聲沙

聲帶 (vocal cords) 位於呼吸道上端，左右各一，肺部呼出空氣流經聲帶令聲帶快速震動，產生聲音，再經咽、喉、鼻共鳴放大。當聲帶受損發炎腫脹，不能如常地開合及震動，便會造成聲沙 (hoarseness)。常見令聲帶腫脹的原因包括傷風感冒、發音時過度用力、胃酸倒流及喉嚨過敏。聲沙應減少說話，讓聲帶得以休息復原，若聲沙時仍持續發聲，可勞損聲帶，造成聲帶出血、結繭（長出小結）(cyst)、長息肉 (polyp)、結疤 (granuloma) 或產生聲帶溝，這時便需要接受治療。

一般來說，如果聲沙病情輕微，可透過言語治療 (speech therapy) 矯正發聲方法，讓聲帶休息逐漸康復，病情嚴重則需要施手術。完成治療後仍需接受言語治療、預防復發，並要培養保護聲帶的習慣，包括用適當的音量、音調和速度說話或歌唱、避免叫喊或高談過久、戒煙、戒酒、多喝水保持聲帶滋潤等。值得一提的是，聲沙也是喉癌的早期徵兆，倘若聲沙持續達四星期或以上，便要多加留意檢查。

Hoarseness is one of the most common complaints referred for ENT evaluation. It is often a result of abnormal vibration of the vocal cords. In order to produce a normal voice, both vocal cords need to come together and vibrate in synchrony. Diagnosis is by direct visualization of the vocal cords via laryngoscopic examination in the office. Processes that may impede normal vibratory function of the vocal cords include infection (eg. laryngitis), inflammation from vocal abuse or laryngeal reflux, benign vocal cord masses (eg. vocal nodules/ cysts/ polyps), and malignant laryngeal tumors. Speech therapy is often necessary to correct abnormal use of vocal cord muscles. Vocal hygiene such as hydration, smoking and alcohol cessation, and voice rest should be followed. Surgery is reserved for large lesions or persistent hoarseness refractory to speech therapy. If there are any concerns about a lesion on the vocal cord, a biopsy procedure under general anesthesia is recommended.

Sources:
http://the-sun.on.cc/cnt/news/20100621/00410_012.html

鼻中隔偏移

鼻中隔 (nasal septum) 是指分隔鼻腔形成兩個鼻孔的骨板組織，鼻中隔偏移 (deviated septum) 很普遍，在外觀上未必看得出，亦不一定有徵狀，但約百分之二十接受鼻鏡檢查的人，都會發現鼻中隔有或多或少的偏移。假如偏移情況嚴重，空氣流通受阻，就可能會造成長期鼻塞、經常流鼻血及嗅覺失靈等等，患者便需接受適當治療。

有鼻中隔偏移的病人未必需要接受治療，但如果呼吸受到阻礙，以及出現復發性流鼻血、嚴重鼻鼾、慢性咽喉炎及睡眠窒息等徵狀，就應接受治療。病情輕微者可接受激光切除手術，病情嚴重要做鼻中隔手術 (septoplasty)。手術不會影響鼻形和外觀，亦不會在面上留下傷口或疤痕。

Nasal septum is the midline structure that provides support of the nose and separates the nose into left and right cavities. Deviated septum is a very common finding, although in most cases it does not cause any symptom of nasal obstruction. If severe, septal deviation can have major impact on quality of life. The problem can be exacerbated by allergic rhinitis and turbinate hypertrophy. Treatment for symptomatic patient involves removing the deviated part of the septum by making small incisions inside the nose. Nasal packing usually stays in the nose for a week. Pain is usually benign and recovery time typically takes 1-2 weeks.

Source:
http://the-sun.on.cc/cnt/news/20100619/00410_003.html

鼻咽癌病徵

不少人以為鼻咽癌 (nasopharyngeal carcinoma) 的早期病徵以流鼻血為主，但事實上，大部分鼻咽癌患者首先出現頸部腫脹的情況，即使鼻咽癌可以引致鼻咽出血，但鼻咽內的血液通常會直落食道，病人多只會嘗到腥味而看不見血紅。在臥眠時，鼻咽的出血則會停留在鼻咽；一夜過後，當病人起床時改變了頭部的角度，或者在刷牙漱口時刺激了喉咽之後，積聚在鼻咽的血液或血塊才會流到喉咽，這時病人的口水和鼻涕中便可能帶血，但總的來說只有兩至三成鼻咽癌患者才出現這些病徵。

鼻咽癌的另一重要病徵是耳鳴 (tinnitus)，這是因為癌細胞的侵襲可以令中耳出現積水 (middle ear effusion)，令一邊的耳朵聽力下降或耳鳴；另外，因為鼻咽癌細胞也會攻擊附近頭部的神經，例如會令控制眼睛轉動的神經受損，使左右眼的轉動不協調，從而令病人的視力產生重影。

頭痛、面癱 (facial paralysis) 等都是鼻咽癌患者的徵狀，卻因為與其他疾病相似，所以更容易讓人所忽略，錯過了治療的黃金時期。故此，當身體出現不適時，應與醫生討論，由醫生辨識病徵，以找出正確的治療方法。

Sources:
http://the-sun.on.cc/cnt/news/20100616/00410_003.html

下鼻甲骨肥大阻呼吸

鼻甲骨 (turbinate) 滿布黏膜及血管，幫助濕潤及暖化吸入的空氣，但如果你有長期鼻炎及過敏性鼻炎，便會刺激黏膜增生加厚，導致鼻甲骨腫脹肥大 (turbinate hypertrophy)，嚴重時更可能會阻塞氣道，令你出現持續及長期鼻塞。

事實上，鼻甲骨肥大是導致鼻塞的常見原因，而下鼻甲骨是最貼近鼻孔的部位，所以一旦它出現肥大就很容易引起呼吸不暢及鼻塞，不少患者因此而改用口呼吸，結果誘發相關的後遺症，包括增加患上慢性咽喉炎、睡眠窒息症及鼻竇炎等問題，有時早上起床時更會有頭痛的情況。你可以接受鼻內窺鏡檢查以確定是否有下鼻甲骨肥大。

如果病人有下鼻甲骨肥大的情況，醫生一般都會嘗試先以藥物治療及控制病情，若藥物無效病人便可考慮進行下鼻甲骨切除術，避免長期受鼻塞的困擾。傳統手術是以鉸剪切除下鼻甲骨，創傷性較大，出血風險較高，故病人通常需入院進行。至於激光切除手術的創傷性會較低，過程中病人幾乎不流一滴血，痛楚亦少，而且可以在診所進行，比較快捷及方便，而療效亦十分理想。

Turbinate is an important part of the nose that helps humidify air during breathing. We normally have 3 turbinates on each side of the nose: superior (highest), middle, and inferior (lowest) turbinates. In chronic sinusitis or allergic rhinitis, however, inferior turbinate can become large and obstruct the airway.
Initial treatment in turbinate hypertrophy is medical, typically with nasal steroid spray such as flonase and nasonex. A trial of at least a month is recommended. Should nasal obstruction continues, there are a number of surgical approaches advocated. Turbinectomy (cutting out part of or the entire turbinate) carries a higher risk for crusting, bleeding, and empty nose syndrome postoperatively. Resecting just the bony component of the turbinate while leaving mucosa intact (submucous resection) has been shown to decrease the risk of crusting. Newer techniques such as laser and coblation have been demonstrated to reduce bleeding during the operation. Recovery time usually is between 1-2 weeks. Pain is usually minimal. Patients are advised to avoid blood thinners and strenuous activities for 2 weeks after surgery.

Sources:
http://the-sun.on.cc/cnt/news/20100612/00410_003.html

游泳耳可損聽力

游水後耳朵痛及流膿，可能是患上俗稱「游泳耳」的急性外耳道炎。游泳期間，不潔的泳池或海水會流入耳道，令內裏的耳垢發脹增大，讓人有「塞住」的感覺，於是嘗試用棉棒探入耳朵吸走水分，但結果刮傷了耳道皮膚，令病菌有機可乘造成感染，引起耳道痕癢、腫脹、疼痛及流膿等情況，腫脹的組織更會堵塞耳道，令聽力受阻。

預防「游泳耳」方法:
首先，你應選擇一些水質較佳的泳灘及泳池場所，游水時可戴上泳帽或專用耳塞，尤其是一些有慢性中耳炎、耳朵敏感及濕疹等患者，更需要用耳塞保護，防止污水入耳。游泳後你可用清潔的毛巾或紙巾拭抹耳道口，吸出積水，但不應用異物伸入耳道，以免弄損耳內皮膚。如果仍覺得耳道有水，可以把一側耳朵朝向地面，然後用手輕輕拉一拉朝地的耳廓，這樣可以把耳道拉直，以利積水排出。

如果你游泳或參與水上活動後一、兩天，出現上述的耳朵不適，便應盡快求醫處理，千萬別自行購買藥物或任由其自行痊愈，原因是耳內的細菌有可能會侵襲其他組織，併發嚴重炎症，對聽力可造成永久性傷害。

Acute otitis externa is commonly known as "Swimmer's ear" since it is frequently associated with swimming activities. Any trauma to ear canal, eg. the use of q-tip after swimming, increases the risk of infection of the ear canal especially in the presence of contaminated water source. Symptoms include ear pain, decreased hearing, ringing, and ear drainage. Topical antibiotics with steroids are treatment of choice following cleaning of debris in the ear canal under microscopy. Sometimes when the ear canal is so swollen that precludes the use of antibiotics ear drops alone, a small wick is placed in the ear canal for a few days, allowing ear drops to diffuse deep in the ear canal via capillary action. Dry ear precaution is paramount in individuals prone to recurrent outer ear infection.

Sources:
http://the-sun.on.cc/cnt/news/20100605/00410_003.html