ENT Gerard Kelly and general practice The Leeds Teaching a lump in my throat an update on voice, swallowing, globus & cancer and general practice The Leeds Teaching Hospitals NHS Trust Gerard Kelly MD MEd FRCS (ORL-HNS) FRCS (Ed) ENT surgeon, Leeds 6th March 2014, Leeds Masonic Hall

aims give an overview of common (EN)T conditions shows some example cases refine our thinking of ENT problems

objectives list the main symptoms in throat conditions relate each symptom to one condition list the ways to examine the head and neck identify an abnormal tonsil list 4 differential diagnosis for dysphonia name 3 treatments for head and neck cancer sequence steps in assessment of a throat patient

first though... history and examination in ENT

history ears otorrhoea otalgia itch hearing tinnitus balance noses nasal obstruction rhinorrhoea facial pain smell epistaxis post nasal drip throats dysphagia dysphonia odynophagia pain neck lumps weight loss

Throat- red flag symptoms dysphagia dysphonia odynophagia pain neck lumps weight loss

Throat- red flag symptoms dysphagia food sticking, level dysphonia to be heard odynophagia not acute pain otalgia neck lumps palpable weight loss noticed

head and neck cancer almost all squamous cell carcinomas

malignant head and neck disease treatment consists of treating the primary disease and treating metastatic disease metastatic disease is to the neck bone, Liver, Lung, Brain metastases are rare

malignant head and neck disease treatment is by radiotherapy, surgery or a combination of both

malignant head and neck disease head and neck cancer is squamous cell carcinoma

malignant head and neck disease squamous cell carcinomas are radiosensitive adenocarcinomas are NOT radiosensitive

malignant head and neck disease small tumours tend to be treated by radiotherapy large tumours by radical surgery and post operative radiotherapy

malignant head and neck disease small tumours tend to be treated by radiotherapy large tumours by radical surgery and post operative radiotherapy and most recently by chemoradiotherapy

malignant head and neck disease typical patient old, male, smoker and drinker

malignant head and neck disease typical patient old, male, smoker and drinker increasing in younger patients due to HPV infection

malignant head and neck disease typical patient old, male, smoker and drinker increasing in younger patients due to HPV infection - these patients can often be identified in GP