• Dr Jeeve Kanagalingam ENT
  • Dr Jeeve Kanagalingam ENT
  • Dr Jeeve Kanagalingam ENT

Hearing and Balance

Hearing is a very complex human function. The ability to hear sounds, perceive and understand speech and appreciate music depends on various functions of the outer, middle and inner ear, the brainstem and the brain. The inner ear and brain is also responsible for balance. There are various conditions that may affect the ear and cause hearing loss and balance problems.


Symptom Possible causes
Hearing loss or deafness Ageing, infections, wax impaction, glue ear, drugs e.g. chemotherapy, hereditary conditions, rare conditions (e.g. otosclerosis)
Tinnitus (ringing in the ear) Often unknown cause. Occasionally due to infections, vascular (blood vessel-related) problems and tumours of the inner ear
Discharge (liquid from the ear) Infections of the ear canal or middle ear. Holes in the eardrum (perforations)
Dizziness / Giddiness / Vertigo Inner ear infections, Meniere's disease and a condition called Benign Paroxysmal Postural Vertigo (BPPV)
Pain Infections, foreign bodies in the ear, wax impaction

Ear wax (Cerumen)

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Ear wax is a common problem. It may cause a sense of ear blockage, hearing loss and sometimes irritation of the ear canals. Some ear wax is normal. It helps prevent infections. However, excess ear was production occurs in some people. A narrow ear canal or the use of cotton buds may predispose to wax impaction.

In the clinic, ear wax is cleared by microsuction. This is a simple procedure and is safer than syringing of the ear with water.

Ear infections

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Infections of the ear are common and may affect the outer ear canal or the middle ear. Outer ear infections or otitis externa may occur following beach holidays or with the use of cotton buds.

Eardrum perforations

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Eardrum perforations may result from repeated infections or trauma. Most perforations heal themselves but some may require surgical closure.

When eardrum perforations do not heal, they can cause repeated ear infections and hearing loss. Surgery to close the perforation in an eardrum is called a myringoplasty. This can be done in 1-2 hours under a general anaesthetic. A graft is usually harvested from the scalp.

Hearing loss

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ParathyroidHearing loss or deafness may be due to a variety of causes but most often it is seen in the elderly as the hair cells with the cochlea of the inner ear degenerate. This is called Presbyacusis. There is little that can be done to reverse deafness as people age.

Loud noise exposure can also result in hearing loss. The exposure to loud noise is only detrimental if it is for prolonged periods.

The hearing test or audiogram shows symmetrical hearing loss to about 50 dB at 4 kHz. The threshold then recover to 10-20 dB at 8 kHz.

In patients with asymmetrical hearing loss, we often obtain an MRI scan of the inner ears (internal auditory meati, IAM) to exclude the possibility of an acoustic neuroma

Tinnitus

Tinnitus is a common complaint. Almost 10% of people have experienced tinnitus at some stage of their lives. Tinnitus is often experienced "somewhere within the head" but may sometimes be heard in only one ear. The most common form is a high pitched ringing or buzzing. In some patients, tinnitus is "pulsatile'. In these patients, a search for a vascular cause is prudent.

Whilst tinnitus can be debilitating, in the vast majority of cases, it resolves. Patient with tinnitus may find benefit in some medication or treatment called TRT (Tinnitus Retraining Therapy)

Eustachian tube dysfunction




Eustachian tube dysfunction is a common problem. This is especially so in this day and age when people fly often and also take up hobbies such as scuba diving. Typically there is fullness then intense pain in the ear upon descent in an aircraft. In some patients, this may lead to recurrent ear infections.

There is now an effective way of treating Eustachian tube dysfunction using a balloon to dilate the tube. This is a simple procedure with few side effects but has to be performed under general anaesthesia.

Dizziness and Vertigo

Dizziness, giddiness and vertigo may be due to ear problems. The inner ear is a complex balance organ that detects the position of one's head and any movements. Dizziness due to inner ear problems often causes rotatory vertigo. This is usually associated with nausea and vomiting. There are several common causes of vertigo that emanate from the inner ear. These include benign paroxysmal postural vertigo (BPPV), Meniere's disease, vestibular neuronitis and viral labyrinthitis