Tracheo-oesophageal puncture now has a well established role and in several units is now the principal means of speech rehabilitation following laryngectomy. Although not a difficult procedure, there are a number of problems and complications that may be encountered. With proper management these can usually be overcome and a useful voice achieved.

This study looks at those problems in a series of 119 patients and discusses their management.

An unusual case of squamous cell carcinoma of the middle ear and mastoid in which syncope was a major presenting feature is reported. No such case has been reported in the literature. A possible explanation is offered.

Foreign bodies in the upper aerodigestive tract represent one of the commonest ENT emergencies. A case report of a fish bone penetrating the anterior tongue is presented which exemplifies this frequent problem. but at a rare site.

Reinke's oedema (RO) of the vocal folds is a condition of unknown aetiology. Cigarette smoking and vocal abuse may contribute to its development. Hypo thy roidism has been described as an aetiological factor but, to date, no controlled study has been published confirming this association. This prospective, controlled study compared thyroid function in 61 consecutive RO patients with an age and sex matched control group (n = 65) without laryngeal disease. Thyroid function was assessed by measuring serum thyroid stimulating hormone (TSH), free thyroxine (T4) and tri-iodothyronine (T3). Hypothyroidism was diagnosed when TSH was above normal with a T3 and T4 below the normal range.

Four RO patients were hypothyroid at the time of diagnosis, compared to five of the control group. Six RO patients had past or present hypothyroidism compared to seven of the controls. One RO patient and two controls were euthyroid with marginally elevated TSH levels. Although the incidence of hypothyroidism in this group of Reinke's oedema patients is higher than expected in a normal population, it is similar to that in an age and sex matched control group, reflecting the prevalence of hypothyroidism in middle aged women.

This study suggests that hypothyroidism is not an aetiological factor in the development of Reinke's oedema.

Cigarette-smoking is a well-established aetiological factor in squamous cell carcinoma of the larynx. In Great Britain the majority of patients with laryngeal cancer are treated by radiotherapy with salvage surgery if necessary. A troublesome side effect of radiotherapy is mucositis which may exacerbate hoarseness, dysphagia, airway obstruction or pain. Although it is a common belief that continued smoking and alcohol consumption during radiotherapy may increase the frequency and severity of these side effects this has not been demonstrated objectively. This study confirms and illustrates the relationship between such radiotherapy reactions to continued smoke exposure by using an objective biochemical marker of smoking status.

Primary carcinoma of the frontal sinus is extremely rare. The aetiology of the tumour remains obscure, and even with rapid diagnosis and radical surgery the prognosis remains very poor.

The distribution of ear drops in normal ears is variable. A new product Otomize® (Stafford-Miller) containing dexamethasone and neomycin has a non-aerosol spray mist delivery system. This has been applied to normal ears and found to be superior in its distribution to generally available ear drops previously assessed.

The literature on this rare tumour has been reviewed and three cases of nasal plasmacytoma are described. Immunohistochemistry demonstrated cytoplasmic IgA and Kappa determinants in all cases. Two patients are disease-free at the present time, the third developed an IgG-k multiple myeloma, previously not described in the literature.

In this series of seven uncommon and complicated cases of foreign bodies in the aerodigestive tract of children, the difficulties in the management, and complications encountered are described. Various factors affecting the outcome of these cases have been highlighted.

Neuroendocrine laryngeal carcinoid tumours are uncommon. The supraglottis is the main location of these tumours. Eighty-one cases have been reported in the world literature. We present the first case of a synchronous laryngeal and pancreatic neuroendocrine tumour.

The disabilities following laryngectomy are well recognized. The incidence of these disabilities and the acceptability of the surgery to the patients were assessed by a questionnaire method. Sixty-five patients participated in the study. The incidence of disabilities are discussed. Total laryngectomy was felt to be a worthwhile operation by most of the patients in the study despite the disabilities they experienced afterwards.

Sensorineural hearing loss has not been previously reported in patients with the Marinesco-Sjögren Syndrome. Two siblings are described where hearing was initially normal but subsequently deteriorated.

A cause of nasal obstruction in sickle cell anaemia not previously described in the literature is presented.

The pathophysiology is the same as in priapism because of the similarities in the vascular arrangement of the turbinate and the penis.

Various treatment options are considered but the best results were achieved by surgical reduction of the inferior turbinates.

A prospective study searching for associated mycobacterial infection of the upper aerodigestive tract in patients with cervical tuberculous lymphadenitis (TBLN) was carried out. One hundred and thirteen patients with a clinical suspicion of cervical TBLN were included. All patients had a physical examination of the upper aerodigestive tract. Routine endoscopy and biopsy of the nasopharynx were performed. All of them had surgery to the cervical lymph node. Seventy-five patients had histologically confirmed cervical TBLN. Culture of the lymph node specimen showed Mycobacterium tuberculosis in 68 (90 per cent). In 45 (60 per cent) patients with cervical TBLN the primary foci of infection could not be found. Twenty-nine (39 per cent) had radiographic evidence of active or healed pulmonary tuberculosis. Sputum culture from two patients showed Mycobacterium tuberculosis. Five patients (six per cent) had tuberculous nasopharyngitis. In one of them (one per cent) the tuberculous nasopharyngitis was primary as no other evidence of mycobacterial infection was found. In the present study, mycobacterial infection of other parts of the upper aerodigestive tract was not found.

Survival of patients with surgically treated malignancy may be adversely affected by blood transfusion. Immune suppression due to transfusion has been implicated but remains unproven. We conducted a study of 240 patients with squamous cell carcinoma of the larynx undergoing laryngectomy to assess the effect of per-operative blood transfusion on survival.

We present a six-year retrospective review of feeding pharyngostomies as performed in this department. The indications, technique and complications of this procedure are discussed.

We report our experience with 199 patients requiring admission with a diagnosis of croup over an 18 month period. The value of using pulse oximetry to monitor these children was critically examined. Twenty-nine patients with clinically significant stridor were monitored for an average of 12 hours. There was poor correlation of clinical status and respiratory rate with hypoxia as shown by the technique, with frequent dips in oxygen saturation being caused by technical problems such as movement artefact. Pulse oximetry is a useful adjunct to the clinical assessment of croup, but cannot be relied upon solely for monitoring these labile patients.

Laryngomalacia is the commonest cause of congenital stridor. The majority of cases are mild and do not require surgical intervention. However in approximately 10 per cent of these infants the condition is life-threatening. The standard treatment for these patients has been to perform a tracheostomy. Recent reports have shown encouraging results following endoscopic surgery to the supraglottic structures. We report a series of twelve patients in whom a tracheostomy was avoided by performing an aryepiglottic fold trim—‘aryepiglottoplasty’. Dramatic improvements were seen in the respiratory obstruction and failure to thrive following surgery.

A case of benign ‘Solitary Fibrous Tumour of the Nasopharynx’, a rare, recently recognized entity, is presented and the clinical and pathological details discussed.

Two brothers with Wegener's granulomatosis are presented. HLA status and associated genes in the brothers and the immediate family are explored. No specific association could be found with tissue types within the family.