Minimally Invasive Tympanoplasty: An Expert Overview by Dr. Chow Chun-kuen
The following content is excerpted from an interview with Hong Kong ENT specialist, Dr. Chow Chun-Kuen, explaining the principles and benefits of minimally invasive tympanoplasty.
Various conditions can lead to tympanic membrane (eardrum) damage, such as excessive force during ear cleaning or chronic otitis media. If not properly managed, these issues may result in eardrum perforation and potential hearing loss. Traditional eardrum repair procedures are often highly invasive and entail prolonged recovery times. However, a more straightforward minimally invasive tympanoplasty is now available; patients can undergo this procedure under local anesthesia and be discharged on the same day. Remarkably, even those with decades-old eardrum damage can experience significant auditory improvements post-surgery.
Eardrum perforations can cause symptoms like pus discharge from the ear, tinnitus (hearing noise), and inexplicable nasal airflow during exhalation—symptoms many patients tend to neglect. In 1999, Dr. Chow pioneered a simplified technique for eardrum repair using a minimally invasive approach through the outer ear canal to harvest a small section of muscle membrane for repairing the damaged eardrum.
Patients undergo local anesthesia for this procedure which takes roughly 30 to 45 minutes to complete. The incision is minimal and located within the inner ear without requiring sutures as it naturally heals within two days post-operation—a stark contrast to conventional methods that involve making incisions behind the ear up to five centimeters long needing ten to twenty stitches along with general anesthesia and hospitalization for at least two days.
Mr. Cheung, who served in an executive role, encountered severe bilateral middle-ear infection due to polluted water exposure while swimming years ago coupled with improper use of over-the-counter ear drops causing both his eardrums’ rupture. After undergoing traditional surgery on his left ear twenty-five years ago where he recovered successfully; three years prior faced recurrent infections affecting his right ear leading him difficulty concentrating at work compounded by strenuous efforts needed for listening exacerbating fatigue levels significantly until opting for this advanced surgical method has progressively restored his hearing capacities encompassing perceiving stereo sounds too.
Accordingly noted by Dr. Chow majority seek tympanoplastic owing chronic otitis media progressing acute states involving pus generation alongside occasional accidental puncture treatment inadequacy reaches beyond normal self-healing approximately spanning few months necessitating operative intervention promptly warned ignoring latent risks deepening untreated paths possibly culminating continuous vertigo episodes thus progressive deterioration optionally avoidable through prompt procedural recourses ensuring preserving optimized auditory functions future devoid adverse postoperative implications whatsoever additional constraints comprising extensive miniaturized perforations width narrowness preclude eligibility newer operant techniques deployed herein.
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Eustachian tube dysfunction seriously affects the hearing of patients. Balloon dilation of the Eustachian tube is currently a widely respected treatment method. What are its advantages? What are the comments between doctors and patients?
This article is an interview with patients and doctors on this surgery with citations for your reference.
Doctor : The tube dysfunction is a problem that can affect the entire population. I think at some point everyone has experienced tube dysfunction as part of an infection and can therefore judge how it impairs upon both hearing and general well-being.
Patient : I constantly had ear pressure issues. I felt that I couldn’t hear conversations properly. My personal impression was that my hearing had greatly deteriorated. In my job, I have to take care of a lot of people, and that was no longer possible. It was also not possible for me to balance the pressure in my ears on an aeroplane. That was particularly awful for me. In larger groups, I felt that I was no longer able to process what was going on around me or follow conversations in a restaurant, for example.
Doctor : Balloon tube dilation has been available for a few years. In this context, a small balloon is inserted via the nose into the tube ostium and then the tube.
Patient : The ENT doctor found out that I had a ventilation problem in the tube. It turned out to be chronic otitis. I was recommended to have a ventilation tube inserted, which was then carried out in the ENT practice. The ventilation tube failed to bring the desired results. The complaints did not go away and I could still hear very little.
Doctor : We have been performing tube dilation for a good year. We treated our first patient in September 2013 and have been able to help a large number of people using this method since then. During the operation, the catheter is placed in the tube via the nose and dilation is carried out at 10 bar pressure for 2 minutes. In our clinic, we perform tube dilation in patients who suffer from chronic middle ear diseases and have developed hearing loss, hoping to eliminate these symptoms and avoid ear surgery.
Patient : In the ENT clinic, Professor suggested expanding the tube with a balloon.
Doctor : The operation itself always takes place under general anaesthetic. Tube dilation is a low-risk procedure that may provoke bleeding in the nasal mucosa, but this can be resolved very easily. There are no serious risks to expect.
Patient : I was able to leave the clinic 24 hours after the operation, without pain, freed of my problems. I was able to resume work immediately.
Doctor : The follow-up inspection is carried out regularly at six to eight weeks. Post-operatively, patients are instructed to safeguard tube ventilation by performing the Valsalva maneuver 20 to 30 times daily. In the Valsalva maneuver, the patient tries to inflate the tube opening by building up pressure in the nasopharynx and thus forcing air into the middle ear areas. It looks like this. I seal my nose and with my mouth closed I increase the pressure until it arrives in the middle ear. This is easy for a person who does not have a tube dysfunction, but for people with chronic tube dysfunction it is sometimes impossible.
Patient : The clinic recommended that I use the Valsalva method Valsalva, which I perform several times a day, so I always ensure that the tube is open.
Doctor : It varies from patient to patient as to how quickly success is achieved. We have some patients where tube ventilation is immediately restored after surgery and who report that they can hear better on the day of the operation.
Patient : For me it was a total improvement in my quality of life. After the procedure I felt that I had been given a completely new quality of life with which I am very satisfied.
Doctor : We often get the feedback that the patients are happier again, more optimistic and not so caught up in their ear problem.
Patient : The surgery took place a year ago. I am still satisfied and free of all complaints.
Doctor : This form of treatment has become well established in adults in recent years. In the future, I think it will probably also be extended to children who also suffer from chronic tube dysfunction. I can imagine that children too will benefit greatly from tube dilation in the future.
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Balloon Sinuplasty is a new treatment for chronic sinusitis. Its basic principle is to place a balloon through a catheter at the opening of the sinus, and expand the opening through the balloon to facilitate sinus drainage. This article is an interview conducted by doctors for patients undergoing this surgery for your reference.
Doctor : A balloon sinuplasty procedure is an in-office procedure that we perform for patients that have either recurring sinusitis, chronic sinusitis, or recurring sinus headaches. It’s performed in the office as an outpatient awake with minimal to no recovery time. If an individual is having multiple sinus infections a year or a chronic sinus infection, meaning an infection that doesn’t resolve with multiple rounds of antibiotics, that’s the first step of determining candidacy for the procedure itself. The second criteria is their CT exam findings. So usually on the first visit or second visit, we’ll perform a sinus scan to sinus-related problems or potentially allergy-related issues as well. So using those two criteria really helps us define which patients will be a good candidate and which patients will have great success from doing the procedure.
The procedure is very simple. It’s usually performed in about a 45 minute to 60 minute time frame in the office. The patient is awake for it, which sounds scary to a lot of people, but in the hundreds of procedures we’ve done, patients have done very well with it. The first 30 to 45 minutes is limited to just numbing up the nose and it’s really a two-step process. The first thing we do is place a piece of cotton that’s coated in numbing medication on both sides of their nasal cavities. And then once that has a chance to set, we then do a numbing injection in their nose, which the patients don’t feel other than maybe a little tingly sensation. Once the anesthetization is complete, then we do the procedure, which lasts maybe 10 to 15 minutes. The procedure itself is really just a dilation of their sinus openings. So we use a balloon and it goes into the narrowed openings of their sinus cavities. Once that balloon is in place, then we inflate it for about 3 to 4 seconds and that expands or opens that sinus cavity up.
Patient : Good. We’re in perfect position here. You’re going to feel a little bit of pressure as we inflate. Go ahead and inflate.
Doctor : There’s usually two to three areas on each side of their sinuses that we dilate. And then once that’s completed, the procedure is done. And typically the recovery time is a little bit of headache for that first evening, maybe the next day, but a lot of patients are able to return to their work, their job, their normal activity that same afternoon.
Doctor : Are you feeling okay?
Patient : Yeah, it really wasn’t that bad.
Doctor : Okay. Great. So I’ll see you back next week and we’ll take a look in there and see how you’re healing. Okay. I’ll walk you up to the front.
Patient : Okay.
Doctor : My experience. And if you look at research across the country, it’s, it’s pretty well documented that the success rate is well above 90%. And I would say it’s even probably above 90% for our practice. We define success as a 85 to 90% reduction in the number of headaches and or sinus infections that that patient has having. Usually I’ll have patients follow up within one to two weeks after their procedure, and almost invariably they all come back with smiles on their face, let me know how much better their sinus issues are, how much better they feel. I’ve had some patients, well, they’ll go 20, 30 years with sinus issues, sinus headaches almost every day of their life, and then you’ll see them at that two-week mark, and some of them even with tears in their eyes are so happy because they’re able to now live without having daily headaches.
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In babies and children, sleep apnea can be a disturbing and dangerous condition. This article goes over causes of sleep apnea in children, symptoms and its treatments.
Sleep apnea is a serious illness that can be life-threatening. It’s when the throat muscles relax and the airway becomes blocked during sleep, disrupting the breathing pattern. Sleep apnea can increase the risk of heart disease, diabetes, and high blood pressure. More than 80% of those who have this condition are overweight or obese. It can also lead to long-term mental health problems such as depression or anxiety.
A recent study showed that about 30% of children in the US have obstructive sleep apnea, even though many are not identified. This is much higher than in adults, where the percentage is around 5%. The percentage in adults decreases when they move into the retirement age.
Children with sleep apnea usually snore, have difficulty breathing or pause for a few seconds while they are sleeping. They also exhibit symptoms of daytime sleepiness and struggle to maintain attention in school. It is important to identify this condition in children because it can lead to emotional and behavioral problems.
Some of these symptoms are similar to those described in children with attention deficit hyperactivity disorder (ADHD). In fact, some children with sleep apnea are misdiagnosed as having ADHD.
Sleep apnea is a sleep disorder that causes people to stop and start breathing during sleep. This may happen as many as 10 times an hour. Sleep apnea is most common in adults, but children can also have it. Symptoms of sleep apnea in children include:
Most children suffering from sleep apnea could be cured by surgical excision of the tonsils and adenoid. It is considered to be a low risk surgical procedure.
When Surgery is considered inappropriate, a continuous positive airway pressure (CPAP) treatment will be considered. The setting of the CPAP treatment has to be determined by a proper overnight sleep test.
Children suffering from mild sleep apnea may also improve with medical treatment.
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Cancer is a disease that has been around for centuries, and it’s a murderer of people all around the world. Diagnosing cancer can be an arduous process, as doctors must thoroughly examine the patient to diagnose the type and severity of their cancer along with what treatments they can offer. Here take a look on the treatment options for hypopharyngeal cancer and choosing the best treatment.
There are a number of different treatment options to choose from for hypopharyngeal cancer. Some patients may only receive radiation therapy while others may require surgery. Others may also need chemotherapy. The treatment plan is customized based on the type of cancer, its location, and other factors like whether or not it has spread to nearby tissue.
The best treatment for hypopharyngeal cancer is based on the stage and type of cancer, as well as your general health. The most common treatments for hypopharyngeal cancer are radiation therapy and chemotherapy. Radiation therapy uses high-energy X-rays to shrink or eliminate cells that continue to grow after surgery or other treatments. Chemotherapy is a drug treatment that targets all rapidly dividing cells in the body.
If you or someone you love is diagnosed with hypopharyngeal cancer, it’s important to understand the many options available for treatment, including surgery and cancer-specific therapies. Make sure to consider supportive care during and after treatment as well. This can include help with eating and drinking, swallowing difficulties, and pain control.
The prognosis of hypopharyngeal cancer is typically poor. The average five-year survival rate is around 27%. However, this number may be misleading because the only people who are generally eligible for standard treatments are those with localized cancers that can be surgically removed or those whose tumors don’t obstruct the upper esophagus.
Side effects depend on the type of treatment that is chosen. Radiation and chemotherapy can cause nausea, fatigue, and temporary hair loss. Surgery can lead to infection, blood clots, and nerve damage. Combining treatments might present risks not seen with one treatment course alone.
Your doctor will decide on the best course of treatment based on your age, the size and location of the tumor, and your overall fitness. Some treatments can include surgery, radiation therapy, chemotherapy, or a combination of these. Treatment options depend on how serious your disease is.
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Lymphoma is a form of cancer that affects the lymph nodes. Lymph nodes are small, bean-shaped collections of immune cells found in various parts of the body including under your arms, groin or near your collar bone. This article will provide tips on what are the symptoms of lymphoma, how you can prevent it and how to diagnose it if you think you have this disease.
Having a sore or swollen lymph node is not an accurate sign of cancer, however it can be a sign of something more serious. If you have been experiencing night sweats, weight loss, persistent cough or pain in the abdomen for more than one week, it may be time to visit your ENT doctor.
Lymphoma is a cancer of the lymphatic system. The risk for this type of cancer is very low, but it’s important to do what you can to prevent it. A healthy diet is one of the most important things you can do to lower your risk of developing lymphoma. Lifestyle factors are also important, including smoking cessation, maintaining a healthy weight, and limiting alcohol consumption.
It is important to know the risk factors that can increase your chances of getting lymphoma. These include age, race or ethnicity, family history, and exposure to other cancers such as breast cancer. Smoking and drinking alcohol can also increase the risk for this type of cancer.
In order to prevent lymphoma, you should practice good hygiene and avoid contact with people who have had the disease. You should also avoid radiation and hazardous chemicals, which can cause an increased risk of contracting lymphoma. Finally, make sure to be vaccinated. The only way to prevent lymphoma is to not smoke. Researchers have found that non-smoking adults are 10 times less likely to develop lymphoma. The risk of developing this blood cancer then decreases by 6% for every additional year that an adult doesn’t smoke. If you are a smoker, it’s even more important to stop smoking.
When lymphoma becomes active, it starts to grow in the lymph nodes. The diagnosis is difficult because the disease can be localized, but it can also spread to other parts of the body. The tumor might only be millimeters in size, but cause other symptoms like weight loss or fever. If you have one or more of these symptoms, see your ENT doctor for an examination and possible blood work. The next step is to do a biopsy of the lymph nodes. The doctor will take out a small tissue sample, usually with a needle , and look at it under a microscope. If the doctor says you have lymphoma, you will probably need other tests to find out which type you have. The doctor might also do a biopsy of the tumor to find out how fast it is growing. A sample will be removed, and it will be tested to find out how fast the tumor is growing, and what kind of cells it starts from. This will help the doctor decide your treatment .
How is lymphoma treated? Once you have been diagnosed with lymphoma, your doctor will decide which kind of treatment to use. The type of treatment you receive depends on the type of lymphoma you have, how big and how fast your tumor grows, and whether it has spread to other parts of the body.
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It is estimated that about one in fifty people are diagnosed with thyroid cancer at some point. Many of these patients may be advised to undergo thyroidectomy surgery to remove all or part of the thyroid gland. This article discusses the pros and cons of thyroid surgery, including things to consider when in doubt.
Thyroidectomy is surgery that involves the removal of the entire thyroid gland or parts of the gland. Indications for surgery include hyperthyroidism, thyroid cancer, thyroid lymphoma, and goiter.
There are many benefits to this surgery, for instance it is a less invasive procedure with few risks involved in comparison to other surgeries. It is most often needed for cancer. If cancer is not present, it can be done as a treatment for enlarged thyroids or benign tumors. It’s also common for hyperthyroidism.
For most people, a special diet after a thyroidectomy is not necessary. It is likely to eat softer foods and drink normally the morning after surgery.
After a total thyroidectomy, the entire thyroid gland is removed and no hormone needed to control the body’s metabolic processes is supplied. Hence, the patient will take lifelong thyroid hormone replacements. She might also have to take supplements to balance the calcium levels.
After a thyroid lobectomy, the patient needs to have her thyroid hormone levels checked and will be prescribed a thyroid hormone replacement, if needed.
In the weeks after surgery, the patient may have a temporary neck pain, soreness of the vocal chords or a weak voice.
Besides, the surgery can result in hypothyroidism, which means the patient will need to take medication for the rest of their life. The other major complication is damage to nerves or vessels during the process, leading to reduced blood flow to the vocal cords, which may cause significant voice problems. Post-operative care can also be difficult because patients are more prone to infection.
After surgery, the thyroid gland needs to be closely monitored. This is done with a series of blood tests and ultrasound scans. Thyroid hormone levels may need to be adjusted, and patients will usually need to take thyroid hormone for the rest of their lives. Patients who keep their thyros naturally active and do not have problems can take control of their health by eating a healthy diet, exercising regularly, and taking supplements.
After the thyroidectomy or thyroid lobectomy, the patient may have a temporary sore throat, neck pain, difficulty swallowing or a weak voice.
Her diet will be restricted for the evening of the surgery, but generally can return to normal the next day.
Most people may return home within one day of surgery, but take off about two weeks from work to recover. It needs to refrain from heavy lifting or other tasks that can strain the neck for up to three weeks after surgery. Soaking or scrubbing the site of your incision is also discouraged for at least one week to allow it time to properly heal. Showering is generally allowed after about one day.
Pain at the site of the incision will improve after a few days but may continue for a week.
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Cancer is a word that strikes fear into the hearts of many people, but the reality is that the majority of cancer cases are curable. In this article, we’ll be exploring several different treatment options for childhood nasopharyngeal cancer and how to choose the right one for your child.
Nasopharyngeal cancer is a rare type of cancer that begins in the upper part of the throat, or nasopharynx. It’s often caused by infection with Epstein-Barr virus (EBV) but can also be caused by other viruses, chemicals, and even radiation. These cancers are usually found at an early stage because they often cause symptoms like stuffy nose, sore throat, hoarseness, and enlarged lymph nodes in the neck. It is more common in teens than in children younger than 10 years of age.
There are different types of treatment for children with nasopharyngeal cancer. Some are standard treatment currently used, and some are being tested in clinical trials to help improve current treatments or obtain information on new treatments.
It is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
It is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing.
Surgery is used to remove the tumor if the tumor has not spread throughout the nasal cavity and throat at the time of diagnosis. If a mass is small, it can be removed with an endoscope, a thin, flexible tube with a light and camera at the end. If it’s larger, a surgeon will make an incision in the skin. The mass may be removed in pieces with a very small tool and then put back together.
It is a type of biologic therapy treatment that uses the patient’s immune system to fight cancer. Several types of immunotherapy are being used to treat children with nasopharyngeal cancer:
(1) Interferon may stop cancer cells from growing and it may also help kill cancer cells.
(2) EBV-specific cytotoxic T-lymphocytes are a type of immune cell that can kill certain cells, including foreign cells, cancer cells, and cells infected with the Epstein-Barr virus. They are being studied to treat refractory or recurrent nasopharyngeal cancer.
(3) Immune checkpoint inhibitor therapy blocks certain proteins. PD-1 is a protein on the surface of T cells that helps keep the body’s immune responses in check. PD-L1 is a protein found on some types of cancer cells. When PD-1 attaches to PD-L1, it stops the T cell from killing the cancer cell. PD-1 and PD-L1 inhibitors keep PD-1 and PD-L1 proteins from attaching to each other. This allows the T cells to kill cancer cells. Pembrolizumab and nivolumab are types of PD-1 inhibitors that have been used to treat adults with refractory nasopharyngeal cancer and may be considered to treat children.
The right treatment for nasopharyngeal cancer will depend on the size of the cancer, how fast it’s growing, and where it’s located. The most common treatments are surgery to remove the tumor, chemotherapy with radiation therapy, or radiation therapy alone. More uncommon treatments include stem-cell transplantation.
Usually, treatment of newly diagnosed nasopharyngeal cancer in children may include the following:
Nausea and vomiting are common side effects of many different medicines and treatments. These side effects may lessen after the child finish treatment.
Pain, sore pink skin, bleeding and swelling are also common side effects of radiation therapy. These side effects usually go away after treatment ends.
Children are typically not able to make decisions related to their treatment. In order to make a decision, you will need to consult with your child’s team of doctors and therapists. You will also need to take into account the location of the tumor as this can affect the type of treatment that is available. Depending on the severity of treatment, you may be able to take it back home with you.
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For details of our ENT services, diagnosis, and treatment, please consult our ENT specialist.
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For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
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