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Obstructive Sleep Apnea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. Snoring is caused by a narrowing of your airway, either from poor sleep posture or abnormalities of the soft tissues in your throat. These are available for you to license for books, magazines, newsletters, presentations and websites. All characters, panels and images are copyrighted by their respective copyright owners and they are used here with permission. All logos and other trademarks are the exclusive property of their respective holders who reserve all rights.
Dr Lynne Lim is recognized as one of the top adult Ear Nose Throat specialists island wide. Dr Lynne is one of the best adult ENT doctors in Singapore managing holistically the full spectrum of ear, nose and throat disorders.
Age-related hearing loss – Natural wear and tear with degeneration of the inner ear and middle ear function is common in adults over 50 years of age, warranting screening for hearing loss. Noise-induced hearing loss – This is due to very high noise level exposure for just a few minutes, or chronic high noise exposure.
Tinnitus – This is a result of hearing loss and may also occur due to tumors, abnormal vessels, thyroid dysfunction and drugs. Otitis media – This can be acute, painful or accompanied with fever when associated with infections. Perforated ear drum – This can result from traumatic injury to the ear drum or chronic untreated middle ear and mastoid infections. Cholesteatoma – A middle ear tumor that is not cancerous, but causes hearing destruction by eroding middle ear bones and bringing about toxin penetration to the inner ear. Malignant Otitis Externa – Bacterial infection of the ear canal and temporal bone causing deep pain and chronic ear discharge, often associated with diabetes.
Mastoid infection – Chronic infection of the mastoid air cells and bony septations due to bacteria, fungus or unusual diseases like Tuberculosis. Acoustic Neuroma – Tumor of the hearing nerve impairs hearing, and may cause facial nerve palsy, giddiness and increased intracranial pressure with growth.
Hearing loss is often missed, and many do not seek treatment from an adult Ear Nose Throat specialist in Singapore for fear of stigmatization or deeming that it is not important. Many teenagers and young adults underestimate their noise exposure and the risk of noise-induced hearing loss. The hearing tests and complete range of services are available in-house in sound-proof and sound-treated rooms, allowing the adult Ear Nose Throat doctor to interpret the tests together with the audiologist to offer a treatment plan on an immediate basis. Tympanometry – this test shows the middle ear pressure and volume, and is a reflection of the state of the ear drum and middle ear.
Radiology: CT scan temporal bone, MRI brain and Internal Acoustic Meatus are required to determine the anatomy of bony and soft tissue structures of the outer, middle and inner ear, cochlear, vestibular aqueduct, hearing and facial nerves and the brain. Topical ear drops, oral medications, and temporary cotton stents can help ear wax, and infectious, traumatic causes. Gentle ear cleaning and culture sensitivity of infection fluids, removal of wax and foreign bodies under light microscopic visualization and fine instrumentation. Under GA for inserting various implants like bone anchored hearing aids, bone anchored hearing implants, middle ear implants for moderate-severe or mixed hearing loss, single-sided deafness and atresia of ear canal.
For outer ear auricle reconstruction: choices include a prosthetic ear, Medpore (artificial graft) or patient’s own rib graft in the first stage, followed by the second stage with split skin graft from the abdomen and superficial temporal artery revascularisation.
Rhinosinusitis can result from acute or chronic nose passages inflammation, infection, polyps, anatomical nose and sinus structure abnormalities. Avoidance of the offending allergen tested positive reduces the need for over-dependence on medication. Inferior turbinates can be chronically hypertrophied from inflammation, allergic rhinitis or are structurally predisposed. Even non-cancerous tumors can erode important surrounding structures, and affect the eye, teeth and cause bleeding or block breathing. Depending on the histology, local excision via endoscopic method or open excision may be needed. Watchful waiting only if episodes are isolated, mild and without significant airway obstruction. Day surgery for tonsils removal may be required for chronic airway obstruction, severe or recurrent tonsillitis.
The exact cause is often unknown, and aggravated by stress, trauma, acidic fruits, braces or ill-fitting dentures.


Salivary gland lumps – These could be benign or cancerous tumors, or swelling due to acute or chronic infections or stones blocking the salivary ducts.
Neck lymph nodes – These could be benign or cancerous nodes, and due to infections, systemic disorders and blood disorders. Thyroid lumps – These can be benign or cancerous, a Multinodular Goitre or generalised swelling eg in Grave’s Disease. Thyroglossal cyst – This is a congenital cyst that is usually sited in the midline of the upper part of the neck, and moves with swallowing. Branchial cyst – This is a congenital cyst that is usually sited at the upper half of the lateral neck. Ranula – This usually presents as a floor of mouth and sometimes below the chin soft cystic swelling. Hemangioma and Lymphangioma – These are vascular and lymphatic malformations, filled with blood or lymphatic fluid. Besides presenting as a lump, head and neck tumors may present as blood stained sputum, nose bleed, hearing loss, ringing in the ear and ear block. Ultrasound scans are useful for neck lumps to determine size, numbers, and suggest if the tumor is likely to be benign or cancerous. For cancer lumps that are not discovered early or contained, surrounding head and neck structures often need to be removed enbloc to reduce the risk of recurrence. Most commonly due to infection, haemorrhage into or allergic reaction of the vocal cords (voice box) if of sudden onset. Surgery for cancer of the larynx would require further investigations for extent of involvement and spread.
Due to poor dentition, neurological conditions (eg stroke, vocal cord, brain and spinal cord injury, Parkinson’s disease, sclerosis, Alzheimer’s disease) and head and neck pathologies (mouth, throat, esophagus cancers, injury and surgery). Observe feeding to see the patient’s posture, behavior, and oral movements during eating and drinking. Include tumor, papillomatosis of the larynx and trachea, compression of the trachea by neck masses like thyroid lumps, base of skull tumors affecting the vagal nerve, strokes, vagal nerve pathology that impair mobility of the vocal cords, swelling and inflammation of the vocal cords due to infection, chemotherapy, drugs, trauma and idiopathic causes. Stridor is noisy breathing arising from blocked airway at the level of the voice box and trachea.
In cancers of the larynx, preservation techniques for voice and swallowing is attempted where possible. Tonsillitis (Tonsil) ENT-Conditions and Tratment from Subang ENT Specialist Clininc in Subang Jaya, Malaysia.
The tonsils and adenoids are composed of tissues that are similar to the lymph nodes or glands found in the neck or other parts of the body. The disease usually begins with high temperature and possibly chills, especially in children.
These periods of 'stopping breathing' only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour.
She specializes in ear disorders as well as the surgical and non-surgical correction of hearing loss, which also entails different types of treatments, and the insertion of cochlear and middle ear hearing implants.
When it is chronic with fluid in the middle ear, a nasopharyngeal carcinoma has to be excluded in adults.
This usually due to infections, Meniere’s Disease, Benign Paroxysmal Positional Vertigo (BPPV) and trauma.
Many in professional jobs with noise exposure do not use hearing protection even if available. Closer collaboration also allows for increased safety of investigations requiring sedation, and optimizes outcomes.
Light microscopy magnifies these images many times and with increased clarity for diagnosis. Contrary to common perception, 75% of newborns or young with hearing loss do not have parents or relatives with hearing loss. Systemic causes include blood disorder, hypertension, and drugs that reduce the ability to clot properly, eg warfarin and aspirin.
Rhinosinusitis may require long term medications and antibiotics, and have risks of eye, brain, teeth complications. The nose bone in the centre can be crooked from birth, a normal growth variation, or due to trauma. Some tumors are cancerous, located in the nose, sinuses or further back in the nasopharynx. Nowadays, Image Guided Systems (IGS) for endoscopic surgery offers increased safety and completeness of tumor clearance.
Recurrent tonsillitis could be associated with sore throats, fevers, poor feeding, antibiotic resistance and absence from work. In Laryngoesophageal reflux disease (LERD), backflow of the acid from the stomach up into the voice box and laryngeal area causes irritation, phlegm and hoarseness in the throat.


More often, it is just chronic throat irritation worse after meals or sleep, or hoarseness of voice that prompts an evaluation.
However, it needs to be evaluated to exclude central or obstructive sleep apnea (OSA) and upper airway resistance syndrome, where there is blood oxygen deprivation and increased work of breathing leading to disturbed sleep and daytime sleepiness. All nodes should be further evaluated if they are increasing in size and numbers, last more than 3 weeks, are fixed to the skin or ulcerate.
The sinus tract is often complexly related to facial nerve and vessels in the head and neck. May be from excessive strenuous voice use, smoking, hypothyroidism and drugs leading to polyps, cysts and nodules.
Better control of gastroesophageal reflux (eg avoid spicy, sour and oily food and caffeine). When significant, there is risk of acute oxygen lack, respiratory distress leading to cardiac arrest and death. Together, they are part of a ring of glandular tissue (Waldeyer's ring) encircling the back of the throat. Normal tonsils are usually about the same size and have the same pink color as the surrounding area. The patient complains of a persistent pain in the throat, and pain radiating to the ear on swallowing.
In addition to this, her repertoire also includes a comprehensive range of investigations and the effective management of different adult ear conditions. The only way to exclude genetic cause is to do an appropriate blood test guided by history.
It can be due to inhalant allergens or food allergies, with either acute or more subtle chronic manifestations.
Obesity, pregnancy, coughing, vomiting, straining or sudden physical exertion can cause increased pressure in the abdomen. Long term however, there is a risk of cancer change in the esophageal and laryngeal and voice box mucosa if untreated. Long term, oxygen deprivation may increase the risks of heart, blood pressure, hormonal, neurological and memory problems. Destruction of structures closely related in the head and neck region results in various problems with breathing, swallowing, eating, voice, dentition, cosmesis and bleeding. May be cancer change in the larynx or invasion from surrounding thyroid or other neck region tumors. On their surfaces are little depressions, called crypts, which may appear deep and contain pus pockets or stones. Opening the mouth is often difficult and painful, the tongue is coated, and there is a mouth odor.
Hearing impairment can afflict a majority of people, and is usually underestimated due to lack of public awareness and the fear of stigmatisation. In Singapore, 40% of patients with unknown cause of hearing loss and other body systems normally have a Connexin 26 gene mutation. Seeking evaluation and treatment as early as possible is critical for ensuring the best outcomes for cancer cases.
The patient may also complain of headache, thick speech, marked feeling of malaise, as well as swelling and tenderness of the neck glands (lymph nodes). Hearing loss is associated with social isolation, inability to communicate with friends and loved ones, depression, and reduced safety. Listening to your music via headphones at maximum volume risks hearing loss in less than an hour. Knowing the genetic cause guides management over a lifetime, as there may be associated eye, kidney, heart or thyroid problems. Post surgery or radiation therapy for cancer or tumors in the head and neck and pathology in the chest.
Both tonsils and the surrounding area including the posterior pharyngeal wall are deep red and swollen.A  Later, whitish spots (follicles) form on the tonsils, hence the nameA follicular tonsillitis.
In the National Health Survey 2010 study Dr Lim assisted with, 1 in 4 between 50-59 years of age; and 2 in 5 adults between 60-69 years old already have hearing loss. It also suggests the progression and prognosis of hearing loss, besides helping families interested in determining the chances of hearing loss in future offspring.



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20.08.2015 admin



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