ENT Head & Neck Surgery Center

ENT Head & Neck Surgery Center

Rm 02, 5/F., Kai Seng Commerical Centre,
4-6 Hankow Road, TST Kln, HK
(near Kowloon Hotel)
Tel: (852) 3100 0555
Fax: (852) 3100 0556

Lawrence Chow / ENT Doctor

下咽癌:沉默的喉嚨殺手 — 不可忽視的吞嚥警訊!

 

「58歲康先生,他有長期吸煙及飲酒的習慣,近期出現持續喉嚨痛、吞嚥困難及聲音沙啞等不適症狀,求診後經內視鏡檢查確診為《下咽癌》第三期,屬中晚期。康先生接受了手術切除了腫瘤及手術後的放射治療,目前仍在觀察中,需定期檢查以防復發。」

 

 

何謂下咽癌?

下咽癌(Hypopharyngeal Cancer)發生於「下咽部」(喉嚨連接食道的區域),屬於頭頸癌的一種。因為位置隱蔽,早期難察覺,約七成的病人如上述康先生一樣,發現下咽癌時,已出現頸部淋巴結的轉移或遠處的轉移至肺部、骨骼、肝臟等部位。故此下咽癌的治療效果通常較差。

 

 

下咽癌的常見症狀及傷害有哪些?

下咽癌早期的症狀並不明顯,發現時往往已較為晚期。但留意有下列變化,就要警剔:

  • 典型症狀:喉嚨痛、吞嚥困難、聲音沙啞、頸部腫塊、耳痛(轉移痛)。
  • 長期傷害:腫瘤可能阻塞呼吸道或食道,導致營養不良或呼吸困難;若擴散至淋巴或遠處器官(如肺、肝),將大幅增加治療難度。

 

 

下咽癌的病因是什麼?

  • 主要風險因素:吸煙、酗酒、嚼檳榔 (某些流行嚼檳榔的地區,嚼檳榔和酗酒更是下咽癌的誘發主要原因)。
  • 其他因素:長期胃酸倒流造成的慢性刺激、飲食缺乏新鮮蔬果、感染人類乳頭病毒(HPV)。
  • 遺傳與環境:家族史或長期暴露於石棉、化學粉塵人士患病風險較高。

 

 

下咽癌如何診斷?要做什麼檢查?

  • 內視鏡檢查:透過軟式纖維喉內視鏡直接觀察下咽部病變。
  • 影像學檢查:電腦斷層(CT)、磁振造影(MRI)評估腫瘤範圍及是否轉移。
  • 病理切片:取腫瘤組織進行活檢,確認癌細胞類型。
  • 全身評估:正電子電腦斷層掃描(PET-CT),檢查癌細胞遠處轉移的可能性。

 

 

下咽癌治療方法是什麼?

  • 早期(第一、二期):以放射治療為主,或搭配局部手術切除。
  • 中晚期(第三、四期):需多專科整合治療,如手術切除腫瘤及淋巴結,手術後輔以放射或化學治療。
  • 標靶與免疫療法:針對晚期患者,可使用抗EGFR標靶藥物(如Cetuximab)或免疫檢查點抑制劑(如Pembrolizumab)。
  • 支持治療:裝鼻胃管放置、語言訓練,助病人康復期間改善生活品質。

 

 

戒除煙酒,及早發現並接受治療是應對下咽癌重要的一環。有吸煙及酗酒習慣的人士,如果出現持續喉嚨不適,不要拖延,及早就醫以排除患惡性腫瘤的可能。有任何耳鼻喉問題,請立即聯絡香港耳鼻喉頭頸外科中心,由我們的耳鼻喉專科醫生為你詳細診治(電話3100 0555)。

 

 

資料來源:

香港耳鼻喉專科

耳鼻喉頭頸外科中心

提供耳鼻喉科服務、頭及頸外科服務

聽力及言語治療、驗配助聽器服務

人工耳蝸植入、睡眠障礙治療

https://www.hkentspecialist.hk

Minimally Invasive Salivary Gland Endoscopic Surgery: Say Goodbye to Pain and Scars, Protect Your “Salivary Health”

 

Case Study:
“Mr. Chao, a 40-year-old patient, experienced recurrent swelling and pain in his left submandibular gland after meals for over two years. The worsening symptoms eventually impacted his work and daily life, prompting him to seek medical help. Examination revealed redness and swelling at the opening of the left submandibular gland duct, with pus discharge upon gentle pressure. Ultrasound confirmed a 1.5cm × 0.8cm stone within the duct, diagnosed as a salivary gland stone. The stone was successfully removed using minimally invasive salivary gland endoscopic surgery, resolving his symptoms.”

 

 

What is Minimally Invasive Salivary Gland Endoscopic Surgery?
This technique employs endoscopic technology to diagnose and treat salivary gland diseases. A thin endoscope with a micro-camera is inserted into the salivary duct, allowing direct visualization of the duct’s interior. Advantages include minimal trauma, reduced pain, rapid recovery, negligible scarring, and preservation of salivary function. It effectively treats ductal stones, strictures, infections, and inflammation.

 

Who Needs This Surgery?
The procedure is suitable for patients with:

  • Salivary stones: Recurrent swelling (e.g., in adolescents) treated by stone extraction, avoiding gland removal.
  • Duct strictures: Caused by trauma or infection; the endoscope can dilate the duct and place stents.
  • Chronic parotitis: Traditional treatments are limited; endoscopic duct irrigation removes infections.
  • Salivary leakage: Post-traumatic saliva leakage repaired via precise duct restoration.

Ideal candidates include those with benign conditions (stones, strictures, chronic inflammation), children, elderly patients unfit for traditional surgery, and individuals prioritizing aesthetics. Contraindications include malignant tumors, acute infections, or coagulation disorders.

 

Procedure Overview:

  1. Preparation: Local or general anesthesia, followed by lesion localization.
  2. Stone Removal: A tiny incision (0.8–2.6 mm) in the mouth or behind the ear allows endoscope insertion. Micro-baskets extract small stones, while larger stones undergo laser lithotripsy before removal.
  3. Duct Dilation: Balloon dilation or silicone stents prevent recurrence.
  4. Irrigation and Drainage: Infected secretions are flushed to alleviate inflammation.
  5. Postoperative Care: Most patients discharge the same day with oral painkillers and follow-ups.

 

Five Key Advantages:

  • High Success Rate: 80–90% stone clearance; >70% stricture relief.
  • Scarless: Incisions hidden in the mouth or behind the ear.
  • Preserved Salivary Function: Avoids dry mouth or taste abnormalities post-surgery.
  • Low Complication Risk: Minimal bleeding/infection; safer for children and elderly.
  • Rapid Recovery: Most resume eating and daily activities immediately.

 

Technological Advances:

  • Single-Port Non-Insufflation Endoscopy: Reduces trauma with one incision.
  • Robot-Assisted Systems: Tested in Japan/Europe for complex cases, enhancing precision.
  • Pediatric Applications: Over 90% of children experience no recurrence or developmental issues post-surgery.

For ENT concerns, contact ENT Head and Neck Surgery Centre . Our specialists provide detailed consultations (Tel: 3100 0555).

 

 

Source:

HK ENT Specialist Ltd.

ENT Head and Neck Surgery Centre

For ENT Services, Audiology & Speech Therapy,

Sleep Disordered Breathing Management,

Hearing Aid Prescription & Medical Cosmetic Services

https://www.hkentspecialist.hk

微創唾液腺內視鏡手術:守護你的「口水健康」,告別疼痛與疤痕!

 

「40年歲的巢先生,每當進食後左側頜下腺就會腫脹疼痛,症狀已月2年,近來疼痛不適情況越加嚴重,已影響到工作和生活,巢先生才決心求診。檢查結果發現其左側頜下腺導管開口處紅腫,輕壓有膿液流出。超聲波檢查顯示左側頜下腺導管內有一粒約1.5cm×0.8cm結石,確診為「口水腺結石」。後透過新式微創唾液腺內視鏡手術將結石抓鉗出來,症狀緩解。」

 

 

微創唾液腺內視鏡手術是什麼技術?

微創唾液腺內視鏡手術是一種利用內視鏡技術進行唾液腺疾病的診斷與治療的微創手術方式。手術中,醫生透過在唾液腺導管內插入帶有微型攝像頭的細長內視鏡,直接觀察導管內的情況。該手術具有創傷小、疼痛輕、恢復快、瘢痕小等優點,並且能夠在保護唾液腺功能的同時,有效地治療唾液腺導管結石、導管狹窄、感染或炎症等疾病。

 

 

哪些人需要微創唾液腺內視鏡手術?

微創唾液腺內視鏡手術能幫助患有下列疾病的人士,包括:

  • 唾液腺結石:如反覆腮腺腫脹的青少年,內視鏡可取出結石,避免切除口水腺。
  • 口水腺導管狹窄:因創傷或感染導致唾液流動受阻,內視鏡可擴張導管並置入支架。
  • 慢性腮腺炎:傳統治療效果有限,內視鏡能沖洗導管、清除感染源。
  • 口水滲漏:如外傷後口水從皮膚滲出,內視鏡可精準修復導管。

 

所以,微創唾液腺內視鏡手術適合良性唾液腺疾病(如結石、狹窄、慢性炎症)、

無法耐受傳統手術的兒童或高齡患者、重視外觀的病人。不過對於唾液腺惡性腫瘤或急性感染或凝血功能異常就不適用。

 

微創唾液腺內視鏡手術如何進行?

手術前準備:局部或全身麻醉,定位病灶。

抓取結石:從口腔或耳後微小切口(約0.8~2.6 mm)插入內鏡,鏡頭即時顯示導管內部。利用微型網籃抓取腺體內的小結石,大結石則以雷射碎石後取出。

擴張腺管:使用氣囊擴張導管,必要時置入矽膠支架防止復發。

沖洗引流:清除腺管內感染的分泌物,緩解炎症。

術後處理:多數患者當天即可出院,僅需口服止痛藥與定期複診。

 

 

微創唾液腺內視鏡手術五大優點

  • 成功率:結石清除率達80%~90%,導管狹窄緩解率超過70%
  • 無疤痕:切口隱蔽於口腔或耳後,術後幾乎看不到痕跡。
  • 保留唾液功能:避免傳統手術後口乾、味覺異常等後遺症。
  • 減低併發症:出血、感染機率低,兒童與高齡患者更安全。
  • 快速恢復:多數患者術後即可進食,不影響工作與生活。

 

 

技術發展與最新趨勢

  • 單孔免充氣內鏡:最新術式僅需單一切口,進一步降低創傷。
  • 機器人輔助系統:日本與歐洲已試驗用於複雜唾液腺手術,提升精準度。
  • 兒童適用性:有醫院統計顯示,90%以上兒童手術後無復發,亦不影響發育。

 

 

有任何耳鼻喉問題,請立即聯絡香港耳鼻喉頭頸外科中心,由我們的耳鼻喉專科醫生為你詳細診治(電話3100 0555)。

 

 

資料來源:

香港耳鼻喉專科

耳鼻喉頭頸外科中心

提供耳鼻喉科服務、頭及頸外科服務

聽力及言語治療、驗配助聽器服務

人工耳蝸植入、睡眠障礙治療

https://www.hkentspecialist.hk

下頜下腺腫瘤:如何診斷與治療,手術後會留疤嗎?

 

上文我們談過什麼是下頜下腺腫瘤,良性和惡性腫癌的區別和症狀,今次會談談如何診斷及治療下頜下腺腫瘤。

 

 

下頜下腺腫瘤如何診斷?

  1. 觸診:可了解腫塊和頜骨的關係,較大腫塊常將下頜骨下緣包繞其中,舌下區也可觸到腫瘤破壞情況。
  2. 超聲波檢查:雙側對比了解下頜下腺病變的情況,單作一側易誤診。
  3. 影像學檢查:X光可了解下頜骨質有無破壞及破壞範圍。CT掃瞄可留意到下頜下腺多形性腺瘤為均勻或不均勻的高密度軟組織腫物。而惡性腫瘤則表現為包膜不完整,邊界欠清晰,腫瘤或病變組織向周圍正常組織的擴散和侵入,淋巴結腫大等。
  4. 細針穿剌細胞檢查:是較為有效的輔助檢查方法,但切忌進行活組織檢查。細針穿刺細胞檢查(Fine Needle Aspiration, FNA)和活組織檢查(Biopsy)並不是同一種檢查,但它們都是用於診斷疾病的醫學程序。

 

 

發生在口水腺上的疾病各式各樣,有炎症或腫瘤,有良性也有惡,如何鑑別下頜下腺腫瘤與其他口水腺腫瘤呢?

 

  • 慢性下頜下腺炎可引致腺體纖維化,下頜下腺會出現呈硬化的腫塊,而且病人大多有進食時下頜下腺腫大、疼痛或曾排出口水結石的經歷。

 

  • 下頜下腺淋巴結結核一般沒有特異性症狀,但腫塊或可自動清失,要鑑別不太容易,進行細胞檢查有助診斷。

 

  • 頸動脈瘤的典型位置是頸動脈三角,但也有不少病例是在下頜下腺後下部出現腫塊,跟原發於下頜下腺腫塊極度相似。不過頸動脈瘤因血管關係而具搏動反應,聽診時有雜音,透過血管造影、超聲波或CT檢查就能區別。

 

  • 神經鞘膜瘤也常在下頜下腺後方出現腫塊。不過腫塊無搏動性,多位於頸外動脈的深層,可順延頸動脈走向生長,病人咽側可見腫塊突出。

 

  • 鰓裂囊腫的腫塊質地柔軟,呈波動感,穿刺細胞檢查能抽出黃色液體。

 

 

「多形性腺瘤」和「腺樣囊性癌」如何治療?

  • 手術切除

多形性腺瘤的治療方法是手術切除下頜下腺。

下頜下腺惡性腫瘤的根治原則是切除下頜下腺外,還包括二腹肌前、後腹及口底肌,這些涉及頸和口腔的肌肉結構。如果腫瘤包繞下頜骨,或相關骨質受破壞,就要切除下頜骨。癌細胞若侵犯周圍淋巴結,進行下頜下腺切除時應將腺內及腺周接近腫瘤的淋巴結一併切除。如果癌腫瘤已轉已頸淋巴結,需進行選擇性頸部清掃術,清除那些最有可能受到癌細胞影響的淋巴結。

 

  • 放射治療

放射治療作為下頜下腺癌的輔助治療,作用是減低癌症的復發。對於腺樣囊性癌,手術後輔以放射治療是必須的,而且宜早不宜遲,最好在手術後6周內進行。

 

  • 化學治療

主要針對後期或復發的下頜下腺癌。化療也適用於只進受保守治療的病人。

 

 

手術切除會留疤嗎?

手術切除必定會留有疤痕,只是目前手術器械及內視鏡,還有達文西機器手臂的先進發展,能讓頭頸外科醫生在進行下頜腺手術時,將手術切口隱藏起來,避免出現明顯的手術傷疤。詳情請咨詢你的主診醫生。

 

 

有任何耳鼻喉問題,請立即聯絡香港耳鼻喉頭頸外科中心,由我們的耳鼻喉專科醫生為你詳細診治(電話3100 0555)。

 

 

資料來源:

香港耳鼻喉專科

耳鼻喉頭頸外科中心

提供耳鼻喉科服務、頭及頸外科服務

聽力及言語治療、驗配助聽器服務

人工耳蝸植入、睡眠障礙治療

https://www.hkentspecialist.hk

下巴無痛腫塊,竟是潛在殺手?認識下頜下腺腫瘤的真相與風險!

 

「年長的柯女士,多年前下頜位置出現一腫塊,由於觸碰不痛不癢,柯女士就一直沒有就醫。就這樣過了六年,腫塊不知不覺已長大到好似一個大包的腫瘤,黏貼在柯女士的下頜位置,導致她頭歪頸歪,頭頸無法活動自如。她就醫後經過手術切除,證實該腫瘤是口水腺的惡性腫瘤一種,稱為《下頜下腺腫瘤》。由於柯女士太遲就醫,癌腫瘤已出現肺和骨轉移,並引起轉移部位的症狀。」

 

 

下頜下腺腫瘤是什麼?

下頜下腺腫瘤是指發生在下頜下腺的腫瘤,而下頜下腺是唾液腺的一部分,因此可以說下頜下腺腫瘤是口水腺腫瘤的一種。這類腫瘤良性和惡性比率各佔一半,常見的良性腫瘤包括多形性腺瘤,而惡性腫瘤則以腺樣囊性癌多見。本文主要談談多形性腺瘤和腺樣囊性癌。

 

 

「多形性腺瘤」和「腺樣囊性癌」如何區分?

區分多形性腺瘤和腺樣囊性癌主要看病理,多形性腺瘤出現在口水涎腺組織內,界限清楚,表面光滑或呈結節狀,在光鏡顯微鏡下會看到腫瘤結構的多樣性,所以稱為「多形性腺瘤」。至於腺樣囊性癌則無包膜,侵襲性強,被癌細胞侵犯的範圍一般超乎手術時肉眼所見的腫瘤範圍,不易對付。

 

 

「多形性腺瘤」和「腺樣囊性癌」的症狀是什麼?

  • 多形性腺瘤較常出現在下頜下三角區,特點是生長緩慢,沒有明顯痛感甚至無痛,症狀除了腫塊,就沒有其他明顯特有症狀。多形性腺瘤的腫塊體積可大可小,呈結節狀態,觸摸時能清楚摸到會滑動的腫塊。

 

  • 腺樣囊性癌早期症狀同樣是無痛腫塊,雖然有些病例也會有疼痛或觸痛,但程度都很輕微,所以不易引起注意。腫塊初期生長十分緩慢,病程可長達數年或十餘年。不過,腫瘤可突然快速生長成為大腫瘤,腫瘤位置固定,不會滑動。腺樣囊性癌具有侵襲性,可沿著神經生長,引起舌痛或舌麻木等神經症狀;也可侵襲舌下神經時,導致舌癱瘓或舌肌萎縮。如侵襲面神經,引致嘴唇不能向外或向下牽拉,唇紅無法外翻等。它也可沿著血管生長,令到血管收縮功能無法正常運作,低血壓、血液循環不良、心血管疾病和供血不足等症狀將相繼出現。癌腫瘤也常侵襲病人下頜下腺周圍的淋巴結。後期的腺樣囊性癌可入侵血管,癌細胞通過血液循環系統從原發腫瘤部位轉移或擴散到身體其他部位。

 

一旦確診下頜下腺腫瘤,手術切除免不了,以往傳統的手法會在病人臉上留下疤痕,令到治療進退兩難。但隨著手術器械及內視鏡系統的發展,頭頸外科醫生能將手術切口隱藏起來。究竟下頜下腺腫瘤如何治療,請留意下篇文章。

 

 

有任何耳鼻喉問題,請立即聯絡香港耳鼻喉頭頸外科中心,由我們的耳鼻喉專科醫生為你詳細診治(電話3100 0555)。

 

 

資料來源:

香港耳鼻喉專科

耳鼻喉頭頸外科中心

提供耳鼻喉科服務、頭及頸外科服務

聽力及言語治療、驗配助聽器服務

人工耳蝸植入、睡眠障礙治療

https://www.hkentspecialist.hk

Desensitization Therapy: Retraining Your Immune System

 

Desensitization therapy is a long-term treatment approach that fundamentally alters the immune system’s response to allergens. Unlike medications (such as antihistamines or steroid sprays) that temporarily “suppress” symptoms, it acts like an immune coach, continuously “training” the body to shift from an overreactive state (attack) to immune tolerance (acceptance), ultimately achieving long-term relief or even a cure.

 

I. Core Principle: From “Attack” to “Acceptance”

Imagine the immune system as a highly alert army that mistakes harmless substances like pollen or dust mites (allergens) for dangerous enemies. Upon detection, it launches a fierce attack, triggering allergic symptoms.

 

Desensitization therapy works as follows:

  1. Start with a tiny dose: Introduce a minuscule amount of the “imagined enemy” (purified allergen extract) to the immune system.
  2. Gradually increase the dose: Allow the immune system to slowly adapt to the presence of the allergen and recognize it as non-threatening.
  3. Sustain maintenance: Administer long-term maintenance doses to solidify a state of “peaceful coexistence.”

 

During this process, the immune system undergoes tangible changes:

  • Reduces the production of allergen-specific immunoglobulin E (IgE).
  • Stimulates the production of immunoglobulin G (IgG4), a “blocking antibody” that acts like a shield. It binds to allergens in advance, preventing them from triggering IgE and mast cells, thereby stopping allergic reactions.
  • Promotes the generation of regulatory T cells (Tregs), which effectively suppress excessive immune responses and maintain immune balance.

 

II. Treatment Process

The entire desensitization therapy course typically lasts 3–5 years and consists of two main phases:

 

  1. Dose Escalation Phase (Initiation Phase)
  • Gradually increase the dose to help the immune system adapt until an effective and sustainable target dose is reached. This phase usually lasts 3–6 months.

 

Method 1: Subcutaneous Immunotherapy (SCIT)

  • Weekly injections at a clinic.
  • The dose is slightly increased with each injection.
  • After each injection, the patient must be observed at the clinic for at least 30 minutesto monitor for acute allergic reactions (e.g., difficulty breathing, severe hives) and ensure prompt medical intervention if needed.

 

Method 2: Sublingual Immunotherapy (SLIT)

  • The first dose is usually taken under medical supervision.
  • Thereafter, patients can self-administer daily at home(tablets or drops).
  • The medication is held under the tongue for 1–2 minutes for mucosal absorption before swallowing.
  • The dose escalation phase is shorter, often completed within days or weeks.

 

  1. Maintenance Phase
  • Stimulate the immune system with long-term “target maintenance doses” to consolidate and enhance tolerance for sustained effects. This phase is the core of the treatment and lasts 3–5 years.

 

Method 1: Subcutaneous Immunotherapy (SCIT)

  • After reaching the target dose, injection intervals are gradually extended to once every 2–4 weeks.

 

Method 2: Sublingual Immunotherapy (SLIT)

  • Patients must continue daily medication without interruption.

The success of the entire desensitization therapy highly depends on patient compliance. Interrupting or discontinuing treatment prematurely may nullify all progress, and the effects may not be sustained.

 

III. Applicability and Efficacy

Suitable for:

  • Respiratory allergies: Highly effective against allergic rhinitis, allergic conjunctivitis, and asthma triggered by dust mites, pollen (grass, tree, weed), mold, or pet dander (e.g., cats, dogs).
  • Insect venom allergies: Extremely effective (success rate >90%) for patients with severe allergic reactions to bee or wasp stings.

 

Less commonly used (still under research):

  • Food allergies: Currently, only peanut desensitization therapy is approved. Treatments for other food allergies are mostly in clinical trials and must be conducted with extreme caution at specialized medical centers.
  • Severe or uncontrolled asthma: Not suitable for this therapy due to the risk of triggering severe attacks.

 

IV. Potential Risks and Side Effects

Desensitization therapy is generally safe. However, since it involves active exposure to allergens, side effects may occur. These are generally categorized into local reactions (more common) and systemic reactions (less common but require vigilance).

 

Local Reactions

  • Injection site: Redness, itching, induration (usually resolves within days).
  • Oral/sublingual: Itching, mild swelling of the sublingual mucosa, throat discomfort (usually occurs shortly after administration and diminishes over time).

 

Systemic Reactions

  • Symptoms may include widespread hives, asthma attacks, throat swelling, nausea, or abdominal pain.
  • The most severe reaction is anaphylaxis, though it is extremely rare. This is why observation after subcutaneous injections and medical supervision during treatment are mandatory.

 

V. Efficacy and Important Considerations

Studies show that immunotherapy significantly alleviates symptoms, reduces the need for medication, and improves quality of life. Its effects can persist for years after treatment ends. For insect venom allergies, the efficacy rate exceeds 90%.

However, it may not work for everyone and requires considerable patience and adherence. Self-administration is strictly prohibited. Treatment must be guided and supervised by a physician to ensure safety and efficacy.

 

 

For assistance, please contact ENT Head and Neck Surgery Centre  (Tel: 3100 0555), where our ENT specialists will provide detailed diagnosis and formulate a treatment plan for you.

 

 

Source:

HK ENT Specialist Ltd.

ENT Head and Neck Surgery Centre

For ENT Services, Audiology & Speech Therapy,

Sleep Disordered Breathing Management,

Hearing Aid Prescription & Medical Cosmetic Services

https://www.hkentspecialist.hk

脫敏治療:如何「訓練」你的身體告別敏感人生

脫敏療法是一種從根本上改變免疫系統對過敏原反應的長期治療方案。它不像藥物(如抗組織胺或類固醇噴劑)那樣只是暫時「壓制」症狀,而是像一名免疫教練,通過持續的「訓練」,讓身體從原本的過度反應(攻擊)逐漸轉變為免疫耐受(接受),從而達到長期緩解甚至治癒的效果。

 

 

一、核心原理:從「攻擊」到「接受」

想像免疫系統是一支高度警覺的軍隊,誤將花粉、塵蟎等無害物質(過敏原)當成了危險的敵人,一旦發現就會發動猛烈攻擊,引發過敏症狀。

 

脫敏療法的做法

從小劑量開始:給免疫系統注入極其微量的「假想敵」(純化的過敏原提取物)。

逐漸加量:讓免疫系統慢慢習慣這個敵人的存在,並發現它其實並不構成威脅。

持續維持:長期給予維持劑量,讓這種「和平共存」的狀態成為常態。

 

在這個過程中,免疫系統會發生實質性的改變:

減少產生針對過敏原的特異性免疫球蛋白E(IgE)。

刺激產生一種稱為免疫球蛋白G(IgG4) 的「阻斷抗體」。這種抗體能像盾牌一樣,提前與過敏原結合,阻止它們觸發IgE和肥大細胞,從而防止過敏反應發生。

促進調節性T細胞(Tregs) 的生成。這類細胞能有效抑制過度的免疫反應,維持免疫系統的平衡。

 

 

二、脫敏治療流程

整個脫敏治療療程,通常持續3-5年,主要分為兩個階段:

 

  1. 增量階段(Initiation Phase

逐步增加劑量,讓免疫系統逐漸適應,直至達到一個有效且可維持的目標劑量。此階段通常需持續3-6個月。

 

方法一:皮下注射(SCIT)

每週需到診所接受一次注射。

劑量在每次注射中逐漸微量增加。

每次注射後,必須在診所內觀察至少30分鐘,以防出現急性過敏反應(如呼吸困難、嚴重蕁麻疹等),確保醫療人員能及時處理。

 

方法二:舌下含服(SLIT)

第一劑通常需在醫生指導下服用。

之後,患者可每日在家自行服用(藥片或滴劑)。

將藥劑置於舌下保持1-2分鐘,讓黏膜吸收,然後吞下。

增量階段較短,通常幾天或幾週內即可。

 

 

  1. 維持階段(Maintenance Phase

長期以「目標維持劑量」刺激免疫系統,鞏固並加強其耐受性,以獲得長期效果。此階段是療程的主體,要持續3至5年。

 

方法一:皮下注射(SCIT)

達到目標劑量後,注射間隔可逐漸拉長,變為每2至4週注射一次。

 

方法二:舌下含服(SLIT)

患者仍需每天堅持用藥,不能中斷。

 

整個脫敏治療療程的成功極度依賴患者的配合。隨意中斷治療或停止用藥會導致前功盡棄,效果無法維持。

 

 

三、脫敏治療適用範圍與效果

適用於:

呼吸道過敏:對塵蟎、花粉(草、樹、雜草)、黴菌、寵物皮屑(如貓狗) 等引起的過敏性鼻炎、過敏性結膜炎和哮喘效果顯著。

昆蟲毒液過敏:對蜜蜂、黃蜂等叮咬會引發嚴重過敏反應的患者,療效極佳(有效率超過90%)。

 

不常用於(仍在研究中):

食物過敏:目前僅有針對花生的脫敏療法批准,其他食物過敏的療法大多仍處於臨床試驗階段,需非常謹慎地在專業醫療中心進行。

嚴重/未受控制的哮喘:不適合進行此療法,因有引發嚴重發作的風險。

 

 

四、脫敏治療的潛在風險與副作用

脫敏療法總體上是安全的,但畢竟是在主動接觸過敏原,因此存在發生副作用的可能,通常分為局部反應(較常見)和全身性反應(較少見,但需警惕)。

 

局部反應:注射部位紅腫、瘙癢、硬結(通常在幾天內自行消退)。口腔發癢、舌下黏膜輕微腫脹、喉嚨不適(通常在用藥後不久出現,會隨時間減輕)。

 

全身性反應:症狀可能包括全身性蕁麻疹、哮喘發作、喉頭水腫、噁心、腹痛。最嚴重的是過敏性休克(Anaphylaxis),但極為罕見。這正是為什麼皮下注射後必須留下觀察,以及為什麼治療必須在醫院或診所並在醫生監督下進行的原因。

 

 

五、脫敏治療療效與注意事項

研究顯示,免疫療法能顯著減輕症狀、減少對藥物需求,並提高生活品質,其效果在停止治療後仍可持續多年。對於昆蟲叮咬過敏,有效率更高達90%以上。然而,它並非對所有人都有效,且需要極大的耐心和依從性。治療絕對不能自行嘗試,必須在醫生的指導和監督下進行,以確保安全與療效。

 

 

需要協助,請聯絡香港耳鼻喉頭頸外科中心,由我們的耳鼻喉專科醫生為你詳細診治及制定治療計劃(電話3100 0555)。

 

 

資料來源:

香港耳鼻喉專科

耳鼻喉頭頸外科中心

提供耳鼻喉科服務、頭及頸外科服務

聽力及言語治療、驗配助聽器服務

人工耳蝸植入、睡眠障礙治療

https://www.hkentspecialist.hk

Understanding Allergies: A Comprehensive Guide to Causes, Symptoms, Diagnosis, and New Treatment Hope

 

Allergies are an extremely common modern-day health issue, affecting hundreds of millions of people globally. Allergy sufferers often experience a significantly reduced quality of life: they may be unable to fully enjoy outdoor activities during spring blooms, may have to part with beloved pets, must carefully check food ingredients before eating, and could even face life-threatening anaphylactic shock from accidental exposure. Traditional treatments, such as antihistamines or nasal sprays, only provide temporary symptom relief without addressing the underlying cause—the immune system’s exaggerated response.

 

What is an Allergic Reaction?

An allergy is essentially a misdirection of the immune system. When the body mistakenly identifies harmless substances—such as pollen, dust mites, pet dander, or certain foods—as dangerous pathogens (like bacteria or viruses), it triggers a defense mechanism. This process involves the production of an antibody called Immunoglobulin E (IgE). IgE acts like an alarm, activating cells such as mast cells to release chemicals like histamine, which leads to classic allergy symptoms such as sneezing, runny nose, and itchy eyes. In short, an allergic reaction is an unnecessary “immune war.”

 

Symptoms of Allergic Reactions

Allergic symptoms vary widely in type and severity, depending on the allergen and the route of exposure:

 

Respiratory Allergies (e.g., Hay Fever, Dust Mite Allergy)

  • Nose:Sneezing, runny nose (typically clear and thin discharge), nasal congestion, itchy nose.
  • Eyes:Redness, itching, tearing, burning sensation (allergic conjunctivitis).
  • Throat and Ears:Itchy throat, itchy palate, ear fullness.

 

Skin Allergies (e.g., Atopic Dermatitis, Hives)

  • Skin:Rash, hives (wheals), eczema, intense itching.

 

Food Allergies

  • Mouth:Tingling or swelling of the lips, tongue, or throat.
  • Digestive Tract:Nausea, vomiting, abdominal pain, diarrhea.
  • Skin:
  • Severe Cases:May trigger a systemic allergic reaction.

 

Insect Sting Allergies (e.g., Bees, Wasps)

  • Localized:Large areas of swelling, redness, and pain at the sting site.
  • Systemic:May cause life-threatening anaphylaxis.

 

The Most Severe Reaction—Anaphylaxis

Anaphylaxis is a rapid-onset, whole-body, and potentially fatal allergic reaction. Symptoms include difficulty breathing, a sudden drop in blood pressure, dizziness, rapid heartbeat, swelling of the throat and tongue causing suffocation, confusion, and even loss of consciousness. This is a medical emergency requiring immediate use of an epinephrine auto-injector (EpiPen) and urgent medical care.

 

Causes of Allergic Reactions

Allergies typically result from an interaction between genetic and environmental factors:

  • Genetic Factors:Children with one or both parents having allergies are at a significantly higher risk of developing allergies. This is known as an atopic
  • Environmental Factors:
    • Hygiene Hypothesis:Overly clean modern environments reduce early childhood exposure to germs and microbes, potentially preventing the immune system from being properly “trained,” making it more prone to overreacting to harmless substances.
    • Allergen Exposure:Allergens present in living environments, such as dust mites, cockroaches, mold, and pollen.
    • Air Pollution:Pollutants can worsen allergy symptoms and increase sensitivity.
    • Dietary Habits:The timing and variety of early food introductions may also play a role.

 

Diagnostic Methods for Allergic Reactions

Effective treatment begins with accurately identifying the allergen. Doctors use the following methods for diagnosis:

 

Detailed Medical History:
A thorough discussion of your symptoms, their frequency, timing, location, and potential triggers is the first and most crucial step in diagnosis.

 

Skin Prick Test:
The most common test. A small amount of purified allergen extract is placed on the skin, and the surface is lightly pricked with a needle. If a raised, itchy bump (wheal) resembling a mosquito bite appears within 15-20 minutes, it indicates a possible allergy to that substance.

 

Blood Test (Specific IgE Test):
A blood sample is taken to measure the level of IgE antibodies produced in response to specific allergens. This method is suitable for patients who cannot undergo skin testing (e.g., due to severe skin conditions or antihistamine use).

 

Challenge Test:
Under strictly controlled medical supervision, the patient is exposed to a small amount of the suspected allergen (e.g., by inhalation or ingestion) to observe if a reaction occurs. Due to its higher risk, this test is only performed when necessary and under specialist care.

 

Allergy Treatment Methods and Process

Treatment can be divided into two main categories: symptom control and root-cause treatment.

 

Symptom-Control Medications:
Antihistamines, corticosteroid nasal sprays, and bronchodilators can quickly relieve discomfort but offer only temporary relief.

 

Root-Cause Treatment—Allergen Immunotherapy (Desensitization Therapy):
This is currently the only therapy that may fundamentally alter the course of allergic disease. It works by exposing the patient to gradually increasing doses of allergen extracts, starting from very low amounts, training the immune system to gradually “accept” the allergen instead of viewing it as a threat, thereby building immune tolerance. The process is akin to a long-term “reeducation of the immune system.” We will explore desensitization therapy in detail in our next article…

 

 

For assistance, please contact ENT Head and Neck Surgery Centre  (Tel: 3100 0555), where our ENT specialists will provide detailed diagnosis and formulate a treatment plan for you.

 

 

Source:

HK ENT Specialist Ltd.

ENT Head and Neck Surgery Centre

For ENT Services, Audiology & Speech Therapy,

Sleep Disordered Breathing Management,

Hearing Aid Prescription & Medical Cosmetic Services

https://www.hkentspecialist.hk

 

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