You are not seeing double. What we have here is a further addition to the remarkable contribution of this publisher to the work of the laryngologist and speech and language pathologist in the management of dysphagia. I was reminded of the extent of that contribution by visiting the Plural website and seeing many familiar texts, most of which have previously been reviewed here, with topics ranging from dysphagia in childhood, to dysphagia associated with movement disorders, trauma, stroke and even litigation. In addition to the earlier editions of this work, we also saw a very similar Plural title from two of these authors a few years ago.

Here, the hardback is the textbook, obviously, and the spiral bound softback is a workbook comprising a series of exercises for self-assessment of the knowledge gained. This is now in its fifth edition and the reviewer's work is greatly eased by an unusually useful Preface, running to four pages. It tells us what is new in each chapter and, indeed, highlights a completely new chapter on dysphagia in the ageing population, including discussion of the ethical concerns that can arise with interventions in advanced dementia. At the other extreme, a chapter on the assessment of paediatric swallowing disorders has clearly been extensively updated. I particularly enjoyed (inevitably I suppose) a chapter on the surgical procedures for relieving obstructions to swallowing or aspiration that have not responded to conservative treatment.

This is a very attractive book, with glossy pages, sharp printing of images, high-quality colour illustrations and clear labelling. It is very nicely set out, with boxed tables, highlighted bullet points and case studies, and even the textbook carries many a question and answer session. As a simple ex-otologist, I learnt much from this book, having had quite an insight into the symptom during the past year, but I am confident trainees will derive great benefit from it. There are some real treasures. There is a ‘Did you know that…’, and I confess I did not know that the masseter, for its size, is the strongest muscle in the body.

The workbook I found much easier after reading the book (having foolishly started in the reverse order). Tasks include: questions that range from simply marking ‘true’ or ‘false’ to ‘Completion statements’ requiring a sentence or two at most, labelling diagrams (they can be challenging), and even ‘Draw sketches that show…’. Multiple choice questions are tricky at any time, as words like ‘never’ and ‘always’ can rarely be applied to medicine. Double or even triple negatives require a code breaker's intellect; ‘Which of the following are NOT a feature of’ is hard enough without an option including ‘None of the above’, but fortunately they are few and far between. After 114 pages of questions, more than the work of one weekend, the 40 pages of answers come as a relief, assuming a decent mark of course.

The textbook is a very comprehensive review of the subject, with impressively updated content. It should appeal to the senior laryngologist as much as the trainee, and is, of course, essential reading for speech and language pathologists, dieticians, and all in the multidisciplinary team.