ENT

The Otolaryngology (ENT) department in NHS Tayside is a multi-disciplinary team comprising medics, specialist nurses and administrative staff. We are predominantly outpatient based; approximately 15% of activity requires a day case procedure or inpatient stay. ENT has close links with the audiology service particularly in relation to balance and hearing clinics. We run in-person clinics in Ninewells, Perth Royal Infirmary and Stracathro and operate in Ninewells.

Our staff:
Consultants: Patrick Spielmann (Clinical Lead), Kerry Haddow, Stephen Jones, Peter Ross, Quentin Gardiner, Richard Green, Rodney Mountain, Samit Majumdar, Ceilidh Kennedy, Jaiganesh Manickavasagam
Registrars: Richard Steven, Somayyeh Shahsavari, Aaron Ferguson, Rasads Misirovs, Clara Smith, Ruqqash Naveed
Specialist Nurses: Elaine Muir, Grace Gibbons
Specialist pharmacist: Ashleigh Harvery

Emergency:

• Intractable epistaxis,
• Tonsillitis (not eating and drinking after appropriate analgesia),
• Quinsy,
• Deep neck space infection,
• Foreign body (airway, button battery),
• Supraglottitis airway obstruction,
• Septal haematoma,
• Sharp (bony) food bolus,
• Adult periorbital abscess,
• Otitis externa with pinna/facial cellulitis,
• Mastoiditis.

Urgent Outpatient:

• Nasal trauma (within 2 weeks of injury),
• sudden sensorineural hearing loss,
• Foreign body (not in emergency list).
• Suspected head and neck cancer with red flags in head and neck/rhinology/otology. Please see Scottish referral guidelines for suspected cancer. Also please refer to RefGuide document for further guidance.

Routine Outpatient:
We see diseases of the ear, nose and throat. Below are some of the common routine referrals and guidance ( blue hyperlinks): 

Otology

• Cholesteatoma (NICE CKS)
• Ear wax (if guidance met)

• Persistent Facial Nerve Palsy

• Hearing loss 
• Otitis externa 
• Vertigo (see document for exclusions)
• Tinnitus 

Rhinology

• Anosmia
• Epistaxis 
• Nasal block
• Nasal trauma (guidance and exceptional referral protocol for rhinoplasty)
• Symptomatic septal perforations

Head and neck

• Feeling of something in the throat 
• Lump in neck
• Snoring 
• Swallowing disorders above the sternal notch
• Tonsillitis
• Voice change not meeting urgent criteria.

Paediatric ENT

• Nasal block
• Non-suspicious neck mass
• Otitis media with effusion 
• Pinnaplasty
• Recurrent acute otitis media

Specialist services

• Auditory implant service
• Grampian, Highland and Fife regional service
• Revision septo-rhinoplasty
• Neurosurgery skull-base team – includes a regional service to Highland and Fife
• Wasp and bee anaphylaxis
• Hereditary haemorrhagic telangiectasia
• Laryngology voice and swallowing service – this is provided regionally
• Balance service  
• Fife and Forth Valley regional service
• Paediatric respiratory service

We often operate with other specialties and the referral route may initially start with the other speciality:
• Epiphora (Ophthalmology) 
• Pituitary tumours (soon to be found under Neurosurgery)
• Skin lesions even if ear or nose (refer to dermatology/maxillofacial/plastic surgery depending on the site of the lesion)

Emergency or urgent
• Soft food bolus, with no airway concern (general medicine)
• Suspicious paediatric neck mass (soon to be found under paediatrics)

Head and neck
• Thyroid without compressive symptoms (General surgery)
• Tonsillitis not meeting the previous sign guidance
• Snoring (Patients with suspected obstructive sleep apnoea should be referred to Respiratory Medicine as per their guidance, which will be available in due course)

Otology
• Ear wax (please read guidance)
• Hearing loss not listed above (even if unilateral, refer to audiology)
• Tinnitus not listed above (refer to audiology)
• Vertigo (Suspected or confirmed BPPV refer to audiology, with neurological symptoms - neurology, dizziness with cardiac symptoms, arrhythmia or low BP - cardiology)

Rhinology
• Facial pain (Unless clear rhinological cause suspected). Most facial pain is neurological in nature.
• Nasal cosmetic deformity that don’t meet the exceptional referral pathway guidance.

Emergency referral or urgent advice via on-call team through Ninewells switchboard 01382 660111. Please be aware the person holding the bleep may be in clinic, treating a patient or in theatre. Please check the RefGuide advice. There are currently 18 referral pathway guidelines.
 
Outpatient referrals or non-urgent advice through SCI Gateway ENT, flagged as urgent (suspected cancer), urgent, routine or advice. 

Urgent advice is available from ENT Registrar through Ninewells switchboard 01382 660111. 
Non-urgent advice available through SCI Gateway advice. 

ENT Section NHS Tayside Formulary
NICE Clinical Knowledge Summaries ENT Section

Links to various guideline pages are repeated below for convenience. These links will open as a separate page.