Health Psychology Health Issue Impacted Earwax

2. 1 2 3 4
Introduction
ONE
Research Study
TWO
Patient’s Experiences
THREE
Healthy Lifestyle Discovery
FOUR
Content
IMPACTED EARWAX
5 6 7
Changing Lifestyle
FIVE
Achievement
SIX
Conclusion
SEVEN

3. • Earwax refers to the cerumen, which is a
waxy oil.
• It is produced by the sweat glands and
sebaceous glands in the ear canal.
• Its colour can be ranged from light yellow to
dark brown.
• It is slightly acidic.
• The earwax will fall out from the ear
naturally.
• Thus, it is possible to leave it alone.
Introduction of Earwax
IMPACTED EARWAX
• Earwax serves as:
• A protection to the eardrum
being harm from
microorganisms, dust and
foreign particles
• A lubrication to hydrate the ears
• A cleanser to move the debris
out to the entrance of the ear
canal by jaw movements

4. Introduction of Earwax
IMPACTED EARWAX

5. A female Chinese
young adult patient
was interviewed.
She has excessive earwax buildup
and blockage easily like some
people since she was a child.
Patient Interview
IMPACTED EARWAX
WHO? WHY?

6. • According to a study,
• This health issue is a great health concern
around the world
• It affects around 6% of the population.
• Notably, there is a study found that
• Primary school students are very likely to have
this health issue
• Therefore, this supports the reason why the patient
started to experience it when she was young.
Research Study
IMPACTED EARWAX
4
6%

8. 01

9. • Growing up, the patient could not hear the sound clearly.
• First discover - when she was wearing the headphones to practise
a musical instrument.
• The sound was sometimes on the left side and on the right side of
the headphones.
• She was getting more aware of the difference in the volume of the
sound.
• The patient asked her family if they could hear the same volume with
their both ears, but they had not thought much about it.
First Situation
IMPACTED EARWAX

10. 02

11. • The patient could hear the sound of pulsing.
• She asked her family if they heard something at that moment
• But to them, nothing was heard
• After that, she had a dream
• Seeing some people beating the drums
• The sound was exactly the same
• Thinking back, only then she realized the sound of pulsing is actually her heartbeat
after she has learned about science at school.
Second Situation
IMPACTED EARWAX

12. • Hearing so many strange questions from her,
• Her parents felt doubtful and did not know what was happening to her ears
• In those early days,
• Her parents did not know any hearing awareness
• About how to care the ears and hearing screening
• Most of the time, her parents were busy at work.
• None of them heard from anyone sharing about the hearing problem of their
children.
• In the end, they decided to bring her to see doctor.
Parents’Responce in Action
IMPACTED EARWAX

13. 03

14. • At a clinic, the patient noticed that the
doctor used an otoscope, also known as
auriscope, as shown on the picture.
• It is a medical instrument with a light and a
magnifier, to examine her ears for the
present of earwax blockage.
First Time
IMPACTED EARWAX

15. • During an aural toilet procedure,
• A small, thin, curved instrument
• Known as curette was used to scrape out the earwax
• After that, in ear irrigation procedure,
• A syringe was used to rinse with cold water manually into her ears
• To drain out the earwax
• It was done slowly,
• The patient could not stand of having something too near in her
ears
First Time
IMPACTED EARWAX

16. • First treatment for earwax removal - aural toilet and ear irrigation
• During the treatments, the patient tried to calm down and be patience.
• After the treatment,
• She felt a great relieve and her hearing was a lot better
• The patient felt very surprise to see
• Her dark brown earwax
• Its amount being taken out from her ears
• Since then, there is no more strange sound could be heard.
First Time
IMPACTED EARWAX

17. • Some time later, the patient felt some itchiness around her ears.
• At that time, her parents brought her to have a haircut.
• At the salon, there was a senior barber who knew how to do aural toilet.
• Once the hair cut was done,
• The procedure was then used
• With a pair of forceps
• After examining her ears
• The patient never thought that the problem was the earwax blockage again.
• She was shown to see her earwax with the forceps once it was first taken out.
• Though she felt discomforted, she tried to be calm during the treatment.
• The result was still exactly the same.
Second Time
IMPACTED EARWAX

18. • When the patient tried to talk to others
• There were no response from them
• The patient was not sure how loud she had
spoken
• She felt being ignored by others
• She had used quite a lot of strength to talk
• It made her feeling more tired
• The patient then went to a government hospital with
her parents.
• After her ears had been examined, the audiologist
prescribed an ear drop
• Cerumol® Ear Drops 11ml, as shown in the
picture
• To loosen and remove her earwax
Third Time
IMPACTED EARWAX

19. • The patient was then instructed:
• To tile her head
• To put three drops into each ear
• To wait for a while
• To tile her head to another side
• To cover with the tissue papers
• To discharge the earwax
• This had to be done continuously for a
week before her next follow-up
appointment.
Third Time
IMPACTED EARWAX
• This time, the patient received another
type of treatment, microsuction
• To remove the earwax blockage
• She felt that this procedure is a lot faster
• It is like a mini vacuum inside her
ears
• Nevertheless, she had to be patience
during the procedure.

20. • There was once the patient had a very bad experience
• At a reception for patient registration
• She had no idea why the receptionist was very
angry at her.
• The patient was quite confused at her follow-up
appointment after using an ear drop for a week
• The patient then went to a student clinic at her university
• She felt upset about the service being referred
there
• The treatment is ear irrigation with an electric pump
connected with a water container.
• It looks like Propulse® Ng Electronic Ear Irrigator as
shown in the picture.
Fourth Time
IMPACTED EARWAX

21. • Before the procedure, the patient was asked if she would prefer slow or high speed
of ear rinsing.
• She was not sure, so she chose to have the slow speed.
• This time, she felt the water was warm enough that did not frighten her.
• After the treatment, the patient noticed that her earwax colour was greenish
brown, which is different from the past.
• This time, she started to mark the date of having the earwax removed.
Fourth Time
IMPACTED EARWAX

22. • Three years later, the patient felt itchy and a sense of fullness at the ear
making her struggle to hear clearly.
• This time, she went back to the same government hospital.
• She was very satisfied with the service there and it did not take her
long to wait for her turn.
• The procedure was done exactly the same she had over there last time.
• The patient started to notice that it was the discomfort that made her shaky
naturally.
Fifth Time
IMPACTED EARWAX

23. 04

24. • In the following year, the patient had a clinical attachment in a larger
government hospital.
• She occasionally noticed that
• Her earwax dropped out itself
• The itchiness was getting more obvious
• There were times she could not hear the voices clearly.
• The patient would like to take this opportunity to check her ears.
• She was lucky that she could choose any of the Medical Officers to consult her
impacted earwax and unbalanced hearing when everyone was not in a hurry.
• The patient was asked if she had any ear infection before.
• Since childhood, she only had her earwax removed.
Sixth Time
IMPACTED EARWAX

25. • The patient was then referred to Ear, Nose and Throat (ENT) Clinic to see
otolaryngologist.
• After the examination, the patient was told that there were more earwax in one
of the ears.
• This time, she had to lie down on a bed for the microsuction procedure.
• During the treatment, the patient felt discomfort and shaky .
• Once it was done, she tried to balance the pressure inside her ears.
• The feeling was like sitting inside the airplane flying up into the sky.
• By the time the patient went for her lunch break, the pressure went off
suddenly.
• She could hear the background noise clearly.
Sixth Time
IMPACTED EARWAX

26. • The otolaryngologist assessed her
unbalanced hearing condition
• For conductive loss and
sensorineural loss
• Done with Rinne and Weber
tests by using 512-Hz tuning
forks as shown in the picture.
• The patient was expected to share
what she could hear.
ENT Assessment
IMPACTED EARWAX

27. • The otolaryngologist asked if she catches cold
or sneeze a lot, but she did not think so.
• Then, the otolaryngologist sprayed
• A topical decongestant to reduce swelling
• An anesthetic to numb briefly her noise in
her nose
• Before passing the nasal endoscope
through the nasal cavity and sinuses.
• The problem could not be identified
• To get the hearing test with audiologist
for the next appointment in five months
ENT Assessment
IMPACTED EARWAX

28. • Next appointment, she never thought
that there were a lot of earwax found in
her ears as the audiologist shared.
• The hearing test was then conducted
after checking her ears.
• There were different sound intensity
transmitted in the headsets for her to
hear.
• The patient was expected to raise her
hand once she could hear anything.
Hearing Assessment / Seventh Time
IMPACTED EARWAX
• Overall, she heard different frequency of
sounds for raining, musical tone and
explosion.
• The audiologist then asked if she had
experienced vertigo like a sense of
spinning after waking up, but her reply
was no.
• The patient was sent to have her earwax
removed straight away with the same
procedure.

29. • The audiologist sent her hearing test report, which is the audiogram results,
as shown in the picture, back to her otolaryngologist.
Hearing Assessment
IMPACTED EARWAX

30. • A superior otolaryngologist asked the
patient if she had a head injury that might
cause the hearing organs to be in
malposition, but it was not the case.
• She remembered vividly that she noticed the
difference of the sound when she was
practising a musical instrument with her
headphones.
• Following that, the Rinne and Weber tests
with 512-Hz tuning forks were assessed on
the patient again.
ENT Assessment
IMPACTED EARWAX

31. • After the patient had responded, she was told
that it might be congenital abnormalities,
• She might be born that way as the
superior otolaryngologist explained.
• Based on her audiogram results, as shown in
the picture,
• An ear is moderate severe hearing loss
(40dB HL)
• Another one is normal (20dB HL)
• It was suspected that malposition of the
malleus, incus and stapes or the cochlear nerve
problem.
ENT Assessment
IMPACTED EARWAX

32. ENT Assessment
IMPACTED EARWAX

33. • A CT scan was ordered to check the positions of the three organs.
• Specifically, it is an HRCT (high resolution computed tomography) of the
temporal bone.
• Before the patient was released, the nasal endoscopy was done to detect
any cancer again.
• Upon getting with the CT scan result, it turned out to be normal.
ENT Assessment
IMPACTED EARWAX

34. • Then, the patient was referred to the audiologist for the free trial of hearing aid.
• To pay RM 40 for an earmold
• To provide her feedback after trying for a month
• The patient was lucky to know that it was the first time the hospital had such
arrangement.
• Normally, they would introduce some hearing aid shops where the
patients can be referred to.
• The financial aid department
• She could receive RM 3,500 of the government support
• If she worked in the government sector
Hearing Aid Trial
IMPACTED EARWAX

35. • The patient was then allowed to ask questions.
• The audiologist explained that the screening test for the hearing is free.
• Young children:
• The parents will notice the speech problem of their child
• The condition of the patient:
• Unilateral hearing loss
• The difficult one that people will think her hearing is normal
• Older people:
• Their earwax will become harder, which makes them struggle to listen
Hearing Assessment
IMPACTED EARWAX

36. • The patient learned about tinnitus, the ringing sound in the ear in her studies.
• The patient heard it once a while, but it rings a little while that she does
not feel being disturbed.
• She was not sure what was so special about it.
• The audiologist explained that
• It is normal to hear the tinnitus sound, because the brain is trying to find
the sound.
• There is research discovered that it is related to personal emotion.
• For severe case, people who are next to them can hear their tinnitus
sound.
Tinnitus
IMPACTED EARWAX

37. • The type of given to try was a behind-the-ear
with a shell earmold, as shown in the photo.
• It is like a little amplifier to increase the sound
intensity to her poorer ear.
• The problem:
• The background noise like the air
conditioner was louder than voices
• It was much better than wearing an earphone
• More sound pressure when she
increased the volume of the sound
intensity
Experience with Hearing Aid
IMPACTED EARWAX

38. • After returning it back, the patient was
introduced another type of hearing aids with a
CROS (contralateral routing of signal) solution,
as shown in the picture
• This version was not available for trial.
• Hearing aids will be placed on both ears.
• The one at the poorer ear is a
transmitter that sends the sound, which
is a wireless Near Field Magnetic
Induction (NFMI) signal, to a receiver on
the better ear.
CROS was Introduced
IMPACTED EARWAX

39. Now Future
Making Decision
The patient felt that the people normally
speak loud enough to hear their voices,
except for a small certain group of people
who speak quite soft.
CROS Solution
The patient decided to wait
for the future technology.
Future Hearing Aid
IMPACTED EARWAX

40. • The patient tried to discover ways to
reduce the development of the excessive
earwax.
• Six months later, she went to a private
hospital to check for her earwax.
• The Medical Officer confirmed that her
earwax was full and prescribed an ear
drop, which is Soluwax® Ear Drops 10ml
as shown in the photo.
• To her surprise, her earwax was gone
after using it for a week.
• She was so happy to know it!
Eighth Time
IMPACTED EARWAX

41. 05

42. Healthy Lifestyle Discovery
• The patient learned more about healthy
lifestyle at a few pharmacies.
• Having different types of screening tests
• The results showed that
• She did not get enough sleep
• She was stressful
• It was suspected
• That her liver was enlarged
• Causing her hair oily that she had to
wash every day
Healthy Lifestyle
IMPACTED EARWAX
Changing Lifestyle
• Other than trying to get enough sleep,
• She tried to change her shampoo for her
hair care
• The patient tried to listen some uplifting music
• To adjust her mood
• Feeling that her ears were getting oily,
• The patient decided not to wear the
headphones often
• Washing her ears while washing her face can
clean the oily ears.

43. • After three years, the patient started to feel
itchy again.
• The earwax was coming out.
• She knows the ear drops are all available in
the pharmacy
• Got Soluwax® Ear Drops 10ml
• While removing the earwax, the earwax
blockage made her difficult in hearing with
a sense of fullness in the ear.
• The feeling is like swimming in the
water, making the patient felt
frustrated.
First Self Attempt
IMPACTED EARWAX

44. • The patient went to a private clinic to see
otolaryngologist after finishing the ear drop.
• Treatment done with
• Aural toilet and microsuction
• The earwax removed was yellowish brown.
• The patient was told that her earwax is oily
type.
• A-Cerumen Spray 40ml, as shown in the
photo, was introduced.
• For the regular ear hygiene routine in
every two weeks
• This is a new product to her for the ear
cleaning solution.
Ninth Time
IMPACTED EARWAX

45. • After six months, the patient suddenly had an earache for the first time.
• She thought about removing the earwax by applying A-Cerumen Spray 40ml.
• At first, the patient thought it was unsuccessful, because she could not hear the
surrounding noise due to the earwax blockage.
• She tried to use tissue papers to remove the earwax with her little finger.
• Seeing that the earwax could come out easily, the patient repeated the same thing
again until her hearing was getting better.
• She had to do it immediately, because she had nowhere to go due to the pandemic.
• The colour of the earwax was yellowish brown.
Sucessful in Second Self Attempt
IMPACTED EARWAX

46. 06

47. • A-Cerumen Spray 40ml is the best choice of ear drop
• Because she could remove the earwax blockage herself
• Checking back for the period of removing the excessive earwax,
• It seemed inconsistent
• There are times that the earwax will drop out itself suddenly.
• At the moment, she hopes her earwax would not be developed
excessively throughout the pandemic.
• To her, it is never comfortable to remove the earwax blockage.
Conclusion
IMPACT EARWAX

48. First
Aural Toilet
Second
Ear Irrigation
Third
Microsuction
Fourth
Ear Hygiene Care
Treatments for Earwax Blockage
IMPACTED EARWAX
1 2 3 4