Prof. Adrian Agius

(1) Agius AM, Cacciottolo JM. Marathon Problems. Medi-scope 1987; 11,6.

(2) Agius AM, Grixti CJ, Cacciottolo JM. The medical experiences of the Malta Marathon 1988. Medi-scope 1989;13,15-21.

(3) Agius AM, Cutajar CL. Hyponatraemia following transurethral resection of the prostate. Journal of the Royal College of Surgeons of Edinburgh 1991; 36, 109-112.

(4) Agius AM, Pickles JM, Burch KL. A Prospective Study of Otitis Externa. Clin. Otolaryngol. 1992, 17, 150-154.

(5) Agius AM, Reid AP, Hamilton C. Compliance with Short Term Topical Aural Antibiotic Therapy.  Clin. Otolaryngol. 1994, 19, 138 - 141.

(6) Agius AM, Wake M, Pahor AL, Smallman LA. Surface morphology of middle ear epithelium in chronic ear disease. J. Laryngol. Otol.  1994, 108, 1024 - 1030.

(7) Agius AM, Wake M, Pahor AL, Smallman LA. Smoking and middle ear ciliary beat frequency in otitis media with effusion Acta Otolaryngologica(Stockholm). 1995, 115, 44-49.

(8) Agius AM, Wake M, Pahor AL, Smallman LA.. The effects of in vitro cotinine on nasal ciliary beat frequency Clin. Otolaryngol. 1995, 20, 465- 469.

(9) Agius, AM, Wake, M, Pahor, AL, Smallman, LA. Nasal  and middle ear ciliary beat frequency in chronic suppurative otitis media Clin. Otolaryngol. 1995, 20, 470- 474.  

(10) Agius AM, Smallman LA, Pahor AL. Age, smoking and nasal ciliary beat frequency Clinical Otolaryngol. 1998, 23, 227-230

(11) Agius AM. Ramsay Hunt Syndrome and Cranial Polyneuropathy-It-tabib tal-familja (16) June 1999, 13-15

(12) Agius AM, Cordina M, Calleja N. The role of atopy in Maltese patients with chronic rhinitis Clinical Otolaryngology 2004   29(3), 247-253

 (13) Agius AM. Long-term followup of patients with facial pain in chronic rhinosinusitis-correlation with nasal endoscopy and CT. Rhinology 2010 48 (1), 65-70

 (14) Agius AM. Chronic sinusitis in Malta-correlation between symptoms and CT scan Rhinology 2010 48 (1), 59-64

(15) Agius AM, Jones NS, Muscat R. A randomized controlled trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and placebo in the treatment of chronic tension-type facial pain Rhinology 2013; 51, 143-153

(16) Agius AM, Muscat R, Jones NS. Serial blood serotonin levels in a randomized controlled trial comparing the efficacy of low-dose amitriptyline, amitriptyline with pindolol and placebo in patients with chronic tension-type facial pain. Rhinology 2013; 51:236-242

(17) Agius AM, Jones NS, Muscat R. Three year follow-up of a cohort of 240 patients with chronic tension-type facial pain.  J Laryngol Otol 2014; 128 (6): 518-526

(18) Agius AM, Jones NS, Muscat R. Is ‘sinus’ pain really sinusitis? Br J Hosp Med 2014; 75 (10): 696-701

(19) Agius AM, Sama A. Rhinogenic and nonrhinogenic headaches. Curr Opin Otolaryngol Head Neck Surg 2015, 23: 15-20

(20) European consensus-based (S2k) Guideline on the Management of Herpes Zoster-guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 1: Diagnosis.  Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Opaeracz M, Agius AM et al. , Eur Acad Dermatol Venereol. 2016 Nov 2. doi: 10.1111/jdv.13995.

(21) European consensus-based (S2k) Guideline on the Management of Herpes Zoster-guided by the European Dermatology Forum (EDF) in cooperation with the European Academy of Dermatology and Venereology (EADV), Part 2 Treatment. Werner RN, Nikkels AF, Marinovic B, Schafer M, Czarnecka-Opaeracz M, Agius AM et al. J Eur Acad Dermatol Venereol. 2016 Aug 31. doi: 10.1111/jdv.13957

(22) Agius TM, Agius AM. Dizziness in the Maltese Community Setting: the implications of good history taking. The Synapse 2017; 16, 7-9

(23) A multidisciplinary European guideline for tinnitus: diagnostics, assessment, and treatment https://link.springer.com/article/10.1007/s00106-019-0633-7

(24) Agius AM, Muscat R. Chronic tension-type facial pain-a pilot study on HTTLPR genetic polymorphisms. Rhinology Online 2019 Vol 2, 125-133

(25) European position paper on rhinosinusitis 2020, W J Fokkens  ¹ , V J Lund  ² , C Hopkins  ³ , P W Hellings  ^{1   4   5} , R Kern  ⁶ , S Reitsma  ¹ , S Toppila-Salmi  ⁷ , M Bernal-Sprekelsen  ⁸ , J Mullol, I Alobid  ⁹ , W Terezinha Anselmo-Lima  ¹⁰ , C Bachert  ^{5   11} , F Baroody  ¹² , C von Buchwald  ¹³ , A Cervin  ^{14   15} , N Cohen  ¹⁶ , J Constantinidis  ¹⁷ , L De Gabory  ¹⁸ , M Desrosiers  ¹⁹ , Z Diamant  ^{20   21   22} , R G Douglas  ²³ , P H Gevaert  ²⁴ , A Hafner  ²⁵ , R J Harvey  ²⁶ , G F Joos  ²⁷ , L Kalogjera  ^{28   29} , A Knill  ³⁰ , J H Kocks  ³¹ , B N Landis  ³² , J Limpens  ³³ , S Lebeer  ³⁴ , O Lourenco  ³⁵ , C Meco  ^{36   37} , P M Matricardi  ³⁸ , L O'Mahony  ³⁹ , C M Philpott  ^{40   41} , D Ryan  ^{42   43} , R Schlosser  ⁴⁴ , B Senior  ⁴⁵ , T L Smith  ⁴⁶ , T Teeling  ⁴⁷ , P V Tomazic  ⁴⁸ , D Y Wang  ⁴⁹ , D Wang  ^{50   51} , L Zhang  ⁵² , A M Agius  ⁵³ , et al

Cosmetic Surgery

ENT surgeons (or Otolaryngologists) have long been involved in facial cosmetic surgery. The nose is a central feature of the face and its modification is known as rhinoplasty.  Pinnaplasty  or correction of prominent ears has also featured high on the ENT surgeon’s list of cosmetic procedures. Blepharoplasty, or the correction of drooping or excessive skin above the eyes or removal of the bags beneath lower eyelids to remove that ‘tired’ look also forms part of facial rejuvenation as do the injection of fillers or botox to smooth out facial wrinkes.

Patients usually come for advice about facial cosmetic surgery after several years of soul searching. They just do not like the person in the mirror. Many would have kept their feelings hidden from their family members and often feel self conscious and over-sensitive about comments directed at their appearance. They often feel guilty because they cannot be happy with themselves and at the same time feel that others consider their desire for cosmetic change as frivolous and low down in the priorities of family life. Indeed, other family members who take for granted the patient’s appearance often show surprise or lack of understanding to this individual since they have accepted that person as he/she was and expect him/her to continue being exactly the same person.

The consultation

A frank discussion with the surgeon should take place where there is good communication and where the patient is as clear as possible on what is bothering him/her. Most individuals would be happy with removing or improving most of the features that are bothering them but surgeons are very wary of those with excessive demands who can never be satisfied. A ‘natural’ look is very important in Southern Europe and people do now want to look ‘operated’.

ENT surgery does not only mean operating. Many ENT ailments are ‘medical’ in the sense that their treatment is by medication, for example allergy, or the treatment of throat or ear infections. Voice conditions often require speech therapy, and throat problems are often related to stomach acid. Under the following headings I will attempt a brief description of the wide variety of common ENT conditions, with some practical hints.

Earache

Earache can occur in a variety of conditions. One immediately thinks of ear infections in sudden earache. Otitis media (middle ear infections-see below) in young children and external infections (see below otitis externa) in adults are very common. The proximity of the ear to the jaw joint means that spasm of the muscles of the jaw, problems with jaw closure due to uneven bite, teeth grinding during sleep or just stress may cause temporomandibular joint dysfunction and pain in the ears. Earache can be referred from the throat in tonsillitis or even from the voice box (growths of the larynx), cervical spine (arthritis of the neck or neck muscle spasm).

Ear wax

This apparently trivial condition can in fact be quite a nuisance. Impacted ear wax may cause earache, unsteadiness, deafness and noises in the ear (tinnitus). Getting water in the ears may make the symptoms worse. The best way of removing wax is by microsuction, which is like vacuum cleaning on a small scale with the surgeon using a microscope to visualize the ear better. It should be painless, and the relief instant.

Using earbuds in those individuals with narrow ear canals may increase wax impaction. Similarly, those suffering from ear canal eczema or psoriasis (skin conditions with flakes in the ear) may have increased wax accumulation and may require more frequent cleaning.

ENT Surgery (Otolaryngology)

ENT stands for ear, nose and throat. ENT surgery is not only about recognizing disease and operating. ENT surgeons spend a large proportion of their time managing a host of medical conditions that also make up ENT practice, like allergy. Nasal allergy occurs in approximately 20% of European populations. Ear infections are mostly treated medically, as are throat and sinus infections. Voice conditions also make up a substantial part of the ENT surgeon’s time-these require special equipment like flexible telescopes to visualize the voice box properly. Vocal conditions do not always need surgery and need the services of a competent speech and language pathologist (speech therapist) for vocal conditions which are mainly functional in nature.

Mr. Adrian Agius graduated MD from the University of Malta in 1987 and carried out his postgraduate training in Otolaryngology in the United Kingdom, where he obtained his FRCS (Ed) in 1992. He is registered with the General Medical Council of the United Kingdom.