Mr Sid Nagala

Neck lumps, head and neck surgery, thyroid and parathyroid surgery, salivary gland surgery, laryngology, voice and throat problems.

Thyroid cancer imaging biomarkers.

Sid’s research during his PhD led to a collaborative paper with the prestigious Head and Neck Unit at Memorial Sloan Kettering Cancer Centre.

• British Association of Endocrine and Thyroid Surgeons
• British Association of Head and Neck Oncologists (BAHNO)
• Fellow of Royal College of Surgeons of England

• Cancer Research UK
• BAHNO Research Grant
• RCS Ethicon Travel Grant
• Monica Kornburg Memorial Grant, University of Cambridge

1. Immunoglobulin G4-related disease of the paranasal sinuses. Bashyam A, Nagala S, Tahir F, Mirza S.  BMJ Case Reports. 2018 May
2. Multi-institutional validation of a novel textural analysis tool for preoperative stratification of suspected thyroid tumors on diffusion-weighted MRI. Brown AM, Nagala S, McLean MA, Lu Y, Scoffings D, Apte A, Gonen M, Stambuk HE, Shaha AR, Tuttle RM, Deasy JO, Priest AN, Jani P, Shukla-Dave A, Griffiths J. Magnetic Resonance Medicine 2016 April; 75(4):1708-16
3. Does error feedback improve the learning of a simple surgical skill? Nagala S, Brar R, Phillips G, Van Wyk C, Lee M.  Ann RCSEng (Suppl) 2014; 96: e1-e4
4. 3T diffusion-weighted MRI of the thyroid gland with reduced distortion: preliminary results. Taviani V, Nagala S, Priest AN, McLean MA, Jani P, Graves MJ.  British Journal of Radiology, 2013 Aug, 86(1028):20130022.
5. Extent of cotton-bud use in ears. Nagala S, Singh P, Tostevin P.          British Journal of General Practice.  2011 Nov, 61(592): 662-3.
6. Diffusion-weighted magnetic resonance imaging: its uses in otolaryngology (Letter). Nagala S, Scoffings D, Jani P.  Journal of Laryngology & Otology.  2010 Mar, 124(3): 352. 
7. Chronic cough – A 12 minute consultation. Nagala S & Wilson JA.      Clinical Otolaryngology.  2008 Apr, 3(2): 94-6.
8. Properties of neurotoxic peptides related to the BRI gene. Austen B, El-Agnaf, Nagala S, Patel B, Gunasekera N, Lee M, Lelyveld V.               Biochemical Society Transactions.  2002 Aug, 30(4): 557-9. 
9. Nonfibrillar Oligomeric Species of the Amyloid ABri Peptide, Implicated in Familial British Dementia, are more Potent at Inducing Apoptotic Cell Death than Protofibrils or Mature Fibrils. ElAgnaf O, Nagala S, Patel B and Austen B.   Journal of Molecular Biology.  2001 Jun, 310: 157168. 

Abstracts

1. Metabolite quantification of thyroid tumours and assignment of potential tumour biomarkers using ex vivo HRMAS 1H NMR. Nagala S, Basetti M, Griffiths, Jani P.  Clinical Otolaryngology.    37 (S1), 7–1
2. A randomised controlled study to examine the benefits of feedback using a novel approach, human reliability assessment principles, on basic surgical skill acquisition. Nagala S, Van Wyck C, Phillips G, Brar R, Lee M.     Clinical Otolaryngology.  2009 Jul, 34 (S1): 54
3. Measuring myringoplasty outcomes: the St. George’s experience. Nagala S, Lee YJ, Tostevin P.  Clinical Otolaryngology.  2009 Jul, 34 (S1): 109

The nose plays a key part in several of our bodily functions. It is crucial in enabling us to smell, and also has an important role in our respiratory cycle. Unfortunately, the nose and surrounding areas can be susceptible to infection and illness, which can seriously impact the quality of life.

Common problems people suffer with include chronic blockages, allergies or the feeling of having a cold. These can often be linked to our sinuses.

When we use the word “sinuses”, we are most often talking about the paranasal sinuses. These are little pockets, or air cavities, within the bones of our face, especially around our nose. These cavities are lined with a membrane which can become infected; this is known as sinusitis.

Symptoms

Sinusitis is a very common illness, and people who have recently been suffering from a cold or flu are particularly vulnerable to it.

Common symptoms of sinusitis include:

• swelling and tenderness in the areas around our nose such as our cheeks, eyes and forehead,
• a blocked or runny nose,
• mucus,
• headache,
• toothache,
• high temperature,
• pressure inside the head, particularly in or around the nose.

The symptoms of sinusitis can also be caused by nasal polyps. These are small, soft lumps that can grow in our nose as a result of inflammation, causing our nose to become partially or fully blocked. Polyps are painless and mostly harmless, but it they continue to grow, they can affect our breathing and our sense of smell. Nasal polyps are associated with asthma, allergies and recurring infection.

In most cases, sinusitis will disappear on its own after two to three weeks, but if the symptoms last for longer there are various medications available which can help. Every now and then medication may not sufficiently deal with the sinusitis, and further intervention will be required. There is a special type of surgical technique called Functional Endoscopic Sinus Surgery (FESS) which we can use to treat sinusitis.

If you have been suffering from the symptoms of sinusitis or nasal polyps, why not see me for a consultation and assessment? Many people I see tell me they've had the symptoms for a long time and have just been putting up with them. As a specialist nose and throat doctor, I will be able to offer you sound advice on the best and most effective course of treatment.

Functional Endoscopic Sinus Surgery (FESS)

Functional Endoscopic Sinus Surgery is carried out under general anaesthetic and is usually a day case, meaning you will be able to return home on the same day. The surgery is performed using an endoscope, which is a thin, flexible tube with a camera and light at one end. The endoscope is carefully placed into your nose, allowing me to see inside very clearly and to work to a high level of precision. During surgery, I can open up your sinuses and remove any polyps if needed.

When the endoscopic surgery is completed, I will apply a special dressing to your nose to prevent any bleeding. I always tell people to avoid blowing their nose as much as possible for the first few weeks after surgery. If you do need to blow, make sure that you do it very gently, one side at a time.

I will always recommend that you take at least two weeks off work to help with your recovery. If possible, you should avoid smoky environments that might cause irritation, and for your own comfort you may wish to avoid busy, crowded environments.

After the operation, it is normal for your nose to continue feeling blocked for several weeks. This is nothing to worry about. Over time, your nose will start to clear and you will begin to feel the full benefits of the sinus surgery.

Moving forward

At Circle, our Ear, Nose and Throat (ENT) Unit specialises in giving an accurate diagnosis for any medical conditions relating to the ear, throat and nose, followed by the appropriate non-surgical or surgical treatment. I work as part of a wider team of experts, each with our own sub-speciality, and together we will identify and treat whatever problems you may be having, making sure that you get the best possible treatment and the highest quality of care.

As a dedicated throat and nose doctor, I have spent years helping people achieve a better quality of life by providing treatment for the range of illnesses and injuries that can hold us back. If you are experiencing any of the symptoms of sinusitis or nasal polyps, I will be delighted to set you on the path to full recovery.

The parotid glands help to make saliva. They are found either side of the mouth, just in front of each ear canal. Sometimes people may develop a lump in their parotid gland, most often in front of or below their ear. This could potentially be caused by a tumour.

The majority of parotid tumours are benign, meaning that they won't spread or cause damage elsewhere in the body. Benign tumours can be present for several months with no real change, and they are not linked to smoking or any other known risk factors. Other tumours can be malignant, meaning that they can spread and cause damage elsewhere, including to our facial nerves and lymph nodes. These tumours can also cause us pain and discomfort.

If you have any kind of lump or tumour in your parotid gland, we will usually recommend a type of surgery called a parotidectomy to have it removed.

Although 80% of lumps found in the parotid gland are benign, a proportion can continue to grow and may turn malignant later on in life. Larger lumps can be uncomfortable and unpleasant to look at. The bigger the lump gets, the harder it is to remove, which is why it's good to act soon. Until we have removed the lump, it can be hard to know exactly what was causing it, so surgery is often a necessary precaution.

If you have any concerns about lumps or pain in your face, particularly in the areas around the parotid glands (near to the ear and cheek), the best thing is for you to come in for a proper examination where my team and I can find out exactly what is going on. We will be able to answer any questions you might have and advise you on the best form of treatment.

Parotidectomy

A total parotidectomy is the complete removal of the parotid gland through surgery. In most cases we would perform a partial parotidectomy, where just the lump and some of the tissue around it are removed. This surgery is done under a general anaesthetic, meaning you'll be asleep for it. During surgery, a long cut is made from your ear down to your neck. (This cut will heal very well over time, meaning that you should only have a discrete scar in the long term.)

Some of the nerves in your skin may be affected as part of the operation, meaning that the side of your face might feel numb for a while afterwards, up to a few months in some cases. A parotidectomy can also sometimes result in a permanently numb ear lobe.

During surgery, dissection of the parotid lump is often very close to the facial nerve.  Bruising of the nerve can result in a weakness of one side or part of your face.  A serious but extremely rare complication of parotid surgery is permanent weakness.

When you wake up from the anaesthetic you may need to have a plastic tube or “drain” attached to prevent any blood from clotting under the skin. You will need to stay in hospital for up to 48 hours before you can go home. This allows us to keep an eye on you and to make sure that your recovery is going well. You will be allowed home after we have removed the drain and when we are happy that you are able to drink and swallow without any trouble.

Following a parotidectomy, it is normal to feel some pain for a while. We will provide you with painkillers to help manage this. You should be able to eat and drink as normal, though chewing can be a bit tricky for the first few days. I will normally recommend that you take a couple of weeks off work to rest and fully recover.

Moving forward

At Circle, our Ear, Nose and Throat (ENT) Unit specialises in giving an accurate diagnosis for any medical conditions relating to the ear, throat and nose, followed by the appropriate non-surgical or surgical treatment. I work as part of a wider team of experts, each with our own sub-speciality, and together we will identify and treat whatever problems you may be having, making sure that you get the best possible treatment and the highest quality of care.

As a dedicated ENT doctor, I have spent years helping people achieve a better quality of life by providing treatment for the range of illnesses and injuries that can hold us back. If you have found any unusual lumps around your ear and cheek, or if you suspect you are experiencing problems with your parotid gland, the best thing is to come in for an examination. I will be delighted to meet with you and get you started on the path to full recovery.

The nasal septum is the thin wall located between our nasal passages, beginning at our nostrils. When you look in a mirror, it is the part separating our nostrils from one another.

It is quite normal for the septum to be off-centre or “deviated,” meaning that one nasal passage is slightly smaller than the other. In cases where this is more severe it can lead to blockages in our nose, reducing airflow and making it harder for us to breathe. For some people a deviated septum can also cause crusting or bleeding in the nose.

Most of the time we won't be able to tell if we have a deviated septum. The deviation can be fairly minor and have little to no impact on daily life. However, a more severely deviated septum can affect us in a number of ways.

• Our nostrils can feel obstructed or blocked, which can get much worse when we have a cold or allergies which cause our nasal passages to swell up.
• If our nasal septum becomes dry, we might find that we have nosebleeds more frequently.
• We might also breathe noisily or snore during sleep, disturbing ourselves or others.
• We might prefer to always sleep on one side as this makes breathing easier.

Over time, these symptoms can start to impact upon our quality of life. Having a blocked nose can be very frustrating, making it harder to breathe and reducing our sense of smell. There can also be quite significant implications for our sleep. If we have nosebleeds, these can be disruptive and distressing. A nasal blockage which causes us to snore can affect our loved ones and those around us, sometimes placing a strain upon our relationships.

A blockage in our nose might be caused by swelling of the tissues lining the nasal passage. There are various medications which can help to reduce swelling, and nasal dilators can also be used to open up our nasal passages. However, if the blockage is as a result of a deviated septum, a special type of nasal surgery called septoplasty will most likely be required to fix the problem.

Causes of a deviated septum

Some people are born with a deviated septum, meaning that that displacement happened in the womb during foetal development. A baby's septum can also become displaced during birth. There are many nose traumas or injuries which can happen to us as children or adults which may lead to a deviated septum, including injuries from contact sports and collisions such as car or bike crashes. The ageing process can also play a part, worsening the effect of a deviated septum as we get older.

If you think you have a deviated septum, the best thing is to come in for an assessment where I can carry out a thorough examination and work out exactly what is going on. I'll be able to suggest the best course of treatment, making sure that you are totally clear about all the details, and there will be a chance for you to ask any questions. If you have a severely deviated septum, surgery may be the best way to fix the problem. If I believe surgery will be helpful, I'll talk you through things clearly, so that you have all the information you need to make an informed choice about whether to have surgery or not. The choice will always be in your hands, and you will never be pressured into choosing surgery.

Septoplasty

The operation to correct a deviated septum is called a septoplasty. It is performed under general anaesthetic and is a day case procedure, meaning you will usually be able to return home on the same day as the operation.

During septoplasty the deviated tissue in your nose is removed and the cartilage taken out, straightened and then replaced. Your nose will be swollen for a few weeks after the surgery, and I usually recommend that you take at least two weeks off work to recover. It can take several months for your nose to feel totally normal, but a successful procedure will effectively deal with the symptoms of a displaced septum.

Moving forward

At Circle, our Ear, Nose and Throat (ENT) Unit specialises in providing an accurate diagnosis for any medical conditions relating to the ear, throat and nose, followed by any appropriate non-surgical or surgical treatment that is needed.

As a dedicated ENT doctor, I have spent years helping people achieve a better quality of life by providing treatment for the range of illnesses and injuries that can hold us back. If you are suffering with any of the symptoms of a displaced septum, the best thing is to come in for an examination. I will be delighted to meet with you and to assess the best way forward.

Our throat and nose are both crucial to some of our most basic activities such as breathing, speaking and smelling. The voice box (larynx) is a key feature of the throat, while the term “nasal” relates to our nose and includes the nasal passages,  which is what we call the airways inside the nose.

All the above are highly important and very sensitive areas of our body. If we are having any problems with their function, it can quickly become very distracting and debilitating.

A team of experts to help you

At Circle, our Ear, Nose and Throat (ENT) Unit specialises in providing an accurate diagnosis and appropriate non-surgical or surgical treatment for any medical conditions linked to the ears, throat and nose. I work as part of a wider team of experts each with our own sub-speciality, and together we are passionate about identifying and treating whatever problems you may be having, making sure that you get the best possible treatment and the highest quality of care.

If you are experiencing any of the symptoms listed below, the best thing is to book in for a consultation where I can carry out a proper examination and find out what is causing the problem. At the examination I will make sure you have a good understanding of any diagnosis, and that you are clear about which treatment options are available to you. I will also be very happy to answer any questions or concerns you may have.

Common problems and symptoms

Dysphagia is the technical term used to describe problems with swallowing. Having trouble swallowing can be very distressing, often causing us to feel anxious about eating and drinking. There may be accompanying pain or discomfort.

There are many different things which can affect our ability to swallow, and these might be linked to our mouth, throat or oesophagus (the tube which carries food from our mouth to our stomach). Injury or illness elsewhere in our body, such as our nervous system or stomach, can sometimes have a knock-on effect on our ability to swallow.

Tonsillitis is a common illness for children but can also be caught at any age. This is where the tonsils at the back of our throat become red and swollen. We might have a sore throat and find it hard to swallow, with cold or flu-like symptoms such as coughing, a hoarse voice, headache and a high temperature. We may also feel lumps or become aware of pain in our neck caused by swollen glands. These symptoms can be painful and exhausting, keeping us bed-bound and low on energy. Tonsillitis normally clears up after 3 to 4 days, but if you continue to experience these symptoms there may be complications requiring treatment.

Symptoms which affect our nose and nasal passage are many and varied and can include having a blocked nose, a runny nose, sneezing, irritation or discomfort around the nose, nosebleeds and having a reduced sense of smell. These can be as a result of any number of nasal and sinus disorders from allergic reactions, rhinitis and sinusitis through to nasal or sinus cancer.

Assessment

There are all sorts of symptoms associated with throat and nose problems. To make things slightly more complicated, many of these problems have similar symptoms. This makes it important to have things properly assessed so that you can be sure you're getting the most effective treatment.  

At your consultation we will start by talking about the history of your symptoms and when you first started noticing any problems. There are a variety of tests I can carry out to help assess things.

Some conditions will be more straightforward to diagnose, often only needing a physical examination. Other conditions may need additional scans or tests carried out to confirm a diagnosis.

Once we've established the cause of your symptoms, I will be able to talk you through the various available treatment options and together we can decide upon the best course of action. I will always make sure you have the information you need to make an informed decision about treatment.

As a dedicated ENT doctor, I have spent years helping people achieve a better quality of life by providing treatment for the range of illnesses and injuries that can hold us back. If you are experiencing any problems or symptoms in or around your ear, nose or throat, often the best thing is to come in for a proper examination.

Our thyroid gland is located below our voice box (where the “Adam's apple” is on some people). It creates the hormones which tell our body how to behave, making sure that our cells and tissues work properly.

If we have a problem with our thyroid, in some cases we might need surgery to have it taken out. This type of surgery is called a thyroidectomy. There are a number of different conditions which might require us to have a thyroidectomy.

Thyroid problems

Sometimes our thyroid might produce too many hormones (hyperthyroidism). If our thyroid gland is producing too many hormones, we say it is “overactive.” This can lead to symptoms such as anxiety, mood swings, trouble sleeping, sensitivity to heat, swelling in our neck, heart palpitations, trembling, weight loss or feeling perpetually tired.

On the other hand, our thyroid might not produce enough hormones (hypothyroidism). If our thyroid isn't producing enough hormones, we say it is “underactive.” This can lead to feelings of tiredness, depression and sensitivity to the cold, as well as muscle aches and weight gain.

Both overactive and underactive thyroid conditions can be hard to identify, as the symptoms come and go and are not always obvious. They can affect anyone, though they are more likely to affect women than men. If our thyroid isn't working properly it can shape how we feel emotionally as well as physically. It may impact upon our energy and our ability to engage with different activities, making day to day life feel that much harder.

Our thyroid gland can become swollen in way that makes it difficult or painful for us to swallow and to breathe. This can be as a result of a non-cancerous thyroid enlargement known as “goitre.” Goitre is often caused by an iodine-deficient diet but can also be caused by an overactive thyroid where there is too much iodine in the body.

If we are experiencing thyroid problems such as goitre, hypothyroidism or hyperthyroidism, especially if the problems are recurring or particularly severe, a thyroidectomy might be the best solution. Some of symptoms mentioned above can indicate the presence of thyroid cancer, which would also require a thyroidectomy.

If you have any of these symptoms, the best thing is to come in for an assessment where my team and I can get a clear overview of what is going on and advise you on the best course of treatment.

Thyroidectomy

As part of your assessment, I will find out about your medical history and look at any possible causes for the symptoms you are feeling. I may carry out tests such as a nasendoscopy to get a clearer picture of what is going on. A nasendoscopy is where I examine your vocal cords using a very small camera which is passed through your nose, enabling me to look inside your throat.

I will usually advise you to have a thyroidectomy if I find that cancer is present, or if I suspect that it might be given your symptoms. I may also recommend surgery if your thyroid is swollen to such an extent that it is affecting your ability to breathe or to swallow, or if another thyroid condition is having a severe impact upon your day to day life.

If you have a thyroidectomy, it will mean staying in hospital overnight. You will be given a general anaesthetic before the surgery and when you wake up you might need to have a drainage tube attached to you to take away any extra fluid. You will have a scar on your neck and sometimes there can be bruising, although this will usually fade after a couple of weeks. Your voice might feel weak following surgery, and it can time for you to recover full strength. Very rarely, your voice will be permanently affected.  It is also normal to have a stiff neck and a sore throat afterwards; these are all normal and nothing to worry about.  I audit my surgical outcomes in line with the British Association of Endocrine and Thyroid Surgeons (BAETS) database.  My outcomes are easily accessed on this forum.

Moving forward

At Circle, our Ear, Nose and Throat (ENT) Unit specialises in giving an accurate diagnosis for any medical conditions relating to the ear, throat and nose, followed by the appropriate non-surgical or surgical treatment. I work as part of a wider team of experts, each with our own sub-speciality, and together we will identify and treat whatever problems you may be having, making sure that you get the best possible treatment and the highest quality of care.

As a dedicated throat and nose doctor, I have spent years helping people achieve a better quality of life by providing treatment for the range of illnesses and injuries that can hold us back. If you are worried you may have a problem with your thyroid, a consultation with me will help to confirm what exactly is going on.

Our tonsils are found at the back of our throat. Similar to lymph nodes, they are made of soft tissue and form an important part of our immune system. Tonsils contain a lot of white blood cells, which help us to fight germs. Our tonsils can also help to stop germs entering the body through our mouth or nose because of where they are positioned.

As we grow up, it can be quite common to have throat or tonsil infections. An infection of the tonsils is called tonsillitis. As we get older these infections become and less and less likely, especially from the age of about 20 upwards.

Symptoms of tonsillitis

Tonsillitis can feel the same as having a bad cold or the flu, with symptoms such as:

• headache,
• earache,
• coughing,
• high temperature,
• feeling wiped out,
• sore throat,
• difficulty swallowing.

One obvious sign of having tonsillitis is that our tonsils (which we can see at the back of our throat when we open our mouth wide) become swollen and turn red. In more severe cases the glands in our neck can swell up, making us feel that we have lumps in our neck, and we might notice white, pus-filled spots on our tonsils.

Treatment

The infection itself is not contagious, but it is caused by other illnesses such as colds and flu which are very easy to spread. If we are ill with tonsillitis, it is important to stay at home and get plenty of rest. We should use tissues whenever we cough or sneeze, making sure to throw them away afterwards. Cool drinks can often help to soothe the back of our throat, and a pharmacist may be able to supply treatments such as lozenges, throat sprays and antiseptic that help to relieve the discomfort and pain.

Tonsillitis usually clears up on its own after three to four days, but while we are ill it can feel very draining. Our throat and mouth can become very painful and uncomfortable, and we might get aches and pains elsewhere in our body too. It can affect our ability to go in to work, school or university, and can impact other areas of our life including our sleep.

If tonsillitis occurs regularly, or if the symptoms are particularly serious, an operation to remove the tonsils (tonsillectomy)may be helpful.

I would only recommend a tonsillectomy when any other treatments have failed or when the tonsillitis keeps occurring. However, a tonsillectomy is a very safe procedure, and my team and I have performed hundreds of successful operations over the years. We will make sure that you are given the very highest quality of comfort and care for the whole time you are with us.

Tonsillectomy and recovery

A tonsillectomy is performed under general anaesthetic, meaning you will be asleep. Because the tonsils are usually accessed through your mouth, there will not be any visible scars or marks. The procedure can vary depending on how old you are. The tonsils are removed and the blood vessels are sealed, and this can take up to an hour in total. At Circle we use cutting edge technology to make the procedure as safe, as painless and as quick as possible.

Normally you will be able to return home on the same day as the procedure, but you will need someone to give you a lift as it is not safe to drive after you've had a general anaesthetic.

I always tell people that it may take a couple of weeks for any throat pain to subside. Swallowing can be especially tricky, but it is really important that you persevere with eating and drinking as this will help your recovery. Avoid drinking fizzy, acidic or alcoholic drinks, as these can interfere with the healing process.

Moving forward

At Circle, our Ear, Nose and Throat (ENT) Unit specialises in giving an accurate diagnosis for any medical conditions relating to the ear, throat and nose, followed by the appropriate non-surgical or surgical treatment. I work as part of a wider team of experts, each with our own sub-speciality, and together we will identify and treat whatever problems you may be having, making sure that you get the best possible treatment and the highest quality of care.

As a dedicated throat and nose doctor, I have spent years helping people achieve a better quality of life by providing treatment for the range of illnesses and injuries that can hold us back. If you are experiencing any of the symptoms of tonsillitis, I will be delighted to set you on the path to full recovery.