Over the past 20 years, jet ventilation techniques have been developed to enable safe and controlled microlaryngoscopy and the accurate treatment of laryngeal pathology. This study examined how advances in jet ventilation tube design have facilitated safe endolaryngeal surgery.

The study documented the development and use of the Jockjet subglottic jet ventilation tube system at the Prince of Wales Hospital, Sydney. The new system consisted of two components: a Teflon tube with an outer diameter of 4 mm at the larynx, and a companion ventilator. The facility for end-tidal carbon dioxide and distal airways pressure monitoring was incorporated via dedicated channels. The Venturi jet was produced via a covered tip to prevent trauma to the tracheal mucosa.

The Prince of Wales and Sydney Children's Hospitals, incorporated with The University of New South Wales.

From June 2002 to March 2008 inclusive, 1000 consecutive patients underwent microlaryngeal surgery at this institution. Subglottic jet ventilation, via the Jockjet tube, was employed for 332 patients.

Anaesthetic safety and intra-operative surgical access.

In all the 332 patients observed, surgical access was optimised and no adverse anaesthetic outcomes were encountered.

Subglottic jet ventilation facilitates safe airway management during microlaryngeal and laser laryngeal surgery.

To compare the complication rates and outcome of computer-assisted versus non-computer-assisted functional endoscopic sinus surgery.

We reviewed retrospectively the medical records of 276 patients who had undergone sinus surgery for chronic rhinosinusitis with (n = 108) or without (n = 168) computer assistance, from 1996 to 2004, to determine the incidence of complications and need for revision surgery.

The incidence of complications was 6.5 per cent in the computer-assisted group and 6.0 per cent in the non-computer-assisted group (p = 1.00). In the computer-assisted group, 9.2 per cent needed revision surgery, compared with 10.7 per cent in the non-assisted group (p = 0.84).

Although our study found no significant difference in complications or revision rates, computer-assisted surgery serves as an important orientation aid during functional endoscopic sinus surgery.

Most patients with nasolacrimal duct obstruction have dry, crusty nasal mucosa. Mucociliary clearance is modulated by the amount and biochemical composition of nasal mucus. Nasolacrimal duct obstruction disturbs the drainage of tears into the nasal cavity.

We examined the effect of nasolacrimal duct obstruction on the mucociliary transport of nasal mucosa, by comparing saccharine test results for epiphora patients versus healthy volunteers.

Prospective, randomised, clinical trial.

Eight patients with bilateral epiphora and 10 patients with unilateral epiphora were included in the study group. Complete nasolacrimal duct obstruction was demonstrated by studying irrigation of the nasolacrimal system, and by fluorescein dye study. The control group comprised 20 healthy volunteers. Mucociliary transport was assessed by the saccharine test in both the study and control groups. The saccharine transit times of 26 impaired nasal cavities were compared with those of 20 healthy nasal cavities of controls. Also, the saccharine transit times of the healthy nasal cavities of the 10 patients with unilateral epiphora were compared with those of their diseased sides, and also with those of healthy volunteers.

The saccharine transit times of the epiphora patients were statistically significantly greater than those of the control group. Also, there was a statistically significant difference in saccharine transit times, comparing the healthy and impaired nasal cavities of patients with unilateral epiphora.

Nasolacrimal duct obstruction has a negative effect on nasal mucociliary clearance. This may be related to changes in the amount and biochemical composition of nasal mucus.

To evaluate pain incidence and intensity in patients undergoing septorhinoplasty, and to assess analgesic treatment effectiveness, in the first 7 days after surgery.

Prospective outcomes analysis using visual analogue scale assessment of pain intensity in the first 7 post-operative days.

Fifty-seven patients were enrolled in the study, 29 women and 28 men, aged 18 to 51 years. All were treated for post-traumatic deformity of the external nose and/or nasal septum, with either septorhinoplasty or septoplasty.

In the first 3 days after septorhinoplasty, patients' mean visual analogue scale pain score exceeded the range denoting ‘analgesic success’, and showed considerable exacerbation in the evening. Patients' pain decreased to a mean score of 15.4 one hour after administration of a nonsteroidal anti-inflammatory drug (metamizole).

Analgesia is recommended for all patients in the first 3 days after septorhinoplasty, especially in the early evening.

In the last decade tonsillotomy has come into vogue again, whereas the number of tonsillectomies is decreasing rapidly. Currently, most tonsils are reduced by utilise electrosurgery, radiofrequency or carbon dioxide laser. However, it is not clear whether radiofrequency tonsillotomy is as effective as laser or other surgical techniques in respect of post-operative pain and haemorrhage.

A prospective, randomised, double-blinded, controlled, clinical study was conducted in the otorhinolaryngology department of Ludwig Maximilians University, Munich, Germany. Twenty-six children with tonsillar hypertrophy were included. Exclusion criteria were: history of peritonsillar abscess, previous tonsil surgery, tonsillitis within two weeks, pain before surgery, psychiatric illness, asymmetrical tonsils, chronic analgesic usage, bleeding disorders and other surgical procedures during the same operation. Tonsillotomy was performed on one side with radiofrequency and on the other side with a carbon dioxide laser. All procedures were performed by a single surgeon, under general anaesthesia. A visual analogue scale was used to measure patients' pain on each side, administered by a ‘blinded’ nurse on the three post-operative mornings and evenings, within the hospital.

There was no difference in post-operative pain scores or haemorrhage, comparing laser versus radiofrequency tonsillotomy. Patient's overall reported pain was very modest compared with post-tonsillectomy pain. No haemorrhage or other adverse effects were observed.

This study aimed to determine the prevalence of pain, and the adequacy of its treatment, amongst patients with head and neck cancer, and to determine whether specific groups could be identified as being at risk of pain.

Consecutive patients attending head and neck oncology out-patient services were surveyed.

The prevalence of pain was 34 per cent, lower than that found in systematic reviews. No specific risk factors for pain were identified. Particular pain problems in this population comprised a high incidence of neuropathic pain, breakthrough pain and pain of non-malignant origin.

The prevalence of unrelieved pain was high in this study population, although no specific risk factors were found. A further study is planned to determine the effect of using a routine screening tool and an immediate pain treatment protocol in this group of patients.

To evaluate the causes, treatment modalities and recovery rate of paediatric facial nerve paralysis.

We analysed 24 cases of paediatric facial nerve paralysis diagnosed in the otolaryngology department of Gachon University Gil Medical Center between January 2001 and June 2006.

The most common cause was idiopathic palsy (16 cases, 66.7 per cent). The most common degree of facial nerve paralysis on first presentation was House–Brackmann grade IV (15 of 24 cases). All cases were treated with steroids. One of the 24 cases was also treated surgically with facial nerve decompression. Twenty-two cases (91.6 per cent) recovered to House–Brackmann grade I or II over the six-month follow-up period.

Facial nerve paralysis in children can generally be successfully treated with conservative measures. However, in cases associated with trauma, radiological investigation is required for further evaluation and treatment.

Nasal septal perforation is a structural or anatomical defect in the septum. The present study focused on the effects of septal perforation on nasal airflow and nasal patency, investigated using a computer simulation model.

The effect of nasal septal perforation size on nasal airflow pattern was analysed using computer-generated, three-dimensional nasal models reconstructed using data from magnetic resonance imaging scans of a healthy human subject. Computer-based simulations using computational fluid dynamics were then conducted to determine nasal airflow patterns.

The maximum velocity and wall shear stress were found always to occur in the downstream region of the septal perforation, and could potentially cause bleeding in that region, as previously reported. During the breathing process, there was flow exchange and flow reversal through the septal perforation, from the higher flow rate to the lower flow rate nostril side, especially for moderate and larger sized perforations.

In the breathing process of patients with septal perforations, there is airflow exchange from the higher flow rate to the lower flow rate nostril side, especially for moderate and large sized perforations. For relatively small septal perforations, the amount of cross-flow is negligible. This cross-flow may cause the whistling sound typically experienced by patients.

To investigate the frequency and management of epistaxis in schools.

A postal survey of schools.

One hundred and fifty-seven questionnaires were posted out to 41 secondary schools (students aged 11–18 years) and to 116 primary schools (students aged four to 11 years). One hundred and twelve completed questionnaires were returned, 32 from secondary schools and 80 from primary schools. Most schools stated that they encountered a nose bleed once per month. The commonest method of treating a nose bleed was to pinch the top of the nose (an ineffective method), although pinching the bottom of the nose was almost as common. Only a minority of primary and secondary schools (37.5 and 25 per cent, respectively) had a policy for dealing with nose bleeds. Despite many respondents reportedly using an ineffective method, only two stated that they did not feel confident in dealing with nose bleeds.

Nose bleeds in school students are common, and management frequently deviates from recommended guidelines.

Over the years, various materials have been used by otologists to protect tympanomeatal flaps from damage by suction equipment or drills.

This report aims to describe the use of Mercian's Visibility Background Material® (an inert, silicone-based material licensed for use in the human body, which does not get caught in drill flukes) to protect tympanomeatal flaps.

We have used this material for over 12 months, without any complications.

Foley catheters are commonly used to control posterior epistaxis in most ENT departments. There are very few studies of the ideal substance for inflating Foley catheters for posterior epistaxis. This in vitro study compared the effects of water, saline and air in delivering effective tamponade.

Three groups of five Foley catheters each were filled with 10 ml of water, saline or air. Forty-eight hours later, the residual volume was aspirated and measured.

At 48 hours, the following residual volumes were aspirated: air, 0 ml; saline, 8.5 ml; and water, 8.7 ml.

This study shows that air is not suitable for inflating Foley catheters, as they had spontaneously deflated when assessed 48 hours after inflation. We hypothesise that water is a better Foley catheter inflation fluid than saline. We recommend a larger, in vivo study to ascertain the benefits of these Foley catheter inflation substances in curtailing epistaxis in the clinical setting.

Perforation after pharyngo-oesophagoscopy is a serious complication, and its identification, through close patient monitoring, is essential. Yet little is known about when symptoms and signs develop, and thus how long any close monitoring should last.

To examine the timing of individual symptoms and signs of perforation after rigid pharyngo-oesophagoscopy.

Three-centre, retrospective study.

Of 3459 patients undergoing rigid pharyngo-oesophagoscopy, 10 (0.29 per cent) developed perforations, nine of which were suspected intra-operatively. Symptoms and signs developed at 1.5 hours post-operatively at the earliest, and at 36 hours at the latest. Three patients were asymptomatic. The majority of procedures (n = 8) were undertaken for food bolus obstruction or foreign body ingestion.

Pharyngo-oesophagoscopy for food bolus obstruction and foreign body ingestion accounts for a large number of perforations, but symptoms and signs may take longer than 24 hours to develop. A contrast swallow should be considered in high risk patients, and a high index of suspicion maintained in order to detect this complication.

To investigate the prevalence of psychological distress in head and neck out-patients.

We used the Hospital Anxiety and Depression Scale to screen 106 patients for mood disorders in a London head and neck ENT out-patient clinic.

Queen's Hospital, Romford, UK.

One hundred and six patients attending a head and neck out-patient clinic.

Hospital Anxiety and Depression Scale score.

Approximately 39 per cent of patients had a possible anxiety disorder (10 per cent were rated as severe), and 27 per cent had possible depression (10 per cent were rated as severe).

We recommend that a member of the head and neck multidisciplinary team should be trained to identify and correctly refer psychologically distressed patients to appropriate existing psychiatric services.

Selective lateral laser thyroarytenoid myotomy is a conceptually sound, simple, minimally invasive, repeatable and predictable new surgical procedure for treating adductor spasmodic dysphonia. This paper aims to introduce and describe the surgical technique, and to present a clinical case series and its outcomes.

A prospective, clinical case series treated with selective lateral laser thyroarytenoid myotomy, with follow up of 2.5 years.

Pre- and post-operative data were collected prospectively for patients undergoing selective lateral laser thyroarytenoid myotomy. These data included patient demographics, previous interventions for adductor spasmodic dysphonia, technical aspects of surgery and clinical outcome. Outcome data included clinical assessment, voice handicap index, need for further intervention, and patient satisfaction assessed by subjective improvement (detailed subjectively by the patients themselves and objectively using the Glasgow benefit inventory).

Four patients (two men and two women; mean age 65 years; age range 41–80 years) were included. The mean duration of adductor spasmodic dysphonia was 11 years. All patients had previously been treated with botulinum toxin A. All patients reported improvement in voice quality, fluency, sustainability and elimination of voice breaks over 2.5 years' follow up. Clinical assessment revealed no alteration in mucosal wave, and complete relief of hyperadduction was observed on phonation. No patients required supplementary botulinum toxin treatment during follow up.

Selective lateral laser thyroarytenoid myotomy seems to represent a curative procedure for adductor spasmodic dysphonia, a chronic, debilitating condition. This procedure is conceptually simple, minimally invasive and repeatable. It also seems to offer a safe and lasting alternative to botulinum toxin therapy.

Recently, the 532 nm pulsed potassium-titanyl-phosphate laser has emerged as an effective angiolytic laser for treating mucosal lesions of the larynx in the operating theatre and clinic. We sought to assess the current impact of potassium-titanyl-phosphate laser on our laryngeal surgery practice.

Retrospective review of 710 patients undergoing endoscopic laryngeal surgery over a one-year period.

Medical records of the endoscopic laryngeal procedures were reviewed; 386/710 had been performed in the clinic and 324/710 in the operating theatre under general anaesthesia. Indications for the procedures were classified by pathology.

Pulsed potassium-titanyl-phosphate laser was used in 209/386 clinic procedures. The indications for these procedures were: dysplasia (114/209 procedures), papillomatosis (89/209), varices or ectasia (three of 209), and ‘other’ (three of 209). Pulsed potassium-titanyl-phosphate laser was used in 178/324 operating theatre endoscopic laryngeal procedures. The indications for these procedures were: cancer (54/178 procedures), dysplasia (52/178), papillomatosis (38/178), varices or ectasia (13/178), polyps (six of 178), nodules (six of 178), stenosis (five of 178), granulation (three of 178), and amyloid (one of 178).

Due to its versatility, the 532 nm pulsed potassium-titanyl-phosphate laser is our most commonly utilised instrument for performing endoscopic laryngeal surgery.

To compare the gross and microscopic appearance of antrochoanal polyps associated with recurrent epistaxis, with those with a more typical presentation.

Prospective, controlled study.

All patients underwent clinical and endoscopic examination, computed tomography scanning, and examination under anaesthesia, in order to detect the gross diagnostic criteria for antrochoanal polyp. Histological findings on light microscopy were compared for polyps presenting with epistaxis versus those without. The number of predominant inflammatory cells in the corium was determined in both groups and statistically compared using the Student t-test.

Recurrent epistaxis was a presenting symptom in 10/84 (11.9 per cent) patients with gross diagnostic criteria for antrochoanal polyp. Grossly, these patients' polyps had a reddish, vascular surface in parts. Histologically, these polyps showed a highly vascular stroma with multiple dilated blood vessels, the typical appearance of an angiomatous antrochoanal polyp. Thrombi at different stages of development were detected, with no infarcts. The remaining cases (88.1 per cent) had no history of epistaxis; histologically, these patients' polyps showed an oedematous connective tissue core with few inflammatory cells. Plasma cells were predominant in the angiomatous polyps, being significantly more prevalent than in the ordinary antrochoanal polyps (p < 0.00).

It would appear that only angiomatous antrochoanal polyps present with epistaxis. Detection of the characteristic gross appearance of these polyps may help avoid unwanted surgery. Histopathological analysis confirms the diagnosis. A significantly increased number of plasma cells may be the underlying cause of the histological changes seen in angiomatous antrochoanal polyps.

Verrucous carcinoma occurs infrequently in the vocal folds. This tumour has an excellent prognosis with proper treatment. Management strategies include surgery, radiotherapy or both.

To evaluate the long-term results of type I and II laser cordectomy for the treatment of verrucous carcinoma of the vocal folds.

We reviewed the files of 18 patients with verrucous carcinoma of the vocal folds treated by type I or II laser cordectomy in our department from 1989 to 2006, and recorded clinical and outcome data.

None of the patients had any major post-operative complications. All had a subjectively satisfactory quality of voice, with no morbidity. Patient follow up ranged from three to 228 months (mean, 48 months). Five patients were treated with post-operative radiotherapy for persistent disease, of whom four underwent repeated surgery due to recurrence.

Type I or II laser cordectomy is a safe, feasible, secure method of treating verrucous carcinoma of the vocal folds. There were no major complications in our patient series. Most recurrent disease was manageable locally with repeated surgery.