Otolaryngology Abir K Bhattacharyya, Nitesh Patel
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s1Otolaryngologys2
s3Otolaryngology
Abir Bhattacharyya MS FACS FRCS(Eng) FRCS(ORL) Consultant ENT Surgeon and Royal College Surgical Tutor Associate Director of Medical Education (Surgery) Whipps Cross University Hospital London, UK Nitesh Patel MBChB(Hons), FRCS(Eng), FRCS(ORL-HNS) Consultant ENT Surgeon Whipps Cross University Hospital London, UK
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© 2012 JP Medical Ltd.
Published by JP Medical Ltd, 83 Victoria Street, London, SW1H 0HW, UK
Tel: +44 (0)20 3170 8910 Fax: +44 (0)20 3008 6180
The rights of Abir Bhattacharyya and Nitesh Patel to be identified as the authors of this work have been asserted by them in accordance with the Copyright, Designs and Patents Act 1988.
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Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included or from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the authors assumes any liability for any injury and/or damage to persons or property arising from or related to use of the material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
9781907816116
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging in Publication Data
A catalog record for this book is available from the Library of Congress
JP Medical Ltd is a subsidiary of Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India
Publisher:
Richard Furn
Development Editor:
Paul Mayhew
Editorial Assistant:
Katrina Rimmer
Design:
Designers Collective Ltd
Index:
Liz Granger
Typeset, printed and bound in India.
s5Foreword
This pocket-sized book is the right size for the many doctors who encounter ENT disorders, whatever stage they have reached in their careers. Unfortunately exposure to ENT is now very variable and often sparse in undergraduate medical education in the UK, and yet the clinical relevance of ENT remains high for many doctors. Large numbers of patients present with ear nose or throat symptoms, particularly to GPs and paediatricians but also to many others. All doctors need to know something about the specialty because there are important life-threatening ENT conditions which can be missed or mismanaged with dire consequences - for instance, subdural empyema secondary to frontal sinusitis, meningitis secondary to acute otitis media and airway obstruction secondary to supraglottitis in adults.
This book is designed to be a comprehensive but portable resource that will prove a valuable aid to doctors of all grades. For those who work in ENT during their foundation years or as part of a rotation in basic training programmes it will prove particularly valuable. Clearly such readers should undergo an induction programme during their ENT exposure, but they will need access to more information when on call for ENT. With this book in their pocket or readily accessible in their departments, they will have rapid access to information and will be in a position to acquire valuable knowledge. The clinical scenarios should prove particularly useful in this setting.
Pocket Tutor Otolaryngology provides a lot of information in a useful accessible format. It will assist those who use it to make better decisions on patient management in real-life situations.
Alan Johnson
President
British Association of Otorhinolaryngologists,
Head and Neck Surgeons
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s7Preface
When we were approached to write a pocket-size book on otolaryngology we were mindful of the challenges ahead. How to cover the breadth of a specialty that extends from ‘dura to pleura’? How to incorporate the vast plethora of clinical information and ever-expanding knowledge that forms the basis of modern medical management? How to construct a concise yet trustworthy clinical tutor for your pocket?
In responding to this challenge we have tried to provide a conceptual framework for clinical thinking. The opening chapter, First Principles, explains the anatomical concepts and physiological principles that together form the building blocks for understanding normal and abnormal function. The second chapter, Clinical Essentials, summarises the examination techniques and investigative tools used to reach a diagnosis. The remaining chapters describe commonly seen clinical disorders. Since approximately one-third of patients seen in primary care have ENT-related pathology, we felt that brief clinical scenarios would be a simple and effective way of introducing a practical, evidence-based approach to the diagnosis and management of common presentations described in the clinical chapters. Another key feature is the ‘clinical insight’ and ‘guiding principle’ boxes interspersed within the text, which draw upon our personal experience.
Throughout the book, we have selected clinical topics which frequently present to the primary care practitioner, together with rare yet significant conditions which the medical student, trainee or junior doctor might encounter in the ward, outpatient clinic or emergency department of the hospital. Our selection is not exhaustive but we hope it is comprehensive for the intended audience.s8
We hope you will enjoy reading this book and that it will serve as a handy companion for quick reference thanks to its convenient pocket-size format. We shall be pleased to receive any comments, criticisms or suggestions at pockettutorotolaryngology@gmail.com.
Abir Bhattacharyya
Nitesh Patel
July 2011
s11Contributors
We offer our sincere gratitude to the following people who have made a significant contribution to this book.
ENT Consultants
Mr Furrat Amen, Mr Mriganka De
ENT Specialist Registrars
Jay Ahmed
Elias Koury
Zaid Awad
Jai Manickavasaram
Raghav Dwivedi
Serge Pal
Behrad Elmiyah
Vyas Prasad
Nancy Grover
Baskaran Ranganathan
Sanjeev Gupta
Anita Sonsale
Rebecca Heywood
Sarju Varsani
Elina Kiverniti
Vik Veer
Acknowledgements
Thanks to Julian East, Medical Photography Unit of Whipps Cross University Hospital, and Dr Cheng for helping with clinical photographs, often at very short notice. Thanks to the many GPs who have given written and verbal feedback to improve the manuscript. The list is long and we apologise for not being able to individually acknowledge all our primary care colleagues but we need to mention Dr A Dhanji, Dr S Dadabhoy and Dr I Bhatnagar for their suggestions.s12
Thanks also to JP Medical Publishers Ltd for their help and support. In particular we thank Paul Mayhew and Richard Furn for their constant encouragement.
Last but not least we acknowledge our families' sacrifice in letting us burn the midnight oil and work at weekends when deadlines were near. Abir would like to thank his wife (Rinku) and his children (Anudeep and Amrita) for letting him complete his academic work unhindered. Nitesh would like to thank Krishna, his mother, his wife (Hema) and his children (Seeta and Sai).
Abir Bhattacharyya
Nitesh Patel