Keywords: a, an, the, is, am, are, was, were
Remarks: this case study was not funded by any organizations
Introduction
    Patients suffering from obstruction of auditory canal will have decreased listening sensation without noticing it for a year.
Case study
    Mr. X, a young Chinese male with history of juvenile dementia discovered decreased listening power for 60% for a week after swimming with his friends in Sai Kung. Initially he blotted dry his ears by cotton wool but found it ineffective. He then came to the clinic for help.
    He was diagnosed as having blocked auditory canal of both ears with a bulk of dirt. Total blokade in Left ear and semiblockade of the right ear. A ear-washing procedure was arranged for him the next day. This night Cerumol ear drops was prescribed for preparation of the procedure.
    A doctor  (C.C.W.) and a nurse of the clinic was responsible for the procedure, consent form was signed. Then the patient was  instructed in right side-lying to receive the Cerumol ear drops again. The position was sustained for half an hour and the patient fell into a good sleep. Same procedure was done on the right ear with the soaking time decreased by 15 minutes since it is less severe.  As the patient recalled, after dropping of the Cerumol to his right ear, air bubbles comes out in a rate of 1 bubble per minute. Kidney dish, towel, metallic syringe with warm tap water was prepared at the same time.
    After the soaking of both ears with Cerumol, the dirt softens and warm water was injected in a speed of 1m/s into the patient's left ear, two syringe of warm water required for the washing. Same procedure was done on patient's right ear.As claimed by the patient, it is not painful despite the high hydrolic speed but the water is a bit hot.  There were frequent conversations between the doctor and the patient to know whether the patient can hear well. Conversations ranged from which department the patient came from to the employment aspect and the face of the patient.
     Two worm-like soft dirt was washed out and put in the sink, patient asked if he can keep it and it was permitted since it is a non bioharzardous speciman. Patient now regained 100% of his hearing power and claimed that he can listen to whisper over 10m and the summer breeze just behind him.....
After effect of the treatment
    As the patient has loss about half of his hearing power in recent years, time is needed for the adaptation. In the computer centre, the patient can't tolerate the noise from the students which is totally different from the tolerance before. Physiotherapy of the ear like progressive sensory stimulation was recommended. Protective covering of ears should also be minized by frequent reminds. The patient also suffered from mild neck pain as he habitually rotate to the side where the hearing power is better, so neck physiotherapy like cranosaccral therapy and myofascial release are also necessary. Talking with the patient in extremely loud noise is prohibited forever.  Moreover, several patient's friends were scared to vomit when they saw the speciman, so public showing of the speciman is strongly recommended.
Discussion
    The treatment was very successful and 'fruitful' but after effects should not be ignored. Suffering from decreased hearing power for nearly a year, the patient needs time to adapt and the rehabilitation phase will be quite long. Support from others like friends, girl friend is the key to successful rehabilitation. Frequent cleaning of ear with a metal rod is strongly recommended daily. However, as the patient also suffers from juvenile dementia, he may need frequent remind in doing so.
     The patient appreciate the remind of his friends and girl friend of frequent reminding of seeking medical help after the blockade. He can now listen to the summer breeze, whisper of others and no need to rotate his neck to listen clearly like a deaf guy.

Acknowledgement:
University Health Service, The Hong Kong Polytechnic University, Yuk Choi Road, Hung Hom, Kowloon.

Journal of auditory canalogy and ear rehabilitation
8th May 2001  All rights reserved
 

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