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.

Sulphur mustard is a chemical warfare agent which was used against Iranian combatants and civilians between 1983 and 1988. The purpose of this study was to document the delayed toxic effects of sulphur mustard in Iranian veterans, focussing on head and neck complications.

This was a two-year, prospective, descriptive study of 43 male Iranian veterans aged 34 to 48 years (mean 41.8 years) who were moderately disabled or worse due to sulphur mustard poisoning. Investigations were performed with consent, including haematological, biochemical and immunological tests, spirometry, chest X-ray, high resolution computed tomography of the lungs, and skin biopsies. Further investigations and interventions were performed as clinically indicated.

The most affected sites were the lungs (95 per cent), peripheral nerves (77 per cent), skin (73 per cent), eyes (68 per cent), and head and neck (16.2 per cent). Of seven patients with mostly head and neck complications, four had a skin disorder (hyperpigmentation in all four, an erythematous, papular rash in two, and dry skin in one). Two patients had thyroid cancer (undifferentiated thyroid carcinoma in one and papillary carcinoma of a thyroglossal cyst in the other, 12 and 14 years after sulphur mustard exposure, respectively). One patient had nasopharyngeal carcinoma, 12 years after sulphur mustard exposure.

Carcinomas of the thyroid and nasopharynx in three patients with sulphur mustard exposure are reported for the first time.

This study aimed to compare the impact of total versus subtotal thyroidectomy on calcium metabolism and bone mineral density in euthyroid, premenopausal women.

The study included 24 premenopausal women who had undergone total (n = 10) or subtotal (n = 14) thyroidectomy and who were receiving nonsuppressive doses of thyroxine. The median post-operative period was four years. We determined, in all patients, the following parameters associated with calcium metabolism: total serum calcium, inorganic phosphate, intact parathormone, calcitonin and alkaline phosphatase. The bone mineral density of the spine and hip were measured using a Hologic QDR 4500C bone densitometer and were compared with controls matched for age and peak bone mineral density (using the t-test).

The measured calcium metabolism parameters were normal in all patients, and none had osteoporosis. There was no significant difference in the bone mineral density measurements for the spine and hip, comparing patients who had undergone total versus subtotal thyroidectomy (using the t-test).

The impact of total thyroidectomy on bone mineral metabolism is not significantly different from that of subtotal thyroidectomy, in premenopausal women with normal thyroid-stimulating hormone values.

To report the short- and long-term results of two techniques (mental imagery and manual shaking of the larynx) in patients with non-organic dysphonia or aphonia.

Retrospective review of patient records, plus follow-up survey (questionnaire).

Academic teaching hospital.

One hundred and sixteen patients with moderate to severe non-organic dysphonia or aphonia.

Cure (i.e. normal voice) and improved voice quality, judged by clinicians and patients.

One hundred (86 per cent) of the 116 patients were cured. Ninety-four (81 per cent) patients regained their normal voice within one therapy session. The follow-up survey revealed that 43 of the 87 (49 per cent) patients who responded had not had a relapse since therapy ended. Of those patients suffering relapse, 15 successfully applied mental imagery in order to retrieve their voice, compared with three patients who applied shaking of the larynx.

Mental imagery, combined if necessary with manual therapy, is an effective therapeutic technique in patients with non-organic voice disorders.

The treatment of children with ‘glue ear’ often presents surgeons with the question of whether or not to insert a grommet when myringotomy reveals no fluid in the middle ear. We present a study designed to assess which factors contribute to the presence of a ‘dry tap’.

We prospectively gathered data from a cohort of 280 children (504 myringotomies). The cohort included two subgroups, one received halothane and nitrous oxide anaesthesia, and the other received enflurane anaesthesia.

The ENT department of a district general hospital.

Children (aged less than 17 years) requiring myringotomy.

The presence of a ‘glue’ or dry tap at myringotomy was documented. We also recorded data on the following: pre- and post-induction tympanometry; age; season; anaesthetic type; and the delay from listing to actual operation.

A non type B pre-induction tympanogram and delay to operation were strong indications of finding a dry tap at surgery.

In our study population, the proportion of dry taps at myringotomy was 18 per cent. The presence of a dry tap was rarely due to the induction of anaesthesia. Multivariate analysis revealed that the combination of factors most likely to predict a dry tap were non type B tympanogram and delay to operation.

Increased post-operative tonsillectomy haemorrhage rates have been observed following ‘hot’ tonsillectomy techniques, compared with ‘cold steel’ dissection. Post-tonsillectomy haemorrhage rates and the degree of blood loss during guillotine tonsillectomy have not been reported in the recent literature.

This retrospective case note review assessed the degree of blood loss during guillotine tonsillectomy, as measured by the number of tonsil swabs used, and the post-tonsillectomy haemorrhage rate.

In a group of 168 patients, no tonsil swabs were used in 13.1 per cent of cases, and less than two tonsil swabs were used in 41.1 per cent of cases.

Guillotine tonsillectomy, when performed by the method described in this article, resulted in minimal intra-operative blood loss in 54 per cent of cases, and appeared to have comparable post-tonsillectomy haemorrhage rates to cold steel dissection techniques.

To describe a new treatment for perichondritis and haematoma of the pinna. At present, the existing treatment for these conditions is initially medical (which usually fails), followed by surgery (incision, drainage and compression to prevent recurrence) with accompanying medical management. However, the result is often a failure, resulting in partial or complete ‘cauliflower ear’ deformity.

The described treatment involves draining the site of infection and irrigating with streptomycin solution. The cavity is then filled with a solution of streptomycin, hyaluronidase and triamcinolone.

The described treatment avoids the conventional surgical procedure, which is cumbersome for surgeons and harrowingly painful for patients.

The new treatment may be recommended for universal use.

To compare three methods of haemostasis used for ‘cold steel’ tonsillectomy, in terms of pain scores and morbidity.

Prospective, randomised, single-blinded, controlled clinical study. Three haemostasis methods were compared: compression of the tonsillar fossae with gauze packs; bipolar diathermy; and local anaesthesia then pack compression. The outcome measures were pain scores (derived from a visual analogue scale), peri-operative bleeding, and post-operative episodes of blood-stained saliva, consultation rate, tonsillar bed healing and days before return to regular diet. One hundred and five patients were included.

Peri-operative bleeding was significantly reduced in the local anaesthesia group compared with the other two groups. Delayed post-operative tonsillar bed healing was noted in the diathermy group. No other significant differences were found between the three haemostasis groups, for any other outcome measures. The presence of blood-stained saliva was associated with higher pain scores.

Diathermy and compression were associated with similar post-tonsillectomy morbidity.

We present an extremely rare case of a 44-year-old woman with right gustatory otorrhoea and otalgia.

The patient had been initially treated for otitis externa after Pseudomonas aeruginosa was grown from a microbiological swab. The otorrhoea fluid was collected and tested positive for amylase. Sialography and computed tomography imaging of the temporal bone confirmed a sialo-aural fistula from the right parotid gland to the bony external acoustic meatus. The defect was consistent with a patent foramen of Huschke. The fistula was identified surgically via a superficial parotidectomy approach, after contrast injection of Bonney's blue dye into the parotid duct, and then ligated and divided. The patient had immediate and sustained resolution of her otorrhoea.

Sialo-aural fistulae are extremely rare, and usually arise as a complication of surgery or as an acquired disease process. To date, only four cases have been reported. This case demonstrates the use of sensitive investigation involving sialography and computed tomography, as well as successful surgical management, with complete resolution of symptoms.

To investigate and compare the sensitivity and specificity of computed tomography and of endoscopy, as diagnostic tests for foreign body ingestion.

Over a two-year period, Asian patients with suspected foreign body ingestion were studied. The clinical findings, computed tomography images, endoscopic results, treatment and outcomes were prospectively analysed.

Over the study period, 193 patients were admitted for foreign body ingestion, complaining of a persistent foreign body sensation in the neck. The sensitivity and specificity of computed tomography were 78 and 96 per cent, respectively; the positive predictive value was 75 per cent and the negative predictive value 97 per cent. The diagnostic accuracy of computed tomography was 94 per cent.

Our study showed that computed tomography had high negative predictive value and accuracy in the diagnosis of foreign body ingestion. It was useful if endoscopy showed negative findings but the patient still had persistent symptoms of foreign body ingestion.

The study aimed to delineate the relationship between 18F-fluorodeoxyglucose uptake and histological findings in nasopharyngeal carcinoma.

We conducted a retrospective review of 88 patients referred to our positron emission tomography department with newly diagnosed, biopsy-proved nasopharyngeal carcinoma. Hospital records were reviewed for demographic and clinical data, including age, gender, body weight, histological analysis and clinical tumour stage.

Nineteen out of the 88 patients (22 per cent) had nasopharyngeal carcinoma of World Health Organization type I, 39 (44 per cent) had type II and 30 (34 per cent) had type III. The mean standardised uptake value for the primary tumour was 9.4 ± 5.0, ranging from 2.2 to 27.1. The mean standardised uptake values were 8.0 ± 3.9 for type I tumours, 9.7 ± 4.4 for type II tumours and 10.1 ± 6.3 for type III tumours (p = 0.451).

Our study found that type III nasopharyngeal carcinoma exhibited a higher 18F-fluorodeoxyglucose uptake than either type II or type I nasopharyngeal carcinoma. However, this difference was not statistically significant.

We evaluated the efficacy and safety of the extra-long Montgomery T tube for the management of major airway obstruction in tertiary care patients in Taiwan.

Eleven patients with major airway stenosis treated with an extra-long Montgomery T tube between April 2004 and December 2006 were retrospectively reviewed. Five patients had tracheostomy stenosis, two had intubation stenosis, one had traumatic stenosis, one had corrosive stenosis, one had laser burn stenosis and one had tubercular stenosis. All patients underwent three-dimensional airway reconstruction and endoscopic evaluation of airway stenosis. After determining the severity and location of airway stenosis, rigid bronchotherapy and Montgomery T tube placement were performed by rigid bronchoscopy.

The overall procedural success rate was 100 per cent. Three (27 per cent) patients were weaned from artificial ventilation, and all patients exhibited improved respiratory and functional status. No major post-operative complications or mortality were observed. At follow up (mean, 21.5 months), the decannulation rate was 27 per cent, and eight (73 per cent) patients had stable T tube ventilation. In four patients, granulation over the end of the T tube was controlled by endoscopic procedures. Three patients with stents above the vocal folds showed aspiration and required further intervention (i.e. one nasogastric feeding tube for nutrient supplement, one feeding jejunostomy and one stent shortening to decrease aspiration).

The extra-long Montgomery T tube is an effective and safe method for treating major airway obstruction in the supra-glottic to lower tracheal region.

The anatomy and function of the oropharynx and larynx during deglutition can be assessed using the flexible endoscope, but this evaluation does not provide information on the oesophagus. Guided observation of oesophageal swallowing enables extended dysphagia evaluation.

To assess the diagnostic utility of guided observation of oesophageal swallowing in the evaluation of dysphagia.

Retrospective case series.

Procedures for guided observation of oesophageal swallowing were reviewed for oesophageal findings and compared with fluoroscopy and manometry.

Twenty-one patients underwent guided observation of oesophageal swallowing and concurrent videofluoroscopy and/or manometry. No complications of the former procedure occurred. The results of guided observation of oesophageal swallowing concurred with those of fluoroscopy in 15/21 cases (71 per cent) and with those of manometry in five of six (83 per cent) cases. Guided observation of oesophageal swallowing revealed anatomic pathology contributing to dysphagia in 15/21 (71 per cent) patients. The procedure identified pathology not detected by fluoroscopy and manometry in 13/21 (62 per cent) patients.

Guided observation of oesophageal swallowing appears to be a safe diagnostic tool with which to evaluate the oesophageal phase of deglutition.

We report a patient with a 20-year history of apparently idiopathic airways stenoses, who presented with an antineutrophil cytoplasmic antibody (ANCA) associated, acute, systemic vasculitis with necrotising glomerulonephritis, subsequently diagnosed as Wegener's granulomatosis.

We present a case report and a review of the world literature on airway stenosis in Wegener's granulomatosis.

To our knowledge, this is the first report of Wegener's granulomatosis manifesting as local airway disease for such a prolonged period, before transforming into a systemic vasculitis.

This case highlights the need for physicians to be alert to the possibility of Wegener's granulomatosis as a cause of apparently idiopathic airway stenosis, and to be aware that systemic disease may occur in very long-standing, limited Wegener's granulomatosis.

An alternative method of reconstruction of a lower lip defect is presented, using a mucosal flap taken from the upper lip. This approach leaves the skin intact and therefore avoids skin scarring, with its associated unpredictable healing. The upper lip mucosal flap applied to reconstruct the lower lip injury was identical to the injured tissue type.

The results were functionally and aesthetically excellent (as illustrated).

This technique represents an excellent alternative to reconstruction of a damaged lip, with the benefits of minimal scar tissue formation and excellent aesthetic result.

To evaluate the efficacy of pure natural honey as prophylaxis against radiochemotherapy-induced mucositis, through clinical scoring of oral and oropharyngeal mucositis, and culturing of pathogenic oral and oropharyngeal microbes.

The study was done in Assiut University Hospital, Egypt, between January 2005 and July 2006. Forty patients diagnosed with head and neck cancer were entered into the trial. Enrolled patients were randomised to either the treatment group, receiving concomitant chemotherapy and radiotherapy (with a significant area of directly visible oral and/or oropharyngeal mucosa included in the radiation fields) plus prior topical application of pure natural honey, or the control group, receiving concomitant chemotherapy and radiotherapy without honey. Patients were evaluated clinically every week to assess development of radiation mucositis. Aerobic cultures and candida colonisation assessment were undertaken, via oral and oropharyngeal swabs, prior to and at the completion of irradiation, and when infection was evident.

In the treatment group, no patients developed grade four mucositis and only three patients (15 per cent) developed grade three mucositis. In the control group, 13 patients (65 per cent) developed grade three or four mucositis (p < 0.05). Candida colonisation was found in 15 per cent of the treatment group and 60 per cent of the control group, either during or after radiotherapy (p = 0.003). Positive cultures for aerobic pathogenic bacteria were observed in 15 per cent of the treatment group and 65 per cent of the control group, during or after radiotherapy (p = 0.007).

This study shows that prophylactic use of pure natural honey was effective in reducing mucositis resulting from radiochemotherapy in patients with head and neck cancer.