Wilhelm Frederick von Ludwig first described in 1836 a potentially fatal, rapidly spreading soft tissue infection of the neck and floor of the mouth. The condition was later named ‘Ludwig's angina’, a term which persists in medicine to this day. A gold medallist at 19 and professor at 25, Ludwig also served as president of the Württemberg Medical Association and chief physician to the royal family. His outstanding contribution to medicine was rewarded with the title Excellence upon retiring in 1855. Ludwig died at the age of 75, ironically, days after developing an inflammation of the neck. Could it be that Ludwig died of his own condition? This article combines a biography of Wilhelm Frederick von Ludwig with an overview of his eponymous condition and its management.

Objectives: To study the effect of pre-operative hearing level and tumour size on the hearing outcome of hearing preservation surgery for vestibular schwannoma.

Study design and setting: A review of literature conducted at Gruppo Otologico, a tertiary referral centre for neurotology and skull base surgery.

Results: A total of 1993 patients in 16 publications addressing the topic of hearing preservation surgery in vestibular schwannoma were analysed. The American Academy of Otolaryngology–Head and Neck Surgery hearing classification system was the classification upon which we based our analysis.

Conclusion: Defining hearing preservation as class-A hearing, there was a strong inverse relationship between pre-operative hearing and post-operative hearing levels and between tumour size and post-operative hearing levels.

Objective: The aim of this study was to identify the distribution of parotid tumours within the gland in relation to the facial nerve branches. Documentation revealing such a relationship has not been reported previously.

Method: A prospective study involving 111 patients was carried out over a period of 18 years in a specialist otolaryngology unit within a district general hospital. The relationship of the facial nerve to the tumour was graded into six types. The grading system was then employed to categorize each case.

Results: More than two-thirds of the tumours were pleomorphic adenomas. The majority of these were located in the body and not in the tail of the parotid gland. In 50 per cent of these cases, the tumour was in close association with the two major divisions of the facial nerve. In the case of Warthin's tumours, 47 per cent were located in the tail, below the lower division of the facial nerve.

Aim: To evaluate the reliability of infrared tympanic thermometry in children who have undergone myringotomy with grommet insertion.

Method: Forty children who had undergone myringotomy with at least one grommet insertion had the tympanic temperature of each ear and the axillary temperature measured on admission and 30 minutes post-operatively.

Result: No difference was found between the pre- and post-operative temperatures measured by either method (p > 0.05, paired t-test, hypothesized difference of 0).

Conclusion: Infrared tympanic thermometry is reliable in monitoring body temperature in children who have had minor ear surgery.

Introduction: Once fitted with hearing aids, much reliance is placed on patients' own ability to manage their devices effectively. There has, however, been little research to assess how patients' own confidence compares with their actual ability to manage their hearing aids. This study compares patients' perceptions of their ability to insert their hearing aids with their observed ability to insert the devices satisfactorily.

Method: Eighty-five patients provided a rating of their level of confidence in fitting their hearing aid, using a visual analogue score (VAS). This was then compared with their observed level of ability, assessed by an audiologist, also using a VAS (both scores 0–100 mm).

Results: We found a weak to moderate correlation between the subjective and objective scores (Pearson r = 0.4912).

Conclusions: From these results, we would advise caution when accepting a patient's perceived level of ability as the only indicator of their true ability to insert their hearing aid. This also has important implications for follow-up services that rely only on telephone conversations with patients after a first fitting.

Background: In the absence of surgical treatments with demonstrable long-term efficacy, conservative treatments for snoring remain appropriate. Only limited evidence evaluating the use of ear protection by partners has been published.

Methods: Eligible couples were invited to participate in a two-month trial, with each partner using custom-moulded ear plugs. Five questionnaires were completed by patients and their partners, at baseline and after two months: the snoring outcomes survey (SOS) or the spouse/bed partners survey (SBPS), the Epworth sleepiness scale (ESS), the general health questionnaire-12 (GHQ-12), the Nottingham health profile (NHP) and the Golombok–Rust inventory of marital status (GRIMS).

Results: After two months, there was a significant improvement in the SOS score for patients (p = 0.005), the SBPS score for partners (p = 0.001) and the ESS for partners (p = 0.004).

Conclusions: For selected couples, ear plugs represent an effective short-term treatment for some of the social effects of disruptive snoring, as determined by the SOS, SBPS and ESS questionnaires.

With the increasing use of the endosheath in clinical practice, we set out to investigate the quality of the nasendoscope image produced with and without an endosheath. It has been suggested by some users that the endosheath degrades the image. We used a spectrophotometer to assess the optical transmission of the endosheath and found no selective chromatic absorption. However, on requesting nine experienced users to document whether they could differentiate between the sheathed and unsheathed endoscope, a significantly correct answering pattern was obtained in repeated blinded experiments. This suggests that individuals can distinguish between the sheathed and unsheathed nasendoscope view and that the image is indeed altered when an endosheath is employed.

Objective: To document the outcome of patients deemed at initial diagnosis to be appropriate for palliative care.

Materials and methods: Over a five-year period, all patients with head and neck mucosal squamous cell carcinoma (HNMSCC) were referred to one consultant surgeon, and data were collated retrospectively.

Results: Of 286 patients with HNMSCC, 60 (21 per cent) were deemed appropriate for palliative care at initial diagnosis. Their median survival was 154 days, with hypopharyngeal and oropharyngeal tumours forming a disproportional percentage of the initial diagnoses (p < 0.001). After initial assessment, 66 per cent of patients were discharged to their home, 17 per cent to hospice care and 17 per cent were transferred to other institutions. Including deaths during the initial admission, 29 per cent of patients did not return home after diagnosis. Palliative treatment included operative interventions in 35 per cent and radiotherapy in 43 per cent. Time spent in further hospital care averaged 47 days, and 47 per cent of patients eventually died in hospital.

Conclusion: One in five patients presenting with HNMSCC were deemed appropriate for palliative care at initial presentation and survived less than six months after diagnosis. More than one-third required surgical intervention, and 29 per cent never returned home.

Introduction: The study sought to compare and contrast squamous cell carcinoma (SCC) of the anterior mobile tongue with SCC of the tongue base, with emphasis on clinical presentation, management and outcome.

Methods: This was a retrospective, comparative analysis of patients treated for SCC of the tongue over a 10-year period. Cox's regression model was used to assess the effect of tumour site on survival.

Results: The study included 142 patients, of whom 86 were treated for SCC of the anterior tongue and 56 for tongue base lesions. Patients with carcinoma of the anterior tongue tended to present with a visible lump or ulceration of the tongue, whereas the majority of patients with tongue base SCC presented with pain. Sixty per cent of anterior tongue lesions were early stage (I or II) at initial presentation as compared with 21 per cent of tongue base lesions.

Conclusion: Patients with anterior tongue lesions had a better prognosis, but this was not statistically significant when adjusted for stage.

Objectives: We aimed to conduct a retrospective analysis of patients treated with radiotherapy for laryngeal carcinoma at a single institution.

Methods: We analysed data from 202 consecutive patients treated with primary or post-operative radiotherapy for laryngeal carcinoma over a 10-year period.

Results: Sixty-nine patients had a T1, 65 a T2, 39 a T3 and 29 a T4 lesion. Forty-one patients were node-positive. The clinical stage was I in 67 patients, II in 53, III in 36 and IV in 46. Primary radiotherapy was given to 152 patients. The median follow up was 60 months. The five-year overall local control rate was 86 per cent, the ultimate local control rate was 93 per cent, the five-year regional control rate was 96 per cent, the five-year relapse-free survival rate was 82 per cent and the five-year overall survival rate was 69 per cent.

Conclusions: Patients with laryngeal carcinoma treated with primary or post-operative radiotherapy had a five-year overall survival rate of 69 per cent.

The administration of anaesthetic gases to an infant undergoing an endolaryngeal laser procedure can be difficult. We describe the use of a Magill's nasal sucker and an anaesthetic connector to maintain anaesthesia during laser surgery.

Proteus syndrome is a rare and highly variable hamartomatous syndrome that can affect multiple organ systems. It is characterized by hyperplasia of connective tissue, vascular malformations, epidermal naevi and hyperostosis. Most of the cases present to plastic and orthopaedic surgeons. Otolaryngologic presentations are minimal. We report such a rare case, which presented with a huge unilateral tonsillar mass causing dysphagia.

Angiolymphoid hyperplasia with eosinophilia is a rare condition that demonstrates dermal or subcutaneous proliferation of endothelial cells associated with an inflammatory cell infiltrate. A case is reported, with emphasis on the histopathological features on repeated biopsies. The report serves to stress the importance of considering this condition in the differential diagnosis of lesions in and around the ear.

A rare facial nerve anomaly was incidentally discovered whilst performing a tympanoplasty and ossicular reconstruction on a patient with an acquired unilateral conductive hearing loss. The nerve was seen to bifurcate and straddle a normal stapes superstructure as it ran posteriorly through the middle ear, a unique and as yet unreported combination. This case highlights the importance of vigilance regarding facial nerve anatomical variations encountered during middle-ear surgery thus avoiding inadvertent damage. The purported embryological mechanism responsible for such anomalies of the intra-tympanic facial nerve is discussed.

Sudden onset sensorineural hearing loss is a well recognized entity frequently encountered in otolaryngological practice. However, the combination of such deafness as part of a wider systemic disorder is fortunately rare. Almost 100 years after the syndrome was classified, we describe a case of Vogt–Koyanagi–Harada syndrome occurring unusually in a Caucasian woman and characterized by sudden hearing loss. A brief review of this rare condition is presented.

In 2003, it was reported that superior semicircular canal dehiscence can mimic otosclerosis because of low-frequency bone conduction hearing gain and dissipation of air-conducted acoustic energy through the dehiscence. We report the case of a 17-year-old girl with left-sided combined hearing loss thought to be due to otosclerosis. Bone conduction thresholds were −10 dB at 250 and 500 Hz and she had a 40 dB air–bone gap at 250 Hz. When a tuning fork was placed at her ankle she heard it in her left ear. Acoustic reflexes and vestibular evoked myogenic potentials could be elicited bilaterally. Imaging of the temporal bones showed no otosclerosis, superior semicircular canal dehiscence or large vestibular aqueduct, but a left-sided, Mondini-like dysplasia of the cochlea with a modiolar deficiency could be seen. Mondini-like cochlear dysplasia should be added to the causes of inner-ear conductive hearing loss.