Two new releases were eagerly anticipated in the Flood household at the end of May 2008. The younger members awaited the new Indiana Jones film. This older and wiser parent rather looked forward to, at long last, seeing the seventh edition of this, our standard UK text book. One is a lavish production that requires suspension of credulity, that proves that advanced age need not mean senility and that shows that salvage after a poor predecessor is possible. The other stars Harrison Ford.
The paper version of the book is a health hazard weighing in at 27 pounds, in three (slightly unwieldy) volumes to replace the six of the last edition. This time there will, we are promised, be a disk (which would have made this review, composed on a train, so much easier!). Neither Ray Clarke nor I could get a pilot version of the disk to view, some months ago. (Indeed, even our offspring failed, suggesting that it really could not be done!) If the quality of the book is ultimately reflected in the disk, I am confident it will be flawless, but I simply cannot read off a screen anyway.
I reviewed the sixth edition of this textbook for ENT News a decade ago and, whilst I was actually somewhat restrained in my criticisms, won no friends in the process. Now I will say it – I thought it was awful. Much careless chapter revision meant that a decade of progress was frequently dismissed with a new sentence or two. Illustrations were mislabelled, inverted, or cropped so as to lose all meaning. The whole effort compared so badly in quality and value with the US competition, most notably Cummins. Mind you, it did make it easy to write a lengthy, critical review.
At a glance, the reader will see the transformation achieved in this new edition. There's an attractive cover (although, as shown, scanning does not do it justice). There is better quality paper and layout and a profusion of colour illustrations throughout. The awful ‘pagination’ of the sixth edition is just a bad memory. Now, there is a completely revised and international authorship.
Volume 1 combines the old ‘Basic Sciences’ and ‘Paediatric Otorhinolaryngology’ volumes into what is now a potentially hernia-inducing tome, but one which perhaps best reflects the improved quality of the seventh edition. Updates are exemplified by chapters on stem cells, contact endoscopy and optical coherence tomography (sensational, and totally new to me!). How clever to bring in communication skills, ethics and a section on the literature appraisal principles that inspired this book. Medico-legal issues are covered in several chapters, all explaining why I have seen so little of Maurice recently. Anaesthesia, ITU, ‘traditional basic sciences’ – they are all there. The book is excellent preparation for that challenging MCQ first part of the Intercollegiate FRCS that has baffled more than examiner.
Paediatric ENT textbooks and lectures are always superbly illustrated for some reason. Is this the national influence of Peter Bull and his totally bloodless operative photographs? It is understandable, if slightly annoying, that some, potentially identifiable, facial pictures are masked with pixelations over the eyes. When attempting to illustrate syndromal facies, this proves a real problem. Oddly, many other illustrations show readily recognisable children, presumably as consent was obtained. There are the expected chapters on airway disease, congenital abnormalities and infectious diseases, but a personal highlight was that on vertigo in children.
The next two volumes get progressively heavier. In the era of evidence-based medicine, this book now really does manage to be different from the traditional multivolume text. Most such, uncritically, present ‘all that is known on’, accompanied by the author's Level VII evidence and personal convictions. Here, each chapter is a poor man's systematic review of a topic. We get a search strategy, critical appraisal of the evidence, recommendations devised, key points, and, best of all, identification of shortcomings in knowledge and the need for subsequent research. We all know that such an effort is all too often rewarded with the conclusion that ‘there is no high level evidence for’ or ‘we have identified a need for further research in’. However, we must start that ball rolling. Volume 2 takes the reader through rhinology and head and neck practice. Volume 3 introduces plastic surgery of the head and neck, but now with a major aesthetic surgery component. Information on otology and skull base surgery is superbly updated, including chapters on BAHAs, cochlear implants and middle-ear implants. Imaging is particularly well reproduced.
Only now – after over 4000 pages – does the index, of nearly 200 pages, appear, making it a bit inaccessible. I accept there was little practical alternative, and the index is also available on the web site.
This book represents a magnificent achievement, and it has been well worth the wait. At times, since I wrote my small contribution on a Cyprus beach in 2002, I have despaired of the advent of the seventh edition, and I suspect I have been in good company.
Compare the book's cost with that of any preparatory course, let alone the entry fee for any exit exam, and it is clearly a bargain. I suspect many train journeys to the November FRCS ORL, to be held in Birmingham, will be passed running the disk on a laptop. I imagine the travelling examiners will learn as much as the candidates (however, we do have the advantage of determining the agenda).
In 1941, every member of the Imperial Japanese Army embarked for Malaya was handed a book entitled, in rough translation, ‘Just read this book and the war is already won’. Well, although there is still the need to apply the knowledge of course, I see the seventh edition of this textbook in the same light.
