Sinonasal inverted papilloma is a benign condition with the potential for recurrence and malignant change. Over the past few decades, numerous studies and reviews have addressed different aspects of this condition.

To amalgamate the current literature on inverted papilloma, in order to review the evidence and consider the gaps in current knowledge.

Retrospective, narrative review.

The reported incidence of inverted papilloma varies between centres and is affected by selection bias. The exact aetiology of inverted papilloma is not fully understood. Currently, there is no reliable histological or biological marker to predict the probability of recurrence or malignant transformation. There is no universally accepted staging system available for sinonasal inverted papilloma. Complete surgical removal of the tumour is the mainstay of treatment, but the method of choice depends on the extent of the disease, the skill of the surgeon and the technology available.

In order to compare different studies and to enable meta-analysis of the literature, there should be a universally accepted staging and classification system for sinonasal inverted papilloma. Further research on the aetiology of sinonasal inverted papilloma, and on biological markers for its recurrence and malignant transformation, is required. To enable meaningful future research, we would encourage multicentre participation with a consensus on management.

To demonstrate the technique and clinical application of vibroplasty in which the floating mass transducer component of the Vibrant Soundbridge implant is coupled directly to the oval window niche, in patients with a mobile stapes footplate but a malformed or destroyed stapes suprastructure.

The underlying concept was to create a soft tissue casing for the floating mass transducer, while also firmly connecting the transducer to a small, solid cartilage ‘plunger’ attached to the stapes footplate. This was realised by removing almost all the cartilage from a larger piece of cartilage–perichondrium, leaving only a tiny cartilage island about half a millimetre in diameter, attached to a much wider ‘blanket’ of perichondrium.

By coupling the floating mass transducer directly to the oval window niche, patients' speech understanding was improved. Post-operative aided thresholds of 30–40 dB HL were achieved by all patients.

In patients with mixed hearing loss combined with a destroyed stapes suprastructure but a mobile stapes footplate, we describe the coupling of the floating mass transducer component of a Vibrant Soundbridge to the stapes footplate, as an alternative to coupling to the round window.

To identify the greatest difficulties reported by people affected by neurofibromatosis type 2, and to determine the relationship between the primary and secondary effects of the disease.

Postal questionnaire study.

Questionnaire sent to subjects' home addresses.

Eighty-seven adult patients under the care of the Manchester multidisciplinary neurofibromatosis type 2 team were invited to take part.

The response rate was 62 out of 87 (71 per cent).

Respondents' answers emphasised that their greatest problem was deafness, which resulted in communication difficulties with social contacts, close partners, family and friends. Correlation coefficients indicated a relationship between general mood changes and hearing difficulties, social communication problems, balance difficulties and mobility problems. Self-confidence was significantly related only to social communication problems.

The use of a closed set neurofibromatosis type 2 questionnaire identified hearing problems and subsequent communication difficulties as the main problems faced by people with this condition.

This study aimed to investigate antimicrobial treatment of an infected cochlear implant, undertaken in an attempt to salvage the infected device.

We used the broth microdilution method to assess the susceptibility of meticillin-sensitive Staphylococcus aureus isolate, cultured from an infected cochlear implant, to common antimicrobial agents as well as to novel agents such as tea tree oil. To better simulate in vivo conditions, where bacteria grow as microcolonies encased in glycocalyx, the bactericidal activity of selected antimicrobial agents against the isolate growing in biofilm were also compared.

When grown planktonically, the S aureus isolate was susceptible to 17 of the 18 antimicrobials tested. However, when grown in biofilm, it was resistant to all conventional antimicrobials. In contrast, 5 per cent tea tree oil completely eradicated the biofilm following exposure for 1 hour.

Treatment of infected cochlear implants with novel agents such as tea tree oil could significantly improve salvage outcome.

To study the outcome of patients with sinonasal teratocarcinosarcoma treated at a single institution.

We reviewed the medical records of 22 patients with histopathologically proven sinonasal teratocarcinosarcoma diagnosed during the period 1993–2007. Treatment was completed in 16 patients.

Fourteen patients underwent surgery (six received craniofacial resection, four open surgery and four endoscopic resection); this was followed by radiation therapy with or without chemotherapy in 11 patients. Two patients received chemoradiation as the definitive treatment. At median follow up in surviving patients of 34 months (range one to 180 months), only five were controlled. Disease recurred in 11 patients, with a median time to recurrence of seven months. The two-year disease-free survival rate and the overall survival rate were 28 and 46 per cent, respectively.

Sinonasal teratocarcinosarcoma appears to be an aggressive disease, with the majority of patients suffering locoregional failure. Multimodality treatment, in the form of a combination of surgery, radiation therapy and chemotherapy, appears to be the optimal approach.

To assess impact of site of idiopathic epistaxis on adult patient management and its association with patient demographics and co-morbidities.

The site of epistaxis, patient data, their management and outcomes prior to discharge was recorded prospectively for 100 consecutive eligible adult patients.

Fifty three patients had anterior and 47 patients had a posterior site of bleeding. The site of epistaxis was not related to the patient s age, medical condition or medication.

Most patients with epistaxis can be controlled with nasal cauterisation. However, patients with posterior epistaxis are more likely to need hospital admission, are twice as likely to require nasal packing, and stay in hospital longer. There appears to be no link between the site of epistaxis and patient factors.

To test the hypothesis that potential sites of weakness within normal nasal arteries, when stressed, contribute to the mechanism of epistaxis, we ‘stress-tested’ nasal arteries in unfixed cadaveric heads, using pressure injection of feeding arteries.

Indian ink with latex was injected into maxillary arteries under high pressure (620 mmHg). Stepwise dissection was carried out and areas showing ink leakage were examined. Control heads were injected at standard embalming pressures (375 mmHg).

Ink leakage was found in all heads injected at higher pressure, and was restricted to the nasal mucosa. Histological examination of leakage points demonstrated vessel disruption consistent with dissecting aneurysm formation.

Results showed that high pressure injection caused leakage from arteries in the posterior nose; the distribution of leakage points was consistent with many clinical investigations. The lesions produced were comparable with our best histopathological model of epistaxis, i.e. dissecting aneurysm formation. This suggests that pre-existing weaknesses in the arterial configuration may exist.

This study was designed to investigate the effects of the tissue adhesive N-butyl cyanoacrylate on nasal septal tissues after septal surgery in a rabbit model.

Forty-two adult New Zealand rabbits were randomly divided into three groups (14 in each group): septoplasty alone, septoplasty plus N-butyl cyanoacrylate, and controls. The open approach was used to explore the nasal septum. After raising mucoperichondrial and mucoperiosteal flaps on both sides of the septum, the septum was detached from the nasal floor in the septoplasty alone and septoplasty plus N-butyl cyanoacrylate groups. In the septoplasty plus N-butyl cyanoacrylate group, the mucoperichondrial and mucoperiosteal flaps were fixed to the septum and the septum was fixed lateral to the nasal spine using N-butyl cyanoacrylate; in the septoplasty alone group, the septum was packed with Merocel. In the control group, no further septal surgery was performed after flap elevation. Animals were observed for bleeding and haematoma formation over the first 24 hours. Seven animals in each group were used to evaluate early histopathological effects on the septal tissues, at four weeks post-operatively; the other seven in each group were used to evaluate late effects, at 12 weeks.

Haematoma formation was observed in 10 animals in the septoplasty alone group, in four animals in the control group, and in only one animal in the septoplasty plus N-butyl cyanoacrylate group. The difference in haematoma incidence between the septoplasty alone and the septoplasty plus N-butyl cyanoacrylate groups was significant (p = 0.000). Histopathological evaluation revealed no significant difference between the groups as regards granulation tissue formation at week four versus week 12; however, there was a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the control groups as regards inflammation at week 12 (p = 0.038). There was a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the septoplasty alone group as regards the composition of the bone–cartilage junction zone at week four (p = 0.001). There was also a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the control group as regards the cellular structure of new cartilage formation at week 12 (p = 0.004).

In this rabbit septoplasty model, N-butyl cyanoacrylate appeared to be an effective nasal tissue adhesive, with a low complication rate.

Cervicofacial necrotising fasciitis carries high rates of morbidity and mortality, and is not often initially suspected due to its rarity and misleadingly innocuous presentation. We propose an algorithm for the timely diagnosis and management of cervicofacial necrotising fasciitis.

Retrospective review of seven patients ultimately diagnosed with cervicofacial necrotising fasciitis.

In these seven patients, common presenting symptoms included sore throat, fever and neck pain. On initial examination and imaging, only three had obvious findings. One patient's diagnosis was facilitated via a bedside cut-down procedure. Six patients underwent surgical debridement. Four required tracheotomy, and five wounds closed via secondary intention. There were two deaths.

The severity of cervical necrotising fasciitis and its rapid spread necessitate early diagnosis and timely surgical management. The presentation often appears benign. A high index of clinical suspicion should be maintained in cases of neck cellulitis with nonspecific clinical findings, especially in diabetic or otherwise immunocompromised patients. A normal computed tomography scan does not rule out necrotising fasciitis. A cut-down procedure may be critical to early diagnosis in some cases.

To determine the accuracy of fine needle aspiration cytology conducted within a standard ENT out-patients service (rather than a one-stop neck lump clinic), and also to assess the value of ultrasound guidance during fine needle aspiration cytology.

Retrospective study of all patients undergoing fine needle aspiration cytology of a neck lump, from 2005 to 2008 in Leeds teaching hospitals.

Accuracy of fine needle aspiration cytology, compared with the corresponding histology report of the original surgical specimen, and non-diagnostic fine needle aspiration cytology rates with and without ultrasound.

Fine needle aspiration cytology yielded the following respective sensitivity, specificity and accuracy rates: 85, 91 and 87 per cent for lymph nodes; 80, 93 and 89 for salivary glands; and 52, 80 and 69 for thyroid. The proportion of non-diagnostic procedures was 28 per cent, both with and without ultrasound guidance.

Cytologist-led fine needle aspiration cytology would have reduced the time to diagnosis and the number of clinic visits per patient. Fine needle aspiration cytology was accurate for predicting malignancy in salivary gland and lymph node lesions, and for diagnosing lymph node pathology. Study results did not support the use of ultrasound guidance during fine needle aspiration cytology.

This study aimed to determine the prevalence of pain, and the adequacy of its treatment, amongst patients with head and neck cancer, and to determine whether specific groups could be identified as being at risk of pain.

Consecutive patients attending head and neck oncology out-patient services were surveyed.

The prevalence of pain was 34 per cent, lower than that found in systematic reviews. No specific risk factors for pain were identified. Particular pain problems in this population comprised a high incidence of neuropathic pain, breakthrough pain and pain of non-malignant origin.

The prevalence of unrelieved pain was high in this study population, although no specific risk factors were found. A further study is planned to determine the effect of using a routine screening tool and an immediate pain treatment protocol in this group of patients.

To investigate the prevalence of psychological distress in head and neck out-patients.

We used the Hospital Anxiety and Depression Scale to screen 106 patients for mood disorders in a London head and neck ENT out-patient clinic.

Queen's Hospital, Romford, UK.

One hundred and six patients attending a head and neck out-patient clinic.

Hospital Anxiety and Depression Scale score.

Approximately 39 per cent of patients had a possible anxiety disorder (10 per cent were rated as severe), and 27 per cent had possible depression (10 per cent were rated as severe).

We recommend that a member of the head and neck multidisciplinary team should be trained to identify and correctly refer psychologically distressed patients to appropriate existing psychiatric services.

Telomere length must be maintained throughout cancer cell progression and proliferation. In most tumours, telomerase activity maintains telomere length. Therefore, telomerase is a target for cancer treatments. However, some cancer cells maintain telomere length through an alternative mechanism termed ‘alternative lengthening of telomeres’. To determine how telomerase inhibition relates to the initiation of the alternative lengthening of telomeres pathway, we investigated telomerase activity and telomere maintenance in Hep-2 cells with and without reduced telomerase activity.

We investigated telomerase activity levels in a normal Hep-2 cell line and in residual cells following telomerase inhibition treatment. Additionally, we looked for expression of a marker protein for the alternative lengthening of telomeres mechanism.

In the residual cells, telomerase activity was eliminated. However, these cells had higher levels of the alternative lengthening of telomeres biomarker, suggesting an alternative mechanism for telomere maintenance following telomerase inhibition. These results could have a major impact on the design of new cancer treatments.

We report a rare and unusual case of a patient with an ingested fishbone which migrated from the oropharynx to the anterior compartment of the retropharyngeal space and then to the deep neck space in the nasopharynx (i.e. the carotid space). This report aims to describe a successful, minimally invasive method of foreign body removal which avoided both major skull base surgery and any potential life-threatening complications. A secondary aim is to highlight the role of intra-operative fluoroscopy, an under-used tool.

We present a 67-year-old man with a history of fish bone impaction but no fish bone visible on plain X-ray or flexible endoscopy. The diagnosis of fish bone lodged in the retropharyngeal space was confirmed by computed tomography. Surgical exploration of the anterior retropharyngeal space failed to locate the fish bone, as it had migrated to a new, unknown location. Intra-operative fluoroscopy was vital for the removal of the fish bone, as it was impossible to see with the naked eye and had migrated from its previously imaged position. The fish bone was finally retrieved bimanually using external pressure on the submandibular region, which displaced the fish bone, and fluoroscopic guidance, which assisted its removal from the nasopharyngeal lumen.

To the best of our knowledge, this is the first reported case of bimanual, intra-operative, fluoroscopy-guided, intra-luminal removal of a migratory fish bone from the deep neck space in this region of the nasopharynx.

We report two rare cases of high and dehiscent jugular bulbs protruding into the external ear canal; one case was silent, the other symptomatic.

The cases are presented and the relevant literature reviewed and discussed.

A 52-year-old woman underwent mastoid exploration for suspected cholesteatoma. On raising the tympanomeatal flap, while still lateral to the annulus, brisk venous bleeding occurred from a high, dehiscent jugular bulb in the external ear canal. The second patient, a 42-year-old man, underwent imaging for suspected glomus tumour. A high, dehiscent jugular bulb was found protruding into the external ear canal and hypotympanum.

High jugular bulbs in the middle ear have been reported many times. To our knowledge, there has only been one previous report of a high jugular bulb in the external ear. These cases illustrate the importance of full, accurate assessment of high resolution computed tomography images, and of appropriate, immediate management of bleeding.

We report the second known case of aggressive angiomyxoma of the larynx.

Case report and a review of the world literature concerning angiomyxoma of the larynx and recent advances in the immunohistochemical, cytogenic and clinical study of its female pelvic counterpart.

Aggressive angiomyxoma is a rare mesenchymal tumour originally thought only to occur in the female pelvis and peritoneum, or rarely in the male genital tract. A 47-year-old man presented with a one-month history of dysphonia. He was found to have a supraglottic mass on endoscopic examination, and underwent a laryngofissure approach excision biopsy and covering tracheostomy. Histological analysis showed a characteristic proliferation of spindle cells widely separated by loose, myxoid stroma with a prominent vascular component. Aggressive angiomyxoma was diagnosed.

To our knowledge, this is the second report in the world literature of aggressive angiomyxoma of the larynx. Comparison with the female pelvic counterpart facilitates diagnosis, aided by recent advances, and suggests that complete surgical excision with a wide margin is the treatment of choice.

We describe a case of benign paroxysmal positional vertigo which occurred after use of a whole-body vibration training plate.

Case report and literature review concerning the secondary causes of benign paroxysmal positional vertigo and the physiological effects of whole-body vibration training plates.

A 44-year-old woman was referred with classic symptoms of benign paroxysmal positional vertigo following use of a whole-body vibration training plate, a popular form of fitness equipment widely used in sports, rehabilitation and beauty treatments. The condition resolved spontaneously after several days. There have been reports of negative side effects in users of this equipment, such as dizziness, headache and a sensation of imbalance; however, there have been no reported cases involving vertigo. Based on a literature review, this equipment may cause side effects, including vertigo, by generating forces that can increase the original amplitude of internal organs, which may potentially cause labyrinthine trauma or dislocation of otoconia, leading to benign paroxysmal positional vertigo.

We suggest that whole-body vibration training plates may potentially induce benign paroxysmal positional vertigo. Manufacturers may need to make users of this equipment aware of this risk, and remind them to use it with caution.

To highlight the clinical presentation and management of a rare case of oncogenic osteomalacia due to an ethmoid sinus tumour.

We examined the case records of a 55-year-old man who presented with progressive fatigue, weakness and bone pain, and noted the clinical presentation, laboratory investigations, computed tomography findings, operative notes and follow-up details.

Oncogenic osteomalacia secondary to a paranasal sinus neoplasm is a rare entity. The causative tumour is often occult and may be missed by routine clinical examination. This case report illustrates the appropriate pattern of evaluation and management to ensure a successful outcome.

We report a typical case of earlobe lymphocytoma.

A case report and literature review are presented.

A 10-year-old girl presented with a blue-coloured earlobe. A diagnosis of Lyme disease was confirmed by serological tests. Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. It is caused by the spirochete Borrelia burgdorferi sensu lato. The patient was successfully treated with antibiotics.

The diagnostic process and ENT symptomatology of Lyme disease and borrelial lymphocytoma are summarised and discussed.