Professor Carl Philpott
Honorary Secretary, ENT UK
The specialty of otorhinolaryngology (ear, nose and throat) looks after a range of conditions crossing the age spectrum from infants through to the elderly and everyone in between.
Aside from head and neck cancers, the majority of ear, nose and throat disorders affect quality of life rather than mortality. As such, in the past, the specialty has not been eminent within the medical sphere for its research endeavours, with evidence for managing various conditions being experiential rather than being evidence-based in clinical trials.
In the modern era, with increasing pressure on healthcare budgets, commissioners are increasingly targeting “Procedures of Limited Clinical Effectiveness” (PoLCE). Often, what is lacking is simply evidence of clinical effectiveness. To counter this, it was clearly identified that high value research needed to be developed and conducted to inform us about what treatments work best and how the specialty can most effectively deliver care.
Recognising the fierce competition for research funding and resources and also the need to build capacity and expertise to deliver the research within the specialty, ENT-UK took the initiative to develop a strategic research agenda called Generate, that was launched in 2015.
Previously under-researched areas are becoming priority
The Generate project developed research priorities in six key domains. Four years on, we are starting to see the fruits of that agenda within the specialty and within some of those domains.
Tinnitus research has previously been under-resourced with a lack of evidence for best management, but there are now three studies underway for tinnitus, two in adults and one in children.
Hearing loss is currently well supported on the national portfolio of research, with 15 active studies currently underway in the UK, ranging from laboratory-based projects to screening studies and to clinical trials.
Balance and smell loss need greater attention from research
Balance problems have received less prominence, which may be in part due to the fact that a number of specialties have input to these patients. Three areas now receiving closer attention include tonsillitis, nasal blockage due to septal deviation and chronic sinusitis, all of which have associated operations undertaken in routine NHS practice: tonsillectomy, septoplasty and endoscopic sinus surgery.
All three procedures have faced the potential for restrictions by clinical commissioning groups, so the funding of major clinical trials by the National Institute of Health Research has been very welcome. These trials are starting to provide evidence for the place of the procedures in managing the affected patients, and indeed in ensuring the correct patients are selected to come forwards for these procedures.
An area of the specialty where funding and new interventions are needed is that of smell and taste disorders. There will be a need to revisit the Generate agenda again in the near future and it is likely that this will provide an opportunity to take stock of key advances and refocus on areas such as balance and smell loss to secure more funding.