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Nakayla’s Preauricular Sinus Infection Part IV

July 17, 2020

So back in late 2013 and early 2014, we contemplated surgery for Nakayla’s ear, which we didn’t go through with eventually. Fast forward to 2019, the infection returned and it was worse than the first time round.

I would love show you a photo of the infection, but I don’t think many will appreciate it. If you have seen the one she had when she was a baby, imagine it a whole lot bigger, more purplish than pink, with pus leaking out. How it became so rapidly horrifying overnight, we’ll never know.

She took antibiotics for it but it didn’t work, so we went straight to KKH A&E where an incision had to be made to remove the pus. This was a very painful and very traumatic period for Nakayla. I’ll never forget the look on her face and how she cried her lungs out while looking at me as they injected her with ketamine, the sedation drug. It was necessary but it really broke my heart.

The surgery went well, but soon after, baby girl started vomiting. Apparently, her stomach wasn’t as empty as we had thought and this was after I gave a later than I remembered timing to the doctors, just to be sure. She had to go on drip as she was losing too much fluid and even the medication to curb the nauseousness didn’t help. Fortunately, she regain her strength and was pretty much her normal self after about an hour of being on drip.

After returning home, we had to ensure that the wound remained dry and we had to return to the hospital daily for about a week to change the dressing.

Something that I failed to do (cos honestly, it really didn’t occur to me) was to give her ibuprofen before going for her appointments. I hadn’t realize that it will help ease the pain, until one of the doctors brought it up. I could’ve saved her so much agonizing pain! But she’s such a trooper for remaining still throughout the cleaning process!

After the infection was completely gone, we scheduled for surgery to remove the ear pit – the cause of infection.

The hubs managed to join us in the morning, before he went off to pick Blake up from school. And I was so glad he came with us cos I told him I don’t want to go through the sedation process again. But according to him, it wasn’t anything like what I experienced cos this time round, it was GA, so all she had to do was breath it in.

Also, this time round, we took extra care in making sure she fasted longer than the stipulated time. Nakayla even forgo drinking water altogether cos she did not want to go through the same thing again. But the result of that meant that she was rather weak after the surgery too. Thankfully, the nurse gave her milo and biscuits when she woke up from GA, which made her feel better.

After they made sure she could walk steadily on her own, we went home. We had a few more follow-ups with the doctors till December, to ensure that the wound was healing well, before she was officially discharged from the hospital. All in all, it took a good 4+ months for us to finally close the chapter on this.

Or so we thought.

Blake came to us the day after Nakayla was officially discharged and showed us his ear. For the first time ever, his ear pit got infected. Fortunately for him, we went through it once with Nakayla, so our actions were a lot swifter, and I knew exactly what actions to take immediately.

First to SingHealth Polyclinic to get a referral latter, then straight to the specialist at KKH, antibiotics to clear the infection first, then scheduling an appointment to remove the ear pit completely.

His process was a lot faster and smoother. I even brought him for a haircut before the surgery, to remove side burns and hair in that area so that the removal of dressings won’t be so painful. It also helped that his infection didn’t look as bad as even Nakayla’s first infection. And within 2+ months, he was officially discharged from the hospital.

Now with both their ear pits removed, the risk of re-infection has also gone down significantly, and I’m so glad that this chapter is really closed for real this time. Finally.

* Notes *

1. One of the specialists we consulted at KKH has actually advised us to have the ear pit remove at first infection. When I mentioned that years back, the specialists at KKH told us we could take a wait and see approach, he said the number of re-infection cases have actually gone up, so now, their advise is to have it removed after the first infection has cleared up.

2. Both Nakayla and Blake’s day surgery to remove the ear pit can be paid using Medisave. The amount paid is in the region of $800-900. This is the subsidized rate for locals (as of Jan 2020). For insurance, it’s best to check with your insurer.

3. I’m not sure if this is the only way for locals to get a subsidized rate, but just to be sure, I brought both children to a SingHealth Polyclinic first to get a referral letter to KKH.

  1. Thanks for sharing this! I’ve been trying to find out the approximate cost for this in Singapore for the longest time and just couldn’t find anything helpful. Only “doctor will give you approximate price upon consultation” :'(
    Now I know how much approximately I need to get ready/save up/ check with my insurance.

    1. You’re most welcome! I’m not sure if the prices have changed since, but do check your insurance and save more than the range provided. If you have medisave, and somehow insurance won’t pay for it, you can use that to pay for the surgery too. Consultations for follow-ups are not included in the range but you can use funds from the baby bonus accounts to pay for it.

  2. Hi! Firstly I’m super thankful for this post! I’m considering getting my preauricular sinus removed too; would like to ask: how much did it cost, and how long did it take to get a referral letter? And after getting the referral letter, do you just make an appointment with a hospital’s ENT outpatient clinic?

    Thanks so much in advance! Sorry if they’re super stupid questions because I hardly go to polyclinics or hospitals.

    1. Hi Eliza, you’re most welcome. I decided to share cos I couldn’t find anything on this when Nakayla first got infected back in 2013/2014. I’m glad that it can provide some insight, albeit maybe a little outdated now.

      To answer your questions (no such thing as stupid questions!)… The cost for the surgery varies. The children had their surgery done at KKH and I was given a range from as low as $800+ to $1000++ (price after subsidy for locals) but it could end up costing more, depending on what happens during the surgery. I’m not sure if the prices have changed since as this was almost 2-3 years back. Both my children’s surgeries also cost differently – one had it done 6 months earlier and they were operated on by different surgeons. Also, assuming you’re an adult, I don’t know if adults and children have a different price tag at different hospitals.

      Regarding the referral letter, are you currently having an infection now? We only went down to SingHealth polyclinic to see one of the doctors to get a referral for it when an infection happened. Waiting to see the doctor to get a referral letter could take as short as 30mins to as long as 2 hours – depending on the number of patients that day. If it’s your first time at that the polyclinic, you’ll need to include time to wait for your turn to register with them before getting a queue number to see the doctor. If you’re already registered at a SingHealth polyclinic, you should be able to book an appointment via the app. That’s what I did for my children. After getting the referral letter, there’s a counter you can go to within the polyclinic to make an appointment with an ENT specialist. The staff there will assist you.

      Please note that our experiences were all pre-Covid days, so I cannot guarantee that it works the same way now, due to all the measures and restrictions put in place to curb the virus.

      1. Thank you so much for your thoughtful reply, Mabel!! This really helped alot! <3

        Yes, I'm an adult, and the reason why I'm considering getting it removed is because I recently had an infection (though it wasn't as bad as your kids'). There is no more pain but the localised swelling was still there, hence I visited my Family doctor. He presented the option of surgery to remove the sinus, but because the Covid situation is so severe now, he actually advised me to wait a few months to decrease contact risk at hospitals (I've lived with it for so many years, what's a few more months right?). As such, I didn't enquire about a referral letter at that time. In hindsight, have neglected to ask him properly about the future procedures to take, from getting a referral letter to actually seeing the ENT specialist, which is why your post was really helpful!

        The clinic I visited was a CHAS clinic so my doctor could very well be able to get me a referral letter instead of having to head down to a polyclinic, but I'll need to confirm on this again. (To be safe, will probably just suck it up and head over to a polyclinic :D) Thanks for the heads up about the pricing, greatly appreciated once again!

        Stay safe during the pandemic!

        1. Hi Eliza, I’m glad to be of some help 🙂

          Maybe you can call your family doctor and ask if the referral letter they issue will have the same subsidy benefits as those from polyclinic? I’m not exactly sure how all these referral letters and subsidies work, I normally just take the safer, and probably longer, route just to be sure. Cos the first time we went down to KKH without anything, back in 2013, the quote given to me was $5+k… I remember being so shocked by the price that we decided to take the wait and see approach. It was only much later when I found out about polyclinic referrals and subsidies (even free/subsidized vaccinations for babies and toddlers – could’ve saved me so much money!)

          If the referral letter from your family doctor gives the same subsidies and benefits, just get it from him. You can cut so much waiting time at the polyclinic!

          1. Hi again, Mabel!

            Yes, I definitely will take up your suggestion! My brother and I will be paying our family doctor another visit soon for our annual flu vaccinations. I’ll ask him about it when the time comes. 🙂

            Meanwhile, during my last visit, my doctor actually checked in with me asking whether I’ve had my HPV vaccine (for preventing cervical cancer). He mentioned that since around last year, the government has been providing subsidies for the HPV vaccine for females aged 9 – 26. I’ve had mine, and if Nakayla is of age and hasn’t had hers, just a friendly sharing that this might be a good time to get it!!

            Thanks for your help thus far! Sending love to you and your family. <3

          2. Oh! I didn’t know HPV vaccine can be taken at such a young age! When I first found out about it a few years back, I wasn’t eligible for the subsidy already… Hahaha! I only took note of the later age, not the minimum. I’ll have to go find out more about it. Thank you for sharing!

            I hope you’ll be able to get the surgery done soon and safely. Sending love to you and your family too! Take care!

  3. Thank you so much for sharing your experience with us. My daughter is 7 years old and she’s going through the first infection due to the preauricular sinus. Currently she’s taking antibiotics but I’m worrying that we will have to go to KK for sedation and to remove the pus. It is heartbreaking to imagine the pain she will have to go through 🙁

    1. Oh dear! I hope the antibiotics will be able to clear the infection! The sedation process to drain the pus is truly heartbreaking, but necessary, if antibiotics are not able to clear it. As for the cleaning process, after draining the pus and surgery to remove the tract, just don’t be as blur as me… Give your daughter some ibuprofen before her appointment and the pain will be reduced! I only found this out towards the end of the daily cleaning, when one of the doctors asked if I gave Nakayla some before she started on the cleaning. I had no idea!

      Fortunately, as they are still young, they heal really fast and it’ll all be over soon! Wishing your daughter speedy recovery!

      1. Hi Mabel, thank you so much for your kind reply! After having the antibiotics for three days and still no improvement in the infected area, I decided to visit KKH again. So we went to the hospital on Thur morning and luckily I met a wonderful doctor. She suggested that instead of sedation, maybe they can try to give anaesthetic injection close to my daughter’s infected area, then proceed with the incision and clean the pus. The doctor explained the situation to my girl, to my surprise, my girl agreed to go for the anaesthetic injection. It was not easy watching my brave little princess to go through the fear and pain, I know she tried so hard to hold her tears 🙁 After the treatment the doctor gave us painkillers and suggested my girl to take the medicine half an hour before the visit to change the dressing. And yes I think the painkillers worked today, so although it was still quite painful but my girl said it was not too bad. Thank you Mabel again for your posts, they really helped me to figure out what the procedure will be, and I definitely felt less fear after reading your posts! Thank you, thank you, thank you! God bless you and your lovely family.

        1. Hi Rosa, I’m glad that your daughter was able to undergo a less scary route for the pus removal and the change of dressing! She’s most definitely a brave girl! Wishing her speedy recovery!

          Also, thank you for sharing your experience as well. It will definitely help others who might chance upon this article for the same reasons!

          May God bless you and your amazing family too!

  4. My gal had her re infection the 3rd time. She was on antibiotics and on day 3, e pus burst out. But it didnt drained all out. So subsequently day 4 also drained some pus as well as day 5. Now her antibiotics had finished. The area is still red and purplish. I dont know if i should consult ent or back to e same pd tat issued her antibiotics. Whats your thoughts?

    1. Hi Hui Chin, I think you should bring your daughter to KKH A&E and let the medical team there take a look. When Nakayla’s infection didn’t get better after the first reinfection, even after the first course of antibiotics, we went straight to KKH A&E and they advised us to drain the pus out that very day.

      1. This afternoon i brought her to ENT dr. Dr ask to continue antibiotics for a week and review. He also suggestion to remove the pit when the infection subside. I really not keen but at the same time worried about the re infection.

        1. Hi Hui Chin,

          Based on my experience, and what the KKH doctors told me when I asked them during Nakayla’s multiple trips to the hospital back then, once the ear pit gets infected, the chances of reinfection is very high. They used to take a wait-and-see approach, but because the ENT doctors have seen a rise in reinfection cases, they now advice to remove the pit upon first infection. Seeing how this is the 3rd reinfection for your daughter, I think it’ll be a good idea to follow the doctor’s advice to remove the pit.

  5. How was your children after the surgery? Was there visible scarring? Their performance still same as the past right? Hows the post surgery care?

    1. Hi Hui Chin,

      Nakayla’s recovery from the surgery was a tad slower than Blake’s, mainly because she had a a terrible reinfection that involved draining of pus before she could have the surgery to remove the pit. Blake’s case was a mild first infection.

      There is a small scar at where the ear pit used to be but it’s not that obvious. You’ll have to go really near in order to see it.

      Their ears work just as they used to. No issues at all ☺️

      Post surgery care was relatively easy for both children as we just had to keep the area clean and dry and return to the hospital for follow-ups. You can double check with the ENT doctors on the post surgery care. Nakayla’s case was a bit more severe, so she had to return to the hospital a few more times, just to make sure everything is ok. Blake only had one more follow-up after the surgery before given the all clear.

      1. Thank you so much for the input. Will check in with e dr when i go back for follow up. It was very helpful 🙂 may you have a good week ahead.

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