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"The Top Brand Award 2011" organized by "Preschool Magazine"
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Sleep Apnea Test | OSAS Assessment by Endoscopy | OSAS management – PAP Machine | Surgical Treatment

Sleep Apnea Test

Sleep Assessment – by Sleep Study - Full Polysomnography
This is the most detailed assessment for patient suspected to have sleep apnea. It is a very comprehensive test.
After the patient is connected with all the sensors, the patient will sleep as usual and when he wakes up in the next morning, all the dad will be collected and then analyzed.  The test can be done at home or in hospitals.
The assessment of sleep apnea by sleep study will tell us whether the patient has central or obstructive sleep apnea, the severity of the conditions, its relation with various sleep stages and associated desaturation, changes in heart rate, snoring and leg movement.

This is a newer form of home sleep test that is less complicated and yet able to provide accurate assessment of the severity of obstructive sleep apnea.  However, there is much less information about the whole process of sleep so is more suitable for reassessment of patient confirmed to have OSA or for preliminary testing.
Sleep Strip
Before Test
This is a very simple and easy to use test and is very comfortable to patient in use, but the result could be an underestimation of the actual severity of the sleep apnea.

After Test
Oxygen Saturation Monitor
Oxygen Saturation Monitor
This is a monitor for oxygen saturation commonly employed overnight to estimate the level of oxygenation and documents the episodes of desaturation. This is a very light, handy, easy to use and comfortable device. This test does not directly or indirectly measure the numbers of apnea so this could only give a rough estimate of the severity of the sleep apnea.
Flexible Laryngoscopy + Muller Maneuver
This is a very well tolerated procedure; no hospitalization required and usually only a small amount of local anesthetics will needed to be applied to the nose and throat regions.
Muller maneuver is a special technique that by consciously generating a negative pressure state within the upper airway, we would be able to estimate and possibly identify the possible locations and pattern of obstruction.
Sleep Endoscopy
sleep endoscopy
This is a procedure to be performed in hospital, where the patient will be induced into a sleep state by medications. Endoscopic assessment will then be performed and the sites of obstruction and patterns of obstruction will then be accurately diagnosed. Since this is a procedures performed in the operative theatre of hospital, it is then more time consuming for the patient and comes with a higher cost.
PAP Machine
There are two types of PAP machines: the CPAP and the BiPAP machines. These machines pumps air through tubing and a nasal mask or face mask to keep our airway open. Other accessories including chin strap and humidifier will give further help in special situations.
Advantages and Disadvantages of PAP Machine
The PAP machine usually can abolish nearly all of the apnea and hyperpnoea episodes, and thus offer more complete treatment. Avoiding surgical management will also avoids all the post-operative complications like pain and bleeding.
When to Consider Surgical Management
The advantages of surgical management is that it offered a almost one-off treatment options that could potentially have long lasting effects in treating obstructive sleep apnea.
Which Procedures to Choose?
For most of the patients who suffer from obstructive sleep apnea, they have obstructions at multiple level and multiple sites, hence frequently require more than one procedures or even more than one stage of surgery to achieve satisfactory result.
Sleep Surgery - Nasal Surgery
Nasal obstruction is a symptoms commonly encountered in patient suffering from obstructive sleep apnea. This stand alone will not cause severe obstructive sleep apnea but could often make the OSA worse.
Correction of deviated nasal septum, commonly performed with Turbinectomy in the treatment of nasal obstruction.
Resection of hypertrophic turbinate helps to relief nasal obstruction. It is commonly performed with septoplasty to achieve satisfactory result.
Laser Turbinectomy
Partial shrinkage of turbinate can be done with laser technology.  This is a repeatable procedure and did not preclude more radical procedure like Turbinectomy.
RF Turbinate
Partial shrinkage of turbinate can be performed with radiofrequency technology. This is a repeatable procedure and did not preclude more radical procedure like Turbinectomy.
This is the site referring to the area behind the uvula and around the tonsils. This is the most frequent level of obstruction in OSA patient and can be affected by various pattern of obstruction, where many different procedures are designed to handle different patterns of obstruction.
It refers to the removal of adenoid tissue.
It refers to the removal of the whole tonsils.
Pillar Implant
It refers to the Implantation of 3 short strips of artificial fiber into the soft palate, which will induce fibrosis and stiffening of soft palate 6 weeks after the procedure.
It refers to the resection of uvula
Modified CAPSO
It is a limited procedure on the soft palate mucosa to stiffen the soft palate and in a smaller extent pulling the uvula into a more anterior position.
Uvulopalatopharyngoplasty UPPP
It refers to the removal of tonsils and uvula and redundant soft tissue in velopharynx.
Expansion Sphincter Pharyngoplasty
This is a procedure in the tonsil area aiming to deal with the lateral wall collapse.
Dorsal Palatal Flap
This is a procedure in the tonsil area aiming to increase the palatal height and width at velopharynx.
Palatal Advancement Pharyngoplasty
This is done by removing a 1 cm segment of bone from the posterior end of the hard palate, the soft palate was then reattached to the hard palate and creating a good depth for the velopharynx.
This is a Laser removal of the uvula under local anesthesia
RF Soft Palate
This is done by employing radiofrequency technology to achieve volume reduction and stiffening in the soft palate with minimal pain, bleeding and ulcer.
Hypopharyngeal area referred to the area below the tonsils to the entrance of trachea, bounded by the base and posterior third of tongue, the epiglottis and the posterior pharyngeal wall. This level is more commonly obstructed in patient with moderate to severe obstructive sleep apnea.
Genioglossus Advancement
The tongue and the epiglottitis was pulled forward to increase the depth of the hypopharynx.
Thyrohyoid Suspension
This is an anterior neck operation aims to displace the whole tongue anteriorly and tilted slightly inferiorly, and fixed with stitches.
Midline Glossectomy
It refers to the removal of tissue in the midline of the posterior third of tongue using radiofrequency plasma technology with removal of enlarged lingual tonsils.
RF Tongue Base
Employ radiofrequency technology to achieve tongue base volume reduction with minimal pain and bleeding under local anesthesia. Multiple sessions are usually required to achieve satisfactory result.
Laser Epiglottoplasty

This procedure involves surgical trimming of the epiglottis usually employing laser and performed under general anesthesia.

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