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Impacted Earwax

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Medical Underwriting of High Risk Infant. High Risk Infant ... Adenotomy 12(33) 37(35) 26(20) Hearing problems 1(3) 5(5) 1(1) Vision problems 10(28) 4(4) 2(2) ... – PowerPoint PPT presentation

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Title: Impacted Earwax

1
2021
Health Psychology
Impacted Earwax
HEALTH ISSUES
2
1
2
3
5
6
7
4
3

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

Earwax refers to the cerumen, which is a waxy
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.

4
Introduction of Earwax
IMPACTED EARWAX
5
She has excessive earwax buildup and blockage
easily like some people since she was a child.
A female Chinese young adult patient was
interviewed.
6

According to a study,
This health issue is 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.

4
7
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8
01
First Situation
With the hearing problem
9

Growing up, the patient could not hear the sound
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.

10
02
Second Situation
With the hearing problem
11

The patient could hear the sound of pulsing.
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.

Hearing so many strange questions from her,
Her 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.

13
03
Experiences
Several Times of Removing the Earwax Blockage
14

At a clinic, the patient noticed that the doctor
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.

During an aural toilet procedure,
A small, thin, 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 treatment for earwax removal - aural toilet
and 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.

Some time later, the patient felt some itchiness
around 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.

When the patient tried to talk to others
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

The patient was then instructed
To tile her 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.

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.

There was once the patient had a very bad
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.

Before the procedure, the patient was asked if
she 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.

Three years later, the patient felt itchy and a
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.

23
04
Grab the Opportunity
To Discover More in Her Unbalanced Hearing
24

In the following year, the patient had a clinical
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.

The patient was then referred to Ear, Nose and
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.

The otolaryngologist assessed her unbalanced
hearing condition
For 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.

The otolaryngologist asked if she catches cold or
sneeze 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

Next appointment, she never thought that there
were a 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.

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.

The audiologist sent her hearing test report,
which is the audiogram results, as shown in the
picture, back to her otolaryngologist.

A superior otolaryngologist asked the patient if
she had 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.

After the patient had responded, she was told
that 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.

32
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33

A CT scan was ordered to check the positions 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.

Then, the patient was referred to the audiologist
for 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

The patient was then allowed to ask questions.
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

The patient learned about tinnitus, the ringing
sound in 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.

The type of given to try was a behind-the-ear
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

After returning it back, the patient was
introduced another 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.

39
Making Decision The patient felt that the people
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.
40

The patient tried to discover ways to reduce the
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!

41
05
Further Discovery
Having Awareness in Healthy Lifestyle
42
Healthy Lifestyle Discovery
Changing Lifestyle

The patient learned more about healthy 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

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.

After three years, the patient started to feel
itchy 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.

The patient went to a private clinic to see
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.

After six months, the patient suddenly had an
earache 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.

46
06
Conclusion
Learning More about Excessive Earwax
47

A-Cerumen Spray 40ml is the best choice of ear
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.