Mr Joseph runs a specialist practice in paediatric ENT at the Royal National Throat, Nose and Ear Hospital.

He has also been trained in the management of snoring and sleep disordered breathing. His training also included the assessment and management of neck lumps and cancers of the head and neck.

Below is a description of some of the more common conditions in the throat.

Short episodes of tonsillitis are usually managed with pain control and the careful use of antibiotics when symptoms do not improve. If however the episodes are recurrent, tonsillectomy is required. Modern techniques ensure this is a safe procedure and reduce the post-operative pain so it is manageable.

In children this is usually related to large tonsils and adenoids. While surgery is a very effective treatment for this, Mr Joseph will only recommend it in those children who show no signs of improvement and exhibit the effects of disturbed sleep in the daytime, such as irritability and lack of energy.

In adults the problem is often multi-level between the nose and throat. Assessment is key to being able to direct appropriate management. Sleep nasendoscopy is a very effective tool for this. It requires a light anaesthetic to induce sleep with snoring and then the use of an endoscope to visualise the areas where the snoring is coming from.

These can be related to over use of the voice or shouting, acid reflux, as a sign of general stress and anxiety and rarely to tumours of the voice box.

These cause a lot of anxiety, particularly in children. Thankfully they are rarely related to a serious underlying problem. Careful assessment is required with appropriate investigations.

The same philosophy underlies the management of these lumps in adults although with a slightly different range of possible causes.

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