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Dr. Simon H.W. Wong Dr. Simon H.W. Wong Specialist in Specialist in Otorhinolaryngology Otorhinolaryngology 黃黃黃黃黃黃黃黃黃黃黃 黃黃黃黃黃黃黃黃黃黃黃
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Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Apr 01, 2015

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Page 1: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Dr. Simon H.W. WongDr. Simon H.W. Wong

Specialist in OtorhinolaryngologySpecialist in Otorhinolaryngology

黃漢威耳鼻喉科專科醫生黃漢威耳鼻喉科專科醫生

Page 2: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

TinnitusTinnitus

Subjective sensation Subjective sensation of sound in the earof sound in the ear

Rarely objectiveRarely objective

Associated with any Associated with any form of ear diseaseform of ear disease

Idiopathic in 20%Idiopathic in 20%

Page 3: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Management ObjectiveManagement Objective

Find causeFind cause

Treat causeTreat cause

Treat symptomTreat symptom

Page 4: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

CausesCauses

Outer, Middle or Outer, Middle or Inner?Inner?

Central: Structural Central: Structural or Functionalor Functional

Systemic: Renal, Systemic: Renal, anaemiaanaemia

Page 5: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

HistoryHistory

AgeAgeDurationDurationFrequencyFrequencyPositionalPositionalNasal symptomsNasal symptomsHearing lossHearing lossVertigoVertigo

Page 6: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

ExaminationExaminationFull ENT examFull ENT exam

Must see the ear drumMust see the ear drum

Always check Always check nasopharynxnasopharynx

AudiometryAudiometry

Page 7: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

MicroscopicMicroscopic ExamExam

Ear toiletEar toilet

Wax hook, suction, Wax hook, suction, forcepsforceps

CultureCulture

Grommet insertionGrommet insertion

Page 8: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Ear Wax ImpactionEar Wax Impaction

Page 9: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Otitis ExternaOtitis Externa

Suction clearanceSuction clearance

Topical antibioticsTopical antibiotics

Ear wickEar wick

Pain reliefPain relief

Page 10: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Fungal Otitis ExternaFungal Otitis Externa

Page 11: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Fungal Otitis ExternaFungal Otitis Externa

Repeated ear Repeated ear toilettoilet

Clotrimazole ear Clotrimazole ear dropdrop

Oral NystatinOral Nystatin

Page 12: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Foreign BodyForeign Body

Page 13: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Otitis Media with Otitis Media with EffusionEffusion

Page 14: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Adhesive OMAdhesive OM

Eustachian tube Eustachian tube dysfunctiondysfunction

AntihistaminesAntihistamines

Steroid nasal Steroid nasal sprayspray

Page 15: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Chronic Suppurative Otitis Chronic Suppurative Otitis MediaMedia

Suction clearanceSuction clearance

Topical antibioticsTopical antibiotics

AntihistaminesAntihistamines

TympanoplastyTympanoplasty

Page 16: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

CholesteatomaCholesteatoma

Keratinized epithelium Keratinized epithelium in middle earin middle ear

Topical antibioticsTopical antibiotics

CT scanCT scan

MastoidectomyMastoidectomy

Page 17: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Nasal EndoscopyNasal Endoscopy

Page 18: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Nasopharyngeal Nasopharyngeal CarcinomaCarcinomaBiopsyBiopsy

TinnitusTinnitus

Hearing lossHearing loss

EpistaxisEpistaxis

Cervical LNCervical LN

Page 19: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Impedance Impedance TympanometryTympanometry

Eustachian Tube Dysfunction

Middle Ear Effusion

Page 20: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Impedance Impedance TympanometryTympanometry

Page 21: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Pure Tone AudiometryPure Tone Audiometry

Page 22: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Pure Tone AudiometryPure Tone Audiometry

Down sloping SNHLDown sloping SNHL

4 kHz dip4 kHz dip

Conductive HLConductive HL

Low frequency SNHL: Low frequency SNHL: Meniere’sMeniere’s

Asymmetrical SHNLAsymmetrical SHNL

Page 23: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Acoustic NeuromaAcoustic Neuroma

SchwannomaSchwannoma

Facial palsy or Facial palsy or numbnessnumbness

Gamma/X-knifeGamma/X-knife

SurgerySurgery

Page 24: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Medical ManagementMedical ManagementVasodilator: Betahistine, CaVasodilator: Betahistine, Ca2+2+ antagonist antagonist

Cerebral activator: Nicergoline (Sermion)Cerebral activator: Nicergoline (Sermion)

Almitrine : increase PaOAlmitrine : increase PaO22

GingkoGingko

Page 25: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Medical ManagementMedical Management

? Vitamin B12? Vitamin B12

SedativesSedatives

MaskersMaskers

Hearing aidHearing aid

Page 26: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

Medical ManagementMedical Management

Self-help groupsSelf-help groupsPsychological counselingPsychological counseling

Page 27: Dr. Simon H.W. Wong Specialist in Otorhinolaryngology 黃漢威耳鼻喉科專科醫生.

ConclusionConclusion

Tinnitus treatableTinnitus treatable

Underlying causeUnderlying cause

Treat symptomTreat symptom