Editorial

Editorial InnovAiT, InnovAiT, 11(6), 11(6), 297 297 Editorial Editorial Dr Dr Alex Alex Watson Watson Guest Guest Editor Editor GP GP Trainer Trainer and and Community Community ENT ENT Specialist Specialist Email: Email: dralexwatson@doctors.org.uk dralexwatson@doctors.org.uk Do Do you you remember remember that that sage sage advice advice from from medical medical school school about about ‘never ‘never and and colleagues colleagues on on acute acute otitis otitis media media emphasises emphasises the the importance importance of of sticking sticking anything anything smaller smaller than than your your elbow elbow in in your your ear’? ear’? Well, Well, II have have checking checking the the ears ears in in any any unwell unwell pre-lingual pre-lingual child. child. lost lost count count of of the the patients patients who who continue continue to to blindly blindly push push cotton cotton buds buds (or (or It It is is not not unusual unusual for for GPs GPs to to be be confronted confronted with with dental dental complaints. complaints. other other sharp sharp instruments instruments of of torture) torture) into into these these narrow narrow and and sensitive sensitive The The article article by by Garrett Garrett and and Sarah Sarah Mills Mills on on managing managing dental dental emergencies emergencies orifices. orifices. And And despite despite warning warning them them of of the the dangers, dangers, they they carry carry on on in in general general practice practice strongly strongly advises advises us us to to work work within within our our scope scope of of regardless! regardless! ‘How ‘How then then Doc, Doc, are are we we to to keep keep our our ears ears clean?’ clean?’ ‘You ‘You competence competence and and experience. experience. Many Many Clinical Clinical Commissioning Commissioning Groups Groups don’t’, don’t’, II retort. retort. ‘They ‘They are are already already clean. clean. Wax Wax is is good good for for the the ears. ears. will will have have their their own own local local guidance guidance and and care care pathways pathways for for dental dental Leave Leave them them alone!’ alone!’ care, care, and and II would would urge urge you you to to become become acquainted acquainted with with these. these. Ear Ear canal canal epithelium epithelium naturally naturally migrates migrates outwards, outwards, and and any any wax wax Neck Neck lumps lumps can can induce induce anxiety anxiety in in both both patients patients and and doctors, doctors, and and produced produced should should move move out out too, too, until until it it reaches reaches the the opening opening of of the the the the article article by by Adnan Adnan Darr Darr and and colleagues colleagues explores explores the the various various causes, causes, ear ear canal canal and and sloughs sloughs off, off, thus thus providing providing aa natural natural cleaning cleaning system system including including the the red red flag flag signs signs and and symptoms symptoms for for possible possible cancer. cancer. (Robb (Robb & & Watson, Watson, 2007 2007). ). Wax Wax (cerumen) (cerumen) is is aa normal normal protective protective secre- secre- Likewise, Likewise, Miklos Miklos Perenyei Perenyei and and colleagues colleagues provide provide us us with with aa systematic systematic tion, tion, which which acts acts as as aa water water repellent, repellent, and and being being slightly slightly acidic, acidic, dis- dis- approach approach to to assessing assessing hoarseness. hoarseness. In In both both conditions, conditions, II would would draw draw courages courages bacterial bacterial and and fungal fungal growth growth too. too. Clearly, Clearly, quite quite aa helpful helpful your your attention attention to to the the current current National National Institute Institute for for Health Health and and Care Care arrangement! arrangement! Of Of course, course, there there are are some some patients patients who who have have wax wax that that Excellence Excellence (NICE) (NICE) Cancer Cancer Guidelines Guidelines (NICE, (NICE, 2015), 2015), which which have have does does not not clear clear naturally, naturally, resulting resulting in in blocked blocked ear ear canals. canals. Structural Structural removed removed specific specific time time frames frames and and advise advise urgent urgent 2-week 2-week rule rule referral referral changes, changes, such such as as exostoses exostoses or or otitis otitis externa, externa, may may interfere interfere with with the the for for any any patient patient aged aged 45 45 or or over over with with persistent persistent unexplained unexplained hoarse- hoarse- normal normal migratory migratory process, process, and and those those with with very very narrow narrow ear ear canals canals may may ness, ness, or or an an unexplained unexplained lump lump in in the the neck. neck. also also develop develop problems problems as as the the meatus meatus blocks blocks more more easily. easily. While While the the UK UK has has been been experiencing experiencing outbreaks outbreaks of of measles, measles, we we are are II run run aa weekly weekly ear ear microsuction microsuction service service for for my my health health locality, locality, and and reminded reminded by by Joshua Joshua Whittaker Whittaker and and Karan Karan Jolly’s Jolly’s article article on on acute acute supra- supra- underlying underlying otitis otitis externa externa is is frequently frequently present present in in those those with with impacted impacted glottitis glottitis of of the the impact impact of of successful successful national national vaccination vaccination programmes programmes –– wax. wax. Ear Ear wax wax gets gets aa bad bad press, press, but but it it is is often often this this common common inflamma- inflamma- in in particular, particular, that that of of the the Haemophilus Haemophilus influenzae influenzae type type B B (HIB) (HIB) vaccine vaccine tory tory skin skin condition condition of of the the ear ear canal canal that that disrupts disrupts the the normal normal cleaning cleaning –– with with subsequent subsequent reduction reduction in in incidence incidence of of all-age all-age supraglottitis supraglottitis process. process. In In this this ear, ear, nose, nose, and and throat throat (ENT) (ENT) special special issue, issue, Emma Emma through through direct direct and and herd herd immunity. immunity. Dickson Dickson reveals reveals how how broad broad aa spectrum spectrum of of severity severity otitis otitis externa externa can can We We all all know know ‘prevention ‘prevention is is better better than than cure’, cure’, yet yet despite despite laryngeal laryngeal be be –– from from mild mild symptoms, symptoms, such such as as itching, itching, to to the the severe severe symptoms symptoms of of cancer cancer becoming becoming less less common, common, the the incidence incidence of of oropharyngeal oropharyngeal malignant malignant otitis otitis externa, externa, aa potentially potentially life-threatening life-threatening condition. condition. This This cancer cancer has has increased increased sharply sharply in in recent recent years, years, as as highlighted highlighted in in the the article article considers considers the the importance importance of of patient patient education education and and self-care self-care in in article article by by Tobias Tobias Moorhouse Moorhouse and and Daniel Daniel Edwards Edwards on on head head and and neck neck managing managing symptoms symptoms and and preventing preventing complications. complications. cancer. cancer. The The human human papilloma papilloma virus virus (HPV) (HPV) is is once once again again implicated implicated as as Confidence Confidence in in examining examining ears ears comes comes with with experience. experience. It It was was only only aa causative causative factor factor –– sso o much much so, so, that that head head and and neck neck cancer cancer is is predicted predicted after after seeing seeing hundreds hundreds of of normal normal ear ear drums drums that that II started started to to feel feel con- con- to to overtake overtake cervical cervical cancer cancer as as the the leading leading HPV HPV related related cancer cancer by by 2020 2020 fident fident in in diagnosing diagnosing those those that that were were not. not. Young Young children, children, especially especially (Paleri (Paleri & & Roland, Roland, 2016 2016). ). Meanwhile, Meanwhile, the the debate debate about about HPV HPV vaccin- vaccin- babies, babies, provide provide an an additional additional challenge, challenge, and and the the article article by by John John Curran Curran ation ation for for males males continues. continues. References References and and further further information information NICE. NICE. (2015). (2015). Suspected Suspected cancer: cancer: Recognition Recognition and and Paleri, Paleri, V V.,., & & Roland, Roland, N. N. (2016). (2016). Head Head and and neck neck core/services/aop-file-manager/file/ core/services/aop-file-manager/file/ Robb, Robb, P., P., & & Watson, Watson, A. A. (2007). (2007). ENT ENT in in Primary Primary referral. referral. Retrieved Retrieved from from www.nice.org.uk/guid- www.nice.org.uk/guid- cancer: cancer: United United K Kingdom ingdom national national multidisciplinary multidisciplinary 57fbbd73983d5b2b18ef2ac9 57fbbd73983d5b2b18ef2ac9 Care Care.. London: London: Rila Rila Publications Publications ance/ng12/resources/suspected-cancer-recogni- ance/ng12/resources/suspected-cancer-recogni- guidelines. guidelines. Journal Journal of of Laryngology Laryngology and and Otology Otology,, tion-and-referral-pdf-1837268071621 tion-and-referral-pdf-1837268071621 130 130(S2). (S2). Retrieved Retrieved from from www.cambridge.org/ www.cambridge.org/ InnovAiT, 2018, Vol. 11(6), 297, ! The Author(s) 2018. DOI: 10.1177/1755738018766201 297 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav journals.sagepub.com/home/ino http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png InnovAiT: Education and inspiration for general practice SAGE

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Abstract

InnovAiT, InnovAiT, 11(6), 11(6), 297 297 Editorial Editorial Dr Dr Alex Alex Watson Watson Guest Guest Editor Editor GP GP Trainer Trainer and and Community Community ENT ENT Specialist Specialist Email: Email: dralexwatson@doctors.org.uk dralexwatson@doctors.org.uk Do Do you you remember remember that that sage sage advice advice from from medical medical school school about about ‘never ‘never and and colleagues colleagues on on acute acute otitis otitis media media emphasises emphasises the the importance importance of of sticking sticking anything anything smaller smaller than than your your elbow elbow in in your your ear’? ear’? Well, Well, II have have checking checking the the ears ears in in any any unwell unwell pre-lingual pre-lingual child. child. lost lost count count of of the the patients patients who who continue continue to to blindly blindly push push cotton cotton buds buds (or (or It It is is not not unusual unusual for for GPs GPs to to be be confronted confronted with with dental dental complaints. complaints. other other sharp sharp instruments instruments of of torture) torture) into into these these narrow narrow and and sensitive sensitive The The article article by by Garrett Garrett and and Sarah Sarah Mills Mills on on managing managing dental dental emergencies emergencies orifices. orifices. And And despite despite warning warning them them of of the the dangers, dangers, they they carry carry on on in in general general practice practice strongly strongly advises advises us us to to work work within within our our scope scope of of regardless! regardless! ‘How ‘How then then Doc, Doc, are are we we to to keep keep our our ears ears clean?’ clean?’ ‘You ‘You competence competence and and experience. experience. Many Many Clinical Clinical Commissioning Commissioning Groups Groups don’t’, don’t’, II retort. retort. ‘They ‘They are are already already clean. clean. Wax Wax is is good good for for the the ears. ears. will will have have their their own own local local guidance guidance and and care care pathways pathways for for dental dental Leave Leave them them alone!’ alone!’ care, care, and and II would would urge urge you you to to become become acquainted acquainted with with these. these. Ear Ear canal canal epithelium epithelium naturally naturally migrates migrates outwards, outwards, and and any any wax wax Neck Neck lumps lumps can can induce induce anxiety anxiety in in both both patients patients and and doctors, doctors, and and produced produced should should move move out out too, too, until until it it reaches reaches the the opening opening of of the the the the article article by by Adnan Adnan Darr Darr and and colleagues colleagues explores explores the the various various causes, causes, ear ear canal canal and and sloughs sloughs off, off, thus thus providing providing aa natural natural cleaning cleaning system system including including the the red red flag flag signs signs and and symptoms symptoms for for possible possible cancer. cancer. (Robb (Robb & & Watson, Watson, 2007 2007). ). Wax Wax (cerumen) (cerumen) is is aa normal normal protective protective secre- secre- Likewise, Likewise, Miklos Miklos Perenyei Perenyei and and colleagues colleagues provide provide us us with with aa systematic systematic tion, tion, which which acts acts as as aa water water repellent, repellent, and and being being slightly slightly acidic, acidic, dis- dis- approach approach to to assessing assessing hoarseness. hoarseness. In In both both conditions, conditions, II would would draw draw courages courages bacterial bacterial and and fungal fungal growth growth too. too. Clearly, Clearly, quite quite aa helpful helpful your your attention attention to to the the current current National National Institute Institute for for Health Health and and Care Care arrangement! arrangement! Of Of course, course, there there are are some some patients patients who who have have wax wax that that Excellence Excellence (NICE) (NICE) Cancer Cancer Guidelines Guidelines (NICE, (NICE, 2015), 2015), which which have have does does not not clear clear naturally, naturally, resulting resulting in in blocked blocked ear ear canals. canals. Structural Structural removed removed specific specific time time frames frames and and advise advise urgent urgent 2-week 2-week rule rule referral referral changes, changes, such such as as exostoses exostoses or or otitis otitis externa, externa, may may interfere interfere with with the the for for any any patient patient aged aged 45 45 or or over over with with persistent persistent unexplained unexplained hoarse- hoarse- normal normal migratory migratory process, process, and and those those with with very very narrow narrow ear ear canals canals may may ness, ness, or or an an unexplained unexplained lump lump in in the the neck. neck. also also develop develop problems problems as as the the meatus meatus blocks blocks more more easily. easily. While While the the UK UK has has been been experiencing experiencing outbreaks outbreaks of of measles, measles, we we are are II run run aa weekly weekly ear ear microsuction microsuction service service for for my my health health locality, locality, and and reminded reminded by by Joshua Joshua Whittaker Whittaker and and Karan Karan Jolly’s Jolly’s article article on on acute acute supra- supra- underlying underlying otitis otitis externa externa is is frequently frequently present present in in those those with with impacted impacted glottitis glottitis of of the the impact impact of of successful successful national national vaccination vaccination programmes programmes –– wax. wax. Ear Ear wax wax gets gets aa bad bad press, press, but but it it is is often often this this common common inflamma- inflamma- in in particular, particular, that that of of the the Haemophilus Haemophilus influenzae influenzae type type B B (HIB) (HIB) vaccine vaccine tory tory skin skin condition condition of of the the ear ear canal canal that that disrupts disrupts the the normal normal cleaning cleaning –– with with subsequent subsequent reduction reduction in in incidence incidence of of all-age all-age supraglottitis supraglottitis process. process. In In this this ear, ear, nose, nose, and and throat throat (ENT) (ENT) special special issue, issue, Emma Emma through through direct direct and and herd herd immunity. immunity. Dickson Dickson reveals reveals how how broad broad aa spectrum spectrum of of severity severity otitis otitis externa externa can can We We all all know know ‘prevention ‘prevention is is better better than than cure’, cure’, yet yet despite despite laryngeal laryngeal be be –– from from mild mild symptoms, symptoms, such such as as itching, itching, to to the the severe severe symptoms symptoms of of cancer cancer becoming becoming less less common, common, the the incidence incidence of of oropharyngeal oropharyngeal malignant malignant otitis otitis externa, externa, aa potentially potentially life-threatening life-threatening condition. condition. This This cancer cancer has has increased increased sharply sharply in in recent recent years, years, as as highlighted highlighted in in the the article article considers considers the the importance importance of of patient patient education education and and self-care self-care in in article article by by Tobias Tobias Moorhouse Moorhouse and and Daniel Daniel Edwards Edwards on on head head and and neck neck managing managing symptoms symptoms and and preventing preventing complications. complications. cancer. cancer. The The human human papilloma papilloma virus virus (HPV) (HPV) is is once once again again implicated implicated as as Confidence Confidence in in examining examining ears ears comes comes with with experience. experience. It It was was only only aa causative causative factor factor –– sso o much much so, so, that that head head and and neck neck cancer cancer is is predicted predicted after after seeing seeing hundreds hundreds of of normal normal ear ear drums drums that that II started started to to feel feel con- con- to to overtake overtake cervical cervical cancer cancer as as the the leading leading HPV HPV related related cancer cancer by by 2020 2020 fident fident in in diagnosing diagnosing those those that that were were not. not. Young Young children, children, especially especially (Paleri (Paleri & & Roland, Roland, 2016 2016). ). Meanwhile, Meanwhile, the the debate debate about about HPV HPV vaccin- vaccin- babies, babies, provide provide an an additional additional challenge, challenge, and and the the article article by by John John Curran Curran ation ation for for males males continues. continues. References References and and further further information information NICE. NICE. (2015). (2015). Suspected Suspected cancer: cancer: Recognition Recognition and and Paleri, Paleri, V V.,., & & Roland, Roland, N. N. (2016). (2016). Head Head and and neck neck core/services/aop-file-manager/file/ core/services/aop-file-manager/file/ Robb, Robb, P., P., & & Watson, Watson, A. A. (2007). (2007). ENT ENT in in Primary Primary referral. referral. Retrieved Retrieved from from www.nice.org.uk/guid- www.nice.org.uk/guid- cancer: cancer: United United K Kingdom ingdom national national multidisciplinary multidisciplinary 57fbbd73983d5b2b18ef2ac9 57fbbd73983d5b2b18ef2ac9 Care Care.. London: London: Rila Rila Publications Publications ance/ng12/resources/suspected-cancer-recogni- ance/ng12/resources/suspected-cancer-recogni- guidelines. guidelines. Journal Journal of of Laryngology Laryngology and and Otology Otology,, tion-and-referral-pdf-1837268071621 tion-and-referral-pdf-1837268071621 130 130(S2). (S2). Retrieved Retrieved from from www.cambridge.org/ www.cambridge.org/ InnovAiT, 2018, Vol. 11(6), 297, ! The Author(s) 2018. DOI: 10.1177/1755738018766201 297 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav journals.sagepub.com/home/ino

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Published: Jun 1, 2018

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