The purpose of this study was to establish the eventual presence of progesterone receptor (PGR) and oestrogen receptor (EGR) in human middle-ear cholesteatoma (MECh) tissues and to compare their expression between male and female patients. An immunohistochemical technique was employed for detection of PGR- and EGR-specific immunoreactivity in MECh samples using formalin-fixed paraffin-embedded tissue sections. The positive results were verified with reverse transcriptase polymerase chain reaction (RT-PCR). The morphological study revealed stable expression of PGR in suprabasal layers of all cholesteatoma samples. Weaker immunoreactivity for PGR was demonstrated in external auditory canal skin (EACS) samples in comparison with MECh, while PGR-specific staining was not observed in retroauricular skin (RAS) samples. EGR was detected only at mRNA levels. Stronger expression of EGR PCR products was disclosed in female cholesteatoma samples, while PGR mRNA was predominantly detected in male cholesteatoma specimens. Our preliminary experimental results give us ground to assume that female sex hormones may stimulate proliferation and affect differentiation of MECh keratinocytes.

Chronic otitis media (COM) patients who had a multichannel device implanted were evaluated regarding surgical problems and technical modifications. In a multicentric study, implantees whose aetiology was COM were retrospectively evaluated. Patients were operated on and evaluated at three different tertiary referral centres: SSK Izmir Hospital Cochlear Implantation (CI) Center (32 cases), Istanbul Marmara University ENT Clinic (six cases), Eskişehir Anadolu University CI Center (one case). Thirty-nine implantees were evaluated with respect to surgical problems, technical modifications, complications and hearing results. All patients had lost their hearings as a result of COM. Three out of 39 cases were children. Thirty-seven of the patients either had a radical cavity or ear converted to radical at the first stage or concomittantly with the implantation. Patients were evaluated in order to find out the best possible surgical solutions to specific problems caused by COM. In seven cases electrode array disrupted the epithelial lining of the cavity despite specific measures. Five of those cases were re-implanted, passing the electrode array through a tunnel under the facial nerve. Seven recent cases were also implanted with the same subfacial route. In all patients but one, satisfactory hearing results were achieved one to five years after implantation (SDS scores with monosyllabic word list were between 59 and 89 per cent, median 67.4 per cent). CI in COM patients necessitates technical modifications. In radical cavities subfacial implantation seems to be a good solution for the protection of the electrode array.

Objective: To investigate the relationship between the extent of sinus disease in chronic sinusitis as detected radiologically by computed tomography (CT) scan and the population of cilia (ciliary area) both before and after functional endoscopic sinus surgery (FESS). In a simple way this is a trial to statistically prove that the CT scan could be a valid indicator and a mirror of the histological status of the sinus mucosa.

Design: Twenty adult patients were enrolled in this study. Radiological extension of the sinus disease was quantitated using the classification proposed by Kennedy in 1992 and the ciliary population was studied using scanning electron microscopy and image analysis softwares.

Results and conclusion: The more advanced the sinusitis, as evidenced by CT scans, the more the expected reduction in the ciliary area (CA) and in the ciliary count. But after FESS the degree of ciliary regeneration does not depend statistically on the radiological condition of the sinuses and the degree of opacity prior to intervention, i.e. a statistically valid inverse relationship exists between the radiological stage of sinusitis and the ciliary population pre-operatively but the same relation does not extend to the ciliary population post-operatively.

Allergic rhinitis is a common cause of nasal obstruction in childhood. This prospective study looked at the effect of passive smoking on nasal obstruction in children with and without allergic rhinitis. Eighty-one children took part. Each child was asked to score his or her degree of nasal obstruction on a visual analogue scale. Exposure to passive smoking was determined subjectively using a parental questionnaire, and objectively by measuring the urinary cotinine/creatinine ratio. Results were tabulated using Microsoft Excel and analysed with SPSS statistical software. Nasal obstruction was significantly worse in children with a positive history of allergic rhinitis (p < 0.05). There was also a trend towards a higher nasal obstruction score in children without allergic rhinitis exposed to passive smoking compared to those who were not so exposed. As would be expected, nasal obstruction is worse in children with allergic rhinitis than in those without. Passive smoking tends to increase the symptom of nasal obstruction in children without allergic rhinitis.

Laryngomalacia is the most common cause of stridor in infants. Severely affected children are at risk of feeding difficulties, apnoeic episodes and cor pulmonale secondary to upper airway obstruction. The aim of this study was to assess the outcome of aryepiglottoplasty. This is a simple surgical procedure that relieves the obstruction by dividing the aryepiglottic folds. Thirty children had an aryepiglottoplasty at the Royal Liverpool Children’s Hospital between January 1995 and June 2001. The case notes of all 30 children were reviewed for age, sex, age at operation, indications, operative technique, complications and long-term outcomes. Complete resolution of stridor was obtained in 83 per cent of patients, with an improvement in a further 7 per cent. Post-operative complications included lower respiratory tract infections (13 per cent) and vomiting (7 per cent). In conclusion, simple endoscopic aryepiglottoplasty remains an effective way of treating upper airway obstruction in children. Its high resolution and low complication rate make it a safe, first choice procedure for treatment of moderate to severe laryngomalacia.

Objective: To conduct a prospective randomized controlled trial describing and investigating the efficacy and safety of radiosurgical excision of benign superficial vocal fold lesions.

Materials and methods: Fifty patients with benign superficial vocal fold lesions (20 vocal nodules, 27 vocal polyps and three Reinke’s oedema) who failed conservative therapy were included in the study. They were equally randomized into cold knife or radiosurgical excision. Clinical and voice assessments were done pre-operatively and after surgery. Voice analysis included a subjective visual analogue scale (VAS) and a perceptual assessment with a simplified version of the GRBAS scale (GRB) consisting of G (grade), R (roughness), and B (breathiness). Acoustic voice evaluation included jitter and shimmer. Post-operative voice therapy was provided for all patients. Complications, smoothness of post-operative recovery, and administration of analgesia were reported.

Results: Both groups experienced significant improvement in VAS, perceptual evaluation and acoustic analysis after surgery, with no evidence of significant differences between the cold knife and radiofrequency groups. The radiofrequency group showed a decrease of 17 per cent in the mean operative time when compared with the cold knife group, but this was not statistically significant. No evidence of a significant difference was noticed in the smoothness of post-operative recovery, administration of analgesia and complication rate.

Conclusion: Radiophonosurgery opens a new therapeutic approach for patients with benign superficial vocal fold lesions. It combines the advantages of both cold knife and laser phonosurgery, being easy, safe, precise and effective, and having excellent tactile and haemostatic properties.

We reviewed acute epiglottitis (AE) and identified factors associated with airway intervention. This report was a retrospective review of patients with AE and compared with factors associated with airway intervention. We reviewed 96 patients who were diagnosed with AE in our hospitals in Japan. Ninety-two (96 per cent) patients were adults, and no seasonal variation in the incidence of AE was encountered. Eight (8 per cent) patients had tracheostomy and endotracheal intubation had not been done. We found that symptoms of stridor and muffled voice, a rapid clinical course, and diabetes mellitus were the factors associated with airway intervention. Extremely severe swelling of the epiglottis such that only less than half of the posterior vocal fold (scope classification (SC): III) could be seen, and extension of the swelling to the arytenoids (SC: B) were the two factors that were strongly associated with airway intervention.

Post-thyroidectomy patients often complain of globus pharyngeus type symptoms. One of the organic pathologies recognized as causing globus pattern symptoms is goitre. We conducted a prospective questionnaire-based study in the thyroid clinic at Hull Royal Infirmary to examine the relationship between goitre, thyroidectomy and globus pattern symptoms by using the Glasgow–Edinburgh Throat Scale. A questionnaire-based study in which 41 consecutive patients due to undergo thyroidectomy prospectively completed the questionnaire pre-operatively and 12 months post-operatively. A subset of 25 randomly selected patients also completed the questionnaire three months post-operatively. Globus symptoms were not worsened by thyroidectomy at three or 12 months. Indeed two of the questioned parameters were significantly improved at three months, and six at one year (p < 0.023). In conclusion, thyroidectomy does not exacerbate globus pharyngeus symptoms. Indeed, in the absence of other clinical causes, when a patient has a World Health Organization (WHO) 2 goitre or greater, thyroidectomy may improve them.

To elucidate the influence of radiation therapy on the larynx in patients who receive radiotherapy to the neck, we observed the changes in the distribution of the laryngeal glands. Human adult larynges from patients with either laryngeal or hypopharyngeal cancer were histopathologically examined, and the changes in the glandular distribution as well as in the ratio of serous or mucous type cells were surveyed using an image analysis system. The mean ratio of the area occupied by glandular acini in the subglottic larynx was 0.182 in the non-radiation group and 0.098 in the radiation group (p < 0.001). Although no statistical difference was observed, the average density of the glands decreased and the average ratio of serous-type/mucous-type glandular cells decreased in the irradiated larynx. The glandular acini are often replaced with fibrous connective tissue and the ratio of serous-type glandular cells decreases. These results indicate that not only the voice function but also the local defence function of the larynx might be impaired after radiotherapy.

The purpose of this study was to dissect various animal larynges in support of a proposal for a laryngeal dissection laboratory. It was found that although the bovine larynx is larger than the human larynx, the anatomy is similar. Thirty-three bovine larynges were dissected by the author in various simulated phonosurgical and partial laryngectomy procedures. Following each procedure, the specimen was photographed for teaching purposes. The author concludes that dissecting bovine larynges offers a valuable aid to training in the field of laryngeal surgery. It is intended to apply these dissections in the form of a departmental surgical workshop.

Objective: Displacement of the tracheostomy tube in paediatric patients is a potentially fatal complication. We describe an extra safety measure which facilitates tube replacement.

Setting: Tertiary referral specialist paediatric centre.

Materials and methods: The method involves the placement of sutures between the anterior tracheal wall and skin to hasten the formation of a mature stoma (maturation sutures). We also undertook a retrospective case note review on patients from an academic tertiary referral centre. Thirty-five notes were reviewed. The most common indication for tracheostomy was airway obstruction (65 per cent). Fourteen patients had early and 10 had late complications with three tube displacements occurring. No added complications due to the use of sutures were found.

Conclusions: Our complication rates compare well with those in the literature, and we recommend considering the use of such a technique.

Insertion of a voice prosthesis through the tracheoesophageal puncture (TEP) is one way to restore the voice after total laryngectomy. The second generation Provox® voice prosthesis is presently one of the most popular devices. Although TEP can be done primarily, there are many centres that prefer it to be done at a second stage for various reasons. However, secondary TEP for retrograde replacement of prosthesis can be difficult and general anaesthesia is very often necessary. Moreover, the presence of neck stiffness and fibrosis from the surgery or previous radiotherapy could affect the neck extension for proper positioning of the trocar. Similarly, it is difficult to insert the prosthesis if there is stenosis at the pharyngoesophageal segment. We describe a technique in which creation of secondary TEP and insertion of Provox®2 is done with local anaesthesia under the same setting. The procedure is well tolerated and can be safely performed on an out-patient basis.

Clear cell carcinoma (CCC) of the larynx is a rare pathological finding; only eight cases are described in the literature. It occurs in older adults and shows a predilection for men. We report the ninth observation of laryngeal CCC in the literature. We reviewed the literature and correlated the prognosis of the tumour according to its site of onset and treatment.

The literature review showed that this neoplasm is highly aggressive, with a high recurrence rate and short mean survival time; the treatment of choice is surgery, and chemo- or radiotherapy are used mainly for the treatment of recurrences.

Stenotic malformations of the internal auditory meatus (IAM) are rare. They are known to symptomatically mimic vestibular schwannomas leading to potential diagnostic error. We present a case (along with literature review) where a stenotic IAM was clinically and radiologically misdiagnosed as a vestibular schwannoma.

Primary tracheal masses are rare. Secondary masses of the trachea are commonly foreign body granuloma, intubation granuloma or viral granuloma. The differential diagnoses given in such cases include both benign and malignant lesions. The otolaryngologist is often asked to perform a biopsy of the lesion to arrive at a diagnosis. However, even malignant processes can cause a granulomatous reaction. The timely diagnosis of tracheal masses depends upon maintaining a high index of suspicion. A rare case of tracheal granuloma leading to pneumomediastinum in a 53-year-old female is presented. The clinical features, investigations and treatment are detailed. The tracheal granuloma was managed by excision through bronchoscopy and the pneumomediastinum was managed conservatively.

Cholesterol granulomas of the middle ear tend to be benign in nature, frequently seen by otologists during cholesteatoma or chronic otitis media surgery and easily dealt with by evacuation. In contrast, cholesterol granulomas of the petrous apex appear to have a more aggressive nature and present significant pathological threats. We present a case of a large destructive cholesterol granuloma of the middle ear eroding the middle and posterior cranial fossa bone and dura to exert a mass effect upon the temporal lobe. We emphasize the destructive potential of this extremely rare middle-ear cholesterol granuloma, and draw attention to the distinction between this variant and the commonplace and benign form of the lesion more usually found at this site. We also present the current theories of the aetiology of cholesterol granuloma formation with possible explanations for the rare aggressive behaviour.

Tubular apocrine adenoma (TAA) is a very rare sweat gland tumour. Comprehensive review of the literature reveals that TAA in the external auditory canal (EAC) has not yet been reported. We report a case of TAA in the EAC, together with characteristic histopathological findings.

We report the case of a 26-year-old man who presented to us with dysphagia secondary to blunt trauma to the neck. The patient was found to have a hyoid bone fracture with pharyngeal perforation and resultant neck abscess. The patient responded to prompt surgical and medical management. We believe this to be the first report of such a case.