Monday, November 16, 2015

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.

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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.

Monday, November 9, 2015

Botox (Wrinkle Reduction Treatment)--PART 2



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.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.

Thursday, November 5, 2015

Botox (Wrinkle Reduction Treatment)--PART 1





The gradual development of facial wrinkles is inevitable and generally represents the early sign of ageing. The most common areas of wrinkling include the forehead, the brows and the outer corner of the eyes (crow's feet). This is mainly related to muscle activity which can be effectively dampened by the use of botulinum toxin, which is a naturally occurring bacterial toxin. This type of treatment to paralyse muscles selectively and reduce wrinkles is commonly known as 'Botox' treatment. Botox is a trade name, and other similar preparations may also be used for this purpose. Botulinum toxin was initially used in the 1970s for treating patients with hyperactive muscles around the eyes. Currently, it is widely used for cosmetic reasons, such as wrinkle reduction and a wide variety of other medical conditions related to dysfunction of muscles.





Consultation and treatment 

During consultation a detailed medical history is obtained by your surgeon and assessment of the facial wrinkles is carried out to determine the exact areas of muscles that require the injection. An appropriate dose of botulinum toxin is then injected into the muscles using a tiny micro needle. Following the treatment with Botox, the skin over the muscles remains smooth and even. Injected muscles are paralysed in about 2-3 days while untreated areas continue to work as normal. As the needle used is very fine and small quantities are injected, the pain is minimal and therefore no anaesthetic is required. You may experience some discomfort over the treated area immediately after treatment. You may resume normal activities immediately however any strenuous activity and massaging the area should be avoided. You must follow the post injection instructions carefully to avoid any untoward effects. Some patients may experience mild headaches in the first week or so following the injection which resolve spontaneously, and the use of mild painkillers such as paracetamol is recommended to relieve the headaches.








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.

Tuesday, October 27, 2015

肥胖可損低頻聽力



肥胖不單導致糖尿病或心血管病,亦會影響聽力。美國哥倫比亞大學研究發現,肥胖年輕 人血漿內可防炎症的蛋白質脂聯素水平低,導致內耳因發炎而受損,他們聽不到各種頻率聲音的比率較高,其中一邊耳朵聽不到低頻率的比率,是體重正常同輩的兩 倍。聽力受損會影響他們對別人說話的理解力,情況令人擔心。

 
內耳受損所致 哥倫比亞大學耳鼻喉及頭頸外科對一千五百名十二至十九歲青少年進行研究,參加者需接受家訪,提供他們近期健康狀況和家族的醫療史、服藥情況、家人吸煙情況、社交生活和生活環境是否嘈雜等因素。
 

一般而言,聽不到二千赫茲(Hz)或以下的聲音,屬於低頻率聽力受損。肥胖青少年因內耳受 損,失去感音神經性聽力,一般人聽到的聲音,他們都聽不到。研究發現,百分之十五肥胖青少年聽不到低頻率聲音,而體重正常青少年出現同類問題的比率只有百 分之八。研究指出,不少肥胖人士能明白別人說話的意思,但在嘈雜或多人在交談的環境中,他們就難聽得清楚。
 

該項研究仍然繼續,直至參加者成年。負責研究的哥倫比亞大學教授建議將「肥胖損害聽力」加入肥胖對健康負面影響的名單中,促使各年齡組別人士控制體重。此外,日後的研究也需要從社交生活、學術表現、行為及認知能力等方面,了解年青人因肥胖影響聽力所帶來的影響。


 
 
新聞來源: orientaldaily.on.cc/
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。
 

Tuesday, October 20, 2015

創傷性疤痕護理須知

即使每天都對肌膚呵護備至,但如偶一不慎撞傷或擦傷,在臉上或身體上留下因外傷導致的「創傷性疤痕」,都總教人苦惱不已。要減低這些疤痕對外觀的負面影響,在護理方面便需格外用心。
 

 
 
如因擦傷而令皮膚出現損口,即使面積不大,但亦有可能會被肉眼難以發現的異物藏入傷口中,有機會令傷口長期難以復原甚至引起發炎,即使傷口最後癒合,留在傷口中的異物也可能會逐漸沉澱,造成「創傷性紋身」,令疤痕顏色明顯。
 
因此,一旦遇上創傷,又不想日後留下不雅觀的傷疤,傷口應交由醫護人員處理,
而為防止創口發炎,耳鼻喉專科醫生會處方抗生素藥膏或口服抗生素藥物,而在傷口癒合後,耳鼻喉專科醫生亦可指導病人以特別的按摩方式,改善疤痕狀況。
 
其實,創傷性疤痕與所有疾病一樣,都是預防勝於治療,各位讀者在進行各項運動時,亦應做足預防措施,例如戴上頭盔、護膝等,傷口癒合需時,病人應保持耐性,期間可定時由耳鼻喉專科醫生視察復原進度。
 
病人在傷口癒合期間,應做好防曬功夫,並繼續保持均衡飲食,但應避免進食任何可導致敏感、或是以生魚烹調的食物,而吸煙及二手煙均可令傷口癒合的時間延長二至三倍,及癒合質素受損,需小心留意。
 
 
 
 
 
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。

Tuesday, October 13, 2015

不尋常流鼻血要當心

半小時也止不到血


六十三歲的樂先生,跟阿勇一樣,有過一段非比尋常的流鼻血經歷。他憶述︰「我記得前年十月開始,有時擤鼻涕都會見到少少血,但咁啱嗰排天氣轉涼,我以為係乾燥,又以為係自己熱氣,所以無理佢。」


直至十二月尾某個晚上,樂先生吃過晚飯後,右邊鼻孔突然湧出血來,他才知驚,「當時情況就好似閂唔到水喉咁,好多鮮血不斷喺右邊鼻窿流出來,我手上一條長長嘅洗臉巾全條都染滿血,而且用咗超過三十分鐘都止唔到,最終要去急症室。」

 

血如泉湧因生瘤





中大耳鼻喉科學系名譽臨床副教授李立言稱,單側流鼻血絕對不能小覷,分分鐘是生腫瘤的徵兆,「一般人流鼻血,可能兩邊鼻窿都會流,但如果鼻腔有腫瘤,好多時就只會單一邊鼻窿流血,或者伴隨單一邊鼻塞。」


急症室醫生替樂先生止血後,再安排他一個月後做電腦掃描檢查,「電腦掃描發現我右邊鼻孔內果然有個腫瘤,當時我第一時間就聯想到自己可能生鼻咽癌,好彩抽組織化驗後,證實係屬於良性嘅血管瘤。」

 
李立言醫生補充,樂先生長出的,其實是相對少見的「血管外皮細胞瘤」,「血管外皮細胞瘤係血管外壁細胞有唔正常嘅新陳代謝,導致血管增生。由於增生出來嘅唔係正常、健全嘅血管,所以如果有破損,就唔識自動凝血、修復,結果就會好似開水喉咁不停流血。」


鼻血嗆喉可致命


他提醒,如果流鼻血時的血量很多,甚至口鼻同時滲血的話,便應該盡快求醫,「如果鼻有腫瘤,尤其係呢種血管外皮細胞瘤,血流量會特別多,萬一長時間止唔到血,一來可導致貧血,二來若血液倒流入氣管,可導致呼吸困難,嚴重起來會有生命危險。」


樂先生的血管瘤直徑約三厘米,本來不算太大,但仍有做手術的必要。李立言醫生解釋︰「呢種瘤,其實係介乎良性與惡性腫瘤,佢唔會變癌,但佢嘅細胞亦有機會演變成具侵蝕能力,可以侵蝕附近嘅骨及組織,包括眼睛、腦部、臉部組織,所以一定要做手術切除。」去年六月,樂先生以微創方式切除了鼻腔內的血管瘤,術後留院兩晚,至今也再無流過鼻血。




參考資料:  http://health.next.hk/treatment/
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。

Tuesday, October 6, 2015

面癱治療





面癱治療, 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.


 黃德彰醫生, 香港耳鼻喉醫生




參考資料:  www.youtube.com/watch?v=uFlu2xG_Pyk
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。

Tuesday, September 29, 2015

滴鼻藥水的方法

   
 

滴鼻的住置準備:
       

坐立式:滴鼻者穩坐在有背靠的椅子、梳化或床上,頭部向後傾,額向天,並靠在椅背上。
       
平臥式:滴鼻者平臥在梳化或床上,頭部懸吊在梳化邊或床邊。

   
依照醫生的指示,把所需的分量用吸液泵沿著鼻孔內側慢慢滴入。


注意事項

   
1. 滴藥時請停止說話及呼吸。
   
2. 滴鼻藥要依照的指示使用,不能過量。
        成人:每次不多於3至4滴
        小孩:每次不多於2滴

3. 保持滴藥的姿勢約半至1分鐘。

4.  藥水須存放於陰涼處,開瓶後的鼻藥水,可存放雪櫃內,若一個月仍未用完,應把它棄 掉。




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。

Monday, September 21, 2015

面相下巴 (下) - 睡眠窒息症




拉長下巴的手術 (SLIDING GENIOPLASTY) 可改善睡眠時呼吸問題。先天性短下巴的病人,因為舌頭位置比常人後移,大部份亦同時有睡眠窒息的症狀。例如睡到半夜時醒來、打鼻鼾、白天打瞌睡等。如有這 些症狀,醫生會為病人進行睡眠測試及睡眠內窺鏡檢查 (SLEEP NASOENDOSCOPY),以找出呼吸道出現阻塞的正確位置。若證實患有睡眠窒息症的問題,並且因為短下巴引致,便可考慮下巴矯形手術,把下巴骨拉 前,解決因短下巴而導致窒礙呼吸道等問題,從而改善睡眠窒息症。


手術通常以全身麻醉進行。醫生會於患者的口腔內下齒槽骨前面作切口,之後把下巴骨拉長約4MM至10MM,並以鈦金屬螺絲固定,令外觀上不會留有疤痕。手 術後以醫療膠布為病人固定傷口位置,以減少術後出現水腫。口腔內切口的縫線是會自行溶化的,病人只需在手術後以漱口水清潔傷口便可。術後的兩星期內要進食 軟性食物,如稀粥等。手術後的一至兩星期下巴患處會消腫,病人可如常上班。


另外,有部份病人在手術後下唇有可能出現麻痺,此情況通常於一至兩個月內自行消退。亦有部份病人擔心手術中用以定位的金屬片在出境過關時會帶來麻煩,但經 驗中並沒有病人的內置金屬片導致過關問題;若患者有此擔心,醫生可為病人準備醫生證明信,證實金屬片乃治療用途,並非危險物品。如有需要,病人可待下巴骨 在新位置完全接駁埋口後(約二年),於同一口腔内切口以局部麻醉手術拆除金屬片,便不用擔心過關或金屬檢查等問題。


最後,沒有患上患睡眠窒息症的病人,如只想改善短下巴,她亦可考慮在下巴植入矽膠或脂肪等物質,使下巴飽滿起來,便可改善外觀。另外,不想做手術的人仕可 考慮非手術性的方法,如注射透明質酸或聚左旋乳酸,以填補下巴短小的部位。此方法的風險最小,康復期約一至兩天,但缺點是不能改善比較嚴重的短下巴問題。


矯形手術不但可重建及矯正過短的下巴,根治睡眠窒息問題,亦可改善面型,令妳的外觀較為美麗,回復自信。若妳認為自己有短下巴的困擾,可向相關的專科醫生查詢。



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。 

Tuesday, September 15, 2015

面相下巴 (上) - 睡眠窒息症





卅多歲從事文職的蘇小姐,上星期與幾位友好的同事去了四日三夜的旅行,然而,跟她同房的女同事卻投訴她有嚴重的鼻鼾問題。在詢問及跟蘇小姐作詳細的 檢查後,發現她是一般東方人十分普遍的典型短下巴,導致有鼻鼾的情況。其實,此現象在她十多歲時已經發生,當時蘇小姐及她的家人誤以為是偶然的傷風感冒而 已,因此沒有立即確診。隨著年紀漸長,加上日間的工作壓力大,蘇小姐的睡眠質每況愈下,每晚都半睡半醒,令她的脾氣變得十分暴躁,偶爾因一些雞毛蒜皮的事 情向下屬發洩。她除了上班時沒有精神做事外,她的壞脾氣亦導致人際關係變差,更沒想到的是她患有睡眠窒息症。


以蘇小姐的短下巴面形和她與下屬的人際關係,在相學中也有提及。下巴是面相中的最後一部分,代表61歲至75歲的整體晚運,亦可反映個人的下屬運。如下巴 比較長或向外兜的人,他們的晚年運一般都是較好的。此類別的人士做事較為積極進取,為人有魄力;在社交方面,他們容易得到很多朋友的幫助,以及朋友及下屬 的信任與支持。相反,下巴短小者則比較缺乏自信,不懂表達自己的感受,做事較為意氣用事,所以晚年時跟朋友及家人的關係便比較差。當然,也要配合整體面形 的輪廓,使外觀取得平衡,決不可能只看一個部位,以爲有好下巴便一定會有好的晚年。


事實上,從現今的醫學角度分析,下巴短小的人士很多都有睡眠窒息症的問題。這是因爲下巴骨與舌頭相連,而下巴短的人,其舌頭比較正常人後縮。因此當睡覺時 肌肉放鬆和受到地心吸力的影響,舌頭會再進一步塌後,阻塞咽喉部位的會厭瓣,聲帶也會因此被掩蓋。因為口腔和鼻孔的堵塞,空氣流進不到肺部,所以患者便要 從睡夢中醒來,以呼吸新鮮空氣。如是者每晚重覆這情況數十次,嚴重的甚至數百次,患者不可能熟睡至天明,嚴重影響睡眠質素。


這亦可解釋了為何相學中短下巴的人晚年運比較差。此外,醫學已證實睡眠窒息症不但會影響患者的心肺功能,更會令患者有高血壓。因此當患者年老時,身體健康會較正常的人更差。所以「短下巴.晚年差」,也是有醫學根據的。



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,
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