We present a patient with an inflammatory pseudotumour of the neck with multifocal sites in the head and chest responding to steroids. A review of the literature revealed that this is the first case of a pseudotumour with multiple sites in the head and neck as revealed by 2-[18]fluorodeoxyglucose(FDG) PET scan imaging.

We report the case of an 18-year-old male patient who presented to us with unilateral conductive hearing loss with duplication of the lobule. An exploratory tympanotomy revealed stapes footplate fixation. A stapedotomy with insertion of a Teflon piston was performed with improvement in his hearing. We believe this is the first reported case of such an abnormality.

Lymphangiomas or cystic hygromas are relatively uncommon congenital malformations of the lymphatic system which usually present in the first years of childhood. Presentation in adult life is rare. We present a case of cervical adult cystic hygroma and discuss radiological and histopathological features as well as the management of these neck masses.

Objective: A new technique of direct phonoplasty under local anaesthetic is described.

Background: Vocal-fold medialization is an accepted method to improve voice in patients with a paralysed vocal fold. Various materials have been used to inject into the paralysed vocal fold, resulting in medialization of the fold and improved phonation. The two established methods are direct injection under general anaesthetic and transcutaneous injection under local anaesthetic; both have advantages and disadvantages.

Method: A Pentax 80K series flexible endoscope is used to directly inject collagen into the paralysed vocal fold via a reusable 23G endoscopic needle under local anaesthetic.

Conclusion: New technology and innovation have allowed development of the new technique of direct phonoplasty under local anaesthetic. This combines the advantages of transcutaneous injection under local anaesthetic and direct injection under general anaesthetic, without their disadvantages.

We present a method to cauterize an actively bleeding source in anterior epistaxis. In our experience, this method is efficient, provides full control of the bleeding, and ensures precise cautery of the bleeding source with minimal usage of chemical cautery sticks.

Objective: Displacement of the tracheostomy tube in paediatric patients is a potentially fatal complication. We describe an extra safety measure which facilitates tube replacement.

Setting: Tertiary referral specialist paediatric centre.

Materials and methods: The method involves the placement of sutures between the anterior tracheal wall and skin to hasten the formation of a mature stoma (maturation sutures). We also undertook a retrospective case note review on patients from an academic tertiary referral centre. Thirty-five notes were reviewed. The most common indication for tracheostomy was airway obstruction (65 per cent). Fourteen patients had early and 10 had late complications with three tube displacements occurring. No added complications due to the use of sutures were found.

Conclusions: Our complication rates compare well with those in the literature, and we recommend considering the use of such a technique.

Iatrogenic injury to the spinal accessory nerve (SAN) during neck dissection may result in significant and avoidable morbidity in the form of ’shoulder syndrome’. The authors describe a simple method, based on the anatomy of the sternocleidomastoid muscle (SCM), which allows consistent and rapid identification of the SAN in the upper neck during dissection, thereby facilitating its preservation.

Objectives: Transtympanic pressure has been shown to influence endolymphatic hydrops. As endolymphatic hydrops plays a key role in Ménière’s disease, a few studies, undertaken by the inventors, manufacturers and associates of the Meniett device,have demonstrated positive short-term effects of transtympanic pressure treatment via the Meniett device in medically intractable Ménière’s disease. The aim of our study was to independently investigate the long-term efficacy and safety of transtympanic pressure treatment in the management of recalcitrant vertigo in Ménière’s disease.

Design: Cross-sectional case study.

Setting: Tertiary referral centre.

Participants: Eighteen patients with Ménière’s disease, suffering from medically intractable symptoms. All patients in the study had Ménière’s disease according to the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head & Neck Surgery.

Main outcome measurements: Outcome and severity of symptoms were assessed, using the six-point functional scale and the vertigo visual analogue scale (VAS), as recommended by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head & Neck Surgery. Changes of pure tone average thresholds and vestibular calorics before and during treatment with the Meniett device were recorded. The mean follow-up time was 18 months.

Results: Twelve out of 18 patients showed significant improvement in the functional score and in the VAS. Five patients displayed an audiometric improvement, out of which three patients showed a pertaining significant hearing gain of more than 10 dB; the remainder had stable hearing levels. Of six patients without any improvement, four had previous invasive surgery for theirMénière’s disease and two had previous vestibular ablation with gentamicin.No changes in vestibular function were noted. There were no complications duringthe treatment with the Meniett device.

Conclusion: According to this independent study, the Meniett device seems to be a minimally invasive, non-destructive treatment tool, which can reduce vertigo and associated functional handicap in Ménière’s disease. These effects are maintained up to 18 months after treatment so far. Previous surgical or chemical vestibular ablation procedures may adversely influence the effect of the Meniett device.

Many surgical approaches have been developed for the treatment of adduction-type spasmodic dysphonia (SPD). We developed and performed a new type of surgical approach (autologous replacement of the vocal fold).

Our new surgical technique increases the advantages and decreases the disadvantages of previous surgical procedures in three ways: (1) It has similar effects to the previous procedures in that it prevents contraction of the thyroarytenoid muscle. (2) It decreases vocal-fold tension, as in framework surgery. (3) It reduces glottal incompetence, as does fibrinogen-glue injection, but it is more suitable because it is autologous. Furthermore, it produces increases in the mass and volume of the vocal-fold body and is also safe because the replacement tissue is autologous.

The short-term results appear encouraging in preventing spastic voice while also avoiding vocal-fold atrophy. Long-term follow up will be necessary to determine the actual efficacy. However, this is clearly a possible choice as a surgical approach for treating adduction-type SPD.

We describe a simple technique of drain fixation in head and neck surgery using a beaded 2/0 nylon suture and a ’clove hitch’ to achieve a non-slip fixation to the drain.

Bleeding into head and neck structures as a complication of thrombolysis is extremely rare but potentially lethal. It is usually associated with local trauma. We describe a case of a 67-year-old woman who developed spontaneous, massive pan aerodigestive tract haemorrhage precipitating airway obstruction following administration of streptokinase for myocardial infarction; a previously unreported complication. This case highlights the importance of being vigilant of airway symptoms following such treatment, prompting early involvement of anaesthetic and otolaryngology personnel.

A case of Pott’s puffy tumour in a diabetic patient with renal failure is reported. The patient did not respond to intravenous antibiotics and further investigation revealed that the patient had mucormycosis. As far as we are aware, this is the first case of Pott’s puffy tumour due to mucormycosis to be reported in the literature.

Impaired laryngeal protective function can result in intractable aspiration, which causes recurrent life-threatening pneumonia. Several surgical operations have been developed to treat intractable aspiration. In this case, we report a successful case of triple-layer laryngeal closure, which was performed in a patient with type II diabetes mellitus and nutritional failure due to intractable aspiration that had been caused by several stroke attacks. Triple-layer laryngeal closure is a unique modified technique that combines laryngotracheal separation and glottic closure operations. The method that we performed can be done more safely in patients who have higher post-operative and general anaesthesia risks.

A 67-year-old patient, who had previously undergone Lucite ball plombage for pulmonary tuberculosis, presented with a hoarse voice, intermittent stridor and breathlessness. Direct laryngoscopy confirmed a left vocal fold palsy. A left supraclavicular mass became apparent and a computerized tomograph (CT) scan showed that a Lucite ball had migrated into her supraclavicular fossa. Subsequently she developed left arm pain and weakness. The balls were removed surgically, following which her arm symptoms improved but her voice remained unchanged. Migration of implanted material should be considered when new symptoms appear in patients who have undergone plombage treatment.

Sigmoid sinus thrombosis (SST) usually follows acute as well as chronic otitis media with coalescent mastoiditis. A singular case of noncoalescent mastoiditis complicated with thrombosis of deep cerebral sinuses occurring in a young child is presented. A genetic thrombophilic disorder (prothrombin G20210A allele mutation) was identified as the predisposing factor for this unusual complication. Particular emphasis is placed on the course of the disease, which showed regression only after surgical exploration and additional anticoagulant therapy. We conclude that a thorough and early assessment of coagulation factors should always be performed, especially in the population at risk, in order to rule out unusual aetiologies of these rare but still life-threatening pathological processes.

Insertion of a voice prosthesis through the tracheoesophageal puncture (TEP) is one way to restore the voice after total laryngectomy. The second generation Provox® voice prosthesis is presently one of the most popular devices. Although TEP can be done primarily, there are many centres that prefer it to be done at a second stage for various reasons. However, secondary TEP for retrograde replacement of prosthesis can be difficult and general anaesthesia is very often necessary. Moreover, the presence of neck stiffness and fibrosis from the surgery or previous radiotherapy could affect the neck extension for proper positioning of the trocar. Similarly, it is difficult to insert the prosthesis if there is stenosis at the pharyngoesophageal segment. We describe a technique in which creation of secondary TEP and insertion of Provox®2 is done with local anaesthesia under the same setting. The procedure is well tolerated and can be safely performed on an out-patient basis.

We present a case report of a female patient with complaints of single-sided nasal obstruction. A polypoid structure was seen in the nasopharynx. Histologic examination showed a respiratory epithelial adenomatoid hamartoma – a rare, benign lesion. Therapy consisted of complete excision. In line with previous reports, the lesion did not recur during 13 months of follow up. The clinical and pathological features of this abnormality are discussed.

Parapharyngeal abscess as a complication of cholesteatoma is an uncommon entity. Endopharyngeal common carotid artery rupture due to parapharyngeal abscess is also uncommon, and these cases usually end fatally. We present a 17-year-old male with parapharyngeal abscess due to cholesteatoma who developed an endopharyngeal common carotid blow out and survived after common carotid ligation without any neurological sequalae.