鼻敏感或是鼻塞的手術

包括下鼻甲減容術及鼻中隔成型術。下鼻甲減容術是適用於因為下鼻甲肥大引致鼻塞的病人，而鼻中隔成型術是適用於因為鼻中隔偏曲而引致鼻塞的病人。有一些病人是兩種情況也有，而耳鼻喉專科醫生就會同時為他們做這兩種手術。

通常先試藥物治療     例如  :  類固醇噴劑或抗組織胺

術前注意       
全身麻醉或局部麻醉

血液或鼻分泌倒流

全身麻醉

術後注意       
填塞方法   (例如海棉或紗布1-2天)

流眼淚，面腫，面痛，頭痛等等

藥物: 去減少這些不舒服

避免過熱的食物

                                                                               

出院以後       
鹽水洗鼻

輕微流血  →   冰敷

嚴重 → 回去急診室

休息兩至三天，視符工作性質

長期問題       
仍然需要藥物，尤其是鼻水，噴嚏等問題

復發(鼻塞)

併發症注意   鼻中隔穿孔

參考資料: 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。

矯鼻手術介紹

鼻矯形及隆鼻手術 面部整形日漸普及，大眾對整形的接受程度也越來越高。改善鼻形手術是其中最普遍和受歡迎的整形項目。除了外觀上的改善外，有鼻塞的人仕更可藉手術治療。 鼻矯形可分為手術性及非手術性兩種。 非手術性鼻矯形 主要是透過注射來達至矯形效果。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，注射性矯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，注射性矯鼻只能改善外觀，並不能幫助有鼻塞問題的人仕。 手術性鼻矯形 手術性鼻矯形，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。

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。 異物植入手術的植入物，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，在決定手術前，請先諮詢專科醫生平衡手術的風險。

黃德彰  耳鼻喉專科醫生

參考資料: prochats.she.com/, 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。

胡亂「自療」致鼻敏感惡化

鼻敏感雖不是致命疾病，可是發作時引來的流鼻水、鼻子癢等問題卻是非常煩人，不少鼻敏感病人卻諱疾忌醫，自行購買成藥或利用針炙、按摩來「自療」。其實，這些「自療」方法只能暫時消除病徵，根本沒有徹底根治鼻敏感帶來的炎症，長期使用，甚至會惡化成鼻膜炎，最終要動手術治療。

一些聲稱可以通鼻塞的噴鼻劑是鼻敏感患者最常使用的成藥。這些噴鼻劑只是利用藥物強力收縮鼻膜及血管，並沒有真正解決鼻敏感引致的發炎問題。長期使用，鼻塞問題不單會反彈，更會演變成慢性鼻炎。

其實，對於這個情況，醫生會向病人處方一些含輕量類固醇的噴鼻劑，病人只需連續噴一個星期左右就可以痊癒。現在含類固醇的藥物十分安全，被身體吸收的份量極微，不會影響身體功能。

參考資料: www.ent.cuhk.edu.hk , 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。

骨膠原

美容醫學可有效刺激皮膚自我增生骨膠原，讓皮膚緊緻有彈性，改善皺紋。

1.  醫學換膚﹕研究證實，高濃度醫學換膚(>20%,  pH<3.5)有效令真皮層的厚度及膠原纖增加。

2.  光學療法﹕利用高能量光束(激光或彩光)在真皮層造成熱能傷害，促使纖維母細胞增加製造優質骨膠原來自我修復。現在常用的嫩膚激光完成後沒有傷口，可即時化妝，對日常作息影響減到最少。

3.  射頻緊膚﹕將高頻電波導入到真皮層，加熱刺激深層的骨膠原收緊及再生。

4.  小分子透明質酸注射﹕透過小針注射小分子透明質酸到皮膚中，深層補水之餘，也可刺激纖維母細胞增加製造骨膠原。

左旋乳酸聚合(poly-L-lactic acid)注射﹕透過小針將左旋乳酸聚合注射到真皮層中，對增加真皮層的膠原蛋白含量十分有效，其效用可長達2年，已被FDA核准作為治療皺紋的方法。

參考資料: www.metrohk.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。

Botulinum toxin safety

Botulinum toxin is a safe drug and when injected by an experienced facial plastic surgeon the incidence of side effects is extremely low. The most common side effects are temporary and localised bruising, slight redness of the skin and occasionally slight swelling at the injection site. The side effects of Botox are completely reversible and are temporary, lasting only a few hours and occasionally up to one or two days.

Rarely unintended paralysis of muscles may result in troublesome cosmetic imperfections such as drooping of the eye brows. The incidence of such side effects is injector dependent and settles with time.

How long does it last? 

The effects of Botox usually last for three to four months after the first treatment. The effects fade gradually, at which point wrinkling begins to reappear and you may return for re-treatment.

Generally, with repeated injections, the effects last longer and the frequency of injections gets lesser. The duration of effect varies from patient to patient and may be less effective in older people.

Reference information: www.eafps.org

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your ENT specialist for diagnosis and treatment.

I cannot hear in one of my ears!

Single sided hearing deafness (SSD) is not uncommon. There are all kind of reasons including accidents & trauma, medication, surgery, strokes, brain tumours, etc. However, usually the reason is never known (idiopathic) as in patients who experience sudden hearing loss of unknown cause. It has been suggested that overall, single sided hearing loss may be as common in our population as 12 in every 100,000 persons.




What problems do these SSD sufferers have?

SSD patients cannot hear clearly from one side, and therefore do not have stereoscopic sound i.e. they are unable to localize the source of a noise. Also in noisy environments, their only hearing ear is challenged by the useless “noise” that masks the useful “sounds” that they want to hear e.g. speech of a friend in an interesting conversation over cocktails in a crowded party. 

SSD patients also automatically modify their lifestyles to better suit their condition. For example, they will always walk and talk with family and friends standing, sitting and walking on their better hearing side. They will arrive at meetings earliest, not because they are the keenest, but so that they can sit strategically with their good ear to the meeting attendees.




What is the solution?

The state of the art evidenced based solution that is better than others on the market, is the  Cochlear™ baha® ( bone anchored hearing aid ) hearing system. The Cochlear™ baha® hearing system was FDA-approved for the treatment of single sided deafness in 2003, and has been successfully used to treat specific hearing conditions in Hong Kong since 1996. The technology translates sounds from an hearing processor, through a titanium implant, to the cochlea or inner ear. The vibrations received are perceived as sounds, and the patient “hears”.

How does the baha help with single sided deafness?

The Cochlear™ baha® hearing system is applied to the deaf side of the head. Sounds that it “hears” are conducted though the implant to the other good and normally functioning inner ear on the opposite side of the head. The good ear interpretes the sound as coming from the deaf side, and the brain does the rest.

Is the hearing normal then?

The hearing is not normal as there is only one inner ear that is functioning and translating sound from both sides. However the brain is able to understand the difference. For the patient, they can now hear sounds from their deaf side.





How do I know if the baha will help me?

The Cochlear™ baha® hearing system comes with a Softband™ for trial in a clinic setting. 
You will be assessed with the Softband™ and advised if the Cochlear™ baha® solution is the right one for you. 
If you are a potential candidate, you can try the Cochlear™ baha® processor in your different sound situations specific to your lifestyle….and then choose for yourself.



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. 

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.