The Cochlear™ baha® hearing system

The Cochlear™ baha® ( bone anchored hearing aid ) sound processor system has been successfully used to treat specific hearing conditions in Hong Kong since 1996. The technology translates sounds from a hearing processor, through a titanium implant, to the cochlea or inner ear. The vibrations received are perceived as sounds, and the patient “hears”.

Today, for the surgeon and the baha client, this simply translates to a direct bone conduction hearing system that is:

• surgically simpler with the Hong Kong incision,
• faster with single stage surgery,
• earlier for baha use with improved implant coating technology and design, and
• higher in fidelity hearing performance with the latest series of digitally programmable hearing processing systems.

                     





Currently the indications by clinical condition for the baha hearing system include any of the following:

Conductive hearing losses e.g. congenital aural atresia, mastoidectomies
Mixed hearing losses e.g. post-irradiated nasopharyngeal cancer patients with hearing difficulties
One-sided total hearing losses ( or medically, single sided deafness, SSD)

How do we know if a patient will benefit from the baha processor. Simply we let them try it with a softband. If they like it, they are potential candidates for….

the only hearing implant system that “you can try before you buy”.

The Cochlear™ baha®  hearing system…..now, how much easier can it be!




Dr Gordon Soo, MD

















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.

Blocked nose (nasal obstruction) – Part Two

Q: Why does my head feel heavy, and sometimes I experience pain between, above and/or behind the eyes, when I am blocked and sneezing?

A: The sinus openings and linings inside the nose, are the same as the nose itself. Hence a rhinitis (inflammation of the nasal lining) is indistinguishable from sinusitis. In fact ENT physicians usually called it by its proper condition i.e. rhinosinusitis.

When the sinus openings are blocked by the inflammation, and they themselves are inflamed, the sinus pressure drops. This negative sinus pressure results in pain and heaviness around and behind the eyes, because the sinuses are all surrounding our eyes. Sinus pressure pain is characteristically worst especially if we put our heads between our knees or bend down to pick something up.






Q: I feel tired in the morning and unrefreshed, even though I have had a good 8 hours of sleep? 

A: Quantity sleep is not the same as quality sleep. If your nose is blocked due to enlarged turbinates, the turbinates are going to even more engorged when lying flat. When one’s nose is blocked, we then have to breathe through our mouth.  Although the mouth is a much larger airway than the nose technically, it can obstruct if the tongue is drawn back during deep sleep, or the tonsils are enlarged. Hence our oxygenation drops intermittently and disrupts our sleep pattern, depriving us of quality sleep.






Q: And my mouth always feels dry in the morning?

A: With a blocked nose, we have to open our mouth to breathe. It will inevitably be dry in the morning.
Mouth-breathing, especially if persistent, predisposes to recurrent sore throat, recurrent mouth ulcers, bad breath and increased dental caries and gum disease.







Q: My spouse / partner tells me I snore heavily. I notice this especially when my nose is blocked. Why?

A: Air passing from the nose to the lung, needs to navigate a gauntlet of structures. In the nose, the structures are relatively fixed, and it is either open or blocked. Nothing vibrates.
But below the nose, the air flows and  passes through

   behind the soft palate and uvula,
   between the tonsils,
   behind the tongue and then
   behind the epiglottis.

All these structures are relatively mobile. They can, and do vibrate according to the airway pressure changes when we breathe in, and especially when the nose is blocked during sleep. When each of these structures vibrate, they emit their own resonant sound like “ a flag furling in the wind “. These different vibrating structures create their own “symphony” of the snore, and the music of the night!








Q: I just feel tired all the time and forgetful, with the blocked nose!

A: This is again related to the poor quality of the sleep.
You should speak to your ENT Physician to assess the underlying blocked nose, and to further assess if there is significant obstructive sleep apnea that requires further management.






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.

Blocked nose (nasal obstruction) – Part One

A blocked nose is the commonest symptom described. It can either be intermittent or persistent.

Causes are many and varied. They include allergy, viral infection, injury to the nose, a bent septum and nose, etc.

The function of our nose is to clean, filter, humidify and warm the environmental air before it reaches our delicate lungs. This function is suitably served by the turbinates in the nose and especially the inferior turbinates. 



If the environmental air is polluted or carries allergens to which a person is sensitive, the nose responds immediately by increasing blood flow to the turbinates. The effects are predictable, and actually physiological i.e. normal responses of the body  :


1. The turbinates swell to prevent the polluted air from entering the nose and lungs ("Doctor, my nose is blocked")


2. The improved blood flow increases nasal secretions, that attempts to cleanse the nose (" I have a running nose and it drips down the back of my throat ")


3. The nasal sensations are heightened, causing the nose to expel out the pollutants/ allergens forcibly ( "I sneeze a lot")

If the condition is an acute viral inflammation, other signs of viral infections are apparent e.g. fever, muscle aches, headaches, tiredness. Viral infections however last only a few days, and usually the average person contracts this 1-2 times a year, usually during the Winter season.


However allergic, vasomotor or pollution-related type rhinitis (inflammation of the nose) happens every day, or predominantly throughout the year, without fever or aches, are more common.  This is the nose reacting to the constant presence of pollutants, allergens, etc.


The treatment for the nose condition depends entirely on the most likely cause, and is best discussed with your physician. It includes conservative treatment as well as surgery to improve the nasal airway diameter.











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.

Nose bleeds (Epistaxis)

Nose bleeds are quite common. The majority of nose bleeds are idiopathic; that is to say we do not know the cause. But that is alright as long as the cause has been sought for, and importantcauses excluded.

The majority of nose bleeds occur in the front of the nose called the septum and turbinates. There are a variety of reasons for nose bleeds:

Nose picking habit

l   Nasal allergy that increases the inflammation of the nose

l   Distorted nasal anatomy like a deviated nasal septum

l   Surgery or major trauma to the nose

l   Tumors and growths (these do not generally cause frank nose bleeds but rather blood-stained nasal discharge)

l   Blood thinning medication usually taken for stroke prevention and hypertension

Nose bleeds are more common in extreme weather conditions and during rapid weather changes especially when the air gets both colder and drier quickly.

Trivia: Why does cold and drier air makes the nose to bleed more?

How to stop a nose bleed?

Lean forward, open the mouth to breathe and apply firm pressure to the soft lower third of the nose (essentially squeeze the bottom half of the nose together so you cannot breathe through the nose at all). By doing this, you are applying firm pressure to Little’s area (the area where the little finger can touch inside the nose and where Keisselbach’s plexus of blood vessels confluence) and where the majority of nose bleeds occur.

Trivia: Why is Little’s area named as such?

By tipping your head forward and down by at least 20 degrees, blood will not run back down to the throat and make you cough and splutter. Also you will be fully aware of any continuing bleeding and the amount of blood loss.

Trivia: What anatomical reason requires us to tip the head forward by 20 degrees? Why not just sit straight?

Hold this for 20 minutes (normal blood will coagulate after 5 minutes and holding longer gives it a margin of security). If available, suck an ice cube as well.

Trivia: How does sucking ice help?

If you are taking blood-thinning drugs like Warfarin, Aspirin, Plavix, Pradaxa, etc., you will need to continue pressing for longer.

If the bleeding persists, especially down the back of the throat, then the bleeding area is most likely at the back of the nose. In this case, an Ear, Nose & Throat Specialist or hospital care should be sought immediately, as the bleeding is less likely to be controlled by your own applied pressure in the front, and may recur later. Bleeding from the back of the nose also tends to be more profuse as the bleeding points are nearer the feeding arteries with a higher pressure.

After the bleeding has been arrested, an endoscopic nasal inspection would be advised especially if this has been a recurrent event.

Reference: www.entific.com.hk/

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.

Nose bleeds in children

Children commonly experience nose bleeds. This occurs for all sorts of reasons but generally children have thinner nasal linings that can break

For children, it is because their nasal lining is thinner and they may have an underlying nasal allergy that:

·         makes them sneeze

·         makes them rub their nose

·         blocks the nose so there is more turbulence and drying

One, or all of the above, causes the fine blood vessels of the Little’s area to rupture and bleed.

Treating nose bleeds in children is relatively simple. If the cause is nasal allergy, that should be adequately treated. Thereafter persisting nose bleeds would require a more comprehensive examination to exclude less commoner causes. Sometimes a troublesome engorged vessel/s may require sealing.

Reference: www.entific.com.hk/

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.

隆鼻失敗 揭面皮矯形 (下)

面部整形「不能做回頭」

康志輝續稱，面部整形「不能做回頭」，又指美國歌星米高積遜的鼻就無醫生敢再碰，他建議市民整容前要慎重考慮。

該學系助理教授洪致偉亦說，曾接收一兩名在內地整容的病人，鼻組織植入矽後發炎，求診時，矽更從鼻孔中掉下，需要接受手術。

除了整容失敗，接受鼻形矯正術的人還包括因意外或運動而鼻創傷的病人。洪表示，無論因整容失敗或鼻創傷而導致鼻部變形，若鼻骨不正，都會影響鼻功能， 病人因呼吸不暢順會用口呼吸，結果引起口乾、喉痛、口氣、蛀牙和鼻鼾，嚴重者會導致睡眠窒息，而且每逢天氣轉變，或置身於有塵埃的環境，都會如鼻敏感般打噴嚏及流鼻水。

固定手術難完全改善鼻功能

「鼻中隔骨鼻形矯正術」屬大型手術，洪致偉指出，以往鼻創傷的常規治療是簡單的固定手術，但愈來愈多數據顯示，固定手術不能完全改善鼻功能及外觀。

中大醫學院外科學系在02年7月至05年6月期間，在威爾斯親王醫院訪問了62名因運動、襲擊、交通意外等造成鼻創傷且接受固定手術的病人。調查發現，有13名病人（21％）在手術後仍然鼻塞，8人（13％）不滿意鼻子仍然變形。

參考資料:www.mingpaohealth.com/

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。

隆鼻失敗 揭面皮矯形 (上)

醫生﹕整容難逆轉須三思

鼻子是面容對稱的界線，故坊間的整容中心多以「隆鼻」為重點。不過，中大醫學院的耳鼻咽喉專科醫生發現，坊間的隆鼻手術，打針將外物注入鼻組織後，可能造成鼻塞、發燒、發炎甚至細菌上腦，曾有女病人隆鼻後不適要入院接受大型鼻形矯正手術，揭開面皮重新「大修」。醫生指整容效果難以逆轉，建議市民整容前要慎重考慮。

打針注入「什麼物質都有」

中大醫學院外科學系耳鼻咽喉科主管唐志輝及名譽臨助理教授蘇明順均表示，曾有病人在坊間整容中心隆鼻，在鼻軟骨組織之間插放了矽，或打針注入物質，「什麼物質都有」，導致鼻骨變形，鼻塞、發炎、鼻腫流膿，需要接受「鼻中隔骨鼻形矯正術」，抽開面皮，「像打開車頭驗車一樣，由頭到尾執過」，修復鼻中隔骨及軟骨。

唐志輝指出，外國曾有整形不當的病人，鼻組織嚴重發炎，令細菌上腦，結果失明甚至死亡。

參考資料: www.mingpaohealth.com/

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。

Hearing Loss (2)

Hearing loss in adults

Hearing loss may be acquired later in life. Causes include the long term sequelae of childhood ear infections like a perforated eardrum or cholesteatoma and hearing loss secondary to aging, ototoxic drugs application, noise-induced loss, barotrauma, occupation related noise exposure, ear surgery or intracranial brain surgery, intracranial tumours, unexplained sudden hearing loss, etc.

 

Hearing loss in one or both ears

Hearing loss can happen in either one (unilateral) or both ears (bilateral). Different hearing problems may co-exist in the same ear or in both ears. The severity of the hearing loss for each ear may vary from a mild loss (cannot hear someone whispering into your ear) to a profound hearing loss (cannot hear someone shouting into your ear) and anything in between.

Patients with a unilateral hearing loss, normal hearing ability may exist on the other side. These sufferers tend to hear only in one ear, and therefore fail to be able to stereo-localise sounds as other normal individuals i.e. they cannot tell the direction of sounds. They also particularly have problems in any noisy environment, such as in a meeting, restaurant, bar, etc. Here the voice of the speaker they are trying to listen to, competes with the noise of the background, which drowns it out. Hence it is hard for them to concentrate on one sound source and listen clearly. Certain adaptations in lifestyles are essential like cocking their heads to one side so the better hearing ear hears what is being said, walking always with friends / family standing on the side of their good ear, attending meeting early to sit in a position that would be advantageous to hearing better in the meeting, etc.

For patients with bilateral hearing loss, usually caused by noisy working environment over time and aging, they require a louder volume of sound stimulus in order to hear better. Turning the television, hifi, or radio up louder appears to do the trick but their family, friends and neighbours may, and do, find it disturbing.

 

 

 

 

Reference: entific.com.hk/

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.

Hearing Loss (1)

Causes of hearing loss

Hearing loss, is the loss of sound sensation and discrimination ability. It can be sudden or gradual. This loss can also be divided into two categories as either congenital (inborn from birth) or acquired hearing loss.

Congenital hearing loss is an hearing deficit since birth.

Acquired hearing loss happens later after birth. Some of the commoner causes are aging, trauma, long term exposure to loud noise, surgery of the ear/brain, infections in the middle or inner ear, and ototoxic drugs.

 

Hearing loss in children

Hearing loss in children is more commonly seen than in adults. This is because acute suppurative otitis media, which is an infection of the middle ear cavity, is the commonest infection of childhood. It occurs after an upper respiratory infection. The majority of these infections subside completely but it is not uncommon that some persists as a collection of a straw-colored fluid in the middle ear. This fluid has the consistency of “glue”, and when present, prevents the eardrum from moving normally. Hence children with acquired “glue-ear” will have a reduction in their hearing similar to water getting into their ear/s after a shower. This condition can exist in one or both ears.

In children, hearing losses should be investigated and treated as early as possible. This is especially true for children aged up to 7 years old as our speech and language development occurs in the first seven years of life. It is accepted that speech and language rehabilitation becomes more difficult and less successful, the later the hearing loss is diagnosed, and after optimal treatment.

 

 

 

Reference: entific.com.hk/

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.

Principles of Asian rhinoplasty

The final result of any Asian rhinoplasty procedure is ultimately a function of the client's preference, the local/racial aesthetic sense, the available donor/synthetic materials and the surgical planning and execution. The surgeon is often faced with the dilemma of choosing from the different techniques and available materials in achieving the desired result for his client with a minimal complication rate.

As mentioned previously, the typical Asian nose lacks tissue in general, both internally as well as externally. The principle of approach for the Asian rhinoplasty is to augment the nose i.e. to increase its radix height, its dorsal height and to project the tip. Tip up-rotation and excessive nostril show should generally be avoided as discussed in our later subchapters. In order to add to the existing structure, additional augmentative implant materials are required. A list of augmentative implant solutions are listed below. This list is illustrative and not intended to be exhaustive; it will change as improved product technology comes to the market.

Autologous grafts

Septal cartilage
Conchal cartilage
Costal rib
Autologous fat
Fascia e.g. temporalis fascia, tensor fascia lata
Bone eg iliac crest, calvarium
"Diced cartilage" in temporalis fascia

Homografts

Tutoplast (Processed human fascia)

Xenografts

Permacol (Porcine dermal collagen)

Reference: www.rhinoplastyarchive.com/

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.