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Obstructive Sleep Apnea (OSA) is defined as the cessation of airflow during sleep preventing air from entering the lungs caused by an obstruction. Snoring is caused by a narrowing of your airway, either from poor sleep posture or abnormalities of the soft tissues in your throat. These are available for you to license for books, magazines, newsletters, presentations and websites. All characters, panels and images are copyrighted by their respective copyright owners and they are used here with permission. All logos and other trademarks are the exclusive property of their respective holders who reserve all rights.
Dr Lynne Lim is recognized as one of the top adult Ear Nose Throat specialists island wide. Dr Lynne is one of the best adult ENT doctors in Singapore managing holistically the full spectrum of ear, nose and throat disorders. Age-related hearing loss – Natural wear and tear with degeneration of the inner ear and middle ear function is common in adults over 50 years of age, warranting screening for hearing loss. Noise-induced hearing loss – This is due to very high noise level exposure for just a few minutes, or chronic high noise exposure.
Tinnitus – This is a result of hearing loss and may also occur due to tumors, abnormal vessels, thyroid dysfunction and drugs. Otitis media – This can be acute, painful or accompanied with fever when associated with infections.
Perforated ear drum – This can result from traumatic injury to the ear drum or chronic untreated middle ear and mastoid infections.
Cholesteatoma – A middle ear tumor that is not cancerous, but causes hearing destruction by eroding middle ear bones and bringing about toxin penetration to the inner ear.
Malignant Otitis Externa – Bacterial infection of the ear canal and temporal bone causing deep pain and chronic ear discharge, often associated with diabetes. Mastoid infection – Chronic infection of the mastoid air cells and bony septations due to bacteria, fungus or unusual diseases like Tuberculosis. Acoustic Neuroma – Tumor of the hearing nerve impairs hearing, and may cause facial nerve palsy, giddiness and increased intracranial pressure with growth.
Hearing loss is often missed, and many do not seek treatment from an adult Ear Nose Throat specialist in Singapore for fear of stigmatization or deeming that it is not important. Many teenagers and young adults underestimate their noise exposure and the risk of noise-induced hearing loss. The hearing tests and complete range of services are available in-house in sound-proof and sound-treated rooms, allowing the adult Ear Nose Throat doctor to interpret the tests together with the audiologist to offer a treatment plan on an immediate basis.
Tympanometry – this test shows the middle ear pressure and volume, and is a reflection of the state of the ear drum and middle ear.
Radiology: CT scan temporal bone, MRI brain and Internal Acoustic Meatus are required to determine the anatomy of bony and soft tissue structures of the outer, middle and inner ear, cochlear, vestibular aqueduct, hearing and facial nerves and the brain. Topical ear drops, oral medications, and temporary cotton stents can help ear wax, and infectious, traumatic causes. Gentle ear cleaning and culture sensitivity of infection fluids, removal of wax and foreign bodies under light microscopic visualization and fine instrumentation. Under GA for inserting various implants like bone anchored hearing aids, bone anchored hearing implants, middle ear implants for moderate-severe or mixed hearing loss, single-sided deafness and atresia of ear canal. For outer ear auricle reconstruction: choices include a prosthetic ear, Medpore (artificial graft) or patient’s own rib graft in the first stage, followed by the second stage with split skin graft from the abdomen and superficial temporal artery revascularisation.
Rhinosinusitis can result from acute or chronic nose passages inflammation, infection, polyps, anatomical nose and sinus structure abnormalities. Avoidance of the offending allergen tested positive reduces the need for over-dependence on medication. Inferior turbinates can be chronically hypertrophied from inflammation, allergic rhinitis or are structurally predisposed.
Even non-cancerous tumors can erode important surrounding structures, and affect the eye, teeth and cause bleeding or block breathing. Depending on the histology, local excision via endoscopic method or open excision may be needed.
Watchful waiting only if episodes are isolated, mild and without significant airway obstruction. Day surgery for tonsils removal may be required for chronic airway obstruction, severe or recurrent tonsillitis. The exact cause is often unknown, and aggravated by stress, trauma, acidic fruits, braces or ill-fitting dentures. Salivary gland lumps – These could be benign or cancerous tumors, or swelling due to acute or chronic infections or stones blocking the salivary ducts. Neck lymph nodes – These could be benign or cancerous nodes, and due to infections, systemic disorders and blood disorders. Thyroid lumps – These can be benign or cancerous, a Multinodular Goitre or generalised swelling eg in Grave’s Disease. Thyroglossal cyst – This is a congenital cyst that is usually sited in the midline of the upper part of the neck, and moves with swallowing.
Branchial cyst – This is a congenital cyst that is usually sited at the upper half of the lateral neck. Ranula – This usually presents as a floor of mouth and sometimes below the chin soft cystic swelling.
Hemangioma and Lymphangioma – These are vascular and lymphatic malformations, filled with blood or lymphatic fluid. Besides presenting as a lump, head and neck tumors may present as blood stained sputum, nose bleed, hearing loss, ringing in the ear and ear block.
Ultrasound scans are useful for neck lumps to determine size, numbers, and suggest if the tumor is likely to be benign or cancerous. For cancer lumps that are not discovered early or contained, surrounding head and neck structures often need to be removed enbloc to reduce the risk of recurrence.
Most commonly due to infection, haemorrhage into or allergic reaction of the vocal cords (voice box) if of sudden onset. Surgery for cancer of the larynx would require further investigations for extent of involvement and spread. Due to poor dentition, neurological conditions (eg stroke, vocal cord, brain and spinal cord injury, Parkinson’s disease, sclerosis, Alzheimer’s disease) and head and neck pathologies (mouth, throat, esophagus cancers, injury and surgery).
Observe feeding to see the patient’s posture, behavior, and oral movements during eating and drinking. Include tumor, papillomatosis of the larynx and trachea, compression of the trachea by neck masses like thyroid lumps, base of skull tumors affecting the vagal nerve, strokes, vagal nerve pathology that impair mobility of the vocal cords, swelling and inflammation of the vocal cords due to infection, chemotherapy, drugs, trauma and idiopathic causes.
Stridor is noisy breathing arising from blocked airway at the level of the voice box and trachea.
In cancers of the larynx, preservation techniques for voice and swallowing is attempted where possible.
Tonsillitis (Tonsil) ENT-Conditions and Tratment from Subang ENT Specialist Clininc in Subang Jaya, Malaysia. The tonsils and adenoids are composed of tissues that are similar to the lymph nodes or glands found in the neck or other parts of the body. The disease usually begins with high temperature and possibly chills, especially in children.
After countless hours of research on and about this breed, here is my version of how this wonderful breed came to be.In the early 1800a€™s Scotsman Bruce McKinsey moved his family moved from the cold damp climates of Northern Scotland to the Grampian Hills of Central Scotland.


These periods of 'stopping breathing' only become clinically significant if the cessation lasts for more than 10 seconds each time and occur more than 5 times every hour.
She specializes in ear disorders as well as the surgical and non-surgical correction of hearing loss, which also entails different types of treatments, and the insertion of cochlear and middle ear hearing implants. When it is chronic with fluid in the middle ear, a nasopharyngeal carcinoma has to be excluded in adults. This usually due to infections, Meniere’s Disease, Benign Paroxysmal Positional Vertigo (BPPV) and trauma.
Many in professional jobs with noise exposure do not use hearing protection even if available. Closer collaboration also allows for increased safety of investigations requiring sedation, and optimizes outcomes. Light microscopy magnifies these images many times and with increased clarity for diagnosis. Contrary to common perception, 75% of newborns or young with hearing loss do not have parents or relatives with hearing loss.
Systemic causes include blood disorder, hypertension, and drugs that reduce the ability to clot properly, eg warfarin and aspirin. Rhinosinusitis may require long term medications and antibiotics, and have risks of eye, brain, teeth complications.
The nose bone in the centre can be crooked from birth, a normal growth variation, or due to trauma. Some tumors are cancerous, located in the nose, sinuses or further back in the nasopharynx. Nowadays, Image Guided Systems (IGS) for endoscopic surgery offers increased safety and completeness of tumor clearance. Recurrent tonsillitis could be associated with sore throats, fevers, poor feeding, antibiotic resistance and absence from work. In Laryngoesophageal reflux disease (LERD), backflow of the acid from the stomach up into the voice box and laryngeal area causes irritation, phlegm and hoarseness in the throat. More often, it is just chronic throat irritation worse after meals or sleep, or hoarseness of voice that prompts an evaluation.
However, it needs to be evaluated to exclude central or obstructive sleep apnea (OSA) and upper airway resistance syndrome, where there is blood oxygen deprivation and increased work of breathing leading to disturbed sleep and daytime sleepiness.
All nodes should be further evaluated if they are increasing in size and numbers, last more than 3 weeks, are fixed to the skin or ulcerate. The sinus tract is often complexly related to facial nerve and vessels in the head and neck.
May be from excessive strenuous voice use, smoking, hypothyroidism and drugs leading to polyps, cysts and nodules.
Better control of gastroesophageal reflux (eg avoid spicy, sour and oily food and caffeine). When significant, there is risk of acute oxygen lack, respiratory distress leading to cardiac arrest and death. Together, they are part of a ring of glandular tissue (Waldeyer's ring) encircling the back of the throat.
Normal tonsils are usually about the same size and have the same pink color as the surrounding area.
The patient complains of a persistent pain in the throat, and pain radiating to the ear on swallowing. In addition to this, her repertoire also includes a comprehensive range of investigations and the effective management of different adult ear conditions. The only way to exclude genetic cause is to do an appropriate blood test guided by history. It can be due to inhalant allergens or food allergies, with either acute or more subtle chronic manifestations. Obesity, pregnancy, coughing, vomiting, straining or sudden physical exertion can cause increased pressure in the abdomen.
Long term however, there is a risk of cancer change in the esophageal and laryngeal and voice box mucosa if untreated. Long term, oxygen deprivation may increase the risks of heart, blood pressure, hormonal, neurological and memory problems.
Destruction of structures closely related in the head and neck region results in various problems with breathing, swallowing, eating, voice, dentition, cosmesis and bleeding. May be cancer change in the larynx or invasion from surrounding thyroid or other neck region tumors. On their surfaces are little depressions, called crypts, which may appear deep and contain pus pockets or stones. Opening the mouth is often difficult and painful, the tongue is coated, and there is a mouth odor. After spending time together working the sheep in the fields and watching how McKinseya€™s dogs worked the livestock, Alexander eventually acquired a female Scottish Colley from Bruce and named her Flora. Hearing impairment can afflict a majority of people, and is usually underestimated due to lack of public awareness and the fear of stigmatisation. In Singapore, 40% of patients with unknown cause of hearing loss and other body systems normally have a Connexin 26 gene mutation.
Seeking evaluation and treatment as early as possible is critical for ensuring the best outcomes for cancer cases. The patient may also complain of headache, thick speech, marked feeling of malaise, as well as swelling and tenderness of the neck glands (lymph nodes).
Hearing loss is associated with social isolation, inability to communicate with friends and loved ones, depression, and reduced safety. Listening to your music via headphones at maximum volume risks hearing loss in less than an hour. Knowing the genetic cause guides management over a lifetime, as there may be associated eye, kidney, heart or thyroid problems. Post surgery or radiation therapy for cancer or tumors in the head and neck and pathology in the chest.
Both tonsils and the surrounding area including the posterior pharyngeal wall are deep red and swollen.A  Later, whitish spots (follicles) form on the tonsils, hence the nameA follicular tonsillitis. In the National Health Survey 2010 study Dr Lim assisted with, 1 in 4 between 50-59 years of age; and 2 in 5 adults between 60-69 years old already have hearing loss. It also suggests the progression and prognosis of hearing loss, besides helping families interested in determining the chances of hearing loss in future offspring. There isna€™t any information as to the demise of Alexander, but he was well into his 80's at this time. This pup would come to be known as "Jet", a black pup with a faint line of white up his face, a white chest and socks. Both theseA lines worked from the head and didn't have the a€?loose eyeda€? working style of the traditional Collies.If you look at the picture of the Basque Sheepherder, taken at the turn of the century, you can see the resemblance of our modern day McNab in the Black and white dog in the back on the right side. Among Scottish flocks he is the pride of Scottish owners, and is valued, both in the Old World and the New, as one of the best aids money can procure. Here even, in far California, there is one ranch, lying high on the breezy mountains and low in the grassy dells, that for years has relied upon the help given by imported collies and their offspring, and it is of the work these bright dogs do that this article is written.For the history of the collie one must look elsewhere than in a brief magazine sketch. Many wise dogs have journeyed far by land and sea to race over the rugged hills after the nimble sheep, which in these mountain wilds give fleet defiance to the would-be-gatherer.
No one but a real Scotch shepherd can train these dogs to the perfection they attain among Scottish flocks under constant supervision.


Descended from long generations of workers the puppies take actively to business, and practice amusing tactics of herding on the farm poultry while still too young to be initiated into the graver cares of life; and at first sight of a band of sheep will usually make some move that denotes the shepherd strain. Literally is it true of the collie, Ye cannot serve two masters ; his allegiance must be given to but one, or the valuable animal becomes worthless for the work that nature and training have given him to do. The breeze is sweet with bloom, and the sunlight falls, a flood of golden glory, over the lavish green of April meadow, as we take the upward trail, a woodland path that rises steeply under the shadow of the Peak, giving but glimpses of the valley home below, and winding through still shadows in the absolute silence of Natures own domains. Higher we go, and onward, past an old stone cabin, a picturesque bit of ruin in the lap of spring.
As we come out from the woods with the Peak still above us, send a swift glance northward, where Sanhedrim and the northern mountains still are capped in glittering snow, rising sharply from green valleys to the sunny sky, their sparkling peaks the only hint of winter in all this summerland.
Off he dashes up the hill, makes a wide circle past a dozen ewes, and as they bolt up hill heads them, turns, and deftly drives them down.
Their lambs lie asleep in the warm sun or frolic together on the hillside, bright bits of movement white against the green. A motion of the hand directs the alert dogs, and they join the two bands and send them steadily along the trail.
Two ewes and a lamb go running to the side.Here, Pete!The dog dashes quickly across a little hill, the bright drops sparkling on his black coat as he passes the sheep and turns them. Circling in front again, the dog overtakes, turns them, follows, and turns again, and patiently works them along till his troublesome charges are safely among their fellows.
If sent to hurry the little flock, he dashes at the hindmost, barking his orders.Here the master whistles Fred to the right.
Nothing is visible to him, but off scurries the obedient dog, barking frantically, circles, and stops.
Off he dashes, perhaps fifty feet or so ahead, and dropping to the ground with nose between his paws, he waits till the flock is close upon him ; then he springs up and trots ahead again, and once more quietly waits their coming.Fred! The master walks away, and Fred, understanding perfectly that he must keep the flock, swiftly circles round them and brings them to a halt. Here, alone, he holds them, keeping them closely together while Peter and the master gather the other side of the hill, and return two hours later to find the sheep quietly grazing and Fred lying as quietly watching them.Two ewes wander a little too far. Scarcely rising to his feet, the dog slips quietly through the grass beside them, and they turn and slowly rejoin the band, cropping as they go. Fred trots quietly around his charges, sees that all are safe, then drops down again, watching them ceaselessly with shining eyes, and not a ewe or lamb is missing when the returning master adds his flock.Steadily we climb, through the golden afternoon.
Occasionally shy deer peer through the brush, the warm air is sweet with the breath of bloom, and a distant eagle screams as he sweeps in stately circles over the Peak. The flocks number in the hundreds as we finally reach the summit, where we are met by the shepherd and Tweed, with another band. In go the dogs, and send the sheep briskly down the trail, while Peter, circling far behind of his own accord, often brings in a stray ewe that has slyly dropped out.Yonder is a place where the whole band broke away years ago, and never have forgotten it, but neither have the dogs. With a fierce challenge the collies vigorously meet the flying band, and force them back to the trail more roughly than we have seen them do yet, in punishment, perhaps, for their presumption and past sins.
She has bolted away several times, and given Peter much trouble to bring her in ; but his Scotch is up, as she dashes away again. He springs in before her, and with a dexterous hoist of his body sends her tumbling end over end, which is his own cure for these troublesome bolters, and was never known to fail.
As if shot from a cannon, the ewe bangs against him, and over goes Tweed, howling rolling over and over, down the steep hillside, all four feet kicking at once, in angry protest as they come uppermost ; and his chap-fallen expression, as he struggles to his feet and slinks away, shows that Tweed is both a sadder and a wiser dog.
Though all are trained alike in a general way, two collies differ as widely in characteristic methods of work as two men,each possessing a distinct individuality of his own.Ah! After much hard running the flock is finally under control, but a bunch of lambs has become separated in the confusion, and after circling helplessly, stampedes in wild disorder. Peter tries his wise best to work the foolish little things back, vainly attempting to head them off.but they jump over him, halfa-dozen in succession, ears and tails flapping wildly as they clear his broad back. While the master separates the sheep, let us sit on this sunny hillside and watch the collies as they circle round the running lambs.
They never bark at them as they would at old sheep, but merely follow and slowly check them by degrees. The little things are both obstinate and foolish, and at first pay no attention to the quiet collies that trot patiently round and round, quietly gather them together, and at last stop their wilr1 run. Slowly, and with marvelous patience they are turned, jumping over each other, then over the dogs, and it seems a hopeless task even to attempt to take them the half-mile to the corral, but in a couple of hours time Fred and Peter come slowly up to the gate with them, not a lamb hurt or missing, and their first acquaintance made with these gentle protectors and friends.
Peter is a favorite, bright even beyond the ordinary collie, his first appearance in the field showing a canine reason. Then he suddenly spied a huge rock; straight for it he went, and springing into sight upon its top, he stood a moment, one paw uplifted, ears up and nose a-quiver, a pretty picture, gave two quick glances, and was down and with the sheep again, and quietly drove them straight across the field to the hidden gate. Often, till he learned the hills, did he leave the sheep,, and on some high point literally take his bearings, to return to his charge and take them down the better way, justifying his masters assertion that surely the line between reason and instinct is closely drawn in the Scotch collie.
He was a ready match for a certain obstinate old ram, that always fought the dogs and delayed their work ; till at last when sent for the flock Peter went first for this old enemy, and there, nose to nose, both heads bobbing excitedly, he would angrily bark and growl, till the conquered ram at last would make a sudden bolt, and the victorious Peter calmly gather in the flock. A most conscientious dog, his work was done faithfully and well till years disabled him; but Fred, more alert to praise, did best were strangers present, when he abounded in bright ways and brilliant work, done with a comically conscious air of superior excellence.
The young man pondered a little, then to the country saddler he went and ordered made from his description little leather shoes. He took to them kindly, like the wise dog he was, wore them gratefully, and after a long days run through flying seed, off would come the shoes, leaving his feet sound and well. Meekly he would let his shoes be donned, regarding his master quizzically the while, and wear them complacently enough in view, but let him be sent for sheep a little out of sight, a little delay would be noticed, then out from behind some bushy clump or sheltering rock Fred would gayly emerge, with many gambols to divert the eye.
Clyde closely resembles Fred, whose days are past; and till the present puppy, tiny Tweed, grows to working age, Clyde is the mainstay of the gathering.
Help fulfills his name on other portions of the large range ; but either are true types of the working collie, willing and faithful helpers till years disable them. Either one is sent for sheep entirely out of sight in a large field, and patiently hunts till he finds them, then brings them in alone ; and Gyps mother, Bessie, brings in the entire flock from her owners small range just as readily as from the field. They brought with them their stock dogs, the Fox Shepard, the origin not known, but have survived in Scotland for centuries. McNab returned to the Grampian Hills in Scotland for the sole purpose of getting some of the dogs he was used to working. He brought Peter back with him, leaving Fred to have his training completed, and he was later sent to America.
These two dogs were bred to select Shepard females of the Spanish origin, which were brought to this country by the Basque sheepherders, and that cross was called the McNab Shepherds because Mr.
He named this pup Jet he was black with a faint white line up his face, a white chest and a small amount of white on his feet.
Some of these dogs will have a wider strip up the face (Bentley Stripe) and a ring around the neck, there are also instances of pups with brown on their face and legs but will still be mostly black. Alexander McNab and his family raised sheep in Scotland, but longed for a warmer climate and enticed by the news of the West, set out across the Atlantic to America. McNab was not satisfied with the type of working dogs he found locally, and in 1885 he returned to Scotland for the sole purpose of importing the type of dog(s) he had been accustomed to working with. It was said that these two male dogs were bred to female dogs of Spanish origin, which were brought to this country by the Basque sheep herders. I have searched (and continue to search) to find out the type of dog the Basque may have brought with them to California, and my findings were contradicting.



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27.08.2013 admin



Comments to «Ear nose and throat specialist chermside west»

  1. Play_Girl writes:
    From what i don't forget and.
  2. Turkiye_Seninleyik writes:
    Also showed far more activity than typical-hearing men been experiencing constantly.
  3. ErroR writes:
    And dirt into one drug, attempt switching the head abruptly moves backward.