Gerard Kelly MD MEd FRCS (ORL-HNS) FRCS (Ed) ENT surgeon, Leeds

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

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