# data[].attributes.body
The NHS Knowledge and Library Hub connects NHS staff and learners to high quality knowledge and evidence resources in one place.

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The NHS Knowledge and Library Hub connects health cares staff and learners to high quality, NHS-funded, knowledge and evidence resources in one place, using a single search.

The 'Hub'

includes all journal articles, e-books, guidelines and evidence summary tools provided nationally and by your local NHS library team

provides seamless access to full text, as an immediate download or on request from an NHS library

avoids the less-reliable sources you might find in a general web search.

Easier access to e-journals

For seamless links, where you want them, install LibKey Nomad on your PC or laptop. Choose your library (or type NHS England) and find your links in PubMed, Google Scholar and many other sites. Or use BrowZine to browse and read the journals you have access to.

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The NHS Knowledge and Library Hub connects health cares staff and learners to high quality, NHS-funded, knowledge and evidence resources in one place, using a single search.

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Click on this link to register with us! Registered members may borrow up to 10 books at one time.

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Register - Medway NHS Knowledge and Library Services

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All Medway NHS Foundation Trust staff, students on placement at the hospital and other NHS staff working across the Medway health economy, may apply to register.

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MFT Knowledge & Library Services Website

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MFT Knowledge & Library Services Website

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Medway NHS Knowledge and Library Services (KLS)

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The Medway NHS Knowledge and Library Service KLS offers the best resources to support clinical decision making, research, and lifelong professional development.

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Click on this link to find our Literature Search Request Form, just complete this and one of our Librarians will support.

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The LKS can conduct literature searching to find the evidence you need for an informed decision.

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Lopes, Natália Vitória de Araújo; de Carvalho, Emanuel Barbosa; Lopes, Márcia Nóbrega; … Cunha, John Lennon Silva

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Oral Diseases — Current Issue — Medway NHS Foundation Trust — BrowZine

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Chowdhury, Ayesha; Tian, Rong; McIlhiney, Paul; … Jayakody, Dona M. P.

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Clinical Otolaryngology — Current Issue — Medway NHS Foundation Trust — BrowZine

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1535-2609 - Search results - Page 1 - Publications A-Z

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EBSCO Search Application for Publications.

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Journal of the American Academy of Audiology

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Journal of the American Academy of Audiology

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Journal of the American Academy of Audiology - Record details - Publications A-Z

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EBSCO Search Application for Publications.

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Audiology Research - Record details - Publications A-Z

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EBSCO Search Application for Publications.

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Journal of Educational, Pediatric and (Re)Habilitative Audiology

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Journal of Educational, Pediatric and (Re)Habilitative Audiology

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EBSCO Search Application for Publications.

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Canadian Journal of Speech-Language Pathology and Audiology

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Canadian Journal of Speech-Language Pathology and Audiology

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Canadian Journal of Speech-Language Pathology & Audiology - Record details - Publications A-Z

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EBSCO Search Application for Publications.

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Ear, nose, and throat | BMJ Best Practice

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Browse BMJ Best Practice ear, nose, and throat specialty and related medical content to help you make evidence-based clinical decisions

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Acute otitis media - Symptoms, diagnosis and treatment | BMJ Best Practice

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May present with otalgia, irritability, decreased hearing, anorexia, vomiting, or fever, usually in the presence of an ongoing viral respiratory infection. Physical examination will reveal a bulging, opacified tympanic membrane with decreased mobility. The membrane may be white, yellow, pink, or ...

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Acute pharyngitis - Symptoms, diagnosis and treatment | BMJ Best Practice US

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Acute pharyngitis is characterized by acute onset of sore throat; the absence of cough, nasal congestion, and nasal discharge suggests a bacterial etiology. Diagnosis begins with history and physical exam and is confirmed by rapid antigen detection tests (in case of group A [GAS] pharyngitis),…

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Acute rhinosinusitis - Symptoms, diagnosis and treatment | BMJ Best Practice US

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Majority of cases of acute rhinosinusitis in adults and children are of viral etiology. Duration of symptoms more than 10 days often indicates bacterial cause. Imaging is not required for diagnosis unless complications are suspected. Condition is usually self-limiting; however, symptomatic therap…

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Evaluation of ataxia - Differential diagnosis of symptoms | BMJ Best Practice US

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Ataxia is a neurologic syndrome characterized by clumsy and uncoordinated movement of the limbs, trunk, and cranial muscles. It results from pathology in the cerebellum and its connections, or in the proprioceptive sensory pathways. The list of causes of ataxia is extensive. Typically, when consi…

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Evaluation of hearing loss - Differential diagnosis of symptoms | BMJ Best Practice US

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Hearing loss is one of the most common sensory impairments. An estimated 1.57 billion people globally had hearing loss in 2019. Hearing loss affects people of all ages and can be permanent if not treated correctly. Proper diagnosis rests on a thorough understanding of ear anatomy and physiology.

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Dysphonia, also known as hoarseness, is a general term used to describe a variety of changes in voice quality. Individuals with hoarseness or voice changes that fail to resolve or improve within a 4 week period should be referred for evaluation and visualization of the larynx.[1]Ferraro EL, Nelson RC, Bryson PC. Hoarseness: when to observe and when to refer. Cleve Clin J Med. 2023 Aug 1;90(8):475-81. https://www.ccjm.org/content/90/8/475.long http://www.ncbi.nlm.nih.gov/pubmed/37527869?tool=bestpractice.com[2] Francis DO, Smith LJ. Hoarseness guidelines redux: toward improved treatment of patients with dysphonia. Otolaryngol Clin North Am. 2019 Aug;52(4):597-605. http://www.ncbi.nlm.nih.gov/pubmed/31101359?tool=bestpractice.com ​

Hoarseness is not normal in adults or children, and may be an indication of a serious underlying pathology. Evaluation should take place as early as possible whenever serious underlying cause is suspected, irrespective of timeframe.[3] Stachler RJ, Francis DO, Schwartz SR, et al. Clinical practice guideline: hoarseness (dysphonia) (update). Otolaryngol Head Neck Surg. 2018 Mar;158(1 Suppl):S1-42. https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1177/0194599817751030 http://www.ncbi.nlm.nih.gov/pubmed/29494321?tool=bestpractice.com

A wide variety of laryngeal and extralaryngeal conditions can cause hoarseness, and there are many challenges associated with its evaluation. Early identification of symptoms, by both the patient and physician, and visualization of the larynx are mandatory for diagnosis. However, confusion surrounding the terminology of the various laryngeal lesions and inadequate laryngeal visualization contribute to the difficulty in diagnosing hoarseness. Diagnosis and treatment are frequently delayed as a result of misdiagnosis or poor awareness of early voice changes.

Management of voice disorders requires specialized knowledge and a multidisciplinary team approach.

# data[].attributes.attachment_link.description
Dysphonia, also known as hoarseness, is a general term used to describe a variety of changes in voice quality. Individuals with hoarseness or voice changes that fail to resolve or improve within a 4 week period should be referred for evaluation and visualization of the larynx. ​ Hoarseness is no...

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Oral mucosal ulcerations are common. Most are self-resolving and transient (e.g., after a simple cheek bite). However, some may require the intervention of a medical or dental practitioner. For example, the serious and potentially life-threatening condition oral carcinoma often initially manifests as a solitary oral mucosal ulceration. The diagnosis of the more common oral ulcerations, in an otherwise healthy patient, is straightforward and determined from the medical history and clinical exam. However, patients with impaired immunologic function (e.g., HIV, chemotherapy, malnutrition) may present with more severe, widespread, atypical presentations that require a comprehensive assessment.

Pathophysiology

Most of the mucosa lining the oral cavity (e.g., floor of the mouth, cheeks, ventral tongue) is thin and delicate, rendering it susceptible to trauma. By contrast, the mucosa of the hard palate and gingiva is keratinized and more resistant to injury. The biologically dynamic nature of the oral mucosa makes it vulnerable to the effects of systemic disease.[1] Hodgson TA, Rachanis CC. Oral fungal and bacterial infections in HIV-infected individuals: an overview in Africa. Oral Dis. 2002;8(suppl 2):80-7. http://www.ncbi.nlm.nih.gov/pubmed/12164666?tool=bestpractice.com

An oral ulcer or ulceration is characterized by the complete loss of epithelium accompanied by variable loss of the underlying connective tissue, which results in a crateriform appearance. It may be augmented by edema and/or proliferation of the surrounding tissue.[2] Compilato D, Cirillo N, Termine N, et al. Long-standing oral ulcers: proposal for a new 'S-C-D classification system'. J Oral Pathol Med. 2009 Mar;38(3):241-53. http://www.ncbi.nlm.nih.gov/pubmed/19141062?tool=bestpractice.com

Ulcers that do not heal within 2 weeks may be considered persistent or chronic. A classification system based on distinguishing whether the ulceration is simple, complex, or destroying has been suggested:[2] Compilato D, Cirillo N, Termine N, et al. Long-standing oral ulcers: proposal for a new 'S-C-D classification system'. J Oral Pathol Med. 2009 Mar;38(3):241-53. http://www.ncbi.nlm.nih.gov/pubmed/19141062?tool=bestpractice.com

Simple: a single ulcer without the involvement of the remaining mucosa.

Complex: a single or multiple ulcers with changes to the surrounding mucosa, skin, and/or systemic manifestations. The lesion may be white, red, or vesiculobullous.

Destroying: diffuse lesion with tissue destruction and severe systemic involvement.

Epidemiology

Oral ulcerations are common, but most occurrences go unreported because they tend to resolve within a few days without the need for medical or dental intervention. Of those ulcerations that are reported, the most common is recurrent aphthous stomatitis, which affects 5% to 25% of the general population.[3]McCullough MJ, Abdel-Hafeth S, Scully C. Recurrent aphthous stomatitis revisited: clinical features, associations, and new association with infant feeding practices? J Oral Pathol Med. 2007 Nov;36(10):615-20. http://www.ncbi.nlm.nih.gov/pubmed/17944755?tool=bestpractice.com

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Oral mucosal ulcerations are common. Most are self-resolving and transient (e.g., after a simple cheek bite). However, some may require the intervention of a medical or dental practitioner. For example, the serious and potentially life-threatening condition oral carcinoma often initially manifest...

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Benign paroxysmal positional vertigo (BPPV) is a common, often self-limited condition, but can be chronic and relapsing. Diagnosis is based on a suggestive history and physical exam with a positive Dix-Hallpike maneuver or a positive supine lateral head turn. Other tests are not usually required....

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Professor and Director

Facial Plastic and Reconstructive Surgery

Otolaryngology - Head and Neck Surgery

Cleft and Craniofacial Team

University of California Davis

Sacramento

CA

Disclosures

TTT has received an honorarium and reimbursement for travel by the AO Foundation for teaching on a facial trauma course. TTT serves on the American Board of Otolaryngology and the American Board of Facial Plastic and Reconstructive Surgery, and receives a royalty from Thieme publishing for the textbook Complete Cleft Care. TTT is an author of studies referenced in this topic. TTT serves as editor-in-chief of the journal "Facial Plastic Surgery and Aesthetic Medicine.

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Cleft lip with or without cleft palate is approximately twice as common as isolated cleft palate. The majority of cleft lip deformities are associated with a varying degree of nasal deformity. Orofacial clefts can occur in isolation or as a component of an identifiable syndrome. They are among th...

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Epiglottitis is an infection of the supraglottis that may cause airway compromise due to inflammation and swelling. It is an airway emergency, especially in children, and precautionary measures must be taken. Epiglottitis is classically described in children aged 2 to 6 years of age; however, it ...

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Fissured tongue is usually a normal variant of tongue appearance and is not considered a pathologic entity. It generally presents in healthy people; however, it is also seen in association with conditions such as Down syndrome and geographic tongue. If the sole manifestation is that of fissured t...

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Hypoparathyroidism - Symptoms, diagnosis and treatment | BMJ Best Practice US

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Hypoparathyroidism has a wide variety of presentations: from the asymptomatic patient with dramatically low serum calcium to the acutely symptomatic patient with neuromuscular irritability, tetany, painful muscle cramps, stridor, and even seizures with low serum calcium in the emergency departmen…

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Tinnitus is a perception of sound in proximity to the head in the absence of an external source. It can be perceived as being within one or both ears, within or around the head, or as an outside distinct noise. The sound is often a buzzing, ringing, or hissing, although it can also sound like other noises.

Tinnitus can be continuous or intermittent. Although both may have a significant impact on the patient, the latter is not usually related to a serious underlying medical problem. The sound may be pulsatile or non-pulsatile. Pulsatile tinnitus raises more concern for underlying significant pathology, though non-pulsatile tinnitus may also be associated with underlying disease.

The epidemiology, pathogenesis, and diagnosis of tinnitus will be reviewed here. The treatment of tinnitus is discussed separately. (See "Treatment of tinnitus".)

EPIDEMIOLOGY

According to the American Tinnitus Association, an estimated 50 million people in the United States have chronic tinnitus defined as persisting for greater than six months [ 1]. This translates into approximately 20 percent of adults. For 12 million, it is severe enough to interfere with daily activities and significantly impacts their quality of life. These people are effectively disabled by their tinnitus to varying degrees. Tinnitus can occur in children [ 2] (although it is less common than in adults), increases in prevalence with age [ 3,4], and is more common among individuals who smoke [ 1].

CLINICAL IMPACT

The impact of tinnitus varies from one individual to the next. About 25 percent of persons with tinnitus report an increase in severity over time [ 5]. Chronic tinnitus is unlikely to remit completely but often becomes less bothersome over time [ 6].

Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2025© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

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Etiology and diagnosis of tinnitus - UpToDate

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Evaluation of a neck mass in adults - UpToDate

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Hereditary hemorrhagic telangiectasia (HHT): Evaluation and therapy for specific vascular lesions

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Hereditary hemorrhagic telangiectasia (HHT): Evaluation and therapy for specific vascular lesions

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Hereditary hemorrhagic telangiectasia (HHT): Evaluation and therapy for specific vascular lesions

INTRODUCTION

Hereditary hemorrhagic telangiectasia (HHT; also called Osler-Weber-Rendu syndrome) is an autosomal dominant vascular disorder associated with a variety of clinical manifestations including mucocutaneous telangiectasia, epistaxis, gastrointestinal bleeding, and iron deficiency anemia. Arteriovenous malformations (AVMs) commonly occur in the pulmonary, hepatic, and cerebral circulations.

This topic review discusses the management of vascular lesions in individuals with HHT, including epistaxis; gastrointestinal lesions; and pulmonary, hepatic, and cerebral AVMs.

Other aspects of HHT care are discussed separately:

● Pathophysiology, epidemiology, and diagnosis - (See "Clinical manifestations and diagnosis of hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome)".)

● Screening for asymptomatic AVMs and testing and counseling of family members - (See "Hereditary hemorrhagic telangiectasia (HHT): Routine care including screening for asymptomatic AVMs".)

Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2025© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.

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Hereditary hemorrhagic telangiectasia (HHT): Evaluation and therapy for specific vascular lesions - UpToDate

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Hereditary hemorrhagic telangiectasia (HHT): Evaluation and therapy for specific vascular lesions

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External otitis in adults: Treatment - UpToDate

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Society guideline links: Thyroid surgery

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Society guideline links: Thyroid surgery

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Society guideline links: Thyroid surgery - UpToDate

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Society guideline links: Thyroid surgery

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Evaluation of hearing loss in adults - UpToDate

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Society guideline links: Tonsillectomy in adults

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Society guideline links: Tonsillectomy in adults

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Society guideline links: Tonsillectomy in adults - UpToDate

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Society guideline links: Tonsillectomy in adults

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The Royal College of Surgeons of England

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The Royal College of Surgeons of England

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The Royal College of Surgeons of England — Royal College of Surgeons

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Committed to enabling surgeons to achieve and maintain the highest standards of surgical practice and patient care.

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This quality standard covers assessing and managing hearing loss in adults (aged 18 and over). It includes people presenting with hearing loss for the first time in adulthood whether it started in adulthood or earlier. It describes high-quality care in priority areas for improvement.

How to use NICE quality standards and how we develop them

Quality standards help you improve the quality of care you provide or commission. Find out how to use quality standards and how we develop them. We check our quality standards every August to make sure they are up to date.

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This quality standard covers assessing and managing hearing loss in adults (aged 18 and over). It includes people presenting with hearing loss for the first time in adulthood whether it started in adulthood or earlier. It describes high-quality care in priority areas for improvement.

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The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Translaryngeal tracheostomy (TLT), in August 2013.

Description

Tracheostomy is commonly carried out for patients in intensive care to maintain their airway, to remove excessive airway secretions and to enable them to be weaned from mechanical ventilation. This may be performed surgically but anaesthetists and intensive care physicians usually perform the procedure using a percutaneous technique, inserting a tube from the outside of the neck into the trachea, using a various devices and, commonly under endoscopic guidance.

The translaryngeal tracheostomy technique may lead to lower rates of bleeding, trauma and infection to the tissues surrounding the insertion area, compared with surgical and other percutaneous techniques. It may also avoid the risk of damage to the posterior wall of the trachea and tracheal rings, because of a lack of external compression during insertion.

E42.3 Temporary tracheostomy

Y76.3 Endoscopic approach to other body cavity

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Translaryngeal tracheostomy (TLT), in August 2013. Tracheostomy is commonly carried out for patients in intensive care to maintain their airway, to remove excessive airway secretions and to enable them to be weaned from mechanical ventilation.

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This guideline covers identifying and managing otitis media with effusion (OME), also known as 'glue ear', in children younger than 12 years. It aims to improve hearing and quality of life in children with OME.

For guidance on antimicrobial prescribing for acute otitis media (ear infection) in children and young people, see the NICE guideline on otitis media (acute): antimicrobial prescribing.

Last reviewed: 30 August 2023

This guideline updates and replaces NICE guideline CG60 (published February 2008).

Next review: This guideline will be reviewed if there is new evidence that is likely to change the recommendations.

Recommendations

This guideline includes recommendations on:

Who is it for?

Healthcare professionals

Commissioners and providers

Children under 12 years old with OME, and their families and carers

Guideline development process
How we develop NICE guidelines
Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

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Overview | Otitis media with effusion in under 12s | Guidance | NICE

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This guideline covers identifying and managing otitis media with effusion (OME), also known as ‘glue ear’, in children younger than 12 years. It aims to improve hearing and quality of life in children with OME

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Join ENT UK membership body and gain access to exclusive benefits and thousands of valuable resources.

# data[].attributes.headline
ENT and Maxillofacial Nursing: Subject Guide

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ENT and Maxillofacial Nursing: Subject Guide

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ENT and Maxillofacial Nursing: Subject Guide | Library | Royal College of Nursing

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ENT and Maxillofacial Nursing subject guide from the Royal College of Nursing Library and Archive Service. Highlights key information resources.

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Select "Click here for institutional access" if you find yourself on the login page. You may need to click this link again once you are logged in.

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HEAD AND NECK GUIDELINES

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Scott-Brown's essential otorhinolaryngology, head and neck surgery

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Scott-Brown's essential otorhinolaryngology, head and neck surgery

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Advanced ENT MCQs : training to pass the FRCS (ORL-HHNS) part 1

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Advanced ENT MCQs : training to pass the FRCS (ORL-HHNS) part 1

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Details for: Advanced ENT MCQs : training to pass the FRCS (ORL-HHNS) part 1 / › KSS Knowledge & Library Services catalogue

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ENT vivas : a guide to passing the intercollegiate FRCS (ORL-HNS) viva examination

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ENT vivas : a guide to passing the intercollegiate FRCS (ORL-HNS) viva examination

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Details for: ENT vivas : a guide to passing the intercollegiate FRCS (ORL-HNS) viva examination / › KSS Knowledge & Library Services catalogue

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Advanced ENT training: a guide to passing the FRCS (ORL-HNS) examination

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Advanced ENT training: a guide to passing the FRCS (ORL-HNS) examination

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Details for: Advanced ENT training: a guide to passing the FRCS (ORL-HNS) examination/ › KSS Knowledge & Library Services catalogue

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