Ask a Ear Nose Throat (ENT) Specialist: Dr Barrie Tan from Gleneagles Hospital Singapore

Ask a Doctor ForumCategory: OtorhinolaryngologyAsk a Ear Nose Throat (ENT) Specialist: Dr Barrie Tan from Gleneagles Hospital Singapore
dr. Barrie Tan asked 2 years ago
I am Dr Barrie Tan, an Ear Nose Throat (ENT) specialist based in Gleneagles Hospital Singapore. I am experienced in managing ENT conditions such as sinus problems, snoring, obstructive sleep apnoea, allergic rhinitis, voice problems, thyroid nodules, neck lumps, hearing loss, tinnitus and giddiness. I am a President’s Scholar and have over 20 years of clinical and surgical experience. For more than 6 years, I was a senior consultant and the head of the department of otolaryngology (ENT) at the Singapore General Hospital (SGH). During my tenure, I routinely managed and operated on young children with ENT conditions as well as the full range of Adult ENT conditions. I am well known for my expertise in treating hearing loss, as well as performing endoscopic ear surgeries. I introduced endoscopic ear surgeries in SGH in 2014 and have been actively spearheading its adoption and development in Singapore since. I have performed over 100 ear surgeries endoscopically, ranging the entire gamut of different ear surgeries. These include endoscopic tympanoplasty, myringoplasty, tympanomastoidectomy, ossiculoplasty, stapedotomy and stapedectomy, as well as endoscopic facial nerve decompression. I am also an experienced cochlear implant surgeon, having personally performed several hundred cochlear implant surgeries in Singapore and countries like Vietnam, Indonesia and Bangladesh. I am often invited to lecture at international conferences on my experience in cochlear implant surgeries, and invited as an instructor in specialised ear surgery workshops and courses. I have served as a course director in numerous symposia and masterclasses in cochlear implant surgery, such as the Singapore General Hospital Cochlear Implant Surgery Masterclass Course in 2017 and 2018. I am passionate about bringing surgical innovations and updates in medical technology to Singapore and the Southeast Asian region, and is an early adopter of approved innovative surgical techniques and surgical hearing implants. I am the current president of the ASEAN Otorhinolaryngological (ENT) Head & Neck Federation, and was the president of the Society of Otolaryngology (ENT) Head & Neck Surgery Singapore from 2017 – 2019. I am also an avid teacher, spending much of my time teaching and nurturing the next generation of ENT surgeons. From 2012 – 2014, I was the director of the SingHealth ENT Residency Training Program. I was also appointed as a member of the National ENT Residency Advisory Committee which oversees the 3 ENT Residency programmes in Singapore. Besides being a surgical innovator, I am also an administrative innovator. I co-founded the SingHealth-Duke NUS Head and Neck Centre in 2014, and from 2014 – 2018, served as the deputy head of the SingHealth-Duke NUS Head and Neck Centre. In this capacity, I helped to coordinate the development of multidisciplinary head and neck surgery capabilities and care of complex head and neck conditions in the various SingHealth hospitals and institutions. I volunteer at the Canossian School, which runs a special education programme for children with hearing impairment and who wear hearing devices like hearing aids and cochlear implants. In the past, I performed ear surgeries like myringoplasties and mastoidectomies in rural communities. In recent years, I have been performing cochlear implant surgeries for deaf Vietnamese children in Hanoi and Ho Chi Minh City under the Hear-The-World programme. Learn more about Gleneagles Hospital here: https://patients.smarterhealth.sg/hospital/gleneagles-hospital-singapore/ Learn more about me here: https://patients.smarterhealth.sg/specialist-doctor/barrie-tan/ I am excited to be here to share/discuss ENT Health with everyone. Whether you've got questions about sinus problems, snoring, sleep and hearing issues, voice problems, neck lumps, ask me anything! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
31 Answers
Aini K answered 2 years ago
Doctor, I have an infection in the middle of my ear. My ENT prescribed antibiotics but it didn't get better. Sometimes white fluid comes out of my ear. What should I do to understand the cause of this problem and how to cure it, Doc? Thank you
dr. Barrie Tan replied 2 years ago

Hi, it would be important to do a Nasoendoscopy to look at the back of your nose. This is a camera attached to a small flexible tube that can be inserted into the nose. This is to evaluate if there are any growths or swellings in the back of your nose that may be blocking or pressing on the openings of the Eustachian Tubes (the natural ventilation path of the ear that connects to the back of the nose). Usually middle ear infections arise from bacteria that go up the Eustachian Tubes to the middle ear space. Problems with the function of the Eustachian tubes may predispose to middle ear infections. Besides antibiotics, nasal decongestant medications are usually also prescribed to ensure that the mucus from the front of the nose does not drip back and block the opening of the eustachian tubes.

As for white fluid coming out of your ear, that would be unusual in a purely middle ear infection unless there is a hole in the ear drum. When that happens the fluid in the middle ear will leak out through the hole into the external ear canal. In such a situation, I would advise you to start some antibiotic ear drops to your affected ear for at least 1 week to treat the infection. When the infection settles, you should have an examination of the ear drum to see if there is a ear drum perforation (hole). If there is one, you should consider undergoing a surgery to repair the hole when the ear is dry, to prevent a future ear infection.

Selna Atha answered 2 years ago
Doctor, I feel something blocking my throat. The throat itself itches. My chest x-ray showed that my heart and lungs are fine, only that there is an allergy. I have had a dry cough for 3 months. What is the solution, Doc? Thank you
dr. Barrie Tan replied 2 years ago

I would suggest that you undergo a Nasoendoscopy to evaluate your nose and also the deeper portions of your throat. This will allow us to visualise any problems that may arise from the nose that may cause a chronic cough like chronic sinusitis with a constant post nasal drip (backdrip of mucus at the back of the nose). Also other causes such as laryngopharyngeal reflux, where the stomach juice and acids reflux into the throat, can be seen with evidence of swellings and redness of certain portions of your throat. The treatment would depend on the diagnosis made after the Nasoendoscopy. Most times, treatment would begin with some medications, before surgeries may be advised for certain conditions.

Refsi Hafiyanti answered 2 years ago
Doctor, I went to an ENT once because I had been finding it hard to breathe. The doctor’s diagnosis was that I'm experiencing the narrowing of the nose canal, but not severely. I was advised to exercise regularly and to breathe clean air, as well as to wear a mask to prevent the dust entering my nose. Yes, if I do those tips, I can breathe easily. But, when I stop doing it, the problem comes back. My question is, is there any permanent solution for this?
dr. Barrie Tan replied 2 years ago

The main problems of your nose is nasal obstruction from what sounds like possible Inferior Turbinate hypertrophy or general swelling of the nasal tissues from underlying allergic rhinitis since you are better when you are not exposed to dusty environments. There are permanent solutions to breathing difficulties from such nasal obstruction. They basically involve shrinking the swollen tissues and correcting any other structural deformities of the nose like deviated nasal septums. This will require an examination with a nasoendoscopy first to look for the sites of nasal obstruction before deciding on what types of surgeries are required. The main types of surgery include the following:

1. Endoscopic Inferior Turbinectomy or Turbinoplasty: This involves resecting (cutting away) or trimming of the inferior turbinates which are the tissues located along the side walls of the nose inside. They are often swollen in underlying allergic rhinitis. They occupy significant space in the nasal cavity and after reduction or removal, there is a much larger available space in the nasal cavity to breathe

2. Septoplasty: To correct any deviation of the nasal septum. That would allow the air entry in the ear to be equal on both sides after surgery.

3. Radiofrequency reduction of the Inferior Turbinates: This is similar in intention to a Inferior Turbinoplasty but serves to reduce size of the front 1/3 of the inferior turbinates on both sides. This will result again in more space available in the nasal cavity.

Zhang hui kian answered 2 years ago
Good afternoon, Dr Tan. I have a sore throat and short breath and chest pain. I saw an ENT, he said I had gastric acid reflux. Is there any way to treat my sore throat, Doc? Thank you in advance, Dr. Barrie Tan
dr. Barrie Tan replied 2 years ago

Hi, Gastric Acid reflux can definitely cause the symptoms that you have mentioned. As such, the treatment of acid gastric reflux would include the following:

1. medications to reduce the stomach acid production
2. Lifestyle changes: Avoid certain foods like citrus fruits, chocolate, coffee, tea, fatty and fried foods, garlic and onions, mint flavoring, highly spiced foods. tomato based foods. To sleep with at least 1 firm pillow to elevate the neck slightly. To avoid going to sleep with a full stomach. Best to allow at least 3 hours interval for the stomach to empty from the last meal before bedtime.
3. If the reflux is very severe, it is necessary to have an evaluation of the esophagous and stomach by a gastroenterologist for any predisposing cause for the reflux.

Elvira answered 2 years ago
Doctor, there is a hole in my ear drum, but it is a small hole. The doctor said it can be treated without surgery, Is there any chance for this hole to get bigger?
dr. Barrie Tan replied 2 years ago

Yes, there is a chance that an unrepaired hole in the ear drum will lead to future middle ear infections and a widening of the ear drum perforation. If you are in good health and under 65 years old, it would be best to undergo a surgery to repair the ear drum perforation as the chance of future infections of the middle ear through entry of bacteria via the perforation, is high.

Tiska answered 2 years ago
Doctor, I feel my nose is full with mucus, but nothing comes out of it actually. It has been 2 weeks. What should I do to get it cured?
dr. Barrie Tan replied 2 years ago

It is important to complete a Nasoendoscopic examination of the nasal cavity and the openings of the paranasal sinuses. The treatment will depend on the underlying problems seen. These can range for excessive mucus production from allergies, to polyps to sinusitis infections. The treatment methods vary for each and may start with medications first before considering various types of surgery.

Toni Syaifudin answered 2 years ago
Doctor, my inner nose has been itching for this past week. When I pried into it, it bled. I used saline once to clean it, but it just hurts. Why is that so, Doc?
dr. Barrie Tan replied 2 years ago

There could be several reasons why it hurts, itches and bleeds. There could be small polyp or growth in the inside of the nostril that is traumatised whenever you insert anything into the nose. There could be an infection of the nose and this is aggravated by introducing anything into the nose. I would suggest that you get a review by an ENT doctor who can do a nasoendoscopy. This would allow the doctor visualise the entire nasal cavity to determine if there is any such problem

Junaidi Suliah answered 2 years ago
Doctor, my left ear rings but without any pain. I saw an ENT specialist, she said my ears are fine, there is no wax, but the ringing is still there and it makes me uncomfortable. Is there any solution? I have hypertension.
dr. Barrie Tan replied 2 years ago

The ringing in the ears are probably what is commonly known as Tinnitus. Usually this condition is not debilitating. But for some it is very disturbing. It is important to perform a Pure Tone Audiogram to ensure that there is no associated hearing loss on the left ear. If there is, then certain investigations such as an MRI scan of the Internal Acoustic Meatus (MRI IAM) should be performed to ensure there are no sinister causes like a tumour in the brainstem pressing on the hearing nerve. Most times, tinnitus tends to fade into the background after a few months. For those in which the tinnitus does not subside, there are various therapies such as masking therapy, the use of hearing aids, acupuncture as well as some medications that may be of some benefit to a few patients. However, there is no one universal treatment that is effective for all patients with tinnitus and oftentimes there may be a need to trial these different therapies to see which one works for you.

Taslim Taslim answered 2 years ago
Doctor, my right ear rings. I saw an ENT specialist, and the examination showed my ears are fine. Besides that, I have a bloating stomach, anxiety, and gastric acid. Thank you
dr. Barrie Tan replied 2 years ago

The ringing in the ears are probably what is commonly known as Tinnitus. Usually this condition is not debilitating. But for some it is very disturbing. It is important to perform a Pure Tone Audiogram to ensure that there is no associated hearing loss on the left ear. If there is, then certain investigations such as an MRI scan of the Internal Acoustic Meatus (MRI IAM) should be performed to ensure there are no sinister causes like a tumour in the brainstem pressing on the hearing nerve. Most times, tinnitus tends to fade into the background after a few months. For those in which the tinnitus does not subside, there are various therapies such as masking therapy, the use of hearing aids, acupuncture as well as some medications that may be of some benefit to a few patients. However, there is no one universal treatment that is effective for all patients with tinnitus and oftentimes there may be a need to trial these different therapies to see which one works for you.

Ruth Murniati answered 2 years ago
My ears are often buzzing/feel clogged. Why is this so?
dr. Barrie Tan replied 2 years ago

The ringing in the ears are probably what is commonly known as Tinnitus. Usually this condition is not debilitating. But for some it is very disturbing. It is important to perform a Pure Tone Audiogram to ensure that there is no associated hearing loss on the left ear. If there is, then certain investigations such as an MRI scan of the Internal Acoustic Meatus (MRI IAM) should be performed to ensure there are no sinister causes like a tumour in the brainstem pressing on the hearing nerve. Most times, tinnitus tends to fade into the background after a few months. For those in which the tinnitus does not subside, there are various therapies such as masking therapy, the use of hearing aids, acupuncture as well as some medications that may be of some benefit to a few patients. However, there is no one universal treatment that is effective for all patients with tinnitus and oftentimes there may be a need to trial these different therapies to see which one works for you.

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