GP-throat - Devon Sessional GPs
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Transcript GP-throat - Devon Sessional GPs
Mr Richard Harris.
ENT SpR
Royal Devon & Exeter NHS Foundation Trust
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!
Birmingham graduate
Currently on Peninsula SpR rotation
Work at RD&E
Fellow in Head & Neck Surgery at Royal
Melbourne Hospital.
Missed red flags
Lack of information on 2ww referrals
Longstanding misdiagnosis
Poor descriptions of anatomy
“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?”
LPR
Vocal cord dysfunction
Reinke’s oedema
Laryngeal SCC
Vocal cord nodules
Catarrh/postnasal drip/phlegm/sinusitis
Absolutely key
Endoscopic predictor
GP advantage of knowing the pt- use it!
Duration
Constant/intermittent
Pain
Dysphagia
Try to avoid the pt
naming a condition
Voice change
Voice fluctuation
Social history
Symptoms through the
day
81 years old
Male non smoker
Wife has trouble hearing him
Voice feels weaker
Has got worse over last 12 months
Harmless
Due to VC atrophy
Rule out neoplasia
Sympathy
Speech therapy
VC augmentation
63 year old male smoker
3 months constant hoarseness
Cough
Husky voice
No weight loss
Neck normal
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 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.
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
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
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
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
Reflux of acid and pepsin
Often silent
Symptoms often fluctuate
Lifestyle change
PPI twice daily (pre-prandial)
Gaviscon advance nocte
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
Chronic vocal cord oedema
Almost exclusive to smokers
50-60 common age at onset
Deeper pitch
Gruff voice
Effortful speaking
Stop smoking
Vocal hygiene
Surgery
?need to do it
Absolutely!
Helps get a good idea of “normal”
Airway!
Oral cavity
Oropharynx
Neck
General appearance
-cachexia
-nicotine stains
Throat symptoms are common
Laryngeal SCC is not that common
History is key
Reassurance very therapeutic
If in doubt-refer.
ENT SpR
H&N CNS
SALTs
-Claire Barber
- Julie Northcott
-Camilla Dawson
-Claire Higgins
Head and Neck
▪ Mr Andrew Brightwell
▪ Mr Andrew Husband
Voice
▪ Mr Malcolm Hilton
Thyroid
▪ Mr Dick Garth.