The Asian nose(2)

Overall the description of the Asian nose is one of petiteness and flatness. Asian clients seeking rhinoplasty therefore not surprisingly request for higher radixes and dorsums with more tip projection and narrower alar bases. The contemporary trend is to request for augmentation and tip projection whilst retaining their Asian ethnicity.

 

In a small sample study by the authors at The Chinese University of Hong Kong, nasal pictures of Chinese male and female individuals were evaluated to determine their aesthetic outcomes. These subjects with a group of independent local Chinese male and female judge observers, were requested to freely simulate with computer software, the nose they would wish to have. There was notable agreement and concordance on the final nasal profile simulated i.e. everyone had the same aesthetic endpoint. What this sample work demonstrated was, whilst all these Asian clients and peer judges preferred higher radixes and dorsums with greater tip projection, the measured parameters differed significantly from accepted Western aesthetic references (see Figure 1 - Graph of Asian aesthetics). This suggested that even though Asian individuals wanted a pointier and higher nose, they wanted to retain their "Asian" sense of aesthetics.

 

 

 

 

 

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.

The Asian nose(1)

The archetypal Asian nose discussed in this chapter is typified by the Asian Malay nose or the East Asian (Chinese, Japanese and Korean) type of nose. There is indeed a spectrum of these noses, with northerners e.g. from north China and Korea having higher dorsums compared to their Asian southerners with lower dorsums. The Asian nose primarily discussed here is typified by petiteness and flatness.

 

The overall mid-facial bony components and nasal septum can be thought of as being "underdeveloped". Hence the radix tends to low with a low rhinion and low mid-third dorsal profile height. The shorter nasal septum with a less projected anterior septal angle results in a nasal tip that lacks projection. A less projected tip, in turn, is more rounded with less tip definition. There usually is also relatively thicker skin overlying the nasal tip and lobules. The ala basal width is also wider.

 

From the basal view, the nostrils of the Asian nostril appear more rounded compared to the tear-drop appearance of the Western nose. This is due to the lack of projection. The columella may appear short and retracted, lacking support from the caudal septum. Internally, the cartilaginous septum of the Asian nose is generally less generous which explains the deprojected tip; this smaller size will impact upon the availability of septal donor material too. The medial and lateral crura of the lower lateral cartilages are smaller, weaker and softer than Caucasian noses, and tend to have a more oblique to vertical lie. The upper lateral cartilages are similarly small in size to.

 

 

 

 

 

 

 

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.

面神經癱瘓(下)

治療

病症治療
一般而言貝耳氏面神經麻痺的預後尚佳，約八成的病患在三到四週之內會恢復原來的功能，但帶狀庖疹病毒所引起之面神經麻痺，其預後較差，約五到六成的病人會痊癒。根據研究顯示，在發病三天內若合併使用抗病毒藥物與類固醇來治療，在復原的比率及病程上，皆優於傳統療法

少數預後較差的患者則須進一步探討病毒以外的致病因，包括耳部疾病等。例如電腦掃瞄或磁力共震掃瞄等。另外，顳骨內面神經之減壓術也可改善部份預後較差的患者。

預防併發症由於眼瞼閉合不全或不能閉合，瞬目動作及角膜反射消失，角膜長期外露，易導致眼內感染。因此眼睛的保護的非常重要的，減少用眼，外出時戴墨鏡保護，同時滴一些有潤滑、消炎、營養作用的眼藥水，睡覺時可戴眼罩或蓋紗塊保護。

外科治療 面部重建手術

目的 : 重建眼瞼的保護功能,防止角膜暴露; 重建口唇至下眼瞼間的功能;重建微笑功能.
決定重建的因素: 面神經麻痺的原因,麻痺和功能缺失的範圍,面神經麻痺 恢復的可能性,是否合併其它顱神經麻痺,麻痺時間的長短,是否滿足患者生活的願望,患者的要求和麵神經功能重建的期望.理想的方式是在面神經中斷處恢復面神經的連續性,但往往是不可能的.組合的方式重建面神經的動態和靜態功能.動態功能的重建可以通過神經替代、神經橋接 和肌肉轉移的方法實現。如，腓腸神經和股薄肌，顳肌等。靜態功能的實現可以眼眉上提、下眼瞼縮減、白金植入等方法.

資料來源：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。

面神經癱瘓(上)

面神經主司面部表情、淚腺與唾液腺之分泌及舌部之味覺。面神經其實就是第七對腦神經(腦神經共十二對)，它的走向為離開大腦後，即進入顳骨之內聽道，並經中耳腔及乳突(以上均包埋在硬骨的管腔內)，再由耳下方穿出顏面；因為顏面神經有一大段包埋在硬骨的管腔內，所以一旦受傷或感染所形成的腫脹，在壓力無法紓解下，將直接壓迫神經纖維之內軸。造成神經功能的障礙。

原因

面神經核上癱或面神經核下癱
約有八成是因為病毒感染所引起，最常見的急性單側面神經麻痺，我們可將它稱為特發性面神經麻痺或貝耳氏面神經麻痺(此症狀於1931年英國貝耳(Bell)醫師最早提出)。目前研究證實貝耳氏面神經麻痺與單純性庖疹病毒第一型有關，另外一種常見的病毒感染為帶狀庖疹病毒。

其他原因包括：

創傷性：車禍外傷

發炎性：急性中耳炎、慢性中耳炎合併膽脂瘤

腫瘤：腦部或顱底腫瘤壓迫所引起

先天性：Moebius綜合症

病徵

有些病人一覺醒來發現自己流涎無控制，半邊臉部麻木，無知覺，照鏡之下發現眼歪嘴斜，好像中風一樣。舌頭有時亦會麻痺，眼乾，口乾等。

其他：耳部附近也會有小水泡，並且異常疼痛。
(續)

資料來源：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。

如何保護你的聲帶

保護聲帶

l   放慢說話速度

l   說話時要作停頓

l   保持聲線得到適當的休息

l   以適合自己的聲調說話

l   多飲水

l   避免長時間逗留在乾燥／多煙塵的地方

l   減少吃刺激性飲食多放鬆自己

l   保持身心愉快，以理性的態度面對問題

l   日常生活有規律

l   減少娛樂中過度用聲

l   在許可情況下，培養多方面興趣

 

損害聲帶的行為

l   課餘時長時間不停的說話或唱歌，例如過度唱詩、煲電話粥

l   說話太快

l   在嘈吵環境中大叫和大聲說話，例如課室、茶樓、街上

l   用不適當音調說話或唱歌，(太高/太低音)

l   用不適當音量說話或唱歌，(太大/太細聲)

l   清喉嚨

l   大力咳嗽

l   激動地大笑/大哭

l   吸煙

l   飲刺激性飲料，例如酒、咖啡、濃茶

l   吃刺激性食物，例如煎炸/熱氣/太乾食物，太鹹/太甜/太辣食物，和太熱/太凍食物

l   吃宵夜過飽

l   娛樂節目中過度用聲，例如唱卡拉OK、打麻雀

 

資料來源：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。

鼻腔灌洗法

 

需要洗鼻的原因：

l   一些嚴重鼻敏感的病人有大量積液引致鼻塞。

l   病人於鼻腔及鼻竇手術後，鼻液和血塊，積聚於鼻腔內，引致阻塞。

l   病人在接受頭頸區放射治療時，鼻黏膜容易受感染而導致鼻液積聚，因此需定時清洗鼻腔減少黏膜發炎機會。

 

所需用品：

l   用1公升沸水加入兩茶匙餐桌鹽待水温和暖後方可使用。

l   20亳升(無針咀) 針筒。

l   器皿一個(如小血) ，用於洗鼻後盛載從鼻腔流出的水。

 

洗鼻過程：

1.          病人可坐下或站立，用針筒注洗器將温暖的鹽水從不同角度，慢慢注入鼻內，使鼻腔內不同位置都可被沖洗。

2.          當水流進喉部時，將水吐出。注意吐出的水是否混濁或有沉殿物質。如有混濁，應重複灌洗直至到流出的水清澈。

3.          建議每天洗鼻至少2次，通常早及晚。若分泌物多時，建議早、午及晚清洗。

4.          噴鼻藥應在洗鼻後使用(如有需要)。

 

注意事項：

l   用和暖的鹽水(使用前請先試水温) 。

l   洗鼻時請停止說話及呼吸。

咳嗽和打噴嚏時，請停止洗鼻。

患有中耳炎或急性上呼吸道感染時不宜洗鼻。

l   已開盬水可存放48小時。

 

資料來源：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。

 

 

隆鼻手術，鼻矯形

面部整形日漸普及，大眾對整形的接受程度也越來越高。改善鼻形手術除了功能及外觀上的改善外，東方人更相信矯正鼻形可以改善面相，從而改善自己的運氣。

隆鼻可分為手術性及非手術性兩種

隆鼻 - 非手術性 ：
主要是透過注射來達至鼻矯形效果。常用物質包括透明質酸(Hyaluronic Acid, 又稱玻尿酸), 微晶瓷 (Calcium Hydroxyapatite) 等。

透明質酸是人體本身物質，常用於注射面部，下巴，鼻部等。好處是簡單而需時較短，一般二十分鐘左右可完成。但是，由於注射透明質酸只可輕微改善鼻形，所以不是所有人也適合。例如，鼻翼左右不平衡，鼻子過大或比較嚴重之鼻部畸形，就需要選擇手術性修復。透明質酸隆鼻通常能維持半年至九個月，需要重覆注射，方可維持效果。

但是，注射性隆鼻並非完全沒有風險，如注射位置紅腫，瘀傷，甚至發炎等。此外，於同一位置多次注射，會有機會影響該位置的血液循環，嚴重甚至會造成皮膚創傷。

隆鼻 - 手術性 ：
隆鼻手術或鼻矯形手術，適合比較嚴重之鼻部畸形，鼻子過大，或有功能上問題如鼻塞之人仕。隆鼻手術之植入物，可分為自體移植和異物植入兩種類型。自體移植的植入物是來自患者身體的其他部份。例如鼻中隔軟骨，耳朵軟骨或肋骨等。好處是副作用如排斥或發炎等，較異物植入為低。

異物植入的植入物一般是人工物質，例如矽膠或合成的聚合物，如Goretex等。異物植入的好處是手術時間較短，而亦不需在病者其他部份造成傷口。

一般來說，單純隆鼻的手術時間較短，大約三十分鐘左右。鼻矯形或鼻雕 ，手術則需時兩至三小時。

每一個患者的需要和狀況也不同，在決定隆鼻手術前，請先諮詢耳鼻喉專科醫生平衡隆鼻手術風險。

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。

止鼻血方法

 

流鼻血是一種常貝症狀，以兒童及老年人發病較多，一旦發生以上情况，發現者應保持鎮定，因為若病者精神緊張，血壓升高，出血會較難停止，對病者不利，以下是一般較簡易的應救措施：

 

l   先讓病者坐下，頭向前傾，解除頸部及胸部衣服的束縛，應保持鎮定，
並安撫病者。

l   指示病人用口呼吸，並揘住鼻翼(鼻子的柔軟部份) 大約十分鐘，
可以達到止血效果。

l   同時利用冰袋敷鼻樑及前額，可以收縮血管，幫助止血。

l   部份鼻血可能會流至口腔，應指導病者不應嚥下，及給予器皿盛載。

l   十分鐘後放鬆壓力，如果仍未止血，再壓十分鐘，此時病者仍不可把頭抬高。

l   不可用紙屑塞進鼻腔內。

l   出血情況停止後，叮囑病者避免身體過份用力，至少四小時內不要擤鼻涕，以免引致再流鼻血。

l   如急劇流鼻血或三十分鐘內仍未止血，應延醫治理。

 

 

 

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。

 

Hearing Loss (Part Two)

 

Hearing loss treatment

The treatments vary depending on the type, site/s and severity of hearing loss. This is best assessed and diagnosed by an Ear, Nose & Throat Specialist.

The appropriate treatment may be conservative observation, hearing aiding and /or ear surgery. For children with persisting “glue ear” especially when in both ears with notable signs of language and /or attention problems, a ventilation tube (grommet) can be placed into the eardrum by surgery. For patients with a perforated eardrum, this can be repaired by surgery.

For patients with bilateral complete deafness, a cochlear implant sound processor should be considered. This re-stimulates the deaf ear using an electrode array and some very clever speech software processing. The new sound that is heard will indeed be different. Speech and hearing rehabilitation exercises to re-learn these sounds would be required. Children do better than adults with these cochlear implants. Studies have shown that a child’s brain has a higher neuro-plasticity than an adult, and therefore a greater capacity to adapt to new sounds and learning development.

 

Hearing aids

Hearing aids are often the first consideration for patients with hearing disabilities. These aids can be similarly considered like glasses for visual problems. They do not require surgery and the advanced technology is relatively inexpensive. Patients can used them when they want and remove them as necessary.

There are many different types of hearing aids available. They vary in size, quality, performance and therefore, price. Hearing aids should always be tailored to the different needs and hearing disability of the user. Hearing aids are however, not without their own problems. Patients may well find them uncomfortable or conspicuous to wear. This perhaps more so if the benefit offered is insufficient to meet the patients’ expectation and needs.

Conventional hearing aids require a sound leak proof occlusion of the ear canal by the ear mold in order to work well. Patients may find the fitting ear mold a little uncomfortable to use. Also, slight movement could alter its position easily and this can create feedback whistling sound, when the amplified sound leaks out of the ear canal, and re-enters the microphone of the same hearing device. This is similar to the whining feedback during karaoke sessions when the sound is picked up by the same microphone in a reverberating circuit.

When properly prescribed and fitted, conventional hearing aids are a good option to rehabilitate most hearing problems.

 

Baha (Bone Anchored Hearing Aid)

The baha, as its abbreviation suggests, works by direct bone conduction of sound to the cochlea via a sound processor and titanium implant on the skull. As the sound conduction is entirely via bone conduction to the cochlea, the external pinna, external ear canal and middle ear bones are not required. In fact they are completely bypassed. Hence the baha is suitable for those without an outer ear and occluded ear canal (microtia and congenital aural atresia) and those with poor middle ear conduction problems (mastoidectomy, loss of ossicles, otosclerosis).

The baha is especially ideal for patients with one-sided complete hearing loss, aka single-sided deafness (SSD). These SSD patients experience a poor perception of sound on one side especially on the phone, during meetings and dinners, and in noisy environments. The baha “captures” sound from the deaf side, and transmits it to the only working ear on the opposite side through bone conduction through the skull. The patient is then able to appreciate sounds and conversation on the deaf side, and finds themselves once again, enjoying their sound rich social environment.

One of the greatest advantage of the baha is that it is the only implantable hearing processor that allows people “to try before they buy”. By using a soft band applicator as a connection to the skull, the baha can be tried without surgery required. If the user likes the baha, they can choose to continue using the softband approach, or undertake a more securely applied baha via a surgical titanium implant to the skull, just behind the ear. Certainly, for the surgical installed baha, as there will be no intervening soft tissue unlike the softband trial, the sound heard will be clearer after the BAHA is implanted.

The surgery is a single-stage surgery, done with a minimal invasive implantation, maximizing the preservations of tissues. It takes around 15 minutes to complete the whole procedure and can be done within a clinical setting.

 

Summary

Hearing loss should be identified early especially with children for their speech and language development. Timely treatment by medication, surgery or hearing aiding can then be advocated.

Hearing aids and sound processors like the baha and cochlea implant, allow sounds to be heard. The sound may not be as rich as the normal ear, but the improvement beyond the hearing disability improves our patients’ social and professional interaction and enjoyment significantly.

 

 

Reference information: 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 (Part One)

 

 

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.

 

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 information: 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.