Disorders & Diseases
Ear, Nose & Throat Disorders
Common voice and ENT disorders that are managed at the HKVENT include:
General ENT problems such as:
- Discharging ears and hearing dysfunction
- Acute/chronic sinusitis
- Nasal polyposis
- Allergic rhinitis
- Sore throat
- Dizziness and vertigo, etc.
Special voice disorders such as:
- Vocal fold paralysis/paresis (vocal fold weakness)
- Benign vocal fold lesions including nodules, polyps, cysts, papillomatosis, and granulomata
- Laryngeal cancer and precancerous dysplasia
- Hoarseness and dysphonia
- Sleep disordered breathing such as snoring and obstructive sleep apnoea syndrome
Sleep Breathing Disorder such as:
- Sleep breathing disorder caused by snoring and obstructive sleep
- Sleep Apnoea
Persistent ear discharge
|Ear discharge in children
Ear discharge in children is mainly caused by otitis media (AOM), a complication of cold or flu. Symptoms of AOM include otalgia and high temperature in children. In severe cases, fluid will be trapped in the middle ear and there may be purulent discharge from perforated ear drums. AOM is common in children aged between 4 months to 5 years old.
Treatment of AOM includes anti-biotics, releasing of fluid through surgery, or myringotomy with insertion of a ventilating tube to reduce the pressure in inner ears.
Ear discharge in adults
Ear discharge in adults is mainly caused by outer-ear infection or otitis media:
i) Outer-ear infection
Generally speaking, most outer-ear infections in adults are caused by the incorrect use of cotton swab or ear pick. Treatment includes anti-biotic eardrops and patients need to keep the ear canal dry.
ii) Otitis Media
The main cause of otitis media in adults is perforated ear drum. Symptoms include persistent ear discharge, hearing impairment, vertigo and tinnitus. In critical cases, patients may suffer from meningitis and facial nerve paralysis.
Some patients with otitis media may develop cholesteatoma, which will erode ear bone, skull, facial nerves and may eventually lead to death.
Treatments for otitis media include anti-biotics, ear drops or myringotomy. If patients suffer from cholesteatoma, mastoidectomy might be needed.
|Normal ear drum
Ventilating tube inserted in ear drum for fluid drainage
Perforated ear drum
The loss of hearing gradually occurs in most individuals when one gets old. Some otolaryngologists believe that hearing impairment may be caused by genetics and long-term exposure under high-noise environment. Other possible causes include excessive ear wax blocking ear canal, perforated ear drum, presence of fluid blocking the middle ear and acute sensorineural hearing loss (SNHL) etc. Speech development will be affected in children suffering from hearing impairment. Parents should thus bring their children to see a doctor as soon as possible if they notice anything unusual with their hearing.
|Excess ear wax blocking ear canal
|Acute Sinusitis /Chronic Rhinosinusitis
Sinusitis is a common nasal disease caused by cold and flu. It occurs when there is inflammation or bacteria is transmitted from nasal cavity to sinuses. Sinusitis can be further categorized into two types: Acute Sinusitis and Chronic Rhinosinusitis.
i) Acute Nasal Sinusitis
When patients with allergic rhinitis or nasal polyps are attacked by virus, their nasal cavity will contract, trapping secretions and mucus. Retained secretions, when infected, may contaminate the sinuses. In addition, upper teeth infection or have periodontal, when combined with rhinitis, may lead to acute nasal sinusitis.
Symptoms of Acute Nasal Sinusitis include:
Nasal mucus is often thick, turbid with awful smell. With prescription of anti-biotics or steroid therapy, patients with acute sinusitis can usually recover in 4 weeks. However, if the nasal ostia is completely blocked after inflammation, sinuses will be infected by virus or bacteria trapped and lead to Chronic Nasal Rhinosinusitisis.
Symptoms of Chronic Rhinosinusitisis is the same as Acute Sinusitis but will last for more than 4 weeks. Patients might need to undergo nasal irrigation to clear out the infected mucus. This is performed endoscopically by using a fiberoptic nasopharyngoscope in line with anti-biotic prescription .
Currently, the cause for nasal polyps is still unknown. However, it is generally believed that long-term inflammation of the mucosa of the nose might be a possible cause. Nasal polyps are common in smokers as well as children with asthma. Nasal polyps will cause breathing difficulties, running nose, loss of smell and Chronic Rhinosinusitisis. It might also lead to snoring, headache, and damage the nose’s shape. Single side nasal polyp is similar to some other nasal diseases such as inverted papilloma of sinuses. Hence, tissue testing is needed for accurate diagnosis.
If the nasal polyp is small in size and benign after testing, steroid nose spray can be used to control symptoms. However, if the nasal polyp is too big, it will block the sinuses and trap nasal secretions. Nasal polyp can then be removed endoscopically by using a fiberoptic nasopharyngoscope. Steroid nose spray is still necessary as post-surgical treatment.
Inverted papilloma of sinuses
CT Scan (Nasal polyp)
Nasopharyngeal cancer is common in Hong Kong especially in people aged 40 to 50. According to the Hong Kong Cancer Registry, newly diagnosed nasopharyngeal cancer cases and mortality rate is ranked no. 7 among the top ten cancers.
Nasopharyngeal cancer is common in males of Southern China, especially Cantonese. It is therefore also known as Canton Cancer. The major cause of nasopharyngeal cancer is diet. For example, excessive intake of salted fish or smoked food. Hence, nasopharyngeal cancer is often found in descendants of fishermen. Other causes include smoking, family history and EB virus infection.
It is a common misconception that patients with nasopharyngeal cancer will only have nose bleeding, tinnitus and bloody secretions between the throat and nose. However, tumor on the neck, presence of fluid being trapped in single ear and hearing impairment are also common symptoms. If diagnosis is delayed, it will result in cranial nerve damage and metastatic cancer.
Symptoms of Nasopharyngeal Cancer:
Doctors need to perform different tests to diagnose nasopharyngeal cancer. This includes biopsy by nasopharyngoscopy followed by tissue testing. Once a diagnosis is made, CT scan and MRI will also be performed afterwards to further analyze the tumor, such as how it is correlated with nearby tissue and to estimate the stage of cancer.
Radiotherapy is the major treatments for nasopharyngeal cancer. In some cases, chemotherapy might be applicable in parallel with targeted drugs. The choice of treatment is dependent on the severity of the disease.
About 80% of patients with nasopharyngeal cancer can be cured after treatment. As for recurrent nasopharygeal cancer and those who do not respond to radiotherapy or chemotherapy, ,transpalatal-maxillary-cervical, transmandibular or transcervico-mandibulo-palata surgery might be needed.
Fluid trapped in middle ear
Lower Turbinate Hypertrophy
Allergic rhinitis is a common disease. In Hong Kong, about 40% of school children have allergic rhinitis, Symptoms included:
Severe cases of allergic rhinitis may lead to sinusitis.
Patients with allergic rhinitis should keep their home clean. They should wash up curtains and beddings often, avoid using carpet and not to keep stuffed toys so as to keep their home clean. This will help to reduce dust mite allergens.
For drug prescriptions, patients need to be aware of the fact that some drugs, such as steroid nose sprays, take two weeks to be effective.Patients should consult their doctors before taking any medication. Surgical treatment might be necessary if lower turbinate is enlarged or the airway is blocked.
|Lower turbinate hypertrophy
The tonsils are composed of two groups of lymphoid organs located at the back of the mouth, They are the defense against any bacteria or viral attack. When bacteria or viruses enter our body through the mouth, they will be recognized by tonsils that generate immune memory. Once they invade again , the tonsils will be stimulated to spur an immune response. However, ones get weakthe , the bacteria or virus in the mouth or hidden in the tonsils cavity will attack the tonsils and cause tonsillitis.
Inflammation is mostly confined within the tonsils which will bring
If tonsillitis is caused by bacterial infection, it is usually treated with a regimen of antibiotics. When symptoms are getting worse, or have been persisted for more than 48 hours, abscess might be developed within tonsils that a surgical treatment is needed to drain the abscess In some serious cases, the inflammation has spread to the neck lymph nodes and causing them swollen and pain.
Recurrent tonsillitis may disturb patient’s working and daily lives . Those patients may consider a surgical procedure to remove the tonsils.
Vertigo generally refers to the feeling of dizziness and losing of balance triggered by the inner ears’ disorder. Vestibulitis、canalithiasis and Meniere’s disease are the most common . Each of them shows different presentation other than vertigo.
Vestibulitis is mainly caused by viral infection. It will disturb the body balance function of the inner ear. Patients will vomit、feel dizzy and spinning around
Canalithiasis happens when the detached otoliths (ear stones) floating around the semicircular canals of the inner ear. Patients will feel dizzy when turning around on the bed. This can be cured by canalith repositioning procedure to move the otoliths that cause the condition Ménière disease
Ménière disease is caused by increased hydraulic pressure within the inner ear due to the excess of endolymph fluid . Symptoms include sudden tinnitus, fluctuating hearing loss and vertigo Symptoms would generally last for a few hours to a day and gradually diminish.
This disease mostly happen in women aged over 40. In around 40 to 50 percent of cases, both ears are suffered. There is no cure up to now. However, staying happy, avoiding tobacco, alcohol and tea can help to reduce the recurrence. When patients feel dizzy, patients can take anti-dizziness medication orally or through injection and lie down to rest. If vomiting continued, patient is required for intravenous hydration to replenish the fluid loss.
In the past, surgical treatment may be performed on those serious cases to drain the excess endolymph fluid in inner ears or cut of the nerves responsible for balancing. However, both surgeries will put patients at risk of hearing impairment or facial nerves paralysis. Some researches suggested applying antibiotics to the inner ears directly to damage the nerves responsible for balancing function may work. Since it will let the patients exposed to certain risks, pre-surgery assessment is necessary.There’s another suggestion that drawing the excess endolymph fluid to the circulation by inserting a small tube to the ear drum, which is connected to a device pumping gas to the inner ears may be another possible solution. However, the effectiveness of this treatment is still under investigated .
|Special Voice Disorder
Unilateral Vocal Fold Paralysis (UVFP)
Unilateral vocal fold paralysis (UVFP) is mainly caused by damage of the recurrent laryngeal nerve. Such damages include
In some cases, the cause of Unilateral Vocal Fold Paralysis (UVFP) is unknown.
Most patients suffering from UVFP show breathy when speaking. They need to pay extra effort in speaking out every single word. And UVFP will also increase the chance of getting swallowing difficulty due to the malfunction of vocal cord. In such case , the food and drinks will always mistakenly enter the trachea or even the lung and might cause aspiration pneumonia.
Medialization thyroplasty is one of the treatment choice that by implanting silicon or Gore-tex This will help to medialize paralyzed vocal fold which can help to relieve the dysphonia and swallowing difficulty.
Bilateral vocal fold (vocal cord)paralysis
|Vocal fold polyps, nodules, cysts granuloma and papilloma Vocal fold nodules & polyps
Vocal fold polyps & nodules are kinds of common vocal fold lesions, which mainly brought by trauma, overuse or inappropriate use.
Vocal fold nodules mostly happen on both sides of vocal cord, while polyps used to appear on either one side. Small polyps can be cured by speech therapy but laryngoscopy surgery is needed for large polyps or nodules. After treatment, patients have to learn how to use the correctly or or the disease will replease .
Laryngeal papilloma is caused by human papillomavirus type 6 or 11. The virus hidden in the mucous membrane of the larynx prolifrateand develop into benign tumor. Laryngeal Papilloma can be found in the whole upper respiratory system but vocal flod larynx and uvula are most common.
About 80% of Laryngeal papilloma patients are children with symptoms started from 3 to 4 years old. The rest are mainly male adults aged between 20 to 40. It mostly causes hoarseness but it can result breathing difficulties in serious cases. Laryngeal papilloma will revive easily,Somepatients might have to undergo several surgical treatments to keep the airway clear with no obstruction.
Papilloma will be atropied in certain children patients when they grow up with mature immune system. But the recovery rate of adult patient general is generally lower than those of children. In these couples of years, there’re several new anti-viral drugs emerged which are suggested to reduce the size papilloma. However, their efficacy is still investigated..
Contact granulomas can be mostly found in three types of patients as listed below:
Patients suffer from contact granulomas will have hoarseness, bloody mucus after coughing. The outlook of large contact granulomas is similar to malignant laryngeal tumor. Therefore, the doctor will have to perform biopsy examination to have a correct diagnosis.
|Vocal fold polyps
Vocal fold nodules
Vocal fold cysts
Endoscopic surgery instruments
|Laryngeal cancer and precancerous lesion
Hoarseness is the main symptom of laryngeal cancer. It is important to seek consultation immediately if hoarseness lasts for more than 4 weeks, to find out whether it is caused by laryngeal cancer.
If laryngeal caner cannot be detected in early stage, the tumor will enlarge and lead to breathing difficulty. Once the cancer cells invades oesophagus, tongue base or larynx tissue, patients will further suffer from swallowing difficulty. Neck lymph node will swollen if the cancer cells further spread to neck lymph node. Regular body check can help to detect the laryngeal cancer at early stage for treatment and larynx preservation.
First and second stage of laryngeal cancer:
Patients suffer from early stage of laryngeal cancer can undergo radiotherapy which can help to retain the function of the larynx. The general survival rate is high.
In some selected cases, laser treatment is also applicable for early stage laryngeal cancer patients. The general survival rate is also high.
Third and fourth stage of laryngeal cancer:
Surgical treatment with or without adjuvant radiotherapy is needed for r third and fourth laryngeal cancer patients to remove the tumor thoroughly. As the larynx which is the vital organ for speech has been removed, patients have to take the speech rehabilitations to acquire the new speaking skills. With the advancement of medical technology, the combination of radiotherapy and chemotherapy cam help to preserve the larynx function of selected patients.
|Snoring and Sleep Apnoea
During sleep , velum, tongue and laryngeal muscle will relax and narrowing the upper respiratory airway. When air goes through the upper respiratory airway, the muscle there will vibrate which cause snoring. Snoring will lead to unbearable noise which might affect family harmony increase couple relationship tension when getting serious.
When the upper respiratory airway is narrowed seriously, other than snoring, apneic events might also happen. If apneic event last for more than 10 seconds and happens for more than 5 times per hour, patient can be diagnosed for having sleep apnoea.
Polysomnogram sleeping test
After asleep, patients with obstructive sleep apnoea will keep on awaking due to breathing disturbance, increase burden on
cardiopulmonary function. In serious cases, patients might be awoken for over a hundred times due to apnoea. Patients without having enough always show daytime sleepiness and chronic fatigue etc. In long-term, obstructive sleep apnoea might trigger high blood pressure, stroke and heart diseases.
Patients first of all should have a weight loss treatment or wear nasal “CPAP” mask and pump (Continuous Positive Airway Pressure = CPAP) so as to keep breathing smooth while asleep. If conditions do not improve, patients might consider surgical treatments.
Radiofrequency has been introduced in recent years as kind of surgery for sleep apnoea patients. Through insertion of a tiny needle to the enlarged upper respiratory tissues such as velum, tonsils, tongue or inferior turbinate, using low-power radiofrequency energy with temperature about 80 degree Celsius to perform tissue coagulation. This helps to solve obstructive sleep breathing problems.
However, radiofrequency is effective in treatment patients patients with snoring problems only. For mild sleep apnoea and uvula oversized patients, staphyloplasty will be a more suitable option. For moderate sleep apnoea patients a more complex surgery such as uvulopalatopharyngoplasty (UVPP) maybe one of the treatment choice
Polysomnogram sleeping test