Bassem Saleh
Copyright © 2026 Bassem Saleh
All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the author, except for brief quotations in a review or scholarly work, or as permitted by copyright law.
Web edition · September 2026
About this book
This book gives general information about common ear, nose and throat conditions. It is for education only. It is not personal medical advice.
It cannot tell you what is wrong with you, and it is not a substitute for seeing a doctor, nurse or other qualified health professional who can assess you in person. Whether a treatment is right for you depends on your own health and circumstances.
The warning signs in this book are a general guide. They do not cover every situation. If you are worried about your health, or someone else's, get medical help. If it may be an emergency, call your local emergency number.
Medical knowledge and guidance change over time. This book reflects information and guidance available in September 2026. Always check current advice with a health professional.
The patient stories in this book are made up. They are composites, written to show common experiences. They are not about real, identifiable people.
This book describes practice in the United Kingdom and the National Health Service (NHS). Services, names and phone numbers are different in other countries. Where the book says "GP", "NHS 111" or "A&E", use the equivalent service where you live.
Reading this book does not create a doctor–patient relationship between you and the author.
The author and publisher have taken care to make the information accurate and up to date. To the extent permitted by law, they do not accept liability for any loss, injury or damage arising from use of, or reliance on, the information in this book.
For my parents, who always pushed me to keep learning.
I am an ear, nose and throat (ENT) doctor. I trained in Egypt and now work in the United Kingdom, within the National Health Service (NHS).
Over years of clinic appointments — most of them far too short for everything a worried patient needs to know — I kept meeting the same uncertainty: what does this symptom mean, what will happen next, and what can I safely do while I wait? This book is my attempt to answer those questions properly, in plain English, for anyone who wants to read them in their own time rather than in a rushed ten minutes.
I wrote it in simple language on purpose. Many of my patients read English as a second language, and complicated medical writing shuts people out exactly when they most need to understand what's happening to them. If a plainer sentence says the same thing accurately, I have tried to use it.
— Bassem Saleh, United Kingdom, 2026
Before we start, a few words about how this book works.
I am an ear, nose and throat (ENT) doctor. In my clinic, I meet many people who feel worried and unsure — unsure what their symptoms mean, unsure what will happen at their appointment, and unsure what they can safely do while they wait. This book is my attempt to answer those questions in plain, everyday words. It covers common problems of the ear, nose and throat, and of the balance organs, which sit inside the ear.
One thing needs to be clear from the start. This book gives general information. It is not personal medical advice. It cannot tell you what is wrong with you, and it does not replace seeing a doctor, nurse or other health professional who can examine you.
This book can help you:
This book cannot:
There are three ways to find your topic:
Each chapter is written so that you can read it on its own. This means a few important points, such as warning signs, appear in more than one place. That is on purpose.
Most chapters follow the same order, so you always know where to look:
In each chapter, the section called When not to wait holds the warning signs. The signs are sorted into three levels, and each level tells you what to do.
| Label | What it means | What to do |
|---|---|---|
| Emergency – act now | Could be life-threatening, or could cause lasting harm within hours | Call 999 now, or go straight to A&E (the hospital emergency department) |
| Get help today | Needs to be seen the same day, but is not an immediate emergency | Contact your GP (your family doctor) for an urgent appointment today, or call NHS 111 (the NHS phone and online service for urgent problems that are not emergencies) |
| Get this checked soon | Should be looked at within days to a couple of weeks | Make an appointment to see your GP |
These lists are a guide. They do not cover every situation. If something worries you, or does not feel right, get medical help even if it is not on the list. Trust your instinct.
Chapter 4 brings all the main warning signs together in one place. If you think you have one now, turn to Chapter 4 before you read on.
This book uses plain English on purpose. When a medical word is useful, it is explained the first time it appears, and then the everyday word is used.
A few short forms come up often:
At the back of this edition there is a glossary in plain English.
This book follows the way ENT care is usually given in the UK, through the National Health Service (NHS). If you live somewhere else, the ideas still apply, but the names are different:
The warning signs are the same wherever you live. Chapter 34 has more on using this book outside the UK.
This book is written by an ENT doctor who trained in Egypt and now works in the UK. It is written in simple English so that it is useful to as many people as possible, including readers who use English as a second language.
Each chapter is based on guidance from trusted sources, such as NICE, the NHS website and ENT UK, and has been reviewed by the author. There is a fuller note about the sources at the back of the book.
You do not have to use this book alone.
Take what is useful here, and set the rest aside. Ask your own doctor or nurse if anything is unclear.
And keep in mind the point that matters most: this book is general information, not a diagnosis. If you are worried about your health, or someone else's, get medical help. In an emergency, call 999, or your local emergency number.
This chapter explains how to use the book. The meaning of 999, NHS 111 and GP urgent care follows NHS advice, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor on September 2026.
You do not need to know anatomy to use this book. But a simple picture of how these parts work makes the later chapters easier to follow, and it helps you understand why the doctor asks what they ask.
Everyone is built a little differently. Sizes, shapes and small details vary from person to person. That is normal.
The ear, the nose and the throat are really one connected system. A doctor who works on one usually works on all three, because a problem in one place often shows up in another.
The ear has three parts: the outer ear, the middle ear and the inner ear.
The outer ear is the part you can see (the pinna) and the short tunnel behind it (the ear canal). The canal ends at the eardrum, a thin, tightly stretched layer of skin about the size of a small fingernail.
The middle ear is a small air-filled space behind the eardrum. Inside it are three tiny linked bones – the smallest bones in your body. They form a bridge from the eardrum to the inner ear.
A narrow tube runs from this space to the back of your nose. It is called the Eustachian tube. Most of the time it is closed. It opens when you swallow or yawn, to let air in and keep the pressure equal on both sides of the eardrum. This is why your ears "pop" in a plane or a lift, and why a heavy cold can make them feel blocked – the tube is swollen and cannot open properly.
The inner ear holds the hearing part, called the cochlea. It is a hollow coil, shaped like a snail's shell, filled with fluid. Its lining is covered with thousands of tiny hair cells.
Here is how a sound gets from the air to your brain:
Different hair cells respond to different pitches. When hair cells are damaged – by ageing, loud noise or some illnesses – they do not grow back, and that part of the hearing is lost. Chapters 5 to 10 cover hearing and ear problems in detail.
Right next to the cochlea sits your balance organ. It has two parts:
These send a steady stream of signals to the brain about where your head is and how it is moving.
But the inner ear is only one of three things your brain uses for balance. The other two are:
The brain adds all three together. When they agree, you feel steady and do not think about it. When they disagree – for example, reading in a moving car, when your eyes say "still" but your inner ear says "moving" – you can feel sick or dizzy. Many balance problems happen because one of the three is giving the brain the wrong information. Chapters 11 and 12 cover dizziness and balance.
The inside of the nose is bigger than it looks. It is a tall space, divided down the middle by a wall of cartilage and bone called the septum. This gives you a left passage and a right passage.
On the side wall of each passage are curved shelves called turbinates, usually three on each side. Air swirls around them on its way through. As it does, the nose:
The filtering works like this. The whole inside of the nose is covered by a moist lining that makes a thin layer of mucus. Dust, smoke, germs and pollen stick to the mucus. Tiny hairs called cilia then sweep the mucus slowly backwards to the throat, where you swallow it without noticing. Stomach acid deals with most of what is caught.
The sinuses are air spaces inside the bones around the nose – in the cheeks, in the forehead, and between and behind the eyes. Each one drains into the nose through a small opening. We are not completely sure what the sinuses are for. They may lighten the skull, help warm and moisten the air, and add resonance to the voice. When a cold or an allergy makes the lining swell, these small openings can block, and the sinus feels full or sore. Chapters 13 to 16 cover the nose and sinuses.
High up inside the nose are the nerve endings for smell. Air has to reach them for you to smell properly, so a blocked nose dulls both smell and taste. Chapter 17 covers smell in full.
The nose is also the way you are meant to breathe most of the time. Breathing through the mouth skips all the warming, moistening and filtering.
The throat is the shared space behind your nose and mouth. It is a crossroads: air passes through it on the way to the lungs, and food and drink pass through it on the way to the stomach. Two tubes lead down from it:
At the top of the windpipe is the voice box. Across it stretch two soft bands called the vocal cords. When you breathe quietly, they sit apart and air passes freely. When you speak or sing, they come together, and air pushed up from your lungs makes them vibrate.
Here is how that becomes speech:
Making the vocal cords tighter or looser changes the pitch. Chapters 18 to 22 cover the throat, voice, swallowing and snoring.
The voice box has a second, more important job: keeping food out of your lungs. Just above it sits a small flap called the epiglottis. When you swallow, it folds down like a lid over the entrance to the windpipe.
Swallowing happens in a set order, in about a second:
If any step is weak or out of order, food or drink can go "the wrong way" and make you cough. Doing this often, or with most meals, is worth getting checked (see Chapter 21).
Near the back of the mouth and nose are the tonsils and adenoids. These are soft pads of tissue that are part of the body's defences. They meet germs that are breathed in or eaten, and help the body learn to fight them. They are busiest in early childhood and often shrink later in life. If they have to be removed, the rest of the immune system carries on the work.
Because these parts share space, air and nerves, a problem in one often affects the others.
This is why an ENT doctor examines the ear, the nose and the throat together, even when your problem seems to be in only one of them.
This chapter describes normal anatomy and how these parts work. It is based on standard anatomy and physiology texts and NHS information, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026.
This chapter is about the appointment itself – how you get one, who you will meet, what the examination is like, and what happens at the end. Knowing this in advance makes the visit easier.
Every clinic is a little different. Take this as a general guide, not an exact script.
Most people are sent to an ENT clinic by their GP (their family doctor). You can also be referred from A&E (the hospital emergency department), from another hospital doctor, or sometimes by a dentist or an optician. There is also a private route, which you pay for.
Your referral is given a priority:
How long you wait for a routine appointment varies a lot. It depends on where you live and how busy the service is, and it can be long. If you have been waiting a while, or your symptoms are getting worse, you can chase it: call the hospital's booking team, ask your GP to follow up, or contact the hospital's patient advice service (in England, PALS – the Patient Advice and Liaison Service).
If a new warning sign appears while you wait – see Chapter 4 – do not sit on it until the appointment. Contact your GP, or call NHS 111 (the NHS phone and online service for urgent problems that are not emergencies).
The ENT team includes several kinds of staff:
You should be told the name and role of the person you see. Ask if you are not sure.
Hospitals also train students. A medical or nursing student may ask to sit in, or to look in your ear under supervision. You can say no, and it will not affect your care.
The talking part of the appointment matters as much as the examination. It often tells the doctor more than any test.
Expect questions about:
Some of this feels very personal. It is asked because it changes what the problem is likely to be, and what treatment is safe. For example, smoking and alcohol change how a long-lasting hoarse voice is assessed. What you say goes in your medical notes and is shared with your GP and the care team. It is not shared with your employer or your family without your permission, so it is worth being honest.
The doctor washes their hands, puts on a bright headlight, and usually sits you in a chair that can tilt back. A good light is the main tool in ENT.
Your ears. They look at the outside of the ear and behind it, then gently pull the ear to straighten the canal and look inside with an otoscope – a small torch with a magnifying lens. They may use a microscope for a bigger view, and to clean out wax or discharge with gentle suction, which sounds loud but is quick. They may hold a humming tuning fork against your head and beside your ear; this compares the different types of hearing loss.
Your nose. They lift the tip of your nose and use a small device to open the nostril a little, with a light, to see the dividing wall, the shelves along the side, and the lining. A decongestant spray is sometimes used first to shrink the lining so they can see further back.
Your mouth, throat and neck. They look inside your mouth with a light and a flat stick that holds the tongue down, and ask you to say "aah". Then they feel your neck, usually standing behind you, checking the glands, the thyroid and the salivary glands for any lump.
None of this should be painful. The tongue stick can make you gag for a second, and the pressing on your neck is firm. Tell them if anything hurts, and they will stop.
To see the back of the nose and the voice box, the doctor needs a camera, because these parts cannot be seen through the mouth. This test is called a nasendoscopy.
Here is what happens:
It feels strange rather than painful. Your eyes may water, and you may gag or sneeze once. You can ask the doctor to pause or stop at any time. You can usually watch the screen yourself, which many people find reassuring. If a throat spray was used, wait until the numb feeling wears off before eating or drinking, so that food does not go down the wrong way.
Some tests are done in the same visit if the equipment is there – a hearing test, for example, when audiology is next door. Others are booked for another day: balance tests, allergy tests, a sleep study, scans, an ultrasound with a needle sample, blood tests, or a small tissue sample (a biopsy). Chapter 26 explains the common tests.
The appointment usually ends with a plan. It may be one of these:
Good things to ask before you leave:
It helps to ask for the diagnosis, or the main points, to be written down.
After the visit, the clinic writes a letter to your GP. In most of the NHS this letter is also sent to you; if not, you can ask for a copy. It is fine to ask for anything in it to be put in plain words.
Results reach you in different ways – a letter, a phone call, a follow-up appointment, or through your GP. Simple results come back quickly. Scans and tissue samples take longer.
If you were told "we will contact you if there is a problem", it is still reasonable to chase after the time you were given. Do not assume that no news is good news.
You are entitled to ask for:
A short amount of preparation makes a ten-minute appointment go much further. Chapter 32 has a full checklist and a one-page sheet you can fill in, and every symptom chapter ends with its own prep sheet.
This chapter describes how ENT clinics usually work in the UK. It is based on standard NHS practice and professional guidance, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026.
Most people who read this page will not have a serious problem. These signs are here so that the few who need fast help get it quickly.
This page brings together the warning signs from across the book. Each one also appears in its own chapter, with more detail.
It is a guide to help you decide what to do now. It is not a way to work out what is wrong, and it does not cover every situation. If something worries you and it is not listed here, still get help. Trust your instinct.
Signs for children are in their own section and are written for the parent or carer.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs below, and your family doctor or a local urgent-care service for the rest.
Call 999 now, or go straight to A&E, for any of these.
Breathing and the airway - breathing that is hard work, or a harsh noise when breathing in, that is not settling - any breathing difficulty together with a muffled voice, dribbling, or being unable to swallow your own spit - choking, or something stuck in the throat that you cannot clear
Signs of a stroke (see the FAST box below) - sudden drooping on one side of the face - sudden weakness or numbness down one side of the body - sudden slurred or muddled speech - sudden loss of balance or severe dizziness with any of the above, or with sudden double vision, or the worst headache you have ever had
Hearing - a sudden drop in hearing in one or both ears – anything from seconds up to a couple of days counts as sudden – do not assume it is wax
Heavy bleeding - a nosebleed that has not stopped after at least 10 to 15 minutes of firm, correct pressure - a nosebleed that is very heavy, or makes you feel faint, or that will not stop when you take blood-thinning medicine - coughing up or vomiting a large amount of blood
With a sinus infection or bad facial pain - swelling or redness around an eye, a bulging eye, or double vision - a severe headache with a stiff neck, drowsiness or confusion
These can be signs that an infection is spreading. They are even more urgent in a child.
Fast-spreading swelling - swelling of the face or neck that is spreading quickly, with a fever and trouble opening your mouth or swallowing
UK stroke campaigns use the word FAST:
A stroke can cause sudden dizziness, a sudden hearing change or a sudden weak voice, which is why it appears in an ENT book. If you are not sure, call 999.
Emergency – act now - a sudden drop in hearing in one or both ears – anything from seconds up to a couple of days counts as sudden - ear pain with swelling, redness or tenderness of the bone just behind the ear, with the ear looking pushed forward, and feeling unwell (this can be mastoiditis, a serious infection of the bone behind the ear)
Call 999 now, or go straight to A&E.
Get help today - discharge from the ear with a fever, spreading redness, or a fast drop in hearing - a very painful ear that is getting worse, or pain that feels out of proportion to how the ear looks, in someone with diabetes or a weakened immune system – this needs to be seen by an ear specialist the same day, so say so when you contact your GP or NHS 111
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - hearing loss in one ear only, or ringing in one ear only, that does not settle - ear pain on one side for more than a few weeks with a normal-looking ear – especially with a sore throat or a hoarse voice, or if you smoke or drink alcohol - a discharging ear that has not settled after treatment
Make an appointment to see your GP.
Emergency – act now - sudden severe dizziness with any stroke sign (see the Emergency box and FAST) - the first time you have sudden spinning that will not stop, with repeated vomiting and being unable to stand
Call 999 now, or go straight to A&E.
Get this checked soon - repeated attacks of dizziness or spinning - dizziness with hearing loss or ringing in one ear - unsteadiness that is getting worse, or that is causing falls
Make an appointment to see your GP.
Emergency – act now - a nosebleed as described in the Emergency box - a sinus infection with any eye sign or brain sign from the Emergency box
Call 999 now, or go straight to A&E.
Get help today - a sinus infection with severe pain and a high fever, or one that is clearly getting worse after seeming to improve
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - blockage of one side of the nose that does not clear over several weeks - blood-stained fluid or crusting from one side of the nose for more than a couple of weeks - a change in your sense of smell that does not come back - numbness of the cheek or face along with nasal symptoms
Make an appointment to see your GP.
Emergency – act now - any breathing difficulty, noisy breathing, dribbling, or being unable to swallow your spit - coughing up or vomiting a large amount of blood
Call 999 now, or go straight to A&E.
Get help today - a severe sore throat on one side, with trouble swallowing, a muffled voice, and difficulty opening your mouth - being unable to swallow fluids, or dribbling, with a fever
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a hoarse or croaky voice that lasts more than three weeks - trouble swallowing, or pain on swallowing, that is getting worse, or food that sticks going down - a feeling of a lump in the throat together with food actually sticking, weight loss, or pain on one side - loud snoring with pauses in breathing that someone has noticed, and feeling sleepy in the daytime - a lump you can feel in the neck (see the next section)
Make an appointment to see your GP.
Get help today - a neck lump that is growing quickly, or a neck lump with a high fever and spreading redness of the skin
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a lump in the neck that lasts more than three weeks and is not clearly from a passing infection such as a cold - a mouth ulcer, or a red or white patch in the mouth, that lasts more than three weeks - a lump on the lip, on the tongue, or inside the mouth that does not go away - loose teeth with no dental cause, or dentures that stop fitting, along with other mouth symptoms - one-sided ear pain with a normal-looking ear, along with mouth or throat symptoms
Make an appointment to see your GP.
Most people with these symptoms do not have cancer. But these are the changes that should always be checked, so that the small number who do have a serious cause are found early.
Children cannot always say what is wrong. Watch how your child is overall – their breathing, their colour, how alert they are, and whether they are drinking.
Emergency – act now. Call 999 now, or go straight to A&E, if your child: - is working hard to breathe, or making a harsh noise breathing in - is drowsy and hard to wake, or floppy - has a stiff neck, or a rash that does not fade when you press a glass against it - is dribbling and cannot swallow, or will not move their neck - has swelling or redness spreading around an eye - has swallowed a button battery or a magnet – go even if your child seems well - has ear pain with swelling or redness of the bone behind the ear, the ear pushed forward, and is unwell (this can be mastoiditis) - is under three months old and has a fever – go the same day even if your baby seems well in themselves
A rash that does not fade under pressure is a useful sign, but many children with a serious infection never develop a rash at all, especially early on – so act on how unwell your child is overall, not on the rash test alone. A rash can also be harder to see on darker skin – check paler areas such as the palms, soles, tummy and inside the eyelids.
Get help today - a child with a fever you cannot bring down who is becoming more unwell
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - hearing concerns, slow speech, or struggling to keep up at school - snoring most nights with pauses in breathing, or very restless sleep - repeated ear or throat infections
Make an appointment to see your GP.
(A condensed one-page version of this chapter. It is repeated at the back of the book. The final designed card, sized to photograph or cut out, is prepared at Stage 7.)
Call 999 or go to A&E now: - hard work to breathe, or a harsh noise breathing in; or breathing trouble with a muffled voice or dribbling - face drooping, one-sided weakness, or slurred speech (stroke – think FAST) - sudden hearing loss in one or both ears - a nosebleed that will not stop after 10 to 15 minutes of firm pressure, or heavy bleeding, or coughing up a lot of blood - with a sinus infection: swelling around an eye, double vision, a stiff neck, drowsiness or confusion - fast-spreading face or neck swelling with fever and trouble opening the mouth - a child who is struggling to breathe, drowsy and floppy, has a non-fading rash, or has swallowed a button battery - swelling or redness of the bone behind the ear with the ear pushed forward and feeling unwell (adult or child) – possible mastoiditis - a baby under three months old with a fever
See your GP the same day (or call NHS 111): - a fast-growing neck lump - a severe one-sided sore throat with trouble opening the mouth
See your GP soon: - a hoarse voice, a mouth ulcer, or a neck lump lasting more than three weeks - one-sided nasal blockage, bleeding or crusting lasting weeks - swallowing that is getting harder, or food sticking - snoring with breathing pauses and daytime sleepiness
If you are worried and unsure what to do, call NHS 111, or contact your GP. It is always all right to ask.
This is general information, not personal medical advice. It cannot diagnose you or replace seeing a health professional. If you are worried, get medical help. In an emergency, call 999 or your local emergency number.
This chapter lists warning signs drawn from across the book. Every time limit and level of urgency is based on guidance from NICE, the NHS website, ENT UK and UK stroke campaigns, current to September 2026. It was reviewed by the author, Bassem Saleh (ENT doctor), on 17 September 2026.
Hearing usually changes slowly, over years. Many people do not notice it themselves at first – the people around them notice. By the time someone comes to my clinic, they have often been managing a quiet world for a long time.
Losing some hearing is common, and it is not something to be embarrassed about. This chapter explains what may be behind it, what the tests show, and what can help.
Hearing loss can come on slowly in both ears, which is the usual pattern, or suddenly, or in one ear only. A sudden change, or a change in one ear, matters more – see "When not to wait" at the end of this chapter.
There are many causes. These are the common ones first.
Age-related hearing loss. This is the most common cause in adults. It builds up slowly over years, usually in both ears, and it affects high sounds first – which is why speech can sound mumbled while you still hear that someone is talking.
Noise damage. Years of loud noise – from machinery, power tools, live music or shooting – wears out the hearing over time. It often comes with ringing in the ears. Once it has happened it does not recover, so protecting your hearing matters.
Ear wax. A very common and easily treated cause. See Chapter 7.
Fluid in the middle ear. After a cold or a bout of sinus trouble, fluid can sit behind the eardrum and dull the hearing for a few weeks. In an adult, if this happens on one side and does not clear, the doctor will also look at the back of your nose. This is a routine check. Now and then a small blockage there stops the ear draining, and it is worth ruling out.
Ear infections and a hole in the eardrum. See Chapters 8 and 10.
Otosclerosis. Here, extra bone grows around one of the tiny hearing bones and stops it moving freely. It tends to run in families and can start in your twenties, thirties or forties. It usually comes on gradually. A hearing aid helps, and there is also an operation that can improve it.
Sudden hearing loss from the inner ear. A drop in hearing over minutes to a few days, usually in one ear, sometimes with ringing, fullness or dizziness. Often no cause is found. This is treated as an emergency, because early treatment gives the best chance of recovery. See "When not to wait".
Hearing loss in one ear, or worse in one ear. Most of the time this has an ordinary cause. But it is usually checked with a scan, because uncommonly it is caused by a slow-growing, non-cancerous swelling on the hearing and balance nerve. Finding it early keeps the options open.
Some medicines. A few medicines can affect the inner ear, including some strong antibiotics and some cancer treatments. If you are on these, your hearing may be monitored.
Less common causes include Ménière's disease (Chapter 12), a head injury, and some general health conditions.
What the specialist is thinking
When someone tells me their hearing has dropped, I am working through a few questions.
One ear or both? Sudden or slow? That alone tells me a lot.
Is there ringing, a feeling of fullness, or any dizziness with it?
What noise has this person been around – at work, in the army, in music, from hobbies?
Does hearing loss run in the family, and did it start young?
Any pain, discharge, or past ear operations? Any medicines that matter?
And underneath all of it: is the problem in the outer or middle ear, where I can often fix it, or in the inner ear and nerve, where the answer is usually a hearing aid? The examination and the hearing test sort that out.
The doctor looks in both ears with an otoscope – a small torch with a magnifying lens – and may use a microscope, and may clear any wax. They hold a humming tuning fork against your head and beside each ear; this quick test helps show whether the loss is coming from the outer and middle ear or from the inner ear.
If there is fluid, or the loss is one-sided, they will also look in your nose and the back of your throat, usually with a thin camera (see Chapter 3). They may check your balance and the movement of your face.
The booth hearing test. You sit in a quiet room or booth, wear headphones, and press a button each time you hear a beep. Sounds are played at different pitches and volumes for each ear. The results are drawn on a chart called an audiogram.
An audiogram has pitch along the bottom, from low notes to high, and loudness down the side. A mark is placed for the softest sound you can hear at each pitch. From the pattern, the audiologist can see how much hearing is lost and where the problem is – the outer and middle ear, the inner ear, or both.
Speech testing. You repeat words or sentences at different volumes, to show how well you make out speech, not just tones.
Tympanometry. A soft tip in the ear changes the pressure slightly and measures how the eardrum moves. It checks for fluid, a blockage, or a hole.
A scan. If the loss is in one ear or clearly uneven, you may have an MRI scan to look closely at the hearing and balance nerve. Chapter 26 explains scans.
Blood tests are sometimes done to look for a general cause.
If there is a treatable cause, that comes first – removing wax, clearing an infection, treating middle-ear fluid, or an operation for otosclerosis or a hole in the eardrum.
Hearing aids are the main treatment for age-related and noise-related hearing loss. In the UK they are provided free on the NHS. A modern hearing aid is small and sits behind or in the ear; some are rechargeable.
What hearing aids do well: they make speech clearer, especially in quiet rooms and one-to-one. What they do not do: they do not give you back normal hearing, and busy, noisy places stay harder than you would like. They also take time – most people need several weeks, sometimes a few months, of daily use before their brain settles into the new sound. People who start early and wear them regularly tend to do better. If both ears are affected, two aids usually help more than one, because two ears working together make it easier to follow speech in noise and to tell where a sound is coming from.
Other devices. For some kinds of loss, a device that sends sound through the bone behind the ear can help. For very severe loss where hearing aids give little benefit, a cochlear implant may be an option; this is assessed at a specialist centre.
Everyday equipment. Loop systems in public buildings, gadgets that stream the television to your ears, and doorbells and alarms that flash or vibrate all make daily life easier.
Support. Audiology teams and hearing therapists help with getting used to aids, with communication tactics, and with any ringing in the ears. Lip-reading classes are available in many areas.
Why treating it matters. Untreated hearing loss makes it easy to withdraw from conversation, and it is linked with loneliness and low mood. Researchers now consider mid-life hearing loss one of the modifiable factors linked with a higher chance of memory problems and dementia in later life. What is less settled is whether treating hearing loss – for example, with a hearing aid – actually lowers that risk for everyone: large trials have found a clearer benefit for some groups (such as people already at higher risk of memory decline) than for others, and research is continuing. What is clear is that staying connected to the people around you is good for you, and hearing better helps with that.
When not to wait
Hearing loss on its own is usually not an emergency, but some changes need fast help.
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - a sudden drop in hearing in one or both ears, over seconds to a few hours – do not assume it is wax - hearing loss with sudden drooping of the face, sudden severe spinning, weakness on one side, or slurred speech
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - new hearing loss with ear pain, discharge and a fever - hearing loss straight after a blow to the head
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - hearing that is worse in one ear only, or ringing in one ear only, that does not settle - hearing loss that is affecting your work, your safety or your daily life - hearing loss with balance problems
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
If wax or fluid was the cause, hearing usually returns once it clears.
Age-related and noise-related hearing loss does not come back. But hearing aids and a few changes to how you communicate make a large difference, and most people are glad they did it once they are through the first few weeks of getting used to the aids.
If you had a sudden hearing loss and were treated quickly, some people recover fully, some partly, and some not at all. This is exactly why it should not wait.
'Wearing hearing aids makes your hearing lazy and worse.' Not true. Hearing aids keep your brain used to the full range of sound. Leaving hearing loss untreated is what tends to make understanding speech harder over time.
'I would know if my hearing was going.' Not always. Age-related hearing loss is slow, and the brain is good at filling in gaps, especially at home where you know the routine. Family members often notice before you do.
'Nothing can be done for nerve deafness.' Not true. Most people with inner-ear hearing loss are helped a lot by hearing aids, and for very severe loss a cochlear implant can work well.
This story is made up to show a common experience. It is not about a real patient.
Aled is 64. For a couple of years he had been sure that his wife and his grandchildren were mumbling. Family meals were the worst – too many voices at once – and he had started to sit quietly and let the talk go past him. His wife booked the GP appointment, not him.
The hearing test showed the pattern of age-related loss in both ears, worse for high sounds. He was given two hearing aids. The first week was strange: his own footsteps sounded loud, and the kettle was startling. He nearly gave up. By the end of the first month his brain had settled, and at Sunday lunch he followed the whole table for the first time in years. He now puts the aids in first thing, out of habit.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE, the NHS website, ENT UK and the British Society of Audiology, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor on September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Hearing tests can feel like an exam you might fail. They are not. Nothing here hurts, there are no needles, and you can stop at any point. This chapter explains the common tests, and how to read the chart you may be given at the end.
Hearing tests are done by an audiologist – a professional trained to test hearing and balance. You might be seen in a hospital audiology department, a community clinic, or a high-street hearing centre.
You sit in a quiet room, sometimes a small sound-treated booth with a window, so that outside noise does not affect the result. A full first assessment usually takes about 30 to 45 minutes.
This is the main test. It has two parts.
Part one: sound through headphones. You wear headphones, or small soft earpieces. You press a button, or raise a hand, every time you hear a beep – even a very faint one, even if you are not quite sure. The audiologist plays beeps at different pitches, from low to high, and at different volumes, testing one ear at a time.
Part two: sound through the bone. A small pad that gently vibrates is placed on the bone behind your ear, or on your forehead. This sends sound straight to the inner ear, skipping past the outer and middle ear. By comparing the two parts, the audiologist can work out where in the ear the problem is.
Tips: it is normal to feel unsure whether you heard something. Press anyway. Concentrate on the quietest sounds. There is no score to pass or fail – the test simply maps what you can hear.
The results are drawn on a chart called an audiogram.
Audiologists often shade an area across the middle of the chart called the speech banana. This is where the sounds of everyday speech sit. If your marks fall below it, those speech sounds are hard for you to hear without help – which is why speech can seem mumbled.
The audiogram shows two things: how much hearing is lost, described in rough bands from mild to profound, and where the problem is. If the two parts of the test (through the headphones and through the bone) do not match, that points to the outer or middle ear. If they match but are both low, that points to the inner ear.
Ask for a copy of your audiogram, and ask the audiologist to talk you through your own chart. It makes later appointments much easier to follow.
Hearing beeps is not the same as understanding words. In speech testing, you repeat words or short sentences played at different volumes, sometimes with background noise added. This shows how well you make out speech in real life, and it helps predict how much a hearing aid is likely to help you.
This test is called tympanometry. A soft rubber tip forms a seal in your ear, and the machine changes the pressure slightly while playing a low hum. You feel a brief fullness, like the feeling in a plane as it lands. It measures how freely your eardrum moves.
A normal trace looks like a smooth hill. A flat trace can mean fluid behind the eardrum, a blockage such as wax, or a hole in the eardrum. It takes only a few seconds for each ear.
In the clinic, the doctor may hold a humming metal fork against your head and beside each ear, and ask which sounds louder. This is a rough, quick check of whether the loss is coming from the outer and middle ear or from the inner ear. The booth test gives the full picture; the tuning fork is just a first look.
Children are tested in different ways depending on their age. The audiologist chooses the method that fits the child.
A parent or carer can usually stay in the room. Chapter 29 covers children's hearing in more detail.
A "normal" hearing test is reassuring, but it does not rule out every problem. Ringing in the ears, sound sensitivity, balance problems, and trouble following speech only when there is background noise can all happen with a normal chart. Difficulty hearing in noise despite a normal audiogram is sometimes called "hidden hearing loss", and researchers are still studying it.
So if your own experience does not match your result, say so. It is useful information, not a complaint.
A hearing test is also a snapshot of one day. Hearing can change over time, so the test may be repeated at a later visit to see which way things are moving.
If your hearing dropped suddenly, do not wait for a routine hearing test. See Chapter 4.
This chapter describes standard hearing tests used in the UK. It is based on guidance from the British Society of Audiology, NICE, ENT UK and the UK Newborn Hearing Screening Programme, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026.
Earwax is normal. Your body makes it on purpose, and most of the time your ear looks after itself. People often come to my ear, nose and throat (ENT) clinic worried that they have "too much" wax, or that they have not cleaned their ears well enough. Usually, they have done nothing wrong.
This chapter explains what wax is for, what is safe to do at home, and when wax is worth getting looked at.
Everyone has some wax. Seeing a little brown or orange wax on a cotton bud or on your pillow is healthy. The colour and feel of wax are different from person to person, and change as you get older. Many people have wax deep in the ear all the time and never notice it.
Wax builds up and blocks the ear more easily when:
It is not caused by poor washing. You do not need to clean inside your ears, and trying to often makes things worse.
A blocked feeling is also not always wax. Fluid behind the eardrum, an infection, or a sudden drop in hearing from the inner ear can feel much the same. If the feeling does not settle, have the ear looked at. And if your hearing drops suddenly, treat it as an emergency – do not wait to see if wax is the cause. See "When not to wait" later in this chapter.
What the specialist is thinking
When someone tells me their ear is blocked, I am asking myself a few things.
Is the wax I can see really enough to explain the hearing loss, or is wax just the thing they noticed?
Did the hearing change suddenly or slowly? A sudden change in one ear makes me look further than wax.
Is there any pain, discharge, or a history of a burst eardrum or ear surgery? That changes how I can safely take wax out.
Does the person have diabetes or a weak immune system? I take extra care with the delicate skin of the ear canal.
Is there dizziness, or ringing in one ear only? I want to know that before anything wet goes near the ear.
And what have they already tried at home?
The doctor or nurse looks in your ear with an otoscope, a small torch with a magnifying lens. They may gently pull the top of your ear up and back to straighten the canal. It does not hurt, though it can feel like a light tug.
Sometimes they use a microscope for a bigger, clearer view. You sit still with your head turned to one side.
They are checking how much wax there is, what it is doing, and whether they can see the eardrum behind it. If wax is hiding the eardrum, they may want to soften and remove it so they can be sure the ear is healthy. They may also do a quick hearing check.
Looking in the ear is not really a test, but it is the main thing that is done.
If your hearing does not come back after the wax is removed, you may be offered a hearing test. The result is shown on a chart called an audiogram, which shows how well you hear different sounds. See Chapter 6.
Sometimes a short, painless test called tympanometry is used to check how the eardrum moves. See Chapter 26.
For most people, softening drops are enough:
A warm flannel held against the outside of the ear can ease a mild ache.
Do not:
If something solid is stuck in the ear, do not try to hook it out – see a health professional. If a live insect has gone in, you can try tilting your head so the affected ear faces upward and pouring in a little warm (not hot) olive or almond oil, which can float or still the insect – but do not do this if you have a known hole in the eardrum or grommets. If this does not work easily, or there is pain, bleeding or discharge, stop and see a health professional rather than trying again.
If you wear hearing aids, clean them the way you were shown, and check whether they use small wax guards.
If drops alone do not clear it, a trained person can remove the wax in one of these ways:
What removal cannot do:
Removing wax that is not causing any problem is not needed.
When not to wait
Earwax on its own is not an emergency. But a blocked or muffled ear is not always wax. Get checked if any of these apply.
Emergency – act now - a sudden drop in your hearing in one or both ears – anything from seconds up to a couple of days counts as sudden – do not assume it is wax - sudden loss of hearing together with severe spinning dizziness
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - hearing that has faded over the last day or two - bad pain in the ear - fluid, pus or blood coming from the ear
Contact your GP (your family doctor) for an urgent appointment today, or call NHS 111 (the NHS non-emergency phone and online service).
Get this checked soon - your hearing has slowly got worse over weeks or months - ringing in one ear only - wax that keeps blocking your ear even though you use drops - you wear a hearing aid and the ear keeps blocking - you have diabetes, a weak immune system, a hole in the eardrum, or past ear surgery, and you think you have wax – have it removed by a professional, not at home
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the urgent signs above, and your family doctor or local health centre for the rest.
Many people hear better as soon as the wax is out. The ear may feel a little tender, watery or blocked for a day or so. That usually settles.
If your hearing does not come back, or the ear becomes painful or starts to leak fluid, get it checked. The problem may not have been only wax.
'You should clean the wax out of your ears every day with cotton buds.' Not true. The ear canal cleans itself. The skin slowly grows outwards and carries old wax with it, helped by the movement of your jaw when you talk and eat. Cotton buds push most of the wax deeper, and can scratch the skin or harm the eardrum.
'Ear candles draw the wax out.' Not true. There is no good evidence that ear candles remove wax. They can drip hot wax into the ear, burn the face or ear, and block the canal. ENT clinics see injuries caused by them.
'A lot of earwax means poor hygiene.' Not true. How much wax you make, and how firm it is, is mostly down to your genes, your age, and the shape of your ear canal. It is not a sign of being unclean.
This story is made up to show a common experience. It is not about a real patient.
Rahim is 68 and wears a hearing aid in each ear. Over a few weeks, sounds on his right side became muffled, and that hearing aid started to whistle. He tried to clean the ear with a cotton bud every morning. The ear felt worse, not better, and began to itch.
His pharmacist looked in and said the right ear was blocked with firm wax, pressed hard against the eardrum. Rahim used olive oil drops for four nights, then had microsuction at a local clinic. The noise surprised him, and the room seemed to tip for a second, but it was soon over. His hearing came back straight away, and the whistling stopped.
He was shown how to clean around his ears, not inside them. He knows to ask for advice if his ear blocks again.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (its Clinical Knowledge Summaries), the NHS website, and ENT UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor on September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Ear pain is one of the most common reasons people come to see me. Most of the time it settles quickly, and often without antibiotics. But "earache" covers several different problems, and they are not all treated the same way. Some ear pain does not even come from the ear.
This chapter is mainly about adults. For a child with earache, see Chapter 31.
An outer-ear infection (sometimes called swimmer's ear). The skin lining the ear canal becomes inflamed and swollen. It often starts with an itch and then becomes painful, and the ear is tender when you touch it. Common triggers are water in the ear, a humid climate, cotton buds or anything else pushed into the ear, skin conditions such as eczema, and wearing hearing aids or earplugs.
A middle-ear infection. This is an infection in the air space behind the eardrum, usually during or just after a cold. It causes a deep, throbbing pain, muffled hearing and often a fever. If the pressure bursts a small hole in the eardrum, there is a sudden discharge and the pain quickly eases. Middle-ear infections are more common in children, but adults get them too.
Ear pain that is really coming from somewhere else (referred pain). The ear shares its nerves with the teeth, the jaw joint, the throat, the base of the tongue and the neck. So a problem in any of those can be felt as earache, even though the ear itself is healthy. Common causes are dental problems, jaw-joint pain and tooth-grinding, tonsillitis, and neck arthritis. In an adult, ear pain on one side that lasts for weeks with a normal-looking ear – especially with a sore throat, a hoarse voice or trouble swallowing, or in someone who smokes or drinks alcohol – needs to be checked properly. See Chapters 4 and 25.
Long-lasting or repeated discharge. This usually points to a longer-term middle-ear problem, sometimes with a hole in the eardrum that has not healed. One particular cause is a build-up of skin cells in the middle ear called a cholesteatoma. It is not a cancer, but it slowly grows and can damage the ear, so it usually needs an operation. Chapter 10 covers this in full.
Other causes. A boil in the ear canal. Shingles affecting the ear, which causes a painful rash and can cause weakness of the face on that side. Pain from a pressure change while flying or diving with a blocked nose (see Chapter 10).
What the specialist is thinking
When someone has earache, my first question is whether the pain is coming from the ear at all.
Does it hurt when I gently pull the ear or press the flap at the front? That points to the outer ear. Pain deep inside with a recent cold points to the middle ear.
Is there any discharge, and what does it look like? Is the person generally well, or unwell with a fever?
Is this a one-off, or does it keep happening? Any swimming, cotton buds, hearing aids, or skin conditions?
If the ear looks completely normal and the pain has been there for weeks on one side, I examine the mouth, the jaw joint and the throat, because that is where the pain is likely coming from.
And if the person has diabetes or a weakened immune system, I treat even a "simple" outer-ear infection with more care, because it can become serious.
The doctor looks at the outer ear and the skin behind it, then gently pulls the ear and presses the flap at the front to see if that reproduces the pain. They look into the canal and at the eardrum with an otoscope – a small torch with a magnifying lens – checking whether the canal is red and swollen, whether there is debris or discharge, and whether the eardrum looks red, bulging or perforated.
If the canal is full of debris, they may clean it gently with suction under a microscope, both to see properly and so that any drops can reach the skin. If there is discharge that is not settling, they may take a swab.
If the ear looks normal, they will look in your mouth and throat, check your teeth and jaw joint, and feel your neck. If the pain is severe, or there is a rash, they will also check that the muscles of your face are moving normally.
Most earache needs no tests at all.
Chapter 26 explains these tests.
Outer-ear infection. The main treatment is ear drops – the type your doctor chooses, based on how the ear looks. If the canal is full of debris, cleaning it in clinic makes the drops work far better. If the canal is very swollen, a small sponge or ribbon (a wick) may be placed just inside it to carry the drops in; it is removed after a few days. Keep the ear dry. It usually improves within a few days to a week. It can come back if the trigger – water, cotton buds, a skin condition – continues.
Middle-ear infection. Most get better on their own within a few days, and pain relief is the mainstay. Antibiotics are used when someone is very unwell, when there is no improvement after two to three days, when the ear is discharging, or when a person is at higher risk of complications. A small hole in the eardrum from an infection usually heals on its own within about six to eight weeks.
Referred pain. The treatment is for the real source – dental care, measures for the jaw joint such as a soft diet and not clenching, or treating a throat infection. Antibiotics for the ear will not help pain that is coming from a tooth or the jaw.
Long-standing discharge, a hole that will not heal, or a cholesteatoma. These are looked after by an ENT team – with regular cleaning of the ear, drops, keeping water out, and sometimes an operation. Chapter 10 has the detail.
A severe outer-ear infection in someone with diabetes or a weakened immune system. This needs urgent hospital assessment and a long course of antibiotics, because the infection can spread to the bone around the ear.
Shingles affecting the ear. This needs antiviral treatment quickly – ideally within about three days of the rash or facial weakness starting – often together with a short course of steroid tablets. Starting treatment early gives the best chance of the face recovering fully.
The limits. Drops cannot work if the canal is blocked with debris – it has to be cleaned first. Antibiotics do nothing for pain from the jaw or teeth. And infections keep returning if the underlying cause – water, cotton buds, a skin condition, a blocked nose – is not dealt with.
When not to wait
Most earache is not an emergency. These signs are the exceptions.
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - swelling, redness or tenderness of the bone just behind the ear, with the ear looking pushed forward, and feeling unwell - an ear infection with a stiff neck, a severe headache, drowsiness or confusion - new weakness or drooping of one side of the face, with ear pain or a rash around the ear - severe ear pain that is quickly getting worse in someone with diabetes or a weakened immune system
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - an ear that is very painful and not settling with regular pain relief - discharge from the ear with a fever, or with spreading redness of the skin - feeling very unwell with the earache
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - ear pain or discharge that lasts more than a couple of weeks, or keeps coming back - ear pain on one side for weeks with a normal-looking ear – especially with a sore throat or hoarse voice, or if you smoke or drink alcohol - hearing that stays muffled after the infection has settled
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
An outer-ear infection usually settles within a few days to a week once treatment reaches the skin. The itch can linger, and it may return if the trigger is still there.
With a middle-ear infection, the pain usually eases within two to three days. Muffled hearing can take a few weeks to clear fully as the fluid drains. A small hole in the eardrum usually heals within about six to eight weeks.
Go back to be checked if the pain returns, the discharge continues, or your hearing stays down.
'Every ear infection needs antibiotics.' Not true. Most middle-ear infections, in adults and children, get better on their own. Pain relief matters more, and antibiotics are kept for the cases that need them.
'You should keep the ear warm and plugged up.' It depends. Warmth can ease the pain. But plugging a discharging ear traps the infection – keep it clean and dry instead.
'Swimmer's ear means there was dirty water in my ear.' Not true. It is about the skin of the ear canal being irritated or damaged so that infection can take hold. Cleaning the ear with cotton buds is one of the most common causes.
This story is made up to show a common experience. It is not about a real patient.
Priya swims four mornings a week. Two or three times a year her right ear would become itchy, then sore, then too tender to lie on. She had got into the habit of drying the ear with the corner of a towel twisted into a point, and, when it itched, a cotton bud.
This time the canal was too swollen to see the eardrum. The nurse cleaned it and placed a small sponge wick with drops. Within three days it was comfortable. At the review, the doctor explained that the towel and the cotton buds were scratching the skin and letting infection in. Priya switched to letting the ear dry on its own, using a few drops of a spirit-based drying spray after swimming, and leaving the buds alone. She has had one mild flare in the year since, instead of three bad ones.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (including its Clinical Knowledge Summaries for otitis externa and acute otitis media), the NHS website and ENT UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Tinnitus is hearing a sound that has no source outside your body – a ringing, buzzing, hissing or humming that only you can hear. It is very common. For most people it is mild and easy to ignore. For some it is loud, constant, and hard to live with, and it can affect sleep and mood.
If your tinnitus is distressing you, please read the section "When not to wait" in this chapter. You are not alone with this, and there is real help.
Almost everyone hears a faint ringing if they sit in a completely silent room. That is normal. Tinnitus becomes something to look at when it stays, and when it bothers you.
Hearing loss. Most tinnitus goes together with some hearing loss, even a mild loss of high sounds that you had not noticed. When the ear sends less sound to the brain, the brain seems to turn up its own volume to compensate – and part of what then gets "turned up" is background nerve activity, which you hear as tinnitus.
Loud noise. A single very loud event, or years of noise at work or from hobbies, can bring on tinnitus, often with some hearing loss.
Ear wax or a middle-ear problem. Wax against the eardrum, fluid behind it, or an infection can all cause tinnitus. This kind usually clears once the ear problem is treated (see Chapter 7).
Other ear conditions, such as otosclerosis or Ménière's disease (Chapter 12), which usually comes with a feeling of fullness and episodes of dizziness.
Some medicines can cause tinnitus, including high doses of aspirin or anti-inflammatory painkillers, and some antibiotics and cancer treatments. This is often reversible. Do not stop a prescribed medicine on your own – talk to your doctor.
Stress, poor sleep and caffeine do not cause tinnitus, but they make it louder and harder to ignore. So can jaw and neck problems.
A heartbeat-like sound (pulsatile tinnitus). If your tinnitus is a rhythmic whooshing in time with your pulse, that is a different situation and is always checked. Most often it is the sound of normal blood flow becoming audible – for example with a low blood count, in pregnancy, or with raised blood pressure. Less often it points to a problem with a blood vessel or with the pressure inside the head.
Often no single cause is found. That is common, and it does not mean nothing can be done.
What the specialist is thinking
First: one ear, both ears, or in the head? And is it steady, or does it pulse in time with the heartbeat? Pulsatile tinnitus sends me down a different path.
Is there any hearing change, a feeling of fullness, dizziness, or weakness of the face?
What noise has this person been around? What medicines? How much caffeine, and how is their sleep?
And the question that matters most for deciding how to help: how much is the tinnitus affecting your sleep, your mood, and your ability to concentrate? Two people with the same sound can be affected completely differently, and it is the effect on your life, not the loudness, that guides what we do.
The doctor looks in your ears for wax, fluid or a problem with the eardrum, and checks your hearing with tuning forks. They look at your jaw and neck.
If the tinnitus is pulsatile, they listen with a stethoscope over and around the ear, the neck and the skull, and check your blood pressure. If you have other symptoms, they check the movement of your face and your balance.
Chapter 26 explains these tests.
There is no pill that removes tinnitus, and no supplement has been shown to work. Be careful with anything sold online as a "cure".
What does help:
What the evidence does not support: most medicines, most supplements including ginkgo, and one-off "reset" devices sold online. Some newer devices that combine sound with mild electrical stimulation are being studied, but they are not yet part of standard NHS care and the picture is not settled.
The realistic goal for most people is habituation – the brain learning to treat the tinnitus as unimportant background, so that it no longer dominates – rather than making the sound itself disappear.
When not to wait
Tinnitus itself is rarely an emergency. These are the situations that need faster help.
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - tinnitus with a sudden drop in hearing - tinnitus with sudden severe spinning, weakness on one side, or slurred speech - tinnitus with new drooping or weakness of one side of the face
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - pulsatile (heartbeat-like) tinnitus together with a severe headache, changes in your vision, or weakness - tinnitus that is causing you thoughts of harming yourself, or a level of distress you cannot cope with
Contact your GP for an urgent appointment today, or call NHS 111. You can also call the Samaritans free, at any time, on 116 123. If you feel unsafe right now, or you have acted on these thoughts, call 999 or go to A&E. Feeling this way with severe tinnitus is more common than people realise, and it can be helped.
Get this checked soon - tinnitus in one ear only, or much worse in one ear - pulsatile tinnitus – a whooshing in time with your heartbeat - tinnitus with any hearing loss, dizziness or a feeling of fullness in the ear - tinnitus that is disturbing your sleep, your mood or your concentration
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest. The Samaritans number is for the UK and Ireland; elsewhere, search for your national crisis helpline.
Here is the honest picture. For many people, tinnitus does not go away completely. But it very commonly becomes much less intrusive over weeks and months, as the brain learns to filter it out. Hearing aids, background sound, better sleep, and taking the focus off it all speed that along.
Some people's tinnitus does settle for good – for example when it was caused by wax, a cold, or a medicine that has been changed.
Flare-ups happen, brought on by tiredness, stress, a cold, or loud noise. They usually calm down again. And the distress almost always eases faster than the sound does – often people reach a point where the tinnitus is still there if they listen for it, but it no longer runs their day.
'Tinnitus means I am going deaf.' Not true. Many people with tinnitus have normal or near-normal hearing. Tinnitus is not a countdown to deafness.
'Nothing can be done – you just have to live with it.' Not true. It is true that no pill removes the sound. It is not true that nothing helps. Hearing aids, sound, sleep, and talking therapy all reduce the impact, often a lot.
'You should rest your ears in silence.' Not true. Silence makes tinnitus stand out more. Gentle background sound makes it easier to ignore.
This story is made up to show a common experience. It is not about a real patient.
Marek is 54 and spent years on a factory floor. The ringing in both ears started gradually, but what changed was one bad week when he could not sleep and became convinced it was a brain tumour. After that he checked it constantly, dreaded going to bed, and stopped seeing friends because he could not follow talk in a busy pub.
The hearing test showed noise damage to the high sounds in both ears, and a normal MRI scan settled the tumour fear. He was given hearing aids, which brought back sounds he had not noticed were missing, and a small sound machine for the bedroom. Six sessions with a therapist helped him stop scanning for the noise. Six months on, the tinnitus is unchanged if he stops to listen for it – but most days he forgets about it for hours at a time, and he sleeps.
Note down, or bring with you:
If you are struggling to cope with the tinnitus, say so at the appointment. It is common, and it is exactly the kind of thing the clinic can help with.
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (including NG155, Tinnitus: assessment and management), the NHS website, ENT UK and Tinnitus UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
This chapter covers three problems that are all about the eardrum and the space behind it: a hole in the eardrum, the ear that feels blocked or keeps popping, and longer-term changes that build up over years. They are linked, because the same small tube – the one that runs from the middle ear to the back of the nose – is often behind more than one of them.
A hole in the eardrum - hearing that sounds dulled on that side - discharge from the ear, especially after water gets in or during a cold - a faint whistle from the ear when you blow your nose - often no pain at all, once any infection has passed - sometimes nothing – it is found when the ear is examined for another reason
The blocked or popping ear - a feeling of fullness or pressure that will not clear, like being in a plane - muffled hearing, or a sense of being "in a barrel" - crackling or popping when you swallow or yawn - your own voice sounding loud inside that ear - it often follows a cold, a bout of hay fever, or a flight, and it comes and goes
Longer-term changes - hearing that has slowly got worse over years - discharge that keeps coming back - a discharge that smells unpleasant, along with hearing loss – this one always needs proper assessment
A hole in the eardrum can come from:
The blocked or popping ear happens when the tube from the middle ear to the back of the nose is not opening properly. Common reasons:
Longer-term changes include an eardrum that has slowly been drawn inwards over years by a poorly working tube (a retraction), and a cholesteatoma – a pocket of skin that becomes trapped in the middle ear and slowly enlarges. A cholesteatoma is not a cancer, but it wears away bone as it grows, and can damage hearing, the balance organ and the nerve to the face. The classic sign is a discharge that keeps coming back and smells bad, with hearing loss on that side.
What the specialist is thinking
Is there a hole? If so, where in the drum, and how big? Is the ear wet or dry today?
Does the size of the hole explain the hearing loss, or is there more going on behind it?
For a blocked ear: is this just a slow recovery after a cold, an allergy problem I can treat, or a sign the tube has a longer-term problem?
Is there any crust or debris in the top of the eardrum that could be hiding a pocket of skin? A smelly discharge with hearing loss moves that up my list.
And are there any warning features – dizziness, or weakness of the face – that change how urgently this needs dealing with?
The doctor looks at the eardrum with an otoscope, usually also with a microscope, which gives a much clearer view. They are looking for a hole and its size and position, an area drawn inwards, crust or debris, and any discharge. They may gently clean the ear so they can see properly.
They may puff a little air at the eardrum to watch it move – a healthy drum flutters, a stiff or holed one does not. They check your hearing with tuning forks. If the ear is blocked, or the problem is one-sided, they look in your nose and the back of your nose. If there are worrying features, they check the movement of your face and your balance.
Chapter 26 explains these.
If you have, or might have, a hole in the eardrum:
If your ear is blocked or popping:
Flying with a blocked ear: stay awake for the descent, keep swallowing and yawning, use the balloon or the gentle blowing technique, and consider a decongestant beforehand or filtered ear plugs. Try not to fly with an active ear or sinus infection.
A hole in the eardrum. Most holes from an infection or a minor injury heal on their own within about six to eight weeks. In the meantime the ear is kept dry, and any infection is treated with the right drops. For a small hole that will not close, a minor procedure in clinic – placing a patch over it – can encourage healing. For a hole that keeps getting infected, causes hearing loss, or stops you swimming, an operation to repair the drum (using a small patch of your own tissue) is an option. It is usually successful at closing the hole, though not guaranteed, and any hearing improvement varies from person to person. Chapter 27 covers operations.
The blocked or popping ear. The first step is treating the nose and any allergy. Autoinflation with the balloon is tried over weeks. If the blockage is long-lasting and clearly affecting your hearing or your quality of life, a grommet – a tiny tube placed through the eardrum – does the job of the tube while it is in place, usually for several months. When it comes out, the effect ends, and while it is in you need to keep water out of the ear. A newer option, widening the tube with a small balloon passed through the nose, is used for carefully selected people, but the evidence for it is still being built.
Longer-term changes. A shallow retraction of the eardrum may simply be watched, with regular checks under the microscope. A cholesteatoma is almost always removed with an operation on the ear and the bone behind it. The first aim is a safe, dry ear; improving hearing comes second, and is sometimes done at a later operation. A cholesteatoma can come back or leave tissue behind, so follow-up – sometimes including a planned second operation or a scan – is normal. A cholesteatoma does not go away without surgery.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - sudden severe hearing loss, spinning, or vomiting after a blow to the ear, a slap, or a blast - new weakness or drooping of one side of the face, with ear discharge or a long-standing ear problem - an ear infection with swelling behind the ear, a stiff neck, a severe headache, drowsiness or confusion
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a fresh injury to the ear with pain, bleeding, or a drop in hearing - heavy, smelly, or feverish discharge from an ear that you know has a hole or a long-standing problem
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a hole in the eardrum that keeps getting infected, or has not healed - an ear that stays blocked or keeps popping for more than a few weeks, especially on one side - a discharge that smells bad, together with hearing loss - hearing loss that you think is coming from a hole in the eardrum
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
A hole from an infection is often closed within about six to eight weeks, with the ear kept dry in the meantime. Your hearing is usually rechecked once it has healed.
A blocked ear after a cold usually clears within two to six weeks. It takes longer if there is ongoing hay fever or a constantly blocked nose.
After an operation to repair the eardrum, expect a few weeks off swimming and flying, a dressing inside the ear for a week or two, and hearing that settles over two to three months. After grommets, hearing improves straight away; the grommet works its own way out over several months, leaving a small chance of a lasting hole. After cholesteatoma surgery, recovery takes several weeks, and you stay under review for a long time, sometimes with a second operation planned.
'A hole in the eardrum means permanent deafness.' Not true. Many holes heal on their own. Even a lasting hole usually causes only mild to moderate hearing loss, which can be helped by repair or by a hearing aid.
'You should keep water out of a healthy ear too, to protect the eardrum.' Not needed. A normal eardrum is a good water barrier. Keeping water out matters when there is a hole, a grommet, or an active infection.
'Popping and crackling in the ear means an infection.' Not usually. It is most often the small tube to the back of the nose not opening smoothly, after a cold or with an allergy.
This story is made up to show a common experience. It is not about a real patient.
Tomasz is 33 and swims most weekends. He had grommets as a child, and one left a small hole in his right eardrum that never closed. For years it caused no trouble. Then, three summers running, the ear became infected within a week of his first outdoor swim – discharge, muffled hearing, and drops from the GP each time.
The ENT doctor showed him the hole on a screen. Because it was affecting his hearing a little and stopping him swimming, they offered to repair it. The operation, under a general anaesthetic, used a thin patch of tissue from just above his ear. He kept the ear dry for six weeks and off flights for a month. At the three-month check the drum had healed over, and the following summer he swam without a single infection.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (including its Clinical Knowledge Summaries), ENT UK, and recognised ENT textbooks, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
"Dizzy" is one of those words that everybody uses and everybody means something slightly different by. Getting clear about what it means for you is the single most useful thing you can do before your appointment, because the description points to the cause more reliably than any scan.
This chapter is about sorting out the type and knowing what the examination involves. Chapter 12 covers the specific inner-ear conditions in detail.
Most dizziness falls into one of four types.
Many people have more than one type, or find that it changes over time. That is normal, and worth telling the doctor.
The likely cause depends on the type.
Spinning most often comes from the inner ear – brief spinning brought on by head movements, a single attack lasting days after a virus, or attacks lasting hours with hearing symptoms. Migraine can also cause it. Less often it comes from the brain, and then there are usually other signs such as weakness, double vision or slurred speech. Chapter 12 covers the inner-ear causes.
Light-headedness is usually about blood flow to the brain – a drop in blood pressure when you stand, not drinking enough, heat, missed meals, blood-pressure tablets, prostate tablets, water tablets, a low blood count, or a heart rhythm problem. A simple faint is common and not dangerous, but fainting during exercise, or with chest pain or a racing heart, needs checking.
Unsteadiness often builds up from several small things at once: reduced feeling in the feet (for example from diabetes), stiff joints, poor eyesight, several medicines together, the normal decline in balance with age, alcohol, or an old inner-ear problem the brain never fully adjusted to.
The vague, floaty feeling is commonly driven by anxiety and over-breathing, or by dizziness that carries on after an inner-ear attack has settled, when the brain stays "on guard" and keeps signalling that something is wrong. Poor sleep, low mood, and busy visual surroundings all feed it.
What the specialist is thinking
First, which of the four types is it, in your own words? "Spinning" and "faint" send me in completely different directions.
How long does one episode last – seconds, minutes, hours, days, or is it there all the time? And what brings it on – standing up, rolling over in bed, walking in the dark, busy patterns and screens, or stress?
Is there any hearing change, ringing, or fullness in an ear? That points me at the inner ear.
Any headaches, or a history of migraine?
And the questions I need answered quickly: any new weakness, numbness, slurred speech, double vision, or trouble walking?
What medicines are you on, and how many times have you fallen? The pattern and the triggers usually tell me more than a scan would.
The examination may make you briefly dizzy. That is expected, and it is useful information.
Often no tests are needed – the bedside examination does most of the work. When tests are used:
Chapter 26 explains these.
Do not drive while you are having episodes of dizziness that could come on without warning at the wheel. If your dizziness is sudden, disabling, or unpredictable, you must tell the DVLA (or the DVA in Northern Ireland). You can usually drive again once it is well controlled. The rules are stricter for bus and lorry drivers. Check the current rules on the DVLA website and ask your doctor if you are not sure.
The treatment depends entirely on the cause, so the detail is in the chapters that follow. In outline:
What does not help: staying still, long courses of sedating tablets, and expecting a scan to explain most inner-ear dizziness.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - dizziness with sudden weakness or numbness on one side, a drooping face, or slurred or muddled speech - dizziness with a sudden severe headache unlike any you have had before, sudden double vision, or sudden trouble walking or using an arm or leg - dizziness with a sudden drop in hearing - fainting during exercise, or with chest pain or a pounding heart - dizziness after a blow to the head, with a worsening headache, vomiting or drowsiness
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a first-ever attack of severe spinning that lasts for hours, with vomiting, and you cannot stand - fainting that has happened more than once - dizziness with a new, bad headache
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - dizziness or spinning that keeps coming back - dizziness with hearing loss, ringing, or fullness in one ear - unsteadiness that is getting worse, or that is causing falls - dizziness that you think started with a new medicine
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
The general rule for balance problems: moving speeds recovery, and resting slows it down.
'Dizziness means something is wrong with my brain.' Not usually. Most dizziness comes from the inner ear, blood pressure, medicines, or anxiety. Brain causes are less common and usually bring other signs, such as weakness or slurred speech.
'If I keep still, it will settle faster.' Not true for most inner-ear causes. The balance system readjusts faster when you keep moving and using it.
'Vertigo tablets are the treatment.' Not true. They are for the first few days of a severe attack. Taken long-term, they slow recovery down.
This story is made up to show a common experience. It is not about a real patient.
Bernadette is 71. Two weeks after her blood-pressure tablet was increased, she started feeling "swimmy" – not spinning, she was careful to say, but as if she might go down – whenever she got up from a chair or out of bed. Once she had to grab the worktop.
At the appointment, her blood pressure was normal sitting but dropped noticeably when she stood. Because she had described it so clearly as light-headedness rather than spinning, the doctor did not send her for inner-ear tests. Her tablet was adjusted, she was asked to drink more water and stand up in stages, and within two weeks the feeling had gone. She keeps a glass of water by the bed now.
Note down, or bring with you:
The most useful thing you can bring is a clear description of what "dizzy" means for you.
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (its Clinical Knowledge Summaries on vertigo, dizziness and blackouts), ENT UK, and DVLA guidance on fitness to drive, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Three inner-ear conditions cause most of the dizziness that ends up with an ENT clinic. They feel different, they are treated differently, and telling them apart mostly comes down to how long an attack lasts and what sets it off.
Positional vertigo (BPPV). Short bursts of spinning, lasting seconds up to about a minute, brought on by a change in head position – rolling over in bed, lying down, sitting up, looking up to a high shelf, or bending forward. The spin builds, then fades if you keep still. It often comes with a moment of nausea. Between attacks you may feel slightly off balance. Your hearing is not affected.
A one-off inner-ear attack. Sudden, severe, constant spinning that lasts hours to days. Bad nausea and vomiting. You cannot walk without holding on, and lying still with your eyes shut is the only comfortable position. It often follows a cold or a virus. If your hearing is affected too, it is called labyrinthitis; if only your balance is affected, it is called vestibular neuritis. The violent phase passes in a few days, then you feel unsteady for weeks, especially with quick head turns or in busy, moving places.
Ménière's disease. Attacks of spinning that last from about 20 minutes to several hours – not seconds, not whole days. During an attack, one ear feels full and blocked, the hearing in it changes (often muffled), and any ringing may get louder. Early on you feel well between attacks. Over years, the hearing in that ear can slowly decline. A few people have sudden falls, dropping to the ground without any warning and without blacking out.
BPPV. Tiny crystals that normally sit in one part of the balance organ come loose and drift into one of its fluid-filled loops. Now, when you move your head, the loose crystals stir the fluid and send a false "spinning" signal. It is more common with age, after a head injury, after another inner-ear illness, and after a long spell lying down. Often no cause is found.
A one-off attack is thought to be a virus affecting the balance nerve, and sometimes the hearing part too. The balance organ on that side suddenly goes quiet, and the mismatch with the healthy side causes the spinning until the brain adjusts to the new normal.
Ménière's disease is linked with a build-up of fluid and pressure in the inner ear, but the underlying cause is not known. It can run in families, and it is associated with migraine. It usually starts in one ear, and in a minority of people the other ear becomes involved later.
What the specialist is thinking
The first question is length. Seconds of spinning on moving the head is BPPV until proven otherwise. Hours, with ear fullness and a hearing change, sounds like Ménière's. Days of constant spinning, once, after a virus, is a one-off attack.
Is it triggered by position, or does it come out of the blue?
Is the hearing involved – muffled, full, ringing – and which ear?
Is this the first time, or a pattern over months or years?
I do the positional test to look for BPPV, and I check the eye movements and the head-turn test for a one-sided loss. Ménière's I diagnose from the story and from hearing tests repeated over time, not from one scan.
If the positional test shows BPPV, the doctor may treat it straight away, in the same visit.
Chapter 26 explains these tests.
If you think you have BPPV: it often clears on its own over a few weeks, but a repositioning manoeuvre is much quicker. Ask the clinic to do it and to show you the home version. In the meantime, sleep propped up on pillows for a few nights, and when you meet a trigger position, move into it slowly rather than avoiding it altogether.
If you are in a one-off attack: rest during the worst of it, take any anti-sickness medicine you have been given for a few days only, and keep sipping fluids. As soon as you can stand, start moving and doing gentle balance exercises – the sooner you get going, the faster you recover. Do not drive while the spinning is happening.
If you have, or may have, Ménière's:
For all three: make your home safer, take care on ladders and near water, and follow the driving rules in Chapter 11.
BPPV. The treatment is a repositioning manoeuvre – a set sequence of head and body movements (the Epley manoeuvre is the common one) that guides the loose crystals back to where they belong. It often works in one or two sessions, and can be repeated. People who get BPPV often can be taught to do the manoeuvre, or a set of home exercises, themselves.
Important: have BPPV diagnosed first, and be shown the manoeuvre by a clinician. The right manoeuvre depends on which ear and which loop is affected, and a positional test also helps make sure the cause is not something else. Doing the wrong manoeuvre, or doing one for undiagnosed dizziness, can make things worse. Tell the clinician if you have neck or back problems.
"Vertigo tablets" do not treat BPPV. BPPV can come back, and often does over the years – but it usually responds to the manoeuvre again.
A one-off inner-ear attack. Anti-sickness or vestibular sedative medicine helps the first few days, but not longer – taken for weeks it slows recovery. A short course of steroids is sometimes given early; the evidence for it is mixed. The main treatment is vestibular rehabilitation – a programme of balance and eye-movement exercises, often with a physiotherapist – which clearly speeds recovery. Most people are back to normal over weeks to a few months. A minority are left with lasting unsteadiness, or with the "on guard" dizziness described in Chapter 11.
Ménière's disease. Treatment is stepwise, and it is honest to say the evidence at every step is limited.
Over 5 to 15 years, Ménière's often settles by itself – the attacks become less frequent – though some hearing loss in that ear usually remains.
The limits. A manoeuvre clears the crystals but does not stop you being prone to BPPV. Nothing brings back a balance nerve that has been damaged – the brain learns to work around it instead. Ménière's treatments cut down attacks for many people, but none of them cures the condition or reliably protects the hearing.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - spinning with sudden weakness or numbness on one side, a drooping face, or slurred speech - spinning with a sudden severe headache, sudden double vision, or sudden trouble walking - a sudden drop in hearing along with the spinning - a sudden fall in which you hit your head, or lost consciousness
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a first-ever attack of severe, constant spinning with vomiting, and you cannot stand - a clear change in your usual pattern of Ménière's attacks - new hearing loss in one ear along with the vertigo
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - positional vertigo that keeps coming back, or is not improving - a one-off attack that has not settled after a couple of weeks - repeated attacks of vertigo with a full feeling in one ear, a hearing change and ringing - falling often
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
'Positional vertigo means my ear is damaged.' Not true. It is loose crystals in the balance organ, and a repositioning manoeuvre usually puts them back. The ear itself is healthy.
'Labyrinthitis always affects your hearing.' Not always. If only the balance nerve is involved, the hearing stays normal, and it is called vestibular neuritis. "Labyrinthitis" is the word used when the hearing is affected too.
'Cutting out salt cures Ménière's.' Not true. A lower-salt diet is a reasonable first step, and it helps some people, but it is not a cure and the evidence for it is limited.
This story is made up to show a common experience. It is not about a real patient.
Fiona is 58. She woke one morning and, as she rolled to her left to turn off the alarm, the room lurched into a violent spin that stopped after about twenty seconds. It happened again when she lay back down, and again when she tipped her head back in the shower. By mid-morning she was frightened it was a stroke and went to the GP.
The GP lay her back with her head turned to the left, watched her eyes flick, and told her it was BPPV – loose crystals in the balance organ, not the brain. A physiotherapist did the Epley manoeuvre that afternoon; it made her briefly very dizzy, then it was done. By the next day the spinning on turning had gone. She was shown a home version to use if it returned. It did, once, about a year later, and she cleared it herself in two goes.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (its Clinical Knowledge Summaries on benign paroxysmal positional vertigo, vestibular neuronitis and Ménière's disease), ENT UK, clinical practice guidelines from the American Academy of Otolaryngology–Head and Neck Surgery, and Cochrane reviews, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
A blocked nose is the single most common reason people are sent to an ENT clinic. It sounds minor, but a nose that will not let air through disturbs sleep, dulls smell and taste, spoils exercise, and wears people down over years.
The good news is that most blocked noses can be improved a great deal, often without an operation. The key is working out what is doing the blocking.
Some swapping from side to side is normal – the two sides of the nose take turns being more open, in a slow cycle through the day. You only notice it when the nose is already narrow.
A swollen lining (rhinitis). This is the commonest cause overall. The lining of the nose becomes inflamed and puffy, from an allergy (hay fever, house-dust mite, pets) or from non-allergic triggers (cold air, strong smells, hormones, some medicines). Chapter 14 covers this in full.
A deviated septum. The wall that divides the nose down the middle is bent, so one side is narrower than the other. This is very common. It often follows a knock to the nose, sometimes years earlier, and sometimes it is just how the nose grew. A bent septum is only a problem if it actually blocks airflow, or stops sprays reaching where they need to go.
Enlarged turbinates. The turbinates are curved shelves on the side wall of each nasal passage. They swell as part of rhinitis, and can stay enlarged.
Nasal polyps. These are soft, painless, grape-like swellings of the lining, usually on both sides. They come from long-term inflammation, and are more common in people with asthma or aspirin sensitivity. They block the nose and are a common cause of losing your sense of smell. Chapter 15 covers polyps.
A collapsing nostril. The narrowest part of the airway is just inside the nostril. In some people the side wall there is weak and gets sucked inwards when they breathe in hard, so the nose feels blocked on effort even though it looks open at rest.
Other causes: a cold that has not fully cleared, chronic sinus inflammation (Chapter 15), large adenoids (mostly in children – Chapter 30), and, uncommonly in adults, a growth at the back of the nose. A blockage on one side with blood-stained discharge or crusting is the sign that always needs checking.
What the specialist is thinking
One side or both – and does it swap? A block that swaps is usually the lining. A fixed one-sided block makes me think of the septum or something structural.
Is it there all year, or does it come and go with the seasons, with animals, with dust? That points me towards allergy.
Has the sense of smell gone? That raises polyps or long-standing inflammation.
Any bleeding or crusting on one side only? I look at that carefully.
What sprays have you tried, and how do you use them? Used wrongly, a steroid spray does very little. And a decongestant spray used for more than a week or two causes a rebound blockage that is worse than the original.
Do you snore, and are you sleepy in the day?
Then I look inside with a light, and usually a small camera, to see the septum along its whole length, the turbinates, the sinus openings, and whether there are polyps.
The doctor lifts the tip of your nose and uses a small instrument with a light to see the front of the nasal passages. A decongestant spray may be used first to shrink the lining so they can see further back.
Usually they pass a thin camera (a nasendoscopy) along the floor of the nose. It is uncomfortable rather than painful, takes a minute, and lets them see the whole septum, the turbinates, the openings of the sinuses, any polyps, and the back of the nose.
They may press on your cheeks and forehead if you have facial pain, look in your mouth and throat, and watch your nostril to see if it collapses inwards when you breathe in.
Often none are needed.
Chapter 26 explains scans and tests.
Two treatments do most of the work, and both need to be done properly and regularly.
Salt-water rinses. A large-volume rinse, once or twice a day, washes out mucus, allergens and irritants, and is safe to use long-term. Use a sachet mix or a ready-made kit. Make it up with water that is cooled after boiling, or bought sterile – not straight from the tap, because untreated tap water very rarely carries bugs that can be harmful in the nose. Lean over a sink, breathe through your mouth, and let the water run in one nostril and out of the other, then swap sides.
A steroid nasal spray. This is the main treatment for a swollen lining. It takes several days, and up to two weeks, to reach full effect, so use it every day, not only when you feel blocked. Technique matters: hold the bottle in the hand opposite the nostril, aim it slightly outwards towards your ear on that side rather than straight up at the middle wall, and breathe in gently – do not sniff hard. Aiming away from the middle wall reduces the chance of a nosebleed.
Other things that help:
A blocked nose from a cold usually clears within two to three weeks.
Medical treatment comes first, and it is given a proper trial of several weeks – a daily steroid spray and salt rinses, with an antihistamine if there is allergy. For severe polyps, a short course of steroid tablets is sometimes used to shrink them.
If a proper trial of medical treatment has not worked, and there is a clear structural cause, surgery is an option.
The limits. Surgery corrects structure. It does not cure an allergy or calm an inflamed lining. Results are usually good when the blockage is clearly structural, and less predictable when the lining is the main problem. A blockage can come back, especially if the triggers are still there.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - a blocked nose or facial pain with swelling or redness around an eye, a bulging eye, or double vision - a severe headache with a stiff neck, drowsiness or confusion - a nosebleed that will not stop (see Chapter 16)
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a one-sided swelling of the face that is spreading quickly, with a fever
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a blockage of one side that does not clear over several weeks - blood-stained fluid or crusting from one side of the nose for more than a couple of weeks - numbness of the cheek or face along with nasal symptoms - a loss of smell that does not come back - a blocked nose with loud snoring and daytime sleepiness (see Chapter 22)
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
With a steroid spray and salt rinses done properly and every day, most people notice a clear improvement within two to six weeks. This is ongoing treatment, not a short course – if you stop, the blockage tends to return.
After septal surgery, expect about a week with a bunged-up, crusty nose, rather like a heavy cold. Any splints or packing are usually removed at around a week. Avoid blowing your nose and heavy lifting for a couple of weeks. Most of the swelling settles by four to six weeks, and the final result is clear by about three months. Most people breathe more freely; some still use a spray for the lining.
After polyp surgery, regular rinsing and a daily spray are needed afterwards to keep the polyps from growing back (Chapter 15).
'Steroid nasal sprays are addictive, or harmful if used for a long time.' Not true. Used at the normal dose, they are safe for long-term daily use. It is the fast-acting decongestant sprays that cause dependence and a rebound blockage.
'A blocked nose is just a cosmetic thing – you should put up with it.' Not true. It disturbs sleep, exercise, smell and quality of life, and it is very treatable.
'I can sort my nose out by straightening it myself.' Not true, and not safe. A nose that needs straightening needs a clinician.
This story is made up to show a common experience. It is not about a real patient.
Idris is 41. His right nostril had been the blocked one since a rugby match at 16. For years he used a decongestant spray from the chemist, a few puffs whenever he could not breathe, and over time he needed it more and more – until both sides were blocked without it.
The ENT doctor explained the rebound effect, and Idris stopped the decongestant, which was a rough two weeks. He started a steroid spray, aimed properly away from the middle wall, and daily salt rinses. The left side settled well. The right side stayed narrow, and the camera showed a clearly bent septum. A septoplasty a few months later opened it up. He still uses the steroid spray most days, and for the first time since school he can breathe through both sides at night.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from the European position paper on rhinosinusitis and nasal polyps (EPOS), the British Society for Allergy and Clinical Immunology, NICE, and ENT UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
"Rhinitis" simply means an irritated, inflamed nose lining. It causes sneezing, a runny or blocked nose, and often itchy, watery eyes. Hay fever is the best-known kind, but many people have it all year round, and not everyone's rhinitis is an allergy.
This chapter covers both the allergic and the non-allergic kinds, because they overlap and the treatments are similar. For the spray technique and the salt rinse mentioned here, see Chapter 13.
The pattern is a strong clue:
Allergic rhinitis. The immune system treats a harmless airborne particle as a threat and reacts to it. The common triggers are grass and tree pollen, house-dust mite (actually their droppings, in bedding and carpets), pet dander from cats, dogs and horses, and mould spores. Some people react to something at work – flour, wood dust, laboratory animals, latex, or certain chemicals – and then the tell-tale sign is that symptoms ease on days off and holidays.
Non-allergic rhinitis. The same symptoms, but allergy testing is negative. It has several forms:
Many people have a mix of both.
Things that can look like rhinitis but are not: an ordinary cold, a sinus infection, nasal polyps or a bent septum (Chapter 13), and – rare but important – a constant clear watery drip from one side of the nose, especially after a head injury or nose surgery, which can be a leak of the fluid that surrounds the brain and needs to be checked. One-sided symptoms with bleeding also need checking (Chapter 4).
What the specialist is thinking
Is there itch – of the nose, the eyes, the roof of the mouth? Itch pushes me strongly towards an allergy.
What is the pattern? A clear season points to pollen. All year round points to house-dust mite or a pet. Set off by smells and cold air points to the non-allergic kind.
Any pets – and did the symptoms start when you got them, or when you moved house?
What is your job, and do your symptoms get better on holiday?
Do you have asthma or eczema? They travel together with allergic rhinitis.
And then the practical question: which treatments have you tried, at what dose, for how long, and how do you actually use the spray? Most "nothing works" turns out to be too low a dose, not long enough, or the spray going straight down the throat.
The doctor looks in the nose with a light, and often passes the thin camera. A pale, swollen, wet lining suggests an allergy. They also look for polyps, a bent septum, and swollen turbinates, check your eyes, and – if asthma is possible – look in your throat and listen to your chest. For work-related symptoms, they will ask in detail about what you are exposed to and when.
Allergy testing is done when the result will change what you do – for example if you are thinking about serious avoidance measures, or about desensitisation, or the picture is unclear.
One key point: a positive test shows that your immune system recognises an allergen. It does not, on its own, prove that this allergen is causing your symptoms. The result is read alongside your story.
Tests to avoid: "food-intolerance" blood tests that measure a different antibody (IgG), hair analysis, and muscle-testing methods. These do not diagnose allergy and can send people down the wrong path.
Sometimes the most useful "test" is simply a proper trial of treatment.
Reduce your exposure where it is realistic.
Treat the lining.
Treatment is built up in steps.
| Step | What is added |
|---|---|
| 1 | Avoiding triggers where you can, salt rinses, and a regular non-drowsy antihistamine (a tablet, or a nasal spray). Eye drops if the eyes are affected. |
| 2 | A daily steroid nasal spray, used with good technique and continued right through the trigger period. This is the mainstay for anyone with a blocked nose or persistent symptoms. |
| 3 | A combined steroid-and-antihistamine nasal spray. A leukotriene tablet may be added if you also have asthma. A short course of steroid tablets, only for a crucial short period such as an exam or a wedding. |
| 4 | Desensitisation (immunotherapy) – see below. |
Depot steroid injections for hay fever – a single long-acting injection given once a year – are not recommended. The dose cannot be adjusted or stopped, it exposes the whole body to steroid for months, and safer treatments work as well.
Desensitisation (immunotherapy) is for people with a confirmed allergy to a single main allergen – most often grass pollen or house-dust mite – whose symptoms are still not controlled by the steps above and are really affecting their life. Small, increasing doses of the allergen are given, either as a daily tablet or drops under the tongue, or as injections, over about three years. It can reduce symptoms and the need for other medicines for years afterwards, and for grass-pollen allergy in children, the largest trial found it reduced asthma symptoms and the need for asthma medicine over several years of follow-up – though it did not show that it prevents asthma from developing in the first place. It is started and supervised in a specialist allergy clinic, because there is a small risk of allergic reactions, and it needs commitment to the daily routine.
For non-allergic rhinitis: a steroid nasal spray; a nasal antihistamine (which helps some non-allergic types); an anticholinergic nasal spray for a nose that runs constantly, or used before meals for the eating-triggered kind; stopping or switching a medicine that is causing it; and treating any hormonal or thyroid cause.
In pregnancy, a blocked, runny nose is common and usually settles within about two weeks of the birth. Avoid decongestant sprays, and get advice on which of the other treatments are suitable during pregnancy.
The limits. Medical treatment controls rhinitis; it does not cure it. Desensitisation is the exception, and even that helps rather than guarantees. Symptoms come back if treatment stops or the exposure continues. And "natural" remedies such as local honey do not have good evidence behind them.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now: a severe allergic reaction (anaphylaxis)
This is different from hay fever. Signs, coming on quickly: - swelling of the lips, tongue or throat, a hoarse voice, or difficulty swallowing - difficulty breathing, or noisy breathing - feeling faint or dizzy, becoming pale and clammy, or collapsing - often, but not always, a widespread rash or flushing
What to do: 1. If the person has an adrenaline auto-injector (such as an EpiPen), use it straight away, into the outer thigh. 2. Call 999 and say "anaphylaxis". 3. Help them lie down with their legs raised. If breathing is hard, let them sit up. If they are drowsy or being sick, lay them on their side. 4. If there is no improvement after 5 minutes and a second auto-injector is available, use it. 5. Stay with them until the ambulance arrives.
Anaphylaxis is usually caused by foods, insect stings or medicines, not by pollen.
Also call 999 or go to A&E for a nasal problem with swelling around an eye, double vision, or a severe headache with a stiff neck or confusion.
Get help today - asthma that is getting worse alongside the rhinitis – more breathless, or needing the reliever inhaler more often
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a constant clear watery drip from one side of the nose, especially after a head injury or nose surgery - one-sided blockage, bleeding or crusting for more than a couple of weeks - a loss of smell that does not come back - rhinitis that is still not controlled despite proper treatment used correctly - a child whose rhinitis is affecting their sleep and school
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
With the right treatment, used properly, most people get good control within two to four weeks.
Hay fever needs treating every season, and it works best if you start before the pollen does. Year-round rhinitis usually needs ongoing daily treatment; if you stop, it comes back. Symptoms flare when exposure is high and settle again afterwards.
Desensitisation takes a few months to show benefit, and about three years for a lasting effect.
Some children's allergic rhinitis improves as they grow, but many carry it into adult life – and it can also appear for the first time in adulthood.
'Local honey cures hay fever.' Not true. There is no good evidence for it. The pollen in honey comes mostly from flowers that insects visit, not from the wind-blown grass and tree pollens that cause hay fever.
'Antihistamines stop working if you take them every day.' Not true. They do not lose their effect. If one is not helping enough, the dose may be too low, or the problem may be blockage – which needs a steroid spray – or a different antihistamine may suit you better.
'You cannot develop hay fever as an adult.' Not true. It most often starts in the teens and twenties, but it can begin later in life.
This story is made up to show a common experience. It is not about a real patient.
Nadia is 19 and sat her second-year university exams in June, in the middle of grass-pollen season. Her eyes streamed, she sneezed through revision, and an antihistamine taken only on bad days barely touched it.
The following spring she started a steroid nasal spray in mid-April, before the pollen arrived, used it every day with the right technique, took a non-drowsy antihistamine daily, and added antihistamine eye drops. Exams that June were manageable. Because grass pollen was clearly her one big trigger and it still limited her, she was referred for desensitisation and started a daily under-the-tongue tablet. Two summers on, she describes her hay fever as "a background nuisance" rather than something that takes over June.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from the British Society for Allergy and Clinical Immunology, the ARIA international guidelines, NICE, and – for the anaphylaxis section – the Resuscitation Council UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
The sinuses are air spaces in the bones around the nose. When the nose lining is inflamed, the sinuses often are too – doctors now usually call this rhinosinusitis rather than just sinusitis, because the two go together.
This chapter covers short-lived sinus infections, the long-lasting kind, and one thing that surprises many people: a large share of "sinus" facial pain is not coming from the sinuses at all.
Things that are usually not sinus trouble: a one-sided throbbing headache with nausea and dislike of light (migraine), a tight band of pressure around the head (tension headache), pain brought on by chewing (the jaw joint or a tooth), and brief, electric-shock face pains (a nerve condition).
A short-lived sinus infection is almost always a virus – a cold that has settled into the sinuses. Only a small share turn into a bacterial infection. Most clear up on their own within two to three weeks.
Repeated short-lived infections – separate episodes, with clear well spells in between.
Long-lasting rhinosinusitis means inflammation that has been there for 12 weeks or more. There are two broad types: without polyps and with polyps (the soft swellings of the lining described in Chapter 13). It is linked with allergy, asthma, sensitivity to aspirin, a bent septum, smoking, and problems with the immune system. Uncommonly it is driven by a fungus, or by an infected tooth root pushing into a cheek sinus.
The pain is not from the sinuses in a large proportion of people sent to an ENT clinic for "sinus pain". The commonest real cause is migraine, which often does not come with a classic headache and can feel like pressure over the face. In fact, most people who believe they have sinus headaches, and who have no nasal blockage, discharge or smell change, turn out to have migraine. Other causes include tension headache, dental problems, jaw-joint pain, brief nerve pains, and a condition called midfacial segment pain – a constant band of pressure across the middle of the face, with a normal-looking nose and a normal scan, which responds to a low dose of a medicine used for nerve-type pain.
One-sided disease – a single blocked or painful sinus, especially with bleeding, crusting, or numbness of the cheek – always needs a careful look, because a fungal ball, a dental cause, or a growth can all do this.
What the specialist is thinking
Are there nasal symptoms – blockage, discharge, a change in smell – or is this facial pain on its own? Pain alone, with a normal nose and a normal sense of smell, is usually not sinusitis, and operating on it does not help.
How long? Days points to a passing infection. Twelve weeks or more points to the long-lasting kind.
Is it one-sided?
Are there migraine features – throbbing, nausea, sensitivity to light or sound, or visual disturbance beforehand?
Any recent dental work, or a painful tooth on that side?
What treatments have you used, and for how long? Sprays and rinses need weeks, not days, to judge.
Do you have asthma, or reactions to aspirin? Have you had sinus surgery before?
Then I look in the nose with the camera, and if it is chronic, one-sided, or we are thinking about surgery, I arrange a CT scan.
The doctor uses a light and the thin camera to see the lining, any pus coming from a sinus opening, polyps, a bent septum, the turbinates, and the back of the nose. They press over your cheeks and forehead, look in your mouth and at your upper teeth, and – if there are worrying features – check your eyes and eye movements and do a basic check of the nerves.
Chapter 26 explains scans and tests.
For a short-lived episode – which is most people:
For long-lasting symptoms:
If it might be migraine: keep a headache diary, note possible triggers, and be open to a trial of migraine treatment – which is often the real test.
A short-lived infection. Most need only the self-care above. If symptoms are severe or have not settled after about 10 days, the GP may give a back-up antibiotic – a prescription to keep and use only if things clearly get worse. An antibiotic straight away is kept for people who are very unwell or who have signs of a spreading infection.
Long-lasting disease without polyps. Long-term steroid nasal spray and salt rinses. Sometimes a longer, low-dose course of a particular antibiotic is used for its calming effect on inflammation, under specialist care. If a proper trial of medical treatment fails, keyhole sinus surgery through the nostrils opens up the natural drainage channels, so that sprays and rinses can reach the lining. It does not remove the tendency to inflammation, so the spray and rinses carry on afterwards.
Long-lasting disease with polyps. Steroid nasal spray and rinses; a short course of steroid tablets to bring things under control; sometimes steroid drops. Keyhole surgery removes the polyps and opens the sinuses when medical treatment is not enough. Polyps commonly grow back, so lifelong spray and rinsing afterwards is expected, and a second operation is sometimes needed over the years.
For severe polyps that keep coming back despite surgery and full medical treatment – especially in people who also have asthma or aspirin sensitivity – a biologic medicine may be an option. These are given by injection, usually every two weeks (dupilumab is the one most used for this), and they work by damping down one particular part of the immune reaction. For many people they shrink the polyps and bring back the sense of smell. On the NHS they are used within set rules: the disease has to be severe, it has to have failed to respond to steroid tablets and to surgery (or surgery is not suitable), a specialist team manages the treatment, and it is stopped if it has not clearly helped by a review point. They are taken long-term and are expensive.
Aspirin sensitivity. Some people have a pattern of asthma, nasal polyps, and reactions – wheeze, a blocked streaming nose – to aspirin and similar anti-inflammatory painkillers. Their polyps tend to be more stubborn. They should avoid those painkillers. A specialist programme that carefully builds up tolerance to aspirin ("desensitisation") helps some people, and the biologic medicines also work well here.
Facial pain that is not from the sinuses. The answer is to treat the real cause – migraine treatment, dental care, measures for the jaw joint, or, for the midface-pressure type, a low dose of a nerve-pain medicine. Sinus surgery does not help these pains, and can leave people feeling worse.
The limits. Antibiotics are given far too often for sinus problems and rarely change how a short-lived episode turns out. Surgery improves drainage and lets treatment reach the lining – it does not switch off the inflammation. Polyps recur. And operating on a face pain that was never a sinus problem is a real and avoidable cause of disappointment.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - swelling, redness or puffiness around an eye, an eye that looks pushed forward, double vision, or reduced vision – with a sinus infection or facial pain - a severe headache with a stiff neck, drowsiness, confusion, or a fit - a swelling of the forehead or face that is spreading quickly
These can mean the infection has spread beyond the sinus. They are more urgent still in a child. Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a sinus infection with a high fever and severe pain, or one that is clearly getting worse after starting to improve, without the eye or brain signs above
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - symptoms on one side only, especially with bleeding, crusting, or numbness of the cheek - sinus symptoms lasting more than 12 weeks - a loss of smell that does not come back - repeated episodes that keep needing antibiotics - facial pain that a scan has shown is not coming from the sinuses – so the real cause can be treated
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
A short-lived infection: most people are better within two to three weeks. A blocked nose and reduced smell can take a few weeks more to clear.
Long-lasting disease without polyps: a steady improvement over four to twelve weeks of daily spray and rinsing. It is control, not cure – if you stop, it returns.
After keyhole sinus surgery: a week or two of a congested, crusty nose with some blood-tinged discharge; saline rinsing from the first day; cleaning appointments in the weeks that follow; most of the benefit is clear by six to twelve weeks. Smell may improve gradually, or not fully return.
With polyps: expect to keep using a spray and rinses for good. Some regrowth is common.
With a biologic medicine: smell and the blocked feeling often improve within a few weeks to a few months.
'Coloured mucus means I need antibiotics.' Not true. Green or yellow mucus is normal in any cold and in a viral sinus infection. On its own, it does not mean a bacterial infection or a need for antibiotics.
'A sinus headache is a common diagnosis.' Not really. Most people who think they get sinus headaches, and who have no blocked nose, discharge or change in smell, actually have migraine. True facial pain from the sinuses on its own is uncommon.
'Sinus surgery is a permanent cure.' Not for long-lasting disease. It opens the sinuses so that treatment can work. The inflammation, and any polyps, can come back – which is why the sprays and rinses continue afterwards.
This story is made up to show a common experience. It is not about a real patient.
Colin is 47 and had been having "sinus infections" for years – a dull, heavy pressure behind his cheeks and forehead, two or three times a month, and a course of antibiotics from the GP most times. They helped, he thought, though the pain always came back.
At the ENT clinic, the camera showed a normal nose, and a CT scan done during a bad spell was clear. His nose was never blocked, and his sense of smell was fine. The doctor asked him to keep a diary and referred him to a headache clinic. The pattern – pressure with nausea, worse with poor sleep and skipped meals, eased by lying in a dark room – fitted migraine. On a daily preventive tablet and with more regular meals and sleep, his "sinus attacks" dropped to a few mild ones a year, and he has not needed an antibiotic since.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on the European position paper on rhinosinusitis and nasal polyps (EPOS), NICE guidance on sinusitis (including NG79 and the technology appraisal of dupilumab), NICE Clinical Knowledge Summaries, and ENT UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Most nosebleeds look worse than they are. They come from small blood vessels near the surface at the front of the nose, and they stop with simple, firm pressure done the right way. This chapter is mostly about that method – and about the smaller number of nosebleeds that need more.
Common reasons:
Less common:
High blood pressure does not usually start a nosebleed, but it can make one last longer, so it is worth having it checked.
The pattern that always needs checking: bleeding that comes from the same side every time, or a blood-stained discharge from one side, especially with a blocked nose on that side. The nose is examined properly to make sure there is nothing growing there.
What the specialist is thinking
One side or both – and is it always the same side?
How often, how heavy, and how long does it take to stop?
Are you on any blood-thinning medicine, or aspirin?
Any easy bruising, bleeding gums, heavy periods, or liver trouble? Anyone in the family with frequent nosebleeds?
Any recent injury? And what is your blood pressure?
Then I look in the nose, usually with the camera, to find the bleeding point – most are an obvious little vessel at the front – and to check there is nothing else there.
The doctor uses a light, and often the thin camera. A spray that shrinks and numbs the lining – and often slows the bleeding – is used so they can see clearly. They look for the bleeding vessel at the front of the middle wall, and check the rest of the nose and the back of the nose.
Usually none are needed.
Do not tip your head back, lie down, blow or pick your nose, or push tissue or cotton wool up it.
Cautery. After a numbing spray, the bleeding vessel is sealed with a silver-nitrate stick or with heat. It takes a minute or two. The nose is sore and crusty for a few days to a couple of weeks afterwards – use the jelly or cream. Only one side of the middle wall is treated at a time, to protect it. Bleeds can come back from a new spot, and cautery is sometimes repeated.
Packing. If cautery is not possible, or the bleeding is heavier or coming from further back, a sponge or dressing is placed in the nose to press directly on the bleeding point. This is done in A&E or on a ward. It is uncomfortable, and it stays in for a day or two. An antibiotic is sometimes given while it is in place.
For a bleed that will not settle, you may be admitted, and occasionally a procedure is done to block off, from the inside, the artery that is feeding the bleed.
For the inherited condition that causes fragile vessels and frequent bleeds, there are specialist treatments and genetic advice.
The limits. Cautery treats the vessel the doctor can see. Packing controls a bleed but does not cure the tendency. The underlying cause – dryness, picking, a medicine, or an inflamed lining – still has to be dealt with.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - bleeding that will not stop after 15 to 20 minutes of correct, firm pressure - very heavy bleeding, or large amounts of blood running down your throat - feeling faint, dizzy or breathless, or looking pale and clammy - a nosebleed after a hard blow to the head or face - a nosebleed that will not stop while you are taking a blood-thinning medicine - a child bleeding heavily, or a child's nosebleed that will not stop
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a very heavy nosebleed that has stopped, but has left you feeling unwell or dizzy - a significant nosebleed while on a blood-thinning medicine, even if it has now stopped – for review
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - nosebleeds more than about once a week, or that always take a long time to stop - bleeding that comes from the same side every time, especially with a blocked nose or a blood-stained discharge - nosebleeds along with easy bruising, bleeding gums, or very heavy periods - a family history of frequent nosebleeds with red spots on the lips, tongue or fingers
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
After stopping a bleed with pressure, the nose may ooze a little and feel tender for a day. Follow the "first 24 hours" list above.
After cautery, expect soreness and crusting for a few days to a couple of weeks. Use the jelly or cream, and avoid picking. There is a small chance you will need it done again.
After packing, the pack is removed after a day or two. The nose is sore and blocked while it is in. A protective ointment or a short course of an antibiotic is sometimes given.
Most people who get repeated bleeds from the front of the nose settle down with cautery, careful aftercare, and dealing with the trigger.
'Tip your head back to stop a nosebleed.' Not true. That sends blood down your throat, which can make you vomit and hides how much you are actually losing. Lean forwards.
'High blood pressure causes nosebleeds.' Mostly not. It rarely starts one, although it can make a bleed last longer – so it is still worth having checked.
'Nosebleeds in children are usually serious.' Not true. They are very common and almost always harmless, coming from a dry, picked area at the front of the nose.
This story is made up to show a common experience. It is not about a real patient.
Margaret is 76 and takes a blood-thinning tablet for an irregular heartbeat. Over one winter she had several nosebleeds, each stopping after 20 minutes of pinching. Then one evening a bleed would not stop at all, and she began to feel faint. In A&E, a sponge pack was placed in her nose and left overnight, and her blood count was checked.
The next week the ENT clinic found a prominent vessel at the front of her septum and cauterised it. She was given an antiseptic cream to use for ten days, told to keep the bedroom air less dry and to sneeze with her mouth open, and the anticoagulant clinic reviewed – and kept – her tablet. She had one small bleed the following month, which she stopped herself, and none since.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (its Clinical Knowledge Summary on nosebleeds), the NHS website and ENT UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Smell is easy to take for granted until it changes. It warns you about gas, smoke and food that has gone off. It is most of what we call the "taste" of food. And it is tied up with memory, mood and closeness to other people. Losing it, or finding that things smell wrong, is more disruptive than people expect.
The change may have happened at a clear moment – after an illness or an injury – or it may have crept up so slowly that you only noticed when someone else pointed it out. A gradual, unnoticed loss is common with age.
A blocked or inflamed nose. If the lining is swollen – from hay fever, long-term sinus inflammation, or, above all, nasal polyps – smell molecules cannot reach the smell area high up in the nose. This kind often comes and goes, is worse with a cold, and improves with steroid treatment. It is the most treatable group.
After a viral illness. A cold, flu, or COVID-19 can damage the smell nerve endings. Here the smell usually drops suddenly, and the nose is clear rather than blocked. It recovers over months, often not completely. Distorted smells frequently appear weeks or months into the recovery, as the nerve regrows.
A head injury. A blow to the head can shear the fine smell nerve fibres where they pass through the skull. This loss is often permanent, though there is sometimes partial recovery over a year or two.
Ageing. Smell slowly fades from around the sixties onwards. It is very common, and usually mild.
Some medical conditions. Reduced smell can be an early feature of some conditions of the nervous system, such as Parkinson's disease – usually alongside other symptoms that develop over time. Losing your sense of smell on its own is not a diagnosis of anything. But a lasting loss with no clear cause is worth a proper check.
Other causes: smoking (which dulls smell, and partly recovers if you stop), some medicines and cancer treatments, exposure to solvents or metals at work, and some general illnesses such as an underactive thyroid or a vitamin B12 deficiency. A few people are born without a sense of smell.
Uncommon but serious: a growth at the front of the skull, or in the nose or sinuses. This usually shows itself as blockage or bleeding on one side, or as a smell loss that gets steadily worse with headaches or a change in personality.
What the specialist is thinking
Did it come on suddenly, or gradually? Was the nose blocked at the time, or clear? Sudden loss with a clear nose, after a virus, is a very different situation from a gradual loss with a blocked, polyp-filled nose.
Was there a cold, flu or COVID, or a head injury, just before?
Is it one-sided?
Any distorted or phantom smells?
Any nasal symptoms – blockage, discharge, bleeding, crusting?
Any symptoms from the nervous system – a tremor, memory trouble, headaches, changes in vision or personality?
What medicines do you take, what is your job, and do you smoke?
The doctor passes the thin camera through the nose to look for polyps, inflammation, a blockage, crusting, or anything growing, and to check the rest of the nose. If the story suggests it, they do a basic check of the nervous system.
Chapter 26 explains scans and tests.
Losing your smell takes away a warning sense.
Give a steroid nasal spray and salt-water rinses a proper trial (Chapters 13 to 15), treat any allergy, and see a doctor about a short course of steroid tablets if polyps are the cause.
This is the main self-help step, especially after a viral illness.
Use essential oils, or the real items. Progress is slow and uneven.
Smell loss commonly dents the enjoyment of food, and can affect weight, mood and relationships. Eat for texture, temperature, colour and the basic tastes, and season food more. Keep an eye on your mood, and get support if it is low. Support organisations such as AbScent and Fifth Sense have practical advice and connect people going through the same thing.
Stop smoking. Keep a simple diary of any change – distorted smells are unpleasant, but they are often a sign that the nerve is recovering.
A blocked or inflamed nose. Steroid nasal spray and rinses; steroid drops used in a head-down position to reach the roof of the nose; a short course of steroid tablets; and sinus surgery for polyps. Smell often improves, sometimes dramatically – but it can fade again if polyps grow back. For severe polyps, the biologic injections described in Chapter 15 bring back the sense of smell for many people.
After a viral illness. Smell training has the best evidence. A short, early course of steroids is sometimes used to treat any inflammation adding to the problem. Other remedies – fish oil, vitamin A drops, and various supplements – have only limited or uncertain evidence. Time matters: most recovery happens in the first year, and some continues beyond it.
Head injury, an inherited absence of smell, or a nervous-system cause. There is usually no treatment that restores smell. The focus is on safety and on adapting, and on treating any underlying condition.
Distorted smells. There is no proven specific treatment. Smell training may help, and it usually eases over months. Meanwhile, cool and bland foods, and avoiding the foods that trigger it, make eating easier.
What does not have good evidence: most supplements, and "smell drops" sold online.
A realistic picture. Loss from a blocked, inflamed nose is the most treatable. Loss after a virus recovers partly in most people and fully in a minority, over months to a couple of years. Loss after a head injury is usually permanent.
When not to wait
A change in smell is rarely an emergency in itself – but it removes a safety sense, so read the home-safety list above.
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - a sudden loss of smell together with sudden weakness or numbness on one side, drooping of the face, slurred speech, sudden vision problems, or a sudden severe headache
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a sudden loss of smell with a fever and confusion, or feeling very unwell
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - loss of smell on one side, especially with a blocked nose, bleeding or crusting on that side - a loss of smell that is getting steadily worse over months, with no clear cause - a loss of smell along with new symptoms from the nervous system – a tremor, memory problems, a change in personality, headaches, or changes in vision - a loss of smell that is still there more than two to four weeks after a cold or COVID - a loss of smell together with nasal polyps or long-term sinus symptoms
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
'Losing your smell just means you cannot enjoy food.' Not true. It also takes away a safety sense – gas, smoke, food gone off – and it often affects mood and relationships. It deserves to be taken seriously.
'If it has not come back in a few weeks, it never will.' Not true. Smell loss after a virus can keep improving for a year or more, and smell training helps.
'Smelling things that are not there means a brain tumour.' Usually not. Phantom smells are most often part of recovering smell loss after a virus, or of sinus inflammation. A tumour is an uncommon cause and usually comes with other signs – though a one-sided or steadily worsening problem is always checked.
This story is made up to show a common experience. It is not about a real patient.
Rosa is 34. She had a mild viral illness one winter and, a week later, realised she could not smell her coffee. Her nose was not blocked. Two months on, her smell started to come back – but wrong. Coffee smelled of drains, and cooked meat was worse. She could barely face the kitchen.
The ENT clinic confirmed the loss on a smell test and a normal camera examination, and explained that the distorted smells were a sign the nerve was regrowing. She started smell training with four oils, twice a day, and kept a diary. She switched to cooler, plainer food for a while, fitted a carbon-monoxide alarm, and started going by dates rather than sniffing the fridge. By eight months, coffee smelled roughly like coffee again. Her smell is not what it was, but she can cook, and she can smell smoke.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from ENT UK, NICE, the British Rhinological Society's position on smell loss after infection, and the smell-loss charities AbScent and Fifth Sense, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Almost everyone gets sore throats. Most are caused by ordinary viruses, clear up within a week, and never need a doctor. This chapter is about telling those apart from the smaller number that do need attention – and about the decision some people face over whether to have their tonsils removed.
The pattern helps:
Viruses cause most sore throats – the same viruses that cause colds and flu, plus the glandular-fever virus and COVID-19.
Bacteria, mainly streptococcus, cause a minority. These are more likely when there is a fever, pus on the tonsils and tender neck glands, and no cough.
Tonsillitis means the tonsils themselves are inflamed, whether from a virus or a bacterium.
Quinsy is a collection of pus that forms beside a tonsil, usually as a complication of tonsillitis.
Glandular fever is a viral illness that causes a long, severe sore throat, very large neck glands, and weeks of tiredness. The spleen, an organ in the upper left of the abdomen, can swell, so contact sport is avoided for a while.
Other causes of a sore or irritated throat: a dry throat from mouth-breathing or dehydration; acid from the stomach coming up and irritating the throat (Chapter 20); mucus dripping from the back of the nose; smoking and vaping; heavy voice use; a fungal infection (thrush), more likely with inhaled steroids or a weak immune system; and the feeling of something stuck after a fish bone.
The one that always needs checking: a sore throat on one side that lasts for weeks, or an ulcer or lump that does not heal – especially in someone who smokes or drinks alcohol. See Chapters 4 and 25.
Rarely, a sore throat is a sign of a serious deep infection in the neck, or of a sharp drop in the infection-fighting white blood cells caused by a medicine.
What the specialist is thinking
Are there cold symptoms too – a cough, a runny nose – or is it just the throat? Cold symptoms point to a virus.
How high is the fever? Can you swallow your own spit, and can you open your mouth normally? If not, I am thinking about a quinsy or a deep infection.
Is the pain much worse on one side?
How many bouts have you had in the last year, and how bad were they – did they stop you working or going to school, and did a doctor see and record each one?
Are you on any medicine that can lower the white blood cells?
For an adult with a one-sided sore throat for weeks, or one tonsil clearly bigger than the other, I examine carefully and keep cancer in mind, especially with a history of smoking or alcohol.
The doctor looks at your throat and tonsils with a light and a flat stick that holds the tongue down. They are checking the size and colour of the tonsils, whether there is pus, whether one side is bulging, and whether there is any ulcer or lump or one-sided swelling. They feel the glands in your neck, check that you can open your mouth and swallow, and take your temperature.
For a persistent or one-sided problem, they pass the thin camera to see the tonsil, the base of the tongue and the voice box. If glandular fever is likely, they look for a rash and feel for a swollen spleen.
Most sore throats need no tests.
Most sore throats – including many bacterial ones – settle within about a week on their own.
See a GP if you cannot swallow fluids, the pain is severe and one-sided with trouble opening your mouth, you have a high fever and feel very unwell, the symptoms last more than about a week, they keep coming back, or any warning sign below appears.
If you have glandular fever: expect two to four weeks of tiredness, sometimes longer. Avoid alcohol while your liver is affected. Avoid contact sport and heavy lifting for at least four to six weeks, because of the risk of injuring a swollen spleen. Do not share drinks or cutlery.
Antibiotics. For a typical sore throat, antibiotics shorten the illness by only about a day, and most people do not need them. A doctor may offer one – often as a "use only if it gets worse" prescription – if a bacterial cause is likely on the scoring system, if you are very unwell, or if you are at higher risk of complications. If antibiotics are given for a streptococcal throat, a course of several days is needed. An alternative is used if you are allergic to penicillin. Note that amoxicillin can cause a widespread rash in someone who actually has glandular fever. Children under 16 should not be given aspirin.
Quinsy. This needs same-day hospital care: the pus is drained, with a needle or a small cut after a numbing spray, and antibiotics are given. It usually improves quickly once it is drained.
Glandular fever. There is no specific treatment – rest, fluids and pain relief. Steroids are used only if the throat swells enough to threaten breathing.
If you get frequent, genuinely disabling bouts of tonsillitis, you may be offered an operation to remove the tonsils (a tonsillectomy). This is a shared decision, and it is worth taking time over.
Surgery is usually considered when the sore throats are caused by tonsillitis, are bad enough to stop you doing normal things, and are frequent – a common guide is:
Doctors usually suggest a period of watching and waiting first, because attacks often become less frequent over time on their own. (These numbers are a guide. Your local NHS may use slightly different criteria.)
Decision aid: removing the tonsils, or waiting
If you have the operation - it reliably stops tonsillitis, and over the next year or two you have fewer sore throats overall - the benefit is clearest for people who meet the frequency guide above; it is smaller for milder cases - you can still get ordinary viral sore throats from the throat lining - it is not a treatment for tiredness, bad breath, or a "lump" sensation on their own - downsides: a genuinely sore throat and ear for one to two weeks, often worst around days 5 to 7; time off work or school; a small risk of bleeding after the operation (see below); the usual risks of an anaesthetic
If you wait and see - no operation and no recovery period - attacks often lessen over months to a couple of years - meanwhile you keep having bouts, with the time off and antibiotics that go with them - you can change your mind and have surgery later
Questions that matter to you - how much are the bouts actually affecting your life, work or family right now? - could you take one to two weeks out for recovery? - how do you feel about the bleeding risk?
Bleeding after tonsillectomy is the main risk to understand. It affects a small number of people – fewer than 1 in 10, and for most of them it is minor – and it can happen at any point up to about two weeks after the operation, not just on the day. Occasionally it needs a return to the operating theatre, or a blood transfusion. You will be told exactly where to go if it happens.
A tonsil that is clearly bigger on one side, or an ulcer or lump that does not heal, is investigated properly. Sometimes that tonsil is removed so it can be examined, because rarely this is a cancer or a lymphoma.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - difficulty breathing, or a harsh noise when breathing in - not being able to swallow your own spit, or drooling - a muffled "hot potato" voice with severe pain on one side and trouble opening your mouth - a swelling of the neck that is spreading quickly, with a fever - a stiff neck, a severe headache, drowsiness, or a rash that does not fade, along with a sore throat
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - severe pain on one side with a fever and trouble opening your mouth (a possible quinsy) - not able to drink enough to stay hydrated - a sore throat with a fever while you are taking a medicine that can lower the white blood cells – for example some medicines for an overactive thyroid, or for rheumatoid arthritis. This needs an urgent blood test.
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a sore throat lasting more than one to two weeks - frequent bouts that are affecting your life – to talk through the options - a lump or ulcer on a tonsil or in the throat that has not healed in three weeks, or one tonsil clearly bigger than the other – especially if you smoke or drink alcohol - a lasting sore throat on one side with ear pain and a normal-looking ear
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
'A sore throat with white spots always needs antibiotics.' Not true. White spots appear with viral tonsillitis and with glandular fever as well. The decision is based on the whole picture, not the spots alone.
'Taking your tonsils out stops you getting sore throats.' Not entirely. It stops tonsillitis and reduces sore throats overall, but you can still get viral sore throats from the throat lining.
'A tonsillectomy is a minor operation with a quick recovery.' Not really. It is a common operation, but the recovery is a genuinely sore two weeks, and bleeding afterwards is a real risk.
This story is made up to show a common experience. It is not about a real patient.
Danny is 28. Over one year he had seven bouts of tonsillitis, each with a fever, pus on the tonsils, three or four days off work, and a course of penicillin from the GP – all written in his notes. By the winter he was dreading the next one.
At the ENT clinic they went through the decision aid together. The bouts clearly met the frequency guide, they were wrecking his work, and he could arrange two weeks off. He decided to go ahead. Days five to seven after the operation were the worst – he lived on ice lollies and regular painkillers – and he had one small bleed on day eight that settled with a night in hospital as a precaution. That was fourteen months ago, and he has not had a single bout of tonsillitis since.
Note down, or bring with you:
Keeping a record of doctor-documented episodes is what makes the surgery discussion possible.
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (including NG84 on sore-throat prescribing and its Clinical Knowledge Summaries), SIGN and ENT UK guidance on tonsillectomy, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Your voice changes for a few days with almost every cold, and recovers. This chapter is about voice changes that do not recover – how to look after your voice so it does, and why a change that lasts more than three weeks always needs to be looked at.
The pattern is a clue. A voice that goes with a cold and comes back within one to two weeks is almost always harmless. A voice that is worse first thing in the morning may point to reflux. A voice that fades through the day points to overuse or a problem with the vocal cords themselves. A voice that is steadily getting worse needs checking.
Laryngitis. Swelling of the lining of the voice box, from a cold or from shouting. This is the commonest cause, and it settles on its own.
Overusing or straining the voice. Teachers, call-centre workers, fitness instructors, singers, and parents of small children all put heavy demands on the voice, often over background noise. This causes swelling, and over time it can lead to nodules – small, matching swellings on both cords, a bit like calluses – or a polyp (a soft swelling, usually on one cord) or a cyst.
Smoking. Smoke thickens and swells the cords, which lowers the pitch – some people are taken for the opposite sex on the phone. Smoking is also the main risk for cancer of the voice box.
Reflux. Stomach acid or vapour reaching the throat can irritate the cords. It often comes with a hoarse voice in the morning, throat clearing, and a lump feeling (Chapter 20). How often reflux is really the cause of a voice problem is debated.
A weak or paralysed vocal cord. One cord stops moving, so the voice is breathy and weak and you may cough when you drink. Causes include a virus, an operation in the neck or chest (on the thyroid, spine, lung or heart), and – importantly – a growth anywhere along the nerve's path, which runs from the skull base down through the neck and chest. A new one-sided weak cord is always investigated.
Muscle-tension voice. The muscles around the voice box overwork, often after an illness or during a stressful period, and the voice sounds strained even though the cords themselves look normal. It responds well to voice therapy.
Hormones and age. An underactive thyroid gives a slow, low, gruff voice. And the vocal cords naturally thin and stiffen with age, giving a weaker, higher, less steady voice.
Nervous-system causes. A tremor in the voice, spasms that chop the voice up, or the quiet, flat voice of Parkinson's disease.
Cancer of the voice box or throat. This is why a lasting voice change is taken seriously. It is usually in people who smoke or drink alcohol, often over 45, with hoarseness that does not recover – sometimes with a neck lump, pain on swallowing, one-sided ear pain, or coughing up blood.
What the specialist is thinking
How long has the voice been changed – days, or more than three weeks? And is it getting better, staying the same, or getting worse?
Do you smoke, and how much do you drink?
What is your job, how much do you use your voice, and do you talk over noise?
Any pain on swallowing, one-sided ear pain, a neck lump, coughing up blood, or noisy breathing?
Any recent surgery in the neck or chest?
Any heartburn or reflux?
For anyone hoarse for more than three weeks – and sooner if there are other features or a smoking history – I look at the voice box with the camera. It takes a minute, and it is the only way to see the cords properly.
The doctor feels your neck and looks in your mouth and throat. Then comes the camera test: a thin, flexible camera is passed through the nose to watch the cords as they open, close and vibrate while you breathe, say "eee", and sometimes sing or cough.
In a specialist voice clinic, a flashing "strobe" light is used to see the fine vibration of the cords in slow motion. This shows up small swellings and stiff patches that a normal light would miss. The whole examination takes a couple of minutes.
The camera examination is the main test.
Chapter 26 explains scans and tests.
See your GP within three weeks if the voice has not settled, or sooner if any warning sign appears.
Laryngitis. Voice rest, fluids, and treating the cold. Antibiotics do not help.
Voice therapy with a speech and language therapist. This is the main treatment for most voice problems – nodules, muscle-tension voice, overuse, mild polyps, and age-related weakness. You learn to make voice with less effort, to support it with your breath, to stop clearing your throat, and to use your voice safely at work. It takes several sessions plus daily practice. For nodules, in both adults and children, therapy is usually tried first and often works, avoiding an operation.
Surgery on the cords (phonosurgery). For polyps, cysts, or nodules that do not respond to therapy, and for smoker's swelling that is affecting the voice or breathing. It is done with fine instruments or a laser, through the mouth, under a brief general anaesthetic. It is followed by strict voice rest for a set period and then voice therapy. Results are usually good, though not guaranteed, and there is a small risk of scarring.
A weak cord. If it has not recovered after a few months, the voice can be improved with a small procedure that moves the cord towards the middle – either an injection of a soft filler, or a small implant placed through a cut in the neck. This makes the voice stronger and reduces choking on fluids. Voice therapy helps alongside it.
Reflux-related change. The Chapter 20 measures. Acid-reducing medicine helps some people, and the evidence that it helps voice symptoms is mixed.
An underactive thyroid. Treating it improves the voice.
Nervous-system voice problems. Botulinum toxin (Botox-type) injections for the spasm type; medicines and therapy for a voice tremor; and intensive voice programmes for the quiet voice of Parkinson's disease.
Age-related weakness. Voice therapy is the first step and helps many people. Occasionally a cord procedure is added.
Cancer. Treated by the head and neck team, with surgery, radiotherapy, or a combination, depending on how far it has spread (Chapter 25). Early cancers of the voice box are often cured, and treatment can usually preserve a usable voice – which is exactly why a lasting voice change should be checked early.
The limits. Voice therapy needs practice and time. Surgery treats the swelling but not the habits that caused it, so therapy usually follows. A cord that has been paralysed for a long time, or a scarred cord, may never sound completely normal again.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - sudden difficulty breathing, or a harsh noise when breathing in, with a hoarse voice - a hoarse voice with sudden severe throat swelling, or after a burn, inhaled fumes, or an allergic reaction - coughing up a lot of blood - a hoarse voice with sudden weakness on one side, or slurred speech
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a quickly worsening voice with a fever and severe throat pain - difficulty swallowing fluids along with the voice change
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a hoarse or changed voice lasting more than three weeks – sooner if you smoke or drink alcohol - a voice change with a neck lump, pain on swallowing, one-sided ear pain, or coughing up blood - a voice that is getting steadily worse - a voice change after neck or chest surgery that is not recovering
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
'Whispering rests your voice.' Not true. Whispering does not rest the voice, and forcing a whisper actually strains the cords. Speak quietly and gently at your normal pitch instead.
'A hoarse voice for a few weeks is nothing to worry about.' Usually it is harmless. But a voice change lasting more than three weeks should always be looked at, because that is how an early cancer of the voice box is caught – when it is very treatable.
'Voice therapy is just being told to talk less.' Not true. It teaches you to produce voice with far less effort and to use it safely, and it fixes many voice problems without any surgery.
This story is made up to show a common experience. It is not about a real patient.
Bernadette teaches a class of thirty seven-year-olds. Over the autumn term her voice grew tired and husky, worse by home time, and she found herself straining to be heard over the classroom. By Christmas she could barely raise her voice at all.
The camera in the voice clinic showed small matching swellings on both cords – nodules – from months of pushing her voice over noise. There was nothing sinister, and no operation was needed. She had six sessions with a speech and language therapist, learning to project from her breath rather than her throat, to stop the constant throat-clearing, and to take short voice breaks. The school fitted a small clip-on amplifier for the classroom. By the spring term her voice was back to normal, and she now uses the amplifier as a matter of routine.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (including NG12 on suspected cancer and its Clinical Knowledge Summary on hoarseness), the clinical practice guideline on dysphonia from the American Academy of Otolaryngology–Head and Neck Surgery, and guidance from ENT UK, the British Laryngological Association and the Royal College of Speech and Language Therapists, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor on September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
A feeling of a lump or something stuck in the throat is one of the most common reasons people are sent to an ENT clinic – and one of the most reassuring, once it has been checked. This chapter explains that feeling, called globus, and the related question of whether stomach acid coming up into the throat is behind it.
One thing matters more than any of the above: with globus, food does not actually stick, swallowing works normally, it does not hurt, and you are not losing weight. Those features point somewhere else, and are covered under "When not to wait".
Globus. This is the sensation itself, with no blockage behind it. The muscles at the top of the gullet are a little tense, and the brain is paying extra attention to normal signals from the throat. Stress and low mood feed it strongly. It is very common, and it is not dangerous.
Reflux reaching the throat. Small amounts of stomach acid, or acid vapour, can travel up and irritate the throat and voice box, often without any of the heartburn you would expect. This is sometimes called silent reflux. It is a real thing – but how often it is truly the cause of throat symptoms is genuinely debated among specialists, and the tests for it are not very reliable.
A dry throat, or mucus dripping from the back of the nose – from a cold, hay fever, or long-term rhinitis (Chapters 13 and 14).
Tension in the throat and neck muscles, often alongside a voice problem (Chapter 19).
Occasionally a physical cause is found – large tonsils, a prominent tongue base, an enlarged thyroid, or a small pouch – which is exactly why an examination is done.
The serious causes that have to be ruled out are cancers of the throat, voice box or gullet. These are much more likely if the feeling is on one side only, if food genuinely sticks, if swallowing hurts, if there is weight loss, a neck lump, or a lasting voice change – especially in someone who smokes or drinks alcohol. See Chapters 4, 21 and 25.
What the specialist is thinking
Is this a sensation, or does food actually stick going down? That is the first fork in the road.
Is it in the middle, or on one side?
Is it better or worse when you eat?
Any pain on swallowing, weight loss, a neck lump, a voice change, or coughing up blood?
Any heartburn, an acid taste, or waking with a sour mouth?
What is happening in your life? Stress and low mood make this far more noticeable, and that is not "all in the mind" – it is how throat sensations work.
Do you smoke, and how much do you drink?
Then I examine the neck and throat and pass the camera. If that is all normal and there are no warning signs, that is genuinely reassuring, and the feeling usually settles.
The doctor feels your neck and your thyroid gland, and looks in your mouth. Then they pass the thin, flexible camera through the nose to see the base of the tongue, the tonsils, the throat and the voice box, and to watch pooled saliva clear normally when you swallow.
They may note some redness or puffiness of the throat lining, but these signs are common in people with no symptoms at all, so they do not prove much on their own. A normal examination is the main thing the doctor is looking for.
See your GP if the feeling lasts more than a few weeks despite these steps, or sooner if any warning sign appears.
Globus. After a normal examination, reassurance is the main treatment, and for most people the feeling fades over weeks to months once they are no longer worried about it. Speech and language therapy, to relax the throat and cut down throat-clearing, helps some people. Talking therapy helps where anxiety is a large part of it. There is no tablet that removes globus.
Reflux-related throat symptoms. The lifestyle steps above, and alginates. A doctor may suggest a trial of an acid-suppressing medicine (a proton-pump inhibitor, such as omeprazole) for a set period, often eight to twelve weeks.
Here is the honest position on those medicines. Trials of acid-suppressing tablets for throat symptoms have shown only a small benefit over a dummy tablet – and more benefit in people who also have clear heartburn than in people with throat symptoms alone. So a trial is reasonable, but if it does not help within the set period, it is usually stopped, rather than continued or increased. Long-term use has its own downsides and should be reviewed with your doctor.
Anti-reflux surgery – an operation that tightens the valve at the top of the stomach – is occasionally considered for well-proven, severe acid reflux in someone who responds to medicine but cannot stay on it. It is not a treatment for globus, or for throat symptoms when the reflux tests are normal.
Treating a contributing nose, sinus or voice problem often settles the throat as well.
The limits. No treatment reliably removes a throat sensation that has no physical cause. Acid-suppressing medicine is prescribed very widely for throat symptoms on limited evidence. And the greater risk with globus is being over-investigated and over-treated, and staying anxious, rather than being reassured.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - food or a tablet completely stuck, so that you cannot swallow your own saliva, or you are drooling - sudden difficulty breathing
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a sharp, worsening pain in the chest or upper back on swallowing, after a recent endoscopy or a hard bout of vomiting - unable to keep fluids down
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - food that genuinely sticks, or is slow going down, and is getting worse - pain when you swallow - losing weight without trying - a lump you can feel in the neck - a voice change lasting more than three weeks - coughing up blood - the feeling on one side only - any of these in someone who smokes or drinks heavily, especially over 45 - a lump feeling that has not settled after a few weeks of the steps above
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
Globus very commonly settles over weeks to a few months, especially once a normal examination has taken the fear out of it. It can come back at stressful times and settle again. A small number of people have it long-term, but learn to pay it very little attention.
Reflux-related throat symptoms are slow to improve – often weeks to a couple of months with the lifestyle steps, and only partly for many people. Morning huskiness and throat-clearing are often the last things to go.
'A lump feeling in the throat means there is a lump.' Not usually. When swallowing is normal, there is no pain, and there is no weight loss, a normal examination is genuinely reassuring. Globus is a sensation, not a blockage.
'Silent reflux is behind most throat symptoms, and everyone should be on an acid tablet.' Not true. Reflux can irritate the throat, but how often it is really the cause is debated, and the medicines help throat symptoms less than most people expect.
'If I just ignore it, I might miss something serious.' The specific warning signs are what matter – food sticking, pain on swallowing, weight loss, a neck lump, a lasting voice change, or symptoms on one side. Without those, a lump feeling is very unlikely to be anything serious.
This story is made up to show a common experience. It is not about a real patient.
Yusuf is 45. For three months he had felt "a walnut stuck" in the middle of his throat. It eased when he ate his lunch and came back in the afternoon. He had started swallowing every few minutes to check it, and had convinced himself it was cancer. His father had been ill that year, and he was sleeping badly.
At the clinic, the camera showed a completely normal throat, tongue base and voice box, and saliva cleared normally when he swallowed. There was no weight loss, no pain, and no voice change. The doctor explained what globus is and why the constant checking was keeping it going. Yusuf stopped the dry swallowing, worked on his sleep, and things at home settled over the spring. By two months, the feeling was gone. It came back briefly the following winter during a busy spell at work, and this time he recognised it and it passed.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from ENT UK on globus, NICE (its Clinical Knowledge Summary on reflux, and NG12 on suspected cancer), and published trials of acid-reducing medicines for throat symptoms, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Chapter 20 was about the feeling of a lump in the throat when swallowing actually works. This chapter is the opposite: swallowing that is genuinely hard, slow, painful, or unsafe.
A new or worsening swallowing problem is always taken seriously and always investigated. Most causes can be treated, and the sooner the cause is found, the better.
The pattern is a clue. Trouble with solids first, then softer food, then liquids – and getting worse – points to a narrowing. Trouble with liquids, or with both from the start, points to a problem with the nerves or muscles that drive the swallow.
A narrowing of the gullet (a stricture). From years of acid reflux, which leaves a scar-like tightening; from a thin ring or web; or from a growth. Cancer of the gullet, or of the junction with the stomach, typically causes a narrowing that troubles solids first and steadily gets worse, often with weight loss – which is exactly the pattern that needs urgent assessment.
A pouch. A pocket that forms at the back of the throat, mostly in older people. Food collects in it and comes back up undigested, often with bad breath, a gurgling sound, and a cough at night.
The throat or gullet muscles not working in time. After a stroke, or with Parkinson's disease, multiple sclerosis, motor neurone disease, or muscle conditions such as myasthenia. There is often trouble starting the swallow, and coughing on thin liquids.
The gullet squeezing abnormally. In spasm, or in achalasia – where the muscular valve at the bottom of the gullet fails to open – food and liquids both stick, sometimes with chest pain and bringing food back up.
Inflammation of the gullet lining. From reflux; from an allergic condition of the gullet, which is more common in younger adults with a history of allergy or asthma and can cause food to become jammed; from a thrush infection, especially with a weak immune system or inhaled steroids; or from a tablet that has lodged and burned the lining.
A painful mouth or throat – tonsillitis, an ulcer, thrush, or a cancer – making swallowing hurt rather than stick.
Something pressing from outside, such as a large thyroid gland.
A very dry mouth, from medicines or from radiotherapy, making a dry swallow difficult.
After treatment – surgery or radiotherapy to the head, neck or chest.
What the specialist is thinking
Solids, liquids, or both – and which came first?
Is it getting worse, staying the same, or coming and going?
Where does it feel like it sticks – high in the throat, or lower, behind the breastbone?
Any coughing or choking with meals, a wet voice afterwards, or chest infections?
Any pain on swallowing? Any weight loss? Are you bringing food back up?
Any symptoms from the nervous system – weakness, slurred speech, double vision, a change in how you walk?
Do you smoke or drink? Any reflux, allergies, or asthma? Any recent treatment to the head, neck or chest?
A high sticking point, with old food coming back up, points me to the throat or a pouch. A lower point that is getting worse points to the gullet, and that needs a camera test quickly. We often see these people jointly – ENT, gastroenterology, and a speech and language therapist.
The doctor checks your general health and your weight, looks in your mouth and at your teeth, and feels your neck and thyroid. They pass the thin, flexible camera to see the base of the tongue, the throat and the voice box, and watch you take a sip of water – does it pool, or spill towards the airway? If a nerve cause is possible, they do a quick check of the face, tongue, voice and limbs, and they listen to your chest.
Chapter 26 explains these.
Do not ignore it. Book to see your GP promptly. A new or worsening swallowing problem should be seen within weeks, and sooner if any warning sign below appears.
While you wait, make eating safer:
If food becomes completely stuck, see "When not to wait".
The treatment depends entirely on the cause.
The limits. Stretching a narrowing often has to be repeated. Swallowing therapy improves safety and function, but after a large stroke it may not fully restore a normal swallow. And some people need a feeding tube – either through the nose for a short period, or directly into the stomach for longer – to stay safe and properly nourished.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - food or a tablet completely stuck, so that you cannot swallow your own saliva, or you are drooling - sudden difficulty breathing while eating - choking that you cannot clear - a sudden inability to swallow, with new weakness on one side, a drooping face, or slurred speech - a sharp, severe pain in the chest or upper back after a hard bout of vomiting or a recent endoscopy
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - not able to take enough fluid to stay hydrated - coughing and choking at every meal - a chest infection, when you already have a swallowing problem
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - food that sticks or is slow going down – especially if it is getting worse, or worse for solids than for liquids - pain on swallowing that lasts more than a week - losing weight without trying - bringing food back up undigested - a wet, gurgly voice after eating - any of these, and especially in someone who smokes or drinks heavily, or is over 45
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
'Trouble swallowing is just part of getting older.' Not true. Swallowing does change a little with age, but a new or worsening swallowing problem is never "just age" and always needs to be checked.
'If it only happens with solid food, it can't be serious.' Not true. A narrowing – including a cancer – classically troubles solid food first. Solids sticking, and getting worse, is exactly the pattern that needs prompt assessment.
'Thickening my drinks will fix coughing when I swallow.' Not on its own. Thickened fluids help some people, but coughing when you swallow needs a proper assessment first, because it can mean food or drink is going towards the lungs.
This story is made up to show a common experience. It is not about a real patient.
Grace is 58 and had lived with heartburn for years. Over three or four months, she noticed that meat and bread would catch behind her breastbone, and she started cutting them up small and drinking more water with meals. She had lost about three kilograms without trying.
Her GP referred her for an endoscopy, and explained that this was needed both to find the cause and to make sure nothing serious was being missed. The camera showed a narrowed section low in the gullet, from years of acid reflux – no growth, and samples confirmed it was not cancer. The doctor stretched the narrowing during the same test. Within a couple of days Grace could eat normally again. She was started on a daily acid-reducing tablet, with a plan to review it, and told she might need the stretch repeated at some point.
Bring a short timeline: when the trouble started, and how it has changed month by month.
Also note:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (including NG12 on suspected cancer and its Clinical Knowledge Summary on dysphagia), ENT UK, the Royal College of Speech and Language Therapists, and the British Society of Gastroenterology, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Snoring is extremely common, and for many people it is only a nuisance – for their partner more than for them. But loud snoring with pauses in breathing and daytime sleepiness can be a condition called obstructive sleep apnoea, which affects health and road safety. Telling the two apart is what this chapter is about.
Some people have obstructive sleep apnoea with very few daytime symptoms, which is one reason a partner's account is so useful.
Simple snoring. The soft palate and the tissues at the back of the throat vibrate as air passes through a partly narrowed airway. It is noisy, but the airway is not actually blocking, and the oxygen level in the blood is not dropping. It is a social problem – embarrassment, separate bedrooms – rather than a health risk.
Obstructive sleep apnoea. Here the throat repeatedly narrows or closes during sleep, so breathing stops or drops for seconds at a time, often many times an hour. Each pause ends with a brief wake-up and a surge of adrenaline. The person almost never remembers these, but the sleep is broken into fragments, and in more severe cases the oxygen level dips with each pause.
What makes the airway more likely to collapse:
Central sleep apnoea is a different, less common type, in which the brain briefly stops sending the signal to breathe. It is linked with heart failure, stroke, strong painkillers such as opioids, and high altitude, and it is managed differently.
Other reasons for daytime sleepiness – simply not getting enough sleep, shift work, depression, some medicines, restless legs, or narcolepsy – are considered alongside.
What the specialist is thinking
Has anyone actually seen you stop breathing, or wake with a gasp?
How sleepy are you during the day – and does it affect your driving or any safety-critical work?
Morning headaches? Getting up to pass urine at night?
What is your weight, your collar size, and the shape of your jaw?
Do you drink alcohol in the evening, take sleeping tablets, or smoke? Is your nose blocked?
Any heart disease, blood pressure that is hard to control, an irregular heartbeat, or a past stroke?
Then I examine the nose, mouth, throat and neck. If the picture points to apnoea, I arrange a sleep study.
The doctor measures your height, weight and neck circumference, and your blood pressure. They look at your nose for a blockage, at your mouth and throat for large tonsils, a low-hanging palate, or a crowded airway, and at your jaw and chin. Sometimes they take a quick camera look at the throat and the base of the tongue. They also check for signs of an underactive thyroid.
The result is usually described as mild, moderate or severe, based on how often your breathing is disturbed each hour and how much it affects you in the day.
See your GP for a referral if a partner has seen you stop breathing, or if you are sleepy during the day.
The lifestyle steps above, and treating the nose. A mandibular advancement device – a custom-made mouthpiece, a bit like a gum shield, worn at night to hold the lower jaw forward – helps many snorers. A palate operation is occasionally considered when a specific floppy area is the problem, but the benefit often fades over a year or two, and it does not treat apnoea.
Treatment is aimed at the underlying cause, sometimes with a special type of breathing machine.
When not to wait
Sleep apnoea itself is usually not an emergency, but it should not be left untreated.
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - waking at night with severe shortness of breath and chest pain, or a pounding or irregular heartbeat – this may be coming from the heart, not the breathing
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - you have fallen asleep, or nearly fallen asleep, while driving, or while doing safety-critical work – stop, and contact your GP urgently (and read "Driving and work" below) - severe daytime sleepiness in someone with known heart disease, an irregular heartbeat, or a recent stroke
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - loud snoring with breathing pauses or gasping that a partner has noticed - unrefreshing sleep with sleepiness during the day - waking with a headache most mornings, along with daytime sleepiness - sleepiness that is affecting your work, your mood, or your relationships - a child who snores every night with pauses in breathing, or very restless sleep (see Chapter 30)
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency sign, and your family doctor or local health centre for the rest.
This part matters, so it has its own section.
If you have obstructive sleep apnoea with troublesome daytime sleepiness, or you have fallen asleep or nearly fallen asleep while driving, you must stop driving and tell the DVLA (or the DVA in Northern Ireland). You can usually go back to driving once your treatment is working well and your sleepiness is controlled, with your doctor's confirmation.
The rules are stricter, and the checks more frequent, for bus, coach and lorry drivers.
Tell your doctor if you do other safety-critical work, such as operating machinery or working at height.
It is against the law to keep driving with untreated sleep apnoea that makes you sleepy. The current rules are on the DVLA website. Chapter 11 has more on driving and health.
'Snoring is harmless – it is just annoying.' Often true for simple snoring. But loud snoring with breathing pauses, gasping, or daytime sleepiness can be sleep apnoea, which raises the risk of high blood pressure, heart problems, stroke, and road accidents.
'CPAP is a last resort, and you are stuck on it forever.' It is not a punishment. Most people who stick with it sleep better and feel much better. It is usually long-term – but weight loss or other changes can sometimes reduce or remove the need for it.
'An operation will cure my snoring or apnoea.' Not usually, in adults. Surgery has a limited role, and palate operations often stop working after a year or two.
This story is made up to show a common experience. It is not about a real patient.
Frank is 52, drives a lorry for a living, and had put on a good deal of weight over ten years. His wife had moved to the spare room because of the snoring, and had told him more than once that he seemed to stop breathing and then jerk awake. What finally worried him was catching himself drifting on the motorway twice in a week.
He stopped driving straight away and told the DVLA, and his GP referred him urgently. A home sleep study showed severe obstructive sleep apnoea. He started CPAP, and although the mask took some getting used to, within two weeks he woke feeling rested for the first time in years and stopped nodding off in the afternoon. After a review confirmed his sleepiness was controlled and he was using the machine every night, he was cleared to drive again. Over the following year he lost weight, and his blood pressure came down as well.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (NG202 on obstructive sleep apnoea, and its Clinical Knowledge Summary), the British Thoracic Society, and the DVLA's guidance on fitness to drive, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor on September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Finding a lump in your neck is frightening. It is also very common, and most neck lumps turn out to be harmless – a gland reacting to an infection, or a cyst. But some are not, and a lump that lasts more than a few weeks in an adult needs to be checked properly and quickly. This chapter explains what the possibilities are, and how they are sorted out.
Note anything you have alongside it: a sore throat, a hoarse voice, one-sided ear pain, a mouth ulcer or patch that will not heal, trouble swallowing, drenching night sweats, unexplained fevers, itching all over, or weight loss.
A swollen gland (a lymph node) reacting to an infection. This is the commonest cause at any age. Lymph nodes are small filters dotted through the neck, and they swell when they are fighting an infection nearby – a cold, a sore throat, tonsillitis, a bad tooth, an ear or skin infection, or a viral illness such as glandular fever. These lumps are usually tender, come up over a day or two, and settle within two to three weeks.
A cyst. A fluid-filled lump. A branchial cyst sits on the side of the neck and often shows up in young adults. A thyroglossal cyst sits in the midline and moves with swallowing and with the tongue. There are also simple skin cysts.
The thyroid gland. A single lump (a nodule), or a general enlargement. It moves up when you swallow. Most thyroid lumps are not cancer, but they are checked.
The salivary glands. A stone blocking a duct (a swelling that comes on at mealtimes), an infection, or a lump in the gland itself. Chapter 24 covers these.
Cancer. This is why a lasting neck lump in an adult is taken seriously.
Less common causes include a soft, slow-growing fatty lump; a lump that pulses in time with your heartbeat, which comes from a blood vessel – this is checked with a scan rather than a needle test, because needling this type of lump can cause heavy bleeding; and tuberculosis affecting a neck gland, which is more common in people who have lived in parts of the world where TB is common, and which can form a matted, sometimes discharging swelling.
Age is a useful guide. In children and young adults, a neck lump is very often a reacting gland or a cyst, and much less often a cancer. In adults over about 40 – and especially in smokers and drinkers – a firm lump that does not settle is treated as a possible cancer until tests show otherwise.
What the specialist is thinking
How long has it been there, and is it growing, shrinking, or staying the same?
One lump, or several?
Is it firm and fixed, or soft and mobile? Tender, or painless? Painless and firm worries me more.
Was there a recent infection – a cold, a sore throat, a bad tooth?
Any of the mouth-and-throat symptoms – a sore throat, hoarseness, one-sided ear pain, a mouth ulcer, trouble swallowing?
Any night sweats, unexplained fevers, itching, or weight loss?
Do you smoke, and how much do you drink?
Then I examine the whole neck, the mouth and throat with the camera, the skin of the head and neck, and the thyroid – because a neck lump is often a clue to something happening elsewhere. A firm, painless lump that has been there more than three weeks goes on the urgent pathway.
The doctor feels the lump – its size and texture, whether it is fixed or moves, whether it shifts on swallowing or with the tongue, and whether it pulses. They feel all the areas of the neck, and behind the ears and the back of the head. They look and feel inside your mouth, at the tongue base, the tonsils and the floor of the mouth, and pass the thin camera through the nose to see the back of the nose, the throat and the voice box. They check the skin of your scalp, face and ears, and feel your thyroid. If the lump pulses, they listen over it.
The suspected-cancer pathway. If the lump has worrying features, you are referred to be seen quickly – in England this is sometimes still called the "two-week" pathway, though the NHS's formal target is now a diagnosis or the all-clear within 28 days – and the tests are done together in a "one-stop" neck-lump clinic where possible. Being sent on this pathway does not mean the doctor thinks you have cancer. Most people referred this way do not.
The treatment depends entirely on the cause.
The limits. A needle test is not perfect, and sometimes has to be repeated. Watching a lump is only safe when its features are reassuring and it is genuinely reviewed. And when a lymph node contains a spread cancer, the treatment depends on finding and dealing with where it came from.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - a neck swelling that is enlarging quickly, with difficulty breathing, a harsh noise breathing in, or being unable to swallow your own saliva - a spreading red, hot, painful neck swelling with a high fever and feeling very unwell, or with trouble opening your mouth - a sudden, severe neck swelling after an insect sting or starting a new medicine
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a hot, red, tender neck lump that is getting bigger, with a fever – a possible abscess - a lump that has grown noticeably over just a few days
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - any neck lump that has lasted more than three weeks - a lump that is firm, hard, or fixed in place - a lump that is slowly growing - a neck lump together with a sore throat, a hoarse voice, one-sided ear pain, a mouth ulcer that will not heal, or trouble swallowing - a neck lump together with night sweats, unexplained fevers, itching, or weight loss - a lump that pulses in time with your heartbeat
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
'A neck lump that doesn't hurt is nothing to worry about.' Not true. A painless lump is actually more concerning than a painful one. A gland fighting an infection is usually tender; a cancerous node is often completely painless.
'If it comes and goes, it can't be serious.' Usually reassuring – a lump that clearly swells with a cold and shrinks again afterwards is likely a reacting gland. But a lump that has never fully gone away still needs checking.
'Being sent on the "two-week" pathway means they think I have cancer.' Not true. It is simply a way of making sure lumps are checked quickly – with a target of a diagnosis or the all-clear within 28 days, though many people still call it the "two-week wait." Most people referred this way do not have cancer.
This story is made up to show a common experience. It is not about a real patient.
Leah is 26. In the shower one morning she felt a smooth, painless lump on the left side of her neck, about the size of a grape. It did not hurt, and over the next six weeks it did not change. She had no sore throat, no fevers, and had not been unwell.
Her GP referred her to a one-stop neck-lump clinic. There, she had an ultrasound scan, a needle test done at the same time, and a quick camera look at the back of her nose and throat, which was normal. The scan and the cells pointed to a branchial cyst – a fluid-filled lump that grows from a small piece of tissue left over from before birth, and that sometimes shows up in young adulthood. A few weeks later it was removed through a small cut in a skin crease, and it has not come back. The surgeon explained that the same clinic, with the same tests, is how the serious causes of a neck lump are picked up early.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (NG12 on suspected cancer and its Clinical Knowledge Summary on neck lumps), ENT UK, and head-and-neck and blood-cancer specialist guidance, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
You have three pairs of salivary glands: a large one in front of and below each ear (the parotid), one under each side of the jaw (the submandibular), and a small one under the tongue. Each one drains into the mouth through a narrow tube. Most swellings of these glands are caused by a blocked tube, a stone, or an infection – all treatable. A smaller number are growths, and those need checking.
In children, both parotid glands swelling with a viral illness may be mumps. This is uncommon now, thanks to vaccination, but it is still seen.
A salivary stone. A small, hard stone forms in one of the tubes – most often the one under the jaw. It blocks the flow, so when the gland makes saliva at mealtimes, the saliva has nowhere to go and the gland swells and aches. It settles between meals as the pressure eases. A blocked gland can then get infected.
A narrowed or scarred tube. The same mealtime pattern, without a stone.
An infection of the gland. This can be bacterial – a painful, red, tender gland with pus that can be squeezed from the tube, more common in people who are older, dehydrated, or unwell, or who have a stone. Or it can be viral, such as mumps, usually affecting both parotid glands with a general illness.
A dry mouth from reduced saliva. Many medicines dry the mouth, as does radiotherapy to the head and neck, and not drinking enough. Less saliva makes both stones and infections more likely.
A condition affecting the whole body. Sjögren's syndrome is an autoimmune condition that reduces the output of the tear and saliva glands, causing dry eyes and a dry mouth, often with tiredness and joint aches; some people also get parotid swelling. There are a few other conditions that enlarge the salivary glands, usually on both sides.
A benign tumour. Most salivary lumps that are not stones or infections are not cancer. The commonest is a slow-growing, painless, rubbery lump in the parotid, usually in middle age. Another common benign parotid lump is linked with smoking and can appear on both sides.
A salivary gland cancer. Less common. It is suggested by a lump that grows quickly, is hard or fixed, is painful, causes weakness of the face on that side, numbs the skin, or changes the skin over it. The chance that a salivary lump is a cancer is higher for the smaller glands than for the parotid.
A swollen lymph node within or beside the gland – see Chapter 23.
What the specialist is thinking
Which gland, and one side or both?
Does it swell at mealtimes and settle in between? That is the stone-or-blockage pattern. Or is it a lump that is there all the time and getting bigger?
Any pain, fever, or a taste of pus?
Is your mouth dry – and your eyes?
Any weakness of the face, numbness, or a change in the skin over the lump? Is the lump soft and mobile, or hard and fixed?
What medicines do you take, and have you had radiotherapy to the head or neck?
Then I feel the gland from the outside and with a finger inside the mouth at the same time, milk the tube to see what comes out, check the movement of your face, and arrange an ultrasound.
The doctor feels the gland from the outside and, with a gloved finger, from inside the mouth at the same time. They look at where the tube opens – inside the cheek for the parotid, under the tongue for the submandibular – and press the gland to see what comes out: clear saliva, thick saliva, pus, or nothing. They feel along the floor of the mouth for a stone. They check that your face moves normally, because the facial nerve – the nerve that works the muscles of the face – runs straight through the parotid gland. They also feel your neck for other lumps.
Chapter 26 explains scans and tests.
If it swells at mealtimes (the stone pattern):
If you think the gland is infected: see your GP promptly. Drink plenty, take pain relief, use warm compresses, keep the saliva flowing, and take antibiotics if a bacterial infection is confirmed.
If it is a lump that is there all the time: see your GP for an ultrasound scan and a referral. Do not just keep an eye on it.
Stop smoking, and ask your doctor to review any medicine that dries your mouth if the glands keep giving trouble.
A common and usually mild after-effect of parotid surgery is sweating or flushing of the cheek when you eat. There are treatments for it if it is troublesome.
The limits. Stone treatment aims to save the gland, but sometimes the gland has to be removed. Parotid tumour surgery carries the risk to the facial nerve. And a dry mouth from radiotherapy or from medicines is managed rather than cured.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - a swelling of the face or under the jaw that is spreading quickly, hot and red, with a high fever, trouble opening your mouth, or trouble swallowing your own saliva - difficulty breathing with a swelling under the tongue or in the floor of the mouth
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a painful, red, tender salivary swelling with a fever and pus in the mouth – a possible abscess - a stone-type swelling that has become constantly painful and swollen and is not settling
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - a salivary lump that is growing, hard, or fixed in place - a salivary swelling with weakness or drooping of the face on that side, numbness of the skin, or a change in the skin over it - a lump that has been there more than three weeks - repeated swellings at mealtimes
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
'A lump in the salivary gland is probably cancer.' Not true. Most salivary lumps that are not stones or infections are not cancer. Cancer is the less common outcome – though every lump that does not settle is checked.
'If it swells at mealtimes, it must be a food allergy.' Not true. Swelling that comes on with a meal and settles afterwards is the classic sign of a blocked tube or a stone, because the saliva is trying to flow against a blockage.
'Salivary stones are just caused by not drinking enough water.' Being dehydrated and having a dry mouth make stones more likely, but that is not the whole story, and people who drink plenty of water still get them.
This story is made up to show a common experience. It is not about a real patient.
Ahmed is 39. For about four months, the gland under the left side of his jaw would swell up and ache within a minute of starting a meal, then slowly go down over the next hour. Twice it became red and very sore for a few days.
His GP could feel a firm swelling, and referred him. An ultrasound scan showed a small stone in the tube under his tongue. Rather than remove the gland, the surgeon passed a fine camera into the tube, found the stone, and removed it in a short procedure under local anaesthetic. The mealtime swellings stopped. He was told to keep well hydrated and to suck a boiled sweet before meals, which he still does out of habit.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE (its Clinical Knowledge Summaries on salivary gland stones and swelling, and NG12 on suspected cancer), ENT UK, and specialist guidance on Sjögren's syndrome, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Cancers of the mouth and throat are not common, and the symptoms that can be caused by them – an ulcer, a sore throat, a hoarse voice, a lump in the neck – are much more often caused by something harmless. This chapter is not here to frighten you, and it is not something to work yourself out from. It is here so that the small number of people who do have a serious cause are seen early, when these cancers are very treatable.
If you notice one of the changes below, the message is simple: do not put it off, and do not lie awake about it. Get it looked at. The check is quick, and for most people it is reassuring.
If you have difficulty breathing, heavy bleeding from the mouth or throat, or you cannot swallow your own saliva, that is an emergency – see Chapter 4.
Any of these, most people with them do not have cancer – but each one is a reason to be checked if it does not settle:
Ulcers come from a bite, a sharp tooth, or stress. Sore throats and hoarse voices come from viruses and overuse. Neck lumps are usually glands fighting an infection. Almost always, these things settle within two to three weeks.
What matters is a change that does not settle, or that keeps coming back in the same place. That is the point to have it looked at.
See a GP or a dentist if any of these has lasted more than three weeks:
Most of the time it will be something harmless. Getting it checked is quick, and usually reassuring.
- a mouth ulcer, or a red or white patch, that has not healed
- a lump on the lip, tongue, or inside the mouth
- a one-sided sore throat, or "something stuck" feeling, that is not settling
- a hoarse or changed voice
- swallowing that is becoming harder or painful
- one-sided ear pain with a normal-looking ear
- a lump in the neck
- loose teeth, or dentures that no longer fit, with no dental cause
If you are not in the UK, take the same list to your family doctor or a dentist.
Both your GP and your dentist can refer you on the urgent pathway – in England this is still often called the "two-week" pathway, though the NHS's formal target is now a diagnosis or the all-clear within 28 days. A dentist checks the lining of your mouth at every routine appointment, which is one good reason to keep going.
Being referred this way does not mean anyone thinks you have cancer. It is simply a way of getting things looked at quickly, and most people referred on it do not have cancer.
What raises the risk
- Tobacco in every form – cigarettes, roll-ups, pipes, cigars, and chewing or "smokeless" tobacco. This is the single biggest risk.
- Alcohol. And tobacco and alcohol together multiply each other's effect.
- Betel quid, paan, and areca nut – with or without tobacco. This is an important risk in South Asian communities.
- A common virus called HPV. Most people meet it, and their body clears it. In a small number it stays, and years later it can lead to a cancer of the tonsil or the base of the tongue – often in people who have never smoked. The HPV vaccine given to teenagers in the UK is expected to reduce these cancers over the coming years.
- a diet low in fruit and vegetables; strong sun on the lips; long-term poor oral health; a previous head and neck cancer; a weakened immune system.
What lowers the risk
- stop all tobacco – the risk falls year by year after you stop
- cut down on alcohol
- stop betel quid and paan
- eat plenty of fruit and vegetables
- use a lip balm with sun protection if you are outdoors a lot
- keep your teeth and gums healthy, and see a dentist regularly
- take up the HPV vaccine if it is offered to you or your child
If cancer is found, you are looked after by a team of specialists who meet to plan your care together before anything is decided: surgeons, cancer doctors, radiologists, the doctors who examine the samples, a specialist nurse who becomes your main point of contact, speech and language therapists, dietitians, dentists who rebuild teeth, and people who provide emotional support. You should be given the name and number of someone to call.
Treatment is surgery, radiotherapy, chemotherapy, or a combination, chosen by the team together with you, depending on where the cancer is and how far it has grown. Some operations are now done through the mouth without any outside cut. For cancer that has spread, newer medicines that work with the immune system are sometimes used.
The aim is to cure the cancer where that is possible, while protecting your speech, your swallowing, and your appearance as much as they can. Getting speech, swallowing, and eating back to their best afterwards, with a therapist and a dietitian, is a large part of the treatment – not an afterthought.
Early mouth and throat cancers are often cured, frequently with a single treatment and with less lasting effect on speech and swallowing. Cancers found later are harder to treat and leave more lasting effects. Cancers of the throat that are caused by the HPV virus generally respond very well to treatment.
This is the whole reason the three-week rule exists. The earlier something is looked at, the better – and, far more often, the sooner you can stop worrying about it.
'Only heavy smokers and drinkers get mouth and throat cancer.' Not true. Smoking and alcohol are the biggest risks, but cancers of the throat caused by the HPV virus happen in people who have never smoked.
'A lump or patch that doesn't hurt can be left alone.' Not true. A painless change is more concerning, not less. Three weeks is the point to get it looked at.
'If my dentist didn't say anything, my mouth must be fine.' Dentists do check the lining of the mouth, which is valuable. But tell them about anything new or that will not settle, and see your GP as well if it lasts more than three weeks.
This story is made up to show a common experience. It is not about a real patient.
Marta is 58 and stopped smoking fifteen years ago. She noticed a small sore on the side of her tongue that she thought she had bitten. After four weeks it was still there, in the same spot, and slightly firm. She mentioned it, almost in passing, at a routine dental check-up.
Her dentist had a good look, felt her neck, and referred her on the two-week pathway. At the clinic she had a proper examination, a camera look at her throat, and a small sample taken under local anaesthetic. It was an early cancer of the tongue. It was removed with a fairly small operation, and she did not need radiotherapy. A year on, her speech and eating are normal, and she goes for check-ups every few months. Her surgeon told her that mentioning it when she did, rather than waiting to see if it went, made a real difference – and that people who have never smoked can get these cancers too.
Note down, or bring with you:
General information only – not a diagnosis. This chapter cannot tell you whether you have cancer. If a change lasts more than three weeks, get it checked.
This chapter is based on guidance from NICE (NG12 on suspected cancer, and its guidance on head and neck cancer services), Cancer Research UK, the Mouth Cancer Foundation, and UK vaccination guidance, current to September 2026. It was reviewed, including for wording and tone, by the author, Bassem Saleh (ENT doctor), on 17 September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
The symptom chapters point here whenever they mention a test. This chapter explains the common ENT tests in one place: what each is for, what it is like, how long it takes, whether there is any risk, and how you get the result.
You can always ask why a test is being done, what it will change, and to have it explained. You can also say no.
Chapter 6 explains the booth hearing test and how to read your audiogram.
Tell the team, before a scan, if you: - are, or might be, pregnant - are breastfeeding (you can usually continue – ask) - have ever reacted to scan dye - have kidney problems, or take metformin - have any metal in your body, for an MRI – a pacemaker, an implant, or eye fragments - find enclosed spaces difficult - and bring your list of medicines
Chapter 22 explains the home and hospital sleep studies.
The common ones in an ENT clinic are a full blood count (for anaemia, infection, or glandular fever), thyroid tests, kidney function (before scan dye), inflammation markers, vitamin levels, allergy antibodies, clotting (before a biopsy or operation), and blood sugar. They are taken with a normal blood sample from the arm, and results come back within hours to a few days.
Results reach you in different ways – a follow-up appointment, a letter, a phone call, or through your GP. Blood tests and simple scans come back quickly. A biopsy usually takes one to two weeks. Results that a team of specialists needs to discuss together take a little longer.
Ask when and how you will get your result, and who to contact if you have not heard. You can ask for a copy. Do not assume that no news is good news – if you were told a time and it has passed, chase it.
This chapter describes standard tests used in ENT care. It is based on guidance from the Royal College of Radiologists, the Society and College of Radiographers, the British Society for Allergy and Clinical Immunology, the British Society of Audiology, and ENT UK, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
If an operation is suggested, it helps to know beforehand what is actually done, what the recovery is like, and what can go wrong. This chapter is a set of short cards, one per operation, in the same format each time. Every card includes the option of not operating, because that is always a real choice.
The general side of surgery – the pre-assessment appointment, fasting, the kinds of anaesthetic, wound care, and time off – is in Chapter 28.
Before you agree to any operation, four questions are worth asking: what are the benefits? what are the risks? what are the alternatives? and what happens if I do nothing? Chapter 33 has more on making the decision. And do not stop any blood-thinning medicine on your own – that is planned individually with the team.
What it's for. Persistent glue ear that is affecting hearing, speech or learning, or repeated middle-ear infections. In adults, a long-standing blocked-ear feeling that will not settle.
What is done. A tiny cut is made in the eardrum, any fluid is suctioned out, and a small tube (a grommet) is placed in the cut to let air in. In children this is often done with an adenoid removal at the same time.
Anaesthetic and stay. A short general anaesthetic for children, sometimes local anaesthetic for adults. Day case. The operation itself takes about 15 minutes.
Recovery. Hearing improves straight away. Very little pain. Back to school or work the next day. The grommet works its own way out over about 6 to 12 months.
Main risks. A runny ear afterwards is common and is treated with drops. A small chance that the eardrum does not fully close after the grommet comes out, leaving a hole. Some scarring of the eardrum.
Water. Advice varies between units – ask yours. Many now allow normal swimming at the surface, and advise against diving deep or pushing water forcefully into the ear.
Instead of surgery. Watching and waiting (glue ear often clears on its own), a hearing aid, or the autoinflation balloon (Chapter 10).
What it's for. A persistently blocked nose, snoring and disturbed sleep, or glue ear, mainly in children.
What is done. The adenoids, at the back of the nose, are removed through the mouth. There is no cut on the outside.
Anaesthetic and stay. A short general anaesthetic. Usually day case.
Recovery. A sore throat and a blocked, blood-tinged nose for about a week. The voice may sound nasal for a few weeks, and breath may be bad for a few days.
Main risks. Bleeding, though less than with tonsils. Rarely, a lasting change in the sound of the voice or a small amount of fluid coming down the nose when drinking – the surgeon checks for a hidden cleft of the palate beforehand, which raises this risk. Regrowth is uncommon.
Instead of surgery. A steroid nasal spray, or watching and waiting.
What it's for. Frequent, genuinely disabling tonsillitis meeting the guide in Chapter 18; disturbed sleep and breathing (mainly children – Chapter 30); or a tonsil that is bigger on one side and needs examining.
What is done. Both tonsils are removed through the mouth.
Anaesthetic and stay. A general anaesthetic. Day case, or one night in hospital.
Recovery. A genuinely sore throat, and ear pain, for up to two weeks – often worst in the middle of that time. White patches appear in the throat as it heals; this is normal, not an infection. Eat and drink normally, as it helps. Expect one to two weeks off work or school.
Main risks. Bleeding is the main one. It affects a small number of people – fewer than 1 in 10, and for most of them it is minor – and it can happen at any point up to about two weeks after the operation. Occasionally it needs a return to the operating theatre, or a blood transfusion. Any bleeding from the mouth after tonsil surgery means going to A&E or calling the ward, even if it has stopped. Other risks: infection, dental or taste changes, and the usual risks of an anaesthetic.
Instead of surgery. Watching and waiting, since attacks often become less frequent over a year or two; managing each episode well; and treating anything that is adding to it, such as reflux.
What it's for. A clearly bent septum that is blocking airflow and has not responded to a proper trial of sprays and rinses (Chapter 13). Turbinate reduction is often done at the same time.
What is done. Through the nostrils, with no cut on the outside and usually no bruising, the bent cartilage and bone of the middle wall are straightened or trimmed.
Anaesthetic and stay. A general anaesthetic, or sometimes local. Day case.
Recovery. About a week with a bunged-up, crusty nose, like a heavy cold. Any splints or packing come out at around a week. Avoid blowing your nose and heavy lifting for a couple of weeks. Most swelling settles by four to six weeks; the final result is clear by about three months.
Main risks. Bleeding. A hole in the septum. A collection of blood inside the septum – a swollen, painful nose in the days after the operation needs to be seen the same day, because it can damage the cartilage if it is not drained. The blockage not improving as much as hoped (this happens for some people). Temporary numbness of the upper front teeth. Rarely, a change in the shape of the nose.
Instead of surgery. Steroid sprays and salt rinses, a nasal dilator, or living with it.
What it's for. Long-lasting sinus disease or polyps that have not been controlled by a proper trial of medical treatment (Chapter 15).
What is done. Working through the nostrils with cameras and fine instruments, the surgeon opens up the natural drainage channels of the sinuses and removes polyps and diseased lining.
Anaesthetic and stay. A general anaesthetic. Day case, or one night.
Recovery. One to two weeks with a congested, crusty nose and a blood-tinged discharge. You start saline rinsing from the first day, and have one or two cleaning appointments in the weeks after. Smell and breathing improve over about 6 to 12 weeks.
Main risks. Bleeding. Rarely, an injury near the eye – bruising, double vision, and very rarely a serious effect on sight. Rarely, a leak of the fluid that surrounds the brain, which needs repairing. A change in the sense of smell. Scar bands inside the nose. Polyps commonly grow back, so a repeat operation is sometimes needed over the years, and daily sprays and rinses continue afterwards.
Instead of surgery. Continuing medical treatment, or – for severe polyps – the biologic injections in Chapter 15.
What it's for. A hole in the eardrum that keeps getting infected, is affecting hearing, or is stopping you swimming (Chapter 10).
What is done. A patch of your own tissue is placed over the hole, working either through the ear canal or through a small cut behind the ear.
Anaesthetic and stay. A general anaesthetic, or sometimes local. Day case, or one night.
Recovery. A dressing in the ear for one to two weeks. Off swimming and flying for a few weeks. Avoid getting water in the ear and blowing your nose hard. Hearing settles over two to three months.
Main risks. The patch not taking, so the hole stays or comes back and a repeat may be needed. Infection. A temporary change in taste on part of the tongue. Rarely, dizziness or worse hearing.
Instead of surgery. Keeping the ear dry and treating infections as they come, or a hearing aid.
Ear surgery for a skin cyst (cholesteatoma). Removes the cyst and makes a safe, dry ear (Chapter 10). A general anaesthetic and usually one night. Several weeks' recovery, and follow-up for years, sometimes with a planned second operation. Risks include a change in hearing, dizziness, uncommon weakness of the face, taste change, and – if a cavity is made – occasional cleaning appointments for life. Not operating risks slow, ongoing damage.
Neck lump and gland surgery. Removing a lump or a gland to diagnose or treat it (Chapters 23 and 24). The scar is placed in a skin crease. The specific risks depend on the site: for the parotid, temporary weakness of part of the face is common and usually recovers, lasting weakness is uncommon, and sweating of the cheek when eating is common; for the gland under the jaw, there is a small risk of weakness of the lower lip. A needle test is usually done first, and a reassuring lump can sometimes just be watched.
Vocal cord surgery. Fine instruments or a laser, through the mouth, under a brief general anaesthetic (Chapter 19), for swellings that have not responded to voice therapy. Strict voice rest afterwards, then voice therapy. A small risk of scarring that affects the voice. The alternative is voice therapy alone.
Nasal cautery. Sealing a bleeding vessel with a chemical stick or heat, after a numbing spray, in clinic (Chapter 16). Sore and crusty for a few days. Only one side of the septum is treated at a time. It may need repeating. The alternative is the first-aid technique and an aftercare cream.
Microsuction of wax. See Chapters 7 and 26.
Operations are done under local anaesthetic (the area is numbed and you are awake), with sedation (a medicine to make you drowsy and relaxed), or under general anaesthetic (you are fully asleep). Many ENT operations are day cases – you go home the same day.
Before a general anaesthetic, an anaesthetist checks that you are fit for it and talks you through the risks. For most people these are low; they are higher with certain heart, lung and other conditions, and the team will tell you if that applies to you (Chapter 28).
Consent means agreeing to an operation after the benefits, the risks, the alternatives, and the option of doing nothing have been explained to you. You can ask for the risks that matter most to you. You can take time to decide, and you can change your mind at any point, including on the day.
For a child, a parent gives consent, and older children are involved in the decision as much as they are able.
This chapter is based on patient-information and consent guidance from ENT UK and the Royal College of Surgeons, the UK tonsillectomy audit, and NICE guidance, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. Consent for your own operation will be based on your own situation. See the full note on sources at the back of the book.
Chapter 27 explains what happens in each common operation, and its specific risks. This chapter is about everything around it – getting ready beforehand, what the day itself involves, what the first two weeks are usually like, and exactly when to call for help.
Before most operations you have a pre-assessment appointment – sometimes in person, sometimes by phone or a questionnaire for a straightforward day case. This checks that you are fit for the anaesthetic and the operation. Expect questions about your general health, your medicines and allergies, and any problems you or a close family member have had with an anaesthetic before. You may have blood tests, and sometimes a heart trace or a swab.
This is the appointment to mention loose teeth or crowns, snoring or sleep apnoea, and whether you are, or might be, pregnant. It is also a good time to ask any questions you have been storing up.
Most of your regular medicines are continued as normal. A few are handled differently:
Bring a list of your medicines, or the boxes themselves, to every appointment.
Stopping smoking – even a few weeks before your operation – improves wound healing and lowers the chance of a chest infection or a wound infection afterwards. Quitting close to the date is not harmful; any amount of time smoke-free helps. Cutting down alcohol beforehand helps too. Ask your GP or the pre-assessment team about support if you would like it.
You will be given clear instructions about not eating or drinking beforehand. A common guide for adults having a general anaesthetic is no food for six hours, and only clear fluids (water, not juice or milk) up to two hours before. Follow your own team's instructions exactly, as the timings they give you can differ from this. Children are given their own timings.
This matters because it lowers the risk of stomach contents reaching the lungs while you are under anaesthetic.
How long you need off depends on the operation – Chapter 27 gives a rough guide for each one. Only drive once you could comfortably perform an emergency stop and are no longer taking strong painkillers or sedatives, and check your insurance policy. Avoid heavy lifting and hard exercise for about two weeks unless you are told otherwise. If your operation was on the ear, nose or sinuses, the relevant chapter covers when it is safe to fly.
When to call for help
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - difficulty breathing - heavy bleeding that will not stop with the advice you were given - chest pain - signs of a severe allergic reaction – swelling of the lips, tongue or throat, or difficulty breathing - severe, worsening pain that your painkillers are not controlling, especially with a fever
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - a wound that is increasingly red, hot, swollen, or leaking fluid or pus - a fever that will not settle - more bleeding than you were told to expect - being unable to keep fluids down
Contact your GP, the ward you were treated on, or NHS 111.
Get this checked soon - healing that is not going the way you were told to expect - a symptom that was supposed to improve by now, and has not
Make an appointment to see your GP.
Remember the specific warnings for your operation – for example, any bleeding after tonsil surgery means going to A&E even if it has stopped, and a swollen, painful nose after septal surgery needs to be seen the same day (Chapters 18, 13 and 27).
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor, the hospital that treated you, or a local urgent-care service for the rest.
If any tissue was sent away for testing, results usually take one to two weeks – longer if a team of specialists needs to discuss them. You will usually be told at a follow-up appointment, where stitches or packing may be removed and your healing checked. Ask when and how you will get your result, and who to contact if you have not heard by then.
'You should push through the pain rather than risk getting addicted to painkillers.' Not true for a short course after surgery. Taking regular pain relief as prescribed helps you move, breathe deeply, and recover. Short-term use for surgical pain does not lead most people into long-term use.
'No bleeding in the first few days after tonsil surgery means you are in the clear.' Not quite. Some bleeding happens later than that, so keep the safety-net advice in mind for the full two weeks, not just the first few days.
'A general anaesthetic knocks you out, and that's the end of it.' Not quite. Tiredness, a hazy memory of the day, and feeling emotionally flat for a day or two afterwards are all common, and they settle.
This story is made up to show a common experience. It is not about a real patient.
Priya, 34, had a straightforward day-case operation on her nose. The pre-assessment two weeks before checked her blood pressure, went through her medicines, and confirmed she was not pregnant. She followed the fasting instructions exactly, and her sister drove her home that afternoon and stayed the night, as she had been told to arrange.
The first two days were sore but manageable with regular paracetamol and ibuprofen. On day three she felt inexplicably tearful and close to tears over nothing in particular – nobody had warned her about that part, and it worried her more than the operation had. A friend who had been through it reassured her it was common, and by the next day she felt herself again. On day six she noticed some crusting and a slightly odd smell from one nostril, called the ward as she had been told to if anything seemed off, and was reassured over the phone that it was normal healing. Her follow-up appointment two weeks later confirmed everything had gone as expected.
What to pack: glasses, hearing aids, your medicines list, a dressing gown and slippers, loose clothing, entertainment for a wait, your phone charger, and details for whoever is picking you up.
Medicines checklist: for each medicine you take, note whether to take it as normal, whether it needs to be stopped (only on the team's advice), or whether you need to ask.
Your recovery timeline: note your own team's instructions for day 1, day 3, week 1 and week 2 – what to expect, and what to do if it is not going that way.
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from the Royal College of Anaesthetists and the Association of Anaesthetists, NICE guidance on perioperative care, and the British Association of Day Surgery, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor on September 2026. It gives general information, not personal medical advice – your own team's instructions always take priority over the general guides in this chapter. See the full note on sources at the back of the book.
Glue ear is the most common reason children are seen by an ENT team, and one of the most common reasons children have an operation at all. Most of the time it is not serious and it gets better by itself. But because good hearing matters so much for speech and learning in early childhood, it is worth understanding properly.
This chapter is written for parents and carers.
It often comes and goes – worse with a cold, better in between – which can make it confusing to spot.
Glue ear. Thick, sticky fluid builds up in the middle ear, behind the eardrum, without necessarily being a painful infection. It is very common between about two and six years old. It is linked with colds, large adenoids, allergies, exposure to cigarette smoke, going to nursery (more colds), a cleft palate, and Down's syndrome. It causes a mild-to-moderate hearing loss that comes and goes, a bit like wearing earplugs.
Repeated ear infections, which can leave fluid behind afterwards.
Wax (Chapter 7) – though wax causing real hearing loss is less common than people assume.
Less common, but important to think about:
Most childhood hearing changes are glue ear, and most glue ear gets better.
What the specialist is thinking
How long has this been going on, and does it come and go with colds?
Any worry about speech, or about how your child is doing at nursery or school?
Any snoring, breathing through the mouth, or signs of large tonsils?
Any ear infections, discharge, or pain?
Does hearing trouble run in the family?
Does your child have Down's syndrome or a cleft palate? These need closer, earlier attention.
A worry about a baby's hearing, or a hearing loss in one ear only, changes how quickly I want to act – I do not simply wait with those. Otherwise, I test the hearing for your child's age, and I often repeat it after a few months, because glue ear comes and goes and usually clears by itself.
The doctor looks in your child's ears with an otoscope – a parent can help by holding a younger child gently and steadily. They look in the nose and throat if there is snoring or a blocked nose. They do the pressure test (tympanometry), which is quick and usually well tolerated even by young children, and which shows whether there is fluid behind the eardrum. They test hearing in a way suited to your child's age – Chapter 6 explains these tests in detail.
The pressure test is the key extra test for glue ear: a flat result suggests fluid behind the eardrum. Hearing is tested in a way that matches your child's age – watching how a baby responds to sound, turning towards a rewarded sound for toddlers, a listening game for preschoolers, and headphones with a button for older children (Chapter 6).
Because glue ear fluctuates, the hearing test is often repeated after a period of watching and waiting, to see whether it has cleared by itself – which it usually does. Results are described in the same way as for adults: mild, moderate, or severe. Rarely, a scan or a genetic test is used if the hearing loss is unusual or getting worse.
Do not delay if you are worried about a baby's hearing, or if the hearing loss seems to be in one ear only. These are checked promptly, rather than watched for the usual waiting period. Do not put anything into the ear yourself to try to clear it.
Watch and wait. Because most glue ear clears by itself within about three months, this is usually the first step, along with a repeat hearing test. It is an active choice, made on purpose – not the same as doing nothing.
Treating a blocked nose or allergy may help a little, but decongestant or antihistamine medicines on their own do not reliably clear glue ear.
Autoinflation – blowing up a small balloon through the nose – has some evidence behind it, mainly once a child is old enough to manage it, which in practice usually means school age. It is low risk and worth trying.
Grommets. If glue ear carries on beyond about three months and is causing a hearing loss that matters for speech, learning, or behaviour – especially in both ears – grommets are considered. This is a short day-case operation (Chapter 27). Hearing usually improves straight away. The grommets work their own way out after several months. They are sometimes combined with removing the adenoids, particularly if there are also nasal symptoms, or if it is a second set of grommets. Some children need more than one set over time.
Hearing aids. A non-surgical alternative, especially if grommets are not suitable, are not wanted, or the fluid keeps coming back. They work very well, but need to be worn consistently.
Down's syndrome and cleft palate. Children with Down's syndrome or a cleft palate get much closer monitoring and often earlier treatment, because glue ear is more common and more long-lasting in these children, and good hearing matters even more for their development. There is a lower threshold for offering grommets or a hearing aid. In Down's syndrome, hearing aids are sometimes preferred, partly because the shape of the ear canal can make grommets and their follow-up more difficult. In cleft palate, grommets are sometimes timed to fit in with palate repair surgery.
A hearing loss in one ear only, or one that is getting worse, is investigated and managed in its own right, rather than simply watched the way ordinary glue ear is.
The limits. Neither grommets nor hearing aids fix the underlying tendency to make fluid. That tendency usually settles by itself as the child grows and the Eustachian tube – the tube linking the middle ear to the back of the nose – matures, commonly by around seven or eight years old. Some children need repeated treatment through the earlier school years in the meantime.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - sudden severe ear pain with swelling behind the ear, in a child who is very unwell - difficulty breathing - a child who is floppy or very drowsy, with ear or hearing symptoms
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - ear pain with swelling or redness of the bone behind the ear, in an unwell child - a painful, discharging ear with a fever
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - any concern about a baby's hearing – do not wait - hearing loss in one ear only - speech that is clearly behind other children the same age - a child who seems to be struggling at nursery or school, if hearing could be the reason - snoring most nights with pauses in breathing, or very restless sleep (see Chapter 22) - glue ear symptoms that have not settled after about three months - repeated ear infections - any hearing concern in a child with Down's syndrome or a cleft palate – see them sooner rather than waiting
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
Most glue ear clears within about three months. By school age – roughly seven or eight – most children have grown out of the tendency completely, as the Eustachian tube widens and straightens. Hearing, speech and behaviour usually catch up once hearing improves, though some children need a little extra speech and language support along the way.
After grommets, hearing improves straight away and usually stays better until the grommets come out, at which point a minority of children need a further set. Children with Down's syndrome or a cleft palate often need longer and closer follow-up.
'Glue ear means my child needs an operation.' Not necessarily. Most glue ear clears on its own within a few months, and watching and waiting is a genuine, active choice – not neglecting the problem.
'My child can't have a hearing problem – they hear the television fine.' Not necessarily. Many children with glue ear hear loud, low sounds well, but struggle with quieter speech sounds, especially in a noisy room – which is easy to miss at home.
'Grommets fix hearing for good.' Not quite. They help while they are in place, but the underlying tendency to make fluid needs to settle with age, and some children need grommets more than once.
This story is made up to show a common experience. It is not about a real patient.
Ali is four. Over one winter his nursery said he seemed to "switch off" during group time, and at home the television volume kept creeping up. His speech was a little behind the other children in his room, mostly missing quieter sounds at the ends of words.
The GP found fluid on the pressure test and referred him. A first hearing test showed a mild loss. Three months of watching and waiting, with the nose treated for a runny allergy, made little difference, and a repeat test showed a moderate loss in both ears – enough to explain the nursery reports. Grommets were fitted as a day case. His mother said the change was obvious within a fortnight: he was turning around when called from another room, and the nursery commented, unprompted, that he seemed "like a different child". His speech caught up over the following months with a few sessions of extra support.
Note down, or bring with you:
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE on otitis media with effusion in children, the British Society of Audiology, and the National Deaf Children's Society and Down's Syndrome Association on hearing in children with additional needs, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
There are two quite different reasons a child's tonsils or adenoids come up for discussion: repeated infections, and a blocked airway during sleep. The story, the assessment, and what surgery is expected to achieve are different for each, even though the operation can look similar. This chapter is written for parents and carers.
If it is about infections: frequent sore throats with fever, white spots on the tonsils, tender glands in the neck, and days off school.
If it is about sleep: loud snoring, pauses in breathing that you have seen or heard, gasping or snorting, very restless sleep, sweating at night, unusual sleeping positions, breathing through the mouth by day. By daytime your child may seem tired – or, just as often, the opposite: hyperactive, "wired", or struggling to sit still and concentrate at school. Bedwetting that had stopped and has come back is a lesser-known but real association. In more severe, longer-standing cases, growth can slow.
If the adenoids are the main issue: a persistently blocked or runny nose, mouth-breathing, a nasal-sounding voice, and recurrent ear problems (Chapter 29).
Recurrent tonsillitis. The tonsils themselves keep getting infected, one episode after another.
Enlarged tonsils and adenoids narrowing the airway during sleep. Even without frequent infections, big tonsils and adenoids can crowd the airway once the muscles relax in sleep. This is common in the preschool and early school years, when the tonsils and adenoids are naturally larger relative to the airway. It is more likely with being overweight, with Down's syndrome, or with some craniofacial or muscle conditions.
Large adenoids causing a blocked nose or glue ear, without necessarily causing breathing problems in sleep (Chapter 29).
The two can happen together, even though the same operation may be used to treat either.
What the specialist is thinking
Is this about infections, or about sleep, or both?
For infections: how many episodes, how bad, confirmed by a doctor, and how much are they disrupting school and family life?
For sleep: has anyone actually watched your child sleep and seen pauses, or heard gasping? Is your child tired by day – or the opposite, hyperactive and hard to settle, or struggling to concentrate at school? Is growth being followed as expected? Any bedwetting that had stopped and has come back?
For a clear story of big tonsils and loud snoring in an otherwise well child, we often do not need a sleep study before deciding. For a younger child, other health needs, or an unclear picture, we do.
The doctor looks in your child's mouth and throat with a light to see the size of the tonsils, and in the nose. They feel the glands in the neck, and check growth against a chart. They may listen to the chest, and sometimes use the camera if the adenoids cannot be seen directly.
Often none are needed for a clear history in an otherwise healthy child. A sleep study (Chapters 22 and 26) is used if the picture is unclear, your child is very young, or there is Down's syndrome, a muscle or nerve condition, extra weight, or an unusual facial or airway shape. Growth is tracked on a chart. Occasionally a blood test is done if tonsillitis is unusually frequent or severe.
Watching and waiting. Many children's tonsils and adenoids shrink relative to the airway as the face and jaw grow, often by around seven or eight. Mild snoring on its own, with no other symptoms, is often simply watched.
Treating the nose helps nasal symptoms, and mild breathing problems in sleep a little, but does not shrink large tonsils.
Removing the adenoids alone is used for a blocked nose or snoring from large adenoids without much tonsil enlargement, or alongside glue ear.
Removing the tonsils, often with the adenoids (an adenotonsillectomy), is considered for:
What it does. For the sleep route, clearing the airway usually improves, and often resolves, the snoring and breathing problems, and very often the daytime behaviour and concentration difficulties too – sometimes the change is dramatic. For the infection route, it reliably stops tonsillitis.
What it does not do. It does not guarantee that unrelated behaviour or attention difficulties will disappear. Snoring can persist to some degree if the nose or extra weight is still a factor. It does not stop ordinary sore throats caused by everyday viruses.
The operation. A short general anaesthetic, as a day case or with one night in hospital. Children under three, those with more severe breathing problems in sleep, or those with other health needs are usually kept in overnight for observation, because of a slightly higher chance of breathing difficulty in the hours right after the anaesthetic.
Recovery – the point that matters most. A sore throat and ears for up to two weeks is normal. Fluids matter more than food in the first few days: a child who is drinking well but eating little is usually fine, while one who is refusing to drink needs attention, because being dry increases the chance of bleeding as the throat heals. Give pain relief on a regular schedule, not only when your child complains – young children often go quiet, clingy, or off their food rather than say they are in pain.
Risks. Bleeding – as with adults, this affects a small number of children, mostly minor, and it can happen at any point up to about two weeks after the operation, occasionally needing a return to theatre or a blood transfusion. Breathing difficulty in the hours right after the anaesthetic, more likely in younger children or those with more severe sleep breathing problems – this is why some children stay in overnight. Dehydration if a child will not drink. Infection. Rarely, a change in the sound of the voice after adenoid removal.
Instead of surgery. Watching and waiting, or treating contributing factors such as the nose or weight, for milder cases.
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - breathing difficulty, or a harsh noise breathing in that is getting worse - a witnessed episode where your child stopped breathing or turned blue - drooling, or being unable to swallow their own saliva, in an unwell child - bleeding from the mouth after tonsil or adenoid surgery that will not stop, or any bleeding with looking pale or faint
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - any bleeding from the mouth in the two weeks after tonsil or adenoid surgery, even if it has stopped - a child who is not drinking at all for many hours after surgery, or shows signs of being dry – a dry mouth, few or no wet nappies, or being very lethargic - a fever with worsening throat pain after surgery - severe ear pain with swelling behind the ear
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - breathing pauses or regular gasping in sleep that you have seen or heard - very restless sleep most nights - daytime behaviour changes, tiredness, or struggling at school that might be linked to poor sleep - growth that has slowed for no clear reason - bedwetting that had stopped and has come back - frequent, doctor-confirmed sore throats affecting school and family life
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
Most children are back to normal eating and activity within about two weeks. Sleep and daytime behaviour often improve within days to a few weeks once the airway is clear – parents sometimes describe it as a completely different child. For recurrent tonsillitis, the infections stop. Snoring may not disappear entirely if the nose or weight is still a factor, but it usually improves a great deal. Growth that had slowed often catches up over the following months.
'Snoring in children is normal and nothing to worry about.' Occasional mild snoring with a cold is common and harmless. Loud snoring most nights, especially with pauses or gasping, is not something to dismiss.
'A hyperactive child can't also be a tired child.' Not true. In children, poor sleep from a blocked airway often shows up as hyperactivity, poor concentration, or difficult behaviour, rather than obvious sleepiness – which can be confusing for parents and teachers alike.
'As long as my child eats a bit after the operation, that's enough.' Fluids matter more than food in the first few days. A child who is drinking well but eating little is usually fine. One who is refusing to drink needs attention.
This story is made up to show a common experience. It is not about a real patient.
Kofi is five. For months his nursery had described him as "wired" – unable to sit still at story time, and quick to lose his temper – and his parents had started to wonder about his behaviour. At home, he snored loudly every night, and his mother had twice seen him stop breathing for a few seconds before gasping and starting again. She recorded a short video on her phone to show the GP.
The video, together with a look at his large tonsils and adenoids, was enough for the ENT team to recommend surgery without a sleep study. He had his tonsils and adenoids removed as a day case, staying in one night as a precaution because of his age. The first week was hard – he did not want to eat, but his parents focused on keeping him drinking, with regular pain relief, as they had been shown. Within a month he was sleeping silently through the night, and his nursery, without being told anything had happened, remarked that he seemed calmer and much easier to settle.
If it is about infections, note down the dates of sore-throat episodes over the last 12 months, whether there was a fever, whether a doctor saw and recorded it, and days off school.
If it is about sleep, note what you have seen and heard, and bring a video if you can. Note how many nights a week it happens, daytime behaviour, tiredness or concentration, any bedwetting, and any growth concerns.
Also note any other health conditions – Down's syndrome, extra weight, or a muscle or nerve condition – and your questions from the list above.
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from SIGN, NICE, and ENT UK on tonsils and adenoids in children, and paediatric evidence on sleep-disordered breathing, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
A child with earache, especially at night, is one of the commonest reasons parents seek help urgently — and one of the most reassuring, because most ear infections settle by themselves. This chapter is written for parents and carers.
Ear pain, or in a younger child who cannot say so: pulling or rubbing at the ear, crying, being unusually unsettled, poor sleep, or going off food. There is often a fever, and sometimes a cold beforehand. Occasionally, fluid or pus starts to leak from the ear – the pain often eases once this happens.
The commonest cause by far is acute otitis media – a middle-ear infection, usually following a cold, which can be viral or bacterial. It is very common in young children, partly because their Eustachian tube (the drainage tube from the middle ear to the back of the nose) is shorter and more horizontal than an adult's.
Less often, earache in a child comes from a foreign object in the ear, from teething pain felt near the ear, or from wax (Chapter 7) – though wax causing real pain is less common than people assume.
What the clinician is thinking
How unwell is your child overall – not just the ear? A child who is alert, drinking, and playing between bouts of pain is reassuring, whatever the eardrum looks like. A child who is drowsy, will not drink, or seems very unwell needs more urgent attention, whatever the ear looks like.
The doctor looks in the ear with an otoscope (a small light with a magnifying lens) to see whether the eardrum is red, bulging, or has a small perforation with discharge. They also check behind the ear for swelling, feel the neck, and – most importantly – assess how your child looks and behaves overall: alertness, breathing, and hydration.
Usually none are needed – the diagnosis is made by looking in the ear and assessing your child. A swab of any discharge is occasionally taken if it does not settle as expected. Chapter 26 covers tests in general.
Most ear infections settle by themselves within a few days, as the body's own defences clear the infection, regardless of whether antibiotics are used.
A "wait and see" approach is standard, common NHS practice. Many GPs will suggest pain relief first, with a plan to start antibiotics only if the pain and fever have not started to improve within about two to three days, or if they get worse. This is not neglect – it reflects good evidence that antibiotics make only a small difference to how long the pain lasts, and do not reliably prevent the rare complications.
Antibiotics are used more readily in babies under a certain age, in children who are more unwell, or where there is a discharging ear or a particular medical condition – your doctor will explain if this applies to your child.
What antibiotics do not do: they do not usually make the pain go away any faster in the first day or so, and taking them "just in case" every time does not protect your child in future – in fact, it can make future infections harder to treat.
Grommets or ENT referral are considered only for children with frequent, repeated infections that are genuinely disrupting life, not for a single episode (Chapter 27 covers grommets; Chapter 29 covers the related picture of glue ear).
When not to wait
These are general guides, not a complete list. If a symptom worries you, do not wait — trust your instinct and get help.
Emergency – act now - swelling, redness, or tenderness behind the ear, with the ear pushed forward, and the child seems unwell - a stiff neck, a severe headache, or being very difficult to wake or rouse - a baby under three months old with a fever - a child who seems very unwell – floppy, will not drink at all, or breathing fast
Call 999 now, or go straight to A&E (the hospital emergency department).
Get help today - discharge from the ear with a high fever, or pain that is getting worse rather than better - earache that has not started to improve after two to three days - a child who is not drinking enough, or is much more unsettled than usual
Contact your GP for an urgent appointment today, or call NHS 111.
Get this checked soon - repeated ear infections, one after another - hearing that seems affected between infections - an ear that keeps discharging on and off
Make an appointment to see your GP.
If you are not in the UK: use your local emergency number and nearest emergency department for the emergency signs, and your family doctor or local health centre for the rest.
Pain usually eases within two to three days, whether or not antibiotics are used, and most infections have fully settled within a week. If the eardrum has a small perforation, it typically heals on its own within a few weeks. Occasionally, fluid lingers behind the eardrum after the infection clears – Chapter 29 covers this if hearing seems affected afterwards.
'Ear infections always need antibiotics.' Not true. Most settle by themselves, and a short period of watching and waiting, with good pain relief, is standard, sensible practice for many children.
'Once an ear has discharged, you must keep it completely dry forever.' Not quite. Keeping the ear dry matters while there is active discharge or a known perforation, but this is usually a short-term precaution, not a lifelong rule – ask your doctor once things have settled.
This story is made up to show a common experience. It is not about a real patient.
Freya, aged three, woke crying at 2am, pulling at her ear, with a slight fever. Her parents gave her the pain relief their pharmacist had recommended and rang 111, who talked them through what to watch for and reassured them it could safely wait until morning. Their GP the next day agreed it looked like a straightforward ear infection, and suggested watching for two to three days rather than starting antibiotics immediately, since Freya was otherwise drinking, playing, and had no worrying signs. By the third day, the pain had eased on its own, and Freya was back to nursery within the week.
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on guidance from NICE and the NHS on ear infections in children, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Most NHS ENT appointments are short – often around ten minutes. A little preparation beforehand can make a real difference to how much you get from that time. This chapter brings together, in one place, the preparation ideas that appear throughout this book.
A short appointment goes further when the clinician doesn't have to spend the first five minutes reconstructing your history. Coming prepared means more time for the part that actually needs a conversation: working out what's going on, and deciding what to do about it.
If your symptom comes and goes, or has been building slowly, a simple diary is more useful than memory alone. It doesn't need to be elaborate:
A week or two of notes, even brief ones, is usually enough to show a genuine pattern.
Alongside the diary, a short timeline helps: when the symptom first started, whether it's got better, worse, or stayed the same, and anything you've already tried – over-the- counter treatments, a pharmacist's advice, or a previous GP visit – and whether it helped.
Bring a current list of everything you take, including anything bought without a prescription, and any known allergies or reactions. This matters for more than politeness – some ENT treatments and tests interact with other medicines (Chapter 26 covers this for scans, and several chapters cover it for surgery).
If you've had a hearing test, scan, or biopsy elsewhere, bring the actual report if you can, not just your memory of what you were told. If you use hearing aids, bring them, even if you don't usually wear them all day – the clinician may want to see how they fit or check them alongside your hearing.
If you need an interpreter, or have any access need – a wheelchair, a support worker, or extra time to process spoken information – let the clinic know in advance rather than on the day. This gives them a real chance to arrange it properly (Chapter 3 covers what to expect once you're there).
However complex the appointment, three simple questions cover most of what matters:
(Chapter 33 covers a fuller way of weighing options, once you know what they are.)
A second person in the room often remembers details you don't, especially if you're anxious or the news is unexpected. If you can, bring someone – or ask if a call can be put on speakerphone for them to listen in.
It's entirely reasonable to write things down during the appointment, or to ask the clinician to write down key points for you. You can also ask for a copy of any letter sent about your care – most patients are entitled to this. Simply asking, "Could I have a copy of what gets written up?" is usually enough.
A shorter version to keep with you:
Before I leave, I want to know: 1. What do you think this is? 2. What are my options? 3. How will I know if it's working? 4. What should make me come back sooner?
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on general guidance on preparing for a medical appointment and on good communication between patients and clinicians, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
"What would you do, doctor?" is a fair question to ask. But understanding your own options – and what matters to you about them – helps you and your clinician reach a decision you can both stand behind. This chapter is a toolkit for that conversation.
Many ENT decisions genuinely have more than one reasonable path – watch and wait, try a treatment, or have an operation – and the right choice often depends as much on what matters to you as on the medical facts. Taking part in the decision isn't about doing the clinician's job for them; it's about making sure the plan actually fits your life.
Whenever you're offered a choice, four questions cover the ground:
(These are sometimes known by the short name BRAN – Benefits, Risks, Alternatives, do Nothing – though the words matter more than the label.)
Clinicians sometimes describe risk as a figure – "about 1 in 10," for example. It helps to remember two things: first, a small-sounding risk still happens to someone, and it's reasonable to ask what that would mean for you specifically. Second, the same number can feel very different to two people – a 1-in-10 chance of a mild, temporary problem may feel quite different from a 1-in-10 chance of something lasting. If a number is given, it is always fair to ask, "What would that actually look or feel like, if it happened to me?"
"Let's wait and see" is sometimes presented as if nothing is being decided – but it is a genuine choice, with its own benefits (avoiding an unnecessary treatment) and its own risks (a problem continuing or slowly worsening). Several chapters in this book describe watchful waiting for exactly this reason – it is not the absence of a plan, and it can always be revisited if things change.
Asking for a second opinion is a normal, accepted part of care, not an insult to the first clinician. You can ask your GP or specialist directly, and most are used to this request. It's particularly reasonable before a major or irreversible decision, or if something still doesn't feel clear after a first explanation.
Consent means agreeing to a plan once its benefits, risks, and alternatives – including doing nothing – have genuinely been explained to you (Chapter 27 covers this in the context of an operation specifically). You are entitled to ask for the risks that matter most to you personally to be spelled out, to take time before deciding where the situation allows it, and to say no.
Agreeing to a plan is not irreversible. If new information comes to light, if your circumstances change, or if you simply feel differently once you've had time to think, it is entirely reasonable to go back and say so – even on the day of a procedure, where a delay is safe to make.
This chapter is about genuine choices – it does not apply to the emergency and urgent situations described in Chapter 4. If a red-flag symptom applies to you, that is not a "shared decision" situation: act on it straightaway, and revisit the wider decision-making described here once the urgent issue has been dealt with.
When weighing a real decision, it can help to write it out side by side:
| Benefits | Risks | What it involves | |
|---|---|---|---|
| Option 1 | |||
| Option 2 | |||
| Doing nothing for now |
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on GMC guidance on consent and shared decision-making, and general NHS resources on making decisions about your care, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
This book was written from UK and NHS practice, because that is the system its author works in. But ear, nose and throat problems, and good judgement about them, are the same everywhere. This final chapter helps you use the book wherever you are, and offers some practical help for the waiting itself.
If you are reading this outside the UK, here is roughly how the terms used throughout the book map onto other systems:
| This book says | You might instead think of |
|---|---|
| GP | Your family doctor, or local health centre |
| NHS 111 | Your local non-emergency medical advice line, if one exists |
| A&E (the emergency department) | Your nearest hospital emergency department |
| "Referral" and "waiting list" | However your own system arranges specialist appointments – directly, through insurance, or through a family doctor |
| ENT specialist / otolaryngologist | The same specialist – "ENT" and "otolaryngology" are used interchangeably in different countries |
Whatever your system is called, the same underlying question applies: who is the right first person to see, and how quickly?
The questions in Chapters 32 and 33 don't depend on which health system you're in:
These are worth asking whether you're seeing a family doctor, a specialist directly, or a clinician through an insurance scheme.
Some readers will have access to private healthcare, either instead of or alongside a public system; others will only have one route available. Paying for faster access does not change what a red-flag symptom means (Chapter 4), and it doesn't change which questions are worth asking. This book does not recommend one route over another – only that, whichever route you take, you take the same care in choosing it.
Whatever happens next with your ENT problem, some things genuinely help in the meantime, regardless of the outcome:
Flying with an unresolved ear or sinus problem can be uncomfortable, because of pressure changes on take-off and landing. A decongestant taken shortly before flying can help some people, if suitable for you (check with a pharmacist). Grommets are the exception that usually helps rather than hinders – once the first day or two after the operation has passed, they equalise pressure through the eardrum and often make flying more comfortable, not less. After an eardrum repair or mastoid surgery, though, flying is usually restricted for a matter of weeks – ask the surgical team when it is safe for you specifically (Chapters 10 and 27 cover this for each operation).
Not every website giving health information is equally trustworthy. A few plain checks help:
This book has drawn on guidance from organisations including the NHS website (NHS.uk) and ENT UK, both referenced throughout. These, along with your own country's national health service or equivalent professional body, are reasonable starting points for further reading. This book is not affiliated with, and does not speak on behalf of, any of them.
Whatever country or health system you are in, the warning signs described in Chapter 4, and repeated throughout this book, do not change. Never delay seeking help for an emergency or urgent sign because of uncertainty about your local system – go to the nearest emergency department, or call your local emergency number, and work out the right longer-term route afterwards.
General information only – not a diagnosis. If in doubt, get medical help.
This chapter is based on general guidance from the NHS and ENT UK, general aeromedical advice on flying with ear and sinus conditions, and general health-literacy guidance on evaluating health information online, current to September 2026. It was reviewed by Bassem Saleh, ENT doctor in September 2026. It gives general information, not personal medical advice. See the full note on sources at the back of the book.
Every fact, figure, warning sign and reassurance in this book is drawn from published clinical guidance, not from personal opinion. The main sources used, in order of how much weight they were given:
This book does not reproduce any of these organisations' own text, scales or questionnaires. Where a named tool such as the Epworth Sleepiness Scale is mentioned, it is described in the book's own words, not printed.
On dates and review: This material was reviewed by its author, Bassem Saleh, ENT doctor, in September 2026. It has not had an independent second-clinician or legal review. Guidance and services can change; check current advice with your own health professional. For corrections or feedback, email support@clinoramedical.com.
Plain-English explanations of the medical words used in this book. Most of these terms are also explained the first time they appear in each chapter — this list is here so you can look one up quickly without hunting back through the book.
A - A&E — the hospital emergency department. - achalasia — the muscular valve at the bottom of the gullet fails to open properly. - acid-suppressing medicine — a medicine that reduces stomach acid (a proton-pump inhibitor, such as omeprazole). - adenotonsillectomy — an operation to remove the tonsils, often together with the adenoids. - adrenaline auto-injector — a pre-loaded pen of adrenaline (such as an EpiPen), used in a severe allergic reaction. - age-related hearing loss — the gradual hearing loss that comes with age. - alginate — a "raft" medicine that floats on the stomach contents to reduce reflux. - anaphylaxis — a severe allergic reaction: a whole-body reaction that can affect breathing and blood pressure. - antihistamine — a medicine that blocks the chemical released in an allergic reaction. - aspirin sensitivity — a pattern linking asthma, nasal polyps, and reactions to aspirin and similar painkillers. - audiogram — the chart that shows how well you hear different sounds. - audiologist — a professional who tests hearing and balance. - autoinflation balloon — a small balloon you inflate through one nostril, to encourage the Eustachian tube to open.
B - back-up antibiotic — a prescription to keep and use only if things clearly get worse, rather than starting it straight away. - balance organ — the part of the inner ear that senses movement and helps you keep your balance. - balance-retraining exercises — exercises that help the brain adapt to a change in balance signals. - barium swallow — an X-ray test taken while you drink a chalky liquid, to look at swallowing. - betahistine — a tablet sometimes used for dizziness caused by inner-ear conditions. - biologic medicine — a medicine, given by injection, that damps down one particular part of the immune reaction. - biopsy — a small sample of tissue taken to look at under a microscope. - booth hearing test — a hearing test done in a soundproof booth (pure-tone audiometry). - branchial cyst — a fluid-filled lump on the side of the neck, often appearing in young adults.
C - cannula — a thin tube placed in a vein, often to give contrast dye for a scan. - chaperone — an impartial person present in the room during an examination. - cholesteatoma — a build-up of skin cells in the middle ear. Not a cancer, but it grows and usually needs an operation. - cilia — tiny hairs inside the nose and airway that help clear mucus. - cochlea — the hearing part of the inner ear, a coil shaped like a snail's shell. - cochlear implant — a device, placed by an operation, that stimulates the hearing nerve directly. - cognitive behavioural therapy (CBT) — a talking therapy that changes how you react to a symptom, such as tinnitus. - consent — agreeing to a treatment after its benefits, risks and alternatives have been explained to you. - consultant — a senior specialist doctor. - contrast dye — a dye injected into a vein that shows blood vessels and some tissues more clearly on a scan. - CPAP — a bedside machine that blows gently pressurised air through a mask to hold the airway open during sleep. - CT scan — a doughnut-shaped scanner that uses X-rays to build a detailed image.
D - decongestant nasal spray — the fast-acting kind of nasal spray, not meant for long-term use. - desensitisation (immunotherapy) — giving tiny, increasing doses of an allergen so the immune system reacts to it less over time. - deviated septum — the middle wall of the nose is bent, so one side is narrower than the other. - distorted smell (parosmia) — familiar things smell wrong. - doctor in training — a doctor working under the supervision of a consultant. - double-sickening — getting better after a cold and then getting worse again a few days later. - dupilumab — a biologic medicine, given by injection, used for some severe allergic and nasal-polyp conditions.
E - ear canal — the short tunnel leading from the outside of the ear to the eardrum. - eardrum — a thin layer of skin deep in the ear canal that vibrates with sound. - eardrum repair — an operation to repair a hole in the eardrum, using a small patch of your own tissue. - ear wax — the natural, waxy coating in the ear canal. - Epley manoeuvre — a set sequence of head and body movements used to treat a common cause of positional vertigo. - epiglottis — a small flap that protects the airway when you swallow.
F - facial nerve — the nerve that works the muscles of the face, running close to the parotid salivary gland. - feeding tube — a tube placed through the nose for a short period, or directly into the stomach for longer, to give food and fluid. - flicker of the eyes (nystagmus) — a fine, involuntary flicker of the eyes, often seen with inner-ear problems.
G - glandular fever — a viral illness causing a long, severe sore throat and weeks of tiredness. - globus — the feeling of a lump in the throat when nothing is actually there. - glue ear — thick, sticky fluid in the middle ear, without necessarily being a painful infection. - GP — your family doctor. - grommet — a tiny tube placed in the eardrum to let air in and fluid out. - gullet — the tube that carries food from the mouth to the stomach.
H - habituation — the brain learning to treat a sound, such as tinnitus, as unimportant background, so you stop noticing it as much. - hair cells — tiny cells in the inner ear that turn movement into nerve signals. - HPV (human papillomavirus) — a common virus; most people who meet it clear it without any problem.
I - injection through the eardrum — a steroid or gentamicin injection given directly through the eardrum, used for some inner-ear conditions. - irrigation — warm water sprayed gently into the ear canal with an electric machine to float ear wax out.
K - keyhole sinus surgery — surgery through the nostrils to open the sinuses, without any external cuts.
L - light-headed / feeling faint — a sensation of being about to pass out, different from vertigo (which is a spinning sensation). - lipoma — a fatty lump, usually harmless. - lymphoma — a cancer of the lymph system.
M - mandibular advancement device — a custom-made mouthpiece worn at night to hold the lower jaw, and so the airway, more open. - Ménière's disease — a condition causing episodes of vertigo, hearing loss and tinnitus, usually in one ear. - microsuction — a low, quiet vacuum that lifts ear wax out while the clinician looks through a microscope. - midfacial segment pain — a constant band of pressure across the middle of the face, with a normal nose and scan. - middle-ear infection — an infection in the air space behind the eardrum. - MRI scan — a scan using a long tube and a strong magnet, not X-rays. - muscle-tension voice — hoarseness caused by the muscles around the voice box overworking, rather than a problem with the vocal cords themselves.
N - nasal cautery — sealing a bleeding blood vessel in the nose with a silver-nitrate stick or with heat. - nasal cycle — the normal process where the two sides of the nose take turns being more open, through the day. - nasal packing — a sponge or dressing placed in the nose to press on a bleeding point. - nasal polyps — soft, painless, grape-like swellings of the nose lining. - nasendoscopy — a thin, bendy camera passed gently through the nose to look at the throat. - needle test (fine-needle aspiration) — a thin needle used to take a few cells from a lump for testing. - NHS 111 — the NHS phone and online service for urgent problems that are not emergencies.
O - obstructive sleep apnoea (OSA) — a condition where the throat repeatedly narrows or closes during sleep. - otoscope — a small torch with a magnifying lens, used to look in the ear. - otosclerosis — extra bone growth that stops one of the tiny hearing bones moving freely. - outer-ear infection — an infection of the ear canal, sometimes called swimmer's ear.
P - parotid gland — the large salivary gland in front of and below the ear. - patulous tube — a Eustachian tube that stays open when it should be shut, causing an odd, "echoey" sensation. - perforation — a hole in the eardrum. - PET-CT scan — a whole-body scan that also uses a small injection of a radioactive sugar to highlight active tissue. - phantom smells — smelling something when there is no actual source. - phonosurgery — surgery on the vocal cords, done with fine instruments or a laser through the mouth. - positional vertigo (BPPV) — short spinning brought on by a change in head position. - pouch — a pocket that can form at the back of the throat. - pulsatile tinnitus — a whooshing tinnitus sound that occurs in time with your heartbeat.
Q - quinsy — a collection of pus that forms beside a tonsil.
R - referral — when one health professional sends you to another for advice or treatment. - referred pain — pain felt in one place (such as the ear) that is really coming from somewhere else. - retraction — an eardrum that has slowly been drawn inwards. - rhinitis — an irritated, inflamed nose lining. - rhinosinusitis (sinusitis) — inflammation of the sinuses and the nose lining together.
S - salivary duct endoscopy — a tiny camera passed into a salivary tube, which can also be used to remove a stone or stretch a narrowing. - salivary stone — a small, hard stone that forms inside a salivary tube. - salt-water rinse — a large-volume wash used to clean the inside of the nose. - septal surgery (septoplasty) — an operation to straighten a bent middle wall of the nose. - shingles affecting the ear — shingles affecting the nerves near the ear, sometimes called Ramsay Hunt syndrome. - simple snoring — snoring where the throat tissues vibrate, but the airway is not actually blocking. - Sjögren's syndrome — an autoimmune condition that reduces how much the tear and saliva glands produce. - skin-prick test — a test where drops of common allergens are pricked into the forearm to check for a reaction. - sleep study — wearing sensors overnight that record your breathing and oxygen levels. - smell training — sniffing a set of strong smells twice a day to help the sense of smell recover. - sound therapy — using gentle background or wearable sound to make tinnitus stand out less. - speech banana — the area of a hearing chart where everyday speech sounds sit. - steroid nasal spray — a nasal spray that reduces inflammation, used regularly rather than for quick relief. - stent — a mesh tube used to hold the gullet open where it has narrowed. - stricture — a narrowing of the gullet. - stroboscopy — a slow-motion light used to examine the vocal cords while they vibrate. - strep throat — a sore throat caused by streptococcus bacteria. - submandibular gland — the salivary gland under the jaw. - swollen gland (lymph node) — a small filter in the neck that swells when it fights an infection.
T - three tiny bones — the three tiny linked bones in the middle ear that carry sound to the inner ear. - throat — the shared space behind the nose and mouth. - thyroglossal cyst — a fluid-filled lump in the midline of the neck that moves with swallowing and with the tongue. - thyroid nodule — a lump in the thyroid gland. - tinnitus — noises in the ear, such as ringing, buzzing or humming, with no outside source. - tonsillectomy — an operation to remove the tonsils. - tonsillitis — inflammation of the tonsils themselves. - tonsils and adenoids — soft pads of tissue, part of the body's defences, at the back of the nose and throat. - trouble swallowing (dysphagia) — difficulty getting food or fluid down safely or comfortably. - turbinate reduction — an operation to shrink the swollen shelves on the side wall of the nose. - turbinates — curved shelves of tissue inside the nose that warm and moisten the air you breathe. - two-week-wait referral — a referral used when a symptom needs to be ruled out quickly; being on this pathway does not mean a doctor thinks you have cancer. - tympanometry — a quick test of how the eardrum moves.
V - vertigo — a spinning feeling, as if you or the room is moving. - vestibular neuritis / labyrinthitis — a one-off inner-ear attack causing sudden vertigo. - vocal cord nodules — small, matching swellings on both vocal cords, a bit like calluses. - vocal cords — two soft bands inside the voice box that vibrate to produce sound. - voice box — the larynx. - voice therapy — therapy with a speech and language therapist to assess and retrain the voice.
W - wait and see — an approach where pain relief is tried first, with antibiotics used only if things are not improving after a few days. - watch and wait — keeping a close eye on something before deciding whether treatment is needed, rather than acting immediately. - wick — a small sponge or ribbon placed just inside the ear canal to carry drops in. - windpipe — the tube that carries air to the lungs.
This edition is text-only. A future edition may add illustrations; the guidance here does not depend on them.
General information only – not a diagnosis. If in doubt, get medical help.
Contents ↑