NEW CLINIC

It has been a while since my last entry. I have been busy moving to my new clinic. I would say that I finally know how much stuff I have accumulated over the years.

Packing and unpacking was only one part of the headache. The clinic renovation was the biggest headache. There are still minor works that need to be done but otherwise my clinic is up and running.

I am happy with how things have turned out. The clinic layout is practical and easy to maintain. Some may say it looks simple as compared to others. But the main thing is all the important features for patient care, safety and comfort are all in place.

Well, best if I get feedback from my patients.

POST TONSILLECTOMY CARE

TONSILLECTOMY

Tonsillectomy is a surgical procedure to remove the tonsils which are lymphoid tissues situated at the back of the throat. It is recommended when the patient has repeated tonsillitis, enlarged tonsils, suspicion of tumour or peritonsillar abscess. The surgeon would only advise for tonsillectomy when the benefits of the procedure outweigh the possible risks and complications. Tonsillectomy is performed under general anaesthesia via trans-oral approach; that is through the mouth opening.

Typical appearance of the back of the throat three days post tonsillectomy
(Wikipedia.org)

COMPLICATIONS OF TONSILLECTOMY

Bleeding- the tonsil area has a rich blood supply and care is taken to stop any bleeding intraoperatively. The risk of bleeding after tonsillectomy is very low and usually present with blood stained saliva. On rare occasions the bleeding can be severe and have to be managed in the operating theatre. Risk of bleeding is higher when there is infection.

Infection- it is a potential risk especially in patients with inadequate food and fluid intake after tonsillectomy. Patients with infection post tonsillectomy will have symptoms of severe throat pain and bleeding. Treatment is mainly antibiotics and may require re-admission.

Injury to lip/mouth- instruments are inserted to help open up the mouth during surgery. There is a small risk of injury to lip, mouth or teeth during this procedure.

POST OP CARE

• Pain post tonsillectomy can be severe and lasts up to 2 weeks. However in children the recovery is much faster usually within 1 week. Sometimes the pain can get worse between 3 to 5 days after the surgery before it gets better. Patients are advised to take their painkiller medication regularly.
• Swallowing can be difficult after surgery because of the pain. However patients are encouraged to drink and eat as soon as they wake up after surgery. It may be easier to take cold fluids and soft food initially. Taking small sips of fluids may be easier than big swallows. Avoid taking any spicy or hot food to reduce risk of bleeding. Eating well would also lead to better and faster healing of the operated area.
• Avoid going out to public places. Patients are advised to rest at home for about 1-2 weeks. This can prevent exposure to infection.
• Small amounts of blood stained saliva can be normal in the first 2 weeks and can be stopped with ice gargles. However if bleeding is continuous and increasing in amount, do seek immediate medical attention at the hospital where the surgery was performed.

Printable patient leaflet

http://www.entheadandneckclinic.com/web_documents/leaflet_tonsillectomy1_.pdf

EAR WAX- To Clean or Not To Clean?

Ear wax is a sticky material produced by sebaceous glands in the ear canal. These glands are situated at the hairy outer part of the ear canal. The earwax helps to lubricate, repel water and trap dirt from entering deep into the ear canal. It is also acidic in nature and has antibacterial properties

There are different types of ear wax- soft or hard, wet or dry. Ear wax do not usually cause any problems and will naturally fall out of the ear along with the debris. However sometimes it can get impacted and block the ear canal.

The most common cause of impacted ear wax is the habit of digging the ears with cotton bud, matchsticks or hairpins which push the ear wax deeper into the ear canal. Hearing aid or ear plug users would also tend to have similar problems. Other causes include narrow ear canal, hairy ear canal, certain skin conditions, hard wax and recurrent ear infections.

Symptoms of impacted ear wax are usually ear pain, ear block and tinnitus. Sometimes ear wax can present with ear infection and patients would have severe pain with ear discharge.

Treatment of impacted ear wax includes using ear drops to dissolve the wax. Patients need to apply a few drops into the affected ear canal, two to three times a day for up to 5 days. The softened ear wax will dislodge itself.

However if the above measures fail or there is severe pain or ear discharge; patients should seek medical attention. The ear wax can be removed by the doctor by other methods such as syringing, suction or using forceps.

STEPS ON HOW TO APPLY EAR DROPS

1. Patient should lie down on his/her side with the affected ear facing upwards
2. Then apply 5-10 drops into the ear canal as prescribed by your doctor, preferably someone else can help to do so. Pulling the pinna backwards can open up the ear canal.
3. Patient should maintain the position for 3-5 minutes
4. Some of the ear drops will flow out when patient sits up, just wipe the outer part of the ear with tissue.
5. Patient can then lie down again to apply to the opposite ear if needed.
6. Note: Good to warm up the ear drops by holding the bottle in the palm of your hands for few minutes before application.

KANSER TEKAK

Kanser tekak lebih tepat dikenali sebagai kanser laring (larynx) dari segi istilah perubatan. Anatomi laring melibatkan kawasan peti suara yang juga berdekatan saluran pemakanan iaitu esofagus (esophagus).
Di dalam kajian National Cancer Registry tahun 2006 terdapat 1.1 kes per 100,000 populasi di Malaysia di mana kaum lelaki mencatatkan kekerapan lebih 5 kali ganda berbanding kaum wanita. Ia juga menunjukkan peningkatan kes bagi pesakit yang berumur 40 tahun ke atas dengan yang tertinggi di kalangan pesakit yang berumur 60-69 tahun.

Kawasan tekak (larynx) melibatkan khususnya organ peti suara (glottis), supraglottis dan subglottis

Gejala kanser tekak seringkali timbul sebagai perubahan suara, suara garau atau masalah menelan makanan dan minuman. Pesakit juga kadangkala berasa seperti ada 'sesuatu yang sangkut' di bahagian tekak. Perubahan suara kerapkali merupakan gejala sakit tekak biasa yang disebabkan oleh jangkitan kuman. Akan tetapi sekiranya perubahan suara itu berlarutan lebih dari 2 minggu, pesakit seharusnya mendapatkan pemeriksaan tekak yang lebih terperinci.

Gejala-gejala lain yang berkaitan kanser tekak adalah bengkak pada leher yang disebabkan oleh kelenjar limpa, batuk berdarah, sesak pernafasan atau pernafasan berbunyi terutamanya di kalangan mereka yang merokok.

PEMERIKSAAN KLINIKAL

Pesakit yang mempunyai gejala- gejala tersebut perlu diperiksa dengan lebih lanjut menggunakan peralatan endoskopi semasa sesi rawatan di dalam klinik pakar. Sekiranya pemeriksaan endoskopi menunjukkan ketumbuhan di kawasan tekak pesakit perlu menjalani pemeriksaan selanjutnya.

Ketumbuhan pada tekak boleh disebabkan oleh pelbagai penyakit seperti tuberkulosis (batuk kering), polip, granuloma selain dari kanser. Untuk mengenalpasti punca sebenar sedikit tisu perlu diambil dari ketumbuhan tersebut. Kerapkali ini melibatkan pembedahan kecil.

Pesakit juga perlu menjalani pemeriksaan CT scan (computed tomography) untuk mengetahui sejauh mana kanser tersebut telah merebak.

RISIKO KANSER TEKAK

Terdapat beberapa faktor yang merupakan risiko tinggi untuk kanser tekak:
Faktor umur- Risiko meningkat semakin pesakit berumur
Alkohol- Tabiat pengambilan alkohol atau minuman keras merupakan faktor risiko yang tinggi terutamanya jika pesakit juga mengamalkan tabiat merokok
Merokok- Perokok tegar yang bertahun-tahun lamanya mempunyai risiko yang amat tinggi
Pesakit kanser tekak di kalangan ahli keluarga terdekat terutamanya ibubapa atau adik-beradik
Human papillomavirus- Jangkitan virus ini juga meningkatkan risiko kanser tekak
Faktor lain seperti Asid reflux, pencemaran Bahan kimia, Diet yang kurang sihat

RAWATAN KANSER TEKAK

Pelan rawatan penyakit kanser perlu pertimbangan antara pesakit dan doktor pakar bedah bersama pakar onkologi. Rawatan kanser tekak yang disyorkan oleh doktor pakar bergantung kepada tahap kanser tersebut.

Sekiranya tahap penyakit kanser tekak masih di peringkat awal rawatan secara pembedahan atau radioterapi perlu dijalankan. Ketumbuhan kanser yang lebih besar terutamanya yang melibatkan kelenjar limpa perlu kedua-dua pembedahan dan radioterapi. Kadangkala kemoterapi juga diperlukan bagi tahap kanser tekak yang lebih lanjut. Pelan rawatan penyakit kanser adalah khusus bagi setiap pesakit setelah mengambil kira tahap kanser, keadaan kesihatan pesakit dan jenis sel kanser.

PERINGATAN
Peringatan yang paling penting ialah pesakit harus cepat mendapatkan pemeriksaan lanjutan sekiranya mengalami gejala-gejala di atas. Kerana pemeriksaan awal dapat mengesan ketumbuhan pada peringkat awal. Sekiranya kanser tersebut dapat dikenalpasti pada peringkat awal, sudah tentu rawatannya kurang rumit dan peratusan kebarangkalian sembuh adalah amat tinggi.