鼻腔灌洗法 - 洗鼻的原因,洗鼻過程

 

需要洗鼻的原因：

• 一些嚴重鼻敏感的病人有大量積液引致鼻塞。
•  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。
•  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：

• 用1公升沸水加入兩茶匙餐桌鹽待水温和暖後方可使用。
• 20亳升(無針咀) 針筒。
•   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：

• 用和暖的鹽水(使用前請先試水温) 。
• 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。
•  已開盬水可存放48小時。

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。

 

Caudal Septal Deflections

Caudal septal deflections (as seen with the patient in Figure 13) can be specific challenges to septal surgery because they can often cause persistent nasal obstruction and may require complex septal reconstructions. 50,51 Simply resecting the caudal septal cartilage would clearly violate the inverted L-strut that is providing tip and colu- mellar support. 47 The simplest technique (and often the first attempt to correct this problem) involves vertically scoring or incising the caudal septal cartilage on the con- cave side in an attempt to remove the "spring" memory from that portion of the septum. 1,50

Another method to correct a deviated caudal septum is the "swinging door" technique, originally described by Metzenbaum. 52 In this technique, the septum is treated as in a standard septoplasty and then raised out of its maxil- lary crest groove with an elevator, like a Cottle. The wedge of cartilage along the maxillary crest is then excised. At this point, the caudal edge of the cartilage is freed from the anterior nasal spine and caudal attachments and is now only attached superiorly. This single attachment then allows the cartilage to swing into a more midline or straight position, where it can be secured with a suture to the nasal spine. 47,52 Pastorek and Becker 50 later modified this method and termed it the "doorstop technique."

In this modification, the cartilage that is dissected out of the maxillary crest is not resected but is instead flipped to the side of the nasal spine, opposite the obstruction, and secured with a suture. In this method, the nasal spine acts as a "doorstop" to prevent the caudal septum from return- ing to the other side.

An additional way to straighten the caudal septum is through the placement of an ethmoid bone splinting graft. As described by Metzinger et al, 51 a straight piece of the perpendicular plate may be harvested and small holes are then drilled in the bone with a hand drill.

A Keith needle then secures the bony splint to the caudal septal cartilage, which may be straightened first by scoring. It should be noted, however, that the ethmoid bone, when secured in place at this location, can cause the caudal septum to thicken. The surgeon should be sure that the additional piece of bone does not itself cause nasal obstruction when it is secured. 1

At times, excision and replacement of the caudal sep- tum may be necessary. An external rhinoplasty approach facilitates this technique.



Figure 13. (A, C) This 45-year-old man presented with a caudal septal deflection, which can be a specific challenge in septal surgery. (B, C) One year after rhinoplasty with the doorstop technique described by Pastorek and Becker. 50

 

 

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.

認識睡眠窒息症 - 睡眠窒息症病徵

 

何謂睡眠窒息症

睡眠窒息症病是指患者在睡眠中停止呼吸，每次持續十秒至數分鐘不等，導致身體缺氧，但窒息後不久，病人會扎醒，並回復正常呼吸，整夜週而復始地病發十數次至數百次不等。

睡眠窒息症的病徵包括

• 睡醒後仍覺疲倦
• 早晨感到頭痛
• 日間常打瞌睡
• 不能集中精神，反應緩慢
• 記憶力衰退
• 性情改變，脾氣暴躁
• 性慾減退
• 嚴重的鼻鼾聲

睡眠窒息症分為三類

甲、阻礙性睡眠窒息症

這是最常見的一類，患者多為過重的中年男仕，由於上呼吸道過窄，或喉部組織鬆弛下垂，造成阻塞，於是空氣不能順利通過，造成窒息。

乙、中樞性睡眠窒息症

由於腦部受創或其他問題，不能有效地發出呼吸指令，令患者睡眠時呼吸間歇停止，造成窒息。

丙、混合性睡眠窒息症

是上述兩種睡眠窒息症的混合體，患者同時有阻礙性及中樞性的病徵。

 

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。

Injection rhinoplasty

Rhinoplasties with injectable fillers are very popular in Asia and are used extensively. The advantages of injection rhinoplasty include:

Short learning curve for clinicians
Minimal tooling necessary
Inexpensive injectables
Local anesthetic procedure
Quick operative time
Immediate result
Per-operative client defined endpoint
Minimal postoperative downtime for patient

The idea of a simple local procedure with immediate results is very attractive to the Asian clients. Furthermore the down time is minimal; this minimizes the social exposure and questioning that some Asian clients may not welcome as plastic surgery on the nose remains a taboo in some Asian communities. The traditional injectables e.g. silicone gel and Teflon paste are generally falling out of favor due to their associated and recognized complications. The newer synthetic NASHA and PAAG injectables are increasingly being used. The skill-training time required for a clinician is very short and hence, many general practice clinicians have embraced this practice. Coupled with the marketing forces, this area of rhinoplasty has increased significantly.

The injection rhinoplasty technique depends primarily on:

• the desired aesthetic result and
• the injectable filler used.

It can be employed either as:

• a primary injection rhinoplasty procedure to augment the nose or
• as a secondary procedure to enhance a surgical rhinoplasty result (See Figures 3a-c)

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.

Implications of Chinese face reading on the aesthetic sense

 

 

Chinese face reading is an ancient art that has been developed over centuries, not only in China but over the wider area of Asia owing to China's cultural dominance in Asia during its imperial rule. Similar to feng shui, Chinese face reading is based on a philosophy held by Chinese people all over the world that expresses itself in contemporary daily life and practices by coloring people's choices, likes, and dislikes. It is inevitable that the aesthetic sense is also affected by face reading principles, especially among those who are most familiar with them. An understanding of these principles and beliefs would help surgeons better understand their Asian patients' requests and perhaps allow them to better communicate appropriate suggestions accordingly.

 
 
 




Reference information: 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.

訓練治療與耳鳴共存-耳鳴訓練治療

突然聽到「嗚嗚」、「嗡嗡」等聲音，煩得令人抓狂。本港約一成七人患有不同程度的耳鳴，其中兩成達嚴重程度，甚至影響工作、家庭關係。有耳鼻喉專科醫生指，七成耳鳴求診者四十歲以上，部分個案成因不明，無根治方法。本港去年引入耳鳴訓練治療，患者佩戴一部發出低響，但不遮蓋耳鳴聲的耳機，減低大腦對耳鳴聲的敏感度，八成患者六個月後有改善。

耳鳴是指在耳朵或頭部內產生「嗡嗡」、「嗚嗚」等聲音，聲音不是從外界傳來。私人執業耳鼻喉專科醫生黃漢威說，醫學界未掌握成因，但耳鳴不是一種疾病，而是一種病徵，像身體警報系統，例如耳蝸內毛細胞受損，便會產生不規律訊號；又或是耳朵、其他周邊器官患病，例如中耳積水、患鼻咽癌、腦腫瘤等。


治療期六至九個月

本港約一成七人患有不同程度的耳鳴，其中兩成達到嚴重程度，即在嘈雜環境中，耳鳴仍然很吵耳，影響日常生活。黃漢威說，臨床所見，耳鳴佔耳疾求診個案一成，七成屬於四十歲以上，三成求診者的耳鳴成因不明，部分人更是聽力正常，目前未有根治方法。

本港去年引入耳鳴訓練治療，安排患者佩戴一部發出低響度而不會遮蓋耳鳴的耳機，以減低大腦對耳鳴聲的敏感度並適應耳鳴。任職私人秘書的林小姐說︰「二十四小時都有沙沙聲，令人情緒起伏好大，有時都會發老公脾氣。」她去年患感冒後受耳鳴困擾，曾看四、五次中西醫生都無改善，之後更有頭痛及失眠，難以集中精神工作。她今年初接受耳鳴訓練治療，佩戴兩周後耳鳴有所緩和。

聽力專家霍曉澄說，以往利用耳鳴遮蔽器治療，透過產生比耳鳴更大的聲音，從而遮蓋耳鳴聲，但患者除下耳鳴遮蔽器，耳鳴反而更吵耳；而新耳鳴訓練治療令患者學習與耳鳴共存，治療為期六至九個月。臨床上，八成患者在治療期後耳鳴有所改善。她指，耳鳴好像心跳聲般，只有自己聽得到，若聲音持續發出並影響日常生活，應及早求診及治療。

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。

The Asian nose

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 too.

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.





With this in mind, the following subchapters discuss in more detail the commoner techniques for Asian rhinoplasty surgery. The discussion below is not intended to be comprehensive due to surgeons' preferences, the wide availability of products and techniques. Readers should instead focus on the underlying principles to permit a more flexible practice of Asian rhinoplasty, as this field and product technology develops.

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.

耳垢處理 -耳垢問題,耳垢 形成

為什麼會有耳垢？

耳垢的產生是一個正常的生理現象，因耳道的皮膚下藏有很多分泌腺，其分泌匯集空氣中的灰塵異物和耳道的死皮，便會形成耳垢。

耳垢的集結需要處理嗎？

一般正常的耳朵都有耳垢集結，並不需要特別處理，而且耳垢有保護外耳道的皮膚免它受細菌感染，所以可不需清理。但如果耳垢的集結而引致聽力减退、發炎或阻礙醫生檢查耳朵的深處時，耳垢便須用人工方法取出。


耳垢可以自行取出嗎？

如果耳垢被推掉到外耳道口，便可用紙巾或棉花抹去，切勿使用棉花棒、耳挖、牙簽、髮夾等東西挖耳，它們不但會把耳垢推進更深的地方，還會弄損外耳道皮膚而引致發炎，嚴重還會弄破耳膜。



嚴重的耳垢問題應怎樣解決？

找耳鼻喉專科醫生檢查耳朵，聽取他們的意見，在專科診所裏去除耳垢。方法包括：
• 用滴耳藥水溶解耳垢，使耳垢自動流出外耳道口。
• 頑固的耳垢，醫生可用吸液機和吸液管把它吸出。





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。

止鼻血方法

流鼻血是一種常見症狀，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：

 

·             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。

·             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。

·             同時利用冰袋敷鼻樑及前額，可以收縮血管，幫助止血。

·             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。

·             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。

·             不可用紙屑塞進鼻腔內。

·             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。

·             如急劇流鼻血或三十分鐘內仍未止血，應延醫治理。

 

  

 

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。

失聰治療 (Part3)

 

骨固定式助聽器, Baha (Bone Anchored Hearing Aid )
骨固定式助聽器是透過一個聲音處理器及一個鈦金屬鏍絲，通過頭骨傳遞聲音到耳蝸。由於聲音的傳遞全透過頭骨，可以不需依靠外耳、耳道和耳骨。所以骨固定式助聽器適合沒有外耳或耳道閉塞的病人(小耳畸形和先天性外耳道閉塞) 及中耳的聲音傳遞有問題的病人(乳突骨手術後、失去耳骨和耳骨硬化症)。

骨固定式助聽器很適合單耳失聰的人。這類病人於聽電話，開會和在宴會或其他嘈吵的地方時，很難集中處理聲音。而骨固定式助聽器可以於失聰的耳那邊”捕捉”聲音，再透過頭骨傳送聲音到正常的耳朵，令病人可以再一次聽到立體的聲音。

而 骨固定式助聽器另一項好處，就是可以讓病人先試用再考慮安裝。透過一條軟帶戴上頭部，便可試用骨固定式助聽器而不需任何手術。如覺得合適，可以繼續以接觸 器傳遞聲音，或接受植入手術，將一個鈦金屬的固定器植入頭骨近耳背的位置。相比前者，後者免除了軟組織的阻隔，可以更直接地傳遞聲音。

植入手術是微創手術，手術時間需要約十五分鐘，可於一般耳鼻喉診所進行。

總結

失聰需盡快診斷，尤其是正處於言語發展階段的兒童。診斷後，耳鼻喉醫生便可針對不同失聰成因，利用藥物，手術或助聽器作出及時治療。

助聽器例如骨固定式助聽器、耳蝸植入手術，可以讓病人再次聽到聲音。雖然聲音未必如正常人一樣豐富，但已可改善生活質素，回復正常的工作及社交生活。

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。