Lawrence Chow / ENT Doctor
What Are Your Surgical Options for Dysphagia?
In some cases, surgery is a must in addressing dysphagia, a condition characterized by persistent difficulty in swallowing. Surgery is usually recommended when the underlying cause is GERD, pharyngoesophageal diverticulum, throat blockages, achalasia, or esophageal cancer.
The type of surgery will depend on the underlying cause. Furthermore, speech and swallowing therapy will likely be recommended after recovery from surgery. Here are three options that you may want to discuss with your ENT doctor.
Heller Myotomy
The Heller myotomy procedure is typically used in the treatment of achalasia, a disorder of the esophagus that makes swallowing abnormally difficult. This is a minimally invasive procedure wherein several tiny incisions are made in the esophagus, followed by the insertion of small scope into these tiny incisions.
The small scope has miniature surgical instruments passing through it while a video camera connected to it sends enlarged images of the esophagus to a monitor. The surgeon can then perform the operation by manipulating the miniature instruments in the scope.
The Heller myotomy procedure has several advantages that make it popular among surgeons and patients with dysphagia caused by achalasia. These include:
- Less pain after the operation since only minimal manipulation has been done
- Faster recovery
- Shorter stay in the hospital, usually 1-2 days, as compared with the possible 7-day stay for a conventional open procedure
In short, you can more quickly return to your normal activities and work.
Peroral Endoscopic Myotomy (POEM)
Yet another possible surgical option for the treatment of swallowing disorders like achalasia is peroral endoscopic myotomy (POEM). This is an endoscopic procedure wherein your surgeon inserts an endoscope through your mouth and down your throat. Your surgeon then makes an incision in your esophagus’ inner lining and cuts the muscle responsible for dysphagia.
POEM is an in-patient procedure requiring between two and three hours for completion. Like the Heller myotomy procedure, it’s popular because it doesn’t require incisions in the abdomen or chest. It also doesn’t require long hospital stays.
Esophageal Dilation
The medical professionals qualified to perform an esophageal dilation are otolaryngologists, or ear, nose and throat specialists, and gastroenterologists. Esophageal dilation stretches the abnormally narrow passages of the esophagus, known as strictures, which can be caused by underlying medical conditions.
In it, your ENT doctor inserts an endoscope into your esophagus, just as with the POEM procedure. He then inflates the balloon attached to the endoscope, which results in the gentle expansion of the strictures.
Esophageal dilation is performed as a treatment for certain swallowing disorders like:
- Achalasia, wherein the sphincter muscle in the esophagus becomes abnormally tight
- Esophageal stricture, or the narrowing of the esophagus
- Schatzki’s ring, an abnormal ring of tissue at the point where the esophagus and stomach meet
These three surgical options have their pros and cons in terms of the success rate, total cost and risks for side effects and complications. You should be well aware of these things before going under the knife, so to speak.
For details of our ENT services, diagnosis, and treatment, please consult our ENT specialist.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Be Prepared to Answer Questions and to Ask Questions During Your Dysphagia Appointment
We experience difficulty swallowing, known as dysphagia, at one point or another, usually when we attempt to swallow large food or when we eat too quickly. When dysphagia happens occasionally, there’s no cause for concern as it’s quite normal. But if you experience persistent dysphagia, you should see your ENT doctor as soon as possible.
Your persistent difficulty may be a sign of an underlying medical condition. This is particularly true if it’s associated with discomfort or pain, perhaps extreme difficulty in swallowing that makes it impossible.
But before getting to your doctor’s clinic for your appointment, you may want to prepare a list of questions and be ready to answer questions from your ENT doctor. The exchange of questions and answers will contribute to a better appointment.
List Down Your Questions
On the phone while setting your appointment, you should ask about pre-appointment restrictions necessary for diagnostic exams. You may have to restrict your diet, for example. You should also list down your symptoms – what they are, when they started and how they are manifested – as well as your medications, drugs and supplements.
You should also write certain key personal information that may have affected your ability to swallow. These can include surgery, medications and major life changes and stressful events.
And don’t forget to list down a few basic questions. You don’t want to forget a question in the clinic and remember it when you’re already at home.
- What are the possible causes of my swallowing difficulty?
- Why are these risk factors in my case?
- What are the medical tests that I have to undergo?
- What are the possible medical interventions for my condition?
- What are the ways I can manage dysphagia with my other health conditions?
- What do I have to do in terms of lifestyle habits?
- What other resources can I refer to about dysphagia?
Don’t hesitate asking these questions as you are well within your rights to do so. Just be courteous so you can get the answers you’re seeking for.
Anticipate Your Doctor’s Questions
The appointment is, of course, a two-way street. Your doctor will also ask questions intended to determine the possible causes of your dysphagia and their corresponding treatments.
The questions your doctor will likely ask and for which you should ideally have ready answers are:
- When did your symptoms start?
- Were your symptoms occasional or continuous, chronic or acute, tolerable or painful?
- What things appear to alleviate or worsen your symptoms? (You may have a more difficult time swallowing some food, for example, than others)
- What other symptoms aside from difficulty swallowing have you experienced? (You may regurgitate food, or vomit after eating or drinking, or bring up black bile-like material or blood)
- Have you been unintentionally losing weight?
The back-and-forth exchange will eventually narrow down the possible causes of your difficulty in swallowing. Be honest in your answers even when it seems embarrassing – your ENT doctor has probably heard and seen it all in his line of work.
If you have been experiencing symptoms such as voice changes, constant coughing, pain when swallowing, ear pain and sore throat that has not disappeared for more than two weeks, get yourself checked by a qualified ENT doctor. It could be nothing but it’s always better to be safe than sorry.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
A Ton of Useful Information About Tonsillectomy: During and After the Surgery
Part of the preparations for a tonsillectomy is getting reliable information about it. The more you know about it, the more confident you will feel of the outcome. Indeed, a tonsillectomy is a routine surgery with high success rate!
Your tonsillectomy journey, of course, starts with a series of consultations with your surgeon. You will be asked to undergo a series of physical and laboratory tests before your surgery is scheduled. Of course, be sure to turn up at the hospital on the scheduled day!
At the Operating Room
When you arrive at the hospital, you will be briefed about the procedure by the anesthesiologist and nursing staff. You will also be asked to change into a hospital gown – you will be completely naked underneath – and to lie down on a gurney. Afterwards, you will be taken into the operating room, transferred to the operating table and strapped down.
(The strapping down part is scary because you will be rendered immobile. When you think about being put under, your anxiety may increase. But trust the ENT doctors and nurses for their professional competence)
During the Operation
You will be asleep during the entirety of the tonsillectomy. But here’s a summary of what goes on while you’re sleeping on the table.
- The surgeon places a small tool in your mouth, said tool of which will keep your mouth open.
- The anesthesiologist and nurses monitor your vital signs, among other tasks.
- The surgeon removes your tonsils or the affected tonsil tissues by cutting, shaving or burning them.
There will be no stitches made on the area operated on because the wounds will heal naturally. The entire procedure can last between 20 and 30 minutes but it may also last for 60 minutes.
After the Operation
You will be still asleep when you’re transferred to the recovery area. You will wake up disoriented from the anesthesia, perhaps even vomit black bile and feel dizzy. You will be asked to stay flat until such time that the anesthesia wears off.
While a tonsillectomy can be a one-day procedure, don’t expect to be sent home a few hours after the surgery. You will be under observation for several hours during which time the surgeon and nurses will regularly check on your condition.
Just like any surgery, the recovery period can be challenging. You may have to take time off work for one to two weeks depending on your progress. You will also feel pain and discomfort in your throat, especially when eating food and drinking fluids.
Your diet for the first few days will include soft foods like ice cream, gelatin and pudding as well as plenty of water and fruit juices. Your transition to a solid food diet should be gradual so as not to further irritate the surgery area.
After a few weeks, you will feel better! You may even thank your ENT doctor because without oft-infected tonsils, you can now breathe easier.
For details of our ENT services, diagnosis, and treatment, please consult HK ENT specialist (the professional ENT clinic centre).
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
What’s Behind Your Hot Ears?
Have you ever felt like your ears was on fire, smoke and all? Yes, you likely have because it’s a quite common occurrence for children and adults alike. But there’s likely no need to worry as hot ears, as the temporary condition is oftentimes called, can be resolved with simple measures.
How do you know when you have hot ears? The symptoms are easy to determine, usually with your ears feeling warm, if not warm, to the touch; the skin on your earlobes turning a reddish color; and possibly a burning sensation. Your ears may or may not feel painful to the touch, and hot ears may affect just one or both ears.
Sunburn
Yes, your ears can become sunburned just as the rest of your body can fry, so to speak, from the sun’s ultraviolet rays. You may have sunbathed for an hour or two in the summer, slathered on sunblock on every nook and cranny of your face and body except for your ears, and ended up with hot ears.
Aside from feeling abnormally warm to the touch, the sunburned skin may also look reddish, flaky or crusty. You may not even want to touch your affected earlobes because of the discomfort.
Fortunately, hot ears caused by sunburns can be prevented. You should apply sunblock or sunscreen on your outer ears and wear a hat to protect them, if possible. But if your ears become sunburned, you can apply ice packs, aloe vera gel, and hydrocortisone cream for faster healing.
Feelings
If you’re the type who feels strong emotions, such as anxiety, embarrassment or anger, you may feel hot ears more times. Think of it as your ears blushing in the same way that your face becomes flushed whenever you feel strong emotions.
Don’t worry about hot ears in this case. Your ears will return to their normal temperature and color once you have calmed down. You may have little to no control over your ears’ reactions to your emotions but at least you know that hot ears aren’t life-threatening.
Temperature Changes
Extremely cold temperatures, such as during the winter months, can result in vasoconstriction wherein there’s reduced blood flow to the body’s surface including the skin. This is the reason why your nose, cheeks and ears appear red when exposed outdoors during the peak of winter.
If you like to engage in winter sports, you will likely get hot ears. Don’t worry as it’s only your body’s attempt at self-regulating blood flow. You can wear ear muffs or caps with covers at the side to keep your ears warm, as well as to protect against sunburn in winter.
Infections and Illnesses
What you should be considered about are the infections and illnesses that may be behind hot ears! If the abovementioned causes aren’t possible, then you should talk to your ENT doctor.
Hot ears can be caused by an underlying medical condition like an ear infection, hormonal changes, and rare illnesses, such as red ear syndrome and erythermalgia.
The good news: Even these rare illnesses are treatable!
For details of our ENT services, diagnosis, and treatment, please consult our ENT doctor.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
Physical and Mental Preparations for a Tonsillectomy
Tonsillectomy is a common procedure wherein the tonsils are removed through surgery. Keep in mind that as a surgical procedure, it isn’t to be undertaken without careful discussions between you and your ENT doctor. You will be considered a suitable candidate for a tonsillectomy if your tonsils are large, or if you have trouble breathing at night, or if you’re experiencing frequent throat infections.
Due to the fairly invasive nature of a tonsillectomy, you should be well-prepared for it physically and mentally. You will be put under general anesthesia, a slightly scary thing in itself, followed by the surgeon removing either both the tonsils or just the affected tonsil tissue.
Physical Preparations
Even if tonsillectomy is a fairly routine procedure, you must be relatively healthy for the surgery. Your surgeon will ask for physical and laboratory exams to be performed, which can take a day or two. These exams can include blood tests, such as a complete blood count, clotting factors and electrolytes, and checks for blood pressure and glucose levels.
Be honest about your medical history and other possible risk factors. If you have a bleeding disorder, your doctor may evaluate your suitability for a tonsillectomy, for example.
Depending on your response to the surgery, you may be sent home on the same day or spend a night at the hospital. In either case, you have to make arrangements for a family member or a friend to drive you home from the hospital.
A few more important things to consider as part of your physical preparations.
- Wear loose-fitting clothes before showing up to the hospital on your scheduled day for surgery. You should be able to change from your street clothes to a hospital gown easily. Don’t wear your jewelry and makeup but do take a shower.
- Stop eating and drinking at the recommended time, usually about 8 hours before the operation. For example, if your operation is at 8 a.m., you will be asked to fast starting at 12 midnight.
- Stop taking medications according to your doctor’s recommendations. These can include ibuprofen, warfarin and naproxen, which increases bleeding.
Your ENT doctor will give instructions on what to do before your surgery – follow them for best results.
Mental Preparations
Be honest about your mental health, too. This is because people with major mental health issues have to be further evaluated before surgery so as to decrease the risk of side effects and complications. People with depression and anxiety disorders, for example, are closely monitored, especially during the recovery period.
If you have concerns and questions about your scheduled tonsillectomy, you should discuss them with your surgeon. You will likely get the right answers, perhaps even be reassured about the safety of the procedure, and have your concerns addressed.
In the end, a tonsillectomy is an elective procedure. You may or may not choose to go through with it but it’s a decision best discussed with your ENT doctor.
For more details of the tonsillectomy, please consult HK ENT specialist (the professional ENT clinic centre).
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
What You Need to Know About Dupixent
Chronic sinusitis is a challenging medical condition that will require patience combined with prompt and proper medical intervention to completely resolve. The presence of nasal polyps aggravates the symptoms and, thus, make it even more challenging for your ENT doctor to treat.
Fortunately, there’s hope for people who suffer from chronic sinusitis with nasal polyps! Here are a few things that you should know about it.
Approved in 2019
The U.S. Food and Drug Administration (FDA) approved Dupixent (dupilumab) only on 26 June 2019. It was considered as the first treatment for chronic sinusitis with nasal polyps, particularly for adult patients. It’s used for inadequately controlled cases of the condition and, as such, can be prescribed along with other medical interventions.
But Dupixent isn’t a new medication per se. In fact, it was originally approved by the FDA in 2017 as treatment for inadequately controlled eczema in patients 12 years old and above. It was also approved in 2018 as an add-on drug for patients 12 years old and up who have been diagnosed with either oral corticosteroid-dependent asthma or severe eosinophilic asthma.
The approval for Dupixent’s use was granted to Regeneron Pharmaceuticals.
Decreases the Need for Oral Steroids and Surgery
By the way, chronic sinusitis refers to the prolonged inflammation of the sinuses and the nasal cavity. Nasal polyps are abnormal growths on the sinuses’ inner lining. In some cases, patients with nasal polyps may undergo surgery to remove them; nasal polyps can also result in loss of the sense of smell.
But surgery may not be necessary since Dupixent works by decreasing the size of the nasal polyps and lessening the nasal congestion. The medication may also reduce the need for taking oral and intranasal steroids, thus, relieving the symptoms.
In two studies about the safety and efficacy of Dupixent, patients who received it experienced significant reductions in the size of their nasal polyps and the severity of their nasal congestion. They also reported better smell ability as well as reduced need for oral steroids and surgery.
Dupixent isn’t an over-the-counter medication that can be taken orally. Your ENT doctor will inject it into your body, a mode of administration that increases its efficacy.
Side Effects Are Possible
Like most medications, Dupixent can cause serious allergic reactions in susceptible individuals. These side effects include:
- Redness
- Itching
- Pain
- Changes in vision
- Conjunctivitis, or inflammation of the eye
- Keratis, of inflammation of the cornea
- Inflammation of the eyelids, which may or may not be accompanied by itching, swelling and redness
If you experience any of these symptoms, you should immediately consult with your doctor and/or your ophthalmologist.
Extremely Important: If you receive Dupixent, you shouldn’t receive live vaccines.
Lastly, Dupixent isn’t the be-all and end-all of treatment for chronic sinusitis with nasal polyps. Your doctor may also prescribe other medications like antibiotics and antihistamines.
For more details of chronic sinusitis with nasal polyps and their treatment, please consult our ENT doctor.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
The Stages of Nasopharyngeal Cancer and Their Treatment Options
Nasopharyngeal cancer (NPC) can be cured but, as with all types of cancer, early detection and treatment are key to excellent prognosis. The types of treatment will vary depending on the stage of cancer; stage refers to the extent of cancer in the affected area and its spread to the surrounding areas. Emphasis must also be made that oncologists typically treat NPC in children and adults in nearly the same manner.
If you have NPC, you and your ENT doctor will discuss the best treatment protocol for your case. Your treatment protocol will likely be unique because your age, physical condition and medical history, among other factors, will be considered.
For Stages 0 and I
At these stages, the cancerous cells haven’t metastasized or spread to the lymph nodes. The typical treatment for Stages 0 and I is radiation therapy specifically targeting the tumor.
But even as the cancer hasn’t spread to the healthy lymph nodes around it, these lymph nodes in the neck will likely be subjected to radiation therapy. Known as preventive radiation, it’s necessary to remove undetected cancer cells in the lymph nodes. Otherwise, these cancer cells can grow and spread to the surrounding tissues.
For Stages II, III, IVA, and IVB
At these stages, the tumor cells have spread beyond the nasopharynx possibly in the lymph nodes either above the collarbone or in the neck. This means more aggressive treatments to kill the cancer cells while, hopefully, keeping the surrounding healthy tissues as healthy as possible.
The typical treatment protocol at these stages include:
- Chemoradiation, or chemotherapy combined with radiation therapy, aimed at the nasopharynx and affected lymph nodes. Cisplatin is the common drug used and it’s sometimes combined with another drug.
- Chemotherapy comes next, usually a combination of cisplatin and 5-FU.
Unfortunately, chemoradiation and chemotherapy may kill the cancer cells but these are aggressive treatments with side effects. You should discuss these side effects with your ENT doctor as there are interventions to decrease their impact on your quality of life.
Your ENT doctor may also consider other treatment protocols. These include induction chemotherapy and chemoradiation in tandem, immunotherapy either on its own or with chemotherapy, or chemoradiation after the chemotherapy with cisplatin and 5-FU.
If deemed necessary, you may also undergo surgery to remove the affected lymph nodes after these treatments have been performed.
For Stage IVC
With Stage IVC NPC, the cancer can be harder to treat. The treatment protocol will depend on your doctor’s professional judgment, but it can be a combination of chemotherapy, radiation therapy and immunotherapy.
Cancer in any form isn’t easy but with modern medical treatments and technology, there’s hope for a remission. It’s vital to know your treatment options, discuss them with your doctor, and adopt healthy lifestyle habits – the healthier you are even with cancer, the better your prognosis.
For more details of diagnosing nasopharyngeal cancer and their treatment, please consult our ENT doctor.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic centre
For ENT Services, Audiology & Speech Therapy,
Sleep Disordered Breathing Management,
Hearing Aid Prescription & Medical Cosmetic Services
https://www.hkentspecialist.hk
The Difference In Symptoms Between Allergies and Coronavirus
2020 hasn’t been good so far and the Covid-19 pandemic is undoubtedly the foremost reason for it. For people who suffer from allergies, it can be more stressful for many reasons. The symptoms of allergies and coronavirus may seem similar while people with allergies have higher risk for contracting respiratory illnesses because of their compromised health.
But there’s little reason to worry because the symptoms of allergies and coronavirus are different! Of course, it’s vital to protect yourself and your family and friends against contracting the coronavirus. These protection measures include frequent hand washing, using a face mask in public, and covering your nose and mouth when you sneeze or cough.
Common Symptoms of Allergies
According to the American College of Allergy, Asthma, and Immunology, allergies usually occur when a susceptible person’s immune system overreacts to things that are harmless for others. These things, known as allergens, include ragweed, pollen and grass, thus, the increase in allergy attacks.
The immune system’s overreaction results in the following symptoms of allergy:
- Stuffy nose, runny nose and/or sneezing
- Dry cough
- Shortness of breath or wheezing
- Fatigue
- Rashes
- Headache
- Puffy, watery and/or itchy eyes
- Itchy throat, nose and ears
Many people with allergies will understandably be worried since many of these symptoms have also been identified as coronavirus symptoms.
Common Symptoms of the Coronavirus
Take note that scientists are still finding out new information about the coronavirus and Covid-19. But they know that these are the three main symptoms of Covid-19. (The U.S. Centers for Disease Control and Prevention also pointed out these symptoms)
- Fever
- Dry cough
- Shortness of breath
According to the World Health Organization (WHO), there are also less common coronavirus symptoms that doctors and individuals should be aware of. These include nasal congestion, body aches and pains, sore throat, diarrhea and/or runny nose.
And this is where the anxiety starts for many allergy sufferers. There are more than a few symptoms shared by allergies and coronavirus infection – dry cough, shortness of breath, and runny nose, for example.
But there’s also something that differentiates seasonal allergies from coronavirus: Fever. Even the worst allergy attack will not bring on the body’s fever reaction but most Covid-19 patients exhibit fever as among their first symptoms.
There are also other major distinctions between the two conditions. First, coronavirus doesn’t bring on itchiness while allergies certainly will cause it. Second, people with allergies are more likely to experience worse nasal issues than people with the coronavirus, although both can experience sneezing.
There’s also the more serious matter of allergies being non-contagious and the coronavirus being extremely contagious. People with allergies can go about their business in public without fear of infecting others but this isn’t the same for Covid-19 patients.
If you would like to learn more of our ENT services, diagnosis, and treatment, please consult our ENT specialist.
Source:
HK ENT Specialist Ltd.
Hong Kong based ENT clinic 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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另所有文章內使用的人名均為化名。
另所有文章內使用的人名均為化名。