Ear, Nose and Throat Fifth Edition Ear, Nose and Throat Harold Ludman Emeritus Consultant Surgeon in Otolaryngology, King’s College Hospital, London, UK Emeritus Consultant Surgeon in Neurotology, National Hospital for Neurology and Neurosurgery, London, UK Patrick J Bradley Consultant Head and Neck Oncologic Surgeon, Department of Otorhinolaryngology, Head and Neck Surgery, Queens Medical Centre, University of Nottingham, Nottingham, UK Fifth Edition EDITED BY © 2007 by Blackwell Publishing Ltd BMJ Books is an imprint of the BMJ Publishing Group Limited, used under licence Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053, Australia The right of the Author to be identifi ed as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First published 1981 Second edition 1988 Third edition 1993 Fourth edition 1997 Fifth edition 2007 1 2007 Library of Congress Cataloging-in-Publication Data ABC of ear, nose, and throat / edited by Harold Ludman and Patrick J. Bradley. -- 5th ed. p. ; cm. Rev. ed. of: ABC of otolaryngology / Harold Ludman. 1997. Includes bibliographical references and index. ISBN 978-1-4051-3656-3 1. Otolaryngology. I. Ludman, Harold. II. Bradley, Patrick J., 1949- III. Ludman, Harold. ABC of otolaryngology. [DNLM: 1. Otorhinolaryngologic Diseases. WV 140 A134 2007] RF46.A2344 2007 617.5'1--dc22 2006036143 ISBN: 978-1-4051-3656-3 A catalogue record for this title is available from the British Library Cover image is courtesy of and adapted from University of Nebraska Medical Centre Set in 9.25/12 pt Minion by Sparks, Oxford – www.sparks.co.uk Printed and bound in Singapore by Fabulous Printers PTE Associate Editor: Vicki Donald Editorial Assistant: Victoria Pittman Production Controller: Rachel Edwards For further information on Blackwell Publishing, visit our website: www.blackwellpublishing.com The publisher's policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. 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The author and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this book. v Contributors, vii Preface to Fifth Edition, ix 1 Pain in the Ear, 1 Harold Ludman 2 Discharge from the Ear, 6 Harold Ludman 3 Hearing Impairment and Tinnitus in Adults, 10 Harold Ludman 4 Adult Hearing Rehabilitation and Cochlear Implants, 16 Kevin Gibbin 5 Childhood Hearing Loss, 20 David Albert 6 Acoustic Neuromas and other Cerebello Pontine Angle Tumours, 25 Anthony Wright 7 Vertigo, 30 Harold Ludman 8 Facial Palsy, 34 Iain Swan 9 Paranasal Sinus Diseases and Infections, 37 Parag M Patel, Julian Rowe-Jones 10 Facial Pain, 45 Nick S Jones 11 Sore Throats, 50 William McKerrow, Patrick J Bradley 12 Breathing Disorders, 55 Vinidh Paleri, Patrick J Bradley 13 Swallowing Problems, 60 Vinidh Paleri, Patrick J Bradley 14 Snoring and Obstructive Sleep Apnoea, 65 Anshul Sama 15 Hoarseness and Voice Problems, 71 Julian McGlashan, Declan Costello, Patrick J Bradley Contents Contents vi 16 Trauma, Injuries and Foreign Bodies, 78 Archana Vats, Antony Narula, Patrick J Bradley 17 Epistaxis, Catarrh, Glossodynia, Halitosis and Somatization, 83 Nick S Jones, Patrick J Bradley 18 Neck Swellings, 87 Shahed Quraishi, Patrick J Bradley 19 Head and Neck Cancer, 93 Patrick J Bradley Index, 103 vii Contributors Parag M Patel Specialist Registrar, Royal Surrey County Hospital, Guildford, Surrey, UK Shahed Quraishi Consultant Head and Neck Surgeon, Doncaster Royal Infi rmary, Doncaster, UK Julian Rowe-Jones Consultant Rhinologist and Nasal Plastic Surgeon, Guildford Nuffi eld Hospital, Guildford, Surrey, UK Anshul Sama Consultant Rhinolaryngologist, Queens Medical Centre, Nottingham, UK Iain Swan Consultant ENT Surgeon, Gartnavel General Hospital, Glasgow, UK Archana Vats Specialist Registrar, St Mary's Hospital, London, UK Anthony Wright Professor of Otolaryngology, Institute of Laryngology and Otology, Univer- sity College London, London, UK David Albert Consultant Paediatric ENT Surgeon, Great Ormond Street Hospital, London, UK Declan Costello Specialist Registrar, John Radcliffe Hospital, Oxford, UK. Kevin Gibbin Consultant ENT Surgeon, Queens Medical Centre, Nottingham, UK Nick S Jones Consultant Rhinologist, Queens Medical Centre, Nottingham, UK Julian McGlashan Consultant ENT Surgeon, Queens Medical Centre, Nottingham, UK William McKerrow Consultant ENT Surgeon, Raigmore Hospital, Inverness, UK Antony Narula Consultant ENT Surgeon and Head of Department, St Mary's Hospital, London; Honorary Professor of Otolaryngology, Middlesex University, UK Vinidh Paleri Consultant Surgeon, Otolaryngology-Head and Neck Surgery, Newcastle upon Tyne University Hospitals, Newcastle, UK ix Preface to Fifth Edition Rhinological change has brought us the endoscopic techniques that have revolutionized treatment for paranasal sinus diseases, while the management of throat malignancy has evolved out of all recog- nition into today’s comprehensive management of head and neck tumours. It is entirely appropriate therefore that, for this expanded fi fth edition, Patrick Bradley FRCSIr, FRCSEd, FRCSEng, MBA, as an internationally recognized authority on head and neck diseases and their treatment, should have become the joint editor, and that sev- eral specialists, recognized as experts in various subspecialties, have been enlisted to write about them. The title has appositely reverted to its briefer, earlier one of ENT, which is so quintessentially British and which trips much more read- ily off the tongue than does otolaryngology. Harold Ludman The fi rst edition of this small volume, The ABC of Ear, Nose and Throat, was derived 25 years ago from a series of articles published at that time in the British Medical Journal to present the substance of this important speciality in an easily assimilable form for a wide readership of general practitioners, medical students, nurses and all those many sprouting paramedical specialties involved with speech, hearing, and head and neck disorders. This target readership has not changed, but the specialty, like most others, has expanded and de- veloped subspecialties in all its divisions. Otology has changed from the exciting renaissance of microscopic middle ear work that began in the 1960s at the start of my personal otological career, to the amazing developments that include cochlear implantation for inner ear deafness, and neuro-otology has extended from the management of peripheral labyrinthine disorders to em- brace surgery within the base of the skull.