CLINICAL EXPERIENCE

A broad experience was gained in all the general and emergency aspects of otolaryngology whilst working in Southampton, London, Newport, Cardiff and Liverpool. This has been complimented by two six-month periods in the USA and Switzerland.

Surgical experience in training was comprehensive and included all aspects of Head and Neck and Reconstructive Surgery, Otology and Neurotology and Skull Base Surgery, Endoscopic Sinus Surgery, Pituitary Surgery, Facial Nerve Surgery and Paediatric Otolaryngology.

Medical experience has also been comprehensive and includes Child assessment clinics , tinnitus clinics, Allergy clinics and Hearing rehabilitation clinics. Currently weekly special interest clinics in Neurotology and Skull Base Surgery are held. Endoscopic Sinus Surgery and Children’s clinics are held on alternate weeks.

Facial Plastic surgery for private patients has been complimented with a two year association with the Transform Clinic


RESEARCH EXPERIENCE

Clinical research has included prospective trials, retrospective studies, clinical reporting and the description of new surgical techniques. The description of new surgical techniques has been particularly important over the last 10 years since Skull Base Surgery has been a rapidly advancing part of Head and Neck Surgery. In combination with my Neurosurgical Colleagues a description has been made of the Walton technique of lateral skull base surgery. This is a synthesis of all the previous techniques that have been described and allows a tailored approach for every individual lateral skull base tumour such that morbidity is minimised and access is maximised. The aspects of all the approaches are added together from the far lateral approach described by Spetzler to the maxillary swing popularised by Wu. On a more mundane level we have also described the benefits of subtotal petrosectomy in lateral skull base CSF leaks. In the generality of ENT I have described 6 new procedures. First, the use of new tissue for repairing the ear drum, the endaural subcutaneous tissue. Second, the use of histoacryl glue in ear surgery in both adults and children. Third, the Lesser malleus osteotomy to provide access to the anterior part of the middle ear for removal of tumours and cholesteatoma, the septotomy for anterior access to the maxillary sinus, the helix transfer meatoplasty and lastly the Lesser technique for insertion of drugs into the inner ear via the round window. This is used for Gentamicin and Dexamethasone and may be used for other drugs in the future. The Lesser technique has revolutionised the management of Meniere’s disease throughout the UK and is now used throughout the United Kingdom. It has been presented at a number of forums, lastly at the Royal Society of Medicine and at the ENT CME conferences. This has provided a cure for many people with debilitating Meniere’s disease for whom no cure was available. It was following the use of this on one patient that I was nominated as an Unsung Hero of the National Health Service.

As well as the description of surgical techniques the management of acoustic neuromas has changed in the United Kingdom following the lead that I have given on this. I commissioned the clinical effectiveness document on acoustic neuromas on behalf of the British Association of Otolaryngologists/Head and Neck Surgeons and am part of the very first MDT in the United Kingdom and possibly in the whole of Europe for the management of acoustic neuromas with my Neurosurgical and Radiotherapy colleagues.

PREVIOUS RESEARCH

Quality of life in Head and Neck Cancer. In 1985 I developed the second specific Head and Neck Cancer Quality of Life questionnaire. The SSS questionnaire dealing with swallowing, social and speech issues before and after the diagnosis and treatment of head and neck cancer. This was based on the very good questionnaires which have been developed by the Speech Therapy Scientists for people who had had strokes. I developed and used this questionnaire for a period of two years and found that it, in common with other assessments of quality of life, was no better than a linear analogue self assessment scale with worse possible and best possible at either end.

Laryngographography. I was the first to apply the techniques of laryngographography to the diseased larynx developing the technique following visiting Professor Forcin at the University College who gave me one of the first laryngographs. I was able to use this for defining the different disease processes affecting the larynx and developed it as a measure of post operative hoarseness.

Rats. In an attempt to define if free radical scavengers were able to decrease re-profusion injuries in random and axial flaps I experimented on some 200 Spraig Doley rats. After these were sacrificed I decided that animal experimentation on rats was not of benefit to human medicine.

Implants in Ears. With my colleagues in America I developed the electromagnetic implantable hearing aid and I undertook the surgery for the first implant into Macac Monkeys, we developed the technique for doing brain stem evoked responses on this model.

This did provide very useful information, not just in terms of the fact that totally implanted middle ear hearing aids have a viable future but because of the technology of the time it will be one in the long term future. It did provide very valuable information on the tension and pressure that ossicular replacement prosthesis need to have, not only to hold it in place but to transmit sound optimally and this has been used by many other scientists and surgeons since then as a seminal piece of work.

Titanium Moulds for Ossicular Regrowth. During my time I became an expert in the interface between materials and the body and I developed a mould machined from titanium, which was inserted into the patients skull at a time when they were having a staged operation for cholesteatoma. The theory was that inside the titanium mould the bone dust that was inserted would turn itself into an Ossicle made by the patient. However, this was totally unsuccessful but fortunately did no patients any harm.

Finite Element Analysis of the Tympanic Membrane and Middle Ear. This was part of the basis of my MS thesis for the University of London in 1995. I was interested to note that in 2001 that at the Royal Society of Medicine, a whole afternoon was dedicated to finite element modelling of the middle ear and its applications, it was said that “no self respecting otologist would undertake experiments on humans without a finite element model”. The model that I created was the very first in the world and all of the current models have been based on the techniques that I developed and introduced. There was one abject failure from the finite element analysis and that was the development of a new grommet to minimise the effects of tympanosclerosis. This, in combination with a commercial company went all the way up to the manufacturing stage using material that is part of Nascar racing car bodies, however, the manufacturers withdrew this as being an American company they were concerned about litigation. Sadly no other material is as yet available to replace this.


Vestibular Rehabilitation in Fallers. A Research Registrar and a Research Nurse undertook this work. It highlighted the problem of dizziness in fallers and the dramatic benefit of vestibular rehabilitation in preventing further falls.

SUPERVISION OF RESEARCH AND THESIS

As well as examining a number of MD and MCh and MSc thesis I have supervised one MSc and two MDs.