Essential Essential ENT Second edition PRELIMS.indd i PRELIMS.indd i 29/07/11 12:04 PM 29/07/11 12:04 PM

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1 Essential ENT Second edition

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3 Essential ENT Second edition Rogan J Corbridge MB BS, BSC, FRCS, FRCS ORL ENT Consultant, Royal Berkshire Hospital, Reading, UK

4 First published in Great Britain in 1998 by Hodder Arnold This second edition publishing in 2011 by Hodder Arnold, an imprint of Hodder Education, a division of Hachette UK, 338 Euston Road, London NW1 3BH Rogan J Corbridge All rights reserved. Apart from any use permitted under UK copyright law, this publication may only be reproduced, stored or transmitted, in any form, or by any means with prior permission in writing of the publishers or in the case of reprographic production in accordance with the terms of licences issued by the Copyright Licensing Agency. In the United Kingdom such licences are issued by the Copyright Licensing Agency: Saffron House, 6 10 Kirby Street, London EC1N 8TS. Hachette UK s policy is to use papers that are natural, renewable and recyclable products and made from wood grown in sustainable forests. The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the author nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new side-effects recognized. For these reasons the reader is strongly urged to consult the drug companies printed instructions before administering any of the drugs recommended in this book. 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 ISBN Commissioning Editor: Project Editor: Production Controller: Cover Design: Index: Joanna Koster Stephen Clausard Jonathan Williams Amina Dudhia Indexing Specialists (UK) Ltd Cover image Medical RF.com/Science Photo Library Typeset in 10/12pt Minions Regular by MPS Ltd, a Macmillan Company, Chennai Printed in India What do you think about this book? Or any other Hodder Arnold title? Please visit our website:

5 Contents Acknowledgements vii Introduction ix 1 The ENT history and examination 1 2 Understanding investigations in ENT 13 3 The mouth, tonsils and adenoids 19 4 The salivary glands 33 5 The larynx 41 6 The oesophagus and dysphagia 65 7 The thyroid gland 75 8 The neck 83 9 The ear The nose and nasopharynx The paranasal sinuses The ENT manifestations of HIV and AIDS Procedures in ENT Pharmacology in ENT 169 Appendix A Glossary of common terms in ENT practice 173 Appendix B Notes on how to approach common ENT symptoms 176 Index 183

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7 Acknowledgements I would like to thank all those who have inspired and taught me through the years in Oxford, Brisbane and London. When the first edition of this book was written my daughter, Olivia, was 5 years old. Now as the second edition is published she is off to medical school herself and I hope that she will enjoy every moment of her life in medicine as I have and come to realise that being a doctor is not a job but a privilege. I thank all my children for being wonderful and accepting the late nights and early starts of their surgeon dad.

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9 Introduction The second edition of this book has been thoroughly updated and revised. It offers a modern guide to ENT practice. Teaching medical students, general practitioners and junior ENT doctors for the last 12 years has helped me to understand their learning needs and, as such, I have developed new materials and concepts which I hope you will find useful and enjoyable in this book and the associated material online. As in the first edition I have tried to approach the subject in a problem-orientated way, which is far more relevant to the day-to-day practice of medicine and will also help the student to prepare to do battle with the examiners where they will be faced with real clinical problems. The case studies and key points presented in each chapter will help to reinforce the most important points. There is a new chapter which will help you to develop an approach to deal with a patient s symptoms, which, after all, is what we are presented with on a daily basis. Most chapters have an overview of the diseases which may affect that area. It is not intended that the student try to memorize these rather daunting lists, but rather that he/she will use them to gain an appreciation of the diversity of conditions which may affect the ear, nose and throat. In each overview the student will be able to identify the more common conditions since these are presented in bold. These lists will also help you to organise your knowledge and thoughts in a structured fashion, following the time-honoured surgical sieve. Clear and structured thinking is the key to good medical practice since, whatever our experience or level, we will be faced with new problems daily, some of which we may not have encountered previously. Here, and particularly in emergency work, it is vital that the medic has a well-practised and structured approach to fall back on; this must be rooted in good basic knowledge and common sense. This book will give you the knowledge and structure you require. Common sense.... is up to you!