Large excisions or Mohs’ micrographic surgery (MMS) are often the suggested treatments for non-melanoma skin cancers (NMSCs) of the external ear. This five-year follow-up attempts to evaluate whether curettage-cryosurgery could be an alternative therapy for selected auricular NMSCs.

One hundred auricular NMSCs, selected at a skin tumour clinic, were treated by a thorough curettage, with different-sized curettes, followed by cryosurgery in a double freeze-thaw cycle. Seventy-seven basal cell carcinomas (BCCs), 13 squamous cell carcinomas (SCCs), six SCCs in situ, and four basosquamous carcinomas were included. The mean diameter of the tumours was 18 mm (range 5–70). Morphoeiform BCCs, recurrent BCCs with fibrotic component, and most of the SCCs were selected for MMS.

Seventy-one patients with 81 tumours were followed-up for at least five years with only one recurrence. Nineteen patients with 19 tumours, followed-up for two to four years, died from other causes with no sign of recurrence at their last visit. Patients followed-up for less than two years were excluded. No major problems were registered after treatment. The cosmetic result was good or acceptable in most patients.

In carefully selected patients a thorough curettage followed by freezing with liquid nitrogen in a double freeze-thaw cycle could be a safe and inexpensive therapy even for large NMSCs of the external ear.

Day-case surgery is particularly attractive for children, allowing post-operative recovery in the safe environment of the family home. Myringoplasty using the traditional method of underlay temporalis fasia is usually performed as an in-patient. From 1995 to 2000, 74 myringoplasties were performed in a dedicated paediatric day surgery unit at the Mayday University Hospital. We have retrospectively reviewed the outcome results of these procedures and reported them here. Only three patients required admission overnight (four per cent) and six grafts failed (8.5 per cent) complying with accepted standards. This series suggests that day-case surgery is a safe and desirable practice for children undergoing myringoplasty. However, there should be the facility for admission if required.

Referrals for epistaxis management constitute a significant proportion of paediatric ENT consultations. A prospective audit of all new referrals to our paediatric ENT department for epistaxis management yielded 88 patients over four months. Parents completed a questionnaire with particular reference to the duration of history and frequency of epistaxis. After assessment some patients were given topical chlorhexidine and neomycin cream (Naseptin), in addition some children also underwent chemical cautery (silver nitrate). Of the 64 children in whom out-patient nasal cautery was attempted it was tolerated by 63 (98 per cent). In response to a follow-up postal questionnaire returned by 65 per cent, most parents (74 per cent) felt that Naseptin was useful. A telephone survey of the patients’ general practitioners found that 91 per cent of the children did not consult their general practitioner regarding epistaxis again. We conclude that paediatric epistaxis can be effectively managed with a single out-patient consultation.

Between May 1997 and May 2001 all patients presenting with a unilateral vocal fold palsy at Gartnavel General hospital were entered into a prospective observational study. The sex, age, side of palsy and aetiology were documented. The aim of the study was to assess the current aetiology of vocal fold palsy in a large teaching hospital in the West of Scotland, and to compare this with the established aetiology in other parts of the world. Seventy-seven patients were studied. Eighty-three per cent were found to have a left and 17 per cent a right vocal fold palsy. The male to female ratio was 2:1, with an age range of 23–85, mean 61. Forty-three per cent of all vocal fold palsies were secondary to an underlying bronchogenic carcinoma and a further nine per cent due to other malignancies. This contrasted with figures quoted in other studies, that gave lung cancer causes of vocal fold palsies ranging from four to 22 per cent. Surgical trauma accounted for 24 per cent and in 11 per cent no cause was found. In conclusion, in our hospital population there is a high rate of vocal fold palsy secondary to bronchogenic carcinoma. This is likely to be associated with the high levels of smoking found in Scotland. Lung cancer rates in Scotland are 1.6 times greater for men, and two times greater for women than the world standard. Malignancies overall cause over 50 per cent of our vocal fold palsies. Vigilance is required in any patient presenting with a vocal fold palsy to ensure a malignancy is not overlooked.

Tonsillectomy is a frequently performed operation but there is little information about the histological features of a tonsillectomy specimen. In this study, we re-evaluated archival materials of 1220 cases who underwent tonsillectomy because of hyperplastic tonsils. Haematoxylin and eosin sections of the cases were re-examined and the presence and the proportion of mesenchymal tissues (skeletal muscle, cartilage, fat, bone) and seromucinous glands were noted as focal, multifocal or abundant. The incidence of skeletal muscle was 89 per cent (1085 cases; 206 focal, 465 multifocal, 414 abundant), seromucinous glands 35 per cent (429 cases; 236 focal, 134 multifocal, 59 abundant), fat 21 per cent (251 cases; 208 focal, 43 multifocal), cartilage three per cent (31 cases), and bone one per cent (seven cases). Also in 165 cases (14 per cent) skeletal muscle, in 12 cases (one per cent) was seromucinous glands, in eight cases (one per cent) was cartilage, in seven cases (one per cent) fat, and in four cases (less than one per cent) bone were found between hyperplastic lymphoid tissue. It can be concluded that mesenchymal tissues (skeletal muscle, cartilage, fat, bone) and seromucinous glands may be seen in different proportions in routine tonsillectomy specimens.

The Doughty split tongue blade is used routinely with the Boyle Davis mouth gag during tonsillectomy. If the width of the slot in the blade is excessive, then the endotracheal tube may herniate through the slot in the blade and become fixed and inseparable from the blade. We report two cases of paediatric tonsillectomy where this potentially serious complication occurred. The slot widths of disposable and reusable Doughty blades were measured and specifications were obtained from several manufacturers. All disposable paediatric Doughty blades and some of the reusable blades were found to have excessively and potentially dangerously wide slots. Compression testing of endotracheal tubes by the manufacturer demonstrated marked increases in deformability on warming to body temperature. Ensuring that the slot width of the Doughty blade is not excessive for the endotracheal tube used is essential and we give recommendations.

This study was performed to find out the effectiveness of three different treatments of patients having acute tonsillopharyngitis. Three groups of patients were selected (50 patients in each group). Group I received one antibiotic according to the result of culture and sensitivity test, while groups II and III received two antibiotics or one antibiotic respectively without a culture and sensitivity test. Diagnosis was based on the acutely subjective symptoms of sore throat and positive clinical examination findings. The effectiveness of treatment in group I (96 per cent) was statistically significant (p<0.05) and higher than group II (82 per cent) and group III (74 per cent), while the difference between group II and III was not statistically significant (p>0.05).

Our findings demonstrate that a culture and sensitivity test of the throat swab is necessary before treating acute tonsillopharyngitis. It was suggested that there should be appropriate selection of antibiotics to preserve normal flora, avoidance antibiotics for viral infections, patient compliance with prescription and educational programmes directed at patients and physicians. All of these measures would assist in reducing the volume of antibiotic use, bacterial resistance and the overall cost of treatment of tonsillopharyngitis.

Between 1985 and 1999, 43 patients with locally-advanced, resectable oropharyngeal cancer were treated with combined surgery and post-operative radiation therapy (RT) at Oregon Health and Science University. Five patients (12 per cent) had Stage III disease and 38 patients (88 per cent) had Stage IV disease. All patients had gross total resections of the primary tumour. Thirty-seven patients had neck dissections for regional disease. RT consisted of a mean tumour-bed dose of 63.0 Gy delivered in 1.8–2.0 Gy fractions over a mean of 49 days. At three- and five-years, the actuarial local control was 96 per cent and the actuarial local/regional control was 80 per cent. The three- and five-year actuarial rates of distant metastases were 41 per cent and 46 per cent, respectively. The actuarial overall survival at three- and five-years was 41 per cent and 34 per cent, respectively. The actuarial rates of progression-free survival were 49 per cent at three-years and 45 per cent at five years. Combined surgery and post-operative RT for advanced-stage oropharyngeal cancer results in excellent local/regional control. This particular group of patients experienced a high-rate of developing distant metastases.

The treatment of cervical lymph node metastases is an important part of the management of oropharyngeal squamous cell cancer. Metastases are already clinically present in 61 per cent (+ or −2.6 per cent) of patients at presentation. Previous studies concerning the prevalence and distribution of neck node metastases in oropharyngeal carcinoma have been retrospective, and little or no information is available about the histopathological methods used.

This study has prospectively analysed 85 neck dissection specimens in 72 consecutive patients with squamous cell carcinoma of the oropharynx, both with clinically N0 and N+ve necks, to identify the prevalence and distribution of cervical metastases. We have used a technique to separate the neck dissection into nodal levels per-operatively, and then embedded the entire specimen for histological examination to avoid missing metastatic disease in small lymph nodes (<3mm diameter).

Familiarity with four types of free tissues transfers allows appropriate reconstruction of most defects in the head and neck region functionally and aesthetically. These include jejunal graft, radial forearm, rectus abdominus myocutaneous and fibula osteocutaneous flaps. Free colonic and gastric patches were used occasionally.

We report our experience of 215 free tissue transfers for reconstruction of defects in the head and neck region after tumour extirpation.

The overall success rate was 94 per cent. The commonest cause of failure was related to arterial inflow (70 per cent). Three patients died in hospital, but their mortality was not related to the tissue transfers. Complications due to free tissue transfer at both the donor and recipient sites were few and manageable.

The co-operation between the two surgical teams, together with the timely application of suitable salvage procedures, contribute to an optimal outcome.

Co-existent comorbidity is a major determinant of treatment outcome in head and neck cancer. Most of the work pertaining to this topic has been done in the United States, where the standard practice is for trained cancer registrars to grade comorbidity using validated indexes by retrospective notes review. The adult comorbidity evaluation – 27 index (ACE-27) is a validated instrument that has been widely used in head and neck cancer. Although the required clinical data may be available in the notes, a significant amount of historical information is required to grade comorbidity. The aim of this study was to assess the accuracy and inter-rater reliability of the retrospective notes review process, in a typical setting in the United Kingdom (UK), by comparing the information obtained on notes review alone by a physician to that available after a structured patient interview. The study concludes that the retrospective notes review is an accurate and reliable technique for grading comorbidity whose completeness can be improved by the use of patient questionnaire as part of a structured interview.

This is a report of three cases of mixed hearing loss that resulted from inner ear disorders. Two cases were unilateral and the third was bilateral. The diagnosis was based on the findings of normal middle and external ears in association with the absence of round window reflexes. The contralateral stapedial reflex was present in the two unilateral cases. This is the first documentation of conductive deafness due to inner ear abnormality. This diagnosis should be considered in cases of conductive hearing loss if the middle and external ears are normal. More studies are needed to establish the pathophysiology of this entity.

Partial cochlear obstruction is a relatively common finding in candidates for cochlear implants and frequently involves the inferior segment of the scala tympani in the basal turn of the cochlea. In such patients, the scala vestibuli is often patent and offers an alternative site for implantation. The current report describes two patients with such partial obstruction of the inferior segment of the basal cochlear turn, caused in one case by systemic vasculitis (Takayasu’s disease) and in the other by obliterative otosclerosis. A scala vestibuli implantation allowed for complete insertion of the electrode array. No problems were encountered during the surgical procedures and the good post-operative hearing and communicative outcomes achieved were similar to those reported in patients without cochlear ossification.

The importance of accurate pre-operative radiological study of the inner ear is underscored, to disclose the presence and define the features of the cochlear ossification and ultimately to properly plan the surgical approach.

Haemangiopericytomas are rare peri-vascular tumours with variable malignant potential. The nasal cavity and the paranasal sinuses are most often involved in the head and neck. Five cases of haemangiopericytomas treated by a strict endonasal endoscopic approach are presented. Bleeding and nasal obstruction are the most frequent symptoms. Computed tomography (CT) scan and magnetic resonance imaging (MRI) allowed pre-operative assessment. Angiography with embolization was needed in two of the five cases. None of our patients presented with malignant histology. Our five cases were operated on, and a total tumour excision was performed through the endoscopic endonasal approach. We had one recurrence with a mean follow-up of 4.5 years. We suggest that when the tumour is purely intranasal or strictly located in the ethmoid or sphenoid sinus, it can be removed via an endonasal approach under endoscopic guidance in experienced hands.

A case of osteochondroma of the posterior nasal septum is presented. A 57-year-old female patient presented with a history of bilateral nasal obstruction for 20 years. To the best of our knowledge, this is the second reported case of an osteochondroma of the nasal septum. It was treated by endoscopic transnasal transseptal surgery.

Intractable paroxysmal sneezing is a rare disease primarily affecting teenage girls. We present the case of a 12-year-old girl who demonstrated the classical features of intractable paroxysmal sneezing of psychogenic origin. Most of the reported cases are psychogenic in origin, but a number of other conditions may cause intractable paraoxysmal sneeze. Apart from a detailed history, clinical examination and relevant investigations, topical nasal anaesthesia should be tried for control of symptoms – that will help to differentiate psychogenic sneezing from organic sneezing. A timely diagnosis can avoid unnecessary medical trials, parental anxiety and poor school performance, as most of the patients are very young.