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

無創科技切除鼻息肉

鼻息肉 (nasal polyps) 可造成不少鼻腔不適，例如鼻塞、容易流鼻血、打鼻鼾、嗅覺不靈、令鼻水混濁及帶有異味等，但倘若鼻息肉沒有得到適當處理，除可併發鼻竇炎 (rhinosinusitis)，鼻腔在長期發炎下，更會影響嗅覺，日後即使成功將息肉除去，患者的嗅覺也未必能夠得以恢復，而且它與鼻竇內翻性乳頭瘤 (inverted papilloma) 的外表類似，故為免卻延治及併發症的風險，應及早確診處理鼻息肉問題。
治療方法視乎病情而定，如果鼻息肉體積細小，可先透過類固醇鼻噴劑控制病情；倘若鼻息肉體積過大，令鼻液不能順利流出時，便可考慮以內窺鏡技術將息肉切除。手術會經鼻孔將內窺鏡放入，再進行切除，故手術不會於患者的面部表面留有傷痕，而手術現時也可用上迴旋刀減低對正常鼻黏膜造成的傷害。
但如果患者過往曾接受鼻息肉手術，鼻腔結構受到改變，為提高手術的精準度，可考慮透過電腦導航技術定位，以減低手術風險。不過，不論接受迴旋刀還是電腦導航技術切鼻息肉，患者於手術後建議在醫生指引下使用類固醇鼻噴劑，降低黏膜發炎及鼻息肉復發的機會。

Nasal polyposis is a common cause of nasal obstruction. It is commonly seen in chronic sinusitis patients, who may suffer from longstanding nasal congestion, decreased sense of smell, and sinus headache. It can be easily diagnosed with nasal endoscopy which shows whitish smooth painless mass blocking the natural sinus drainage pathways. Initial treatment is medical involving oral and topical steroid spray, and comprehensive allergy treatment. Refractory cases require polypectomy via functional endoscopic sinus surgery (FESS). New techniques in sinus surgery include computer navigation system, microdebrider, balloon sinuplasty, and coblation. Patients with nasal polyposis are recommended to follow up with ENT physicians regularly to ensure control of disease.

Sources:
http://www.metrohk.com.hk/index.php

生飛滋

「飛滋」的學名為復發性口瘡或復發性口腔潰瘍 (aphthous ulcer)，是一種經常復發而又能自愈的口腔黏膜潰瘍，它通常出現於唇、面頰或齒齦等，邊界清晰而中間發紅及微腫，有時會造成灼痛感。

其實，飛滋是口腔黏膜表皮層受損傷後形成的傷口，成因未確定，但可能與多種因素有關，例如精神壓力、抵抗力差、身體受流感等病毒感染而削弱黏膜的抵抗力，再加上外來的刺激，如被食物刮損口腔、煙草中的尼古丁等，都會增加飛滋出現的機會。

要避免生飛滋，就要改善上述提過的誘因，多吃蔬果及多喝水，尤其要攝取足夠的維他命B2，以促進黏膜細胞健康。此外，亦要保持口腔清潔，減少細菌孳生，平日最好少吃燒烤、過熱或油炸等食物。

飛滋一般數日內可自愈，若情況持續兩周未愈甚至加劇，又或是經常長出又大又嚴重的飛滋，便可能是口腔黏膜病變或免疫系統出問題的徵狀，應盡快求醫檢查。

Aphthous ulcer is the most common type of nontraumatic ulcer. Incidence ranges from 10-20 % in the general population. The exact etiology is unknown but it has been linked to immunologic mechanism. Minor aphthous ulcers measure less than 1 cm while major ones are larger than 1 cm. The former typically lasts 1-2 weeks and resolves spontaneously, while the latter can persist up to months and heal by scarring.
Diagnosis is clinical and no microscopic feature is diagnostic of aphthous ulcer. Non-painful minor ulcers require no treatment. For painful and major ulcers, treatment ranges from dietary supplements, antibiotics, anti-inflammatory, oral mouth rinse, to chemical cautery with silver nitrate application.

Source:
http://the-sun.on.cc/cnt/news/20100508/00410_003.html

成年睡眠窒息症

一個人常常睡醒, 日間又無精打彩, 很可能是患上睡眠窒息症，保守估計約百分之四的成年男士患有此病，女性發病率則約百分之二，而肥胖及年老退化會增加組織垂鬆阻塞呼吸道的機會，頸頜結構異常的人士亦較高機會患病，例如下顎較小和下巴向後的人，舌頭會被推向咽喉，故也較易出現睡眠窒息症。

在正常情況下，無論我們睡得多熟，身體仍然會維持呼吸，但患有睡眠窒息症的病人，上呼吸道被鬆垂的軟組織及脂肪壓迫，以致呼吸間歇停頓。當大腦感應到身體缺氧時，便會發出指令要身體醒來，咽喉肌肉亦隨即恢復張力並重開氣道，讓空氣再次進入，身體也可以再次入睡。這種睡睡醒醒的情況可能出現多達數百次，而每次窒息可由數秒至數分鐘不等，因此實際上並無充分休息，導致日間精神委靡及感到睏倦，直接影響到工作和學業表現，若在駕駛或操作機械時打瞌睡便更為危險。

睡眠窒息症不能以藥物作治療，但仍有不少方法可以改善病情，例如使用正氣壓睡眠機，便是治療睡眠窒息症的最有效方法。睡眠機把空氣加壓並透過喉管及面罩泵入鼻腔，藉以打開阻塞了的呼吸道，令空氣可如常進出肺部，病人就不再因缺氧而醒。此外，肥胖的病人減肥後情況多會好轉，而避免仰睡則可減少舌頭阻塞咽喉，亦有助紓緩病況。若患者對睡眠機產生抗拒，可考慮接受手術治療，例如喉嚨矯型手術，對初度至中度的睡眠窒息症尤其有效。

Obstructive sleep apnea (OSA) affects close to 12 million Americans and results in significant loss of work efficiency if not treated. It is different from primary snoring disorder in that the latter does not cause long term cardiopulmonary complications such as pulmonary hypertension. Sleep study is the diagnosis of choice and is performed with patient spending a night in a sleep lab. An apnea event is defined as cessation of breathing for 10 seconds. A score known as apnea hypopnea index (AHI) is obtained and used to classified sleep apnea into mild, moderate, and severe categories. CPAP machine is the first line of treatment for OSA, although non-compliance remains a major issue with the device due to the discomfort of sleeping with the mask. For patients unable to tolerate CPAP, surgery is an option offered by Ear, Nose and Throat specialists. Surgery is most effective for patients with favorable anatomy (large tonsils, small tongue), mild apnea (AHI < 15), and strong motivation to lose weight.

Source:
http://the-sun.on.cc/cnt/news/20100507/00410_003.html