In pharyngeal pouch surgery, the relatively new technique of endoscopic stapling diverticulotomy has a number of advantages over more traditional surgical treatments, such as Dohlman’s procedure and open pouch excision, and now seems to be the procedure of choice. However, a number of iatrogenic perforations and deaths have been reported with this procedure. We present three cases of iatrogenic perforations occurring during endoscopic stapling of a pharyngeal pouch by different surgeons in our unit, and review the management, causes and prevention of this potentially life-threatening complication.

This article presents a new approach to understanding the physiological functions of the mastoid cell system. It is suggested that the cell system, in combination with the continuous blood flow through the adjacent large vessels, makes up a compound functional unit that serves to protect the sensitive vestibular part of the inner ear from inadequate stimulation by external temperature changes. By virtue of the large surface area of the cell system mucosa with respect to the enclosed gas volume, the mastoid cell system may also work as a pressure regulator. Variations of the bi-directional exchange of fluid over the capillary network in the mucosa will change the size of the lumen that is available for the gas in the cell system. Volumes of gas and fluid can thus be exchanged to keep the intratympanic pressure within physiological limits. The process is most effective in a cell system with a high area-to-volume ratio.

The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.

The aim of this study was to determine which anaesthetic and vasoconstrictor preparations UK Otorhinolaryngologists use for rhinological surgery, with particular reference to cocaine and adrenaline. The incidence and types of adverse reactions to cocaine were also recorded.

A postal survey of all BAO-HNS consultant members was performed. Of the 360 consultant surgeons included in the survey, the majority still use peri-operative cocaine on a regular basis, 66 per cent use cocaine and adrenaline together and more than 40 per cent use cocaine in paediatric patients. Sixteen per cent of respondents did not use cocaine. Only 11 per cent of surgeons had experienced cocaine toxicity in their patients, with only one recorded case of mortality.

Most surgeons in the UK use cocaine because of the superior operative field it provides and because they consider it to be safe even with adrenaline. The actual incidence of adverse reactions to cocaine is low, with serious complications being less common than the risks from general anaesthesia. Cocaine remains a valuable agent in the armamentarium of the rhinologist.

Clinical success of laryngotracheal protheses are constrained by a combination of biocompatible response in the host and a suitable functional rehabilitation. This review considers clinical limits of different materials commonly used in ear, nose and throat surgery and will more particularly focus on titanium, one material recognized to be well tolerated in implantology.

Helicobacter pylori is an accepted cause of chronic active gastritis and has a major causative role in peptic ulceration. It is a gastric carcinogen. Its role in non-ulcer dyspepsia (NUD) is less clear; yet 50 per cent of patients with NUD are infected with H pylori. H pylori has been investigated in several other organ systems, but has not been investigated extensively in squamous cell carcinoma of the upper aerodigestive tract, a region which could be directly exposed to the bacterium by gastro-oesophageal reflux (GOR).

In this study 61 patients with severe laryngeal dysplasia or frank carcinoma of the head and neck are striated by age, investigated for the presence of antibodies to H pylori and compared to age and sex matched controls.

In the age group of 46–61 years, the presence of H pylori antibodies was marginally greater in the experimental (63.0 per cent) than the control group (40.7 per cent) (Pearson Chi square p = 0.055, Fisher 2-sided exact test p= 0.066). When combining this age group with the younger age group and thereby creating two roughly equal groups (n = 31 and n = 30) there was also a statistical trend towards increased positivity in the experimental group. These findings are discussed in the light of other studies with gastro-oesophageal reflux disease (GORD).

Nosocomial infections are an important cause of morbidity and contaminated equipment may contribute to this. There has been little work concerning contamination of non-disposable equipment in Otolaryngology. This study investigates the efficacy of the cleaning regimen for non-disposable instruments in an Otolaryngology out-patients clinic. Instruments were swabbed before each clinic, when they had been autoclaved, then after use on patients, when they had been washed with detergent and chlorhexidine. Swabs of 86 instruments were cultured using standardized microbiological techniques. Fifteen instruments (17 per cent) were contaminated, most with coagulase negative staphylococci. Two specimens of Micrococcus luteus were cultured and one each of Pseudomonas aeruginosa, Acinetobacter lwoffii and Aureobacterium spp. Micrococcus luteus and coagulase negative staphylococci may represent skin contaminants, but Aureobacterium spp. and Acinetobacter lwoffii can be sources of nosocomial infection. Pseudomonas aeruginosa is a potentially serious pathogen and is implicated in the aetiology of otitis externa. These findings question the efficacy of the current cleaning techniques.

It is standard practice to write to a patient’s general practitioner (GP) following an out-patients consultation. This study set out to assess whether sending a copy of this letter to the patient improves their satisfaction with the consultation. Two hundred patients were randomly assigned to receive or not to receive a copy of their GP letter. Their satisfaction was then assessed by means of a postal questionnaire. The two groups were compared to ensure that there was no significant difference between them with regard to any other aspect of their consultation. Those who did not receive a copy letter had a median overall satisfaction score of 7.75 whilst those who did had a median score of 9.0 (p = 0.014). The only other factors predictive of overall satisfaction were receiving an explanation of the problem and spending sufficient time with the doctor. Sending patients a copy of correspondence to their GP is one means of aiding communication and improving overall satisfaction.

Canalicular blockage of the lacrimal system still remains a major challenge for oculoplastic surgeons. The conventional treatment of conjunctival dacryocystorhinostomy using the Lester Jones bypass tube is often associated with tube migration and foreign body reaction. The authors report a new technique to reconstruct the lacrimal passage on a single patient with severe canalicular obstruction following repeated failures from previous Lester Jones tube operations. An epithelial-lined tube was recreated between the nasal cavity and the conjunctiva using a superiorly based mucoperichondrial flap from the nasal septum (Ipswich lacrimal tube). The pedicle of the flap was divided six weeks following the operation. The patient was still symptom free two years following the operation together with a positive dye test confirming the patency of the new lacrimal tube.

Anterior ethmoidal artery ligation is a well-established surgical procedure in the management of epistaxis. We describe a procedure of anterior ethmoidal artery ligation via minimal access external surgery with the use of a rigid endoscope. This is, as far as we are aware, the first description of an external approach endoscopic anterior ethmoidal artery ligation.

Exposure to carbon monoxide is a well-recognized cause of morbidity and mortality. Both acute accidental poisoning and chronic exposure are associated with a range of adverse health effects. We report two cases of carbon monoxide poisoning with the associated phenomenon of sensorineural hearing loss. Although hearing loss as a result of acute carbon monoxide exposure has previously been described, here we emphasize the need to consider chronic exposure to carbon monoxide as a potentially reversible cause of sensorineural hearing loss if diagnosed and treated early.

Air bag safety systems have significantly reduced the number of occupant injuries from road traffic accidents (RTA). However air bag deployment is also associated with unavoidable risks.

We report the acoustic trauma incurred by a young female driver who was a heavy smoker as a consequence of air-bag deployment in a low speed RTA and the sparing of her child seated in the rear.

A 20-year-old woman developed gross surgical emphysema tracking down to the chest after an episode of nose blowing. Fortunately there were no ocular complications and the patient settled with conservative management. Follow-up showed no recurrence. The case presented illustrates the very rare complication of orbital fracture following nose blowing.

Aspiration of a foreign body is a recognized cause of accidental death in children. Paediatricians are aware of the symptoms of inhaled foreign bodies in the lower respiratory tract. However, symptoms which suggest impaction in the larynx do not appear to raise the same index of suspicion of a foreign body. One case of laryngeal foreign body is described with a delay in diagnosis of five days. The clinical presentation, investigations and management are discussed.

Post-intubation laryngeal dysfunction is well documented. Both common and rare patterns of injury have been described in the literature. An unusual pattern of intubation injury is described in this case report. The different patterns of post-intubation laryngeal injury are discussed as well as the possible aetiology in the case described.

Oral manifestations of Crohn’s disease may present to the Otolaryngologist in the form of ulceration, glossitis and odynophagia, but rarer examples of presentation are also recognized. In this case a 24-year-old lady presented with cervical lymphadenopathy, the subsequent investigation of which resulted in the identification of the disease both in this node and in the tonsils. It is noted that these lesions may precede the classical intestinal manifestations and so the Otolaryngologist could aid in the initial diagnosis of the disease. The pathogenic possibilities of how Crohn’s disease might have arisen in these and other extra-intestinal regions, are discussed.

Wegener’s granulomatosis is a potentially fatal disease of unknown origin affecting mainly the upper and lower respiratory tracts and kidneys. Prompt recognition of the more unusual presentations of the disease is necessary to ensure early treatment. We present a case of a 46-year-old female with bilateral submandibular and parotid gland enlargement.

Parotid or submandibular salivary gland enlargement is a rare presenting feature of Wegener’s granulomatosis. Common to 80 per cent of these cases is nasal involvement, while ear pathology or lung lesions may occur in the remaining cases. The diagnosis is both clinical and pathological, biopsy of suspicious tissue, serum c-ANCA levels and a chest X-ray are valuable investigations. Treatment with immunosuppressive therapy is essential, and usually ensures a long-term remission.

We present a case of a 40-year woman with bilateral parotid salivary gland enlargement as presentation of primary Sjögren’s syndrome. Computed tomography (CT) and magnetic resonance imaging (MRI) showed parotid cysts, suggestive of cystic benign lymphoepithelial lesions. A sub-labial biopsy confirmed the syndrome. After 24-month follow-up, the left parotid cysts remain the same, whereas other cysts have appeared in the right parotid gland. Parotid involvement in Sjögren’s syndrome is discussed.