Scott-Brown’s Otorhinolaryngology Head and Neck Surgery, Volumes 1–3, 8th edn

Review by L Flood
Middlesborough, UK

Since the 1950s, Scott-Brown’s (we never use the full title, we do not need to) has guided generations of ENT surgeons through training, clinical practice and then teaching others. For many, last-minute reading allowed us to examine with great authority on topics in which we were actually profoundly ignorant.

Editing a new edition is a massive task, which the preface admits may have been grossly underestimated. To produce 330 chapters, even in this digital age of instant communication, still requires many a reminder, an appeal, even a threat to the numerous authors. Contributors are largely UK-based, but citizens of over 20 countries add to the content, we are assured.

There are many challenges to reviewing what is, after all, a cherished national institution. The editors, and indeed many an author, are old friends. Would I have dared to repeat the outrage I expressed when reviewing the 6th edition in 1996? What could I add to the masterful review by Emma Stapleton in the July/August issue of ENT and Audiology News? (I now had the advantage of the book itself and not just the Portable Document Format (PDF) proofs. At my age, I simply could not have read this off a monitor as she did and done it any justice). Which leads me to another chal- lenge. This is no pocket book. The set of three books weighs a ton (actually over 14 kg) and, setting out from my office to the hospital car park, I rapidly decided I did not have the physique to make it in a single journey.

The immediate impression is of a vast content, and a totally revised look, content and style. My review could almost end there, because, let us face it, at the very least, every UK department has to have the latest copy. Yet, in 1996, I felt the revisions were so minor (and frequently disastrous) that there was little justification for an expensive replacement of the earlier edition. How things have changed.

For example, half of Volume 1 deals with head and neck endocrine surgery. A few decades ago, the odd (and by that I do mean the occasional) ENT surgeon would maybe gaze up a nose to access the pituitary gland. Few, however, would tackle the thyroid gland and fewer still the parathyroids. At 350 pages, this text would justify a book of its own and shows how our practice has expanded. I must ask Sean Carrie or John Hill, though, why the poor chap shown in Figure 82.1, as head and shoulders, is so typical of hypopituitarism, especially as the accompanying text suggests that his reproductive system is most likely affected. To my untrained eye, he is surely ‘NFN’ (normal for Newcastle). But I digress.

The basic sciences section is always a marker of how truly updated is any book. This can, of course, also be indicated by searching the list of references in every chapter for those dated after the millennium. This work passes both tests magnificently. Nearly 600 pages of ‘basic sciences’ (again enough for a book in itself) covers the obvious topics such as immunology, wound healing or microbiology, but is most impressive on ‘recent advances’. These include optical coherence tomography, contact endoscopy of the upper aerodigestive tract or ‘Recent Advances in Technology’ (a brilliant chapter). This section also goes beyond the ‘hard science’ with what are sometimes termed ‘the softer skills’ of communication, ethics and clinical governance, and an intriguing chapter entitled ‘Non technical Skills for ENT Surgeons’. This is thought-provoking stuff on leadership, situational awareness, decision making and just how to be an effective surgeon. My old friend and colleague, Maurice Hawthorne, provides two chapters based on his career’s medico-legal experience, and the personal anecdotes make for great reading (and that is not just Blarney). There follows over 50 pages on research, data interpretation and evidence-based medicine. Indeed, an excellent feature of almost every chapter in the book is an addition to the usual boxed ‘key points’ and ‘best clinical practice’. This is a boxed recommendation on topics for future research, a rare and very welcome supplement.

Now, by the end of day 1, I was only about 1000 pages into Volume 1, with over 300 pages still to go on rhinology. If this review was ever to be completed, it was time to concentrate on those chapters where I could claim some expertise. Having read both of them, I could at least spot the occasional minor error, of which more anon.

For some reason, after a career in otology, I have written a series of papers on paediatric ENT recently, so must be an expert somehow? Well, there are over 500 pages here, again enough for a book on its own. This is a topic that always lends itself to superb photography, as here. Just see chapter 30 on congenital airway disorders or chapter 44 on oesophagitis. I have heard of the ‘EXIT’ (ex utero intrapartum treatment) procedure, but never seen it illustrated, and I do marvel at the surgical skill and steady nerve required. Now I have also read of the marvellously entitled alternative, ‘OOPS’ (operation on placental support)!

There is of course wide coverage of audiology, again superbly updated. Read chapter 58 on autosomal dominant non-syndromic sensorineural hearing loss; it proves far easier going than its daunting title suggests. The most impressive feature was that the references are almost exclusively post 2000 and, indeed, one is dated 2018! I did read all through ‘Idiopathic Sudden Sensorineural Hearing Loss’ but, bless them, the authors really could add little, as there is very little knowledge to add, in all fairness. I did enjoy that old chestnut ‘Spontaneous improvement in hearing is most likely to occur in the first 2 weeks’ followed, only two lines later, by ‘Early corticosteroid treatment within the first two weeks is associated with greatest hearing recovery’. Two chapters I did enjoy were on subjects where, in my experience, nothing works, namely granular myringitis and obliterative otitis externa. The nice illustrations and useful tips (almost) made me wish I was not retiring in two months. A short ‘pearl’ of a chapter, by one Tristram Lesser, was probably the first I have ever read that sensibly distinguishes the various erosive diseases of the bony external ear canal. To prove I did read much of this book, I will suggest that Figures 91.7 a and b might puzzle a few, and need transposing to fit the legend to the illustration. I know which of the two ears I would prefer! Imaging of the temporal bone is briefly covered but, frankly, every otology chapter is filled with superb quality illustrations of scans and radiology atlases abound, for those interested. Again, the perils of so many illustrations, regarding Figures 105.2 or 105.5, I cannot resist suggesting that cerebrospinal fluid appearing white on a magnetic resonance imaging scan suggests a T2-weighted image. Again, let me stress this is only mentioned to prove to the likes of Martin Bailey that I do actually read (much of anyway) the books I review!

Finally, Volume 3 covers the head and neck (over 1000 pages) and plastic surgery (250 pages). Conventionally, chapters deal with the various sites of tumours, operative and non-operative management, and again those basic sciences. Once more, what impressed was the contemporary updates on transoral laser surgery, robotics and (I really liked this one) the hunt for the unknown primary (this last with references dated 2018!).

I flicked through this, next to the 7th edition, and was struck by the transformation, in terms of the print quality, illustrations, sensible use of coloured boxes for key points and, again, that inspired feature ‘future research in’. Each of the books can be purchased alone, and colour coding along the top right corner of each page helps with orientation.

My only criticism is just how massive this is. I have several times in my review praised a section as meriting a book of its own. I do feel the three books would have been less unwieldy as maybe five books. The binding I am sure can take the weight, but I do wonder about the spine. I freely confess to complete ignorance here, and I am sure the publishers are the professional experts and my fears are groundless. Maybe I will get mine leather-bound, or even enter the twenty-first century and access the online version, by attacking that scratch-off panel. Yet, somehow, I agree with Emma Stapleton and her desire for ‘glossy pages, fresh ink and delicious creak as I open the hardback cover’. Actually, the last feature is my one reservation.

I would like to believe that, if this had been rubbish, I would have said so, even if more tactfully than I did in 1996. Instead, it is a brilliant achievement by the editors. Just compare the cost with one examination entry fee, or what you get back for your annual subscription to the Colleges of Surgeons, once admitted to Fellowship.

Amazon Link: Scott-Brown’s Otorhinolaryngology Head and Neck Surgery, Volumes 1–3, 8th edn
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