Skin cancer is the most common cancer, and often occurs in the head and neck region. This study aimed to investigate whether a combination of inhibitors of cyclo-oxygenase-2 and 5-lipoxygenase, applied via a microemulsion delivery system, would be effective in topically inhibiting skin carcinogenesis.

Randomised animal study.

Twenty-four nude mice were intradermally inoculated with carcinoma cells and then divided into three groups (eight animals each): group one received no treatment; group two received celecoxib alone; and group three received a combination of zileuton and celecoxib. Tumour incidence and growth were measured for 14 days.

Both treatments significantly delayed the onset and development of tumours. However, the combined treatment had the best response (p < 0.01).

The results clearly showed that topical treatment with either celecoxib alone or celecoxib plus zileuton significantly inhibited skin carcinogenesis, and that a combination of both agents had the best results.

To determine the most effective local anaesthetic method for manipulation of nasal fractures, and to compare the efficacy of local anaesthesia with that of general anaesthesia.

Systematic review and meta-analysis.

Medline, Embase, Cochrane Library, National Research Register and metaRegister of Controlled Trials.

We included randomised, controlled trials comparing general anaesthesia with local anaesthesia or comparing different local anaesthetic techniques. Non-randomised studies were also systematically reviewed and appraised. No language restrictions were applied.

Five randomised, controlled trials were included, three comparing general anaesthesia versus local anaesthesia and two comparing different local anaesthetic methods. No significant differences were found between local anaesthesia and general anaesthesia as regards pain, cosmesis or nasal patency. The least painful local anaesthetic method was topical tetracaine gel applied to the nasal dorsum together with topical intranasal cocaine solution. Minimal adverse events were reported with local anaesthesia.

Local anaesthesia appears to be a safe and effective alternative to general anaesthesia for pain relief during nasal fracture manipulation, with no evidence of inferior outcomes. The least uncomfortable local anaesthetic method included topical tetracaine gel.

In epistaxis, anterior bleeding points are easily cauterised under direct vision, but those which occur in the posterior nose present a greater challenge. Standard cautery techniques limit simultaneous use of other equipment in the narrow posterior nose.

This article presents a novel device which combines suction, cautery stick and sheath in one single-handed implement for ease of use.

This novel, hand-held device for simultaneous suction and safe cautery of posterior epistaxis is both safe and cost-effective. It enables successful treatment by a single operator and is relatively easy to use by the non-skilled, junior trainee.

To evaluate the quality of out-of-hours ENT on-call cover by junior doctors, in view of the European Working Time Directive and the recent changes in the National Health Service workforce due to the ‘Modernising Medical Careers’ initiative, in England.

We performed a national survey of first-on-call doctors for ENT, using a telephone questionnaire. Hospital contact details were sourced from the National Health Service website. The inclusion criterion was hospitals providing acute ENT facilities overnight in England.

One hundred and nineteen hospitals were contacted; 91 were eligible, and 83 interviews were conducted. The grade of the first-on-call ENT doctor ranged from foundation year two (19 per cent) to registrar level or above (13 per cent). Forty-nine respondents (68 per cent) reported having no previous ENT experience. Fifty-three respondents (74 per cent) covered more than one speciality at night, with seven (10 per cent) covering four or more specialities. The second-on-call doctor was non-resident in 63 cases (88 per cent). Thirty respondents (42 per cent) stated that they did not feel comfortable managing common ENT emergencies as the first doctor on call. Otorhinolaryngology induction courses were offered in 37 of the respondents’ hospitals (51 per cent), these courses were of varying duration.

Night-time ENT care is often provided by junior doctors with little experience of the speciality, who are often also responsible for covering multiple specialities. Many reported not feeling comfortable managing common ENT emergencies. Structured induction programmes would help to provide basic knowledge and should be mandatory for all doctors covering ENT.

A reliable diagnosis of malignant carotid body tumour can only be made in the presence of metastatic disease, because the histological features of the primary tumour do not correlate with clinical behaviour.

We report two cases of malignant carotid body tumour in which regional nodal biopsy at the time of excision of the primary tumour revealed unsuspected metastatic disease.

Reoperation in the neck for recurrent metastatic carotid body tumour is difficult and potentially hazardous. The presence of occult metastatic disease is easily identified if a selective – or sentinel – nodal dissection is performed routinely in cases of carotid body tumour excision. Such an approach adds very little morbidity, effort or time to the primary surgery, and is recommended. This view has been supported by some other authors but is generally overlooked in clinical practice.

Conscious and deceptive exaggeration of hearing loss is termed pseudohypacusis. Even though the Stenger test has been used in the management of pseudohypacusis for almost a century, its sensitivity, specificity and predictive values for unilateral pseudohypacusis have not previously been reported, to our best knowledge. We investigated the efficiency of the Stenger test in detecting unilateral pseudohypacusis, accepting auditory brainstem response testing as the ‘gold standard’.

Candidates with questionable profound or total hearing loss were enrolled in the study. Pure tone audiometry, speech and tonal Stenger tests, and click test auditory brainstem response measurement were performed. Accepting auditory brainstem response testing as the gold standard, the sensitivity, specificity and predictive values of the Stenger test for unilateral, profound pseudohypacusis were assessed.

Two hundred military candidates were enrolled in the study. The sensitivity and specificity of the Stenger test in verifying unilateral, profound hearing loss were 99.4 and 70 per cent, respectively. The positive and negative predictive values of the test were 87.5 and 98.4 per cent, respectively.

The Stenger test is widely used for the evaluation of unilateral or asymmetrical pseudohypacusis. In our opinion, it is a powerfully reliable test. More difficult cases require objective electrophysiological testing to verify functional hearing loss and to exclude specific diagnoses that may imitate pseudohypacusis.

To describe a series of 40 culture-proven, Streptococcus suis infected patients, focusing on route of entry and on hearing and vestibular dysfunction.

Retrospective study of patient records in a tertiary care hospital in northern Thailand, 2003–2007.

The majority (75 per cent) of cases were men with heavy drinking habits. A past history of the consumption of raw pork and/or pig's blood was found in 62.5 per cent of cases, whereas contact with swine products was found in 25 per cent. Thirty patients presented with sepsis, 19 with meningitis and 10 with infective endocarditis. The overall mortality rate was 20 per cent. After a mean follow up of 17 months, 73 per cent of the surviving meningitis cases had persistent sensorineural hearing loss and 50 per cent demonstrated vestibular impairment. In one patient, roentgenographic studies of the temporal bone were compatible with labyrinthitis ossificans.

Permanent hearing loss and vestibular impairment occur frequently in persons surviving meningitis caused by Streptococcus suis.

Haemangiomas do not develop as commonly in the sinonasal cavity, compared with other head and neck sites. The clinical characteristics of sinonasal cavity haemangiomas and the results for endoscopic resection have been addressed in the literature only briefly. Thus, this study aimed to evaluate these points.

A retrospective chart review was undertaken of 22 patients who had undergone endoscopic excision of sinonasal cavity haemangiomas, in order to define clinical characteristics and tumour control rates.

The most common presenting symptom was epistaxis. The most prevalent site was the inferior turbinate (45.5 per cent), followed by the maxillary sinus (18.2 per cent). No recurrence was observed in any patient.

Although past studies have described external approach sinonasal surgery as the mainstay of treatment, our results imply that endoscopic excision of sinonasal haemangiomas yields excellent outcomes in terms of tumour control and safety.

To analyse the correlation between visual fixation suppression test results and the occurrence of post-operative vertigo in patients receiving a cochlear implant, and to compare this with other possible risk factors.

In a prospective study setting, caloric vestibular responses, visual fixation suppression and subjective vertigo symptoms were assessed in 59 adult patients undergoing cochlear implantation. These parameters were compared in patients with post-operative vertigo versus vertigo-free patients.

Vertigo symptoms were reported by 49 per cent of patients. Thirty-nine per cent of the patients had a decrease in caloric response on the implanted side. There was no statistically significant difference between the two patient groups regarding canal paresis, age, sex, implanted electrode type, implant side, surgeon, cause of deafness, petrous bone computed tomography findings and incidence of pre-operative vertigo. Patients with post-operative vertigo had a significantly greater prevalence of insufficient visual fixation suppression. All patients who suffered long-term post-operative vertigo had insufficient visual fixation suppression.

Pre-operative impaired visual fixation suppression is a major risk factor for the occurrence of vertigo after cochlear implantation.

To discuss the technique and outcome of this simple procedure and the management of post-traumatic parotid sialocoeles, and to review the literature regarding this condition.

We report the successful surgical treatment, by peroral drainage, of three patients with post-traumatic parotid sialocoele resistant to conservative management.

We discuss the method and outcome of the surgical procedure performed, along with the causes, presentation and management of parotid sialocoele.

Correct initial management of a parotid duct injury may prevent the formation of a sialocoele. When conservative treatment of post-traumatic parotid sialocoele fails, we advocate the surgical technique described in this report as it is effective, simple and carries minimal risk to the patient.

The diagnosis and treatment of unilateral vocal fold palsy is a common part of otolaryngology practice. In those patients in whom resolution of symptoms is slow, the resulting dysphonia can have a dramatic effect on the patient's quality of voice and life. We have previously described the procedure of direct phonoplasty under local anaesthesia using the transnasal laryngoesophagoscope.

To examine the subjective and objective data for the first five patients to undergo this procedure, in the form of laryngographic speech analysis, perceptual assessment and therapy outcome measures.

Analysis showed a statistically significant improvement in voice quality, in all the above assessment categories, following local anaesthetic direct phonoplasty using the transnasal laryngoesophagoscope.

Collagen injection via transnasal flexible laryngoesophagoscopy is a particularly useful technique for treating vocal fold medialisation, especially in palliative care patients and those with shortened life expectancy.

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.

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.

We report a case of benign intranodal neurilemmoma, an extremely rare tumour arising from a nerve sheath within a lymph node.

A 67-year-old woman underwent surgery for a left-sided parotid mass. Histopathological analysis revealed a tumour arising from a lymph node within the superficial lobe of the parotid gland. The tumour demonstrated histological features of an intranodal neurilemmoma.

This case represents the first report of an intranodal neurilemmoma arising within a parotid lymph node, and supports the proposal that intranodal neurilemmoma be recognised as a distinct histological entity.

The advantages of bilateral, simultaneous cochlear implantation include: the possibility to pre-empt cochlear calcification following meningitis; reduction of the intervention to only one procedure, general anaesthetic and course of clinical care (with obvious benefits for the patient); and greater cost-effectiveness. The disadvantages of such a procedure include: doubling the risk of associated complications; placing the patient on the implanted side during contralateral implantation; the possibility of vestibular alteration simultaneously in both ears; the need for precise planning of symmetrical incisions and implant sites; and longer surgery time.

The study cohort included 10 children who underwent bilateral, simultaneous cochlear implantation using the suprameatal approach.

The overall operation time, inclusive of anaesthesia, was approximately three hours in all cases. None of the children had any intra- or post-operative complications.

From a surgical perspective, bilateral, simultaneous cochlear implantation is a safe procedure. The use of a non-mastoidectomy approach is recommended.

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.

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.