To evaluate potential pre-dive parameters in relation to paranasal sinus barotrauma in sports self-contained underwater breathing apparatus divers.

The pre-dive and follow-up records of 46 healthy sports self-contained underwater breathing apparatus divers were analysed.

In the routine pre-dive examination of diving candidates with no symptoms of rhino-sinus disease, rhinoscopy, sinus radiography and nasal endoscopy indicated no signs of rhinitis and/or sinusitis. Any signs of paranasal sinus barotrauma were noted, and several parameters were evaluated in relation to occurrence of barotrauma.

Of the studied parameters, a history of sinusitis and of middle-ear barotrauma was significantly more frequent in divers in the barotrauma group (p < 0.05).

In divers undergoing a routine pre-dive examination, paranasal sinus barotrauma was not related to sex, alcohol consumption, smoking, decongestant use, mild nasal septal deviation, or inability to perform the Valsalva or Toynbee manoeuvres. However, divers with a history of sinusitis or middle-ear barotrauma may be more prone to paranasal sinus barotrauma. A more detailed pre-dive examination may be useful for such individuals.

To discuss the management and to review the literature regarding retained knife blades in the head and neck.

We present three cases in which patients presented with retained knife blades in the head and neck region; in two of these, the diagnosis was delayed by more than eight weeks. In all patients, the retained knife blade was removed through the pathway of insertion, without significant sequelae.

The methods of removal, appropriate radiological investigations and patient profiles are discussed.

We propose that radiography be performed on all patients presenting with facial stab injuries which are anything more than superficial. We further suggest that the direct extraction of sharp objects through the pathway of insertion is safe if radiological studies show no risk of vascular injury.

Patients who have undergone tracheoesophageal puncture for surgical voice restoration often use unnaturally high oesophageal air pressures during speech. This study examined the effect of high oesophageal air pressure on oesophageal body motility, lower oesophageal sphincter function and dyspeptic symptoms.

Cross-sectional study using several investigative tests of oesophageal function.

Sixteen patients who used tracheoesophageal fistula speech underwent several investigations, including: oesophageal manometry, videofluoroscopy, barium swallow, and tracheal pressure measurements during speech. The patients were also asked to complete a dyspepsia questionnaire.

We demonstrated that more than 50 per cent of these patients had subjective or objective disordered oesophageal function. Videofluoroscopy and manometry identified oesophageal dysmotility in the same patients.

Oesophageal function appears to be altered by tracheoesophageal fistula speech. However, our study showed that there is no contraindication to proceeding with tracheoesophageal fistula voicing even in patients with a history of oesophageal dysfunction.

We report an extremely rare case of distant metastasis to the rectus femoris muscle from a laryngeal squamous cell carcinoma.

We present a case report and a review of the world literature concerning distant skeletal muscle metastasis from head and neck squamous cell carcinoma.

The patient showed no evidence of distant muscular recurrence at follow up after 21 months; however, two years later he died from brain and suprarenal metastases.

This report describes the first case of haematogenous distant metastasis to the left rectus femoris muscle from a laryngeal squamous cell carcinoma, without evidence of cervical lymph node metastases. To the best of our knowledge, this is the second reported case of muscular distant metastasis without cervical lymph node involvement. Although the prognosis associated with skeletal muscle metastasis is considered to be poor, surgical excision may be indicated for an isolated muscular metastasis.

A case of tracheopathia chondro-osteoplastica causing sub-glottic stenosis is described.

Case report and literature review.

A 37-year-old man presented with a 15-year history of gradually worsening dyspnoea and stridor due to sub-glottic stenosis. His medical and radiographic records were reviewed. This patient's presentation, histopathological findings and radiology images are presented and discussed.

Histopathological evaluation of microlaryngoscopy biopsy specimens, taken during laser debulking of the stenosis, confirmed the presence of tracheopathia chondro-osteoplastica.

This is the first reported case of sub-glottic stenosis caused by tracheopathia chondro-osteoplastica which required an urgent tracheostomy.

We report an adult case of nasopharyngeal carcinoma treated with radical chemo-radiotherapy, with subsequent development of a histologically proved temporal cavernous haemangioma within the radiation field.

Case report and review of the current literature concerning radiation-induced, secondary, space-occupying lesions.

The increasing role of radiotherapy in nasopharyngeal carcinoma treatment, together with improved patient survival, is likely to lead to radiation-induced, secondary, space-occupying lesions being encountered more frequently. We emphasise the need to be vigilant for this important but relatively rare complication, which has significant associated morbidity.

Office-based laryngeal injection for the treatment of a variety of voice disorders is an established practice. Various methods of delivery to the vocal folds are in practice.

We present a simple and repeatable method of injecting botulinum toxin into the larynx.

Botulinum toxin A (Botox®) was delivered into the larynx using a channelled fibre-optic laryngoscope under local anaesthetic, in an office setting.

Seven patients received regular botulinum toxin injections, via our preferred method. The treatment intervals and dosage regime varied depending on patient requirements. The procedure was carried out in an office setting, with minimal discomfort and inconvenience to the patient.

We present a method of botulinum toxin delivery to the larynx which is simple, easily repeatable and simply learnt by the otolaryngologist familiar with fibre-optic laryngoscope usage. This method is also comfortable and convenient for the patient.

To determine the frequency of altered tongue sensation following tonsillectomy, and its relationship to different surgical techniques.

Case–control study.

District general hospital.

One hundred and four consecutive adults undergoing tonsillectomy, and 43 control patients.

Altered tongue sensation.

Twenty-eight of 100 patients described altered tongue sensation post-tonsillectomy. No patients in the control group experienced altered tongue sensation. There was a difference in rates of altered sensation between tonsillectomy patient groups undergoing bipolar diathermy and ‘cold steel’ techniques (p < 0.019). Three months after surgery, 22/23 contactable patients reported complete recovery of tongue sensation. One patient experienced tongue paraesthesia persisting until one year post-tonsillectomy.

Tonsillectomy resulted in altered tongue sensation in 28 per cent of our study group. Bipolar diathermy dissection was significantly more likely to cause altered sensation than cold steel dissection. Ninety-six per cent of these disturbances resolved by three months, all by one year. Possible alteration of tongue sensation should be discussed whilst obtaining consent for tonsillectomy.

To emphasise the importance of considering a diagnosis of early acquired syphilis in all sexually active adults, and to review the ENT manifestations and treatment of acquired syphilis.

A 24-year-old woman presented with sudden hearing loss, and subsequently developed clinical features suggestive of secondary syphilis. She was seen in the departments of ENT, dermatology, rheumatology and infectious diseases before a correct diagnosis was made. Treatment resulted in only partial recovery of hearing.

With the exponential rise in syphilis cases in the UK, there has been a re-emergence of presenting manifestations that had previously become rare. Early syphilis should be considered in all sexually active adults who present with deafness, as prompt diagnosis and treatment are crucial for maximum recovery.

The presence of distant metastases affects the therapeutic regime in patients with head and neck squamous cell carcinoma. This study evaluated the necessity to undertake bone scanning, chest computed tomography and abdominal ultrasonography in patients presenting with primary advanced head and neck squamous cell carcinoma.

Retrospective analysis, university setting.

One hundred and sixty-three patients with head and neck squamous cell carcinoma who were scheduled for major surgery underwent screening for distant metastases. Chest, head and neck computed tomography, abdominal ultrasonography and bone scanning were performed in all patients.

Distant metastases were detected in 5.52 per cent of the 163 patients. All of these patients had locoregional advanced (stage IV) tumours. Computed tomography scanning of the lungs revealed metastases in six patients. Bone metastases were found in three patients. Only one patient with primary liver metastases was detected by abdominal ultrasonography; this patient also had pulmonary metastases.

Computed tomography of the thorax is the most important technique for screening patients with head and neck squamous cell carcinoma.

To analyse correlations between quality of life measures, aspiration and extent of surgical resection in patients who have undergone free-flap tongue reconstruction.

Nine consecutive patients (seven men and two women; average age 51 years) who had been diagnosed with T4a carcinoma of the mobile tongue and/or tongue base and treated by glossectomy, free-flap reconstruction, and either radiation therapy or chemoradiation responded to the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire, the performance status scale questionnaire and the hospital anxiety–depression scale questionnaire, an average of 43 months after treatment (range 18–83 months). Aspiration was evaluated by fibre-optic laryngoscopy. Correlations between quality of life domain scores, extent of surgery and the presence of aspiration were evaluated using non-parametric statistical analysis.

Scores for the swallowing and aspiration domains of the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire were significantly correlated with the extent of tongue base resection (Spearman's correlation, p = 0.037 and 0.042, respectively). Despite a strong correlation between the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire results and the performance status scale global scores (correlation coefficient = 0.89, p = 0.048), the performance status scale domain scores were not correlated with the extent of tongue resection. Clinically apparent aspiration was not correlated with the extent of tongue resection, nor were the anxiety or depression scores. However, clinically apparent aspiration was significantly related to the swallowing and aspiration domain scores of the European Organization for Research and Treatment of Cancer Head and Neck-35 questionnaire (p = 0.017 in both cases).

Our results imply that the volume of tongue base resection is a major factor in swallowing- and aspiration-related quality of life following tongue resection and free-flap reconstruction. Free-flap reconstruction does not seem to palliate the effect of the loss of functional tongue base volume, as regards swallowing-related quality of life.

A variety of topical preparations are used for symptomatic relief following nasal surgery. The aim of this study was to compare the effect of two commonly used products on patient symptom scores following nasal surgery.

Randomised, single-blinded, comparative clinical trial.

A single, secondary otorhinolaryngology centre.

One hundred and twenty patients undergoing septoplasty or functional endoscopic sinus surgery as an isolated procedure between November 2003 and January 2006. Patients undergoing additional nasal procedures were excluded, as were those requiring additional post-operative medications other than standardised analgesia.

Following nasal surgery, patients were randomised to receive either xylometazoline hydrochloride 0.1 per cent nasal spray or a sterile physiological saline aerosol.

Visual analogue scale symptom scores for nasal obstruction, rhinorrhoea, pain, loss of sense of smell and bleeding were assessed at day 10 post-operatively.

Post-operative symptom scores were compared between treatment groups. Overall, median pain scores were significantly higher in the xylometazoline group (p = 0.03, chi-square test). When analysed by procedure, median pain scores were significantly higher in septoplasty patients using xylometazoline (p = 0.019, chi-square test).

There is no evidence to support the use of xylometazoline hydrochloride 0.1 per cent nasal spray over aerosolised physiological saline alone, following nasal surgery. Furthermore, there may be more pain associated with the post-operative use of xylometazoline.

We present an unusual case of a 12-year-old child with state-dependent laryngomalacia presenting after anaesthesia with a laryngeal mask airway.

Current literature on state-dependent laryngomalacia and injury following laryngeal mask use is reviewed.

A child who had previously suffered with laryngomalacia as an infant presented with disturbed breathing at night and during exercise. After anaesthesia using a laryngeal mask airway, these symptoms became more pronounced. Microlaryngoscopy revealed laryngomalacic type movement of the larynx.

Our case seems to support a more complex, multifactorial aetiology for laryngomalacia, including both the neurological control of the larynx as well as its structure.

The aim of this study was to describe the successful operative management of a patient with superior semicircular canal dehiscence syndrome, using the transmastoid approach under local anaesthesia.

The transmastoid approach was used to plug the superior semicircular canal.

Post-operatively, the patient experienced significant improvement in his symptoms of sound- and pressure-induced dysequilibrium, autophony and imbalance.

Successful operative management of superior semicircular canal dehiscence can be achieved via the transmastoid approach under local anaesthesia.

We report an extremely rare case of congenital cholesteatoma affecting the occipital bone.

We present a case report, plus a review of the world literature on similar lesions.

This case report describes the presentation and treatment of a congenital cholesteatoma arising in an apparently unique location within the occipital bone, with no effect on middle-ear structure or function. The different imaging characteristics of this lesion are described and illustrated. The discussion centres on the differentiation of this lesion from intradiploic epidermoid cysts, more commonly described in the neurosurgical literature. The possible methods of pathogenesis are discussed, along with treatment suggestions.

Congenital cholesteatomas and intradiploic epidermoid cysts are indistinguishable both histologically and radiologically, and would appear to be the same disease.

We report a rare presentation of ancient schwannoma of the oesophagus, management of which required tracheal resection.

A 40-year-old woman was referred to our hospital with a six-year history of progressively worsening stridor. She had undergone laser excision of a tracheal tumour thrice in the past. Fibre-optic bronchoscopy showed a tumour arising from the posterior wall of the trachea. Computed tomography scanning showed evidence of extension along the retrotracheal plane. The patient required tracheal resection and anastomosis due to significant involvement of the posterior tracheal wall. The mass was seen to be arising from the oesophagus, and was able to be enucleated from the oesophageal wall. Histopathology was typical of an ancient schwannoma.

This case emphasises the need to consider oesophageal schwannomas in the differential diagnosis of posterior tracheal tumours; it also highlights the need for careful pre-operative assessment in the management of these tumours in order to avoid complications.