We report a case of post-partum surgical cervical emphysema, which is a rare but well recognised complication of labour. By reporting the first case in the ENT literature, we aim to raise awareness of this complication, particularly amongst trainees, to ensure that patients are managed most appropriately.

A 36-year-old, primigravida woman developed neck swelling and odynophagia post-partum. Surgical cervical emphysema was palpated, with further examination excluding pneumomediastinum and pneumothorax. The patient was managed conservatively, with complete resolution of symptoms within a week.

Surgical cervical emphysema, pneumothorax and pneumomediastinum are all well recognised post-partum complications. The vast majority of cases do not present with respiratory or cardiac compromise and can be appropriately managed conservatively, with expectation of resolution in a fortnight. There is no evidence that such patients are at increased risk during subsequent pregnancies.

Secondary or referred otalgia can represent a diagnostic challenge to the otolaryngologist. Collectively, dental disorders are the most common causes of secondary otalgia presenting to the ENT clinic, and may account for up to 50 per cent of referred otalgia. Temporomandibular joint dysfunction syndrome represents the most common dental cause of referred otalgia. Decay and pulpal inflammation of posterior teeth can also frequently present as otalgia. The common embryological developmental origin of both oral and dental structures and the ear is responsible for their overlapping sensory nerve supplies, and this explains referred otalgia secondary to dental and temporomandibular joint disorders. These disorders can be easily overlooked, resulting in unnecessary and costly investigations.

This review aims to give a succinct overview of common dental causes of otalgia, and to provide ENT clinicians with guidelines for performing a rapid and simple dental and temporomandibular joint examination, which will reliably diagnose or exclude dental otalgia.

To observe trends in the number of major otological procedures performed in England, in the context of advances in the understanding of disease.

The data used were obtained from the Hospital Episode Statistics statistical database, published by the UK Department of Health, for England, 1989 to 2005. Specific otological procedures were identified using the Classification of Surgical Operations and Procedures system (fourth revision) of the Office of Population, Censuses and Surveys. Trend analysis of different procedures was performed using exponential smoothing (using the Statistical Package for the Social Sciences version 13 software).

Our study did not confirm any reduction in the number of surgical procedures performed for cholesteatoma or otosclerosis. We noted a sharp decline in the number of endolymphatic sac surgical procedures performed, probably attributable to the increased use of intratympanic therapy.

The number of major otological procedures (other than endolymphatic sac surgery) was consistent over the period examined. The generally perceived reduction in the number of procedures performed by individual surgeons may be due to a dilutional effect. This can only support the need for subspecialisation, particularly regarding the training of junior surgeons.

The aetiology of otosclerosis is complex, and probably involves an interaction between genes and environmental factors. Previous studies have revealed genetic linkage with a number of chromosome regions, including position 7q33–36.

To confirm whether linkage exists between otosclerosis and chromosome region 7q33–36.

Seven multiply affected families were ascertained. Deoxyribonucleic acid from members of these families was extracted, and six markers were genotyped to cover a 16 cM region at 7q33–36. Both parametric and non-parametric multipoint linkage analyses were performed.

Parametric multipoint linkage analysis excluded any linkage at 7q33–36 (logarithm of odds score <−4.0). Non-parametric linkage analysis also failed to confirm any linkage (non-parametric linkage < 1.66). When tested individually, pedigree four was the only one to show a significant non-parametric linkage score between D7s684 and D7s2513 (non-parametric linkage = 1.96).

No linkage was detected between otosclerosis and the 7q33–36 region. This could be explained by the study's lack of power, due to the limited number of families available.

To present our personal experience of a series of 10 patients suffering from tympanosclerosis with functional blocking of the stapes or footplate, who underwent malleostapedotomy surgery. The criteria for patient selection for this type of operation, and its results and complications, are discussed.

Prospective study.

Incus and malleus dysfunction was observed in 70 per cent of cases, either alone or combined with fixation of the stapes. The post-operative hearing results were considered to be satisfactory (i.e. within 20 dB) in 80 per cent of cases. Only one patient had sensorineural hearing loss over 10 dB.

Malleostapedotomy has proved its practicability in the treatment of patients with fixed footplate or stapes complicated by ankylosis of the incudomalleolar joint. This procedure can be considered a further, valid technique within the otologist's surgical armamentarium.

To evaluate the outcome and the change in quality of life of patients with chronic rhinitis after treatment with desloratadine.

A prospective, open-label, non-blinded, non-randomised study of patients in a secondary and tertiary ENT referral centre.

Chinese patients with chronic rhinitis were recruited. The patients were assessed by a questionnaire that included rhinitis symptoms score and SF-36 health survey components. Endoscopic assessment was performed with a rigid nasoendoscope and scored according to the modified endoscopic appearance score of Lund and Kennedy. A 12-week course of desloratadine 5 mg daily was prescribed. Patients were re-evaluated after treatment. A total of 47 subjects completed the study.

There were significant reductions in median rhinitis symptoms score, from six to five (p < 0.001), and in median endoscopic appearance score, from five to three (p < 0.001). Patients' general health perception was also improved after treatment (p == 0.022).

Desloratadine may be an effective treatment which provides symptomatic relief and improves the quality of life in patients with chronic rhinitis.

Nasal polyposis associated with aspirin-intolerant asthma tends to be difficult to control, with frequent recurrences. We examined the effect of intranasal lysine-aspirin administration on resistant nasal polyps of asthmatic, aspirin-intolerant patients, when used in addition to routine therapy.

Thirteen patients with asthma and intolerance to aspirin were recruited. All but one had undergone numerous polypectomies and were uncontrolled on standard therapy with intranasal corticosteroids, leukotriene receptor antagonists and nasal douching. Aspirin treatment involved one drop (100 µl) of 30 mg/ml lysine-aspirin solution to each nostril, initially daily, increased every two or three days up to a maximal of 18 drops (54 mg lysine-aspirin) a day. Nasal symptoms, nitric oxide level, nasal inspiratory peak flow rate, peak expiratory flow rate and nasendoscopic grading were assessed prior to therapy and three months later. We also compared the change in endoscopic polyp scores during three months of lysine-aspirin administration with the changes which had occurred during the three months prior to administration (during which time other therapies had been identical).

Nasal blockage symptoms tended to decrease; other nasal symptoms were unchanged. Significant changes were seen in nasal inspiratory peak flow rate (103.3 ± 18.9 and 140.0 ± 16.7 l/min before and after aspirin, respectively; p = 0.014), but not in peak expiratory flow rate (438.7 ± 33.4 and 440.0 ± 28.4 l/min before and after aspirin, respectively; p = 0.700). Nasal nitric oxide levels rose significantly (in both sides, p = 0.028). Expired chest nitric oxide levels did not change. Nasal polyp scores on nasendoscopic examination were significantly reduced (right side, p = 0.027; left side, p = 0.018). Compared with the preceding three months, adding intranasal lysine-aspirin application had the effect on decreasing nasal polyp volume (right side, p = 0.031; left side, p = 0.016).

This open study suggests that intranasal lysine-aspirin administration reduces nasal polyp volume in aspirin-intolerant patients, without any adverse affect on concomitant asthma. This was a preliminary study and should be followed by a placebo-controlled, double-blind trial.

Electrogustometry is an accurate and increasingly popular method used to examine taste. However, its usefulness as a screening test is unknown.

We asked 114 subjects, some healthy but most with medical conditions possibly affecting taste, to rate their overall taste ability, on a scale of zero to 10. Those who had current symptoms related to taste– and who rated their taste as five or worse – were defined as ‘aberrant tasters’. We recorded automated electrogustometry thresholds, and visual analogue scale intensity ratings, for solutions of the four basic tastes (sweet, sour, salty and bitter). A visual analogue scale score of 50 was used as a cut-off point to identify ‘poor tasters’.

The sensitivity and specificity of electrogustometry in identifying abnormal taste function were low.

We conclude that automated electrogustometry is not a useful clinical screening method for taste disturbance in a population such as ours.

Patients with laryngopharyngeal reflux uncommonly suffer from conditions associated with gastroesophageal reflux disease. However, in some laryngopharyngeal reflux patients, oesophagitis and Barrett's metaplasia can be diagnosed by oesophagogastroduodenoscopy. However, it is unclear which patients with laryngopharyngeal reflux would benefit from routine oesophagogastroduodenoscopy.

Retrospective analysis.

Analysis of the results of oesophagogastroduodenoscopy in 28 patients with pH-documented laryngopharyngeal reflux.

Oesophagogastroduodenoscopy showed oesophagitis in five patients (four with grade A, one with grade B), hiatus hernia in 10 patients (36 per cent), Barrett's metaplasia in two patients, Helicobacter pylori-associated chronic gastritis in two patients and gastric mucosal erosions in seven patients (25 per cent). In 13 patients, no abnormalities were detected (46 per cent). Barrett's metaplasia or grade B oesophagitis was diagnosed only in patients with heartburn as their main presenting symptom.

Oesophagogastroduodenoscopy is indicated in at least those laryngopharyngeal reflux patients reporting heartburn as their main complaint.

Rhinostomy patency is a problem in all forms of dacryocystorhinostomy. Laser-assisted procedures are potentially fast and result in excellent haemostasis. However, they may induce more fibroblastic activity, resulting in excessive scarring and stenosis of the rhinostomy, compared with non-laser dissection.

The objective of this study was to compare subjective outcomes following dacryocystorhinostomy conducted with endoscopic endonasal laser and with endonasal surgical techniques.

Prospective, randomised, controlled trial comparing potassium titanyl phosphate endonasal laser dissection with endonasal surgical techniques, for dacryocystorhinostomy to treat epiphora due to primary, acquired nasolacrimal duct obstruction.

One hundred and twenty-six adult patients with chronic epiphora due to primary, acquired nasolacrimal sac or duct obstruction.

Interventions comprised endonasal dacryocystorhinostomy, performed using potassium titanyl phosphate laser or surgical dissection, in order to open the lacrimal sac into the nasal cavity.

These were: symptom score and symptom relief of epiphora (at three and 12 months post-procedure); duration and ease of procedure; and duration of hospital stay.

Sixty patients underwent endonasal laser dacryocystorhinostomy and 66 underwent endonasal surgical dacryocystorhinostomy. Symptomatic success was 82 per cent at three months and 68 per cent at 12 months in the laser group, and 76 per cent at three months and 74 per cent at 12 months in the surgical group. A two-point reduction in the symptom score was associated with symptomatic success at three and 12 months. Eight patients randomised to the laser group required additional instrumentation in order to remove thick bone over the lacrimal sac.

At three months, endonasal laser dacryocystorhinostomy had better results than endonasal surgical dacryocystorhinostomy. However, at 12 months, the surgical procedure had better results than the laser procedure. There was no statistically significant difference between the two groups at three or 12 months with regard to symptomatic outcome. The ease of procedure (on a scale of zero to 10) was 4.5 for the laser procedure and 4.1 for the surgical procedure. The average times for the procedures were 25 minutes in the laser group and 20 minutes in the surgical group. No statistical difference was found when comparing: symptom score improvement for local anaesthetic vs general anaesthetic; ages over and under 70 years; laterality; or operating surgeon. Change in the symptom score was a useful indicator of symptomatic success.

To determine the correlation between expression of cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2, in patients with laryngeal carcinoma.

The study included 85 primary laryngeal squamous cell carcinoma cases. Expression was assessed using Envision immunohistochemical stains for cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2.

A tissue microarray containing samples from the 85 primary laryngeal squamous cell carcinoma cases was assembled. Immunohistochemical testing for cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2 was performed. Using Pearson correlation, expression of these proteins was compared with the following clinicopathological variables: age, sex, clinical tumour–node–metastasis staging, and prognosis. Three-year survival curves, factored by cyclooxygenase-2, vascular endothelial growth factor and matrix metalloproteinase-2 expression, were generated for overall survival, by Kaplan–Meier analysis.

The expression of cyclooxygenase-2 significantly differed between patients with different pathology, tumour–node–metastasis stage and prognosis. A marked difference in vascular endothelial growth factor expression was seen between two histological grade groups. Expression of matrix metalloproteinase-2 protein statistically significantly differed between patients with different tumour–node–metastasis stages, lymph node metastases and three-year survival rates. The expression of cyclooxygenase-2 in laryngeal carcinoma tissue was found to be associated with the expression of matrix metalloproteinase-2.

Cyclooxygenase-2 and matrix metalloproteinase-2 may act as clinical prognostic indicators of tumour growth and differentiation in laryngeal carcinoma.

Early glottic cancer may be treated with primary radiotherapy or transoral laser microsurgery with comparable survival. The choice of therapy therefore depends on patient preference after discussion of risks, benefits and alternatives.

All previously untreated patients undergoing transoral laser microsurgery for T1 or T2 glottic cancer at St Vincent's Hospital between July 1997 and December 2004 had their staging and demographics recorded. Surgery was categorised according to the European Laryngological Society. A voice recording was made pre-operatively then at 12 weeks post-operatively and scored by two independent speech therapists on the Oates Russell Voice Profile – a scale of zero (normal) to five (severe dysphonia). Follow up was for a minimum of two years.

Fifty-three patients with a mean age of 56 were included. The observed survival was T1 89.4 per cent and T2 85.3 per cent after a mean follow up of 47 months. Nineteen patients staged T1 underwent cordectomy. A second procedure was required in 22.2 per cent, however, none required a laryngectomy. Thirty-four patients staged T2 underwent hemilaryngectomy. A second procedure was required in 41.2 per cent including 8.8 per cent requiring salvage laryngectomy. One patient died with unresectable nodal disease. The mean Oates Russell Voice Profile for T1 disease was 2.37 and for T2 2.68 (range 1 to 4) indicating a mild (2) to moderate (3) degree of voice impairment.

Survival outcomes following transoral laser microsurgery are comparable to treatment with radiotherapy. Voice impairment is usually mild to moderate following transoral laser microsurgery for early glottic cancer but overall may be greater than in radiotherapy patients. The repeatability of transoral laser microsurgery may result in a lower laryngectomy rate compared with published series using radiotherapy.

The ENT emergency clinic provides an important out-patient service; however, often, no correspondence is sent to the general practitioner.

To conduct a general practitioner questionnaire audit in order to assess whether a standardised, computerised clinic letter template could improve communication between the ENT emergency clinic and patients' general practitioners.

All ENT emergency clinic patients should have a summary letter sent to their general practitioner.

One hundred general practitioner questionnaires were enclosed with the first 100 ENT emergency clinic template letters sent to patients' general practitioners.

Seventy-two general practitioners responded (72 per cent). Of these respondents, only 7 per cent had previously received regular correspondence from the ENT emergency clinic before the introduction of the computerised letter template. Following its implementation, such a letter was sent to 100 per cent of the clinic patients' general practitioners. Ninety-seven per cent of the general practitioners valued the template letter, with a mean satisfaction score of 8.4 on a 10-point scale. Eighty-six per cent of the general practitioners stated that they would not prefer a dictated letter.

The introduction of a simple, computerised clinic letter template improves communication with ENT emergency clinic patients' general practitioners.