AKT question relating to hoarse voice

AKT question relating to hoarse voice InnovAiT Another Another exciting exciting technological technological advance, advance, although although not not currently currently in in treatment treatment of of head head and and neck neck cancer. cancer. Side Side effects effects may may not not be be immedi- immedi- ately, ately, outwardly outwardly obvious, obvious, but but xerostomia xerostomia and and difficulty difficulty swallowing swallowing mainstream mainstream use use in in the the UK, UK, is is trans trans oral oral robotic robotic surgery surgery (TORS). (TORS). There There secondary secondary to to radiotherapy radiotherapy have have aa dramatic dramatic effect effect on on the the quality quality of of are are aa number number of of centres centres across across the the UK UK sub-specialising sub-specialising in in TORS, TORS, but but it it life life after after treatment. treatment. There There are are aa number number of of complications complications of of treatment treatment is is still still at at an an early early stage stage of of development. development. TORS TORS gives gives the the surgeon surgeon that that have have not not been been considered considered in in detail detail in in this this article, article, but but MDTs MDTs across across increased increased visualisation visualisation and and precision precision despite despite limited limited access access allowing allowing the the UK UK are are subject subject to to audit audit of of patient patient morbidity morbidity and and there there is is ongoing ongoing surgeons surgeons to to potentially potentially operate operate around around corners. corners. It It is is proposed proposed that that research research to to improve improve patient patient experience experience (Paleri (Paleri & & Roland, Roland, 2016 2016). ). TORS TORS will will lead lead to to reduced reduced hospital hospital stay stay and and better better morbidity morbidity out- out- comes; comes; it it is is the the subject subject of of ongoing ongoing research research (Hans, (Hans, Delas, Delas, Gorphe Gorphe Menard, Menard, & & Brasnu, Brasnu, 2012 2012). ). One One current current application application of of this this technique technique KEY KEY POINTS POINTS is is in in resection resection of of tongue tongue base base mucosa mucosa in in diagnosis diagnosis of of the the unknown unknown .. HPV HPV is is responsible responsible for for aa significant significant increase increase in in the the inci- inci- primary, primary, It It is is also also being being used used with with great great effect effect to to precisely precisely excise excise dence dence of of head head and and neck neck cancer cancer traditionally traditionally difficult difficult to to access access tongue tongue base base and and tonsil tonsil cancers, cancers, espe- espe- cially cially if if extending extending to to the the lateral lateral pharyngeal pharyngeal wall wall when when traditionally traditionally .. The The common common presenting presenting symptoms symptoms of of head head and and neck neck excision excision is is much much more more invasive. invasive. cancer cancer include include hoarse hoarse voice, voice, odynophagia, odynophagia, dysphagia, dysphagia, Further Further development development and and use use of of TORS TORS may may change change the the way way these these otalgia otalgia and and neck neck mass mass cancers cancers are are managed. managed. Currently, Currently, the the mainstay mainstay of of treatment treatment for for oropha- oropha- .. Progressive Progressive symptoms symptoms lasting lasting 33 weeks weeks or or more more need need ryngeal ryngeal cancer cancer is is chemoradiotherapy, chemoradiotherapy, which which has has significant significant side side referral referral to to ENT ENT under under the the suspected suspected cancer cancer referral referral effects, effects, particularly particularly on on the the patient’s patient’s ability ability to to swallow. swallow. pathway pathway Understandably, Understandably, not not all all cases cases are are suitable suitable for for TORS, TORS, and and patient patient selec- selec- .. Patients Patients suspected suspected of of having having metastatic metastatic lymph lymph node node dis- dis- tion tion is is important important (Paleri (Paleri & & Roland, Roland, 2016 2016). ). ease ease require require urgent urgent ENT ENT referral referral under under the the suspected suspected There There is is aa major major drive drive in in head head and and neck neck cancer cancer to to improve improve sur- sur- cancer cancer pathway pathway vivorship. vivorship. Patients Patients often often end end up up with with significant significant morbidity morbidity following following References References and and further further information information BMA. BMA. (2017). (2017). General General practice practice in in the the UK UK –– back- back- head head and and neck neck cancer. cancer. European European Annals Annals of of Paleri, Paleri, V., V., & & Roland, Roland, N. N. (Ed.) (Ed.) (2016). (2016). Head Head and and www.rcgp.org.uk/training-exams/gp-curriculum- www.rcgp.org.uk/training-exams/gp-curriculum- ground ground briefing. briefing. Retrieved Retrieved from from www.bma.or- www.bma.or- Otorhinolaryngology, Otorhinolaryngology, Head Head and and Neck Neck Diseases Diseases,, neck neck cancer: cancer: United United Kingdom Kingdom national national multidis- multidis- overview/online-curriculum/applying-clinical- overview/online-curriculum/applying-clinical- g.uk/-/media/files/pdfs/news%20views%20analy- g.uk/-/media/files/pdfs/news%20views%20analy- ciplinary ciplinary guidelines. guidelines. Journal Journal of of Laryngology Laryngology and and 129 129(1), (1), 32–37. 32–37. doi: doi: 10.3332/ecancer.2013.359 10.3332/ecancer.2013.359 knowledge-section-2/3-15-ent-oral-and-facial- knowledge-section-2/3-15-ent-oral-and-facial- sis/press%20briefings/general-practice.pdf?la sis/press%20briefings/general-practice.pdf?la¼¼en en Otology, Otology, 130 130(S2), (S2), 1–226. 1–226. Retrieved Retrieved from from problems.aspx problems.aspx Mehanna, Mehanna, H., H., Beech, Beech, T., T., Nicholson, Nicholson, T., T., El-Hariry, El-Hariry, www.cambridge.org/core/services/aop-file-man- www.cambridge.org/core/services/aop-file-man- Cao, Cao, S. S. M., M., Simons, Simons, M. M. J., J., & & Qian, Qian, C. C. N. N. (2011). (2011). The The I., I., McConkey, McConkey, C., C., Paleri, Paleri, V., V., & & Roberts, Roberts, S. S. (2013). (2013). Warnakulasuriya, Warnakulasuriya, S., S., Trivedy, Trivedy, C., C., & & Peters, Peters, T. T. ager/file/57fbbd73983d5b2b18ef2ac9 ager/file/57fbbd73983d5b2b18ef2ac9 prevalence prevalence and and prevention prevention of of nasopharyngeal nasopharyngeal car- car- Prevalence Prevalence of of human human papillomavirus papillomavirus in in oropha- oropha- (2002). (2002). Areca Areca nut nut use: use: An An independent independent risk risk factor factor cinoma cinoma in in China. China. Chinese Chinese Journal Journal of of Cancer Cancer,, Philpott, Philpott, C., C., Tassone, Tassone, P., P., & & Clark, Clark, M. M. (2014). (2014). Bullet Bullet ryngeal ryngeal and and nonoropharyngeal nonoropharyngeal head head and and neck neck for for oral oral cancer. cancer. BMJ BMJ,, 324 324(7341), (7341), 799–800 799–800 30 30(2), (2), 114–119 114–119 points points in in ENT. ENT. Stuttgart, Stuttgart, Germany: Germany: Theime Theime cancer cancer –– systematic systematic review review and and meta-analysis meta-analysis of of trends trends by by time time and and region. region. Head Head & & Neck Neck,, 35 35(5), (5), Hans, Hans, S., S., Delas, Delas, B., B., Gorphe, Gorphe, M., M., Me Me´´nard, nard, M., M., & & RCGP. RCGP. Clinical Clinical module module 3.15: 3.15: Care Care of of people people with with 747–755. 747–755. doi: doi: 10.1002/hed.22015 10.1002/hed.22015 Brasnu, Brasnu, D. D. (2012). (2012). Transoral Transoral robotic robotic surgery surgery in in ENT, ENT, oral oral and and facial facial problems. problems. Retrieved Retrieved from from DOI: DOI: 10.1177/1755738018767520 10.1177/1755738018767520 AKT AKT question question relating relating to to hoarse hoarse voice voice A. A. Alendronic Alendronic acid acid Single Single Best Best Answer Answer B. B. Bisoprolol Bisoprolol A A 68-year-old 68-year-old lady lady presents presents with with chronic chronic hoarseness. hoarseness. She She saw saw an an ear, ear, nose nose and and throat throat (ENT) (ENT) consultant consultant 33 months months ago ago and and sinister sinister causes causes C. C. Gliclazide Gliclazide were were ruled ruled out. out. She She wonders wonders if if any any of of her her medications medications are are causing causing D. D. Losartan Losartan the the hoarseness. hoarseness. E. E. Sertraline Sertraline Which Which SINGLE SINGLE agent agent is is MOST MOST likely likely to to cause cause hoarseness? hoarseness? Select Select ONE ONE option option only. only. Answer Answer DOI: DOI: 10.1177/1755738018767521 10.1177/1755738018767521 Dr Dr Anish Anish Kotecha Kotecha GP GP Partner, Partner, Cwmbran Cwmbran Village Village Surgery, Surgery, Wales Wales http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png InnovAiT: Education and inspiration for general practice SAGE

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1755-7380
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1755-7399
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10.1177/1755738018767520
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Abstract

InnovAiT Another Another exciting exciting technological technological advance, advance, although although not not currently currently in in treatment treatment of of head head and and neck neck cancer. cancer. Side Side effects effects may may not not be be immedi- immedi- ately, ately, outwardly outwardly obvious, obvious, but but xerostomia xerostomia and and difficulty difficulty swallowing swallowing mainstream mainstream use use in in the the UK, UK, is is trans trans oral oral robotic robotic surgery surgery (TORS). (TORS). There There secondary secondary to to radiotherapy radiotherapy have have aa dramatic dramatic effect effect on on the the quality quality of of are are aa number number of of centres centres across across the the UK UK sub-specialising sub-specialising in in TORS, TORS, but but it it life life after after treatment. treatment. There There are are aa number number of of complications complications of of treatment treatment is is still still at at an an early early stage stage of of development. development. TORS TORS gives gives the the surgeon surgeon that that have have not not been been considered considered in in detail detail in in this this article, article, but but MDTs MDTs across across increased increased visualisation visualisation and and precision precision despite despite limited limited access access allowing allowing the the UK UK are are subject subject to to audit audit of of patient patient morbidity morbidity and and there there is is ongoing ongoing surgeons surgeons to to potentially potentially operate operate around around corners. corners. It It is is proposed proposed that that research research to to improve improve patient patient experience experience (Paleri (Paleri & & Roland, Roland, 2016 2016). ). TORS TORS will will lead lead to to reduced reduced hospital hospital stay stay and and better better morbidity morbidity out- out- comes; comes; it it is is the the subject subject of of ongoing ongoing research research (Hans, (Hans, Delas, Delas, Gorphe Gorphe Menard, Menard, & & Brasnu, Brasnu, 2012 2012). ). One One current current application application of of this this technique technique KEY KEY POINTS POINTS is is in in resection resection of of tongue tongue base base mucosa mucosa in in diagnosis diagnosis of of the the unknown unknown .. HPV HPV is is responsible responsible for for aa significant significant increase increase in in the the inci- inci- primary, primary, It It is is also also being being used used with with great great effect effect to to precisely precisely excise excise dence dence of of head head and and neck neck cancer cancer traditionally traditionally difficult difficult to to access access tongue tongue base base and and tonsil tonsil cancers, cancers, espe- espe- cially cially if if extending extending to to the the lateral lateral pharyngeal pharyngeal wall wall when when traditionally traditionally .. The The common common presenting presenting symptoms symptoms of of head head and and neck neck excision excision is is much much more more invasive. invasive. cancer cancer include include hoarse hoarse voice, voice, odynophagia, odynophagia, dysphagia, dysphagia, Further Further development development and and use use of of TORS TORS may may change change the the way way these these otalgia otalgia and and neck neck mass mass cancers cancers are are managed. managed. Currently, Currently, the the mainstay mainstay of of treatment treatment for for oropha- oropha- .. Progressive Progressive symptoms symptoms lasting lasting 33 weeks weeks or or more more need need ryngeal ryngeal cancer cancer is is chemoradiotherapy, chemoradiotherapy, which which has has significant significant side side referral referral to to ENT ENT under under the the suspected suspected cancer cancer referral referral effects, effects, particularly particularly on on the the patient’s patient’s ability ability to to swallow. swallow. pathway pathway Understandably, Understandably, not not all all cases cases are are suitable suitable for for TORS, TORS, and and patient patient selec- selec- .. Patients Patients suspected suspected of of having having metastatic metastatic lymph lymph node node dis- dis- tion tion is is important important (Paleri (Paleri & & Roland, Roland, 2016 2016). ). ease ease require require urgent urgent ENT ENT referral referral under under the the suspected suspected There There is is aa major major drive drive in in head head and and neck neck cancer cancer to to improve improve sur- sur- cancer cancer pathway pathway vivorship. vivorship. Patients Patients often often end end up up with with significant significant morbidity morbidity following following References References and and further further information information BMA. BMA. (2017). (2017). General General practice practice in in the the UK UK –– back- back- head head and and neck neck cancer. cancer. European European Annals Annals of of Paleri, Paleri, V., V., & & Roland, Roland, N. N. (Ed.) (Ed.) (2016). (2016). Head Head and and www.rcgp.org.uk/training-exams/gp-curriculum- www.rcgp.org.uk/training-exams/gp-curriculum- ground ground briefing. briefing. Retrieved Retrieved from from www.bma.or- www.bma.or- Otorhinolaryngology, Otorhinolaryngology, Head Head and and Neck Neck Diseases Diseases,, neck neck cancer: cancer: United United Kingdom Kingdom national national multidis- multidis- overview/online-curriculum/applying-clinical- overview/online-curriculum/applying-clinical- g.uk/-/media/files/pdfs/news%20views%20analy- g.uk/-/media/files/pdfs/news%20views%20analy- ciplinary ciplinary guidelines. guidelines. Journal Journal of of Laryngology Laryngology and and 129 129(1), (1), 32–37. 32–37. doi: doi: 10.3332/ecancer.2013.359 10.3332/ecancer.2013.359 knowledge-section-2/3-15-ent-oral-and-facial- knowledge-section-2/3-15-ent-oral-and-facial- sis/press%20briefings/general-practice.pdf?la sis/press%20briefings/general-practice.pdf?la¼¼en en Otology, Otology, 130 130(S2), (S2), 1–226. 1–226. Retrieved Retrieved from from problems.aspx problems.aspx Mehanna, Mehanna, H., H., Beech, Beech, T., T., Nicholson, Nicholson, T., T., El-Hariry, El-Hariry, www.cambridge.org/core/services/aop-file-man- www.cambridge.org/core/services/aop-file-man- Cao, Cao, S. S. M., M., Simons, Simons, M. M. J., J., & & Qian, Qian, C. C. N. N. (2011). (2011). The The I., I., McConkey, McConkey, C., C., Paleri, Paleri, V., V., & & Roberts, Roberts, S. S. (2013). (2013). Warnakulasuriya, Warnakulasuriya, S., S., Trivedy, Trivedy, C., C., & & Peters, Peters, T. T. ager/file/57fbbd73983d5b2b18ef2ac9 ager/file/57fbbd73983d5b2b18ef2ac9 prevalence prevalence and and prevention prevention of of nasopharyngeal nasopharyngeal car- car- Prevalence Prevalence of of human human papillomavirus papillomavirus in in oropha- oropha- (2002). (2002). Areca Areca nut nut use: use: An An independent independent risk risk factor factor cinoma cinoma in in China. China. Chinese Chinese Journal Journal of of Cancer Cancer,, Philpott, Philpott, C., C., Tassone, Tassone, P., P., & & Clark, Clark, M. M. (2014). (2014). Bullet Bullet ryngeal ryngeal and and nonoropharyngeal nonoropharyngeal head head and and neck neck for for oral oral cancer. cancer. BMJ BMJ,, 324 324(7341), (7341), 799–800 799–800 30 30(2), (2), 114–119 114–119 points points in in ENT. ENT. Stuttgart, Stuttgart, Germany: Germany: Theime Theime cancer cancer –– systematic systematic review review and and meta-analysis meta-analysis of of trends trends by by time time and and region. region. Head Head & & Neck Neck,, 35 35(5), (5), Hans, Hans, S., S., Delas, Delas, B., B., Gorphe, Gorphe, M., M., Me Me´´nard, nard, M., M., & & RCGP. RCGP. Clinical Clinical module module 3.15: 3.15: Care Care of of people people with with 747–755. 747–755. doi: doi: 10.1002/hed.22015 10.1002/hed.22015 Brasnu, Brasnu, D. D. (2012). (2012). Transoral Transoral robotic robotic surgery surgery in in ENT, ENT, oral oral and and facial facial problems. problems. Retrieved Retrieved from from DOI: DOI: 10.1177/1755738018767520 10.1177/1755738018767520 AKT AKT question question relating relating to to hoarse hoarse voice voice A. A. Alendronic Alendronic acid acid Single Single Best Best Answer Answer B. B. Bisoprolol Bisoprolol A A 68-year-old 68-year-old lady lady presents presents with with chronic chronic hoarseness. hoarseness. She She saw saw an an ear, ear, nose nose and and throat throat (ENT) (ENT) consultant consultant 33 months months ago ago and and sinister sinister causes causes C. C. Gliclazide Gliclazide were were ruled ruled out. out. She She wonders wonders if if any any of of her her medications medications are are causing causing D. D. Losartan Losartan the the hoarseness. hoarseness. E. E. Sertraline Sertraline Which Which SINGLE SINGLE agent agent is is MOST MOST likely likely to to cause cause hoarseness? hoarseness? Select Select ONE ONE option option only. only. Answer Answer DOI: DOI: 10.1177/1755738018767521 10.1177/1755738018767521 Dr Dr Anish Anish Kotecha Kotecha GP GP Partner, Partner, Cwmbran Cwmbran Village Village Surgery, Surgery, Wales Wales

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InnovAiT: Education and inspiration for general practiceSAGE

Published: Jun 1, 2018

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