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

TMJ DISORDERS- PAIN IN THE EAR?

TMJ stands for temporomandibular joint. It’s the joint that allows our jaws to open and close. By anatomical position, it is situated in front of the ear canal. And like any joints it can give rise to pain when inflammed. However symptoms of TMJ disorder are unlike other usual joints. Most patients will present with ear pain, headache or ear pain on chewing.

Symptoms of TMJ disorder

Ear pain Headache Pain on chewing Jaw pain Facial pain Uncomfortable bite Locking of jaw Clicking sound during mouth opening

Why does it happen?

Most of the time, it is difficult to determine the actual cause or trauma that relates to TMJ disorder. There are certain risk factors associated such as it occurs more commonly in women between 30 to 50 years of age and those with jaw deformity. It can also be related to rheumatoid arthritis, teeth grinding during sleep or fibromyalgia.

During the doctor’s consultation

A thorough history is taken to assess the condition. Examination of the ear, nose, throat and face area is done to ascertain other causes for the symptoms. The TMJ on both sides is assessed and often is tender on palpation. Clicking or grating sounds can also be heard during mouth opening. Further imaging studies may be required to assess the joints.

Treatment

Treatment often consists of painkillers and medication to help ease the pain and relax the jaw muscles. Certain jaw exercises can also help, which will be taught by the doctor. These exercises will help to stretch the jaw muscles and reduce the pain.

If there is a very abnormal bite or teeth grinding then the patient is advised to seek corrective dental treatment and use bite guards.  Surgery is reserved for very advanced joint disease.

TAKE AWAY ADVICE

Avoid chewing gum or other chewing habits Eat soft food in small sizes Avoid eating nuts Ice packs applied over joint area Relaxation to reduce stress and jaw clenching

MIDDLE EAR EFFUSION

Middle ear effusion (MEE) is a condition caused by fluid in the middle ear. The fluid can be thin and serous like, or thick and glue like. Therefore middle ear effusion is also synonymous with others names such as glue ear, otitis media with effusion, secretory otitis media etc.

How does it occur?

The middle ear is normally an air-filled space deep to the ear drum. The pressure in the middle ear is equalized to the atmospheric pressure through the Eustachian tube. The Eustachian tube would open and close when we swallow or yawn. When there is poor function of the Eustachian tube, negative pressure will develop in the middle ear which leads to fluid accumulation.

Risk factors for MEE

Exposure to secondary smoking Frequent upper respiratory tract infections Frequent ear infections Attending daycare centres Allergic rhinitis

MEE is usually common in children especially those with frequent upper respiratory tract infections and allergies.  It can also occur within weeks after an acute middle ear infection, which doctors call acute otitis media.  It is less common in adults and if unilateral, it can be associated with nasopharyngeal carcinoma.

Symptoms of MEE

Ear block

Tinnitus

Reduced hearing- children may become inattentive in classroom or not respond to soft sounds

Ear pain, fever and irritability- if infected

How is MEE diagnosed?

An otoscopic examination by the doctor may show fluid or bubbles behind the ear drum. The ear drum may also take a yellowish hue.

The diagnosis can also be confirmed by performing a tympanometry which shows impaired mobility of the ear drum. A hearing test would also show a conductive type of hearing loss.

Treatment of MEE

Most cases of middle ear effusion will resolve within weeks. However doctors would prescribe medication to treat the underlying conditions. Antibiotics are indicated when there is infection and antihistamines are considered in patients with allergies. Nasal decongestants are sometimes prescribed to treat the nasal congestion.

Unfortunately in some cases the MEE persists despite medical treatment. In these cases a simple procedure such as myringotomy and grommet insertion is performed to remove the fluid and restore ventilation to the middle ear. This surgery is indicated in chronic MEE especially with significant hearing loss.

The hearing loss in MEE can be significant enough to affect the speech development in infants and the learning process of a school going child.

CARE AFTER ENDOSCOPIC SINUS SURGERY

Endoscopic sinus surgery is a procedure that is performed to open up blocked sinuses. It entails using scopes which provide good visualization of the nasal cavity structures without having to make any external skin incisions. Compared to yesteryears of open sinus surgery, endoscopic sinus surgery allows shorter hospital stay and faster recovery.

Endoscopic sinus surgery is recommended when there is failure of medical therapy in treatment of sinus infections.  It is also performed when there are polyps or tumours within the nasal cavity. Correction of deviated nasal septum causing nasal blockage can also be performed by endoscopy.

What to expect when you wake up from the surgery?

Usually the nose will be blocked with nasal packing and a gauze dressing is placed at the front of the nostril to absorb any blood stained discharge and changed whenever soaked. There are two types of nasal packing; dissolvable and non-dissolvable. The non-dissolvable nasal packing which looks like nasal tampon is usually removed 24-48 hours after the operation. The dissolvable nasal packing is left in place and will dissolve within few days.  Patients may have to breathe through their mouth because of the nasal pack.

Patients will experience some pain over the nose area and mild headache is expected. Analgesics are prescribed for pain relief. Inform the surgeon if you still experience considerable pain.

Once the nasal pack is removed, the patient is advised to pinch the nose for at least 15 minutes to stop the bleeding. The patient is also propped up in a sitting forward position and a kidney dish/basin is placed in front so that the patient can spit out any blood discharge trickling at the back of the throat.

The patient is then observed for any serious bleeding before allowed home. A small amount of blood stained discharge is expected for the next few days.

Post op advice for patients

• When lying in bed, keep the head elevated to reduce bleeding from the operated site.
• Patients should not blow their nose for 1 week after surgery. When they sneeze, make sure the mouth is open to reduce pressure in the nasal cavity and prevent bleeding.
• Nasal douching will be prescribed by the surgeon using pre-prepared salts which are dissolved into cooled boiled water. Patients are expected to perform the douching twice a day until healing is complete. The nasal douching will prevent dry crusting in the nasal cavity and allows easy dislodgment of blood clots.
• Patients should also avoid straining, heavy lifting, swimming and flying for a few weeks.
• Patients should avoid allergies and any food known to cause an allergic reaction. Reduce intake of dairy products which can increase mucous production. Refrain from smoking and exposure to secondhand smoke. Patients should also avoid crowded places in case they may catch an infection.
• Patients must comply with the medications prescribed by the surgeon which often includes antibiotics.
• Patients are required to come for follow-up at 5-7 days post operation. During the follow-up visits, the surgeon will monitor the recovery process by endoscopic examination in the clinic and suction removal of blood clots or secretions will be performed.

What next?

The recovery period can take between 2-4 weeks. Patients are often given at least 1 week home rest after the operation. The recovery process varies from patient to patient.

Some patients require long term medication after the endoscopic sinus surgery to prevent recurrence of the disease such as polyps.

Follow up is necessary until the recovery is complete and in patients with polyps they may still need a 6-12 monthly checkup to monitor for recurrence.

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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SNORING AND OBSTRUCTIVE SLEEP APNEA

Snoring occurs due to narrowing of the airway causing vibration of the soft tissues of the throat during sleep. It is more common in men generally whereby 45% of men and 30% of women snore on a regular basis.

Risk factors for snoring include overweight, increasing age, nasal blockage, sedating medications, alcohol, sleeping position and thick neck. It is important to recognize if snoring is related to an underlying medical problem such as obstructive sleep apnea (OSA) or is an isolated problem


What is obstructive sleep apnea (OSA)?
It is a severe form of snoring which has serious health consequences. OSA occurs due to complete collapse or obstruction of the upper airway, at one or a combination of these levels:

• Nasal Airway  

• Soft Palate/Tonsils

•  Tongue Base 

• Pharyngeal Walls

Symptoms of OSA

• Loud, irregular snoring
• Daytime tiredness and sleepiness
• Early morning headaches
• Poor concentration
• Deterioration of intellectual capabilities
• Mood swings

Diagnosis of OSA

A complete ear, nose and throat examination by endoscopy is performed in the clinic to assess the possible sites of airway obstruction during sleep. The body mass index is measured.

Sleep study is often recommended to confirm and determine severity of OSA
OSA severity is indicated by the Apnea / Hypopnea Index (AHI)
· Mild: 5 – 15 events / hour
· Moderate: 16 – 30 events / hour
· Severe: > 30 events / hour
(events is when there is almost or total obstruction of the airway causing a drop in oxygen blood saturation)

Consequences of OSA
It is very important to recognize and treat OSA because if left untreated it can lead to serious health consequences:
Hypertension
Myocardial infarction
Stroke
Type II diabetes
Depression
Cognitive dysfunction
Impotence, sexual dysfunction, or reduced libido
Morning headaches

General preventive measures for snoring
§ Sleep hygiene
     - Regular sleep-wake times
     - Peaceful surroundings
     - Moderate room temperature
     - Avoidance of night shift and changing work shifts
§ Reduction of weight
§ Exercise
§ Avoid alcohol and sedatives before bedtime


Treatment options for OSA



APAP (Automated Positive Airway Pressure) with Mask
It is the Gold Standard treatment for Sleep Apnea. Patients are required to wear a face or nasal mask which blows in humidified air. This will help to ‘splint’ the airway open during sleep.

Oral appliance
Oral Appliance Therapy is a suitable front-line treatment option for mild to moderate OSA sufferers and simple snorers. The Oral Appliance is worn during sleep to maintain the patency of the upper airway.


Surgical treatment options for OSASurgery is aimed to relieve the obstruction. Therefore the type(s) of surgery recommended varies between patients.

The surgeries that can be performed include
· Tonsillectomy and adenoidectomy
· Septoplasty and turbinate surgery
· Soft palate surgery
· Base of tongue surgery
· Surgery to facial bones in selected cases

OSA in children 

The symptoms may differ from adults as children with OSA can present with mouth breathing, behavioural problems/ irritability, learning difficulties, hyperactivity and bedwetting. Often these children have large tonsils and adenoids which cause the airway obstruction and snoring. Obesity is a less common reason for OSA in children.

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)