At-a-Glance

ENT covers the senses and functions that connect us to other people: how we speak, hear, smell, taste, swallow and breathe. The ENT surgeon is thus the healer of 4 out of 5 special senses, smell, taste, hearing and balance. Add to that the importance of speech and swallow and the very essence of life – the airway and it comes as no surprise the hugely important role ENT surgeons play.  Small structures in the head and neck carry enormous consequences for quality of life. That mix of delicate surgery and very human outcomes drew me in, and laryngology in particular, because the voice is so closely tied to a person’s identity and livelihood.

See an ENT specialist if a symptom persists or keeps coming back. Common reasons include hoarseness lasting more than three weeks; a neck lump that has not settled within two to three weeks; difficulty or pain on swallowing; a blocked nose, nosebleeds or discharge on one side only; loss of smell that has not recovered; persistent runny nose and sneezing despite medication; recurrent tonsillitis; ear discharge or hearing loss; and loud snoring with pauses in breathing, in children as well as adults. Sudden hearing loss in one ear should be assessed urgently, ideally within a few days.

Through clinical research, publishing and collaboration. I contribute to peer-reviewed literature and international consensus work, including the IFOS consensus on laryngopharyngeal reflux, and I keep close links with colleagues in Europe from my fellowship years. I attend international meetings, and my academic affiliation with Duke-NUS Medical School keeps me engaged with teaching, which is one of the best ways to stay sharp.

Diagnose first, then treat. Many patients come to me after years of trying treatments that did not address the underlying cause. I take time to examine thoroughly, usually with in-clinic endoscopy, and to explain what I find. I start with the least invasive option likely to work, and I recommend surgery only when it is clearly the right choice for that patient.

The cases that have shaped me most involve professional voice users: singers, teachers and lawyers, for whom a small lesion on the vocal fold affects their livelihood. They taught me that the decision to operate is as important as the operation itself. Timing, voice therapy and the patient’s own goals all matter, and the best plan is the one made together with the patient.

Three come up often. First, that hoarseness is just a cold or overuse and will settle; usually it does, but persistent hoarseness needs to be examined. Second, that smell loss is permanent and nothing can be done; there are treatment options worth discussing. Third, that a constantly blocked or runny nose has to be lived with, or that major surgery is the only alternative. I address these by examining carefully, explaining what I see, and setting out the realistic options.

I explain the diagnosis in plain language, often using the images from the endoscopic examination, and set out all the reasonable options, including non-surgical ones and the option of watchful waiting where appropriate. I discuss the expected recovery and the risks openly, give patients time to ask questions and think it over, and welcome a second opinion if they want one.

Outside the clinic I am a keen wine collector, and I listen to a lot of piano music, especially Schumann and Liszt. I read widely on geopolitics and I enjoy etymology, tracing where words come from. Time with my family matters most. Stepping away properly means I come back to my patients with full attention.

Flexible robotic and laser systems now allow precise surgery through the mouth, without external incisions. More procedures can be done in the office under local anaesthesia. In rhinology, cryotherapy offers new options for chronic rhinitis that does not respond to medication, and regenerative approaches such as platelet-rich plasma are being explored for smell loss. Voice analysis is also becoming more objective, which helps both diagnosis and tracking progress.

Hoarseness that lasts more than three weeks should be examined by an ENT specialist, sooner if you smoke, are a professional voice user, or have warning signs such as pain, difficulty swallowing, a neck lump, coughing up blood or noisy breathing. Most causes are benign and treatable, such as reflux, nodules or polyps, but only an examination of the vocal folds can confirm that. Examination with a flexible endoscope takes a few minutes in clinic and needs no sedation.