Gerard Kelly MD MEd FRCS (ORL-HNS) FRCS (Ed)

ENT surgeon, Leeds

6th March 2014, Leeds Masonic Hall

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and general practice

a lump in my throat an update on voice, swallowing, globus & cancer

aims

give an overview of common (EN)T conditions

shows some example casesrefine our thinking of ENT problems

objectives

list the main symptoms in throat conditionsrelate each symptom to one conditionlist the ways to examine the head and neckidentify an abnormal tonsillist 4 differential diagnosis for dysphonianame 3 treatments for head and neck cancersequence steps in assessment of a throat

patient

first though...

history and examination in ENT

history

ears

otorrhoeaotalgiaitchhearingtinnitus balance

noses

nasal obstructionrhinorrhoeafacial painsmellepistaxispost nasal drip

throats

dysphagiadysphoniaodynophagiapainneck lumpsweight loss

Throat- red flag symptoms

dysphagiadysphoniaodynophagiapainneck lumpsweight loss

Throat- red flag symptoms

dysphagia food sticking, leveldysphonia to be heardodynophagia not acutepain otalgianeck lumps palpableweight 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 patientold, male, smoker and drinker

malignant head and neck disease

typical patientold, male, smoker and drinker

increasing in younger patients due to HPV infection

malignant head and neck disease

typical patientold, male, smoker and drinker

increasing in younger patients due to HPV infection -these patients can often be identified in GP