Laryngology: Clinical Reference Guide

Review by L Flood
Middlesborough, UK

Whenever the postal delivery worker brings a heavy box from this US publisher, I am taken back some (quite a few actually) decades to the excitement of many a Christmas morning. As I struggle with the indestructible packaging, I hope that I have been good all year and the contents will be what, like those girls sang, I really really want, something of relevance to our readership. Plural Publishing do annually also publish a vast range of books aimed more at audiologists, or speech or language pathologists, than ENT surgeons, but this parcel proved that I have been recorded as ‘nice and not naughty’ on Santa’s list.

For me, this is a godsend. I have somehow been ‘volunteered’ to provide a series of e-learning question and answer topics for the new Asia-Pacific Laryngology Association. Well, with four subjects done (arytenoid granuloma, leucoplakia, laryngomalacia and papillomatosis), I had exhausted any suggestion of expertise. That was until this book arrived, of course.

Most of us are familiar with the format of the paperback Clinical Reference Guide series, and especially Pasha’s Otolaryngology Head and Neck Surgery. These are characterised by a pocket-sized (if needing a very large pocket though) delivery of bullet-pointed text, ideal for ‘dipping into’, marvellous for pre-examination revision and all very well updated. The Preface concedes that this is not a 2000-word laryngology textbook, but its style does allow a great deal of easily accessible data to be amassed in its 534 pages.

The book opens with a very readable chapter on the history of laryngology, from Imhotep of Ancient Egypt, to the Sataloff of our own day. Basic science chapters include a real pearl in ‘Patient History and Physical Examination’. I can now, with great authority, speak of such vocal fold abnormalities as decreased amplitude, glottic gap, mucosal wave abnormalities and so on. How many readers knew that, during endoscopy, you should get the patient to count 60–69 to detect abductor spastic dysphonia, and 80–89 for adductor spastic dysphonia? As an otologist, I had long been baffled by the acronym (or maybe it is an initialism, as unpronounceable) of ‘GRBAS’ (grade, roughness, breathiness, asthenia, strain scale), but can now even offer ‘CAPE-V’ (Consensus Auditory-Perceptual Evaluation of Voice) as an alternative. The text is even better on special investigations, whether stroboscopy, electromyography and all the armamentarium of the clinical voice laboratory.

You would expect extensive coverage of trauma, tumours, inflammatory diseases and congenital abnormalities, and will not be disappointed. What was particularly novel though was a collection of four chapters on neurolaryngology, one on ‘Cough and the Unified Airway’ and, especially thought-provoking, ‘Care of the Transgender and Gender Nonconforming Patient’. I had always wondered why there was seemingly only a type II thyroplasty (for vocal fold paralysis), but have finally discovered the type IV, a cricothyroid approximation, along with several others aiming to raise vocal pitch. Dysphagia, reflux and oesophageal dysmotilities, with the appropriate investigations, make up no fewer than 60 pages, despite the book title. Add to that a very easily understood chapter on pulmonary function tests, and this proves a very comprehensive work indeed.

Overall, I found this the best of the Clinical Reference Guide series, as it is clinically relevant throughout, but dealing with a subject of which I know little in truth. Laryngology has developed more than most ENT subspecialties, yet has remained a niche (almost a minority) interest in the UK and a mystery to those of my generation. Books such as this are changing all that, and I see that Plural Publishing will shortly be releasing a further laryngology text from some well-known UK authors, the local ‘big names’. I feel a letter to the North Pole coming on.

Amazon Link: Laryngology: Clinical Reference Guide
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