oil. • It is produced by the sweat glands and sebaceous glands in the ear canal. • Its colour can be ranged from light yellow to dark brown. • It is slightly acidic. • The earwax will fall out from the ear naturally. • Thus, it is possible to leave it alone. Introduction of Earwax IMPACTED EARWAX • Earwax serves as: • A protection to the eardrum being harm from microorganisms, dust and foreign particles • A lubrication to hydrate the ears • A cleanser to move the debris out to the entrance of the ear canal by jaw movements
a great health concern around the world • It affects around 6% of the population. • Notably, there is a study found that • Primary school students are very likely to have this health issue • Therefore, this supports the reason why the patient started to experience it when she was young. Research Study IMPACTED EARWAX 4 6%
clearly. • First discover - when she was wearing the headphones to practise a musical instrument. • The sound was sometimes on the left side and on the right side of the headphones. • She was getting more aware of the difference in the volume of the sound. • The patient asked her family if they could hear the same volume with their both ears, but they had not thought much about it. First Situation IMPACTED EARWAX
She asked her family if they heard something at that moment • But to them, nothing was heard • After that, she had a dream • Seeing some people beating the drums • The sound was exactly the same • Thinking back, only then she realized the sound of pulsing is actually her heartbeat after she has learned about science at school. Second Situation IMPACTED EARWAX
parents felt doubtful and did not know what was happening to her ears • In those early days, • Her parents did not know any hearing awareness • About how to care the ears and hearing screening • Most of the time, her parents were busy at work. • None of them heard from anyone sharing about the hearing problem of their children. • In the end, they decided to bring her to see doctor. Parents’Responce in Action IMPACTED EARWAX
used an otoscope, also known as auriscope, as shown on the picture. • It is a medical instrument with a light and a magnifier, to examine her ears for the present of earwax blockage. First Time IMPACTED EARWAX
curved instrument • Known as curette was used to scrape out the earwax • After that, in ear irrigation procedure, • A syringe was used to rinse with cold water manually into her ears • To drain out the earwax • It was done slowly, • The patient could not stand of having something too near in her ears First Time IMPACTED EARWAX
ear irrigation • During the treatments, the patient tried to calm down and be patience. • After the treatment, • She felt a great relieve and her hearing was a lot better • The patient felt very surprise to see • Her dark brown earwax • Its amount being taken out from her ears • Since then, there is no more strange sound could be heard. First Time IMPACTED EARWAX
her ears. • At that time, her parents brought her to have a haircut. • At the salon, there was a senior barber who knew how to do aural toilet. • Once the hair cut was done, • The procedure was then used • With a pair of forceps • After examining her ears • The patient never thought that the problem was the earwax blockage again. • She was shown to see her earwax with the forceps once it was first taken out. • Though she felt discomforted, she tried to be calm during the treatment. • The result was still exactly the same. Second Time IMPACTED EARWAX
There were no response from them • The patient was not sure how loud she had spoken • She felt being ignored by others • She had used quite a lot of strength to talk • It made her feeling more tired • The patient then went to a government hospital with her parents. • After her ears had been examined, the audiologist prescribed an ear drop • Cerumol® Ear Drops 11ml, as shown in the picture • To loosen and remove her earwax Third Time IMPACTED EARWAX
head • To put three drops into each ear • To wait for a while • To tile her head to another side • To cover with the tissue papers • To discharge the earwax • This had to be done continuously for a week before her next follow-up appointment. Third Time IMPACTED EARWAX • This time, the patient received another type of treatment, microsuction • To remove the earwax blockage • She felt that this procedure is a lot faster • It is like a mini vacuum inside her ears • Nevertheless, she had to be patience during the procedure.
experience • At a reception for patient registration • She had no idea why the receptionist was very angry at her. • The patient was quite confused at her follow-up appointment after using an ear drop for a week • The patient then went to a student clinic at her university • She felt upset about the service being referred there • The treatment is ear irrigation with an electric pump connected with a water container. • It looks like Propulse® Ng Electronic Ear Irrigator as shown in the picture. Fourth Time IMPACTED EARWAX
would prefer slow or high speed of ear rinsing. • She was not sure, so she chose to have the slow speed. • This time, she felt the water was warm enough that did not frighten her. • After the treatment, the patient noticed that her earwax colour was greenish brown, which is different from the past. • This time, she started to mark the date of having the earwax removed. Fourth Time IMPACTED EARWAX
sense of fullness at the ear making her struggle to hear clearly. • This time, she went back to the same government hospital. • She was very satisfied with the service there and it did not take her long to wait for her turn. • The procedure was done exactly the same she had over there last time. • The patient started to notice that it was the discomfort that made her shaky naturally. Fifth Time IMPACTED EARWAX
attachment in a larger government hospital. • She occasionally noticed that • Her earwax dropped out itself • The itchiness was getting more obvious • There were times she could not hear the voices clearly. • The patient would like to take this opportunity to check her ears. • She was lucky that she could choose any of the Medical Officers to consult her impacted earwax and unbalanced hearing when everyone was not in a hurry. • The patient was asked if she had any ear infection before. • Since childhood, she only had her earwax removed. Sixth Time IMPACTED EARWAX
Throat (ENT) Clinic to see otolaryngologist. • After the examination, the patient was told that there were more earwax in one of the ears. • This time, she had to lie down on a bed for the microsuction procedure. • During the treatment, the patient felt discomfort and shaky . • Once it was done, she tried to balance the pressure inside her ears. • The feeling was like sitting inside the airplane flying up into the sky. • By the time the patient went for her lunch break, the pressure went off suddenly. • She could hear the background noise clearly. Sixth Time IMPACTED EARWAX
conductive loss and sensorineural loss • Done with Rinne and Weber tests by using 512-Hz tuning forks as shown in the picture. • The patient was expected to share what she could hear. ENT Assessment IMPACTED EARWAX
a lot, but she did not think so. • Then, the otolaryngologist sprayed • A topical decongestant to reduce swelling • An anesthetic to numb briefly her noise in her nose • Before passing the nasal endoscope through the nasal cavity and sinuses. • The problem could not be identified • To get the hearing test with audiologist for the next appointment in five months ENT Assessment IMPACTED EARWAX
lot of earwax found in her ears as the audiologist shared. • The hearing test was then conducted after checking her ears. • There were different sound intensity transmitted in the headsets for her to hear. • The patient was expected to raise her hand once she could hear anything. Hearing Assessment / Seventh Time IMPACTED EARWAX • Overall, she heard different frequency of sounds for raining, musical tone and explosion. • The audiologist then asked if she had experienced vertigo like a sense of spinning after waking up, but her reply was no. • The patient was sent to have her earwax removed straight away with the same procedure.
a head injury that might cause the hearing organs to be in malposition, but it was not the case. • She remembered vividly that she noticed the difference of the sound when she was practising a musical instrument with her headphones. • Following that, the Rinne and Weber tests with 512-Hz tuning forks were assessed on the patient again. ENT Assessment IMPACTED EARWAX
it might be congenital abnormalities, • She might be born that way as the superior otolaryngologist explained. • Based on her audiogram results, as shown in the picture, • An ear is moderate severe hearing loss (40dB HL) • Another one is normal (20dB HL) • It was suspected that malposition of the malleus, incus and stapes or the cochlear nerve problem. ENT Assessment IMPACTED EARWAX
of the three organs. • Specifically, it is an HRCT (high resolution computed tomography) of the temporal bone. • Before the patient was released, the nasal endoscopy was done to detect any cancer again. • Upon getting with the CT scan result, it turned out to be normal. ENT Assessment IMPACTED EARWAX
the free trial of hearing aid. • To pay RM 40 for an earmold • To provide her feedback after trying for a month • The patient was lucky to know that it was the first time the hospital had such arrangement. • Normally, they would introduce some hearing aid shops where the patients can be referred to. • The financial aid department • She could receive RM 3,500 of the government support • If she worked in the government sector Hearing Aid Trial IMPACTED EARWAX
The audiologist explained that the screening test for the hearing is free. • Young children: • The parents will notice the speech problem of their child • The condition of the patient: • Unilateral hearing loss • The difficult one that people will think her hearing is normal • Older people: • Their earwax will become harder, which makes them struggle to listen Hearing Assessment IMPACTED EARWAX
the ear in her studies. • The patient heard it once a while, but it rings a little while that she does not feel being disturbed. • She was not sure what was so special about it. • The audiologist explained that • It is normal to hear the tinnitus sound, because the brain is trying to find the sound. • There is research discovered that it is related to personal emotion. • For severe case, people who are next to them can hear their tinnitus sound. Tinnitus IMPACTED EARWAX
with a shell earmold, as shown in the photo. • It is like a little amplifier to increase the sound intensity to her poorer ear. • The problem: • The background noise like the air conditioner was louder than voices • It was much better than wearing an earphone • More sound pressure when she increased the volume of the sound intensity Experience with Hearing Aid IMPACTED EARWAX
type of hearing aids with a CROS (contralateral routing of signal) solution, as shown in the picture • This version was not available for trial. • Hearing aids will be placed on both ears. • The one at the poorer ear is a transmitter that sends the sound, which is a wireless Near Field Magnetic Induction (NFMI) signal, to a receiver on the better ear. CROS was Introduced IMPACTED EARWAX
normally speak loud enough to hear their voices, except for a small certain group of people who speak quite soft. CROS Solution The patient decided to wait for the future technology. Future Hearing Aid IMPACTED EARWAX
development of the excessive earwax. • Six months later, she went to a private hospital to check for her earwax. • The Medical Officer confirmed that her earwax was full and prescribed an ear drop, which is Soluwax® Ear Drops 10ml as shown in the photo. • To her surprise, her earwax was gone after using it for a week. • She was so happy to know it! Eighth Time IMPACTED EARWAX
lifestyle at a few pharmacies. • Having different types of screening tests • The results showed that • She did not get enough sleep • She was stressful • It was suspected • That her liver was enlarged • Causing her hair oily that she had to wash every day Healthy Lifestyle IMPACTED EARWAX Changing Lifestyle • Other than trying to get enough sleep, • She tried to change her shampoo for her hair care • The patient tried to listen some uplifting music • To adjust her mood • Feeling that her ears were getting oily, • The patient decided not to wear the headphones often • Washing her ears while washing her face can clean the oily ears.
again. • The earwax was coming out. • She knows the ear drops are all available in the pharmacy • Got Soluwax® Ear Drops 10ml • While removing the earwax, the earwax blockage made her difficult in hearing with a sense of fullness in the ear. • The feeling is like swimming in the water, making the patient felt frustrated. First Self Attempt IMPACTED EARWAX
otolaryngologist after finishing the ear drop. • Treatment done with • Aural toilet and microsuction • The earwax removed was yellowish brown. • The patient was told that her earwax is oily type. • A-Cerumen Spray 40ml, as shown in the photo, was introduced. • For the regular ear hygiene routine in every two weeks • This is a new product to her for the ear cleaning solution. Ninth Time IMPACTED EARWAX
for the first time. • She thought about removing the earwax by applying A-Cerumen Spray 40ml. • At first, the patient thought it was unsuccessful, because she could not hear the surrounding noise due to the earwax blockage. • She tried to use tissue papers to remove the earwax with her little finger. • Seeing that the earwax could come out easily, the patient repeated the same thing again until her hearing was getting better. • She had to do it immediately, because she had nowhere to go due to the pandemic. • The colour of the earwax was yellowish brown. Sucessful in Second Self Attempt IMPACTED EARWAX
drop • Because she could remove the earwax blockage herself • Checking back for the period of removing the excessive earwax, • It seemed inconsistent • There are times that the earwax will drop out itself suddenly. • At the moment, she hopes her earwax would not be developed excessively throughout the pandemic. • To her, it is never comfortable to remove the earwax blockage. Conclusion IMPACT EARWAX
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