I reviewed the third edition of this book in 2011 and the fifth as recently as 2018.^{Reference Flood1} On both occasions, I commented on the amusing preface by the senior author and this one is the best yet. I cannot improve on his description of the novelties in this update. ‘Ok, this version is a complete revamp letter to letter. New are more pics and flow charts for those who chose comics over prose as a kid’. Sure enough, this is highly topical, with its description of the current pandemic (which will just be a bad memory by the time you read this, I really, truly, believe), or the reassurance it gives me that, according to the recent changes in the American Joint Committee on Cancer (‘AJCC’) Staging Handbook, a p16 positive oropharyngeal cancer that was classified as T₁N_2b is now ‘only’ T₁N₁ (fine by me, downstage away!).

The format will be very familiar to generations of former trainees, but it is still of great value to the more experienced, simply for ‘dipping in’ and acquiring knowledge randomly. I now know my male pattern baldness is only type IV of a range of I–VII. I am assured that future otologists will suffer less neck and backache as they work through an ‘exoscope’ and not a direct vision microscope. I think of all the informed consent forms I completed for parotid surgery, when I had never even heard of ‘first bite syndrome’. I knew that there was a series of targeted chemotherapeutic agents with unpronounceable names ending in ‘–mab’ or ‘–nib’, but thought that everything which preceded the suffix was meaningless and just a series of syllables drawn from a hat (read pages 264–6). Who knew that restless legs syndrome had anything to do with iron deficiency in the brain? Indeed, it is apparent how much the whole subject of sleep medicine has become a mainstream ENT subspecialty.

The book closes with a very nicely reproduced series of well labelled scans, mostly of normal anatomy. There is also the Plural Plus website with a digital bank of questions and model answers. The book remains an invaluable quick reference on any ENT topic, great for last-minute revision at the station or departure lounge before the end of training examination, but also a highly entertaining read for the most senior. The ‘KITTENS’ acronym (which stands for congenital (K), infectious and idiopathic, toxins and trauma, tumour, endocrine, neurological, and systemic) for causes of airway obstruction, ‘CHAOS’ (congenital high airway obstruction syndrome) needing an ‘EXIT’ (ex utero intrapartum treatment) procedure, or ‘Sonic the Hedgehog’ signalling will all make more sense after reading this.

I have to like an author who has spent the pandemic making model airplanes (we must swap notes), and I will watch out for him next time my two sons (regularly) force me to stay up all night watching Ultimate Fighting Championship fights from Vegas. As two individuals can kick each other so hard as to memorably break their own legs (indeed, on two occasions!), he may well be ringside I gather.