need to freeze their sperm. Dr Agilan says that sperm freezing is often an option to consider if the man is about to go for cancer treatment. Other than that, he believes that there isn’t any need for a man to freeze his sperm.

However, do note that male fertility has been decreasing on a global scale, although we have yet to fgure out the exact reasons for this phenomenon. Dr Agilan believes that some men may have fertility issues after the age of thirty, and as such, they should consider visiting a fertility specialist if they had been trying to have a child through regular sexual intercourse for a year or so, but have yet to be successful.

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A Closer Look At Cervical

A Closer Look At Cervical

 April 27, 2022   Return

WORDS ABRAHAM MATHEW SAJI

Sarah—the writer’s late mother—frequented visits to her doctor when she was in her mid-60s due to occasional vaginal discharge with bleeding and fever. Initial examination revealed urinary tract infection and she was treated accordingly. She reduced her visits to her doctor due to shyness and inability to afford the costs of treatment. Within a period of about 9 to 12 months, her condition started getting worse with discharge and blood stains visible on her clothes and bed sheets. Pathological, radiological and biopsy tests revealed that she had stage 4 cervical cancer. The cancerous cells were so active and malignant that they had spread to her bladder and colon. The treatment options available then could hardly sustain her for another 3 months and she passed away.

To avoid the trauma that Sarah and her loved ones had, and in conjunction with World Immunization Week (April 24 to 30, 2019), let’s take the opportunity to learn and spread the awareness of cervical cancer. 

INTRODUCTION TO CERVICAL CANCER

The cervix is the lowest part of the uterus. It is also commonly known as the neck of the womb. Cancer of the cervix, also known as cervical cancer, begins with abnormal changes in its tissues.

The human papillomavirus (HPV) is responsible for the majority of cervical cancer cases. The cancerous cells can grow abnormally and invade the other adjoining tissues and organs like vagina, bladder, rectum, liver or lungs. In 2018, more than 300,000 women died due to cervical cancer and more than 85% of them were from low- and middle- income countries. In Malaysia, cervical cancer is the third most common cancer among women, with an average of about 2,000 women being diagnosed every year. Due to its slow progression rate, cervical cancer can be detected early and treated. It can also be prevented by HPV vaccine.

Some of the common symptoms of cervical cancer are:

  1. Abnormal vaginal discharge
  2. Abnormal vaginal bleeding (different to menstrual bleeding eg, bleeding after sexual intercourse)
  3. Vaginal bleeding post- menopause
  4. Pain in the pelvic region (eg, pain during sexual intercourse)

It is recommended for women to consult their doctor if they have any of the above symptoms.

CAUSES OF CERVICAL CANCER

The most common causes or associated risk factors for cervical cancer are:

  • HPV infection: A sexually transmitted disease, HPV infection manifests itself in different forms and is the number one cause of cervical cancer.
  • Weakened immune system: The risk of contracting an infection which can thereby progress to be cancerous is higher in those with HIV/AIDS and those who have undergone an organ transplant.
  • Birth control medications: Long term use of certain birth control medications can increase the risk of developing cervical cancer.
  • Sexually transmitted diseases (STDs): Other sexually transmitted diseases like chlamydia, gonorrhea and syphilis infections can also increase the risk of developing cervical cancer.
  • Smoking: The chemicals in cigarette smoke interact with the cells of the cervix to cause certain precancerous changes that could lead to cervical cancer over a period of time. The risk  of cervical cancer is about two to five times higher in smokers compared with non-smokers.
  • Socioeconomic background: The rates of STDs and cervical cancer appear to be higher in lower income groups.

“LADIES, CONSULT YOUR DOCTOR QUICKLY IF YOU HAVE UNUSUAL VAGINAL DISCHARGE OR BLEEDING TO RULE OUT CERVICAL CANCER.”

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STAGES OF CERVICAL CANCER

Timely detection of the cancer and determining its stage is one of the main steps in the treatment of cervical cancer. It helps to identify the most appropriate treatment to prevent the cancer from spreading and affecting other organs. Treatment options are based on age, severity of condition, other underlying diseases in addition to the rate and extent of the cancer. The stages of cervical cancer are:

 Stage 0: Precancerous cells are present in the cervix.

 Stage 1: The cancerous cells have grown, divided and spread from the surface of the cervix to other deeper tissues near or maybe even into the uterus.

 Stage 2: The cancerous cells have spread beyond the cervix, past the uterus into the lower parts of the vagina, affecting the adjoining lymph nodes.

 Stage 3: The cancerous cells have spread beyond the lower parts of the vagina to the walls of the pelvis, blocking the passage of the ureters and affecting the surrounding lymph nodes.

 Stage 4: The cancerous cells have grown and spread affecting the bladder or rectum and begins to grow out of the pelvis to affect other organs like liver, lungs, bones and lymph nodes.

“EARLY DETECTION AND TREATMENT OF CERVICAL CANCER HELPS TO PREVENT IT FROM SPREADING TO OTHER PARTS OF THE BODY.”

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DETECTION OF CERVICAL CANCER

Early detection of cervical cancer significantly improves the success rate of treatment.

  • Cervical smear test: A Pap smear test can identify early signs of cervical cancer. This test helps to identify abnormal changes in the cervical cells, which when left untreated could develop into cancerous cells. The test is recommended for every woman aged 30 and above.
  • HPV DNA test: This test can help to determine if the patient has any HPV infection. Cervical cells are collected for testing for any abnormality and HPV infection especially the high-risk HPV strains. (Read Cervical Cancer Elimination Receives a Boost with ROSE, page 30-31, HealthToday March 2019)
  • Colposcopy: In this test, the cells of the cervix and vagina are examined visually using a speculum and colposcope. The colposcope is a lighted magnifying laboratory instrument that can aid in the visual examination of abnormalities in the cells. In cases where a more thorough examination or incision is required, the examination may be done under anaesthesia.
  • Biopsy: A small section of the cervical or affected tissue is taken out for further laboratory analysis and investigation.
  • Cone biopsy: It is an extended form of the normal cervical biopsy where a small cone-shaped wedge of the cervical tissue is removed for further laboratory analysis and investigations.
  • Large loop excision of the transformation zone (LLETZ): A fine wire loop charged with electricity is used to shave off the cervical tissue which contains abnormal cells and seals the blood vessels in the adjoining area. This procedure is normally performed under anesthesia.
  • Blood tests: Additional pathological tests and blood counts can identify liver or kidney dysfunctions related to spread of cancer.
  • Ultrasound of the pelvis: An ultrasound uses high frequency sound waves to create an image of the target area which is examined on a monitor for any abnormalities.
  • Scans: A computerised tomography (CT) is widely used to improve clinical staging of cervical carcinoma. CT is useful in evaluating tumour size, lymph node status and distant metastasis which are all critical prognostic factors in cervical carcinoma. A magnetic resonance imaging (MRI) scan can also help in local staging of cervical carcinoma.

TREATMENT OF CERVICAL CANCER

Cervical cancer cases can be treated by surgery, radiotherapy, chemotherapy or a combination of these methods. The type, dosage and regimen of treatment will depend on various factors like age of the individual, stage of the cancer, other underlying conditions and overall state of the individual’s health. The success rates of treatment in early stages of the cancer are high; with reducing trends due to treatment delays and extent of spread. During early stages of the cancer, surgery combined with radiotherapy can help to a large extent. Advanced stages of cervical cancer may require a combination of surgery, radiotherapy and chemotherapy to kill the cancer cells and prevent further spread.

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PREVENTION OF CERVICAL CANCER

Some of the preventive measures that every woman can take are:

  • Get vaccinated for HPV: There is a clear and established link between the HPV infection and development of cervical cancer. Two HPV types (type 16 and type 18) are responsible for 70% of the cervical cancer cases.
  • Practice safe and protected sex: The HPV vaccine can only protect from two strains of the virus. Other strains of the virus may also lead to cervical cancer.
  • Cervical screening: Regular cervical screening and smear tests can help to detect and identify any abnormal cells.
  • Stop smoking: As there is a clear line of incidence of cervical cancer among smokers, it is best to avoid smoking.

THE ROAD AHEAD

A comprehensive cervical cancer control begins with primary prevention (HPV vaccination), followed by secondary prevention (early detection and treatment), tertiary prevention (timely diagnosis and appropriate treatment depending on the stage of cancer) and palliative care (inter-disciplinary approach of specialized medical and paramedical care). Cervical cancer is both preventable and treatable. HT

“CERVICAL CANCER IS BOTH PREVENTABLE AND TREATABLE. A COMPREHENSIVE CERVICAL CANCER CONTROL BEGINS WITH HPV VACCINATION.”

References: 1. World Health Organization. Human papillomavirus (HPV) and cervical cancer. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/ human-papillomavirus-(hpv)-and-cervical-cancer. 2. Immunise4Life. 7 Vital Facts About Cervical Cancer. Retrieved from: https://immunise4life.my/diseases/7-vital- facts-about-cervical-cancer/.

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Breathe Easy, Wheeze Easy

Breathe Easy, Wheeze Easy

 April 27, 2022   Return

WORDS PANK JIT SIN

Hi there. It’s me. Your friendly neighbourhood health writer. World Asthma Day is around the corner and there are important things you need to be reminded about it.

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  1. Asthma is a chronic disease. It affects your airways leading to the lungs. While you may have heard of someone growing out of asthma, the truth is their airways have broadened or their symptoms lessened.
  2. Asthma can strike at any age. Just because you didn’t have asthma as a child, it doesn’t mean you’re scot-free. In fact, older people who develop asthma may have a difficult journey in getting diagnosed, as it is similar in symptoms to diseases such as emphysema and heart disease.
  3. My kid will never be a competitive sportsperson! Well, you’re wrong. Proper management of symptoms will allow a child to lead a normal life and this includes being competitive in sports and even going on to achieve greatness. David Beckham (the world-famous footballer), Jackie Joyner Kersee (the Olympian) and Kashyap Parupalli (an elite Indian badminton player) all achieved greatness in spite of asthma.
  4. Steroids in the inhalers will cause problems in my kids when they grow up. The misinformation about steroids in inhalers have been going on for generations. It needs to stop. The amount of steroid in each puff is miniscule. The steroids used in asthma inhalers are very safe and have a very low risk of side effects even over many years of use.
  5. Not everyone experiences the same symptoms. Symptoms may differ from person to person. Because of this, treatment for every asthma sufferer is also different. Some may need larger doses of inhalers; some may even need to take oral steroids to bring their airway inflammation under control. The key message here is—please visit your doctor regularly for checkups and maintenance.

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Every year, the worldwide authority in asthma management decides on a theme and helps empower organizers around the world to undertake their own World Asthma Day event. The body is known as Global Initiative for Asthma or GINA. GINA collects scientific information from existing research and updates the guidelines on asthma treatment periodically.

This year’s theme is ‘STOP for Asthma,’ with STOP being the acronym for Symptom evaluation; Test response, Observe and assess and Proceed to adjust treatment. The acronym is for doctors to quickly recall the steps to undertake each time they see patients with asthma. It is also helpful for persons with asthma to know the basic steps in managing and modifying their treatment each time they go for a follow up with their doctor.

Remember, asthma doesn’t need to be problematic and does not translate to a poorer quality of life. All you need to do is get it under control. The sky is still the limit! HT

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Asthma – How it Takes Your Breath Away

Asthma - How it Takes Your Breath Away

 April 27, 2022   Return

WORDS MAK WEN YAO

On every first Tuesday of May, health advocacy groups and educators from around the globe celebrate World Asthma Day where they strive to improve awareness of the airway disease. As asthma continues to burden both the patients and the health system, it is high time for us to further understand what asthma really is, and what we can do to minimise its impact.

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UNDERSTANDING WHAT ASTHMA REALLY IS

Asthma is a chronic condition where the airways become inflamed and stimulated to produce excessive sticky mucus. The bronchial tubes of an asthmatic patient, or the air passageway that connects the windpipe to the lungs, will become narrow as the muscles surrounding them constrict in response to the noxious external stimuli. As these tubes struggle to remain open, the patient’s ability to breathe also becomes compromised. 

An asthma attack is frequently described as having to struggle to draw a full breath, often accompanied by coughing, wheezing, and an overall tightness across the chest. When the airway becomes constricted and obstructed by thick mucus, the patient has to spend every ounce of energy just to draw in enough oxygen to make it to  the next breath. This could be a harrowing experience to patients and uninformed family members. Some patients say, “It’s like drowning in air.”

However, people with asthma may experience the disease in other ways. The condition is largely dependent upon the types of the trigger and other aggravating factors. A mild attack could last only minutes and resolve spontaneously without any treatment, while severe attacks could span hours and may require hospitalisation.

Asthma is a non-communicable disease that is common among children but can affect adults as well. According to the National Health and Morbidity Survey in 2011, more than 1-in-20 Malaysians self-reported that they suffered from asthma (6.4%). In addition, many patients or family members are not fully aware of the disease symptoms or the appropriate management of the condition. The head of the Ministry of Health’s Pulmonology Services, Dr Jamalul Azizi Abdul Rahaman, once said that out of 2 million patients with asthma, only 6% were well controlled. “There is low awareness of the disease, leading to poor compliance,” said Dr Jamalul Azizi.

COMMON CAUSES OF ASTHMA ATTACK

  1. POLLUTION                        
  2. PETS                         
  3. DUST               
  4. CHEMICALS                
  5. MOLD

Although we have yet to completely understand the fundamental causes of asthma, we now know that the exposure to certain environmental particles or inhaled substances could cause an asthma attack.

Research has revealed a delicate interplay between the physical and psychological components of an asthmatic patient. Available scientific evidence points to a relationship between heightened emotional arousal, such as extreme anger or fear, and dyspnoea—difficulties in breathing—in asthmatic patients.

 Certain household medicines could trigger an attack as well. Aspirin and a group of painkillers known as the non-steroidal anti-inflammatory drugs (NSAIDs) may cause symptoms in certain patient populations. NSAIDs such as ibuprofen or naproxen are thought to increase the production of some pro-inflammatory chemicals in our body that can cause asthma attacks.

It is important to understand that asthma may not always manifest in the same way. Each individual may respond differently even if they were exposed to the same aggravating factor. It would be essential to understand how the body reacts when exposed to a potential allergen and take the appropriate steps as recommended by the doctor.

ASTHMA TREATMENT AND CARE

While there is currently no cure for asthma, the condition can be well controlled if managed appropriately. Advances in medical care allow asthma medicine to be directly administered into the lungs,thus bypassing many unwanted side effects associated with systemic treatment method. The inhaler is, by far, the most extensively used option, but certain patients may have to use a nebuliser (a machine that helps one breathe in the medicine as a mist through a mask or a mouthpiece) or depend on oral medicine as an add-on treatment to the inhaler.

The array of treatment options and medical devices can be confusing. It is important to discuss any treatment option with your doctor and pharmacist in order to gain the best benefits and avoid any asthma emergency.

There are generally two types of asthma treatment:

  1. The quick reliever
  • functions as the rescue medicine to rapidly relax muscles around the airway during an asthma attack.
  • relieves symptoms of breathlessness and helps the patients to regain control of their breathing.

For example, short-acting beta- agonists.

  1. Long-term controller medicine
  •  functions to prevent asthma attacks.
  • reduces inflammation of the airway, making it less likely for allergens to trigger an attack.
  • may be given in a combination of inhaled and oral medicine.

For example, long- acting beta-agonists that relax the airway muscles and corticosteroids that reduce airway inflammation and swelling.

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USEFUL TIPS

Are you using your inhaler properly?

  1. Always shake the inhaler canister before use. This action will mix the active drug well with the propellant to deliver the right dose into the lungs.
  2. Your lips should form a tight seal around the inhaler to ensure the dose reaches its target.
  3. Time your breathing appropriately while using the inhaler. Breathe out completely and take a deep breath while pressing the canister.
  4. Hold your breath for around 10 seconds with your lips closed and then breathe out slowly after a puff is delivered to allow for the medicine to exert its effect.
  5. If your doctor prescribed a second puff, wait for about 1 minute. Then, repeat the steps 1-4. HT

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When Parts of Our Ears Become Red & Swollen

When Parts of Our Ears Become Red & Swollen

 April 27, 2022   Return

Words Lim Teck Choon 

ENTirety with

Professor Dato’ Paduka Dr Balwant Singh Gendeh

Consultant Ear, Nose & Throat Surgeon Pantai Hospital Kuala Lumpur

 

Unlike our eyes, our ears do not have any protective lids to keep things from finding their way inside. Perhaps unsurprisingly, ear discomfort is common among those who spend a considerable amount of time in water. We have terms such as ‘surfer’s ear’, which describes a condition in which lumpy bony growth forms in the ear canal due to prolonged irritation from cold and wet conditions. More common, though is ‘swimmer’s ear’, which describes ear discomfort such as pain, redness and swelling.

Swimmer’s ear is commonly attributed to water finding itself into the ear, but the actual cause is infection. The medical term for swimmer’s ear is otitis externa, and it can happen to anyone, not just swimmers.

Let’s find out more about otitis externa this month with Professor Dato’ Paduka Dr Balwant Singh Gendeh.

WHEN OUR EAR CANAL HAS UNINVITED GUESTS

Otitis externa is an infection in the ear canal. Bacteria such as Staphylococcus aureus are the most common unwanted guests that trigger this infection, but it is also possible for fungi (such as Candida albicans) to trigger an infection.

Such infection commonly affects swimmers and other people whose ears are in contact with water for a simple reason: the water that gets into the ear creates a moist environment that encourages the unwanted guests in the ear canal to increase in numbers large enough to cause an infection.

However, Prof Dr Balwant points out that otitis externa is not just a swimmer’s problem. Anyone can be affected by it, so long as certain conditions are present for the unwanted guests to thrive in the ear canal.

“IF WE MAKE IT A HABIT TO REMOVE EARWAX TOO OFTEN, WE ARE MAKING OUR EAR CANAL MORE VULNERABLE TO UNWANTED GUESTS.”

A suitable environment. Our ear canal is dark and warm, which makes it a great place for many bacteria and fungi to move in and live. These guests feed on the dead skin, secretions and various other substances trapped among the fine hairs in the ear canal.

Moisture. Even if we don’t swim regularly, our unwanted guests rarely worry about being deprived of moisture. This is because we live in a tropical climate, where it is humid all year long!

WAIT, SO OUR EARS ARE ALWAYS VULNERABLE TO THESE UNWANTED GUESTS?

Not always. As Prof Dr Balwant points out, our ear has its own defense mechanism – our earwax. Earwax, or cerumen, is secreted in the ear canal and it is an acidic substance containing enzymes that inhibit the growth of bacteria and fungi. It also traps and removes debris and other substances that nourish these unwanted guests.

However, this is not a fool-proof mechanism. Excessive moisture spilling into the ear canal can dislodge the cerumen coating the ear canal. If we make it a habit to remove earwax too often, we are also making our ear canal more vulnerable to these unwanted guests.

  1. Therefore, we should always dry our ears as much as possible after a bath, a swim or a hot sweaty day.
  2. Also, we should only clean our ear canal once in about every three weeks.
  3. We should also avoid inserting our fingers or foreign objects into our ear canals.

WHAT HAPPENS AFTER THE UNWANTED GUESTS MOVE IN?

Prof Dr Balwant points out that so long as our unwanted guests are living happily in our ear canal, there is a risk of infection. This is because the skin lining the ear canal  is very thin, unlike the skin lining elsewhere. Hence, it can be damaged easily due to frequent ear picking resulting in recurrent ear infection.

When there is a tear in the skin, the unwanted guests can move inside. This will trigger our immune system to react and get rid of these guests, resulting in the inflammation seen in otitis externa. The thinness of the ear canal lining and the ease in which it becomes damaged can cause recurrent infection.

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LET’S HEAR MORE ABOUT THE SIGNS & TREATMENT OF OTITIS EXTERNA

WHAT ARE THE SYMPTOMS?

  • Ear discomfort (otalgia), such as itchiness, ‘fullness’ inside the ear due to swelling, and pain that radiates to the face, neck and side of the head.
  • Ear discharge (otorrhoea).
  • Some hearing loss (usually temporary).

ARE THERE ANY LONG-TERM COMPLICATIONS?

If not treated properly, the infection can spread over time into surrounding tissues and even nearby bones. Increasingly severe hearing loss may also result.

These complications will require more complex treatments, possibly even surgery.

HOW IS OTITIS EXTERNA TREATED?

Prof Dr Balwant explains that most mild cases can be successfully treated using appropriate topical medications (such as eardrops, ointments or creams). If we are unsure as to what to do, we can seek advice from a general practitioner.

If still no improvements are seen, or if the symptoms are severe, it may be time to visit an ENT specialist.

HOW CAN THE ENT SPECIALIST HELP?

To properly clean the ear canal. The ear canal of someone with otitis externa is often clogged with earwax, debris and various secretions. (In fact, long standing impacted wax is one of the common causes of otitis externa!).

The ENT specialist will perform a procedure called ‘ear toilet’ or rarely  ‘flushing’.  Guided by direct visualization from a device called the otoscope, the specialist will use a medical device to create a gentle suction in order to clean the ear canal. If the debris and  secretions are thick and hard to dislodge through suction alone, the ENT specialist can use antibiotic or hydrogen peroxide droplets to soften them first.

To inspect the eardrum. Our eardrum allows us to hear. It is also a thin piece of tissue. During an infection, the weakened eardrum is especially vulnerable to damage.

The ENT specialist will inspect the eardrum to ensure that it is in good shape. If the eardrum is damaged, the use of water and other fluids (such as eardrops) will be avoided, as doing so may cause damage to other ear structures normally protected behind an intact eardrum.

Damaged eardrum can usually heal on its own after a few months, although sometimes surgery may be necessary. Treatment is determined on a case-by-case basis, so our ENT specialist may advise us on our options after performing an examination.

To determine the nature of the uninvited guests in our ear canal. Oral or topical antibiotics can help with getting rid of bacteria, but they do not work on fungi and viruses. Therefore, determining the type of the microorganisms that are giving us so much problem will allow the ENT specialist to prescribe the best treatment option.

What If Otitis Externa Keeps Coming Back?

Some people may experience long-term infection called chronic otitis externa. It’s more common among people with existing chronic skin- related diseases, such as eczema and psoriasis, as well as people with diabetes or conditions that affect the ability of their immune system to fight infections properly. People with chronic otitis externa should consult an ENT specialist for a proper treatment plan tailored for their conditions instead of self- medicating. HT

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