We describe a previously unreported case of ethmoid silent sinus syndrome.

Case report and review of the world literature regarding silent sinus syndrome.

A 33-year-old woman developed medial displacement of the left orbital contents in the absence of trauma, surgery or other significant pathology. Imaging showed opacification of the left ethmoid sinus and implosion of the medial orbital wall. Previously reported cases of silent sinus syndrome have all involved the maxillary sinus, with subsequent implosion of the orbital floor. Computed tomography scans of our patient showed wide, flat ethmoidal bulla and surrounding cells, with few horizontal bony septae reinforcing the area of collapse.

This case represents the first report of ethmoid silent sinus syndrome. We argue that, in anatomically susceptible individuals, the silent sinus syndrome can present due to chronic ethmoidal sinusitis.

To highlight the possibility of pituitary apoplexy after functional endoscopic sinus surgery for elimination of sinonasal infection, an important preparatory step for safe trans-sphenoidal access to the pituitary fossa.

A 67-year-old man with a known pituitary macroadenoma developed headache, diplopia and reduced vision after endoscopic middle meatal antrostomy and ethmoidectomy for rhinosinusitis with polyps. Magnetic resonance imaging showed pituitary haemorrhage. The patient underwent emergency endoscopic trans-sphenoidal resection of the tumour, with significant symptomatic improvement. Despite mild right eyelid ptosis and persistent diabetes insipidus, the patient resumed normal activities in a few weeks. To our knowledge, this is the first report of pituitary apoplexy after a nasal operation.

Pituitary apoplexy is a rare and potentially life-threatening event in high risk patients with pituitary adenomas; it may occur spontaneously or after surgical procedures. Early, combined surgical intervention by rhinologists and neurosurgeons is recommended. The endoscopic trans-sphenoidal approach is a safe and effective technique for the acute management of pituitary apoplexy.

We report an extremely rare case of congenital cholesteatoma of the infratemporal fossa.

The clinical, radiological and intra-operative findings of the patient are presented.

A five-year-old girl presented to our hospital with symptoms in the left ear consistent with middle-ear effusion. A congenital cholesteatoma was not suspected until an enlarging mass in the anteroinferior quadrant of the tympanic membrane was observed. Radiological studies revealed that the mass was located largely in the infratemporal fossa, with limited extension into the tympanic cavity. The patient underwent surgical treatment, which confirmed the clinical and radiological findings.

This patient's clinical, radiological and intra-operative findings strongly suggested the infratemporal fossa as the site of origin of her congenital cholesteatoma.

We present two cases of a hyoid bone fracture identified through careful clinical examination with a Valsalva manoeuvre during nasendoscopy.

Case reports and review of the literature, with emphasis on technique during nasendoscopy.

The first patient had sustained a blow to the neck with a stick, six months prior to presentation with a globus sensation. External examination and standard nasendoscopy were unremarkable. The second patient had been struck across the neck by a wire whilst riding a motorbike at low speed. Endoscopy revealed swelling of the supraglottis. He recovered and was asymptomatic at review one month later. Computed tomography scans on both patients were unremarkable. During nasendoscopy, both patients were asked to forcibly expire with their mouths closed (the so-called nasal Valsalva manoeuvre), and the hyoid bone was seen to swing into view on the side where the first patient complained of symptoms, and in the second case where swelling had been noticed previously.

We would not ordinarily have reached a diagnosis in these patients, as radiography and examination were otherwise unremarkable. The use of the nasal Valsalva manoeuvre during routine nasendoscopic examination is recommended, as unusual pathology may be demonstrated and the need for direct laryngoscopy under general anaesthesia may, in some instances, be avoided.

To report our experience of using propranolol to treat an infantile airway haemangioma.

A five-week-old girl presented with upper airway obstruction. Having started systemic steroids, concurrent propranolol therapy was commenced. Propranolol was given with close monitoring of the blood pressure, pulse and capillary glucose level. The dose of propranolol was gradually increased to 2 mg/kg total daily dose, with simultaneous reduction and withdrawal of steroids.

Prior to propranolol treatment, laryngotracheobronchoscopy revealed an extensive haemangioma extending from the posterior pharyngeal wall to the subglottis. Following initiation of propranolol, a dramatic reduction in tumour bulk was seen on repeated laryngotracheobronchoscopy within 10 days of treatment. Eight months on, the patient remained asymptomatic on propranolol, with no endoscopic evidence of disease apart from mild telangiectasia.

Haemangiomas of the airway can cause obstruction which may potentially be life-threatening. This case demonstrates the potential of propranolol to become a valuable therapeutic option in such clinical situations.

We report an extremely rare case of recurrent laryngeal nerve paralysis due to subclinical Lyme borreliosis.

Case report presenting a 15-year-old girl referred with hoarseness and soft voice.

Right-sided recurrent laryngeal nerve paralysis was observed using videolaryngoscopy. Imaging was used to exclude intracranial, cervical and intrathoracic embryological lesions, vascular malformations and tumours. Laboratory and electrophysiological investigations were used to exclude inflammatory and paraneoplastic processes, endocrinopathy and metabolic disorders. Serological testing was positive for Lyme disease. Parenteral ceftriaxone therapy was commenced. The patient's nerve paralysis showed complete recovery on the seventh day of antibiotic treatment; this was confirmed by videolaryngoscopy.

Recurrent laryngeal nerve paralysis is an extremely rare complication of neuroborreliosis associated with Lyme disease. In patients with recurrent laryngeal nerve paralysis in whom the clinical history is uncertain and the usual diagnostic methods give negative results, screening with anti-borrelia immunoglobulin M is suggested.

To highlight the clinical presentation and management of a rare case of oncogenic osteomalacia due to an ethmoid sinus tumour.

We examined the case records of a 55-year-old man who presented with progressive fatigue, weakness and bone pain, and noted the clinical presentation, laboratory investigations, computed tomography findings, operative notes and follow-up details.

Oncogenic osteomalacia secondary to a paranasal sinus neoplasm is a rare entity. The causative tumour is often occult and may be missed by routine clinical examination. This case report illustrates the appropriate pattern of evaluation and management to ensure a successful outcome.

We report identical twins with Zenker's diverticulum.

Case report and literature review.

Geographical and racial variation in occurrence, and rare familial cases, suggest that inherited factors play a role in the pathogenesis of Zenker's diverticulum. The identical twins reported here provide further evidence supporting a genetic predisposition.

We present two cases of dental implant migration into the maxillary sinus, with subsequent removal via image-guided, transnasal endoscopy.

Presentation of clinical cases, together with a literature review of alternative surgical techniques, the theories behind implant migration, and the benefits of an image-guided, endoscopic approach.

One patient was asymptomatic, and the other had begun to experience sinogenic symptoms after implant displacement. Both patients presented to the ENT clinic, and both underwent the BrainLab protocol to generate computed tomography images for navigational reconstruction. Transnasal endoscopy was carried out with this guidance, and the implants were removed successfully in both cases. Previously used surgical techniques such as the Caldwell-Luc procedure or extraction through the tooth socket have higher rates of conversion to open procedures, more damage to the nasal sinuses and higher post-operative complication rates compared with the transnasal endoscopic approach.

Both patients underwent successful removal of their migrated dental implants with no complications, and neither required any follow-up intervention.

We report the first case of nasal and nasopharyngeal amyloidosis secondary to multiple myeloma; this case also represents the fourth report of systemic nasal or nasopharyngeal amyloidosis.

Case report and review of the world literature concerning nasal and nasopharyngeal amyloidosis epidemiology, presentation and management.

Nasal and nasopharyngeal amyloidosis is rare. The presentation, clinical course and treatment are discussed for the presented patient. The amyloid tumour, which recurred in correlation with the progressive transformation of the multiple myeloma, was treated surgically. Subsequent localised radiotherapy decreased the size and growth rate of the tumour.

Amyloid should be considered as a cause of resistant or recurrent epistaxis provided a mass lesion is seen on radiological imaging. Radiotherapy may be a treatment option in nasal and nasopharyngeal amyloidosis.

Hyperacusis may be described as a decreased threshold for discomfort from sound. It may have a serious impact on an individual's lifestyle, as a result of decreased sociability and inability to spend time with family and friends due to intolerance of sound.

We present a case of hyperacusis associated with depression, with no other audiological abnormality. The patient reported greater difficulty during the depressive episode.

Audiological investigation was undertaken, followed by counselling and medication for depression.

The pathophysiological mechanism of hyperacusis in depression is discussed. Outcomes following treatment with directive counselling and lithium (an antidepressant) are described. Research indicates that both hyperacusis and depression can be caused by hypoactivity of 5-hydroxytryptamine (also known as serotonin) in the brain. The patient reported improvement which cannot be explained solely on the basis of counselling. Enhancement of serotonin activity due to lithium, prescribed for depression, may also play a role in alleviation of hyperacusis.

To report a case of Langerhans cell histiocytosis of the temporal bone presenting with cerebrospinal fluid fistula.

A Caucasian woman presented to a tertiary care centre in Quebec, Canada, with a new onset of cerebrospinal fluid fistula. She had a significant destructive lesion of the temporal bone, and was diagnosed with Langerhans cell histiocytosis on biopsy.

The patient underwent surgical resection with reconstruction of the posterior fossa and tegmen. She suffered a relapse less than one year after surgery, and was finally treated with chemotherapy.

The patient was free of disease at three-year follow up. No recurrence of the cerebrospinal fluid leak was observed after treatment.

Langerhans cell histiocytosis of the temporal bone with intra-cranial involvement is rare in adults, with only two cases previously reported. Eleven paediatric cases have been reported. To our knowledge, this patient represents the first report of cerebrospinal fluid fistula as the initial presentation of the disease.

We report a typical case of earlobe lymphocytoma.

A case report and literature review are presented.

A 10-year-old girl presented with a blue-coloured earlobe. A diagnosis of Lyme disease was confirmed by serological tests. Lyme borreliosis is the most common tick-borne disease in the northern hemisphere. It is caused by the spirochete Borrelia burgdorferi sensu lato. The patient was successfully treated with antibiotics.

The diagnostic process and ENT symptomatology of Lyme disease and borrelial lymphocytoma are summarised and discussed.

Nasopharyngeal foreign bodies are relatively uncommon, compared with other aerodigestive sites. They may mimic a lower airway location, or may be coughed up into the nasopharynx prior to endoscopic evaluation.

To describe our experience with nasopharyngeal foreign bodies mimicking a more distal airway location.

Case series from a tertiary referral children's hospital.

We present a series of four children who were initially thought to have a lower aerodigestive tract foreign body (three respiratory, one oesophageal), but who were finally diagnosed with nasopharyngeal foreign body. The concept of panendoscopy at all foreign body removals is suggested as a means to avoid a missed nasopharyngeal foreign body.

Although nasopharyngeal foreign bodies are uncommon, their rare ability to mimic distal sites mandates a thorough endoscopic approach to ensure that all sites (i.e. larynx, lungs, oesophagus and nasopharynx) are evaluated endoscopically.

To present an interesting cause of pre-auricular swelling.

We report the case of a 39-year-old woman who presented to the ENT department as an emergency with swelling in the left pre-auricular region. The patient had recently travelled to Central America, where the botfly is endemic. On examination, there was a raised, indurated area with a central orifice. A botfly larva was suspected. The larva was suffocated with paraffin paste, allowing removal without remnants being retained.

Suffocation of botfly larvae is favoured to surgical removal, due to the possibility of larval remnants being retained and acting as a nidus for infection. The increasing frequency of exotic travel means doctors need to be more aware of tropical medicine.

The development of a tracheo-arterial fistula is a rare but severe complication of tracheotomy. The reported patient presented with such a fistula involving an aberrant right subclavian artery, termed an arteria lusoria, an aortic arch abnormality which is usually asymptomatic.

A 30-year-old man was admitted to our institution for bleeding through his tracheotomy. He had been treated for advanced Duchenne muscular dystrophy, involving invasive assisted ventilation, since the age of 10 years. Surgical exploration and computed tomography scanning revealed a tracheo-arterial fistula involving an aberrant right subclavian artery, associated with severe scoliosis. Emergency, transient haemostasis was achieved by over-inflation of the tracheostomy tube cuff. Aneurysm ablation was successfully achieved as the result of an endovascular interventional radiology procedure.

Arteria lusoria is one of the most common aortic arch abnormalities. The occurrence of an aneurysm of this artery in a tracheotomised patient has not previously been described. In Duchenne muscular dystrophy patients, spinal deformities may result in thoracic compression, which may alter the anatomical relations of mediastinal vessels. Such deformities are slowly progressive. Thus, vigilance is required in the long term management of Duchenne muscular dystrophy patients with a tracheostomy.

We report an extremely rare case of an organised haematoma arising in the sphenoid sinus.

An 85-year-old woman presented with an expansile soft tissue mass in the left sphenoid sinus, with bony destruction of the sella turcica, which mimicked the extrasellar extension of a pituitary tumour. The tumour was excised using an endoscopic, transsphenoidal approach. Histopathological examination revealed an organised haematoma.

To our knowledge, this is the first report of an organised haematoma arising in the sphenoid sinus. This case indicates that organised haematoma should be included in the differential diagnosis of extensive sphenoid lesions; it also emphasises the importance of correct pre-operative diagnosis for therapeutic planning, as complete surgical resection by an endoscopic approach is curative.

We report a case of bilateral conductive hearing loss caused by stapedial suprastructure fixation with normal footplate mobility.

A 50-year-old woman had suffered hearing loss in both ears since childhood. Exploratory tympanotomy revealed immobility of the stapes due to a bony bridge between the stapedial suprastructure and the fallopian canal. The incus was missing, while the malleus handle was minimally deformed. The mobility of the stapes footplate was normal. Post-operatively, the hearing in the right ear improved both subjectively and audiographically, while that in the left ear did not improve because of footplate subluxation during surgery.

This is a rare case of congenital stapedial suprastructure fixation with normal footplate mobility. In this patient, development of the second branchial arch was arrested. When performing exploratory tympanotomy for stapedial fixation, one must keep in mind that normal footplate mobility is possible.

Airway compromise due to paediatric intubation injuries is well documented; however, intubation injuries may also cause severe voice disorders. We report our experience and review the world literature on the voice effects of traumatic paediatric intubation.

We report five cases of children referred to Great Ormond Street Hospital for Children who suffered traumatic avulsion of the vocal fold at the time of, or secondary to, endotracheal intubation. All children had significant dysphonia and underwent specialist voice therapy.

The mechanisms of injury, risk factors and management of the condition are discussed. Children suffering traumatic intubation require follow up throughout childhood and beyond puberty as their vocal needs and abilities change. At the time of writing, none of the reported patients had yet undergone reconstructive or medialisation surgery. However, regular specialist voice therapy evaluation is recommended for such patients, with consideration of phonosurgical techniques including injection laryngoplasty or thyroplasty.

We report an extremely rare case of a complete congenital third branchial arch fistula in a nine-year-old boy.

A case report and a review of the English literature concerning third branchial arch fistula of congenital origin are presented.

A nine-year-old boy presented with a history of a small opening in the middle third of the anterior neck since birth, with recurrent surrounding swelling. There was no history of surgical drainage or spontaneous rupture. Computed tomography with contrast injection into the external cervical opening revealed a patent tract from the neck skin to the base of the pyriform sinus. Complete excision of the tract up to the pyriform sinus with left hemithyroidectomy was performed. Follow up at 22 months showed no recurrence.

To our knowledge, this case represents a very rare occurrence of the congenital variety of complete third branchial arch fistula at an unusual site. This case indicates that third branchial arch fistula can be complete, and may present in the anterior neck, an unusual site. In such cases, computed tomography fistulography and injection of dye into the pyriform sinus enables intra-operative delineation of the tract.