Alendronate is a bisphosphonate used in treating osteoporosis. Its recognized side-effects include oesophageal irritation and ulceration. The authors describe a case of laryngitis induced by transient contact of this medication with the laryngeal mucosa. Successful management of this case is also detailed.

With increasing use of expandable metallic stents to manage patients with a variety of endobronchial pathologies, some will have a subsequent need for tracheostomy insertion. We describe a successful technique to insert a tracheostomy using rigid and fibre-optic bronchoscopy in a patient who had an 8 cm expandable metallic tracheal stent deployed previously on account of tracheomalacia.

Epidermoid tumours are non-neoplastic inclusion cysts representing up to 1.1 per cent of all intracranial tumours, typically presenting with symptoms related to pressure or intracranial rupture in the fourth or fifth decade of life.

The authors present a case of a parasellar epidermoid cyst which has ruptured in to the nasopharynx; to the best of their knowledge, this has not been previously reported.

The computed tomography (CT) and magnetic resonance imaging (MRI) are presented. The pathology and radiological features of epidermoid tumours are discussed, particularly in relation to extracranial connections. The differential diagnosis of lesions eroding the central skull base is reviewed.

Two cases of deep lobe parotid tumours extending into the parapharyngeal space and causing obstructive sleep apnoea are described. Post-operatively, marked improvements in nocturnal hypoxic episodes and the symptoms of obstructive sleep apnoea were seen. Although minor salivary gland pleomorphic adenomas have been described as a cause of airway compromise, pleomorphic adenomata arising from the deep lobe of the parotid, causing proven obstructive sleep apnoea, have not previously been documented. The anatomy and common pathologies of the parapharyngeal space are discussed.

Tuberculosis of the parotid gland is very rare and clinically indistinguishable from a neoplasm. Thus the diagnosis of parotid gland involvement with tuberculosis has traditionally been made after surgical resection. We present a case which was diagnosed on fine needle aspiration cytology and managed medically.

We report a case of mucocutaneous leishmaniasis caused by Leishmania viannia braziliensis. Despite several courses of both oral and intravenous antibiotics no improvement was seen. This case highlights the importance of taking a thorough history, including details of recent travel, and considering rarer causes when no improvement with antibiotics is seen. Our patient was infected with a particularly virulent strain and destruction of the mucous membranes is not uncommon. Rapid diagnosis and treatment are therefore crucial.

Clear cell carcinoma (CCC) of the larynx is a rare pathological finding; only eight cases are described in the literature. It occurs in older adults and shows a predilection for men. We report the ninth observation of laryngeal CCC in the literature. We reviewed the literature and correlated the prognosis of the tumour according to its site of onset and treatment.

The literature review showed that this neoplasm is highly aggressive, with a high recurrence rate and short mean survival time; the treatment of choice is surgery, and chemo- or radiotherapy are used mainly for the treatment of recurrences.

Sarcoidosis often presents with signs and symptoms within the head and neck. In this region, it most commonly affects the nose, larynx, parotid and cervical lymph nodes. Within the ear, it usually causes sensorineural hearing loss of varying severity. We report a patient in whom sarcoidosis involved the middle ear and presented with a conductive hearing loss. Granulomata were found in the middle ear during an exploratory tympanotomy. The granulomatous process had caused necrosis of the long process of incus and was also encasing the chorda tympani nerve. Histological examination confirmed the diagnosis.

The Medicines and Healthcare Products Regulatory Agency stated in 2003 that doctors should endeavour to avoid using products in treatments not covered by their product licence. Foley catheters are commonly used in the management of epistaxis although their product licence does not cover this. We undertook a questionnaire survey of members of the British Association of Otorhinolaryngologists – Head & Neck Surgeons to study the extent of the use of these catheters and the knowledge that members had of their legal status.

Most members appear to use Foley catheters in the management of epistaxis; however, many are not aware that the product is not licensed for this purpose. Because of this lack of knowledge, only half obtain verbal consent for treatment with this device and only a very small number obtain written consent from patients.

In the era of increasing litigation, documentation of informed consent could be considered mandatory to protect us from possible legal action, and this needs to be known by all practising otolaryngologists.

Anterior cervical spine fusion and stabilization is a well-recognized procedure for a number of cervical spine disorders. Unfortunately, the complex anatomy of the cervical spine means that these procedures are not without complications. Pharyngo-oesophageal perforation is a rare but potentially life-threatening complication of cervical spine surgery and may present intra-operatively, in the immediate post-operative period or many years later. We present the case of a gentleman with ankylosing spondylitis who presented with a pharyngeal perforation and fistula five years after cervical spine surgery.

This paper describes a method of radiofrequency ablation of adenoid tissue using a coblator, comparing it with conventional and other newer methods of adenoidectomy. Its chief advantages are that it produces a bloodless field, precision of tissue removal and leads to less damage to surrounding tissues.

Although rare, ototoxicity from the use of aminoglycoside drops is well recognized. Ototoxicity has not been described with the use of combination aminoglycoside-steroid-antifungal creams or ointments. We present the case of a 60-year-old man with a perforated tympanic membrane who suffered a total hearing loss after the instillation of cream containing triamcinolone, neomycin, gramicidin and nystatin (Tri-Adcortyl™ cream) into his ear canal. On balance, we believe that a number of potentially ototoxic constituents in this cream were responsible. Other possible causes of sensorineural hearing loss and the possible mechanisms of ototoxicity of this cream are discussed. The reasons why such creams may be particularly ototoxic, compared with drops, are also considered. The authors caution against the use of such creams or ointments in the ear if there is any suspicion of a tympanic membrane perforation.

We report a case of B-cell lymphoma with the larynx as the primary site of presentation in a rheumatoid arthritis patient previously treated with methotrexate. Primary non-Hodgkin’s lymphoma (NHL) of the larynx is rare. There may be an increased risk of lymphoma in patients with rheumatoid arthritis, with an even higher risk in those patients treated with methotrexate. The diagnostic and treatment options are discussed.

Mycotic aneurysm of the petrous temporal bone is extremely rare, with only 12 cases previously reported. We review the literature to date and present a case of petrositis complicated by a mycotic aneurysm of the internal carotid artery, which was managed by endovascular balloon occlusion and subsequent total petrosectomy. We can find no other case in the literature where balloon occlusion has been used to treat a mycotic aneurysm of the intrapetrous carotid artery prior to total petrosectomy to treat petrositis.

Spontaneous perforation of the oesophagus is an uncommon condition that almost invariably affects the thoracic oesophagus. We present an unusual case of perforation of the cervical oesophagus, in which an unsuspected ingested foreign body was ultimately found to be responsible.

Oropharyngeal lipomas are rare tumours. We present the case of a young man with an asymptomatic lipoma almost completely occluding his supraglottic airway, found on magnetic resonance imaging (MRI) for a separate oral cavity lesion. Pre-operative anaesthetic assessment was undertaken because of the risk of airway obstruction at induction of general anaesthesia. We discuss the awake fibre-optic technique used for induction, as well as the treatment and follow-up of these tumours. This case highlights the need for formal anaesthetic assessment, in such cases, to avoid total airway obstruction at induction of general anaesthesia. It also emphasizes the extent of supraglottic obstruction that can be present without giving rise to any symptoms.

Schwannoma is a solitary, benign tumour arising from the neural sheath Schwann cells of the peripheral, cranial or autonomic nerves. In the head and neck region, it occurs most commonly in association with the acoustic nerve within the skull and is rarely found in oral structures. When it is found in oral structures, the tongue is reported to be the favoured site. Schwannoma of the tonsil is extremely rare, with only two cases reported in the literature. We report what is, to our knowledge, the third case of schwannoma of the tonsil, diagnosed by histopathology.

Two cases of linear IgA bullous dermatosis initially presenting as ulcerative lesions in the larynx and pharynx are reported. It was difficult to diagnose and treat the lesions, but they were finally diagnosed from the histopathological findings of accompanying skin lesion specimens. One of the patients required a tracheostomy due to increased airway stenosis by a laryngeal lesion. Despite general corticosteroid administration this could not be completely resolved, although partial opening of the glottis was observed, and the patient died of accidental tracheostomy tube complications during home care. Although there are no reports of this disease in the otolaryngological field, these rare diseases involving the skin and entire body should be considered in the differential diagnosis of laryngeal and pharyngeal ulcerative lesions, including airway stenosis. Furthermore, simple and safe procedures for relieving airway stenosis should be selected for rare and difficult-to-diagnose airway disease, prior to the final diagnosis.

We describe a case of a newborn baby with a prenatal diagnosis of an epignathus (oropharyngeal teratoma). With the potential for airway problems at birth, he was delivered by an elective EXIT (Extra Utero Intrapartum Treatment) procedure at 38 weeks of pregnancy. The airway was secured and rigid bronchoscopy performed. Initially he was stable, but developed cardiorespiratory difficulties 40 minutes after birth and died from a cardiac arrest 17 minuteslater. Tension pneumothorax is a devastating complication that can occur with lower airway manipulation for anaesthesia and rigid bronchoscopy. The addition of positive pressure during mechanical ventilation converts the pneumothorax into a tension pneumothorax. The possibility of tension pneumothorax should be entertained in a mechanically ventilated patient whose ventilatory pressures are increasing, with diminishing cardiac output. A complicated case is presented, where the diagnosis was missed with a fatal outcome.