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Balance and thyroid disease. Not areas of ENT you would normally expect to see in the same sentence and unlikely to excite interest in the same ENT specialists, but both have been affected by recent political changes influencing referral patterns.

First: balance. Most of you will now be aware of a recent position paper from the Royal College of Physicians entitled ‘Hearing and Balance Disorders: Achieving excellence in diagnosis and management’. The paper, the result of a working party on the provision of balance and hearing services in the UK came to a number of conclusions, one of which was that there is a severe lack of service provision for patients with imbalance. This implies that unless the dizzy patient is seeing an audiological physician, preferably leading a multidisciplinary clinic team, they are receiving a substandard service. Given the recent developments in the banking world it can only be a matter of time before its referred to as a ‘sub-prime’ service. ENT Consultants who for years have been providing excellent care for these patients were probably less than amused to hear that they are surgeons rather than doctors, dabbling in an area in which they lack expertise.

Second: thyroid. For years the surgical management of thyroid disease has sat somewhere between Otorhinolaryngologists and General Surgeons. It still does. Interestingly though with developments in the ‘two-week-wait’ pushing patients with neck lumps to the fore, Head and Neck Surgeons have noticed more thyroid disease coming through the clinic doors. One unforeseen circumstance of this DOH initiative may be to increase the proportion of thyroid disease seen in ENT clinics rather than general surgery outpatients.

Future editions of The Otorhinolaryngologist will look at these subject areas in more detail. Both balance disorders and thyroid management are areas in which specialist expertise exists within ENT departments throughout the UK but are the current training schedules for registrars reinforcing these skills? Some may argue that unless a trainee is lucky enough to work for a consultant with a niche interest these topics may be only taught at a superfi - cial level. Within the British Society of Otology the present discussion is regarding balance skills. Should these be taught within the new curriculum to any great depth or reserved for those going on to a specialist otology/neurootology fellowship? A similar argument holds for thyroid surgery. Trainees or consultants with strong views on this are encouraged to email and the most informative responses will be published.

Anil Banerjee
Editor in Chief

Additional Info

  • Authors: Anil Banerjee
  • Keywords: editorial
Read 3501 times Last modified on Tuesday, 19 May 2020 15:08

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