Introduction: At present there is a strong emphasis on carrying out more elective day-case surgery. This paper presents a series of major ear cases performed on a day-case basis.

 Method: This is a retrospective review of outcome. Surgery was performed over 10 years at the Queen Elizabeth Queen Mother Hospital (part of the East Kent NHS Trust, UK).

 Results: Over 10 years 253 major ear cases were performed. The unplanned admission rate for overnight stay was 2.8 per cent and the rate of short-period transfers to in-patient wards (for less than a six-hour stay) was 2 per cent.

 Conclusions: Our experience shows that major ear surgery, including mastoidectomy, is safe on a day-case basis in all age groups. With the advent of new anaesthetic agents recovery is faster, and modern anti-emetic cover for post-operative nausea and vomiting makes nearly all such major ear surgery feasible as day-case procedures.

This aim of this study was to determine the effect of anaesthetic agents on stapedius reflex (SR) thresholds and transient evoked otoacoustic emissions (TEOAE). Fifty patients who were scheduled for operation and who had normal hearing were included in the study. All were given midazolam for premedication and propofol for induction. Anaesthesia was maintained in five different ways in each group of 10 patients. Groups I–IV received inhalational anaesthesia: group I received 70 per cent N2O plus 30 per cent O2, group II sevoflurane, group III desflurane and group IV halothane. Group V received total intravenous anaesthesia with propofol plus sufentanil. The SR and TEOAE of the patients were measured four times: on the day before surgery (first measurement), after premedication (second measurement), after induction of anaesthesia (third measurement) and during maintenance of anaesthesia (fourth measurement). Midazolam significantly increased ipsilateral and contralateral SR thresholds and decreased TEOAE wave reproducibility. Propofol significantly increased only the SR thresholds. The other anaesthetic agents significantly increased only the contralateral reflex thresholds. Of these, the highest increase was seen after sevoflurane and the lowest after halothane. The changes in TEOAE wave reproducibility due to anaesthetic agents used for maintenance were not significant. We concluded that midazolam premedication may affect audiological evaluation with SR and TEOAE tests, and sevoflurane should not be used when it is necessary to measure SR under general anaesthesia.

This study was conducted with an aim to assess the prevalence and profile of ear diseases in children from the higher and lower socioeconomic strata of society. Two groups of schools within Delhi were selected. Group A comprised of government schools located in slum areas with an average parental income of INR (Indian National Rupees) 1050 per month and group B of elite private schools with an average family income of TNR 35 000 per month. Three thousand children between the ages of 5–12 years were screened with the help of a written proforma and ear examination. Tympanometry and audiometry were done, where required. 19.6 per cent of children of group A were found to be suffering from ear diseases compared to 2.13 per cent of group B children. The two groups were also compared for number of family members, status of hygiene and parental education.

Two studies were performed to determine whether topical phenol is a safe and well tolerated local anaesthetic for grommet insertion. Study 1 was a retrospective examination of audiological outcomes and complications. Data were obtained regarding 71 procedures in 57 patients. One late infection and nine early extrusions were noted. No statistically significant changes between pre- and post-operative bone conduction thresholds were found. Study 2 was a prospective analysis of patients' perceptions of the procedure. Data from 17 patient questionnaires were analysed as follows: pain rating – not painful, three patients; slightly painful, 14 patients. Overall experience rating – pleasant, four patients; slightly unpleasant, 10; unpleasant, three. All patients stated that they would undergo the procedure again. In conclusion, we found no evidence of phenol-induced hearing loss. The complication rate was within normal limits and patients were satisfied with the procedure. Grommet insertion using phenol as a local anaesthetic is safe and acceptable to patients.

The aim of this study was to evaluate the patient's experience of transnasal flexible laryngo-oesophagoscopy under local anaesthetic in an out-patient setting. This was a clinical observational study using a patient questionnaire and visual analogue score. Subjects were 50 patients seen in the hospital's ENT outpatient clinic between March and August 2004 in whom transnasal flexible laryngo-oesophagoscopy was performed and who completed pain discomfort questionnaires. Any patient undergoing transnasal flexible laryngo-oesophagoscopy, for either diagnostic or therapeutic purposes, was included in the study. Patients in whom transnasal flexible laryngo-oesophagoscopy was not necessary as part of their investigation or treatment were excluded. Patients completed a questionnaire, providing a simple visual analogue score for discomfort during the procedure. Any operative complications were noted by the surgeon. All patients completed transnasal flexible laryngo-oesophagoscopy, and the upper aerodigestive tract was clearly visualized. The procedure is well tolerated, with mean score of <  1 out of 10 for all forms of discomfort. There was a complication rate of 2 per cent (one patient with epistaxis); no other complications occurred. Transnasal flexible laryngo-oesophagoscopy is a new diagnostic and therapeutic technique which is well tolerated by patients. It compares favourably with other flexible endoscopic techniques. This report documents for the first time a detailed description of patients' experience of this technique.

Nitinol stents have been used in the treatment of benign tracheal stenosis. A retrospective review of five patients treated at Stobhill Hospital over the last six and a half years is presented. Age at presentation ranged from 17 to 76 years. The minimum follow-up period was 23 months and the maximum was 78 months. All our patients were successfully decannulated, with none requiring recannulation. Four patients developed granulation tissue related to the stent at intervals ranging from three weeks to 41 months post stenting. Topical mitomycin C application has been useful after resection of granulations using the carbon dioxide (CO2) laser. Stent migration occurred in one patient three weeks after insertion. Nitinol stents are easy to insert and effective in the treatment of tracheal stenosis, but can have associated morbidity. Their use should be considered carefully, as insertion should be regarded as permanent. Publications reporting experience and outcome with the use of Nitinol stents in the trachea are reviewed.

Although unilateral vocal fold palsy (UVFP) is a common problem, data relating to swallowing dysfunction are sparse. We reviewed the clinical findings (method of presentation, underlying diagnosis and position of the vocal folds) of 30 patients and conducted a follow-up telephone survey. Outcome measures used were direct visualization of fold function, position and compensation. In addition, standardized speech and language assessments for swallowing dysfunction and dysphonia were noted and compared to presentation. Our study indicates that 56 per cent of patients with UVFP have associated dysphagia. Outcome with speech therapy is significant, with 73 per cent showing improvement. These data indicate a significant link between UVFP and swallowing dysfunction. There is a marked therapeutic benefit from voice therapy. Further work is required to evaluate the long-term outcomes and establish the mechanism of swallowing dysfunction in these patients.

The aim of this study was to assess the value of rigid endoscopy in patients presenting with globus symptoms. We conducted a retrospective analysis of 250 patients who underwent rigid endoscopy for globus symptoms over a 12-month period. In 217 patients (86.8 per cent) the examination of the larynx, pharynx and upper oesophagus was entirely normal. Abnormal findings included cricopharyngeal spasm in 12 patients (4.8 per cent), reflux in 11 (4.4 per cent), pharyngitis in two (0.8 per cent), web in two (0.8 per cent), and retention cyst in three (1.2 per cent). The 95 per cent confidence interval (CI) for the mean number of persons with malignancy based on the Poisson distribution is 0 and 3.7 (0 and 14.8 as rates per 1000). The relationship between the clinical diagnosis and endoscopic findings was examined using the chi-square test, with a p value of 0.0001. These results suggest that patients presenting with globus sensation are unlikely to harbour neoplastic lesions and therefore rigid endoscopy may well be an inappropriate investigation in this group. The risks, costs and discomfort associated with this intervention can often be avoided.

Introduction: Head and neck lipomas have seldom drawn attention in the literature, except in isolated case reports.

Aims: This study aimed to assess the presentation variability of head and neck lipomas as well as the relative importance and efficiency of pre-operative diagnostic methods used.

Materials and methods: A retrospective review was undertaken of medical records and imaging studies of 24 patients with histopathologically proven head and neck lipomas, over a three-year period.

Results: The 24 patients had 26 lipomas. Men predominated (62.5 per cent). The posterior subcutaneous neck was the most common site. Three patients had deep lipomas affecting the hypopharynx, larynx and parotid gland; all were correctly diagnosed pre-operatively. Computed tomography (CT) scan with specific radiodensity recording was the preferred pre-operative investigation.

Conclusions: Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses even in rare locations. A CT or magnetic resonance imaging scan can correctly diagnose a lipoma pre-operatively, thereby allowing better treatment planning.

Balloon dilatation is well established in the management of enteric strictures. The use of this technique in the pharynx has been reported under radiological and endoscopic guidance. We describe the hydrostatic dilatation of a benign pharyngeal stricture in a laryngectomy patient under local anaesthetic, without radiological guidance, in the ENT out-patient department. This procedure was effective and well tolerated in a patient who required regular dilatations.

Aortitis and saddle nose deformity are extremely unusual manifestations of a variety of systemic diseases. The concurrent appearance of these apparently disparate clinical features is a clinical rarity. A case of saddle nose deformity in a patient with confirmed Takayasu's arteritis is presented. The relevant literature is reviewed with reference to the possible differential diagnosis of patients with aortitis and saddle nose deformity.

Infection with methicillin-resistant Staphylococcus aureus (MRSA) is increasing. It may be community or hospital acquired and is characteristically difficult to eradicate. Here we report a case of a two-year-old girl who sustained a traumatic tympanic membrane perforation following a minor burns injury. She was seen as an out-patient in a burns unit and subsequently developed MRSA otorrhoea. This was treated with a two-week course of fusidic acid topical drops. At three-week follow up the tympanic membrane had healed and the infection had healed completely. Fusidic acid is safe and effective in the treatment of MRSA otorrhoea. We need to maintain vigilance in the treatment of otorrhoea, as MRSA may become an increasingly common pathogen in the future.

Electrocution is a rare cause of sensorineural deafness. We describe and discuss the first reported case in this country of domestic electrocution resulting in a bilateral sensorineural deafness.

Disseminated histoplasmosis is a disease with a high case-fatality rate, especially in patients with the acquired immunodeficiency syndrome (AIDS). The disease can occur in various sites, such as the lungs, eyes, oral cavity, larynx, nervous system, gastrointestinal tract and, more rarely, the nasal sinus region. It is a cosmopolitan mycosis with a high prevalence in Brazil. Nasal manifestation of the disease is rare, with only three cases reported in the literature, but it is part of the differential diagnosis for other granulomatous diseases, such as Wegener's granulomatosis, tegumentary leishmaniasis and nasal lymphoma. The authors of this study present a literature review and report a case of nasal histoplasmosis in a patient with AIDS. No record of such an aggressive presentation has been reported previously in the literature.

Hamartomas of the cerebellopontine angle or internal auditory canal are very rare and only four cases have been reported. We report an unusual case of a glioneural hamartoma of the VIIIth nerve with clinical, radiological and audiometric similarity with vestibular schwannoma.

With the exception of moderately differentiated neuroendocrine carcinoma of the larynx, neuroendocrine carcinomas are very rare head and neck malignancies. We report a case of a small cell neuroendocrine carcinoma in the petrous apex of the temporal bone. This unusual site for this tumour has not yet been reported in the literature. We confirmed the location and extent of the primary tumour by positron-emission tomography scan. The final histopathological diagnosis was of small cell carcinoma, and this was confirmed by immunohistochemistry. We treated this patient with surgery followed by radiotherapy and chemotherapy. After the treatment was completed there was subtotal remission of the tumour, with no distant metastases.