Ageing gracefully with your Ear Nose & Throat

Ageing gracefully with your Ear Nose & Throat DR HUANG SHOOU CHYUAN Ear Nose Throat Surgeon, Huang Ear Nose Throat Surgery Gleneagles Medical Centre #04-17 Tel: 64757995 Website: www.entsurgery.com.sg

"Give a man a fish and he will eat for a day. Teach a man to fish and he will eat for a lifetime." Unknown author

Singapore websites: Huang Ear Nose Throat Surgery entsurgery.com.sg Health Promotion Board (HPB) hpb.gov.sg/healthtopics.aspx hpb.gov.sg/hpb/default.asp?pg_id=911 National Cancer Centre (NCC) nccs.com.sg/pbcation/HB/Nasopharyngeal_Cancer_Eng.pdf Singapore Cancer Society www.singaporecancersociety.org.sg/lac-fcn-nasopharyngeal-cancer.shtml Overseas websites: healthyagingprograms.org/content.asp?sectionid=73 nihseniorhealth.gov/exercise/toc.html aafp.org/afp/990501ap/990501d.html

Inner ear Outer ear Middle ear Deafness in the Elderly

How do I know I have a hearing loss? Difficult to hear: women’s voices bird’s singing TV or phone conversation within a group tinnitus Coping behaviours: avoid group meetings asking others to repeat themselves turning up volume of TV misinterpreting messages

Frequency in Hertz Loudness in decidels Frequency in Hertz Loudness in decidels

Common causes of deafness in elderly Inner ear:Presbycusis – degeneration of cochlea bilateral with tinnitus lose hi pitch first distorted hearing worse with previous noise exposure & family history

Outer ear: Ear wax- Perforated drum- External ear infection

Middle ear: Eustachian tube blockage after flights or “colds” Nasopharyngeal cancer (NPC): Nose Cancer

Hearing aids

Head & Neck Cancers- Signs and Symptoms头部与頚部癌症 黄守全医生 Dr.Huang Shoou Chyuan Nose Cancer 鼻咽癌 Salivary Gland Tumour 唾腺癌 Thyroid Cancer 甲状腺癌 Lymph Node Lumps 淋巴癌 Vocal cord cancer声带癌 Tongue Cancer 舌头癌

Nasopharyngeal Cancer (1968-2002) 鼻咽癌统计数字(1968-2002年) 男性男性女性女性

Causes of Nose Cancer鼻咽癌病因 • Genetics基因-Chinese esply southern Chinese 尤其华南一带的华族 • Epstein-Barr Virus (EBV)细菌 • Diet eg salted fish 饮食习惯例如咸鱼咸菜 • Familial 家族遗传

Signs and Symptoms of NPC 鼻咽癌的症状 • Ear 耳 Deafness 耳聋 Tinnitus 耳鸣 • Nose 鼻 Nosebleed 流鼻血 Blood in sputum咳嗽出血 • Throat 喉 Neck Lumps頚部肿瘤

Naso-endoscopy 用内窥镜检查鼻子 Nose Cancer 鼻咽癌 Normal 正常的

Treatment Methods治疗方法 • Radiotherapy 电疗 - Early stage NPC 早期 • Combination Radio- and Chemotherapy 化疗与电疗- Mid- and Later stage NPC 中期后期 • Surgery 动手术-Recurrent Neck Lump 頚部肿瘤复发 Early stage NPC has cure rate of about 80% ! 早期治愈机会高+/- 80%!

Neck Node Swelling淋巴肿瘤 Lymphoma淋巴癌 : Fever 发烧 General Malaise 疲倦 Metastatic Neck Swelling 癌症扩散: Cancer-related swelling 与癌症有关的肿瘤

Thyroid Cancer甲状腺癌 Neck swelling肿瘤 Hoarseness (Recurrent Laryngeal Nerve) 声音嘶哑 Swallowing difficulty 吞咽困难 Airway obstruction 呼吸困难 Pain 疼痛

Salivary Gland Cancer 唾腺癌 Swelling 肿瘤 Facial paralysis脸部扭曲 Pain 疼痛

Vocal Cord Cancer声带癌 Swelling 肿瘤 Hoarseness 声音嘶哑 Swallowing difficulty吞咽困难 Airway obstruction呼吸困难 Pain 疼痛 Blood in sputum 咳嗽出血

Tongue Cancer舌头癌 Non-healing ulcer 无法痊愈的溃疡 Pain 疼痛 Bleeding 口部流血 Swallowing difficulty吞咽困难 Airway Obstruction呼吸困难

Snoring: More Serious Than You Think! • 45% normal adults snore (occasionally) • 25% habitual snorers • More frequent in males/overweight/elderly Mechanisms of snoring: Partial obstruction throughout airway Poor muscle tone eg elderly/alcohol/sleeping pills Excessive tissue eg obese/tonsils/small lower jaw posterior tongue base Long soft palate/uvula Nose blockage

Obstructive Sleep Apnea apnea episodes (more than 10 secs) + reduced airflow = > 5/hr Gasping for air during sleep Witnessed apnea (stopping of breathing for at least 10 seconds) Waking up tired, even after a full night's sleep Feeling sleepy during the day (at work or while driving) Irritability or short temper Problems with concentration or memory Pure snoring or OSA? 7. Medical conditions such as high blood pressure and heart disease OSA Risks • Risks of accidents • High blood pressure • Heart disease • Stroke • Sudden deanth NB: More than 50% (!) of men with untreated OSA suffer a serious health condition or even death within 10 years.

Obstructed airway Tests & Treatment for OSA Polysomnogram PSG (Sleep Study): gold-standard for OSA diagnosis originally done at attended Sleep Laboratory Watch-PATtechnology: Avoids pitfalls of conventional PSG ie.Electrodes & wires cannot sleep! Expensive FNE-First Night Effect Results validated with sleep lab’s data Reimbursable in many parts of USA Watch-Pat 200: Non-invasive; Minimal sleep interference Comfort of home Single-button operation Instant analysis and report USA FDA & European CE cert Conventional PSG with electrodes & wires

Ambulatory Sleep Study by Watch-Pat Peripheral Arterial Tone Technology(PAT) • physiological signal mirroring autonomic nervous system changes caused by respiratory disturbances during sleep • proprietary algorithm analyzes PAT signal identifying sleep apnea events with high degree of specificity and sensitivity • Parameters measured or derived during the night include oxygen saturation, heart rate, sleep and wake states, and REM and non-REM sleep. Heart rate O2 satn Sleep stage Body position Snoring level

OSA treatment options • 1. Weight loss:Body Mass Index BMI less than 25 (BMI) = weight(kg) divided by height(m)2 eg Ht 1.67 , Wt 70, BMI= 25 avoid sedatives(including alcohol, antihistamines and sleeping pills aids), and avoid sleeping on one's back • 2. CPAP (Continuous Positive Airway Pressure)

OSA treatments • 3.Dental splint:keeps tongue and jaw forward to prevent airway collapse. Sleep strip on the nose: improves nasal airway Medications to lessen nose blockage

OSA treatments • 4.surgery:to improve airway in nose & throat Turbinate reduction Septal surgery UPPP- Uvulopalatopharyngoplasty

谢谢Thank you

Ageing gracefully with your Ear Nose & Throat