What if i'm referred with a head and neck problem?

We strive hard to make sure you are seen on time but providing medical care is extremely complex. There are many reasons why there are delays including:-

• Unfortunately we can only allow 15 minutes for a New patient appointment - some patient's problems are very complex requiring longer than their allotted time.

• Extra urgent patients are often added to the normal numbers seen in a clinic because results or decisions about their treatment need to be made quickly. Everyone wants to be seen as quickly as possible but we have limited capacity and resources. Remember this is what you would want if you were in that situation.

• Doctors may be delayed because they have to sort out other urgent or emergency problems.

• Patients requiring hospital transport sometimes arrive late or need to be prioritised and seen quickly. They may be severely unwell or may miss their lift back if delayed causing them to wait for hours in the department.

• The consultant has to supervise other members of the team which may delay your appointment.

• Occasionally we have to wait for results to come back during the clinic if they are clinically required for the same day.

You will receive your appointment within two weeks of referral. It is very important that you make every effort to attend. This may require you to alter your plans at the last minute, but it is essential that we begin investigations and treatment (if necessary) as soon as possible.

We encourage you to bring a partner, relative, close friend or carer to your appointments for support, as we will need to discuss your condition with you in detail.
This may involve: 

• talking about complex clinical issues which you may have

• the tests or treatment you may need

• and giving good or bad news which could be upsetting.

Having someone with you also helps you take in and remember the important information you will be given. It is often difficult to recall it on your own.

Please do not wear high-necked clothing or jewellery around your neck as it is likely the doctor you will see need to examine this area. Lipstick and eye makeup may be smudged or run during the examination procedures so be prepared!

Please also remember to check your appointment letter for anything specific you have been asked to take with you. In addition, it would be helpful if you could bring the following:

• Your full address and telephone contact number(s)

• Your appointment card and appointment letter

• Your GP’s name and address

• Money to pay for any prescriptions, or an exemption card

• A list of questions you may want to ask the doctor

• A list of your current medications.

The Ear, Nose and Throat Department is on A floor in the Eyes, Ear, Nose and Throat Building (EENT). When you arrive please go to the Reception desk immediately on your right as you enter the department ( See:How to get to the EENT Building at the QMC Campus). You may be directed to Reception area 2 which is a little further round the corner in the department. You may be asked to check in there.

During the check-in process the receptionist will make sure your personal details are correct and that they match the details we have on the Hospital system. This is an opportunity to update details if, for instance, you have recently moved house or changed GP. Once checked in you will be directed to a seating area where you will wait until called to see a doctor by one of the clinic nurses.

Unfortunately there are often delays in being seen the clinic (see:Why am I not being seen at my appointment time?). You need to allow at least two hours for your appointment so please bring reading material or other non-intrusive devices such as personal music players with head phones to occupy you if you wish. There is a television in Clinic 2 waiting area.

Please note:

• that if you bring valuable items you do so at your risk

• there is no storage area for any personal belongings/bags that you may bring with you

• there is no public access Wi-Fi available in the waiting area

Please also note:

• that we are a teaching hospital, so medical students may be present for some appointments. If you do not wish to have them in the room please let the nurse or doctor know and the students will be asked to step outside.

• you may not always see the consultant whose name is on your appointment letter. Most consultants have trainee doctors (registrars, Trust doctors) working with them as part of a team. They will discuss your problem with the consultant.

• although you will initially be seen by a doctor, you may have to see more than one team member or be asked to attend other departments within the hospital. This may also add to the time you need to be at the hospital and unfortunately is not predictable.

Once called into the room a doctor will first take a detailed history of your symptoms.

A lot of information is now available on computer which means the doctor may frequently have to check this during your consultation.

You will then be examined and depending on the problem this may involve:

• an examination of the inside of your mouth and back of throat

• examination of your nose and ears

• an examination of the back of the nose (nasopharynx) and deeper part of your throat (hypopharynx) and voice box (larynx) with a small tube (see: nasoendoscopy)

• and a feel (palpation) of your neck

In some clinics your surgeon may be able to perform biopsy for you there and then which may involve:

• taking a sample of cells from a lump using a small needle (see: Fine Needle Aspirate)

• taking a small sample of tissue taken after numbing the area (see: incisional biopsy, core biopsy or punch biopsy)

Once you have been assessed the surgeon will then be able to:

• reassure you and discharge you
• recommend treatment without further tests
• advise you that you need further tests before a diagnosis can be made or confirmed or treatment advised

Depending on the problem further tests may include one or more of the following:

• an ultrasound scan
• a CT scan of your neck and chest
• an MRI scan
• a PET-CT scan
• a gastroscopy
• barium swallow X-ray
• an examination of your mouth, the deep part of the throat (hypopharynx), voice box (larynx), swallowing passage ( oesophagus), wind pipe and bronchial tubes (trachea and bronchi) with biopsy of any abnormal tissue under a general anesthetic (see: Panendoscopy)
• a tonsillectomy under general anaesthetic
• a lymph node biopsy under a local or general anesthetic