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Otorhinolaryngology

1. What is otitis media? What are the treatments for otitis media?
 

Otitis media is a bacterial or viral infection of the middle ear which is one of the most common infections in childhood. It sometimes can be caused by Eustachian tube obstruction.

 

Otitis media is usually induced by spread of common cold virus or flu bacteria into the middle ear, resulting in fluid accumulation in the middle ear. The fluid buildup may increase the pressure in the ear and lead to eardrum perforation and thus leakage of fluid.

 

Common symptoms of otitis media include:

  • Ear pain
  • Hearing problems
  • Vertigo or body imbalance
  • Nausea or vomiting
  • Ear discharge

 

The first line treatment of otitis media is medication. However, if eardrum perforation occurs, the doctor may suggest myringotomy to incise a small opening on the eardrum for fluid removal and pain alleviation. The opening will heal within a few day after the surgery without damage to the eardrum. The doctor may insert a ventilating tube after myringotomy to equalize ear pressure with the environment pressure and prevent fluid accumulation. The tube will fall off from several months to one year. Please be reminded that avoid flowing of water into the ear which can cause infection.

   
2.

My kid accidental puts foreign bodies into the ear. How can I deal with the situation?

  Parents should seek help from the doctor to remove foreign objects from the ear. A microscope is used for observation of the ear canal during removal of the objects to avoid damage of ear tissues. Parents should never remove the objects by themselves since this may push the objects into inner part of the ear and cause perforation of ear drum. The doctor also uses a microscope in removal of impacted wax and fluids.
   
3.

What are the problems need to undergo tympanoplasty?

  Tympanoplasty is applied to the situation of unhealed ear perforation which may be caused by otitis media. Tympanoplasty refers to eardrum repair in order to prevent infection and recover hearing ability. It can also be used to rebuild auditory ossicles.
   
4.

What are the treatments of haematoma auris and perichondrial effusion?

  Haematoma auris and perichondrial effusion is a collection of blood or fluid  between auricular cartilage and perichondrium due to ear trauma or inflammation. Apart from repeated aspiration of the blood or fluid, patients can consider undergo buttoning surgery in which pinna will be incise for drainage of blood or fluid. The wound will then be covered by cotton swabs to prevent recollection of blood or fluid. Patients should keep the wound dry and clean after the surgery to prevent infection and promote wound healing. The cotton swabs will be removed in a week.
   
5.

What are the causes of nasal polyps? What are the examinations and the treatments for nasal polyps?

 

Nasal polyps are soft, painless, noncancerous growths on the lining of the nasal passages or sinuses. Nasal polyps may obstruct airway and cause long-term nasal congestion. Other symptoms include headache, loss of smell and sinusitis.

 

Nasal polyps appear under the condition of overstimulation and excess growth of nasal mucosa. People with allergic rhinitis, allergy to Aspirin and infection are at high risk. However, no specific causes of nasal polyps are proven.

 

CT scan and nasal endoscopy will be performed for investigation of inner structure of the nose to locate nasal polyps. If the tissue growth is suspected to be malignant, nasal biopsy may be needed to confirm carcinoma.

 

For treatments, patients may have medication such as nasal spray containing steroid. If the nasal polyps or infection are not well controlled with medication, patients may need to consider sinus surgery.

   
6.

When do you need to have nasal biopsy?

  When patients are suspected to have nasal carcinoma, a small piece of tissue will be extracted from the suspected body site for laboratory investigation on the malignancy of the tumor. The procedure is assisted by nasal endoscopy with patients under anaesthesia care.
   
7.

How is nasal bone fracture treated?

  Nasal bone fracture is generally treated by closed reduction and stabilization in which the fractured nasal bone will be repositioned and external nasal splint will be applied to support and protect the nasal bone. The fractured nasal bone will then healed with correct position.
   
8.

How does enlarged inferior turbinate cause nasal congestion? What are the treatments?

 

Turbinate is composed by bone and mucosa with the main function of warming and moisturizing incoming air. Long-term rhinitis may lead to overstimulation of mucosa and cause growth of excess tissue of turbinate. Enlarged inferior turbinate occupies nasal space and obstruct airway, resulting in long-term nasal congestion.

 

Patients will always receive medication treatment. If medication is not effective in reducing turbinate mass, surgeries such as radiofrequency inferior turbinate reduction or turbinectomy can be chosen. Radiofrequency inferior turbinate reduction uses radiofrequency to produce heat energy to reduce mass of turbinate. Turbinectomy is a surgery using an endoscopy to locate the target turbinate site for excision.

   
9.  Is that smoking causes laryngeal cancer true? What are the symptoms of laryngeal cancer?
 

True. Cigarettes contain many carcinogens such as hydrogen sulfide and sulphur dioxide cause laryngeal cancer. Many laryngeal cancer sufferers have history of smoking over 20 years. With the reason of more male smokers than female, there are more male laryngeal cancer patients at the middle or old age.

 

The most common symptom of laryngeal cancer is persistent hoarseness over 4 weeks. If the above symptom is present, ENT consultation should be made. Other symptoms involve difficulties in breathing and swallowing and pain of larynx and pharynx.

   
10. What are the examinations and treatments for laryngeal cancer?
 

Preliminary check of laryngeal cancer will be carried out by inserting a flexible fibreoptic laryngoscope through nostril and pharynx to examine the condition of larynx.  Further investigation includes biopsy of suspected site of carcinoma with aid of microlaryngoscopy. Biopsy can help investigate whether the tumor is benign or malignant. Other examinations involve CT scan and x-ray.

 

Stage 1 and 2 laryngeal cancer is mainly treated by radiotherapy and laser therapy to destroy carcinoma using limited amount of radiation and laser. The two types of therapies can retain function of throat.

 

Stage 3 and 4 laryngeal cancer needs to be treated by combination of surgery and radiotherapy in which the whole throat may be removed. Since air cannot enter lung through throat, doctor may make a stoma on the patients’ neck to allow air flowing into lung. Patients need to have speech therapy as well.

   
11.  What are the causes of cord polyps or nodules?
  Cord polyps or nodules usually grow with the cause of excessive or improper use of vocal cord such as shouting. Therefore, teachers and singers are more likely to have cord polyps or nodules. Other causes can be upper respiratory tract infection, smoking, breathing in irritant substances and abnormal functioning of thyroid glands.
   
12. What are the investigations of cord polyps and nodules?
  Doctor needs to understand the medical history of patients. Observation of vocal cord function will be done by inserting a fibreoptic nasopharyngoscope through nostril to check the function of vocal cords. Also, excision of biopsy assisted by microlaryngoscopy will be done to determine the presence of carcinoma.
   
13. Why do children always have tonsillitis? How does tonsillitis be treated?
 

Tonsillitis is the inflammation of tonsils usually due to infection. Tonsils locate at either side of the back of the throat and are part of immune system. When there is tonsillitis, tonsils will enlarge leading to difficult swallowing, throat pain, fever, headache and other signs and symptoms. Since tonsils are more active in childhood and immune system of children is weaker, children are more likely to have tonsillitis compared with adults.

 

When suffering from tonsillitis caused by virus, patients should take rest and drink more water to promote recovery. When suffering from tonsillitis caused by bacteria, it needs to be treated by antibiotics. Patients may consider tonsillectomy when have persistent or recurrent tonsillitis.

   
14. Neck pain is common among us. How can we deal with neck pain?
  Patients should seek medical consultation to find out the causes of neck pain and receive individualized treatment plan. Doctor needs to know the medical history of patients and characteristics of neck pain such as onset, pain location, duration and symptoms and any associated symptoms. Also, examinations such as neck flexibility test will be carried out. Neurological examination is needed to assess presence of nervous system dysfunction related to neck pain. Further investigation includes X-ray, CT scan, MRI scan etc.
   
15. Is investigation needed to assess lumps in the neck? Is surgery needed to treat the condition?  
  Investigation is needed to find out the causes of neck lumps since the problem can be serious. Neck lumps can be caused by lymphatitis in neck such as infection. They can even be benign or malignant tumors. Therefore, investigation is needed to assess the condition of neck pain. If the lumps are the products of infection, antibiotic treatment can be applied to reduce lumps. If the lymph node has not subsided after antibiotic, USG guided FNAC or excision is needed for diagnosis.
   
16. What is sleep apnea? What are the risk factors?
 

Sleep apnea is a sleep disorder characterized by pauses in breathing or periods of shallow breathing during sleeping. The common signs and symptoms of sleep apnea are:

 

  • Snoring
  • Nap during reading, conference and watching television
  • Pause in breathing during sleeping
  • Breath with mouth during sleeping
  • Headache in the morning
  • Fatigue, dozing off, difficulty in concentration
  • Emotional problem
  • Decreased memory
  • Sexual dysfunction

 

Classification of sleep apnea

  1. Obstructive sleep apnea
    Obstructive sleep apnea may be caused by blockage in airway by excessive subcutaneous tissues or enlarged tonsils. Common sites of obstruction are tonsillar hypertrophy, enlarged uvula and thick tongue base. 
  2. Central sleep apnea
    The airway is not blocked but the brain fails to signal the muscle for breathing to contract and relax due to instability in the respiratory control center. This problem is more common in patients with stroke or brain injury.
  3. Mixed sleep apnea
    Patients suffer from both obstructive sleep apnea and central sleep apnea.

Risk factors

  • Being over age 40
  • Being male
  • Being overweight
  • Having large tonsils, a large tongue, or a small jaw bone
  • Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
  • Smoking
  • Drinking alcohol
  • Use of hypnotics
  • Gastroesophageal reflux, or GERD
  • Having a family history of sleep apnea
   
17. What are the investigations of sleep apnea?
  The common investigations of sleep apnea involve sleep study, flexible laryngoscopy & Müllers’ maneuver and sleep endoscopy.  Sleep study monitors patients’ respiratory rate, heart rate, electroencephalogram and other parameters to find out any abnormalities during sleeping. Mullers’ maneuver is a procedure needs to create a negative pressure in upper respiratory tract and insert a flexible laryngoscopy to investigate any blockage of airway. Sleep endoscopy is performed with insertion of an endoscope through the nose to assess the severity of structural obstruction or narrowing of the upper airway with patients under sedation. 
 
18. Which kind of sleep apnea can be treated by uvulopalatopharyngoplasty(UPPP)?
  The enlarged tissues will obstruct the airway. Influence on breathing and snoring will be more serious when people lie down to sleep since uvula will fall down to airway. The enlarged uvula may be due to inflammation. Therefore, doctor will suggest uvulopalatopharyngoplasty to treat obstructive sleep apnea caused by enlarged ovula. This surgical procedure is used to remove tissue and/or remodel tissue in the throat. It involves removal or remodeling of the posterior surface of the soft palate and the uvula. The uvula is then folded to the soft palate and sutured together.
     
19. How is obstructive sleep apnea treated by radiofrequency tongue base reduction?
  This is minimally invasive surgery is to treat obstructive sleep apnea caused by enlarged tongue base. The surgery uses radiofrequency to produce heat energy which heats enlarged tongue base. Protein in tongue base is destroyed and mass of tongue base reduces, resulting in improved patency of airway. This procedure is relatively safe.