PEMBEDAHAN MASTOID

Mastoid adalah bahagian tulang tengkorak yang berkaitan dengan telinga. Ia merupakan sambungan kepada bahagian telinga tengah dan tulang mastoid dipenuhi oleh rongga-rongga udara. Sekiranya terdapat jangkitan kuman pada telinga tengah (otitis media), jangkitan tersebut dapat merebak ke tulang mastoid (mastoiditis). Ini menyebabkan bengkak pada bahagian belakang cuping telinga dan pesakit merasa amat sakit dan demam.

Tulang mastoid terletak di bahagian belakang cuping telinga (anak panah). Ia mempunyai sambungan kepada telinga tengah.. Wikipedia image

Gambarajah di atas menunjukkan sambungan (melalui tympanic antrum) antara telinga tengah dan tulang mastoid. Ia juga menunjukkan bahawa tulah mastoid dipenuhi oleh rongga-rongga udara (mastoid cells). Wikipedia image

Pembedahan mastoid pula merupakan pembedahan yang dilakukan oleh pakar ENT sekiranya ada jangkitan kronik pada tulang mastoid (chronic mastoiditis), cholesteatoma, ketumbuhan (tumor) pada telinga tengah, implan koklear dan lain pembedahan telinga dalam/tengah.

Sebelum pembedahan mastoid, pesakit perlu membuat ujian pendengaran untuk mengetahui tahap pendengaran. Imbasan CT juga perlu agar pakar ENT dapat mengetahui sejauh mana jangkitan atau penyakit tersebut telah merebak.

Pembedahan mastoid dilakukan melalui torehan pada kulit di belakang cuping telinga (postaural). Tetapi kadangkala ia dilakukan melalui torehan di bahagian atas lubang telinga (endaural). Ia melibatkan penggunaan mikroskop dan drill untuk membersihkan tulang mastoid yang tidak sihat atau mengalami jangkitan.

Kenapa perlunya pembedahan mastoid?
Pembedahan mastoid perlu dilakukan sekiranya jangkitan kuman pada tulang mastoid tidak dapat disembuh dengan rawatan antibiotik dan cucian telinga yang dilakukan oleh pakar ENT di klinik. Ia juga perlu sekiranya pesakit mempunyai penyakit cholesteatoma atau ketumbuhan di dalam telinga. Ini adalah kerana sekiranya dibiarkan berlarutan jangkitan atau penyakit tersebut akan merebak ke telinga dalam menyebabkan pekak pendengaran, mengganggu saraf muka dan juga boleh berjangkit ke bahagian otak.

Saranan selepas pembedahan mastoid
Pesakit mungkin berasa pening selepas pembedahan dan disyorkan agar berehat di rumah selama 5-7 hari. Sekiranya pesakit mempunyai pekerjaan berat yang memerlukan banyak pergerakan dan mengangkat benda berat, pesakit mungkin perlu bercuti selama 2 minggu.
Kesakitan pada bahagian pembedahan selalunya dapat dikawal dengan ubat tahan sakit. Tetapi jika masih mengalami kesakitan yang teruk, mungkin ia tandanya jangkitan kuman telah berlaku.
Bahagian torehan akan dijahit dan jahitan ini perlu dibuka selepas 5-7 hari oleh doktor di klinik.
Bahagian telinga yang dibedah pula akan dibalut dengan 'mastoid bandage'. Ia kelihatan seperti serban kepala yang kecil dan ini perlu dipakai selama lebih kurang 24 jam.
Bahagian lubang telinga pula selalunya disumbat dengan kain antiseptik dan ini harus dibiarkan selama 2 minggu. Pesakit tidak boleh sama sekali menarik keluar sumbatan tersebut. Di bahagian luar sumbatan telinga tersebut pula ditutup oleh kapas (cotton ball). Kapas di luar ini perlu ditukar selalu oleh pesakit di rumah, sekurang-kurangnya setiap kali selepas mandi.
Pesakit harus mengambil langkah berhati-hati agar bahagian telinga yang dibedah dan 'dressing' tidak basah atau dimasuki air.

Perkara-perkara yang perlu dielakkan selepas pembedahan mastoid
Jaga kebersihan telinga yang dibedah dan jangan biarkan ia dimasuki air selama 6-8 minggu
Elak dari menghembus hidung dengan kuat. Sekiranya bersin, pastikan bersin dengan mulut terbuka
Elak daripada mengangkat benda berat dan aktiviti fizikal selama 3-4 minggu selepas pembedahan
Elak daripada menaiki kapal terbang selama 3-4 minggu selepas pembedahan
Pesakit disyorkan meminta nasihat pakar ENT sebelum memulakan pekerjaan dan sebarang aktiviti berat

Masalah-masalah yang dijangkakan selepas pembedahan mastoid
Dengan sumbatan di dalam lubang telinga,  pesakit boleh mengalami bunyi air atau buih di dalam telinga dan ini akan hilang apabila sumbatan tersebut dikeluarkan oleh pakar ENT pada masa 2 minggu selepas pembedahan.
Selepas itu tahap pendengaran pesakit bergantung kepada kerosakan yang dialami oleh telinga dalam disebabkan jangkitan kuman sebelumnya (mastoiditis atau cholesteatoma). Ujian pendengaran selalunya dilakukan 3 bulan selepas pembedahan.
Amat jarang sekali ada pesakit mengalami kelemahan otot muka. Ini kerana ada bahagian saraf muka (facial nerve) yang melalui bahagian telinga tengah boleh tercedera/terganggu semasa pembedahan. Dalam kebanyakan kes, kelemahan ini adalah sementara.
Pesakit juga mungkin mengalami deria rasa yang lain pada bahagian lidah dan ini juga bersifat sementara.

Bila pesakit harus mendapatkan rawatan doktor dengan segera selepas pembedahan mastoid
Demam tinggi
Cecair busuk/Nanah yang sentiasa mengalir dari dalam telinga
Sakit pada bahagian pembedahan yang teramat sangat
Bengkak ketara pada bahagian sekeliling telinga yang dibedah
Pening atau rasa kepala berpusing yang menyebabkan rasa loya dan muntah

NOTA:
Cholesteatoma adalah penyakit yang disebabkan oleh gumpalan sel-sel kulit mati dan inflammasi tisu yang mampu menghancurkan struktur-struktur tulang disekelilingnya. Sifat sebegini amat membahayakan sekiranya  ia tidak dirawat dengan segera.

SEPTOPLASTY AND TURBINATE SURGERY

Septoplasty is a surgical procedure to correct a deviated or crooked nasal septum. Patients often complain of nasal block and congestion, which can disturb their sleep. They may also have symptoms of rhinitis such as runny nose, sneezing and postnasal drip. Some patients have a deviated nasal septum as a result of trauma or blow to the nose. 

Turbinate surgery refers to a procedure performed to reduce the size of the enlarged nasal turbinates, which often contribute to the nasal block and congestion. There are many methods how the ENT surgeon reduce the size of the turbinates. Regardless of the surgical method used, the turbinates may slowly increase back in size if patients do not take care of their allergies.

The ENT surgeon may put the patient on a trial of medication which include nasal sprays and antihistamine to control their allergies. If the nasal block is still not relieved or minimally relieved with medication then septoplasty and turbinate surgery should be considered. However in severely deviated nasal septum especially post trauma, medication often bring little improvement. Septoplasty can also be indicated for recurrent epistaxis.

Complications of septoplasty and turbinate surgery are uncommon however patients should be aware of the possible complications including bleeding, infection, nasal crusting, numbness and septal perforation.

General care after septoplasty and turbinate surgery

The nose may be packed after surgery and patients are warned to breathe through their mouth upon waking up from surgery. The nasal pack is usually removed the following day after surgery. Following nasal pack removal, patients should expect bloodstained nasal secretions for a few days. Patients should not blow their nose for about 10-14 days. When sneezing, patients should keep their mouth open to reduce built-up pressure in the nose.

Patients may also experience swelling and pain around the nose including numbness of the upper teeth; which usually resolve in a few weeks. 

Patients are advised to take light soft cool diet when awake after surgery. Hot food and drinks are to be avoided for a few days after surgery.

Patients should rest with their head elevated on 2-3 pillows to reduce swelling around the nose area. Patient should also avoid straining and lifting heavy objects to reduce risk of bleeding.

Medications that can thin the blood, such as Aspirin and Warfarin, should be avoided until advised by the ENT surgeon.

The ENT surgeon would often prescribe nasal douching where patients will flush the nasal cavities using saline irrigation for a few weeks. This will ensure good healing and prevent formation of dried crusts or blood clots. Patients will also be prescribed with a course antibiotic that should be completed.

Patients are also expected to take some time off until the doctor says it is safe to return back to work. Patient should refrain from smoking or exposure to smoky areas as this can impair healing and cause further irritation to the nose.

When should you see your ENT surgeon urgently?

• Continuous bleeding despite nasal compression and ice
• Increasing swelling over the nose and eyes 
• Persistent high grade fever >38 Celcius
• Severe pain or headache not relieved by the pain medication given.

HERBAL SUPPLEMENTS AND SURGERY

Many patients are not aware of the possible adverse events that can happen during surgery if they consume herbal supplements. Patients are advised to disclose to their doctors of the types of herbal supplements they are taking prior to surgery. They are also advise to stop taking these herbal supplements about 2 weeks before surgery.

Some of these herbal supplements can cause significant bleeding, heart problems, blood pressure changes and drug interactions. This would have an effect on the possible surgical complications and surgical outcome. Therefore patients should also seek their doctor's advice if they wish to resume their herbal supplements after surgery.

LIST OF SUPPLEMENTS

Supplements that can cause bleeding
Ginkgo biloba
Ginseng
Garlic
Fish oils (Omega 3-fatty acids, doses more than 3gm/day)
Dong quai
Feverfew

Supplements that can cause cardiovascular effects
Ephedra
Garlic

Supplements that can cause drug interactions
Echinacea
Goldenseal
Licorice
St John's Wort
Kava
Valerian

Supplements that can have anaesthetic effects
Valerian
St John's Wart
Kava

Reference websites
http://plasticsurgery.about.com/od/beforesurgery/a/herbal_supp.htm
http://my.clevelandclinic.org/heart/prevention/alternative/herbals_theheart.aspx
http://my.clevelandclinic.org/heart/prevention/alternative/herbals_surgery.aspx
http://edition.cnn.com/HEALTH/library/herbal-supplements/SA00040.html
http://suite101.com/article/herbs-surgery-anesthesia-a15521

Laryngopharyngeal reflux- the chronic cough

Have you experienced an irritating cough that doesn’t get better despite cough mixtures and antibiotics? If yes, then you may be suffering from laryngopharyngeal reflux (LPR); also known as ‘silent reflux’. Most patients may not have the typical symptoms of gastroesophageal reflux (GERD) such as heartburn.

LPR occurs when the acid contents of the stomach is washed up (refluxed) all the way up to the throat (larynx) and even the back of the nose. It may be due to laxity of the muscle sphincter or gatekeeper between the oesophagus and stomach. The mucosal lining of the throat gets inflamed when exposed to the acid.

Symptoms of laryngopharyngeal reflux (LPR)

• Chronic cough
• Frequent throat clearing
• Feeling of mucous at the back of the throat
• Hoarseness
• Foreign body sensation or feel of a ‘lump’ in the throat
• Difficulty swallowing
• Sore throat
• Difficulty breathing

Diagnosis of laryngopharyngeal reflux

Most of the time the ENT Surgeon would make a diagnosis of LPR from the medical history and throat examination with a 70 degree scope or flexible nasopharyngolaryngoscope. This will allow visualization of the larynx, showing inflammation of the vocal cord and surrounding areas.

Sometimes a double probe pH monitoring may be required. This involves inserting a small tube through the nose into the oesophagus to record the frequency and severity of the acid reflux. This would have to be worn for 24 hours. However this test is only necessary for certain cases.

Treatment of laryngopharyngeal reflux

The inflammation of the larynx due to acid reflux may take weeks to months to recover. The doctor would recommend some medication such as proton pump inhibitors, antacids, prokinetic agents.

However it is also important that the patient adhere to some lifestyle changes for better recovery and control of the reflux in the long run. Smoking habit and some food can aggravate the condition. Patients who are obese and overweight are also prone to LPR.

Most patients respond well to medication and lifestyle modification/ dietary change. Some may require prolonged treatment. Only a few patients may not respond to the above measures and require surgery; which involves wrapping around the muscle sphincter to improve its strength.

Home care measures for LPR

• Stop smoking
• Lose weight
• Avoid alcohol
• Avoid caffeinated drinks such as coffee, tea including cola fizzy drinks
• Avoid acidic fruit juices such as orange, grapefruit, tomato
• Avoid spicy and fatty foods such as curry, tomyam even tomato based sauces
• Do not wear tight fitting cloths especially at the waist
• Stop eating at least 3 hours before going to bed
• Elevate the head of the bed at least 4-6 inches
• Take the medications prescribed according to instructions. Proton pump inhibitors are taken 30 minutes before meals and most are given for twice a day.

·      

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.

NASAL POLYPOSIS

Nasal polyps are growths or masses in the nasal cavity which is not cancerous. It usually arises due to chronic inflammatory process and will continue to increase in size if not treated. It can even cause distortion in the shape of the nose and eventually bulge out through the nostrils in severe cases.

Nasal polyps usually occur in young and middle aged adults. It is uncommon in children. Nasal polyps are often bilateral (both nasal cavities involved). A unilateral polyp is called an antrochoanal polyp which usually arises from the maxillary sinus and affects teens and young adults.

The cause of nasal polyps is open to much debate but it is agreed that an ongoing inflammatory process is the main pathophysiology. There are however certain associated conditions which increase the risk of developing polyps.

These conditions include asthma which is an inflammatory condition of the airways triggered by allergens, chronic rhinosinusitis which is a chronic infection of the sinuses, aspirin sensitivity, allergic fungal sinusitis which is an allergy to airbone fungi, cystic fibrosis especially suspected in children with nasal polyps (rare disease in Malaysia) and other less common syndromes such as Churg Strauss syndrome, Kartagener’s syndrome and Young’s syndrome. Recent understandings have also shown the relevance of family history and certain genetic predisposition to nasal polyps.

SYMPTOMS

The symptoms or nasal polyps are similar to other inflammatory conditions of the nose such as runny nose, post nasal drip and pressure around the face. However when there is persistence in the symptoms especially when associated with unrelenting nasal block/stuffiness, loss of sense of smell or taste, headache, pain around face and teeth and snoring then possibility of nasal polyposis should be considered.

HOW TO DIAGNOSE NASAL POLYPS?

Diagnosis of nasal polyposis can only be confirmed with an endoscopic examination of the nose. A small rigid or flexible scope is inserted into the nose to fully inspect the nasal cavities. It is a simple procedure performed in the ENT clinic. Polyps appear as grapelike structures protruding into the nasal cavities.

Imaging studies are also performed to see the origin of the polyps and extent of the disease. A computed tomography (CT) or magnetic resonance imaging (MRI) is usually requested. The imaging studies can also reveal possible fungal disease or complications.

Other tests such as allergy test, test for cystic fibrosis or others may be indicated depending on a patient to patient basis.

TREATMENT

The treatment of nasal polyps is long term suiting its nature; underlying chronic ongoing inflammatory process. The aims of treatment are to shrink the size of polyps and prevent complications. Most polyps would respond to medical treatment however some would require surgical intervention.

Medical treatment would consist of topical intranasal steroids, oral corticosteroids, antihistamines and antibiotics in various combinations.

Endoscopic sinus surgery is considered when the polyps do not respond to optimal medical treatment. Surgical intervention is also recommended earlier if patients present with complications. Large nasal polyps often may not shrink considerably with medication alone. However patients have to be aware that nasal polyps do recur after surgery. Therefore adequate followup care and ‘maintenance’ medication is necessary to prevent recurrence.

HOLIDAY BUGS

It’s the school holidays and with the busy jammed packed holiday resorts the children especially can easily catch an infection such as the common cold. Public places are a constant source of germs and we pick them up in playgrounds, supermarket trolley handles, lift buttons, armrests, public transport, swimming pools etc. But bear in mind that it’s pretty normal for a child to have between 6-8 colds a year in the first three years.

The common cold gives rise to symptoms of nasal congestion, runny nose, sore throat and fever. It is caused by the adenovirus and coronavirus and usually runs a self limiting course.  These symptoms last between seven to ten days. Therefore patients rarely need antibiotics unless there is superadded bacterial infection. Treatment of the common cold is symptomatic ie paracetamol/brufen for the fever, oral decongestant/nasal decongestant spray for the blocked nose, cough syrup etc. Hence why a nice bowl of hot chicken soup makes the patient feels better. Symptomatic treatment only helps to ease the symptoms but it’s the patient’s immune system that will continue working against the infection. 

When do we need antibiotics?

Antibiotics are prescribed when there is superadded bacterial infection. Usually this occurs when there’s complication due to spread of the infection.

• Sinusitis- Patients will have badly congested nose, post nasal drip, yellow to greenish phlegm, headache, facial pain/fullness.
• Otitis media- Patients will complain of pain in the ear with high grade fever. The ear feels blocked and may have ear discharge.
• Throat infection such as tonsillitis or severe laryngopharyngitis- This is commonly due to the postnasal drip. In common cold, initial throat discomfort caused by the viral infection is common. However if the sore throat becomes severe and there is pain on swallowing, most likely there is superadded bacterial infection such as Streptococcus.
• Lung infection such as bronchitis or pneumonia- Patients will present with productive cough, shortness of breath and fever. 

Best remedy- prevention, prevention & prevention

Good hygiene can reduce the exposure and risk of catching a cold. However bear in mind that ‘too much’ hygiene or ‘living in a bubble’ is also not advisable because exposure to some germs are needed to mature and strengthen the immune system. So moderation is the key. (Look up articles on hygiene hypothesis)

1. Proper hand hygiene and handwashing technique
2. Avoid close contact with anyone having a cold and do not share utensils
3. Best to use tissues that can be disposed after use         
4. Keep the house/bedrooms well ventilated
5. Boost your immune system- many good habits such as taking supplements, adequate sleep, regular exercise, reduce stress and avoid smoking. There are many articles written on this topic and I leave it to individuals to find what’s best for them. I find this article apt at summarizing this topic Strengthen your immune system 

HEALTHY EATING AFTER CANCER TREATMENT

As ENT doctors we often deal with cancers involving the head and neck area, commonly the oral cavity, throat and nose (nasopharynx). Treatment of these cancers entail either surgery, radiotherapy, chemotherapy or a combination of them. Because of the location of the cancer itself and the treatment, patient often have problems related to the head & neck area such as chewing and swallowing. And yet nutrition is an integral part of treatment to combat the disease.

During the course of the treatment patients should seek the doctor's advice before taking any supplements because it can interfere with the therapy. The doctor would also inform patients of the possible side effects of treatment and how best to prepare and deal with the problems. With the advent of new radiation technology there is less severe side effects such as those seen many years ago.

But what about after treatment? When follow-up examination and scans show that the cancer was successfully removed or had responded well to treatment, is it important to continue with a healthy diet?

An article published in the Harvard's Medical School's consumer health journal advocates healthy lifestyle as the key for cancer survivors to decrease the likelihood of recurrence. Their advice includes healthy eating with at least 5 servings of fruits and vegetables per day, exercise, maintaining body mass index between 20-25, eat fatty fish two to three times a week and having normal vitamin D levels.

The American Cancer Society has produced an informative booklet which provides nutrition advice during and after cancer treatment. The list below is taken from their booklet on tips of healthy eating after cancer treatment.

Tips on Healthy Eating after Cancer Treatment (American Cancer Society Nutrition Guide)

• Check with your doctor for any food or diet restrictions.
• Create healthy balance meals. Choose a variety of food.
• Eat at least 5 to 7 servings a day of fruits and vegetables, including citrus fruits and dark-green and deep-yellow vegetables.
• Eat plenty of high-fiber foods, like whole-grain breads and cereals.
• Decrease the amount of fat in your meals by baking or broiling foods.
• Limit your intake of red meat to no more than 3 to 4 servings a week.
• Avoid salt-cured, smoked, and pickled foods (including bacon, sausage, and deli meats).
• Choose low-fat milk and dairy products.
• If you choose to drink alcohol, limit the amount.
• Maintain a healthy weight.
• Exercise. Ask your doctor before starting any exercise regime.

USDA update pyramid 2005

Reference
Stephanie Meyers, 2009. Does diet affect cancer recurrence?
Healthy Eating. National Cancer Institute
American Cancer Society. Nutrition

Image credits:
http://www.flickr.com/photos/calliope/4206360542
http://www.flickr.com/photos/62116165@N00/2461157879

APABILA TELINGA BERAIR…..

Apabila telinga menjadi berair dan mengeluarkan bau yang busuk, itu tandanya ia mengalami jangkitan kuman. Tetapi ada kalanya telinga yang ada jangkitan hanya berasa gatal dan sebu atau tersumbat. Selain dari jangkitan kuman, telinga juga boleh dijangkiti oleh kulat.

Fenoma berasa sakit pada telinga selalunya bermakna jangkitan yang lebih serius yang boleh membawa kepada komplikasi.  Pesakit juga selalunya merasa demam dan sakit kepala.

Jangkitan pada telinga boleh berlaku samada di bahagian telinga luar atau telinga tengah. Jika jangkitan melibatkan telinga tengah, gegendang telinga mungkin bocor atau bengkak.

Kenapa ia berlaku?

Jangkitan pada telinga luar berkait rapat dengan tabiat membersihkan telinga menggunakan putik kapas atau alatan lain. Tabiat ini boleh menyebabkan luka pada kulit yang kemudiannya dijangkiti bakteria. Ini amat merbahaya terutamanya pada pesakit diabetes. Jangkitan telinga luar juga boleh berlaku selepas pesakit berenang di kolam mandi ataupun di laut dan sungai. Air yang masuk ke dalam telinga mengandungi kuman yang boleh menyebabkan jangkitan.

Jangkitan telinga tengah pula berkait rapat dengan masalah hidung. Infeksi hidung seperti selsema atau sinusitis boleh menyebabkan jangkitan merebak ke telinga tengah melalui tiub Eustachian. Ia lebih kerap berlaku pada kanak-kanak kerana mereka seringkali mengalami selsema dan tiub Eustachian mereka senang tersumbat. Pesakit seringkali mengalami selsema dan kemudiannya mengadu sakit telinga atau telinga tersumbat.

Gambar sebelah menunjukkan gegendang telinga yang bengkak dengan nanah di dalam bahagian telinga tengah. Jangkitan ini dinamakan 'otitis media'. Sekiranya tidak dirawat ia boleh menyebabkan jangkitan yang lebih serius dan rosak pendengaran.

Rawatan

Pemeriksaan oleh doktor akan memastikan punca masalah yang menyebabkan telinga berair. Cecair atau kotoran di dalam telinga akan dibersihkan oleh doktor dan rawatan perubatan akan disusuli. Perubatan yang seringkali disyorkan merupakan ubat titis telinga dan kadangkala pil antibiotik. Doktor juga akan merawat  permasalahan hidung sekiranya dialami oleh pesakit.

Pesakit dinasihatkan agar mengelak air masuk ke dalam telinga dan berhenti membersihkan telinga dengan putik kapas di rumah. Pesakit juga disyorkan berhenti aktiviti berenang untuk sementara waktu.

Cara menggunakan ubat titis telinga

1. Pesakit perlu baring mengiring dengan telinga yang bermasalah menghadap ke atas
2. Ubat dititiskan ke dalam telinga, selalunya 5-10 titis, mengikut preskripsi doktor. Elok sekiranya ada orang lain yang membantu menitiskan ubat tersebut
3. Pesakit perlu mengekalkan posisi selama 3-5 minit.
4. Apabila bangun, sebahagian dari titisan akan mengalir keluar. Ini adalah normal dan pesakit hanya perlu mengelap di bahagian cuping telinga dengan tisu
5. Pesakit kemudiannya beralih ke posisi mengiring untuk telinga yang sebelah lagi dan ulangi proses tersebut jika perlu.

Sumber imej

http://en.wikipedia.org/wiki/File:HumanEar.jpg

http://en.wikipedia.org/wiki/File:Acute_Otitis_Media.jpg

MENGATASI MASALAH ALAHAN (RESDUNG)

Masalah resdung seringkali berkaitan dengan gatal hidung, bersin, hingus cair dan hidung sumbat. Dalam bahasa perubatan ia lebih sesuai dipanggil sebagai ‘Allergic Rhinitis’ atau alahan hidung. Pesakit juga boleh mengalami simptom gatal pada bahagian mata dan kulit muka. Gejala ini berlaku kerana pesakit alah kepada pelbagai bahan terutamanya hama, makanan laut, belacan dan sebagainya.

Perkara utama dalam menangani masalah alahan hidung adalah untuk mengelak dari bahan yang menyebabkan alahan atau ‘alergen’. Salah satu cara untuk mengenalpasti alergen adalah dengan mencatatkan dalam diari makanan yang diambil setiap hari dan juga keadaan persekitaran. Seringkali apabila diimbas kembali pesakit mungkin dapat meneka alahan mereka dengan tepat.

Selain daripada usaha pencegahan, para doktor mungkin mengesyorkan pengambilan ubat anti-alahan hidung samada dalam bentuk pil antihistamin atau pam/spray hidung. Ubat ini dapat membantu mengawal simptom alahan hidung dengan lebih berkesan, terutamanya bagi pesakit yang mengalami alahan yang teruk atau yang terpaksa terdedah kepada alergen seperti mereka yang bekerja di gudang yang berhabuk.

Langkah- langkah mengatasi alahan

Elak dari terdedah kepada alergen Pengambilan ubat yang disyorkan doktor apabila mengalami kes alahan teruk

Mengatasi masalah alergen utama iaitu HAMA

Ramai pesakit alahan hidung mempunyai alahan terhadap hama. Hama adalah binatang yang hanya dapat dilihat melalui kanta mikroskop. Sebenarnya alahan itu adalah terhadap najis hama tersebut. Hama hidup dengan memakan sel kulit mati yang terdapat pada katil dan perabot di dalam rumah kita. Ia suka kepada keadaan yang panas dan lembab.

Selain dari alahan hidung, alahan kepada hama juga boleh menyebabkan sakit asma (lelah) atau gatal kulit (eczema). Ciri utama dalam mengatasi alahan hama adalah pencegahan dan kebersihan.

Cara mengatasi hama

1. Elak penggunaan permaidani di dalam rumah terutamanya di bilik tidur
2. Elak mengunakan terlalu banyak kusyen atau perhiasan rumah yang dapat mengumpul habuk
3. Alat mainan seperti patung beruang seharusnya jenis yang boleh dibasuh dengan senang dan kerap
4. Basuh cadar dan selimut sekurang-kurangnya dua kali seminggu
5. Elok basuh cadar dan selimut dengan menggunakan air panas 60⁰C
6. Menggunakan hampagas untuk mengurangkan habuk. Penggunaan hampagas yang mempunyai filter yang bagus (high efficiency filter, HEPA) dapat mengurangkan habuk dan hama dengan berkesan
7. Mengelap perabot dengan kain lembap lebih berkesan dari menggunakan bulu ayam/plastik
8. Memakai 'face mask' terutamanya semasa mengemas rumah ataupun di tempat kerja yang berhabuk
9. Mengelakkan haiwan peliharaan seperti kucing atau anjing dari kawasan bilik tidur
10. Penggunaan lapik katil dan bantal yang anti-hama (anti-dust mite covers) juga dapat membantu

Apa yang boleh berlaku sekiranya masalah alahan hidung (resdung) tidak dikawal?

• Boleh menyebabkan masalah infeksi atau jangkitan kuman pada rongga hidung dan sinus (sinusitis)
• Boleh menyebabkan masalah polip hidung
• Gejala hidung yang sentiasa sumbat boleh mengurangkan daya konsentrasi dan menyebabkan pesakit merasa lesu
• Hidung tersumbat boleh mengganggu tidur yang berkualiti
• Alahan hidung juga berkait rapat dengan penyakit asma/lelah yang sukar dikawal
• Alahan hidung juga boleh menyebabkan pesakit mengalami masalah jangkitan telinga ‘otitis media’ terutamanya pada kanak-kanak

NOSEBLEEDS: WHAT TO DO?

Most of us would have had a nosebleed, especially during childhood. However it can still occur in adults. It is usually incited by trauma such as nose digging and upper respiratory tract infection. Sometimes the amount of bleeding can be alarming. Doctors would refer nosebleeds as epistaxis in its medical term.

What to do during nosebleeds?

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1.       Sit down calmly.

2.       Bend upper body and head forwards, this will prevent swallowing of the blood which can upset the stomach and cause vomiting.

3.       Use a tissue paper of soft towel to pinch the soft part of the nose using the thumb and index finger.

4.       Breathe through the mouth and spit out any blood trickling down the back of the throat.

5.       Continue to pinch the nose between 5 to 15 minutes. Check after first 5 minutes to see if the bleeding has stopped.

6.       It may help to gargle with ice water or to suck on an ice cube.

7.       Once the bleeding stops, do not pick the nose or blow harshly to remove the blood clots. Avoid straining and lifting heavy objects.

8.       If it continues to bleed, please seek medical help.

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When to seek medical treatment?

·         If the bleeding does not stop despite the above measures after 15-20 minutes

·         Nosebleeds following trauma to the nose or head/face area

·         Repeated episodes of nosebleeds

·         When you feel faint, dizzy or appear pale

·         Large amount of bleeding especially with blood clots

·         If you are taking medications that thin the blood such as Aspirin or Warfarin

·         Nosebleeds associated with bruising on other parts of the body

What are the causes of epistaxis?

• Upper respiratory tract infections
• Nose digging or vigorous nose blowing
• Dry, low humidity air
• Trauma to face or nose
• Allergic and non allergic rhinitis
• Foreign objects inserted into the nose
• Use of medications such as Aspirin and Warfarin
• High blood pressure
• Tumours

The nasal cavity is well vascularized.
Epistaxis commonly occurs from the Little area.
Posterior epistaxis is often more serious.

Printable leaflet

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

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FACIAL EXERCISES FOR BELL'S PALSY

www.nyhq.org

Bell’s palsy is a common cause for facial nerve palsy. It causes a temporary paralysis of the facial muscles of expression usually on one side of the face. However it is important that the doctor exclude other more serious causes of facial nerve palsy such as stroke, Ramsay Hunt syndrome, otitis media, tumours or trauma.

The facial nerve weakness in Bell’s palsy usually recovers within a month and some up to one year. Progress of recovery is best when treatment is commenced as early as possible. The doctor would often prescribe oral steroids within 72 hours of onset. Physiotherapy is also recommended as part of the treatment. It may consist of electrical stimulation or facial exercises, or both. The facial exercises can be performed at home whilst the electrical stimulation is done by the physiotherapist at their clinic.

The facial exercise involves doing different muscle movements to work each group of the facial muscles. Patients do not need to exert themselves and not get disheartened when there is little muscle movement when doing the exercises. These exercises should be repeated three times a day.

STEPS FOR FACIAL EXERCISE

• Sit relaxed in front of a mirror
• Gently raise eyebrows, you can help the movement with your fingers
• Draw your eyebrows together, frown
• Wrinkle up your nose
• Take a deep breath through your nose, try and flare nostrils
• Gently try and move corners of mouth outwards
• Try and keep the movement the same on each side of your face
• You can use your fingers to help. Once in position take your fingers away and see if you can hold that smile
• Lift one corner of the mouth …. then the other

EXERCISES TO HELP CLOSE THE EYE

• Look Down
• Gently place back of index finger on eyelid, to keep the eye closed
• With opposite hand gently stretch eyebrow up …. working along the brow line. This will help relax the eyelid and stop it from becoming stiff.
• Now try and gently press the eye lids together
• Narrow eyes as if looking into the sun 

Link
Facial exercise chart (The Bell's Palsy Association UK)