耳膜修補手術

在進行耳膜手術前需進行聽力檢查，檢查聽力受損的程度。一般來説，大面積的耳膜穿孔，以及中耳骨受損的話，聽力受損會比較嚴重。手術方法則要視乎病人的情況。如穿孔面積很小，如針孔一般(Pinhole Perforation)，醫生會在患者耳後抽取脂肪粒，填補穿孔位置(Fat Plug Myringoplasty)，讓其自然癒合。

一般而言，成人只需局部麻醉便可。若穿孔面積達耳膜的二至三成，則要在耳道前開一道約1厘米左右的切口(Endaural split)，取出顳肌膜（Temporalis Fascia）填補耳膜。事實上，由於耳膜穿孔邊上的三層組織會因黏連在一起令穿孔不能癒合，因此手術時醫生會先把穿孔邊上的粘連切掉，才在耳膜底部填上顳肌膜作支撐。手術後患者需有充足的休息及暫時不能乘搭飛機。大部分患者在一至二個月內便可痊癒，而此手術的成功率高達八成半。

然而，若穿孔面積大，至7至8成或以上，則需在耳後開一道切口(Post-Aural Incision)進行耳膜修補手術。其方法跟上述一樣，但所用的時間較長及傷口會較大，由於傷口在耳殼後面不容易看見的位置，因此不會影響外觀。手術後一天需在傷口上敷上紗布及用綳帶壓住，以防止滲血的情況。一般術後7天便可拆線及拆除耳道内的敷料。


最後，在修補耳膜時，醫生亦會為病人檢查中耳骨的情況，因中耳內共有三個互相連接的耳骨(Ossicles)，以幫助聲音傳入內耳。因此若耳骨移位或碎裂，便會導致傳導性失聰(Conductive Hearing Loss)。情況較耳膜穿孔更嚴重。

在不能修復的情況下，便需要做耳骨重整手術(Ossiculoplasty)，以人工耳骨替代原來耳骨，使耳朵系統(聲音傳遞鏈 – Ossicular Chain)得以收復，從而改善聽力。痊癒期需兩至三個月，若效果理想，病人的聽力會接近正常。重要一提，修補好耳膜後，外耳及中耳被隔開，便可避免因沾水而增加患上中耳炎的風險。要知道中耳炎嚴重者，會有機會誘發併發症如腦膜炎、腦膿腫等，危及生命。因此大家要好好保護耳朵。






資料來源： www.entific.com.hk/eardrum-surgery.html
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
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耳膜破裂原因

導致耳膜受損的成因眾多，最常見的是採耳（俗稱挖耳）或是耳朵受到巨大的撞擊，令耳膜受損。

先說採耳，常有病人問應使用那些採耳用具較為安全? 事實上，耳垢是耳道內脫落的皮膚、分泌物及毛髮堆積而成的，它會隨著皮膚生長由內向外推出，並排出外耳道，所以我們並不需要採耳，當耳垢排出外耳道時清潔便可。而坊間最常用的採耳用具如棉花條及耳挖，兩者均有弊處。前者因體積太大，在使用時容易將耳垢往耳膜方內推，日積月慮下耳垢便不容易排出，嚴重時更需要醫生清理。而耳挖則較少出現上述情況，但因體形尖硬的關係，較容易挖損耳朵，而相比棉花條，耳挖亦較易刺穿耳膜。


至於強大的撞擊或壓力會令耳膜穿破。例如跳水時耳朵衝入水裡，耳膜有機會受到水的撞擊而穿破；又或是乘坐飛機時有部分人士會感到耳鳴或耳痛(特別在於感冒前後)，這是由於連接中耳與鼻腔的耳咽管受到阻塞，中耳平衡失調在壓力下導致耳鳴或耳痛，期間有人會透過反壓動作以解決問題（即按住鼻翼同時用力呼氣，讓耳咽管打開），但有時效果不然，反而會因用力過度導致耳膜破損。


如何得知耳膜破損?

不少人誤以為耳膜受損會即時失去聽覺，事實並不然。不過耳膜的傳聲能力會因而減低，聽覺能力減弱，其程度要視乎穿孔的大小。小則降低約2成聽力；大則降低3至5成不等，此情況稱為傳導性失聰(Conductive Hearing Loss)。一般來說，這並不是失去聽覺。當然，極大撞擊如車禍所造成的耳膜穿破、耳骨鬆落及神經線受損等，其失聰程度會更為嚴重。另外，其他症狀包括排出分泌(如血水)、耳鳴、耳內有風聲(氣流通經過耳膜穿孔的聲音)、微痛及頭暈等。

若不幸耳膜受損，應立即求醫。醫生會因應成因作出適當的治療。若成因是採耳，醫生除清理外耳道的耳垢外，亦會向病人使用抗生素滴耳藥水，以避免中耳及耳膜受細菌感染而發炎。一般情況下，耳膜就像人體的皮膚般可自然癒合，但如是中耳發炎，則加劇聽力受損及引起併發症，而耳膜發炎使傷口難以癒合。因此，避免發炎是非常重要的。治療後，觀察期一般為3個月，期間要小心保護耳朵，避免沾水及採耳，和使用醫生處方的滴耳藥水等。若3個月後情況沒有改善，便需要進行手術治療。





資料來源： www.entific.com.hk/eardrum-upture.html
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。

耳鳴成因

 


曾有病人說：「醫生醫生，我成日都聽到些怪聲，是否患有耳鳴？」

耳鳴簡單可分為外在及內在兩種因素，以後者較為常見。內在因素指耳朵在沒有外來聲音的刺激下感覺耳內有聲響；外在因素的情況相反，指耳朵聽到一些微小但實在的外來聲音。

導致內在耳鳴的成因眾多，但無論是什麼原因，均與患者的腦部中樞神經系統有關連。這是由於耳蝸或耳朵神經產生異常訊號到大腦，使它誤以為有聲響。另外，在訊號傳遞中，因接觸到腦部負責感覺、情感的腦部邊緣系統 (Limbic System) 及自主神經系統 (Autonomic Nervous System)，患者的情緒往往因而受到影響。與此同時，耳鳴在情緒反應下亦有機會因而加重或減弱。

內在因素導致的耳鳴可分為五大類，包括：

(一) 耳朵問題 － 退化、耳水不平衡、耳骨硬化或發炎及耳垢堵塞等。
(二) 神經線受損 － 頭或腦部受傷、神經線上長出良性神經線瘤等。
(三) 感染 － 內耳神經受到感染或腦膜炎。
(四) 藥物 － 某些藥物可引起耳鳴，如阿士匹靈或抗抑鬱藥等。
(五) 其他 － 顳下頷關節(俗稱:牙骹)出現問題

治療前，耳鼻喉專科醫生會檢查患者的耳朵是否有明顯症狀，如耳膜穿孔、中耳及頸部有否出現不正常的血管、聽覺受損、神經或牙科問題等。之後會檢查患者的聽力，當中包括聽力測驗及耳鳴音量配對(將耳鳴音量及音調與外來聲音進行配對)，這可讓醫生分辯患者的耳鳴類別及有助檢定治療前後的耳鳴情況。

如果在初步檢查中懷疑患者有內科疾病引致耳鳴，亦可通過抽血檢驗包括血色素、甲狀腺、維他命B及血糖等等。若懷疑耳鳴的成因與神經線有關(如持續耳鳴或聽覺受影響)，可透過磁力共振(MRI)作進一步的檢查。若懷疑是心跳血管性耳鳴，則可透過電腦素描檢查是否患有良性血管瘤。

至於外在因素導致的耳鳴，除了病人本身會聽到聲音外，醫生在檢查時也有機會聽到。其成因包括頸部動脈血管收窄，又或是不正常血管瘤在內耳或中耳(使如心跳聲的聲響傳到患者耳內)，上顎肌肉抽搐或患者耳朵內自身發出聲響。




資料來源：http://entific.com.hk/tinnitus-causes.html
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。

Voice Loss (Part Two)

In the first part of this article, we understand how our voice is produced, and in simple terms, how we lose our voice. Losing our voice is a problem for anyone as we are always communicating our wishes, dreams, love and needs to others.

So what can we do if we lose our voice? Firstly, we should not panic as common things happen commonly, and the commonest cause by far, is an acute viral laryngitis. The swelling from acute laryngitis is usually maximal at three days, after which the swelling subsides gradually, and the voice gradually returns to normal. During the inflamed phase, sufferers are best advised not to use their voice, as continuing voice use could damage and permanently scar the vocal cord lining. This scarring could result in a permanent hoarse voice by impairing the movement of the mucosal lining over the vocal ligaments.

Losing one’s voice is not unusual at all and most voices recover very quickly. If our voice doesn’t return to normal and you remain hoarse beyond three weeks, medical attention to make a diagnosis and to prevent long term irreversible damage would be recommended. Your ENT Surgeon can easily inspect your voice box by performing a flexible endoscopic examination of the larynx. So what conditions can cause chronic loss of voice that can be seen by endoscopy?

A growth on one or both vocal cords can prevent optimal closure of the cords. Excess air then leaks through the gap and voice production is impaired in terms of quality as well as intensity of the voice. Commonly the early formation of vocal cord nodules is the cause. Two non-cancerous thickening of the vocal cords on exactly opposite vocal cord surfaces prevent the cords from coming together well. With the leak, the voice is lost, and we try even harder to produce a voice by speaking louder. This means that the nodules can get bigger, and the hoarseness continues. Treatment here is primarily by speech therapy to re-educate the user how to use their voice better like a singer. If the nodules are too large and /or speech therapy has not worked, then phonosurgery to trim away the nodules may be necessary. If a growth is seen only on one vocal cord, then early surgery may be necessary to exclude cancer. Here the lesion is examined close up, excised and sent for testing. If it is cancerous, then follow up treatment protocols will be advised. However if the lesion looks like a cyst or a polyp under close up endoscopic examination during surgery, the lesion is removed with gentle and careful preservation of the vocal cord lining. This is called phonosurgery and requires great skill. The removal of the lesion is both diagnostic (as we sent the lesion for testing to know what it is) as well as also therapeutic (as the hoarse voice is treated as well)

A total loss of one’s voice is a catastrophe. This is unusual but it happens when one of the two vocal cords is paralysed. They are unable to meet in the midline, the gap is left wide open and therefore no turbulence or voice can be made. The cause here is damage to the nerve that moves the vocal cord. This nerve travels from our brain, down our neck pass our thyroid gland and even as far down as our lung, before turning around to innervate our voice box, one on each side. Cancer in the neck, lung cancer, strokes, penetrating trauma and surgery to the neck and thyroid are the usual causes that damage this nerve. If this is the case and recovery is not forthcoming, the voice can be improved by surgical treatment that pushes the affected cord to the center to a “closed” position. By re-siting the affected vocal cord to the midline “closed” position, surgeons allow the voice to be reproduced again when the normally functioning opposite vocal cord moves and easily close the gap. Rushing air from the lung re-vibrates the cords once again, turbulence of the air is produced and a voice is regenerated again. This particular treatment is important for these paralyzed vocal cords sufferers, as aside from a more normal voice, upper body strength is improved with an improved cough to maintain a clean and sputum free lung.

Remember, our voice is important and most loss of voice conditions are mild, short-lasting with full recovery. A persistent hoarse voice should not be regarded as normal as diagnosis is easily made with endoscopy in a clinic setting. Timely treatment ensures a good quality strong voice either by medication, speech therapy, surgery or all a combination of treatment to suit the problem.

Dr Gordon Soo, The ENTific Centre





Reference: Entific.com.hk/voice-loss-treatment.html
The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

Voice Loss (Part One)

Humans are social beings. We communicate with others using our voice as well as body language. So it naturally becomes a problem when we lose our voice.

We make our voice in our larynx. Here sit two ligaments called vocal cords, that are joined together in the front and sit apart at the back, like an open “V”. The vocal cords are covered with a soft mucosa lining, and lie horizontally immediately above our windpipe, acting as two guards protecting our airway.

So how do these two vocal cords make a voice? We need two things to occur for sound to be made. First the two vocal cords are brought together by a muscle, and at the same time, air from our lung is expelled through these closed cords. The air passing through our cords cause the mucosa covering to vibrate, and hence a sound (voice) is made. 

The pitch of this sound, our voice, is changed by other muscles tightening or relaxing the tension of the vocal ligaments. When the vocal ligaments are tightened, the voice becomes higher pitched, like when we strum a tightly stretched guitar string to create a higher note. For a lower tone sound, the tension is reduced, and a lower, more bass voice is produced. The voice of children, adult males and adult females also vary due to the size of the vocal cords and the “laryngeal” box that it sits in. 

A shorter vocal cord in a smaller box as in children produce a shriller, high tone voice whilst at the other extreme, a longer vocal cord in a bigger box of an adult male produces a deeper voice. Here the analogy is that of a child ukulele as compared to an adult double bass. The female adult voice is somewhere in between. So that is how the voice is made. Speech and language which strings sounds together to form words is different. Speech that form words of what we want to say, in the form of phonetics as well as the tone in tonal languages like Putonghua and Cantonese, comes from movements of our tongue above our voice box.

So how do we lose our voice? The commonest cause is an acute inflammation of our larynx (acute laryngitis) e.g. when we catch the flu. The lining of the vocal cords become swollen, inflamed and stiff and the inflammation causes pain when we try to speak. As air passes through the cords, the vibration is impaired. Making a sound is difficult as well as painful, and the voice changes to a very hoarse rasp or total loss altogether.

Another way that voice production can be impaired is if there is a growth on a vocal cord that prevents both the vocal cords from coming together perfectly. Conditions that could do this are e.g. cancer of the vocal cords commonly seen in smokers. These growths tents open the gap between the cords, and allows air to leak through the gap, making voice production inefficient at best, and sometimes impossible at worst.

The ultimate voice loss occurs when the vocal cords cannot come together. This is definitely an uncommon condition. We need both vocal cords to vibrate to make a sound. When one of the vocal cords cannot be drawn close, the gap between the vocal cord is too wide for turbulence of the air, and therefore sound, to made by the passing air. It is the same as when we try to whistle. We can only make a whistle with “closed” lips and not an “open” mouth. Here the reasons why a cord cannot “close” is usually due to damage to the nerve that supplies the “closing” muscle of that vocal cord.

To lose one’s voice is not unusual at all and most voices recover very quickly. However, a persistent hoarse voice or loss of voice for more than three weeks is not normal. If this continues, further medical attention for a diagnosis would normally be advised.

 .......cont'l

Dr Gordon Soo, The ENTific Centre

 

 

Reference: Entific.com.hk/voice-loss.html

The information aims to provide educational purpose only. Anyone reading it should consult ENT Specialists before considering treatment and should not rely on the information above.

唾液腺腫瘤的類別

一般而言，大部份唾液腺腫瘤都生在淺層位置，病人會察覺到耳珠下方有明顯的腫塊慢慢變大。然而，深葉唾液腺和小唾液腺腫瘤則長於口腔裹形成腫塊，因此較難察覺，但幸好大部份唾液腺腫瘤是良性的，當中最常見的良性腫瘤是多形性腺瘤。

多形性腺瘤大多出現在腮腺，其次為頜下腺，以中年女性較易患上此症。它通常是一個單一的腫塊，其質地較硬，邊界呈不規則形狀。雖然多形性腺瘤是良性，但它會逐漸變大而影響鄰近正常組織，若不切除，若干年後會有機變惡性。

第二個常見的唾液腺腫瘤是沃辛瘤，又稱淋巴樣乳頭囊狀腺瘤。這是一種生長較緩慢的良性腫瘤，男性和吸煙者較易患上。沃辛瘤一般長在腮腺尾部，其質地較柔軟及由多個囊腫物組成。相比多形性腺瘤，他們生長較緩慢，並不太具侵略性，正正是這個原因，患者往往會忽略它的存在，而任由它生長到嚴重影響面部輪廓的地步，此時，因為腫瘤太大會導致反覆出血和感染。另外，惡性唾液腺腫瘤是比較少見的，而患有乾燥綜合症 ( Sjogren syndrome)的病人患上惡性腮腺淋巴瘤的風險較高。

上文提及，多形性腺瘤患者如不切除，將來有很高的風險轉變成惡性腫瘤。所以，上述兩個情况的病人應留意自己的腮腺有否突然快速地長出腫塊，因惡腫瘤的增長速度是十分快的。其它惡性腫瘤的特徵包括：淋巴結轉移/擴散、皮膚變紅、疼痛和面部神經麻痺/癱瘓。因唾液腺內和附近藏有多組淋巴結，有時變大的淋巴結亦可像一個唾液腺腫瘤，因此，要準確地診斷唾液腺腫瘤，必須利用先進的影像掃描和細胞檢查。

所有唾液腺腫的病人都必須接受超聲波掃描。超聲掃描可以檢測及初步區分唾液腺病理和其他頸部病理，如淋巴結變化，它也可以測量腫瘤的位置和大小，並可引導微針到腫瘤核心位置抽取細胞做病理組織檢查。對於較複雜和深層的腫瘤，則需要電腦掃描和磁力共振的恊助，去達到準确的診斷，繼而降低手術的風險。




耳鼻喉專科  陳慶生醫生





資料來源：www.entific.com.hk
以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向自己的耳鼻喉專科醫生查詢，而不應單倚賴以上提供的資料。