As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.

What you need to know hearing, ear care and hearing loss treatment options.

Sometimes I tell my patients that they should hope they go deaf. This is because for total deafness to naturally occur, one would have to live to a ripe old age. Just as our muscles weaken, eye sight deteriorates and hair turns grey, hearing loss is a very common part of ageing. In most cases, a person loses about one decibel (or about 1% of hearing) every year after the age of 55. The good news is that hearing aids today are much more advanced than they were in the past.

All Plugged In For Clarity

Unlike the hearing aids of the past few decades, today’s versions give very good clarity and are virtually unnoticeable. With many people commonly ‘plugged in’ to earphones, earbuds and Bluetooth hands-free sets, there is also less stigma about having a little wire trailing from behind your ear. All this has made hearing aids a lot more acceptable to elderly patients. Although these inconspicuous hearing aids are popular, I often advise my elderly patients to use a more noticeable behind-the-ear hearing aid because...

NASAL ALLERGY IS WHEN THE NOSE over-reacts or over-responds to certain stimuli, usually triggered by an allergen. Common allergens are dust mites, animal danger, pollen, mold and certain foods.

The nose has turbinates – fleshy swellings, filled with blood vessels, which act like filterson the lateral walls of the nasal passages. The entire surface of the turbinates is covered with glands that secrete mucous. Various stimuli and allergens change the flow of blood through these turbinates, causing them to swell or shrink in size, and to increase and decrease mucous production. With these turbinates, the nose can humidify, warm and regulate the air flowing through the nasal passages. The nose also has nerve endings that can cause a reflex sneezing to expel unwanted substances or irritants.

However, when the nose is over-stimulated or allergic, it may lead to symptoms of allergic rhinitis, including:

• Blocked nose
• Runny nose
• Post-nasal drip
• Itchy nose
• Excessive sneezing
• Headache
• Clogged ears
• Puffiness and dark-circles around the eyes
• Puffiness of the nose
• Loss of sense of smell

Keenly inquisitive, ready for new challenges, ENT (ear, nose, and throat) specialist and head and neck surgeon Dr. Lau Chee Chong has a fascinating and multi-faceted life that he manages with laughter and energy.

Dr Lau is certainly not your stereotypical doctor. A cool and incisive mind, steady hands, dedication and passion are traits that have served him well in the operating theatre. They also serve him well in other aspects of his full and interesting life. Dr Lau is one of Singapore’s most successful veteran (over-40) fencers, proudly donning the shooting star colours of Singapore’s national team. “Fencing,” he shares, “is like operating – with a very long scalpel. It’s hard to imagine another sport which can simultaneously challenge your mind, your body, your instincts and your training. Everything needs to come together perfectly in a split second. It’s a fascinating and intense sport”. Dr Lau won an individual bronze medal for sabre in the 2012 Commonwealth Veteran Fencing Championships and anchored the Singapore team to a bronze finish in the team event. He was the 2012 Taipei Open Masters individual sabre champion. He makes time in his busy schedule to train regularly, up to six times a week before a major competition.

Dr Lau is also a keen scuba diver, tennis player and shotgunshooter (game-shooting in Africa and crow-culling in Singapore). Until he suffered a knee accident on the snow slopes, the family also enjoyed skiing trips. But fencing is his favourite. In addition to its personal charms, it is a sport that allows him to do what he loves best - maximise his time with his two daughters – Ysien, 15 and Ywen, 13.

A COUGH IS YOUR BODY'S WAY OF TRYING to get rid of any kind of irritation in your mouth, throat or lungs. Although it is a natural reflex that will often go away by itself whenever the irritation is cleared, a cough can sometimes become chronic and last for a very long period of time, taking a toll on our health and affecting our daily activities.

A cough is considered chronic when it lasts for eight weeks or more. Anything that may cause the onset of acute (i.e. non-chronic) coughing may lead to chronic coughing, but there are some factors that may exacerbate the condition and make it more likely for the cough to persist.

The most common cause of cough is an allergy. As an individual’s allergies may vary from person to person, different stimuli may set off coughing fits in different people. Common stimuli include: dust and pollen in the air, certain kinds of food or drugs, or even some types of perfume. However, patients should not be too quick to jump to conclusions and assume that every chronic cough is brought on by an allergen.

Chronic rhinosinusitis and chronic tonsilitis is another possible cause. When the former is the result of post-nasal drip, it is very often missed due to the fact that it tends to present purely as a cough without any nasal symptoms.

NOSE CANCER, KNOWN MEDICALLY AS NASOPHARYNGEAL CARCINOMA (“NPC”) IS ONE OF THE MOST COMMON cancers in Singapore, China, Taiwan and Hong Kong and in Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese. NPC occurs more commonly in men than in women. Tragically, it often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (“EBV”) is a likely cause of NPC, although the presence of EBV does not mean that a person must have or definitely will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish) and poor hygiene. There is a strong heredity factor. People with a family history of NPC should be particularly aware of the signs of NPC.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

As with most cancers, early detection is very important, because early-stage NPC, if treated promptly and properly, enjoys a very high cure rate. If detected early, the NPC may require only radiotherapy. Later stages may require both radiotherapy and chemotherapy. If the NPC fails to respond to radiotherapy or chemotherapy, surgery may be required.

AN EARACHE CAN BE ONE OF THE MOST PAINFUL CONDITIONS THAT A PATIENT CAN EXPERIENCE

This is because the ear is richly endowed with sensory nerve supply from all around the ears and shares the sensory nerve with the surrounding structures. They are extremely sensitive parts of the human body.

One of the most common causes of earache is external ear infection. This happens frequently to people who like to “dig” their ears, thinking that what they are doing is keeping the ear clean. This is not true! The ear has a natural self-cleaning and protective mechanism. Ear wax is produced in the outer one third of the ear canal. This ear wax is a wonder of nature: it has antiseptic properties, it prevents insects from entering the ear and it literally “waterproofs” the ear canal. The skin cells of the ear canal “migrate” out of the ear like a conveyor belt, carrying the earwax out with them. The skin cells when the cells and the wax reach the end of canal (the entrance of the ear) and they fall out. “Digging” the ear will push the dying skin cells and the wax back in. It will also remove the wonderful and protective earwax, exposing the defenseless ear canal to recurrent external ear infections. This is precisely why the English have a saying: “Do not stick anything smaller than your elbow into your ear!”

In children, a common cause of earache is middle ear infection (“otitis media”). The middle ear is the area behind the eardrum .It is connected to the back of the nose by a tube called the Eustachian tube. In adults, the Eustachian tube is angled downwards for better drainage. However, small children have Eustachian tubes which are less-developed and less angled. Common colds and flu may travel through the Eustachian tube to the middle ear, causing a build-up of mucopus behind the ear drum. The ear drum will be stretched and may rupture, causing intense ear pain and discharging mucopus from the ear. Otitis media classically causes most problems at night, when the child is sleeping. The mucopus builds up, pushing against the ear drum, and causing the child to wake up crying and usually clutching his ear.

Sinusitis is the infection of sinuses, which are hollow cavities (FILLED WITH AIR IN THE HEALTHY STATE) in the skull

There are four pairs of sinuses: the maxillary sinuses in the cheekbones, the frontal sinuses in the centre of the forehead, the ethmoid sinuses between the eyes at the nasal bridge and the sphenoid sinuses in the bones behind the nasal cavity. Sinuses are ventilated by natural openings into the nasal passages.

The purpose of the sinuses is unknown but probable reasons include: they provide a framework for the teeth to “sit in”, they act as shock absorbers (the anterior wall can collapse when traumatised to prevent direct impact to the brain), they insulate the surrounding organs like the eyeballs, brain and great blood vessels from the drastic changes in air temperature that we breathe, and they lighten the weight of the skull.

Sometimes, however, the sinuses can become infected by bacteria, viruses or fungi. At times, sinusitis can also be caused by dental infections as the roots of the upper teeth are close to the maxillary sinuses. Sinus conditions can be divided in three categories: acute, sub-acute and chronic sinusitis. Acute infections last up to a month, sub-acute infections last two to three months and chronic infections last for longer than three months. Sinus doctors are able to diagnose sinusitis from a detailed history of the patient and examining the nose.

I have always been fascinated by the delicacy and intricacy of the Ear, Nose and Throat (ENT) structure and the work that we do in the head.

The practice involves about 80% of medical management and 20% surgical management of patients. This means that I get to spend time and interact a lot with my patients. These include children, and they are always very funny. It’s a great feeling to make them well and see them laughing again. I also enjoy surgery because of the very fine and detailed work that it requires and how it tends to produce almost immediate results. It’s very satisfying to see the happy patient and relatives after surgery.

In terms of lifestyle, my family is very glad that I do ENT. All medical professionals need to work very hard and for long hours. Unlike some other specialist disciplines, in ENT, we are able to maintain a good family and social life, as we do not have too many emergencies. Although, occasionally, we do get very exciting emergencies like massive nose bleeds and airway obstructions which can be life threatening.

One common problem area that I treat at my ENT clinic comprises of snoring and obstructive sleep apnea (OSA) and other sleep disorders.

SENSORINEURAL HEARING LOSS IS A COMMON PROBLEM THAT TENDS TO DEVELOP AS WE AGE when we reach the 50 to 60 year mark, many of us will tend to experience some level of hearing loss but not realise it until we find ourselves turning up the volume on the TV or needing other people to constantly repeat themselves. This can be an embarrassing problem, but thankfully not one that is difficult to treat.

Aside from the obvious symptoms of hearing loss, one of the more common signs of sensorineural hearing loss is the development of tinnitus, or a constant ringing sound in one’s ears. If other people also complain that you have started speaking louder than you used to, it may also be a sign: people who are unable to hear themselves often speak louder to compensate.

While the most common form of hearing loss, sensorineural hearing loss is most certainly not the only kind. Acoustic trauma - when one is exposed to a sudden, very loud burst of noise (such as a bomb going off nearby, which can reach noise levels of up to 150 decibels) - is another way one can lose one’s hearing, as is noiseinduced hearing loss.

In noise-induced hearing loss, one must be exposed to loud noise (anything above 85 decibels) for a prolonged period of time; this used to be fairly isolated to rock band musicians and people who work near loud machinery, but in today’s iPod era many teenagers are starting to present with symptoms that indicate that they have developed such hearing loss.

SNORING IS THE NOISE MADE DURING SLEEP WHEN SOMETHING OBSTRUCTS airflow through the airways. The air squeezes past the obstruction, making a whistling or rattling sound.

The obstruction could be caused by rhinitis, sinusitis or some other infection. It could be due to an anatomical fault, like a crooked nasal septum, enlarged turbinates or tonsils or polyps. The obstruction could be due to floppy throat walls (these walls are stretched over time, with age) or excessive fat in the neck “strangulating” the airway.

Chronic snoring usually gets worse over time and may lead to a disorder called “obstructive sleep apnea” (OSA). In these cases, the obstruction is so severe that the air entering the lungs is greatly reduced. The heart and lung muscles must therefore work harder to get an adequate oxygen supply. The lungs become so tired that they “take a break.” The sleeper then stops breathing. A non-breathing period that lasts more than 10 seconds is called an “apnea”. A patient is diagnosed as having OSA if he has more than ten apnea episodes an hour. In severe OSA cases, the sleeper may have 50-60 (or even more) apnea episodes an hour, some lasting over a minute long.

OSA has many undesirable effects. When the blood oxygen levels drop, there is a drop in the oxygen supply to the brain and other organs, possibly leading to “brain suffocation” and adversely affecting the body’s performance and functions. Also, because of the lowered oxygen levels, the heart may increase its rate, cardiac output and blood pressure, which could increase the risk of heart attack or stroke.

Is snoring a serious medical problem?

Depending on the severity, yes. Chronic snoring is the first classification of a scale of sleep disordered breathing syndromes. These syndromes are classified in accordance with their severity:

• Chronic Snoring
• Upper Airway Resistance Syndrome (UARS)
• Obstructive Sleep Apnoea (OSA)

Understanding Snoring

In the US alone, roughly 90 million adults are affected by snoring. Almost everybody snores now and then, but habitual snoring could be more than just a nuisance for your partner. It can lead to impaired sleep quality as a result of frequent sleep disruptions, and it can also be a sign of a more serious illness...

Snoring and Obstructive Sleep Apnea

"Sleep is sweet to the labouring man" – John Bunyan

Snoring is not funny. It is not merely a social problem, although you may have heard stories about spouses using snoring as grounds for divorce! Depending on the severity, snoring may also lead to serious medical problems, such as upper airway resistance syndrome (UARS) and (worst of all) obstructive sleep apnea (OSA).

What is snoring?

Snoring is the noise that occurs during sleep when there is something obstructing the flow of air though the airways.

What causes snoring?

There are many different causes for snoring, and treatment needs to be specific to the cause and the particular patient. The particular part of the airway that commonly causes snoring is full of various anatomical parts. There is the tongue, the tonsils, the soft palate, the uvula and surrounding throat tissue and muscles. Obstructed nasal airways, adenoids or deformities of the nose could be causing the problem. For maximum benefit, it is vital to determine exactly which part or parts are causing the snoring. A detailed analysis by an ENT Doctor is crucial.

"Chronic snoring in children is not normal" - Professor Christian Guilleminault, Stanford University

Snoring and sleep disorders are problems that most people associate with adults. However, these problems also afflict many children. People do not simply start snoring at age thirty – the problem usually begins many years beforehand, and develop and worsen as time passes. The exact incidence of OSA in children in Singapore has not been intensively studied, although one recent study of school children estimated a prevalence of about 6%.

There appears to be a significant genetic component to the likelihood of a child having OSA. There is also a racial element. OSA is more common generally in the Chinese population, particularly the Southern Chinese.

1. Very often, a child's sleeping problem is due to obesity, enlarged tonsils or adenoids or nasal congestion (from sinusitis, polyps or allergic rhinitis), or sometimes a combination of these causes. In most children's cases, the problem is readily treated or corrected.

2. A failure to diagnose and properly treat these conditions when the child is still young may have impact on the child's physical and mental development and may have extremely serious medical consequences, as the child gets older. There is an urgency to correct the problem before puberty, as this may lead to a serious OSA problem in adulthood.

What is a cochlear implant?

An electronic device designed to give partial hearing to people who are profoundly deaf.

The anatomy of the ear

The ear has three sections:

• the outer ear (the visible part)
• the middle ear
• the inner ear

Sounds are created when something vibrates.

The outer ear "captures" these vibrations and funnels them into the middle ear.

The middle ear is comprised of the ear drum

and three tiny bones (the "mallus" (hammer), the "incus" (the anvil) and the "stapes" (the stirrup). The vibrations strike the ear drum and the vibration of the ear drum is transmitted by the three bones to the cochlea in the inner ear.

The inner ear has two main parts:

• the semi-circular canal, which is part of the vestibular system (which controls balance)
• the cochlea (for hearing).

Image Guide System For Sinus Surgery (also known as the Navigational System).

What is the Image-guided system (IGS)?

The Image-Guided System, also known as the Navigational System, is a virtual 3D model and mapping of the patient's sinus anatomy, and an interactive display of the sinus surgeon's instruments during surgery.

Most sinus problems go away on their own. Some are caused by bacterial infection and can easily be treated with prescribed and over-the-counter medicines and saline sprays. Others, however, are more complex and may require sinus surgery. The procedure usually involves opening up the sinus pathways and clearing blockages.

Sinus surgery is also the main treatment for chronic sinusitis, polyps, deviated or crooked septums, as well as other structural abnormalities.

How does the IGS work?

One such surgical procedure utilizes the image-guided system (IGS), which greatly enhances precision, safety and accuracy of the procedure.

IGS can be divided into three stages:

• Before surgery – Capture a 3D anatomical model of the patient’s sinuses, usually via CT scans or MRI. This stage shows the precise location of the blockage, and enables the ENT doctor to determine the least invasive way to access it.
• During surgery – Use of the 3D model and tracked instruments (e.g. endoscopes) to guide the sinus surgeon in accessing the sinus area. The process is displayed in real time on a monitor.
• After surgery – Capture another 3D model to ensure that the blockage has been removed.

Nose cancer, medically known as nasopharygeal carcinoma ("NPC") is one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities in Indonesia, Malaysia and around the world. Studies indicate that the Chinese race is genetically predisposed to this kind of cancer. It is particularly common amongst the Southern Chinese (such as the Cantonese, Teochews and Hokkiens). It is relatively rare in Caucasians, Indians and Japanese.

Studies indicate that for Chinese born in China, the incidence of NPC is 118 times that of Caucasians, while for North American-born Chinese, the incidence of NPC was 7 times that of Caucasians.

NPC occurs more commonly in men. Tragically, NPC often occurs when the patient is in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus ("EBV") is a likely cause of NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the combustion of fossil fuels), nitrosamines (a chemical seen in salted fish), chronic sinus infections and poor hygiene.

NPC often originates in the back part of the nose and above the soft palate. Because it is not readily visible, its existence is usually not noticed until it is very large or when it causes other symptoms. This explains why it is often diagnosed late. It is therefore important that people who are predisposed to this cancer are aware of the early symptoms.

Coughing is the body's reflexive response when something irritates the lungs or air passages (including the nasopharynx, oral parts, throat, larynx and upper esophagus). This reflex causes the relevant body part to forcibly expel the irritation or unwanted particles from the air passages.

• Common causes of chronic cough include:
• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, chest infections and dental infections, where sticky mucous and inflammation of the throat irritate the air passages. The sticky mucous may also be inhaled into the lungs. Coughing is the reflex to expel this mucous.
• Smoking (which may constantly irritate the air passages)
• Cancer of the throat, oral cavity, lungs or esophagus.
• Medication - certain antihypertensive medication such as Ace inhibitors (note, in particular, medication with names ending with "pril")
• Allergy - allergic rhinitis, throat allergy, cough variant asthma and asthma
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition, though often undiagnosed. The throat and larynx serve as a passage way, not only for air to go to the lungs, but also for food to reach the stomach, via the esophagus.

Not uncommonly, the contents of the stomach can regurgitate back into the esophagus, and can sometimes reach the upper esophagus and larynx. This form of involuntary regurgitation is known as LPR.

The regurgitated stomach content would include stomach acids, which could burn the sensitive larynx and irritate it, thus causing coughing.

LPR often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper esophagus. LPR is also known to reach the nasopharynx. If LPR reaches the Eustachian tubes (which links the nasopharynx to the ears), it can cause otitis media (middle ear infection).

During the night, while the patient lies horizontally, the stomach content may make its way up the esophagus to the back of the throat and collect there. Patients are often awoken by their own coughing, or wake up in the morning complaining of throat discomfort.

LPR (even a mild case) may exacerbate the severity of an existing cough.

As someone who grew up paying more attention to sports and other activities that fascinate energetic young boys, Dr Lau Chee Chong never imagined that he would one day become an ENT specialist with a successful private practice.

However, his father firmly believed that being a physician was not only a worthy profession, but one that makes a direct and positive impact on many people, patients and non-patients alike. Due to his love and respect for his father, Dr Lau buckled down and focused on his studies, and that was the first step on the pathway that led him to the prestigious Mount Elizabeth Medical Centre, where his practice, Ear Nose & Throat Centre CC Lau, is located.

Parental Pressure

"It was my father who wanted me to become a doctor," admits Dr Lau.That was not a surprising position for the older Mr Lau to take. After all, he was a director of a medical supply company, with a lot of contacts with the medical profession. Dr Lau remembers him as a quintessential Chinese gentleman. "He would tell us, ‘Saving lives, healing people — it's honourable and meaningful work'," says Dr Lau. "It was his dream that all of his children would become doctors."

Many patients know of GERD (gastro-oesophageal reflux disease), where acidic stomach contents are returned back up the oesophagus, often with a burning sensation in the chest (heartburn). However, reflux may occur without alerting symptoms of heartburn. This is known as laryngopharyngeal reflux (LPR) - the ‘silent reflux’.

Because most people do not realise that reflux can occur without heartburn, LPR is often under-diagnosed or misdiagnosed as other conditions with similar characteristics.

In LPR cases, the acidic stomach contents are returned beyond the oesophagus, reaching the throat and back of the nose, causing various problems in these areas.

The pharynx and larynx serve as a passageway for air to reach the lungs and for food to reach the stomach via the oesophagus. At each end of the oesophagus is a muscular ring (sphincter), which prevent regurgitation of the contents of the stomach. When these sphincters are incompetent, acidic stomach contents can regurgitate back into the oesophagus, sometimes reaching the throat and back of the nose. This commonly occurs when an LPR patient lies horizontally, such as while sleeping.

Most people can expect to be affected by at least one of these three common hearing problems in their lifetime.

Impacted Earwax

Earwax protects the ear by trapping insects, bacteria and other small particles, preventing them from reaching - and potentially damaging or infecting - the eardrum. It is produced in the outer third of the ear canal and, if left alone, the wax will be pushed out of the canal together with the natural migration of skin outwards, like a conveyor belt. When you insert something into the ear, you could push the wax back into the ear canal, leading to an impacted lump - consisting of wax, dead skin and shed hair - which can block the ear canal.

Water that enters the ear while showering or swimming may be absorbed by the impacted lump, making it swell up, which may lead to sudden hearing loss, or bacterial and fungal infections. Impacted earwax tends to happen to those who habitually attempt to remove earwax using a stick of cotton swab, hair pin or ear digger.

Treatment: As the ears are self-cleaning, there is no need to insert anything to remove the wax. See an ear doctor if you are plagued by decreased hearing, ear pain, dizziness or ringing in the ear.

Middle Ear Infections

Infection from flu, sinusitis and adenotonsillitis may spread from the back of the nose and throat via the Eustachian tube to the middle ear. This is common in babies and children as their Eustachian tubes are not yet fully developed. If the eardrum is perforated, bacterial infection can occur via external sources.

Which are they? What are their symptoms? What are the treatment options?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

THIS IS THE MOST COMMON TYPE OF SLEEP DISORDER IN CHILDREN, AFFECTING ABOUT 5% OF THEM. BUT WHAT DOES IT MEAN AND WHAT DOES A PARENT NEED TO KNOW?

Cancer in the head and neck region can occur in the nasopharyngeal (nose) region, the thyroid, the laryngeal (throat) region, the oropharyngeal (mouth, tongue, tonsils, pharynx) region, the salivary gland, the sinus, and the hypopharyngeal (hypopharynx) region. Of these, the three most commonly occurring here are nasopharyngeal carcinoma, thyroid cancer, and oropharyngeal/ laryngeal/hypopharyngeal cancers.

NASOPHARYNGEAL CARCINOMA (NPC)

This is the eighth most common cancer in Singapore, and tends to occur in patients at their prime (30–50 years of age). People of Southern Chinese descent (Cantonese, Hokkiens, Teochews, etc) are 20–30 times more likely to get this disease than people of other ethnic backgrounds, although incidences have been decreasing over the last few decades. NPC is often “hidden” in the back of the nose and above the oropharynx. This used to mean that it was only detected in the late stages, when it became very large or caused other problems. Nowadays, it is often diagnosed early, thanks to increased community awareness and the routine use of endoscopic nasal examination and cancer marking blood screening (EBV-serology).

Common symptoms

• Blood-stained sputum upon waking up in the morning
• Blocked sensation or tinnitus (ringing sound) in the ear, similar to the sensation when you are landing in an aircraft
• Lumps in the neck (lymph node spread)
• Late stages present as headache, squint (double vision), nose bleed and blocked nose

导致慢性咳嗽的原因很多, 正确诊断是缓解不适的关键。

当有东西刺激上呼吸道 或食管道的某个部位（如鼻腔、口腔、咽喉、喉头、上食道或肺部），人体会透过 咳 嗽 来 做 出 反 应 。这 种 本能反应，是人体强行驱逐 上呼吸道或食道中的刺 激 物 或 多 余 物 体 的 方 式 。

慢性咳嗽的定义，为咳嗽时间 持续在八周以上，又没有明显 肺疾病证据的咳嗽，咳嗽往往 是患者唯一或主要症状。慢性 咳嗽患者在内科门诊十分常 见，但因为缺乏明显的伴随症 状，X光检查也无明显异常，所 以确诊病情极具挑战性。

01. Impacted Ear Wax and Blocked Ears

Cause: Ears are designed to be self-cleaning. Ear wax and skin lining from the ears are naturally expelled by the gradual migration of skin out of the ear canal. Many of us, especially Asians, have been taught from young to clean our ears with Q-tips, hair pins and specially designed ear diggers. These practices are absolutely wrong. The common use of earphones has increased the incidence of these conditions.

In the Chinese and Malay languages, ear wax is wrongly referred to as “ear shit”. In reality, ear wax has lubricating and antiseptic properties. Ear wax protects the ear from water, insects, bacteria and fungal infections. It is produced in the outer third of our ear canal, and if left alone, is pushed out naturally by the migration of skin outwards. Inserting anything into the ear may instead push the wax and dead skin deeper into the ear canal, leading to an impacted lump which blocks the ear canal. Water from showers and swimming may be absorbed by this, and can cause sudden hearing loss and an ideal breeding ground for bacterial and fungal infections.

Treatment: “Don’t put anything smaller than your elbow in your ear” is the traditional golden rule, as ears are self-cleaning.

02. External Ear Canal Itch and Pain

Cause: Ear itch and pain are commonly self-inflicted by impacted wax, removal of the natural protective layer of wax, abrasion of the ear canal and the introduction of bacteria by digging.

Treatment: Do not try to remove ear wax from your ear.

Identifying node, head and neck cancers in an early stage ensures a high survival rate.

In Singapore, over 800 cases of head and neck cancers are diagnosed each year.

Nasopharyngeal carcinoma (NPC)

The eighth most common cancer among Singaporean males, NPC predominantly affects Chinese men between the ages of 35 and 55.

The nasopharynx is a passage that links the back of the nose to the back of the mouth. As it is not visible from the nose or mouth, tumours go undetected until the cancer protrudes out of the nose or into the back of the mouth.

Early-stage NPC can be detected via nasal endoscopes and EBV (Epstein-Barr virus) serology tests. Biopsies of tumours in the nasopharynx can also be taken via endoscope...

When something irritates a part of the upper airway or oesophageal tract (the UAOT), such as nasal passages, oral parts, throat, larynx, upper oesophagus or lungs, the body reacts by coughing. This reflex is how the body forcibly expels the irritation or unwanted particles from the UAOT.

Common causes of chronic cough

• Chronic infections such as sinusitis, tonsillitis, pharyngitis, laryngitis, bronchitis, and chest or dental infections, where mucus and inflammation of the throat irritate the air passages. The sticky mucus may also be inhaled into the lungs. The body responds by coughing it out.
• Smoking (or haze in the air) may cause constant irritation of the airway.
• Cancer of the throat, oral cavity, lungs or oesophagus.
• Certain antihypertensive drugs such as ACE inhibitors (look out for drugs with trade names ending with “pril”) have the side effect of increasing throat sensitivity.
• Allergies such as allergic rhinitis, throat allergy, cough variant asthma and asthma.
• Laryngopharyngeal Reflux (LPR)

LPR is a fairly common condition where the contents of the stomach regurgitate back up the oesophagus and larynx. Often, the sufferer is not aware of this reflux and it is left undiagnosed.

When this substance reaches the upper oesophagus and larynx, the acidity of the stomach content burns the larynx (which doesn’t have a protective lining, unlike the stomach and oesophagus). This reflux often leads to inflammation or ulcerations in the back of the larynx, where the larynx meets the upper oesophagus. LPR has also been known to reach the nasopharynx and Eustachian tubes in the ears, causing otitis media (middle ear infection).

Medical advances such as endoscopes and image-guided surgery have made this once invasive and potentially scarring procedure more patient-friendly, more targeted and more effective than ever before

Sinuses are air cavities in the bony walls surrounding the nasal passages. Sinuses are drained and ventilated by small openings called ostia. Infection to these sinuses usually occurs with any common cold caused by bacteria or viruses. Most cases of such sinus infections (as in the common cold) recover spontaneously in a few weeks. Sinusitis which fails to resolve in a few weeks tends to occur (and recur) more commonly in individuals with/who:

• Structural abnormalities (e.g. enlarged nasal turbinates, a deviated nasal septum or structurally narrow sinus openings)
• Nasal polyps
• Allergic rhinitis
• Live in polluted environments
• Smoke
• Respiratory airways and swallowing may be affected if there is a large tumour

Treating acute sinusitis is the same as treating any common cold. In prolonged sinusitis cases, treatment would involve medical management of allergies and lifestyle changes (such as smoking cessation and avoidance of exposure to pollution). Surgery may be considered in cases of structural abnormality or nasal polyps which compromise drainage and ventilation of the sinuses, causing recurrent or chronic sinusitis.

When you first meet Dr Lau Chee Chong of the Ear Nose & Throat Centre CC Lau at Mount Elizabeth Medical Centre, you are immediately struck by his warm smile, quiet humour and by the enthusiasm and passion he has for all aspects of his life.

Dr Lau has enjoyed two decades of what he calls “the most enjoyable and interesting ENT private practice imaginable” and he still loves it. He is a surgeon of extensive experience, having worked at the Great Ormond Street Hospital and the Royal National Throat Nose & Ear Hospital in London and the City Hospital in Edinburgh. He has also lectured and taught other doctors in conferences and workshops in Singapore and overseas, and has served on boards and panels of various embassies, medical societies and the Subordinate Courts.

One might imagine that such a man would not have the energy or passion to take on another role.

But when he exchanges the surgical mask for a fencing mask, Dr Lau transforms into one of Singapore’s most successful national veteran (over 40) fencers. His primary weapon is the sabre, which allows you to slash as well as thrust with the tip. Sabre fencing is also well known for its speed, which forces you to think and react in a split-second. “It’s like a giant game of chess, but you have to make your reply moves immediately. Many sabre matches are over in a few minutes.”

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Also known as Contact Point Headache, this rather frustrating condition is very rarely diagnosed, often misdiagnosed and frequently treated incorrectly.

Most nasal neuralgia sufferers would have been seen many doctors and specialists like neurologists, pain specialists, neurosurgeons, acupuncturists, psychiatrists and even ENT specialists, but their condition is often erroneously diagnosed as migraine, tension headache or psychogenic. These patients are plied with the same solutions which, often, do not tackle the real problem.

Anatomy of the nose

Understanding the syndrome is helpful to interpreting the pain and responding to it. The best starting point is to get to know a little about the nose’s anatomy.

The nasal septum is the bone and cartilage that divides the nasal cavity. Several nerves, covered by a thin mucosal lining, run directly along its length.

This nasal passage is very narrow and the opposing lateral wall has ‘erectile’ tissue called turbinates. These help to moisturise, filter and warm incoming air, and constantly change in size according to how dilated the blood vessels are. If a turbinate happens to enlarge over a nasal nerve on the septum, this may cause varying degrees of pain because there is no soft tissue to absorb the pressure.

One of the Five senses, hearing is an ability we cannot do without. Treat your ears well and you will be rewarded as you sail into the sunset years.

We should count ourselves lucky if we live long enough to become naturally deaf. The chances of becoming deaf if you live to a ripe old age is high, given that we start losing one decibel (or 1%) of our hearing per year after the age of 55. By the time we reach 110 we should be easily 90% deaf and that is provided we have good hearing during our younger days. Not being able to hear, however, is no laughing matter. Hearing plays a vital role in effective communication and enables as to enjoy simple pleasures such as listening to music, and enjoying the sounds of nature and the laughter of grandchildren. Knowing how to take care of your ears will help you maintain your hearing into the golden years.

How Do We Hear?

Sound waves enter the ear, travel through the external ear canal and strike the eardrum, causing it to vibrate. The eardrum is connected to three small bones which move with the vibration. This movement is passed onto the cochlea. The cochlea is a fluid-filled structure that contains a receptor organ for hearing. This organ is made up of tiny nerve endings called hair cells. When the fluid in the cochlea moves with the vibration, the tiny hair cells translate this vibration into electrical impulses. The impulses are carried to the brain by the hearing nerves.

Besides being one of the top 10 cancers in Singapore, nose cancer is also common in China, Taiwan and Hong Kong - and often hereditary in South Chinese communities around the world.

The Chinese (particularly Southern Chinese, like Cantonese, Hokkiens and Teochews) are genetically predisposed to nasopharyngeal carcinoma (NPC), one of the most common cancers in Singapore, China, Taiwan, Hong Kong and Chinese communities around the world. NPC is more common in men than in women. Tragically, NPC often occurs in the prime of life, between 30 and 50 years of age.

Studies have shown that the Epstein Barr Virus (EBV) is a likely cause, although the presence of EBV does not automatically mean one has or will have NPC. Other implicated factors are polycyclic hydrocarbons (compounds produced in the burning of fossil fuels, like charcoal), nitrosamines (chemicals in preserved foods, like salted fish) and poor hygiene. There is also a strong heredity factor. People with a family history of NPC are predisposed to it and should be particularly aware of early symptoms.

Symptoms of NPC

NPC often originates in the back of the nose and above the soft palate, so it is often not visible of noticeable until it is very large or when it causes other symptoms. Therefore, NPC is often diagnosed late. Those who are predisposed to NPC need to be aware of the early symptoms, such as...

Snoring happens when something obstructs the airflow through your airway. When you breathe, the air squeezes past this obstruction, causing a whistling or rattling sound.

Rhinitis, sinusitis or similar types of infection could cause the obstruction. Sometimes, the obstruction is caused by anatomical faults, like a crooked nasal septum, enlarged tonsils or polyps. Even floppy throat walls (which have stretched over time with age) or excessive fat in the neck can “strangulate” the airway, leading to snoring.

Chronic snoring usually gets worse over time and may lead to a disorder known as obstructive sleep apnea (OSA), where the obstruction is so severe that the airflow is greatly reduced. The heart and lung muscles must work harder to get enough oxygen. The lungs eventually become so tired that they have to “take a break”, and the sleeper effectively stops breathing for a short period of time.

When OSA happens and oxygen levels drop, the brains and other organs do not receive enough oxygen, possibly leading to “brain suffocation” and an adverse effect on the body’s performance and functions. Also, lowered oxygen levels increase heart rate and blood pressure, leading to a higher risk of heart attack or stroke.

Here are some areas of ENT practice that particularly trouble children. Dr Lau Chee Chong, Paediatric Ear Nose & Throath Specialist

CHRONIC COUGH is often caused by one or moreof the following:

Upper airway infections (eg nose, sinuses, adenoids, tonsils); allergies (eg to dust, mould, cigarette smoke, pollution); or Laryngopharyngeal reflux (LPR), a condition where gastric contents back-fl ow into the throat. Other LPR symptoms include throat discomfort, itch and pain, hoarseness and vomiting.

Look for signs of infection (coloured mucus or phlegm). Keep the home free of allergens. For suspected LPR, ask if the child experiences burping, a sour taste in his mouth or the feeling of food coming back up his throat; avoid heavy meals and acidic/sour food and drinks; don’t eat or drink in the two hours before bedtime; manage obesity (which exacerbates LPR); try anti-refl ux and anti-acid medication.

CHRONIC BLOCKED NOSE is often undiagnosed because children can breathe through their mouths. Th e nose fi lters, humidifi es and warms air before it reaches the lungs. Mouth-breathers lack these benefits. Blocked nose also increases the likelihood of snoring, dry mouth (leading to bad breath), asthma and upper respiratory tract infections. It is often caused by enlarged turbinates, adenoids or tonsils, deviated nasal septum, polyps, allergic rhinitis or chronic sinus infection.

Today's method are describe as minimally invasive, but that doesn't mean complex surgeries are excluded. Here's a quick guide to the procedures and the reasons for them.

Thirty years ago, a surgeon would perform sinus surgery under a beam of light mounted on his head, with one hand holding a speculum to spread open the nostrils. Peering down the dark passages as far as the light could go, the surgeon operated by feel, instinct and a little guesswork, relying on his experience and knowledge of anatomy as to how far an instrument could safely go.

Some operations required a large incision to split open the skin (and often the facial bones) to gain access to deeper structures. In the early 80’s, the endoscope was introduced and it removed the need for guesswork (and often, the need for skin incisions on the face). Its use quickly became routine.

Minimally Invasive, Maximally Effective

The endoscope consists of a long, thin tube with a light and a view at the opposite end of the scope. In endoscopic sinus surgery (ESS), the endoscope is inserted through the nasal passages, with no surface incision, to operate on a variety of conditions in the nasal passages and sinuses. Advancements in instrument design allow us (with eye and brain surgeons) to operate on areas beyond the nose, such as the eyes, skull base and brain.