This paper evaluates the feasibility of transoral, endoscopic resection of macroscopically localised, low grade, subglottic chondrosarcoma.

Retrospective case study including patients diagnosed with low grade, subglottic laryngeal chondrosarcoma. Tumours were resected endoscopically via direct laryngoscopy with microlaryngeal technique, under jet ventilation. The post-operative course, vocal fold function, airway patency and oncological results were evaluated.

Two male patients aged 49 and 60 years underwent endoscopic, translaryngeal, en bloc resection of low grade chondrosarcoma of the cricoid cartilage. Extubation was performed immediately after surgery. Neither patient required tracheostomy or developed subglottic stenosis. No tumour recurrence was noted after an average follow up of 10.5 months. Voice quality was stable and dyspnoea improved.

Transoral, endoscopic resection of low grade, subglottic chondrosarcoma is a viable technique with good functional outcomes. Extensive resection of subglottic disease is possible, which may afford patients an alternative to total laryngectomy.

The aim of the study was to determine the effectiveness of alcohol sclerotherapy in patients with human immunodeficiency virus related salivary gland disease.

Prospective study investigating the effectiveness of alcohol as a sclerosing agent.

Tertiary referral hospital.

Eleven human immunodeficiency virus positive patients with benign lymphoepithelial cysts were included in the study, from July 2005 to September 2006.

Alcohol sclerotherapy was performed under local anaesthesia, with alcohol infiltrated into the benign lymphoepithelial cysts.

Alcohol injection sclerotherapy proved to be an effective, simple, cheap, ambulatory procedure for patients who did not qualify for antiretroviral treatment.

Methods of perceptual voice evaluation have yet to achieve satisfactory consistency; complete acceptance of a recognised clinical protocol is still some way off.

Three speech and language therapists rated the voices of 43 patients attending the problem asthma clinic of a teaching hospital, according to the grade-roughness-breathiness-asthenicity-strain (GRBAS) scale and other perceptual categories.

Use of the GRBAS scale achieved only a 64.7 per cent inter-rater reliability and a 69.6 per cent intra-rater reliability for the grade component. One rater achieved a higher degree of consistency. Improved concordance on the GRBAS scale was observed for subjects with laryngeal abnormalities. Raters failed to reach any useful level of agreement in the other categories employed, except for perceived gender.

These results should sound a note of caution regarding routine adoption of the GRBAS scale for characterising voice quality for clinical purposes. The importance of training and the use of perceptual anchors for reliable perceptual rating need to be further investigated.

This study aimed to investigate the outcomes of autologous ossiculoplasty following temporal bone fracture.

We analysed 10 patients who underwent autologous ossiculoplasty following temporal bone fracture from 1993 to 2006. Average results for air conduction, bone conduction and air–bone gap were calculated, using both a three- and a four-frequency average, in order to evaluate the effect of the operation.

The average follow-up time was 24.4 months. Dislocation of the incus was the most common operative finding. The average three- and four-frequency post-operative air–bone gaps were 12.0 dB (standard deviation 8.3) and 13.8 dB (standard deviation 7.7), respectively. The average air–bone gap improvements were 24.5 dB (standard deviation 13.8) and 24.4 dB (standard deviation 12.1), respectively. Eighty per cent (eight of 10) of the patients had socially acceptable hearing in the operated ear. However, only 50 per cent achieved closure of the air–bone gap to within 10 dB.

Methods of maximising the stability of the reconstructed ossicular chain should be further studied.

The tracheoesophageal puncture technique of voice restoration enables successful voice rehabilitation after total laryngectomy. Because post-operative voice quality can vary significantly, depending on which type of hypopharyngeal repair is chosen, the aim of this study was to evaluate the effect of such repair on tracheoesophageal puncture voice after total laryngectomy.

Prospective, clinical study.

Otolaryngology department, Tanta University, Egypt.

Tracheoesophageal puncture voice was quantitatively and qualitatively evaluated in 40 patients using a Provox 2TM prosthesis after standard total laryngectomy. The patients were divided, according to the type of hypopharyngeal repair, into four groups of 10 cases each, as follows: group one, pharyngoesophageal myotomy; group two, pharyngeal plexus neurectomy; group three, non-muscle vertical repair; and group four, transverse repair. These surgical groups were compared with each other with respect to different voice parameters.

Patient profiles were almost equivalent in all surgical groups. The mean values of most of the parameters of quantitative tracheoesophageal puncture voice did not differ significantly, comparing the four surgical groups; however, a slightly significant difference was observed regarding loud intensity in the non-muscle repair group, and soft and loud jitter in the transverse repair group. Mean values for qualitative measures of intelligibility and communicative effectiveness did not show significant difference. However, a slightly significant difference was observed regarding fluency, word correctness, speaking rate and wetness, with higher values for all these parameters except wetness in the myotomy group, and higher values for wetness in the non-muscle repair group.

The four hypopharyngeal repair types – primary pharyngoesophageal myotomy, pharyngeal plexus neurectomy, non-muscle vertical repair and transverse hypopharyngeal repair – were almost equivalent in prevention of pharyngoesophageal spasm in total laryngectomy patients who had undergone primary tracheoesophageal puncture for voice restoration.

Following a suggestion by ward patients that Rapid Rhino™ nasal packs may deflate over time, allowing recurrence of epistaxis, we aimed to demonstrate deflation of 7.5 cm Rapid Rhino packs when used in vivo for post-operative nasal packing.

The volume of air insufflated and retrieved from Rapid Rhino nasal packs used for post-operative nasal packing was recorded, as was the pressure following inflation and prior to removal. The time taken for the initial inflation pressure to stabilise was monitored in a number of packs. Similar pressure and volume measurements were repeated in a series of in vitro packs for comparison.

Fourteen consecutive patients undergoing septoplasty were recruited. High but unsteady pressure values were obtained in the first patient's packs. In the subsequent five patients, continuous pressure monitoring demonstrated that gradual depressurisation occurred over the first 16 to 22 minutes following inflation. A typical pressure was 35 cmH2O after inflating with 8 ml of air. Only one Rapid Rhino pack was demonstrated to leak air in vivo.

When used in vivo, Rapid Rhino nasal packs initially depressurise over a period of about 20 minutes. Actual leakage (deflation) was not demonstrated to be an expected feature of Rapid Rhino packs in this study.

To present the theory that large vestibular aqueduct syndrome (i.e. the recognised existence of an enlarged vestibular aqueduct with progressive sensorineural hearing loss) and endolymphatic hydrops are due to a common primary dysfunction of inner-ear fluid homeostasis.

Case report and review of the world literature concerning large vestibular aqueduct syndrome and endolymphatic hydrops.

We report a family in which one sibling suffered from large vestibular aqueduct syndrome while the other had classic Ménière's disease. This suggests that large vestibular aqueduct syndrome and endolymphatic hydrops, in some cases, may be due to a common primary dysfunction of inner-ear fluid homeostasis.

To our knowledge, this is the first report in the world literature to postulate that variation in the relative compliance of inner-ear membranes could be the factor that determines the manifestation of the disorder as either endolymphatic hydrops or large vestibular aqueduct syndrome.

S-phase kinase-associated protein 2 is required for the degradation of p27 protein, which is a negative regulator of cyclin E/cyclin-dependent kinase 2 complex. The present study examined the expression of cyclin E, S-phase kinase-associated protein 2 and p27 protein in nasopharyngeal carcinoma.

Tissue from 35 cases of nasopharyngeal carcinoma and 10 normal nasopharyngeal tissue samples underwent reverse polymerase chain reaction to detect messenger ribonucleic acid. Immunohistochemical analysis was performed on 29 nasopharyngeal tissue samples in order to detect protein expression.

Messenger ribonucleic acid expression in the nasopharyngeal carcinoma tissue samples analysed indicated a 1.75-fold change in the amount of S-phase kinase-associated protein 2, a 0.34-fold change in the amount of cyclin E and a 0.31-fold change in the amount of p27 protein, compared with positive controls. High levels of cyclin E significantly correlated with late-stage nasopharyngeal carcinoma (p = 0.009) and a poor overall survival (p = 0.010). Immunohistochemical analysis indicated positive expression of S-phase kinase-associated protein 2 in 16/29 nasopharyngeal tissue samples (55 per cent), of cyclin E in 13/29 samples (45 per cent) and of p27 protein in 17/29 (59 per cent) samples.

Overexpression of cyclin E messenger ribonucleic acid showed an adverse prognostic significance, correlating with an advanced stage of nasopharyngeal carcinoma and a low overall survival rate.

To investigate the safety and efficacy of ozone therapy in adult patients with sudden sensorineural hearing loss.

Prospective, randomised, double-blinded, placebo-controlled, parallel group, clinical trial.

Forty-five adult patients presented with sudden sensorineural hearing loss, and were randomly allocated to receive either placebo (15 patients) or ozone therapy (auto-haemotherapy; 30 patients). For the latter treatment, 100 ml of the patient's blood was treated immediately with a 1:1 volume, gaseous mixture of oxygen and ozone (from an ozone generator) and re-injected into the patient by intravenous infusion. Treatments were administered twice weekly for 10 sessions. The following data were recorded: pre- and post-treatment mean hearing gains; air and bone pure tone averages; speech reception thresholds; speech discrimination scores; and subjective recovery rates.

Significant recovery was observed in 23 patients (77 per cent) receiving ozone treatment, compared with six (40 per cent) patients receiving placebo (p < 0.05). Mean hearing gains, pure tone averages, speech reception thresholds and subjective recovery rates were significantly better in ozone-treated patients compared with placebo-treated patients (p < 0.05).

Ozone therapy is a significant modality for treatment of sudden sensorineural hearing loss; no complications were observed.

To audit the number of patients attending an ENT emergency clinic more than twice in the same clinical episode.

A completed audit cycle. The inclusion criterion for the retrospective arm was patients who had attended the ENT emergency clinic more than twice between 1 September to 30 November 2007. Data were analysed and interventions implemented. The re-audit, using the same inclusion criteria, was done between 1 March to 31 May 2008.

The initial audit found that 38 patients were seen more than twice in the ENT emergency clinic, giving rise to 81 ‘excess’ clinic appointments. After intervention, the re-audit identified 19 patients who were seen more than twice in the ENT emergency clinic, giving rise to 24 ‘excess’ clinic appointments.

By insisting that patients seen more than twice in the ENT emergency clinic were reviewed by a senior clinician, and by introducing a management guideline for acute otitis externa, we reduced excess clinic appointments by 70 per cent.

To provide an up to date review of the literature on aneurysmal bone cysts, including their diagnosis, pathology, pathophysiology, radiology and management.

Retrospective review of six cases over a 15-year period.

Six patients (age range, eight months to 17 years; mean, 9.6 years) presented with an aneurysmal bone cyst in the mandible (n = 3), maxilla (n = 2) or occipital soft tissue (n = 1). Each patient underwent primary excision, with one subsequent recurrence.

Aneurysmal bone cysts are benign but locally destructive entities which may occasionally present to otolaryngologists, since they can involve the head and neck region, in particular the mandible.

The pathophysiology of snoring and obstructive sleep apnoea is still unclear. Two theories are proposed. The first is the obstructive theory, which postulates palatopharyngeal muscle hypertrophy leading to airway narrowing; there is no neural role. The second is the neurogenic theory, which postulates neural degeneration due to vibratory stretch trauma, leading to muscle atrophy and collapse. As identification of nerve fibres in the uvula and palate is difficult and time-consuming, all previous studies aiming to differentiate between these two theories have been based on indirect observation of the muscles, rather than direct study of the nerves.

We conducted a prospective study to directly observe and study nerve fibres in uvular specimens from 10 cases of obstructive sleep apnoea, compared with specimens from 10 cases of simple snoring, using transmission electron microscopy. Five autopsy cases served as controls.

Obstructive sleep apnoea was associated with definite degenerative changes in myelinated and unmyelinated nerve endings. These degenerative changes were present to a lesser degree and in a smaller proportion of cases of simple snoring.

The events postulated by the neurogenic theory of obstructive sleep apnoea appear to play an important role in the pathophysiology of snoring and obstructive sleep apnoea.

After excision of a preauricular sinus, a head bandage compressive dressing is usually used to reduce dead space and to decrease the risk of recurrence. However, such use of a head bandage may cause various problems. We assessed a new method of compressive dressing, using suture transfixion of silicone sheets to the former sinus tract, following preauricular sinus excision.

This retrospective study reviewed the medical records of patients undergoing preauricular sinus excision in a tertiary referral centre over a five-year period. After excision of the preauricular sinus, patients underwent suture transfixion of silicone sheets. Post-operative outcomes were analysed.

The new dressing method was performed on 50 ears of 37 patients. The post-operative incidence of recurrence and haematoma formation was 4 and 2 per cent, respectively. Other problems possibly caused by head bandaging, such as headache, facial flushing, and nausea and/or vomiting, were not observed.

Compressive dressing by suture transfixion of silicone sheets is safe and effective following preauricular sinus excision.

This retrospective study reviewed the ENT-related cases seen, and the discharge or transfer outcomes, at both a local ‘walk-in centre’ and the respective emergency department, over one year in Norwich.

Of the 7657 ENT cases seen at the walk-in centre, the commonest conditions included tonsillitis or pharyngitis, otalgia, cough, and deafness. In comparison, 1586 patients were seen at the emergency department, and the commonest conditions were epistaxis and throat foreign bodies. Of the ENT cases seen at the walk-in centre, 85.4 per cent were treated and discharged. Of the 14.6 per cent referred to other healthcare providers, 11.1 per cent were to the general practitioner. In comparison, the emergency department discharged 41.2 per cent and referred 58.8 per cent to other healthcare providers.

This study indicates that ENT cases may constitute a large proportion of patients seen in walk-in centres, and that the case types seen may differ from those presenting to emergency departments. It also indicates that walk-in centres may potentially be assessing, treating and discharging 85.4 per cent of ENT patients seen.

The commonest form of extrapulmonary tuberculosis is tubercular cervical lymphadenitis, or scrofula.

A total of 1827 patients with cervical lymphadenopathy who presented to various out-patients clinics of our institution were studied over a three-year period. Eight hundred and ninety-three (48.87 per cent) of these patients had lesions of tubercular origin. The most common observation was unilateral, matted adenopathy in female patients aged between 11 and 20 years and without constitutional symptoms of tuberculosis. Posterior triangle nodes were affected in 43.8 per cent of cases, followed by upper deep cervical nodes in 33.9 per cent. Fine needle aspiration cytology constituted the main diagnostic tool, with a positive yield in 90 per cent of patients. Polymerase chain reaction analysis was performed in 126 patients, with a sensitivity of 63 per cent. Only 18 per cent of patients had associated pulmonary tuberculosis, the rest having isolated involvement of cervical nodes. Medical treatment with anti-tubercular drugs for a period of six months formed the mainstay of treatment and cure. Surgical management was reserved for selected refractory patients.

Tubercular cervical lymphadenitis can readily be diagnosed by fine needle aspiration cytology, a simple and cost-effective test. The disease can be cured completely by a short course of anti-tubercular chemotherapy, without surgical intervention.

Follow up of patients with differentiated thyroid cancer is based upon anatomical imaging, thyroglobulin assay and functional imaging in the form of iodine uptake scanning. A significant cohort of such patients have rising thyroglobulin levels but negative iodine scans. In this group, 18fluoro-2-deoxyglucose positron emission tomography scans have been commonly employed. The aim of this study was to assess the usefulness of such investigation.

The sensitivity of 18fluoro-2-deoxyglucose positron emission tomography for detecting recurrence of differentiated thyroid cancer was calculated from a retrospective review of scan results from patients with iodine scan negative recurrence.

Eighteen patients with rising thyroglobulin levels underwent 18fluoro-2-deoxyglucose positron emission tomography scanning. Fourteen patients had negative (and four equivocal) whole body iodine scintigraphy scans. Of these 14, six patients had a positive 18fluoro-2-deoxyglucose positron emission tomography scan, giving a sensitivity of 42.9 per cent.

When assessed in the clinical setting and restricted to patients with negative iodine scans, the sensitivity of 18fluoro-2-deoxyglucose positron emission tomography was found to be lower than in previous case series.

To introduce the use of optical coherence tomography with an operating microscope for intra-operative evaluation of the human larynx.

A specially equipped operating microscope with integrated spectral domain optical coherence tomography apparatus was used during microlaryngoscopy.

Technical improvements in optical coherence tomography equipment (e.g. pilot beam, variable focal distance, improved image quality and integration into an operating microscope) have enabled greater sensitivity and imaging speed and a non-contact approach. Spectral domain optical coherence tomography now enables a better correlation between optical coherence tomography images and histological findings. With this new technology, the precision of biopsy can be improved during microlaryngoscopy.

Use of this new optical coherence tomography technology, integrated into an operating microscope, enables the surgeon to define the biopsy site location and resection plane precisely, while the optical zoom of the operating microscope can be used over the complete range.

To highlight a poorly known anatomical variation of the lateral lobe of the thyroid gland, which can be useful in identifying the recurrent laryngeal nerve during thyroid surgery.

We performed a three-year prospective study of 79 thyroid surgery patients. Great attention was paid to anatomical variations of the thyroid gland (i.e. the presence or absence of a distinct tubercle of Zuckerkandl), the recurrent laryngeal nerve and the location of the parathyroid glands.

A total of 71 right lobectomies and 74 left lobectomies were performed. Five tubercles of Zuckerkandl were identified (7.04 per cent of cases) and were useful in detecting the recurrent laryngeal nerve (but only on the right side).

The tubercle of Zuckerkandl is a poorly known and variable anatomical feature of the thyroid gland which may not, in fact, be so rare. It arises for embryological reasons, and it can be a reliable anatomical landmark for identifying the recurrent laryngeal nerve during thyroid surgery. It should be included in the Nomina Anatomica as the ‘processus posterior glandulae thyroideae’ described by Zuckerkandl.