The consequences of vocal fold paralysis include voice change, airway problems and difficulty swallowing. Medialisation procedures using injected material have been used for many decades, with varying outcomes, mainly secondary to lifespan, tissue reaction or migration. Newer materials have recently become clinically available which are easier to manage and supposedly less likely to elicit foreign body reaction.

Case report.

We report a case of foreign body reaction and possible migration of polymethylsiloxane gel (Bioplastique™), one such material, after vocal fold injection. To our knowledge, this is the second such case described.

This case highlights the fact that the risk of foreign body reaction and migration is still present for this material, albeit low. We also highlight the fact that, although this material can cause foreign body reactions and may possibly migrate, it is removable by microlaryngoscopy via the microflap technique, with vocal improvement.

Endoscopic sinus surgery has been widely performed to treat nose and paranasal diseases. However, it is difficult to manipulate anterior wall lesions of the maxillary sinus using conventional surgical instruments. This paper presents a method of performing endoscopic surgery for anterior wall lesions of the maxillary sinus, using a 135° reflective CO2 laser.

A CO2 laser with a 135° reflective tip on the pipe-guide handpiece and a CO2 laser angulated to the same degree were used. The pipe-guide handpiece with reflective tip was inserted into the nasal cavity and the base of the maxillary sinus anterior wall lesion was vaporised and removed via an enlarged natural ostium. During the procedure, the maxillary antrum was visualised with a 70° endoscope. Ten cases of maxillary sinus anterior wall lesion underwent this surgical procedure.

In all cases, the base of the maxillary sinus anterior wall lesion was removed completely and recurrence avoided.

This method is a reliable procedure enabling endoscopic sinus surgery for anterior wall lesions of the maxillary sinus.

To determine the long-term outcome for children treated for recurrent epistaxis, and to compare the efficacy of antiseptic cream treatment and nasal cautery.

Retrospective analytical cohort study of 88 children treated for recurrent epistaxis in 2001.

Five-year data on chlorhexidine–neomycin cream usage, nasal cautery, current epistaxis frequency and emergency room attendance was collected by telephone interview and case record review.

During their first clinic visit, 51 per cent of the children had been treated with cautery and cream and 35 per cent with cream alone; 14 per cent had received no treatment. Five years later, 65 per cent of these children were still having ongoing epistaxis. Those who had undergone cautery and received cream had the highest ongoing bleeding rate (77 per cent).

The majority of children treated at our clinic for recurrent epistaxis had ongoing bleeding five years later. Despite the proven short-term efficacy of chlorhexidine–neomycin cream, few patients receive further courses of cream or are referred back to the clinic.

Stellate cells in the maculae flavae, located at both ends of the human vocal fold mucosa, have been considered an independent category of cells. We aimed to isolate and subculture these stellate cells, and to observe their morphological characteristics.

Stellate cells from the maculae flavae and fibroblasts from Reinke's space were cultured in three normal, adult human vocal fold mucosa preparations.

The subcultured cells from Reinke's space were conventional fibroblasts. The subcultured cells from the maculae flavae were stellate in shape and had cytoplasmic processes. They were larger than conventional fibroblasts, and lipid droplets in the cytoplasm disappeared in the second culture. These stellate cells proliferated by attaching their cytoplasmic processes to each other. During the seven to 10 month subculture period, each cell type continued to exhibit its own morphological characteristics.

This study demonstrated that such stellate cells form an independent cell category, which should be considered as a new category of cells within the human vocal fold.

To investigate prognostic factors for survival and locoregional control in patients with stage I–IVA hypopharyngeal cancer treated with laryngeal preservation radiotherapy.

This study was a retrospective analysis of 108 patients with stage I–IVA squamous cell carcinoma of the hypopharynx, treated with laryngeal preservation radiotherapy. Actuarial survival, disease-specific survival and local relapse-free survival were calculated, and multivariate analyses were performed using Cox's proportional hazards model.

After a median follow-up duration of 39 months, the five-year local relapse-free survival rate was 35 per cent for all patients, 66 per cent for those with stage I–II disease, 46 per cent for those with stage III disease and 20 per cent for those with stage IVA disease (p = 0.004). Multivariate analyses showed that tumour and node stages were independent prognostic factors.

Patients with stage I–II disease were suitable for laryngeal preservation radiotherapy. For most patients with stage III–IVA disease, other than those who were T1 N1 or T2 N1, the treatment results were poor.

We aimed to evaluate the accuracy of ultrasonography, radioactive iodine uptake and serum thyroid-stimulating hormone level in predicting the volume of remnant thyroid gland.

Sixty-six thyroidectomy patients were divided into two groups according to their functional status, i.e. those operated upon for nontoxic multinodular goitre (group one) and those operated upon for hyperthyroidism (group two). Ultrasonography, radioactive iodine uptake and thyroid-stimulating hormone assay were performed in all patients during the first post-operative month. The two groups were subdivided according to the amount of remnant thyroid volume detected on ultrasonography: <2 ml, 2–5 ml and >5 ml.

The remnant thyroid volume was positively correlated with the radioactive iodine uptake (rs = 0.684, p = 0.0001). The increase in remnant thyroid tissue radioactive iodine uptake was significantly greater in the patients operated upon for hyperthyroidism compared with those operated upon for nontoxic multinodular goitre (p = 0.0001). There was a negative correlation between remnant thyroid volume and post-operative serum thyroid-stimulating hormone level (rs =  −0.865, p = 0.0001) and between remnant thyroid tissue radioactive iodine uptake and post-operative serum thyroid-stimulating hormone level (rs = −0.682, p = 0.0001).

Ultrasonography is a more accurate measure of remnant thyroid volume than radioactive iodine uptake in patients operated upon for hyperthyroidism, compared with those operated upon for nontoxic multinodular goitre.

To study the development of the organ of Corti in the human cochlea, and to correlate our findings with the onset of auditory function.

Step sections of 81 human fetal temporal bones were studied, from eight weeks of gestation to full term.

By the end of the 10th week, the tectorial membrane primordium could be traced even in the most apical turns. Individual hair cells became identifiable at the basal turn at 14 weeks. At the same time, a small but well formed oval space was observed between the inner and outer hair cells in the basal turn. This does not correspond to the tunnel of Corti, as is erroneously quoted in the literature, as the individual pillar cells develop at later stages. Between 14 and 15 weeks, Hensen's cells were recognised for the first time. Individual pillar cells were identifiable at 17 weeks and the tunnel of Corti opened at 20 weeks. By 25 weeks, the cochlea had reached its adult size, but continued to develop until full term.

A temporal coincidence of different developmental events is responsible for early fetal audition at 20 weeks, including growth of pillar cells, opening of the tunnel of Corti and regression of Kollicker's organ, with the subsequent formation of the inner spiral sulcus and then separation of the tectorial membrane. The fine structures of the organ of Corti continue to develop well after the 25th week, and this may well alter the mechanical properties of the vibrating parts of the cochlea, which may in turn account for the frequency shift observed in preterm infants. These changes will have to be taken into account in the development of prenatal hearing screening tests.

Many surgical and nonsurgical procedures have been designed for the treatment of snoring due to palatal flutter. All work in some, but not all, snorers. The difficulty lies in making the definitive diagnosis of palatal flutter as the cause of snoring, and in deciding which patients should undergo which treatment, which in some cases are relatively radical.

This study aimed to assess the usefulness of injection snoreplasty in differentiating palatal flutter from other forms of snoring. This was done in the hope of determining which patients would benefit from definitive palatal surgery such as uvulopalatopharyngoplasty and laser-assisted uvuloplasty.

Sixty consecutive patients referred for habitual snoring were treated with sodium tetradycil sulphate during their first consultation visit. No patients were excluded and none refused the treatment. Forty patients received a single 1 ml dose of 1 per cent sodium tetradycil sulphate, and twenty patients received a single 1 ml dose of 3 per cent sodium tetradycil sulphate under topical anaesthesia. Visual analogue snoring scales were completed by the patient and their partner six weeks, three months, six months and 12 months after the procedure.

Forty of the 60 patients showed improvement in snoring and therefore were considered for definitive surgery. Four of the 60 patients found the investigation unpleasant and did not want any further treatment. Of the 40 patients who showed improvement, 29 maintained this at one year. The other 11 underwent uvulopalatopharyngoplasty or laser-assisted palatoplasty. All patients had successful snoring scale outcomes following the surgery.

A significant number of the patients, 62 per cent, were demonstrated to have significant improvement in the short term. Single dose injection snoreplasty seems not only to be an effective investigation but may constitute a safe and simple treatment within the clinic. At the very least, patients in whom the palate appears not to be the problem are prevented from undergoing painful, unpleasant surgery. Our results support the use of injection snoreplasty, both as an investigation and in some patients as a treatment, for habitual snoring.

To evaluate the character and significance of microsatellite deoxyribonucleic acid allelic imbalance in laryngeal squamous cell carcinogenesis.

We investigated the frequency of expression and clinical relationships of loss of heterozygosity and microsatellite instability in 49 laryngeal premalignant and malignant lesions. Allelic imbalance was analysed using six polymorphic markers (D3S1234, D9S171, D9S1748, D9S162, D9SINFA and D17S796), via polymerase chain reaction – single sequence length polymorphism – silver staining.

Allelic loss was seen in 3.7 per cent of the six markers in hyperplastic lesions, 10.81 per cent in mild dysplasia, 26.03 per cent in moderate to severe dysplasia, and 38.67 per cent in laryngeal squamous cell carcinoma. Significant associations were found between allelic loss and clinical pathological grades (χ2 = 17.686, p = 0.000). No statistically significant difference was found in the frequency of microsatellite instability (χ2 = 0.314, p > 0.05). In the early stages of neoplastic change, the incidence of microsatellite instability was higher than that of loss of heterozygosity.

Allelic imbalance was associated with the carcinogenesis and progression of laryngeal squamous cell carcinoma. Microsatellite analysis might provide new approaches to early genetic detection for patients with premalignant laryngeal lesions.

We performed endoscopic dacryocystorhinostomy in cases diagnosed with both anatomical and functional lacrimal obstruction, and here report results for the latter cases.

Sixty-eight endoscopic dacryocystorhinostomies were performed for functional obstruction on 44 patients. The indication for surgery was epiphora in 66 patients and recurrent dacryocystitis in two. The minimum follow up was six months.

There was complete cure in 44 (65 per cent) patients, partial cure in nine (13 per cent) and no improvement in 15 (22 per cent). Revision surgery was performed in five of the 15 cases with no improvement, after which there was an overall complete cure in 47 patients (69 per cent), partial cure in 10 (15 per cent) and no improvement in 11 (16 per cent).

Endoscopic dacryocystorhinostomy is indicated in cases of epiphora with a diagnosis of functional lacrimal obstruction. Currently available investigations cannot reliably distinguish partial anatomical obstruction from pump failure.

We aimed to devise a method whereby every surgeon performing gold eyelid implantation could have easy and quick access to the implant. Furthermore, we aimed to develop a means of creating an implant of the exact weight required for complete eyelid closure.

A prospective study was performed from 1997 to 2005 in a tertiary research hospital, involving 50 subjects requiring gold upper eyelid implantation and using the technique in question.

Only patients with a minimum follow up of one year were included in the study group. Symptoms improved in 96 per cent of subjects, who were able to dispense with eyedrops and eye ointments. Visual acuity improved in 92 per cent of patients. There were two extrusions amongst the early cases.

Customised gold eyelid implantation offers an alternative in regions where commercial implants are not easily obtained.

Although electrocautery has been used widely in surgery, the fear of delayed wound healing and infection persists. We aimed to evaluate the risk factors for wound complications and the rate of wound complications, comparing the use of electrocautery or scissors in cutaneous flap creation during thyroidectomy.

The study group comprised 239 consecutive patients scheduled for thyroidectomy.

Patients were randomly assigned to cutaneous flap dissection by either electrocautery (group one, n = 126) or scissors (group two, n = 113). Age, gender, body mass index, American Society of Anesthesiology score, tissue weight, operating time, incision length, cutaneous tissue depth, thyroid function and surgeon experience were recorded and compared with the rate of post-operative wound complications in both groups.

There were no significant differences between the overall rate of post-operative wound complications, comparing groups one and two (7.9 vs 10.6 per cent, respectively; p = 0.74). Significant positive correlations were found between wound complication and age (Spearman's rank coefficient (rs) = 0.135, p = 0.036), body mass index (rs = 0.379, p = 0.0001), cutaneous tissue depth (rs = 0.677, p = 0.0001) and tissue weight (rs = 0.643, p = 0.0001). According to logistic regression analysis, a body mass index of more than 27.5 kg/m2 was associated with a 13.7-fold increased rate of post-operative wound complications.

When creating cutaneous flaps during thyroidectomy, the use of electrocautery is as safe as the use of scissors. Such electrocautery does not increase the risk of wound complications in thyroid surgery.

To determine the characteristics of causative factors of taste disorders amongst the elderly, and to examine the therapeutic effect of a zinc agent, taking into account age-related factors.

A total of 408 patients with taste disorders were divided into three groups by age: 49 years or younger, 50 to 64 years old, and 65 years or older.

The incidence of taste disorders caused by drug administration and systemic disease were significantly higher in the elderly group. A serum zinc concentration of 69 µg/dl or lower was found in 33 per cent of the elderly group, significantly more (p < 0.001) than the 19 per cent of the 49 years or younger group with such a concentration. Zinc administration was therapeutically effective in 70 per cent of the whole population studied, and in 74 per cent of the elderly population.

In the elderly, the incidence of taste disorders caused by drug administration or systemic disease was significantly greater compared with other age groups. The curative effects of zinc administration were not observed to be influenced by age.

Telomerase is an attractive molecular target because it is active in most malignant cells but undetectable in most normal somatic cells. Small, interfering ribonucleic acid segments have been shown to be effective tools for inhibiting the expression of a given gene within human cells. In the present study, we examined the effects of short hairpin ribonucleic acid expression vectors on the growth of laryngeal squamous cell carcinoma in nude mice, and we assessed potential side effects in these animals.

Short hairpin ribonucleic acid expression vectors targeting the messenger ribonucleic acid of the telomerase catalytic unit were constructed and transfected into Hep-2 human laryngeal squamous cells carcinoma in nude mice. Apoptosis and telomerase catalytic unit expression within tumour cells were evaluated after treating with short hairpin ribonucleic acid. Peripheral blood was collected for haematological and biochemical analysis.

The findings demonstrated that short hairpin ribonucleic acid plasmids could inhibit tumour cell growth by 76.5 per cent, and that many tumour cells underwent necrotic or apoptotic cell death. There were no significant side effects of short hairpin ribonucleic acid on the heart, liver, kidney, spleen or blood system in this experimental model.

These results indicated that the short hairpin ribonucleic acid expression vector targeted at the telomerase catalytic unit of messenger ribonucleic acid significantly inhibited the growth of laryngeal carcinoma in nude mice, with no significant side effects on the experimental animals.

Wound healing, epithelial regrowth and collagen synthesis are very important factors in the repair of the traumatised tympanic membrane. The aim of the present study was to determine the role of plasma fibronectine in the aetiopathogenesis of tympanosclerosis.

This prospective study included 58 patients with and 49 without tympanosclerosis. No inflammation or trauma was noted in either patient group. All patients underwent otoscopic and otomicroscopic examination, and the degree of tympanosclerosis was graded from mild (stage I) to severe (stage III). Following otological examination, blood samples were taken for plasma fibronectine measurement.

Following otoscopic and otomicroscopic examinations, patients' tympanosclerosis was graded as follows: 18 patients were stage I; 29 were stage II; and 11 were stage III. Statistical analyses revealed that the plasma fibronectine concentrations were significantly lower in the study group compared with the control group (p = 0.031). In addition, fibronectine levels were lowest in the patients with severest tympanosclerosis (p = 0.0001 in each comparison).

The results of the present study show that serum fibronectine is important in the development and severity of tympanosclerosis.

To evaluate the efficacy of ultrasonic shear (‘harmonic scalpel’) thyroidectomy, compared with conventional thyroidectomy.

Prospective, case–control comparison.

Twenty-three consecutive patients were recruited over an eight-month period. Patients were divided into two groups according to their thyroidectomy technique, i.e. ultrasonic shear technique (harmonic scalpel) vs conventional technique (scalpel and bipolar diathermy). Surgical time, thyroidectomy type and thyroid specimen weight were recorded by theatre nursing staff. The ratio of surgical time to specimen weight, in minutes per gram, was used to measure surgical efficiency. The unpaired Student's t-test was used for statistical analysis.

The mean surgical time per specimen unit weight was 2.56 min/g for harmonic scalpel thyroidectomy and 5.99 min/g for conventional thyroidectomy. This difference was statistically significant (p = 0.037). The difference was most evident for procedures involving smaller thyroid glands.

Our study suggests that thyroidectomy using a harmonic scalpel is more time-efficient than conventional thyroidectomy, especially when operating on smaller thyroid glands.

This study evaluated the role of botulinum toxin type A in the treatment of refractory laryngeal granulomas.

Retrospective clinical review at a tertiary care hospital. Seven patients with vocal process granulomas underwent percutaneous injection of botulinum toxin into both vocal folds, performed in an office setting. Total doses ranged from 10 to 25 U, divided between both vocal folds.

All patients experienced resolution of their granulomas over two to seven weeks. No patient developed aspiration pneumonia. All patients experienced hoarseness secondary to the injections, but voice quality returned to baseline in all patients as the toxin was degraded.

Botulinum toxin is safe and effective therapy in resolving vocal process granulomas in patients refractory to traditional therapy. The optimal treatment dose remains to be determined.

Percutaneous botulinum toxin injection is helpful in resolving laryngeal granulomas.

This study investigated the extent to which the anterior ethmoidal artery and anterior ethmoidal foramen could be reliably identified on routine coronal sinus computed tomography scans. Where they could be identified, the relationship of these structures with the vertical height of the skull base, and their distance from an anterior landmark, were measured.

Fifty consecutive coronal sinus computed tomography scans were viewed independently by two observers. Scans were reviewed when the observers' opinions differed.

Inter-observer concordance was high. The anterior ethmoidal foramen was visualised in 95 per cent of cases bilaterally and in the remaining 5 per cent unilaterally. The anterior ethmoidal artery was visualised in 33 per cent of scans. The anterior ethmoidal foramen was at skull base level in 72 per cent of sides studied, and below it in the remainder. The distance from the lacrimal crest to the anterior ethmoidal foramen was 22.4 mm (mean; standard deviation 3.7).

The anterior ethmoidal foramen is a reliable landmark on coronal computed tomography scans of the paranasal sinuses. From this, the position of the anterior ethmoidal artery can be inferred.

After tympanoplasty using a total ossicular replacement prosthesis, many unsatisfactory hearing results are due to dislocation of the prosthesis.

We developed a cartilage guide for stabilising the total ossicular replacement prosthesis in the oval window niche. An oval-shaped piece of cartilage measuring 2.5 × 3.5 mm with a central hole was precisely punched out of a thin cartilage plate. The cartilage was placed in the oval niche, and its hole centred the prosthesis on the stapes footplate.

Hearing results in 52 patients confirmed acoustically the effectiveness of this method of total ossicular replacement prosthesis stabilisation on the stapes footplate. Subsequent ‘second-look’ surgery revealed stable ingrowth of the cartilage ‘shoe’ into the oval niche.

Such a cartilage shoe might address one of the causes of unsatisfactory hearing following ossicular chain reconstruction with a total ossicular replacement prosthesis.