The Journal of Laryngology & Otology

Published by Cambridge University Press (CUP)
Online ISSN: 1748-5460
Print ISSN: 0022-2151
Publications
The object of this double-blind study was to assess the therapeutic effects of a combination of two per cent sodium cromoglycate and 0.025 per cent xylometazoline compared with a matched placebo. Forty patients were included in the two-week study. The treatment was found to be rapidly effective taking only a day to control symptoms in almost 80 per cent of the patients in the group receiving active treatment. No evidence of rebound effects due to the decongestant was observed during the study.
 
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. Main outcome measures: 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.
 
Background: There is a considerable scarcity of reliable population-based data on the prevalence of preventable ear disorders in developing countries. This study was conducted to determine the prevalence of preventable ear disorders in primary school children (aged 5 to 12 years) in northern India. Method: A pro forma questionnaire was used to screen 15 718 primary school children in New Delhi for ear disorders. Ear examinations were conducted using otoscopy and impedance audiometry. Results: Impacted cerumen was prevalent in 7.93 per cent of schoolchildren, 4.79 per cent suffered from chronic otitis media and 3.06 per cent suffered from otitis media with effusion. Acute otitis media was detected in 0.65 per cent and foreign bodies were found in 0.34 per cent of the children. Conclusion: Preventable ear diseases posed a significant health problem among children at primary school level. Regular screening of children during this stage would ensure that their school lives were not affected by hearing impairments or preventable ear disorders. Information gathered in this study will help in effective treatment prioritisation of ear disorders, planning and resource allocation.
 
The purpose of this paper is to define the incidence of squamous cell carcinoma (SCC) of the head and neck as seen at the Free University Hospital, Amsterdam, the Netherlands, in the last six years, according to the latest revised classification system of the International Union against Cancer (UICC, 1982). In addition, male to female ratios, relative frequencies at the various sites, age distribution, incidence of second or third primary and the relationship of distant metastases to the nodal metastases and the T-stage of the primary lesion are reported. These incidences are compared with those in other countries and the major differences are discussed.
 
A series of 1,724 clinical patients suffering from epistaxis was analyzed. Of these patients 58% were male and 42% female; 71.4% were aged over 50. The number of cases of epistaxis was greatest during autumn and winter months, being lowest from May to August. Cardiovascular diseases were believed to be a causative factor in 47.3% of the cases. The cause of the bleeding remained unknown in about 30% of the cases. Arterial ligature was carried out in 81 cases (4.6%). The various ligature procedures are discussed and the advantages of transantral ligature of the internal maxillary artery are pointed out. The treatment of epistaxis is discussed and it is pointed out that, in view of the inherent risks of complications in cases with protracted and severe bleeding, attitudes towards arterial ligation should be more strict than has hitherto been the case. A prospective study with the aim of clarifying the causes of spontaneous bleeding is planned.
 
The purpose of this study was to evaluate whether use of a positioner for situating the Clarion 1.29 standard electrode array in close proximity to the modiolus, causes damage to fine intra-cochlear structures, and to provide a comparison with results obtained for insertions of the array performed without a positioner. The study was performed in seven freshly frozen human temporal bones. Electrode location and intra-cochlear trauma was analysed using cross-sectional imaging and histological analysis. Insertion of the Clarion array did not reveal major trauma. The devices inserted with the positioner showed a consistently closer location of the electron array towards the modiolus, however, insertion resulted in significant displacement of both the electrode array and the positioner resulting in severe destruction of the basilar membrane and osseous spiral lamina along the length of the basal and middle turns. The devices inserted with the positioner resulted in major trauma to the basilar membrane and osseous spiral lamina. Therefore, systematic safety studies in larger samples of human temporal bones should be performed and the results carefully evaluated before implantation can be recommended unreservedly.
 
We present a review and analysis of 102 cases of Polytef injection of the larynx. We discuss the factors influencing the outcome of the procedure and its value.
 
During the eight-year period, 1983-1990, 102 cases of intracranial (IC) and extracranial (EC) complications from 17 144 suppurative otitis media were reviewed. The prevalence of each complication was 0.24 and 0.45 per cent respectively. Facial paralysis, subperiosteal abscess and labyrinthitis were the common complications among the EC group, while meningitis and brain abscess were common in the IC group. Twenty five per cent of the EC group and 44 per cent of the IC group had more than two complications. The reliable warning signs and symptoms for IC complications were fever, headache, earache, vestibular symptoms, meningeal signs and impairment of consciousness. Proteus spp., Pseudomonas aeuruginosa and Staphylococcus spp. were the commonest organisms isolated from both groups. Cholesteatoma and granulation/polyp in the middle ear/mastoid were the major findings in both patient groups. Mortality rate in the IC group was 18.6 per cent. Morbidity rate in each group was 14.3 per cent (EC) and 27.9 per cent (IC) respectively. Epidemiological presentations, clinical features and the result of treatment are discussed.
 
The thick oily and pigmented skin present in majority of tropical patients makes rhinoplasty challenging surgery. Rhinoplasty by the external approach though gaining increasing acceptance all over the world is yet to gain popularity in this country. Hypertrophied scars are not uncommon in coloured skin and the reluctance to give an external incision for a cosmetic procedure is natural. We started the external rhinoplasty approach with some reservations, however in a series of over seventy cases, no significant problem has been encountered, with the columellar scar. Accurate approximation of the columellar wound is probably a more important factor in wound healing than the skin colour. Our experience of external rhinoplasty is presented.
 
In a continually renewing cell population, stem cells can be regarded as a reservoir of cells with a high capacity for self renewal that give rise to all differentiated progeny. They are the primary source for the generation and maintenance of cellular diversity and tissue homeostasis. In general, neoplasms manifest differentiation pathways similar to those found in the development and renewal of the normal tissues from which they arise. This feature serves as a basis for classification schemes of neoplasms and, as in the normal tissues, there is usually an inverse correlation between proliferative capacity and differentiation within the neoplasms. In our postulate of the histogenesis of salivary gland neoplasia, we evoke the stem cell model to account for the considerable phenotypic heterogeneity seen with these neoplasms. We further consider the neoplasms and, in particular, their myoepithelial constituencies to be manifestations of escape from normal regulatory mechanisms that determine differentiation pathways which a stem cell and its progeny can take. Clinical and basic scientific evidence are presented to support the postulate and also to point to the mitigating role that myoepithelial differentiation has in the biological course of salivary gland neoplasms.
 
Objective: To determine the prevalence and characteristics of various diagnostic groups amongst patients referred to ENT practices with the primary complaint of dizziness. Study design: A prospective, observational, multicentre study. Methods: Consecutive patients presenting with dizziness to the participating ENT practices were enrolled. Seven ENT specialists at three clinics participated. Results: Benign paroxysmal positional vertigo was diagnosed in 53.3 per cent of the 1034 study patients. Fifty-nine per cent of these experienced night-time awakening with dizziness, which was a significant proportion in comparison to the other diagnostic groups. Benign paroxysmal positional vertigo was the most frequent diagnosis in all age groups, including those over 70 years. Conclusion: In this study of patients referred to ENT for dizziness, benign paroxysmal positional vertigo was the dominant diagnostic entity, in all age groups and overall. All clinicians in contact with dizzy patients must consider benign paroxysmal positional vertigo, especially in the elderly.
 
One hundred and four cases of osteoradionecrosis (ORN) of the mandible following irradiation of head and neck cancer are reported. Conservative management for ORN failed in all cases. Indications of hemimandibulectomy included intractable pain, severe trismus, pathological fracture, oro-cutaneous fistula and persistent exposure of bone. Surgical approach was intra-oral in 100 cases and extra-oral in four. Immediate soft tissue reconstructions were carried out in 20 per cent cases. Post-operative complications included minor sepsis (8.6 per cent), major sepsis (2.9 per cent), haemorrhage (2.9 per cent) and fistula (3.8 per cent). Major complications occurred only in patients treated exclusively by external irradiation at doses equal to or higher than 65 Gy. Relief from pain and trismus was obtained and normal swallowing was established following radical surgery.
 
Basically, for the production of speech it is necessary to have bellows, a vibrator and an articulatory mechanism. The laryngectomized patient can be helped in several ways. The electronic larynx is expensive and difficult to repair, and the speech produced by it is mechanical and monotonous. Successful oesophageal speech requires great motivation, expert guidance and great perseverance, and still it has a high failure rate. Surgical speech rehabilitation has a high rate of success. We strongly recommend this technique for all under-developed countries, where patients are poor, they often come from villages where there is no electricity, and there is normally no speech therapist.
 
Forty-six patients who had undergone a radical neck dissection more than six months previously were assessed to determine the degree of handicap that results from division of the accessory nerve. Employment problems, amount of pain, and social and recreational difficulties were assessed. Forty-six per cent of those in employment prior to their operation gave up their work specifically because of problems with their shoulder; this affected more manual than non-manual workers (11 out of 20 manual compared with zero out of four non-manual). Thirty per cent complained of moderately severe or severe pain related to the shoulder. The amount of pain could not be correlated with age, sex, side of operation in relation to handedness, physical build of the patient, or whether the patient had been treated with radiotherapy. Although this is the largest study to address this question since that of Ewing and Martin in 1952, the small numbers involved mean that if any such correlation exists then it may not have become apparent. In view of this incidence of pain and occupational handicap, we feel that efforts should be made to preserve accessory nerve function in cases where surgical clearance of the tumour field is not compromised as a result.
 
Oxymetazoline has been used as decongesting nosedrops for more than 25 years but so far no objective does-response study of the drug has been published. In this double-blind clinical trial the decongestant effect on the nasal mucosa by the doses and concentrations traditionally used of oxymetazoline were studied. In 106 men with acute infectious rhinitis, a significant dose-response relationship was found when the decongestant effect was measured objectively by anterior rhinomanometry and subjectively by symptom scores. The concentration and volumes of the drug recommended from clinical experience seem to be adequate.
 
One hundred and eight parotidectomies performed by a single consultant were reviewed. Eighty-five patients had primary parotid disease, 23 patients had extra-parotid primaries. Pleomorphic adenoma was the most common histological diagnosis. In patients with primary parotid disease, a post-operative temporary facial nerve palsy was noted in 15 patients, with a further four developing a permanent palsy. Patients with metastatic disease to the parotid had a poor prognosis.
 
We undertook a prospective observational study of 108 consecutive patients with endoscopic paranasal mucopurulent secretions. Only 31 patients (29 per cent) had facial pain. In 20 (65 per cent), the endoscopic site of purulent secretions corresponded to the site of pain. In those with facial pain, 74 per cent had nasal obstruction, 68 per cent had objective hyposmia and 84 per cent had mucopurulent rhinorrhoea. In the 31 patients with facial pain, 19 (61 per cent) became symptom free following medical treatment. The remaining 12 patients underwent surgery and their symptoms resolved, except for one patient with a tension-type headache and another with pain of unknown cause. Most patients with purulent secretions from the paranasal sinuses do not have facial pain; therefore, chronic rhinosinusitis is not synonymous with pain. Patients with sinogenic facial pain usually have endoscopic findings that correlate with the site of pain, and the majority also have other nasal symptoms. Chronic infective rhinosinusitis usually responds to medical therapy, and the remainder resolve with surgery.
 
This study aimed to estimate the effectiveness of a full digital, high definition video system for laryngeal observations. A newly available, full digital, high definition video camera and high definition video monitor were used. With an endoscopic adaptor and rigid telescope, laryngoscopy and stroboscopy were performed on patients with various kinds of laryngeal lesions. All laryngeal lesions were observed and recorded by the full digital, high definition video camera without incident. The image quality for laryngoscopy and stroboscopy was far superior to that of a conventional video system, including video-endoscopy. Even tiny structures or lesions could clearly be visualised on the monitor. The still image obtained from the full digital, high definition video camera was 1920 x 1080 pixels and was comparable to that obtained from a still camera. Full digital, high definition video cameras are now commonplace products and can easily be applied to patients with laryngeal disorders. They provide superior laryngeal images, compared with conventional video systems. Furthermore, high definition video systems are cheaper than proprietary medical video systems. We consider our system to represent an accessible technique of gaining superior laryngeal observation in otolaryngological clinics.
 
The records of 109 patients, presenting with functional voice disorder during the years 1977-1981, have been reviewed. The mean age was 45 years and the F : M ratio is 2 : 1. Excess voice use was not obviously an aetiological factor. Sixty-one of the 109 patients (56 per cent) were cured by speech therapy, in that their voices returned to their pre-morbid state, and a further 28 (26 per cent) were improved by therapy; seven patients (6 per cent) did not improve and 13 (12 per cent) were lost to follow-up. Of the patients that were 'cured', 54 per cent were discharged after three months' treatment and 72 per cent after six months' treatment. Eight per cent required treatment for more than a year.
 
A case of Staphylococcus aureus peritonsillar abscess in an 11-week-old infant is described. The importance of peritonsillar abscess culture and its changing management is discussed.
 
This is a retrospective study of 10 patients (11 ears) out of 132 cochlear implant patients of the Cambridge cochlear implant programme. These patients have all been explanted. Individual problems have been studied, relevant literature reviewed and the pitfalls of implant surgery re-examined in the light of our experience.
 
We describe multiple cutaneous squamous cell carcinomas of the head and neck in five patients with chronic lymphocytic leukaemia (CLL). When associated with CLL, cutaneous squamous cell carcinomata behave in a much more aggressive manner than otherwise expected. Four patients developed local recurrence after primary treatment. All five patients developed lymph node metastases containing squamous cell carcinoma. Three of five patients (60 per cent) had multiple primary lesions. Whereas the increased incidence of second cancers in CLL and notably of skin cancers is documented, little has been written to describe the aggressive behaviour of these tumours. It is important, when treating these patients, to be aware of the high tendency towards local recurrence and lymph node metastasis and to consider an aggressive management plan and careful follow-up.
 
A restrospective study was performed on 61 eligible patients with stage III and IV (AJC/UICC Staging System) squamous carcinomas of the head and neck region who were treated with definitive radiotherapy with, or without, surgery. DNA contents were measured by flow cytometric analysis of archival paraffin blocks and were correlated with clinicopathological findings, tumour response and patient survival. Comparison of variables including treatment modality was performed for identification of significant prognostic factors. There were 28 diploid, 27 aneuploid tumours and the remaining six were questionable. All patients were followed-up for at least two years or until death. Aneuploid tumours had a significantly higher S-phase fraction (percentage S-phase) ( p <0.001). Neither ploidy nor percentage S-phase were found to have predictive value in tumour response or patient survival within the power of a sample size of 61. Twenty of the 27 (74 per cent) aneuploid tumours had a complete response (CR) whereas 19 out of 28 (68 per cent) diploid tumours achieved CR. Five-year survival by the Kaplan-Meier method was 33 per cent for both aneuploid and diploid tumours. However, nodal stage (N stage) was found to have significant predictive value in both tumour response and patient survival. The complete response for stage N 0 patients was 96 per cent, N 1 patients 61 per cent, N 2 patients 60 per cent and 43 per cent for N 3 patients ( p <0.002). Similarly, the five year survival for the N 0 and N 3 groups of patients was 53 per cent and 29 per cent respectively ( p <0.05).
 
Retractions of the pars flaccida (PF) and the pars tensa (PT) were assessed in 250 atelectatic ears in an attempt to find out the way in which the differences in mechanical properties of the two parts of the tympanic membrane are reflected clinically. Retraction of PF was found in 217 ears (86.8 per cent) and retraction of PF in 150 (60 per cent). The concomitant presence of both types of retraction was observed in 117 ears (46.8 per cent) while 133 (53.2 per cent) had only one type, 100 of them (75.1 per cent) PF retraction and 33 (24.9 per cent) PT retraction. When only one type of retraction was present, the empirical probability of having a PF retraction was 75.1 per cent, while the probability of having a PT retraction was only 24.9 per cent. Clinically, the more frequent occurrence of PF retraction in the absence of PT retraction than vice versa reflects the greater collapsibility of the PF. When both types of retractions were present, we found a positive correlation between their severity.
 
Many articles have been written, analysing the results of tympanoplasty operations. Few have paid specific attention to tympanoplasties performed in childhood, despite the fact that it is during this period that most perforations occur. Perforations as a result of acute suppurative otitis media and trauma occasionally fail to heal spontaneously, and leave a child with impaired hearing and associated educational problems. Re-infection of the middle ear can restrict schooling and social activities. The aim or surgery is to correct these problems. With increasing age the incidence of upper respiratory tract infections decreases, and eustachian tube function improves. The question must then be asked: Is operative success related to age? This study attempts to answer this question by analysing, restrospectively, the results of tympanoplasties performed on children.
 
To evaluate the hearing results of a large series of primary stapedotomies, according to American Academy of Otolaryngology, Head and Neck Surgery guidelines and Amsterdam hearing evaluation plots. Retrospective chart review. The charts for 1369 consecutive stapedotomy cases were reviewed; 1145 cases of primary stapedotomy were included. Raw data from the audiometric database were evaluated using Amsterdam hearing evaluation plots. The effect on outcomes of using different audiological parameters was analysed. A significant improvement was demonstrated in mean post-operative air conduction and speech reception thresholds, with no change in bone conduction. Air-bone gap closure of 10 dB or more was achieved in 82 per cent of cases. A 'dead ear' occurred in one patient (0.1 per cent). This study reports the largest series of primary stapedotomies evaluated with Amsterdam hearing evaluation plots. This method enables visual identification of successful and unfavourable results, providing more accurate and detailed presentation of surgical outcomes.
 
The anti-tumour effect of the angiogenic inhibitor TNP470, sigma-(chloro-acetyl-carbamoyl) fumagillol, a synthetic analogue of fumagillin, was studied in vitro and in vivo using KB cells, one of the human head and neck carcinoma cell lines that produce interleukin(IL)-8. In the in vitro study, the combination treatment of TNP470 and anti-IL-8 antibody significantly reduced the proliferation of KB cells. In the in vivo studies, TNP470 administration by any route (intratumoral: i.t., intraperitoneal: i.p., intravenous: i.v.) reduced the tumour volume significantly, compared to the control group. Among the groups administered TNP470, the anti-tumour effect was strongest in the it group. Furthermore, the concurrent treatment of anti-IL-8 antibody and TNP470 also maximally reduced the tumour volume. The combination therapy of TNP470 and anti-IL-8 antibody was very effective. These results suggest that combination therapy of TNP470 and anti-IL-8 antibody could be beneficial for solid tumours, such as head and neck cancer.
 
To report the short- and long-term results of two techniques (mental imagery and manual shaking of the larynx) in patients with non-organic dysphonia or aphonia. Retrospective review of patient records, plus follow-up survey (questionnaire). Academic teaching hospital. One hundred and sixteen patients with moderate to severe non-organic dysphonia or aphonia. Cure (i.e. normal voice) and improved voice quality, judged by clinicians and patients. One hundred (86 per cent) of the 116 patients were cured. Ninety-four (81 per cent) patients regained their normal voice within one therapy session. The follow-up survey revealed that 43 of the 87 (49 per cent) patients who responded had not had a relapse since therapy ended. Of those patients suffering relapse, 15 successfully applied mental imagery in order to retrieve their voice, compared with three patients who applied shaking of the larynx. Mental imagery, combined if necessary with manual therapy, is an effective therapeutic technique in patients with non-organic voice disorders.
 
Epistaxis is the most common nasal emergency and if nasal packing is required this commonly results in admission. A literature search could find no published (UK) protocols for the management of this common condition in accident and emergency (A&E) departments. This paper presents a retrospective review of 116 patients with epistaxis, following implementation of the new peer reviewed protocol in June 2004. Apart from cautery, 62 had nasal packing inserted. Only 17 required admission. Forty-six patients were discharged with nasal packing in situ and only seven (16 per cent) returned due to bleeding. The overall return rate was 11 per cent. We feel this is a safe and logical protocol. Compared to mandatory admission after nasal pack insertion, we saved 39 admissions in five months. There were also the added benefits to patients of being able to recuperate at home rather than in hospital and avoidance of the risk of hospital acquired infection.
 
The pathogenesis of cholesteatoma remains unclear, despite several theories. Alterations in the density of mast cells positive for cluster of differentiation 117 protein (also known as CD117) can be critical to cholesteatoma formation, due to the effect on keratinocyte growth factor production. This study aimed to investigate the potential role of these mast cells in cholesteatoma pathogenesis. The number and density of mast cells positive for cluster of differentiation 117 protein were immunohistochemically analysed in 52 patients: 22 with chronic otitis media alone (group one), 25 with chronic otitis media with cholesteatoma (group two) and five controls. The number of these mast cells was much higher in group two (in cholesteatoma matrix tissue) than in group one (in chronic otitis media granulation tissue) or the controls (in normal post-auricular skin). The density of these mast cells was significantly greater in group two than in group one or the controls (p < 0.05). The number and density of these mast cells was much greater in group one than in controls (p < 0.01). Mast cells positive for cluster of differentiation 117 protein could play a role in cholesteatoma formation. Further investigation of the role of these mast cells in cholesteatoma may suggest new ways of addressing this disorder, and may enable the development of targeted treatments.
 
Based on this review of 1192 intranasal sinus procedures under endoscopic control with video assistance, the risk of major complications was estimated to be about 1.3 per cent. Ethmoidectomy was the most hazardous procedure. Operation by a right-handed surgeon standing on the right side of the patient was an added risk factor. We stress ways of achieving prevention, peroperative recognition of cerebrospinal fluid leaks and proper management of complications.
 
To report our experience of the management of patients with primary sinonasal malignant melanoma, and to review the relevant medical literature. Retrospective review examining treatment and outcomes. Twenty-four patients were treated between 1982 and 2007. The mean age at presentation was 67.5 years. The overall five-year survival was 30 per cent; mean survival was three years and eight months. Sinonasal malignant melanoma is associated with a poor outcome, and survival statistics have not improved over the last 40 years. Treatment should include radical surgery wherever possible. Local recurrence is common; radiotherapy may help control this but does not appear to affect overall survival. The limited evidence available suggests that endoscopic removal of sinonasal malignant melanoma is as effective as other local surgical means, but that craniofacial resection remains the 'gold standard' for tumours that contact or traverse the skull base. Novel biological treatments are emerging and hold promise for the future.
 
Objective: To determine the rate of spontaneous tumour shrinkage in a group of patients with sporadic vestibular schwannoma managed with a 'wait and scan' approach. Patients: All patients with a unilateral cerebello-pontine angle tumour resembling a vestibular schwannoma were registered prospectively in a national database in Denmark. Patients registered with tumour shrinkage were identified and all computed tomography and magnetic resonance imaging scans retrieved, re-evaluated and related to the clinical data. Results: Of 1261 observed patients, 48 displayed spontaneous shrinkage (3.81 per cent). Mean absolute shrinkage was 6.25 mm, equivalent to 52.1 per cent. Absolute shrinkage correlated with tumour size and followup period, whereas relative shrinkage was significantly greater for tumours which were purely intrameatal at diagnosis. There was no correlation between age and the degree of shrinkage. Conclusion: Four per cent of sporadic vestibular schwannomas shrink spontaneously. These findings substantiate the 'wait and scan' strategy for tumours with a largest extrameatal diameter of up to 20 mm.
 
To analyse the epidemiology, presentation and diagnosis of head and neck tuberculosis (TB). We conducted a 10-year retrospective study of all cases of tuberculosis of the head and neck region occurring in Bradford, UK. Of a total of 1315 cases of TB, 128 presented with head and neck TB (12 per cent of which (15/128) were in children). Cervical lymph nodes were most commonly involved (87 per cent, 111/128), other sites being: salivary glands (five cases); larynx, oral cavity, eyes and ears (two cases each); and skin, thyroid, nasopharynx and retropharyngeal space (one case each). Patients' ethnic origins were Asian (89 per cent, 114/128), Caucasian (10 per cent, 13/128) and African (one case). Only 26 per cent (33/128) had constitutional symptoms, and 20 per cent (25/128) had a coexistent site of TB. Only 39 per cent (40/105) of surgical specimens were sent for culture. Isolated head and neck TB is not uncommon. Atypical presentations render diagnosis challenging, so awareness aids early diagnosis. Mycobacterial cultures should be performed, where possible, for diagnosis.
 
Medical reports of 1293 patients with squamous cell carcinoma (SCC) of the head and neck were retrospectively evaluated. The patients were classified according to their age, sex, primary tumour localization and tumoral stage. There were 1181 males (91.3 per cent) and 112 females (8.7 per cent), with a male to female ratio of 10.5:1. The peak incidences for all primary tumour localizations were observed in the fifth decade. Most common primary tumour localizations were the larynx (71.1 per cent), the nasopharynx (10.1 per cent) and the oral cavity (8.8 per cent). Of all patients in whom staging was complete, 43.1 per cent presented at early and 56.9 per cent at advanced stages. The proportion of patients presenting with metastatic neck nodes was 34.4 per cent and the incidence of metastatic neck nodes increased with increasing T stage. The supraglottic region was the most common primary site among all laryngeal SCC, with a supraglottic to glottic SCC ratio of 1.5:1. Glottic SCC presented at earlier stages compared to supraglottic SCC. The incidence of nodal metastases increased with increasing T stage for SCC of the larynx, the oral cavity and the oropharynx.
 
The prognosis for cases of idiopathic facial palsy is usually good. However, some cases develop disabling sequelae, such as synkinesis or severe facial hemispasm, despite targeted medical treatment. The authors try to achieve that electromyography is useful to identify patients with severe palsy and an unfavourable prognosis. These patients would probably benefit from facial nerve decompression. The otolaryngology-head and neck surgery department of Pitié-Salpêtrière Hospital, Paris, a tertiary referral centre.Participants:Thirteen cases undergoing surgery between January 1997 and March 2007. We describe the electromyographic findings that led to surgery. All patients underwent surgery via a subpetrous approach, within four months of the onset of palsy. Decompression involved the first and second portions of the nerve and the geniculate ganglion. Recovery to House-Brackmann grade III was obtained in all cases at one year follow up. These results compared favourably with previous reports. A new therapeutic procedure may allow improved results.
 
Sixteen patients with unresectable recurrent head and neck carcinomas were treated with 13-cis-retinoic acid and interferon-alpha. All patients had presented with recurrences after having been treated primarily with surgery and radiotherapy, while two of them had also received induction chemotherapy. The site of relapse was strictly locoregional in all cases (only at the primary site in three cases, at the cervical lymph nodes only in four cases and both at the primary site and the neck in the remaining nine cases. Two patients were female, and 14 male, with an age range of 47-72 years (median 61 years). Interferon-alpha was administered subcutaneously at a dose of 3 x 10(6) IU every second day. The dose of retinoids was 40 mg per os every day. The duration of treatment was two to 14 months (median seven months). There were two cases of partial response (tumour regression > 50 per cent), eight cases of stable disease lasting for three to seven months (median four months) and six cases presented with progressive disease. All patients died after a survival of three to 17 months (median 9.5 months). Toxicity was generally minimal. We believe that the results are not encouraging, but also not disappointing. The fact that toxicity was indeed mild, with not a single case of life-threatening sequellae even after prolonged administration of the two agents, allows us to conclude that an increase of the dose of IFN-alpha might be more beneficial. Selection of patients with more 'favourable' recurrences will give a better chance to the treatment combination to prove its real efficacy. Larger numbers of patients have to be treated and evaluated before definite conclusions can be reached.
 
Proceedings of the 132nd Semon Club, Otolaryngology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK, 17 November 2006 - Volume 122 Issue 9 - Ricard Simo, Leslie Michaels, Ann Sandison, Steve Connor
 
Top-cited authors
Nicholas Jones
  • Nottingham University Hospitals NHS Trust
S S M  (Musheer) Hussain
  • Ninewells Hospital
Patrick J Bradley
  • University of Nottingham
Samy Elwany
  • Alexandria University
Kenneth Mackenzie
  • University of Strathclyde