OtoRhinoLaryngology Portal

The Leading Online Gallery of Otolaryngology and Head & Neck Surgery Specialty


Laryngology & Phonosurgery

  1. Do you know that our voice box moves during swallowing.

    This act is automatic during swallowing as our laryngeal structures has attachments to many muscles on its outer surface.  As the nerves stimulated the muscles contract and moves it up at the same time.  Laryngeal elevation enables protection of the larynx from aspiration (food passing into the wind pipe or lungs) while eating or drinking.

  2. Do you know that our vocal folds can increase its length?

    It does so when we sing high note or increase the voice pitch.  This is contributed by cricothyroid muscles contraction which rock forward the laryngeal cartilage towards the cricoid at the cricothyroid joint.  Thus, in superior laryngeal nerve paralysis, the voice may end-up weaker, warbly, and monotonous in quality.

  3. Do you know that hearing impairment can cause delay of speech development?

    It is important to recognize hearing loss early in infant and children as it would affect normal speech development.  Many hospital has implemented universal screening programme to pick up these cases early and given them some form of hearing aids as early possible.  These patient are also given speech therapy appointment to have proper intervention and follow-up.

  4. Do you know that vocal hygiene is essential for voice care?

    Vocal hygiene is concern with the hygienic practices that preserve the voice and prevents traumatic or adverse effects from improper vocalization technique.  Some of these measures include:

    1. Taking enough fluid (recommended 6-8 glasses/day.

    2. Avoidance of dust, smokes, and other inhaled irritants.

    3. Humidification of room air especially when heater being used constantly.

    4. Avocating good vocal habits.  These include avoidance of shouting, screaming, prolonged and excessive loud speaking.

    5. Avoidance of excessive alcohol and caffeinated drinks (diuresis effect).

    6. Behavioral changes (e.g., avoidance of frequent coughing and throat clearing/hawking.

    7.Advocation of silent cough technique.

    8.Getting enough sleep and relaxation.

    9. Awareness of surrounding background noise.  Raising the pitch may potentially strain and harm the vocal folds.

    10. Learn good breathing technique upon speaking.

Back to top


  1. Do you know that ear digging or procedure can trigger coughs?

    This occurs spontaneously or reflex in nature, probably as a protective mechanism to prevent injury to the eardrum.  As part of the nerve supply to the ear also share similar innervation to the throat, this may cause ticklish sensation and stimulate the cough reflex.

  2. Do you know that using Q-tip can be harmful?

    Generally, the ear has self-cleansing mechanism provided by normal epithelium migration form the center of the eardrum and moving outward towards the ear passage opening.  Frequent use of Q-tip may alter these property and contribute towards earwax accumulation or even impaction.  It can also cause abrasion, laceration, or eardrum injury. 

  3. Do you know that we can feel ear block and pain when going uphill?

    Altitude changes can affect the middle ear pressure especially if the eustachian tube do not function properly.  This causes negative ear pressure to developed causing ear discomfor and in more severe cases can result in serous effusion or an eardrum perforation.  These cause and effect changes are called barotraumatic injury.  The reaction is worse if someone's has upper respiratory tract infection or flu.  Similar reaction can happen in air flights during take-off and descent especially in poorly pressurised cabin.

Back to top


  1. Do you know that nose block can change voice quality?

    This part of airway involves in the resonance of the voice produced upon phonation.  The air chambers along this segment include the nasopharynx, nasal cavities, and paranasal sinuses.  When the nose is block from whatever causes, the quality of voice changed as if someone's talks with the nose pinched or occluded.  The nature of voice produce is called hyponasl speech.

  2. Do you know tooth problems can cause sinusitis?

    It is highly suspected if sinusitis occurs on one side in a patient with poor dental conditions for examples caries, root canal problems, or apical abscess.  As some of the upper molar teeth roots can reach the maxillary sinus floor, these can incite inflammatory reactions with subsequent infection in the sinus.  Your dentist will examine the oral cavity thoroughly and order some investigations for confirmation, and perform the necessary treatment thereafter.

  3. Do you know nose watery eyes can be caused by nose problems?

    Our tears finally drained into the nose.  Anatomically, the tears passage (nasolacrimal duct) ends in inferior meatus of the nasal cavity.  Any obstruction of the tears passage either anatomical or functional can cause this effect.  Opthalmologist and otolaryngologist usually works together to solve this problem.  Certain procedures like nasal endoscopy, duct irrigation, and special X-ray (dacrocystogram) need to be carried out for confirmation prior to definitive corrective procedure.

Back to top

Head & Neck

  1. Do you know that cervical spondylosis can cause dysphagia?

    Degenerative changes occur with ageing process and may involve the cervical spines.  Cervical spondylosis affects the adjacent vertebral bodies where it meet the intervertebral disc and may cause significant anterior body projections.  These cause extrinsic compression of the oesophageal or hypopharyngeal lumen and results in difficulty of swallowing.  X-ray detects this changes quite well.  Other causes of dysphagia need to be excluded with appropriate investigations.

  2. Do you know that radiotherapy in head and neck cancer can cause throat dryness?

    Radiotherapy can results in reduced saliva production if the field of treatment includes the salivary glands.  Most of serous component of saliva comes from parotid glands.  These glands can undergo atrophy and end-up with markedly reduced saliva formation causing difficulty in swallowing.  Patients are advised to take frequent sips of water and maintain good oral hygiene.

  3. Do you know that feelings and emotions affect our facial expressions?

    There are many muscle groupsin the face which contribute to minute changes in our expressions.  These muscles are innervated by the Facial Nerve (Cranial Nerve VII) which has direct influence from the brain relating to our emotions and reactions.  Attributes to feelings like joy, sadness, and anger can be seen readily.  The underlying muscles contractions and its tone were adjusted automatically to suite our feelings.  So, be happy and smiley and cut down those frowns!!!

  4. Do you know that patient who had total laryngectomy can still perceived smells?

    Patient can still have smell sensation provided the olfactory nerve is still intact and small flow of air present through nasal cavity.  This can be archieved by performing soft yawning without having the mouth open.  A brisk air flow that pass through the nose will then directed backward into nasopharynx, oropharynx, and finally the oral cavity. Substantial amount of air which reach the olfactory cleft is thus capable of stimulating the nerve. 

Back to top


  1. Do you know that some patients become fainted while outpatient procedure being performed to them?

    The condition called vasovagal syncope causes someone's to feel, lightheaded, fuzzy, sweaty, and finally black-out.  The heart rate slows down, blood pressure drops, and there is reduced blood circulation to the brain resulting in temporary dysfunction.  However, patient soon recover consciousness without sequelae.  This usually occurs in tense, very anxious and stressed patient being commoner in females.  Overstimulation of vagus is centrally mediated upon introduction to triggering stimuli including the commonly performed otolaryngology procedures.  This is self limiting and rarely required first aid treatment.

Back to top