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Mr Richard Harris. ENT SpR Royal Devon & Exeter NHS Foundation Trust.

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Presentation on theme: "Mr Richard Harris. ENT SpR Royal Devon & Exeter NHS Foundation Trust."— Presentation transcript:

1 Mr Richard Harris. ENT SpR Royal Devon & Exeter NHS Foundation Trust

2  ENT poorly taught in the UK  Throat symptoms common in GP  Symptoms are often vague  Patients are often anxious  GPs may be daunted/uninterested/naïve  Many conditions treatable  Cancer prognosis dependent on stage  Nimita asked me to!

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4  Birmingham graduate  Currently on Peninsula SpR rotation  Work at RD&E  Fellow in Head & Neck Surgery at Royal Melbourne Hospital.

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6  Missed red flags  Lack of information on 2ww referrals  Longstanding misdiagnosis  Poor descriptions of anatomy

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9 “what should I not refer?” “what should I definitely refer?” “how should I manage X in the community?” “when should I be worried about….?” “how should I describe this?” “who can help me with this?”

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12  LPR  Vocal cord dysfunction  Reinke’s oedema  Laryngeal SCC  Vocal cord nodules  Catarrh/postnasal drip/phlegm/sinusitis

13  Absolutely key  Endoscopic predictor  GP advantage of knowing the pt- use it!

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15  Duration  Constant/intermittent  Pain  Dysphagia  Try to avoid the pt naming a condition  Voice change  Voice fluctuation  Social history  Symptoms through the day

16  81 years old  Male non smoker  Wife has trouble hearing him  Voice feels weaker  Has got worse over last 12 months

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18  Harmless  Due to VC atrophy  Rule out neoplasia  Sympathy  Speech therapy  VC augmentation

19  63 year old male smoker  3 months constant hoarseness  Cough  Husky voice  No weight loss  Neck normal

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22  Strong link with tobacco  Alcohol synergistic  Glottic most common  Voice symptoms common -hoarseness -hot potato  Distant Sx may present first  Beware otalgia in the normal ear!

23  23 years old newly qualified teacher  Non smoker  8 weeks of constantly altered voice  Pretty quick onset over a few days  Getting worse  Husky and breathy.

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25  Due to “voice abuse”  More common in women  Cause a husky, breathy voice  Most respond to SALT  Some need surgery  ~6% of adult voice disorders

26  57 year old female  Ex smoker  Intermittent voice change  Sometimes has to strain to speak  Can feel a lump in her throat  No dysphagia  Examination NAD

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28  Common!  Due to loss of synergy in laryngeal muscles  Often globus Sx accompany  Often psychological component  SALT/ENT collaboration to treat  Response to PPI usually placebo

29  48 year old company director  Voice gruff in the morning  Throat dry and sore first thing  Things get a bit better in the day  Needs to clear throat a lot but can’t  No weight loss

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31  Reflux of acid and pepsin  Often silent  Symptoms often fluctuate  Lifestyle change  PPI twice daily (pre-prandial)  Gaviscon advance nocte

32  54 year old female bank manager  Heavy smoker for 30 years  Upset as voice gruff and low pitched- has been mistaken for a man on the phone!  No weight loss  No heartburn

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34  Chronic vocal cord oedema  Almost exclusive to smokers  common age at onset  Deeper pitch  Gruff voice  Effortful speaking  Stop smoking  Vocal hygiene  Surgery

35  ?need to do it  Absolutely!  Helps get a good idea of “normal”

36  Airway!  Oral cavity  Oropharynx  Neck  General appearance-cachexia -nicotine stains

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38  Throat symptoms are common  Laryngeal SCC is not that common  History is key  Reassurance very therapeutic  If in doubt-refer.

39  ENT SpR  H&N CNS-Claire Barber - Julie Northcott  SALTs-Camilla Dawson -Claire Higgins

40  Head and Neck ▪ Mr Andrew Brightwell ▪ Mr Andrew Husband  Voice ▪ Mr Malcolm Hilton  Thyroid ▪ Mr Dick Garth.

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