This page explains what a vestibular schwannoma (VS) is and what it might mean for you. Your doctors and nurses can tell you more and answer your questions. At the end, there is information about groups that can help.

What is a VS?

A vestibular schwannoma, also called an acoustic neuroma, is a non-cancerous tumour. It grows on the balance nerve that
connects the inner ear to the brain. This nerve sits very close to the hearing nerve and to the facial nerve, which helps you move your face.
Because the tumour is benign, it does not spread to other parts of your brain or body.

What causes a VS?

The tumour starts in Schwann cells, which are cells that cover nerves and help them send messages. Most of the time, doctors do not know why the tumour appears. A very small number of people with a rare condition called NF2 can get tumours on both sides of the head.

Symptoms

A VS usually grows very slowly, so symptoms may take months or years to appear. Some people do not notice any symptoms at first.
As the tumour grows, it may press on nerves nearby. This can cause hearing loss, ringing in the ear, dizziness, or balance problems. If it grows more, it may cause numbness in the face, weakness in the face, pain around the ear, or trouble walking steadily.

Very large tumours can block the normal flow of fluid around the brain and cause something called hydrocephalus. This can lead to strong headaches, sickness, vision problems, nausea, memory troubles, wobbliness, or feeling extremely sleepy.

If you suddenly lose hearing in one ear or suddenly notice weakness on one side of your face, you should get urgent medical help from your doctor or go to an Emergency Department. Steroid medicine may help if it is given quickly.

Diagnosis and tests

A VS is sometimes first noticed after an unusual hearing test result. You may have more hearing tests to check how well you hear sounds and speech. Sometimes, a VS is found on a scan performed for a different reason altogether. 

Most VS tumours are found using an MRI scan. This scan is safe and does not hurt. If someone finds small spaces uncomfortable, they may have be offered a mild sedative. 

Some people cannot have an MRI because of metal in their body, such as a pacemaker. In that case, a CT scan can be used to make the diagnosis.

The care team (MDT)

Treatment options

Hearing loss

Tinnitus

Dizziness

Sudden changes

Driving

Follow-up and recovery

Further support

Date published: 30 June 2026 Review due: 30 June 2029 PI number: BFT003103

Introduction  

This information aims to answer some of the questions you may have about leech therapy. It explains the benefits, risks and alternatives of the procedure, as well as what to expect.  

If you have any questions or concerns, please do not hesitate to speak to one of the team caring for you.  

What are leeches and why are they used?  

Medicinal leeches are worms that suck and feed on blood. Their scientific name is Hirudo medicinalis and Hirudo verbana.  

They have been used in medicine since the dawn of civilization, and recently there has been an increase in using leeches in reconstructive surgery.  

Leeches help to improve blood circulation in congested flaps or other tissue (such as an amputated finger that has been re-attached).  

How do they work?  

They latch to the skin with their tiny sharp teeth and their saliva contains a number of chemicals to aid them to suck and feed on blood. These chemicals include a local anaesthetic (to reduce pain) and blood thinners.  

Am I going to feel pain?  

Leech bites are typically painless because they have a  local anaesthetic in their saliva.  

What are the benefits of leeches?  

In some cases where blood is congested and needs to be released release, leech therapy can help. 

Leeches can suck a large amount of blood relative to their body. Each leech can suck between 5 - 15 millilitres of blood in one feed. The bite mark can still bleed a little for up to 72 hours after the leech has detached, due to the blood thinners in the leech’s saliva which act only locally (on this area). This often resolves the problem with the circulation.  

Why was I chosen to be offered leech therapy?  

You have been offered leech therapy because we believe it would be the best treatment for your congested flap or other tissue.  

If there is not enough outflow of blood in this area and it is left untreated, it may lead to the flap or other tissue dying.  

What are the side effects and risks of leeches?  

• Leech therapy is often associated with bleeding and commonly transfusion of blood / blood products during or after treatment. We will do blood tests every day to see if you need a blood transfusion. Leech therapy will not be started unless you are comfortable with the possibility of blood transfusion. If you cannot or would not like to have blood transfusion, leech therapy will not be started.  
• Leeches contain bacteria that sometimes cause infection. You will be started on an oral antibiotic to prevent this. The leech site will be monitored daily by the nurses and doctors. If you are allergic to any of the antibiotics started, please tell your medical team and you will be offered an alternative antibiotic. 
• Rarely, people may develop an allergic reaction to leeches. Leeches will not be used on you if you have any history of allergic reactions to them.  
• Leech therapy may not be suitable if you have an immunodeficiency, bleeding disorders, heart problems, unless you and your consultant decide the benefits of using leeches outweighs the risks.  
• eeches can sometimes migrate into dressings. Nurses will be closely looking after your leeches when they are used.  
• It has been reported that some patients may have some psychological difficulties in dealing with leeches. If that is the case, our psychologists will be happy to offer their advice and help.  
• Leeches in our department are never used between patients and are disposed of humanely and safely. Transmission of blood borne diseases is not a risk.  

Is there an alternative?  

Usually, if your doctor has decided to use leech therapy, it means it is the last resort to save your congested flap. If you choose to do nothing, blood may clot and prevent blood flow to the flap. This may lead to some or all the tissue dying and the flap will need to be removed.  

How do I give my consent?  

If you agree to go ahead with leech therapy, you will be asked to sign a consent form.  

What happens next? 

• The nurse will clean the area and apply the leech. Sometimes the nurse will scratch the area to allow the leech to latch on.  
• We will closely monitor the leeches and the area to check its response to treatment. The number of leeches used and how often we use them depends on the response. 
• You will have daily blood tests. 
• After each feed, leeches are disposed of safely and according to trust policy.   

What do I need to do?  

You will be asked to stay in a position that allows the leech therapy to work.  

You will be asked to avoid eating or drinking any caffeine- containing food or drinks (such as tea; coffee or cola) and to avoid the use of nicotine-containing products (such as cigarettes or nicotine replacement therapy), during your hospital stay. 

What do I need to be aware of after the leech therapy finishes?  

There are no specific aftercare instructions. However, if you feel unwell (for example, if you have a fever, increased redness, or pain in the area) please let the team caring for you know.  

Contact us  

If you have any questions or concerns about leech therapy, please talk to your clinical team, including your plastic surgeon, plastic clinical nurse specialist, nursing team or pharmacy staff.  

You can also speak to the ward sister or nurse in charge of Ward 33A on 0117 414 3100.  

Feedback 

If you would like to give us any feedback on your care or treatment please see this page Feedback | North Bristol NHS Trust 

Further information 

• For online information about health visit nhs.uk 
• NHS 111 offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. 
• References available on request. 

© North Bristol NHS Trust. This edition published June 2026. Review due June 2029. NBT002763  

Azithromycin prophylaxis

Azithromycin is an antibiotic. It can be used for a few days to treat certain infections. 

Azithromycin can also be used for a long period (months) to help protect people with some types of lung disease. This leaflet is about long term use of azithromycin for people with lung disease. This is called azithromycin prophylaxis.

Why have I been prescribed long-term azithromycin (azithromycin prophylaxis)?

You have been prescribed long term azithromycin to prevent chest infections and to improve your chest symptoms. 

Azithromycin does not work for everyone with lung disease but it may help you in two ways:

1. it is an antibiotic and can kill some of the bugs (bacteria) that could cause chest infections
2. it can reduce inflammation in the airways so it can help to relieve cough, sputum production, and breathlessness

Azithromycin used in this way, is “off-label” and is different to what described in the patient information leaflet that comes with the medication. Using it like this is endorsed by the British Thoracic Society. It is important to take the medication as your Respiratory Consultant has advised.

What do I need to know before I take azithromycin?

Do not take this medication if you are allergic to azithromycin, any of its ingredients, or any other macraolide antibiotic such as erythromycin or clarithromycin.

To make sure azithromycin is the best choice for you your consultant/respiratory nurse specialist will:

1. ask you to provide phlegm samples, to check for non tuberculosis mycobacterium. If this bacteria is present, azithromycin cannot be used
2. check your heart’s rhythm using an electrocardiogram (ECG); this is also known as a heart tracing
3. take some blood tests and check your liver function before and one month after starting azithromycin

Azithromycin will not work if you are a current smoker. You should have stopped smoking completely before we prescribe it. Azithromycin can also make you more prone to sunburn and we recommend using sun block on hot sunny days or when on holiday. Speak to your doctor or pharmacist to see how we can support you to stop smoking.

How long will I be on this medicine? 

Usually for 6 to 12 months. This gives enough time for you and your doctor to see if it works for you. If you get less chest infections or have less cough, sputum production, and breathlessness then it may be useful to stay on it for longer.

What are the common and important side effects? 

Most people have no troublesome side effects.

• Some people have tummy upset, feeling sick (nausea), getting sick (vomiting). 
• Some people get light headedness, dizziness, or fast heart rate (palpitations) and may need to get their ECG (heart tracing) checked. 
•  A small number of people get jaundice (yellow colour of the skin or whites of your eyes) or itching because of liver upset. 
• A very small number of people get hearing problems (ringing in the ears or poor hearing). If you notice a change in your hearing, it is important you stop the medication and seek medical advice 
• A very small number of people get poor balance (unsteady on their feet). 
• Some people get diarrhoea caused by overgrowth of a bacteria known as C diff (Clostridioides difficile). 

If you think azithromycin is causing you troublesome side effects at any time you should talk to your doctor. You may need to stop taking it.

What dose do I take? 

The usual dose of azithromycin is 250mg tablets (one capsule) three times per week; normally taken on a Monday, Wednesday, and Friday. In certain situations, your doctor may prescribe you a higher dose of 500mg. Occasionally, it may be prescribed for you to take every day. 

Take your dose 1 hour before food or at least 2 hours after food. Swallow whole with a glass of water.

What if I forget to take my dose? 

This should not cause any problems. Take your next dose at the normal time.

Will azithromycin interfere with any other medicines that I am taking? 

• Azithromycin can interfere with many other medicines and herbal remedies. 
• Tell your doctor or pharmacist if you are taking any other medicines or herbal remedies before you start taking azithromycin. 
• Tell your doctor or pharmacist before you star t on any new medicines or herbal remedies while on azithromycin. 
• If you are prescribed another antibiotic, check with your doctor whether you should continue to take azithromycin.

What should I do if I have a flare-up of my lung condition? 

Although azithromycin is an antibiotic, you may still need to take other antibiotics for any chest infections or flare-ups of your lung condition. You may need to stop your azithromycin when starting a course of antibiotics and your team will advise you.

Can I drink alcohol when taking azithromycin? 

Yes, within the government guidance of no more than 14 units of alcohol per week. Azithromycin does not interact with alcohol. 

More information 

If you have any other questions, please speak to the doctor or nurse who prescribed you the azithromycin.

Date published: 31 May 2026 Review due: 31 May 2029 PI number: BFT003626

Access in AAC means the way a person makes their communication system work. Directly touching a screen with a finger is the easiest way to make a device work, but for people who are unable to do this there are different access methods that can be explored.

Direct touch access

Direct touch access means using your finger to select icons on a touchscreen device, such as a smartphone or tablet. This is a common AAC access method because it is the easiest way to make a selection. 

To make touch access easier, the device accessibility settings can be used. For example, press and holding for a set time to select, ignoring accidental touches or making the text bigger. 

Some AAC users use a keyguard, which is a thick plastic cover with holes that sits on the screen. Keyguards can help guide your finger to the right place and make it easier to select what you want without errors.

Partner assisted scanning (PAS)

Pointer control

Pointer control works like a computer mouse, where the cursor freely moves across the screen of a communication device using tools such as:

• joystick
• trackball 
• mouse
• trackpad
• head mouse (allows you to control the cursor by moving your head)

This access method allows AAC users to navigate a communication aid without needing to touch the screen directly. Pointer control tools come in a range of size, shapes and sensitivities, to suit different needs. 

Eye pointing

Eye gaze

Switch access

A switch is something you press, touch or move near to make an electronic device do something. For example, to turn on a light, control your TV or to access a communication aid. There are many different kinds of switches. They work in different ways, need different amounts of pressure and can be used by different parts of the body. The photo below shows a small selection of switches and examples of how people might use them. 

Photo description: 

1. Ping-pong switch: Only requires light action. Is water and moisture resistant. Ideal for use as a head switch. 
2. Buddy button with softy top – Durable and highly responsive switch. Gives auditory and tactile feedback with a click on activation. Using a softy top can reduce discomfort and improves tactile feedback.
3. Wobble switch – Sprung switch that activates with light touch in any direction. 
4. Finger mouse – Handheld mouse that can be used as a switch. Also used as a pointer for computer access. 
5. FingerButton switch – Highly responsive with small activation area and very little force required to activate. Can be wraped around a finger.
6. Pal pad switch – Ultra-sensitive and low-profile. Is durable and rigid. 
7. Puff switch – Can be used hands-free. Use a puff (breath) to activate. 
8. Pillow switch – Soft and smooth suitable for head or cheek activation.

To use a switch with a communication aid the switch can be used to move the highlight around the screen and then select what you want. To see how this works watch the video below. 

WAMS is a specialist service supporting people living with obesity who are motivated to explore behavioural, medical and/or surgical management of their weight.

We are a friendly team offering support and guidance to help you lose weight and improve your health and wellbeing. 

The team includes consultant endocrinologists (medical doctors), dietitians, psychologists, a pharmacist, and office staff. 

How does the service work?

WAMS is a 12 month service where you will be offered an assessment appointment followed by a support plan. This will be tailored to you. 
As you progress through the service, the team will discuss your care to find the best way to continue supporting you.

Our approach

We hope that you feel respected and valued during your time in our service. We are not here to shame or blame. Our approach is to view obesity as a complex, long-term health condition. 

Please be reassured that we would like to hear about what is actually happening in your life, rather than what you think we might want to hear. We are here to listen and help you to achieve the most positive outcomes that you can, and this is only really possible if you feel able to be open and honest about your situation.

What can you expect at your initial assessment?

At your first appointment you will speak with a consultant endocrinologist who will check for any medical causes for obesity and check other medical problems that may need treatment. You may be referred for further tests if considered necessary. These may include: blood tests, CT scans, camera investigations (endoscope). 

You will speak to a dietitian to understand your eating habits and explore your relationship with food, both now as well as in the past. We understand this can be difficult, but we encourage you to share what you can so that we can help you as best as possible. 

You may also see a psychologist who will ask about your wellbeing and help you to identify how your thoughts and feelings may be affecting your weight. They might make some suggestions to help you with your mood and work towards making changes.

What can you expect after your initial assessment?

After these first meetings, we will agree on a weight management plan for you. Sometimes we will need to signpost people onto other services before we can offer support. This is so that they are ready and able to work on their goals with our team. 

Most of our interventions are offered in an online group format, for example:

The Mood and Food programme

A blend of nutrition advice and support with the psychological aspects of eating – jointly run by dietitians and psychologists.

Our Coping with Emotion programme

A space in which to develop coping strategies for emotional eating behaviours – run by the psychology team.

Quotes from people who have attended sessions:

• “The group sessions I have attended have been excellent and very informative.”
• “Positive environment, non-judgemental, non-prescriptive. Lots of really useful advice and tips.”

There is the possibility of 1-1 sessions if the team feel that there are strong reasons for this. These may be online, via the phone, or in-person, depending on the situation.

Medical management of weight

Some people may be able to have medication to support weight loss. When available, this will be prescribed in line with local and National Institute for Health and Care Excellence (NICE) guidelines. 

People who are being prescribed medication for weight management by our team are able to receive this support for up to two years. 

Bariatric surgery (‘weight loss surgery’)

We work closely with members of the bariatric surgery service which is made up of surgeons, dietitians, psychologists and a nurse specialist.
Some people in the weight management service are interested in bariatric surgery, others are not, and some people are unable to have it for various reasons. 

It is normal for people to need support and preparation to make sure that they are ready for surgery. Our aim is to prepare people for the significant dietary and psychological changes which are required for surgery to be effective and safe.
Please note that completing your weight management plan in the WAMS service does not necessarily guarantee that you would be eligible for bariatric surgery. 

It is our policy that people who miss appointments without giving any notice, or cancel more than two consecutive appointments, may be discharged back to the care of their GP.

© North Bristol NHS Trust. This edition published May 2026. Review due May 2029. NBT002960.

This is a searchable database of information about tests offered by Severn Pathology. You can browse the index, enter a test name, part of a test name, abbreviation or clinical indication below.

Information available depends on the type of assay and department, but generally consists of alternative names, clinical indications, patient preparation (where appropriate), special precautions, department responsible for the test and reference ranges (where applicable).

The containers listed refer to those used to collect samples from adults locally in GP practices and hospital wards/outpatients. Details of the containers used for neonates, children and in the emergency zone (ED, AAU, ITU) can be found here Tube Guide and Recommended Order of Draw.

You may also find Lab Tests Online UK useful an additional resource for help you understand the many clinical laboratory tests that are used in diagnosis, monitoring and treatment of disease.

Medical Same Day Emergency Care (SDEC) 

Medical Same Day Emergency care (SDEC) is situated at Gate 36, Level 1, within the Emergency Zone, Brunel building.

The Same Day Emergency Care Unit provides:

• assessment
• investigation
• diagnosis
• management of patients with an acute illness within 1 day.

The Same Day Emergency Care team consists of consultants, nurses, pharmacists, junior doctors, advanced practitioners, and physician associates. Support is provided to the team by specialist nurses and doctors in other specialties.

Aciclovir

Amikacin

Benzylpenicilin (Penicillin G)

Chloramphenicol

Ciprofloxacin

Colistin

Cycloserine

Daptomycin

Ethambutol

Flucloxacillin

Fluconazole

Flucytosine

Ganciclovir

Gentamicin

Isavuconazole

Isoniazid (+ N-Acetyl-Isoniazid)

Itraconazole

Levofloxacin

Linezolid

Meropenem

Moxifloxacin

Posaconazole

Rifabutin

Rifampicin

Streptomycin

Sulphamethoxazole in (Co-trimoxazole)

Teicoplanin

Tobramycin

Trimethoprim in (Co-trimoxazole)

Vancomycin

Voriconazole

What is pulmonary fibrosis?

Pulmonary fibrosis is when normal lung tissue is replaced by scar tissue and/or inflammation. This makes the lungs stiff and not work as well.

• Pulmonary is the medical term for your lungs.
• Fibrosis means scarring.

We know what causes some types of pulmonary fibrosis. But sometimes we cannot find a cause, including in Idiopathic Pulmonary Fibrosis (IPF). We do know that it is not a form of cancer or cystic fibrosis, and it is not contagious.

How common is IPF?

IPF is rare - only around 14 to 43 people out of 100,000 have IPF. It can affect anyone but is much more common in older people.

What are the symptoms?

At first, people with IPF can have no or only mild symptoms. If the pulmonary fibrosis worsens then you may have:

• Difficulty breathing.
• Dry cough.
• Feeling tired.
• Poor appetite.

IPF can cause weight loss. You should weigh yourself regularly and speak to your GP or team if you are losing weight over time.

What tests will I have?