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It is considered by many to be one of the greatest distinctions a UK ENT surgeon can achieve, and this year Professor Peter Rea achieved it, being elected President of the Royal Society of Medicine Section of Otology for 2023-24. Here, Prof Rea talks about his career, the founding of the Leicester Balance Centre and why Â鶹´«Ã½ is uniquely placed to help strengthen the future of balance medicine.

On a quiet weekday afternoon, in a clinic in Leicester, Professor Peter Rea is about to perform a treatment that patients often consider a miracle.

He is treating a woman who, for several years, had suffered dizziness whenever she laid down in bed or looked up. It had made her life, at times, unbearable.

Prof Rea asks the woman to lie down, before turning her head one way, waiting 30 seconds, turning it the other, and then once more so she is facing down. He then helps her to sit up. She sits up.

She is cured.

This kind of manoeuvre is repeated at the London Road Clinic time and time again for patients with the commonest type of episodic vertigo: BPPV, a condition affecting about 1 in 40 people at some stage of their lives. “80% of our patients are immediately cured of their current bout of vertigo” Prof. Rea says. “And they are bemused that such a simple procedure can resolve such unpleasant symptoms. It can seem miraculous.”

Standing on two legs makes human beings innately unstable. To get up from your chair to walk to the kitchen, you rely on a complex set of subconscious reflexes between your eyes, ears, joints and muscles, and brain to remain upright and to maintain balance. And it is studying balance and the ear that Professor Peter Rea has dedicated most of his professional life to.

It is this dedication which has earned him one of the most distinguished titles in his speciality: President of the Section of Otology of The Royal Society of Medicine. His presidency is within the specific field of otology, the study and treatment of the ear and its diseases, such as hearing loss, tinnitus, vertigo and dizziness.

“For an otologist, to be elected president of your section is the pinnacle of your career,” Prof. Rea said. “From the time that you are a trainee, the Royal Society of Medicine is the place you go to in order to meet the great and the good in your profession. It allows interaction with the best teachers, and particularly for young doctors, it’s a vital networking opportunity where career and research ideas can be exchanged. Ultimately the aim is always to progress our understanding of medicine to benefit our patients. Balance disorders, he explains, can have a devastating impact on a person’s life. “

“Many people lose their jobs, become depressed,” he said. “Sometimes a person suffering from damage to the balance organs in the inner ear might start using other systems, such as vision, to try and overcome their imbalance. But this means they may struggle in complex visual environments such as supermarkets or find car journeys unbearable.

“Some of our patients become housebound, they lose muscle conditioning, and enter a downwards spiral. The longer the wait for treatment, the worse the prognosis can be.”

Prof. Rea began his medical training in 1985 at the University of Cambridge, graduating with first-class honours in 1988. He had always been interested in the world that exists under the microscope – and with the brain. At Cambridge he studied under Roger Lemon, noted Professor of Neurophysiology, with whom he had an emotional reunion when Prof. Rea gave his Presidential Address last year, 35 years after they had last seen each other.

After Cambridge, Prof. Rea studied at The University of Oxford, and it was early in his time there that he decided that he wanted to specialise in ear, nose and throat surgery (ENT). “I was based at the Radcliffe Infirmary and there was a consultant who shared his experiences of ENT surgery. Inspirational teachers are so important in all of our careers, whatever path we take in life, and I felt so fortunate to have learnt from great names in two of the world’s greatest Universities.”

“Otology and ENT surgery combined neurological and research opportunities that I found very interesting, with the surgical possibilities of ENT. Neuro-otology was the natural choice for me.”

 Upon completing his specialist training, he obtained the coveted Royal Society of Medicine Gold Medal. Junior training in Bath and Bristol followed, and then an ENT training program on the North Thames Training Programme in London. After a year spent in Sydney performing cochlear implants, he was approached to take on similar surgery at consultant level by several institutions in London when he was contacted by the Leicester Royal Infirmary with an offer to take up a position at the Leicester Balance Centre.  “I saw a life and career outside London, in a centre of excellence, which appealed to me.”

The centre had been conceived by Jim Cook, consultant ENT surgeon, after he attended a conference in San Diego, where he learned of exercises given to astronauts who had severe dizziness on returning to Earth. It was opened in 1999, supported by Leicester City and Leicester Tigers.

The opportunity to practice at such a famous balance unit was one that Prof Rea was delighted to accept. Within a year of arriving in Leicester however, Jim Cook died. “Suddenly, as a very young consultant, I had one of the country's most famous balance centres on my hands. The genius of Jim Cook was to create a named centre. It was a great honour to be asked to take the service forward. Within a few years, my colleagues and I had increased the number of appointments from 2,500 to 7,000 per year and we have subsequently been joined by a number of outstanding individuals to further expand the service we can offer our patients.”

The critical part of the success, in Prof. Rea’s opinion, has been the relationships he has built between the Balance Centre and Â鶹´«Ã½ and the University of Leicester. “This really accelerated our status. At the Infirmary we have the Balance Centre with our wonderful patient population. At The University of Leicester, we have world leading research scientists led by Dr Qadeer Arshad. And at Â鶹´«Ã½ we have the finest equipment in the country on which students can learn, a centre developed by the tireless efforts of Professor Rakesh Patel (Associate Head of School and Associate Professor in Audiology).”

In the past decade, Â鶹´«Ã½ has established itself as a leading centre for the training of audiologists, hosting state-of-art teaching equipment such as the Bertec Computerised Dynamic Posturography (CDP) and the TRV Chair. Several graduates have gone on to work in Prof. Rea’s team, and the university is now attracting PhD students. “Doctors and audiologists have to fight for their own departments, developing their staff and their networks. Â鶹´«Ã½ has gone from being a very small training centre to being nationally recognised as a centre of excellence for both the training of undergraduates and postgraduates. A lot of credit must go to Rakesh. He’s turned Â鶹´«Ã½ into a gold standard training centre.”

Building on its reputation for its great equipment, for several years, Â鶹´«Ã½ has hosted the Leicester Balance Course, a three-day intensive course which brings together ENT clinicians and other medical professionals from around the world to learn the latest developments and techniques in the treatment of a range of conditions including Benign Paroxysmal Positional Vertigo (BPPV), Menieres Disease, vestibular neuritis, and a whole host of other conditions causing verigo and balance problems.

Being entrepreneurial is an important aspect of building a successful department.  “In the internet era, if you are a successful department with a successful lead, people will find you, patients and doctors alike” Prof. Rea explains. “The population is getting older. Under the age of 65, 30 per cent of the population will see their GP at some stage with dizziness. Over 75 it’s the commonest reason to see a GP. Up to 5% of the population experiences dizziness in any one year. There is a massive demand out there. Pulling that expertise together under a banner (The Leicester Balance Centre) helps focus attention which might otherwise be diluted by a GP simply referring a patient to a generalist.”

Access to care, Prof. Rea highlights, is vital. Some conditions which have plagued people for years can be solved with relative ease. Across the country, balance and dizziness services vary from region to region. So popular is the Leicester Balance Centre that it is unable to see people from outside Leicestershire. “There is a bit of a postcode lottery. Ten to 15 years ago there was an effort to advocate for a Balance Centre in every region, but this hasn’t happened as widely as we had hoped.” With many balance disorders in effect being hidden illnesses, it can often be difficult for patients to express what the problem is, and for their GP to refer appropriately.

There is, however, good reason to feel positive about the future. Like many branches of medicine, diagnosis and treatment have the potential to be aided by the introduction of artificial intelligence (AI). Working with the University of Leicester and IBM, Professor Rea jointly led an attempt to develop an AI enabled balance diagnostic tool – BalanceAid. This never reached commercial development but was a great learning experience for all involved (Prof Rea quotes Einstein here: Failure is success in progress). Prof Rea is also co-applicant on a large and successful NIHR grant to develop the CAVA, a head worn diagnostic device which records muscle movements and electrical activity around the eye over a whole month in each patient. This data is run through newly developed algorithms, and is showing fascinating insights in our patients experiences and it is hoped will improve outcomes in hard to diagnose cases of vertigo.  

More broadly, Prof. Rea is ambitious when he speaks of the future of the field. “I think recognising the importance and impact of dizziness and imbalance on patients' lives, the risk to them of falling, of losing employment, means we really need to develop expertise around the country. Getting Balance Centres in place in every region, building the infrastructure needed to treat people effectively with the appropriate equipment and the appropriate staff and taking these conditions seriously. Our patients deserve nothing less.”