Ent specialist johor bahru

耳鸣是许多医生可能会忽视的问题之一，因为它可能很常见，无需担心。 大多数情况下是正确的，但在某些患者中，需要首先排除更险恶的事情。 鼻咽癌可能是耳鸣的罕见原因之一。 然而，除了癌症以外的鼻子病理应该总是得到很好的治疗，因为它可能是治疗耳鸣问题的关键。

Tinnitus(ringing sound in the ear) is one of the problem that might be overlook by many medical doctors as something that might be very common and nothing to be worry about. Most of the time is true but in certain patient something more sinister need to be rule out first. Nasopharyngeal cancer might be one of the uncommon causes of the tinnitus. However, the pathology in the nose other than cancer should always be treated well as it might hold the key treatment of the tinnitus problem.

颈部肿胀可能是由多种原因造成的。 颈部肿胀最常见的原因是淋巴结肿大。 淋巴结肿胀可能是由于感染引起的，感染可能是急性的，由病毒或细菌感染引起。 在马来西亚，外劳导致肺结核感染的增加，这也可能导致颈部肿胀。 除了感染，淋巴结肿胀可能是由癌症引起的，无论是由淋巴结本身（淋巴瘤）引起的，还是由于耳、鼻、喉、头皮或颈部的癌症并扩散到颈部的淋巴结。 因此，对于急性感染期间发生的小于 2 周的颈部肿胀，可以开具抗生素和抗炎药。 但是，如果肿胀持续时间超过两周，则必须进行全面的头部、颈部、耳朵、喉咙和鼻子检查。 必须做一个范围来检查鼻子的较深部分和喉咙，以排除特别是鼻咽癌。 如未查明原因，应先行淋巴结抽吸排查排除恶性肿瘤。 手术切除不应是正常情况下的首选，除非强烈怀疑淋巴瘤或淋巴结癌或初始抽吸未能得出结论性结果。

Neck swelling could be due to alots of causes. The commonest cause of neck swelling is lymph node swelling. Lymph node swelling could be due to infection which could be acute and cause by virus or bacteria infection. In malaysia, the foreign workers have contribute to the rise of tuberculosis infection which might also present with neck swelling. Besides infection, lymph node swelling could be due to cancer whether its arise from the lymph node itself (lymphoma) or due to cancer of the ear,nose, throat, scalp or neck and spread to the lymph node over the neck. Hence, in neck swelling of less than 2 weeks and occurs during acute infection, antibiotic and anti-inflammatory could be prescribed. However, if the swelling persists longer than two weeks, a complete head,neck,ear,throat and nose examination have to be conducted. A scope must be done to examined the deeper part of the nose and also throat to exclude especially nasopharyngeal carcinoma. If no prominent cause being found, an investigation which aspiration of the lymph node should be first conducted to exclude malignancy. Surgical excision should not be the first option in normal circumstances except in the condition where lymphoma or cancer of lymph node is strongly suspected or the initial aspiration failed to yield the conclusive result.

Oral candiadiasis usually happened in immunocompromised patient or patient with weak immunity. These includes cancer patient especially during or after chemotherapy, uncontrolled diabetic, HIV infection, patient on prolonged wide spectrum antibiotic or on steroid inhaler for asthma. It also happens in some elderly with the low immune system. Workout need to be done if no prominent cause being identified from clinical history and examination. Blood test need to be done to work out for the cause. Treatment should includes treating the real cause plus the antifungal treatment intraorally.

Stone in the salivary gland or duct?
It is not a common disease in comparison with kidney stone. Salivary stone might involve submandibular gland or parotid gland. Patient usually will present with swelling and pain or discomfort over the upper neck or angle of jaw region. The pain and swelling usually associated with meal. Pain and swelling started during the meal and subsided after the meal is over. Ct scan or a sialogram (a scan where contrast is being injected into the salivary duct system to see the narrowing of the duct and also to delineate the salivary duct and stone). Treatment done via a minimally invasive procedure where a small scope (sialoendoscopy) being use to see and remove the stone or to dilate the salivary duct narrowing. A bigger stone might need go be removed via surgery.

Hoarse voice for more than 2 weeks which is not improving in nature should have a scope done to determine the cause. Smoking and drinking are the two most important common risk factors contributing to the rise of the vocal cord cancer. The initial management should be biopsy to confirm the nature of the mass plus scan to assess the extent of the tumour. Treatment of the vocal cord cancer depend on the stage of the cancer. Early stages could be treated with endolaryngeal laser excision or radiotherapy. In more advance cases, the vocal cord will have to be removed partially or fully from external.

Cholesteatoma. Which can be called as skin's cell at the wrong place. Our normal cells lining the ear canal produce ear wax. Usually ear wax which is dry will dropped out from the ear canal by itself and the moist/wet type of ear wax need to be the removed from the ear canal. However, in cholesteatoma disease, the skin's cells which usually only available at the ear canal is noted to have went to the roof of the ear drum or into the middle ear. These cells will produce wax and some enzymes. The enzyme will cause slow erosion of the surrounding bone and structures. This disease is a slow progressive disease which causes slow erosion of the surrounding structures eg- bony wall, small conducting bone, balancing organ, facial nerve and also hearing organ.
Patient might be complaining of unresolving smelly ear discharge. The progression of this disease might cause hearing loss, ear infection, dizziness, facial weakness, headache and brain infection in severe cases.
Diagnosis mainly depends on the clinical features-whitish keratin debris at the roof of the ear drum or in the middle ear. Ct scan would be helpful in assesing the extend of the disease. Hearing test is done to assess the level and type of hearing loss cause by the cholesteatoma.
This disease usually could be removed via minimally invasive endoscopic surgery where the cholesteatoma is being removal together with reconstruction of the eroded structure via ear canal. In some very severe cases where there is alot of disease in the mastoid bone, the mastoid bone need to be opened up and the disease bone need to be clean up.

Thyroid growth.
Patient presented with neck swelling which is increasing in size and causing discomfort to the patient.
The investigations done includes neck ultrasound, blood test to check thyroid level and also FNAC to aspirate some sample from the mass for cytology study in lab to confirm the nature of the mass.

Endoscopic external ear canal exostosis/ bony growth removal.
Patient presented with ear blocakage, ear pain and reduced hearing. Aural/ ear scope showed a bony growth over the external ear canal. Minimally invasive Endoscopic removal of the bony growth done