揀睡眠偵測智能手帶5大要點 醫生見解：深層睡眠好重要 (3)

坊間的裝置未必百分百準確

就穿戴式裝置取得的數據，我們找來杏澤醫療的 耳鼻喉專科 陳慶生醫生解說一下穿戴式裝置的數據有甚麼用？陳醫生認為：「要知道一個人的睡眠模式最好就是透過偵測睡眠時的腦電波和眼球轉動，以分晰屬於那一個層次的睡眠。」然而，現在市面上很多簡單的產品都不是直接量度腦電波，而是間接量度睡眠時的生理反應，但生理反應未必只屬於某層次的睡眠，所以不是百分百準確。同樣，量度睡眠質素的方法每間生產商都不同，「應用程式所說的深層睡眠未必和醫學上所說的是屬於同一類。雖然現時有醫療公司發展到戴在手上或放在心口的儀器就可以幫病人診斷睡眠窒息，不過都不時平時在街上買到的可以媲美。」

REM sleep 夠數最重要

一個正常睡眠是大約有 4-5個循環，第一二個階段進入淺睡，到第三四個階段是深睡，熟睡到一段時間會進入快速動眼期 Rapid eye movement sleep (REM sleep) ，開始發夢。有部份智能裝置會用光線或震動控制起身前的睡眠層次，聲稱可以讓人起床更精神。陳醫生解釋在深睡時，但未到 REM sleep 起床的確會有疲倦感，不過「一般來說，我們只要著重 REM sleep 已經足夠。如果一晚已經有 4-5個 REM sleep ，在第 6個 REM sleep 中間被人嘈醒都唔使擔心。」因此，陳醫生認為只要每日睡覺都培養成規律，身體會自動瞓調節，「身體會知道自己那個時間需要醒，從而做好準備，未必需要光線或震動去控制。」

心率分析只屬輔助

另外，不少智能裝置都有心率偵測功能，到底對了解睡眠質素有用呢？陳醫生認為是有一定的幫助，但不會全部準確，因為心率有好多嘢影響。「睡眠時，心率不是唯一數據判斷睡得好不好。心率在不同層次睡眠時都很複雜。心率用於分析睡眠質素係輔助多過主力。但因為心率容易量度，所以很多公司都將功能加進去。」

解讀數據才是關鍵　有病徵要及早求醫
事實上，這類的穿戴式裝置量度睡眠質素和脈搏有多準確，但數據都只能用作提醒，不能分析病情。陳醫生解釋：「失眠原因很多，單靠手帶的數據可能只反映部份潛在嘅睡眠問題，若果應用程式無顯示有深層睡眠，可以再試多幾次，如果有明顯的病徵，例如每朝起身還是沒有精神，記憶力衰退，或者睡眠時有很大的鼻鼾，那就最好及早求醫了。」




資料來源：https://unwire.hk/2016/11/11/sleep/life-tech/health/
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。

揀睡眠偵測智能手帶5大要點 醫生見解：深層睡眠好重要 (2)

4) 螢幕光影響入睡

穿戴式裝置可以偵察到睡眠質素，而且 Gear S2 、  charge 2 及 小米手環 2 等智能手錶都有無聲振動鬧鐘，無形中鼓勵大家在睡眠時裝戴。不過，智能手錶的螢幕光亦是不可忽視的，特別是 Gear S2 這些螢幕較大的手錶。雖然靜止的時候螢幕不會亮，但未入睡前，每次轉換睡姿，螢幕都會亮起，變得更難入睡。此外，如果穿戴式裝置和手機整合，設定了在來電、簡訊和各類訊息通知時震動的話，就隨時睡不到了。Gear S2 都還好，可以設定不被騷擾模式，但 Ray 就不可以了，萬一有來電就會被震動驚醒。

5) 小型錶續航力較長

既然是手錶，日常都應該不離身，但睡眠時都要戴的話，續航力變得很重要。4者當中 Gear S2 的功能比較多，螢幕相對較大，故續航力亦最低，官方稱可用兩日，但實際只捱到一日半，所以每日都必要找一些時間來充電。至於較小型的 charge 2 可用 4至 5日，而 小米手環 2 更可用 20日，不需要日日充電。而最長氣的是 Ray ，使用 3粒原廠電池，足夠使用半年，毋需充電，最為方便。

耳鼻喉專科 陳慶生醫生
.........續



資料來源：https://unwire.hk/2016/11/11/sleep/life-tech/health/
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。

揀睡眠偵測智能手帶5大要點 醫生見解：深層睡眠好重要 (1)

有沒有發覺自己起身經常都仲好眼瞓？家人又投訴自己鼻鼾太大影響他們睡眠呢？其實這些都可能顯示了不同的睡眠問題，而最近不少穿戴式裝置都配備睡眠偵測功能，透過監測用戶的活動去判斷睡眠質素，到底這些數據有甚麼用？又應該如何選擇穿戴式裝置用作記錄最好呢？

依莉詩教你揀：睡眠偵測功能大不同

市面上有很多的裝置或是手機應用程式可以偵察睡眠質素，當中有些利用加速感應器測量用家睡眠時的動作估計用戶是否熟睡，亦有些利用咪高峰收音記錄用戶睡眠的狀態。

今次我依莉詩就針對如何選擇穿戴式裝置用作記錄睡眠質素來比較，並借來了 4款智能手錶及運動手環，包括多功能的 Samsung Gear S2 Classic、針對健康愛好者的 Fitbit charge 2、簡約時尚的 Misfit Ray 及 出名性價比高的 小米手環 2。經過數個月至數天的使用後，現在就同分享一下當中的分別啦！

1) 自動偵測入睡先方便

雖然市面上大部份智能手錶及運動手環都聲稱可以監察睡眠，不過大部份都需要在入睡前及起床後手動輸入，才能分析該次的睡眠質素，甚至有部份只能在睡醒後手動記錄睡眠時間，要每天記錄其實都比較麻煩。而今次試戴的 4款裝置都有自動偵測睡眠的功能，只要在半小時內手腕沒有太大運動，裝置會自動開啟睡眠模式，並透過肢體運動的幅度及頻率，判斷用戶處於熟睡還是淺睡狀態。

依莉詩把 4款裝置分別佩戴於左右手 3晚，各自的應用程式全部都是用深淺表示睡眠層次，量度出的入睡時間及深層睡眠的時間都相當接近，不過起床的時間就有一至兩小時的出入。以 10月 11日為例，我實際起床時間是大約 8點，但 Charge 2 及 小米手環 2 偵察到 8時左右是淺睡狀態，直到一至兩小時後才顯示真正起床。另外，小編在另一天午睡了兩小時，除了 Gear S2 有入睡記錄，其他都沒有數據，相信其他裝置是需要長時間配戴，才到準確判斷，並不能睡前才戴上。儘管 4者的睡眠監測數據有些少差異，不過大致都符合實情，所以會自動開啟睡眠模式的裝置亦不失為好選擇。

 2) 圖表顯示一目了然

基本上所有穿戴式裝置都有小量記憶體用作暫儲數天至一個月的數據，要觀看睡眠方面的記錄還是需要開啟對應的手機應用程式。在更新數據的速度和次數方面，Gear S2 比較頻密亦快速，幾乎每次開啟應用程式都已經顯示最新的數據，而 charge 2 及 小米手環 2 在開啟後會自動連接並更新數據，但 Ray 就需要手動更新，要等數分鐘才下載完成。

至於應用程式介面方面，4者都是以圖表顯示每日睡眠質素處於不同深淺的狀態，另外例出總睡眠時間、入睡及起床時間、深層睡眠時間等。當中 Ray 的資訊比較少，而 Gear S2 則比較多，更有一星期睡眠時間的趨勢圖可以參考，了解自己的作息週期。

 3) 同時偵測心率更準確

除了依賴測量肢體運動的幅度及頻率來判斷用戶處於熟睡還是淺睡狀態，要了解睡得好不好，還需要了解作息時的心率。例如發惡夢或是生病，心跳都可能突然加快，影響睡眠質素。現在市面上大部份穿戴式裝置都使用 LED 綠光偵測方式，以血紅蛋白通過時綠光的反射訊號，來計算每分鐘的心跳次數。

不過，在測試的 4款穿戴式裝置中，只有 Gear S2 、  charge 2 及 小米手環 2 有心率感應器。當中小米手環 2 只會在按鍵時才會偵測單次心率，沒有一定持續性，所以睡眠時起不到作用。而 Gear S2 只在用戶靜止的狀態，例如坐得久或睡眠時才會每小時量度一次心率，如果心跳是突然加快就偵測不到了。相反， charge 2 會每分鐘持續測量心率，所得的數據就比較起參考作用。

耳鼻喉專科 陳慶生醫生

.........續







資料來源：https://unwire.hk/2016/11/11/sleep/life-tech/health/
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。

Epistaxis / Nosebleeds – What to do

Nosebleeds can happen when you least expect it. At the very least, they are alarming especially with small children, and at the worst, possibly life threatening. So what can you do about the bleeding nose and what action should you take after it has stopped bleeding?

The first thing is to stop the “stoppable” bleeding. Bleeding that comes from the front of the nose can be stopped by pressure. All other bleedings from the middle or back of the nose stops only by your own blood clotting or with medical attention. The first thing to do in a nose bleed is place your head forward, breathe through the mouth and press gently but firmly on the soft part of the nose. This is the lowest third of the nose that you can wiggle with your fingers. Placing your head forward means that you will be less likely to choke and swallow your blood, and any continuing bleeding is clear to see. Pressure should be applied for 15 minutes and this is usually more than enough to stop the small bleed, as our blood will effectively clot in less than 3 minutes. If you are on blood-thinning medication, this can take much longer.

After releasing the pressure, if there is no further active bleeding, this suggests that the bleeding is from the front of the nose. Dry weather and a long flight travel in a dry cabin may be the cause and applying some Vaseline ointment inside the nostrils will help. Seeking the early attention of your ENT Physician would be recommended so that a good check up can be done to prevent further bleeds and treating the underlying cause. You can usually expect that the nose will be clearly visualized with an endoscope of the front, middle and back of the nose. Sometimes a scan of the sinuses may be required as the cavities of the sinuses are not usually visible to the naked eye or endoscope. If a bleeding point is identified, it can be electro-cauterized and this is very successful in preventing future bleeding in 90% of cases. If a nasal allergy causing rhinitis exists, this is also easily treated with medication.

If the bleeding is especially heavy and/or does not stop, it is usually from the middle to the back of the nose. Here the reason is because the vessels are larger and we cannot physically press on them as they are situated inside the face. Situations such as this will require immediate attention at your nearest hospital as you may have lost a lot of blood. Your attending doctor’s priority would be to stop the bleeding first. This is usually undertaken with nasal packs placed into the nose. They are uncomfortable to put in but their intention is life saving. They may then possibly refer you to the ENT Physicians to identify with their special endoscopes where the bleeding is coming from, and treat you accordingly. Nowadays modern endoscopes for the body cavities have revolutionized epistaxis care. After identifying the bleeding point, if appropriate, the source maybe cauterized.

Nosebleeds are frightening for the sufferer as well as family and friends. Thankfully the majority of nosebleeds are minor and easily stopped by pressure as mentioned above. If the bleeding is unduly heavy and does not stop, urgent hospital attention should be sought.

]

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.

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.

鼻竇炎的病因

透過上期文章，相信大家已知道鼻竇炎的治療方法，但預防勝於治療，今期將解說鼻竇炎的病因，希望讀者對此病有更多的了解。

鼻竇是鼻腔旁邊及頭顱骨內的多處空間，位於前額內的空間稱為「額竇」，而面額內的上額骨中的空間名為「上頜竇」。另外，鼻樑骨後有很多細小空間，它們分別稱為「篩竇」及「蝶竇」。鼻竇的出入口全部與鼻腔相連，在正常情況下鼻竇的分泌物會引流到鼻腔中，然後再流到後面的鼻咽，經吞嚥到達腸胃。

鼻竇炎是泛旨鼻竇黏膜有發炎情況，主要分為急性和慢性鼻竇炎兩大類。其分別在於病徵持續期長與短，通常以三個月為分界線，若持續時間少於三個月屬於急性，而多於三個月以上則為慢性。此分類法基於兩者的病因、病徵、治療的方法及治療的效果都有所不同。

急性鼻竇炎成因大多由感冒引起。當上呼吸道受到感染時，鼻膜會出現腫脹。此時，有可能導致鼻竇出口阻塞，影響鼻竇暢通，令鼻竇內的分泌物無法正常排出，再加上細菌侵入，引發鼻竇炎。其次是因分隔兩邊鼻腔的鼻中隔骨偏斜到其中一方，使鼻竇出口阻塞，引致上述情況。

此外，因蛀牙而導致急性鼻竇炎亦是一個經常被遺忘的病因。事實上，牙齒(特別是大牙的牙根) 跟上頜竇的底部非常接近，甚至有些人天生的牙根已輕微伸延至鼻竇內。因此，若有蛀牙或細菌感染時，很大機會會擴散至上頜竇，引致急性鼻竇炎。還有，急性鼻竇炎通常是單邊鼻竇受到影響，患者會單邊鼻塞，鼻涕量多、鼻水倒流及輕微流鼻血情況。另外，不同鼻竇發炎其疼痛的位置亦不同，如上頜竇發炎，臉頰會出現痛楚；而額竇發炎則會出現額頭痛。

至於慢性鼻竇炎通常是兩邊同時受到影響，患者出現兩邊鼻塞、流鼻涕及味覺可能受到影響，但一般情況下，嚴重性較急性為低。目前為止，慢性鼻竇炎的主因仍未確定，但有多份醫學研究顯示，慢性鼻竇炎跟鼻腔內局部性敏感反應有關。



耳鼻喉專科 李立言醫生





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。

甲狀腺舌骨囊腫

人體的甲狀腺是源於舌根位置的軟組織，這些軟組織在胚胎形成時由舌根轉移至喉嚨甲狀腺軟骨，此轉移管道通常會被身體吸收並於胚胎的第10週時消失。若它沒有消失，便會殘留在頸部並形成甲狀腺舌骨囊腫 (Thyroglossal Duct Cyst，簡稱TGDC)。雖然它屬於先天性的缺陷，但往往是在後天發現，亦可發生於任何年齡及性別的人士身上，而男女的發病率比例相若。

甲狀腺舌骨囊腫一般位於頸部上方的中線位置，其質地柔軟、呈圓形及邊緣界線清楚。因囊腫與舌根相連，因此它會隨著舌頭活動時而移動。

最常見的症狀是頸部中線位置腫脹，使患者在吞嚥時感到不適。如囊腫受到感染而發炎，便會有疼痛及形成膿瘡。大部份的甲狀腺舌骨囊腫均屬良性，然而亦有部份囊腫病變成惡性腫瘤，形成癌症。

若懷疑患上甲狀腺舌骨囊腫，醫生除利用超聲波掃描外，亦會進行穿刺抽取細胞檢查(Fine Needle Aspiration)，以排除其他疾病(如脂肪瘤、淋巴結或惡性腫瘤)的可能性。此外，醫生亦會建議病人進行切除手術，避免囊腫持續擴大, 受到感染或增加病變的機會。若囊腫已受到感染，病人需要在手術前先進行抗生素治療。

治療方面，於1920年首次出現名為Sistrunk 程序的切除手術，現今已成為外科醫生處理甲狀舌骨囊腫的標準手術方法。在此以前，因大家對甲狀腺舌骨囊腫與胚胎學的形成認知不足，手術後的復發率較高。Sistrunk 程序除了切除囊腫外，也涉及切除甲狀舌管和伴隨的舌骨中段，醫生均會一併切除，以減低復發的機會。

這是由於甲狀舌骨囊腫連結甲狀舌骨管道，甲狀舌骨管道必須一併清除以防止囊腫的復發，然而甲狀舌骨管道在解剖位置上與舌骨有密切的關係，試圖去將甲狀舌骨管道與舌骨分離，在技術上是相當困難。因此切除一部分舌根的軟組織連同舌骨的中央部分及囊腫，似乎是將甲狀舌骨囊腫連同其管道一併清除的最好方式。



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。

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，
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。