1. 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

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

3. 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

4. first though...
history and examination in ENT

5. 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

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

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

8. head and neck cancer
almost all squamous cell carcinomas

9. 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

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

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

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

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

14. 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

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

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

17. 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