Major vascular complications in patients with head and neck cancer have previously been thought of as terminal events. However, it is now possible to intervene in many situations, with benefits for quality of life as well as survival. Endovascular techniques have reduced morbidity and mortality in many situations, both emergency and elective.

We describe the techniques that can be employed in such situations, and present illustrative case reports. Life-threatening haemorrhage, carotid compression and radiation-induced carotid stenosis are all discussed.

It is possible to predict where complications may arise, and to take prophylactic steps to allow treatment to continue. Early intervention can reduce both morbidity and mortality in this high-risk patient group.

This study aimed to assess the quality of information available on the World Wide Web for patients undergoing thyroidectomy.

The first 50 web-links generated by internet searches using the five most popular search engines and the key word ‘thyroidectomy’ were evaluated using the Lida website validation instrument (assessing accessibility, usability and reliability) and the Flesch Reading Ease Score.

We evaluated 103 of a possible 250 websites. Mean scores (ranges) were: Lida accessibility, 48/63 (27–59); Lida usability, 36/54 (21–50); Lida reliability, 21/51 (4–38); and Flesch Reading Ease, 43.9 (2.6–77.6).

The quality of internet health information regarding thyroidectomy is variable. High ranking and popularity are not good indicators of website quality. Overall, none of the websites assessed achieved high Lida scores. In order to prevent the dissemination of inaccurate or commercially motivated information, we recommend independent labelling of medical information available on the World Wide Web.

To determine the implications of a functional approach to vestibular schwannoma surgery, with facial nerve function prioritised higher than total tumour excision.

A case–control study in a tertiary referral neurotology clinic.

A ‘functional’ surgical group treated after April 2007 (n = 44, mean cerebellopontine angle dimension 27 mm), and an ‘excisional’ surgical group matched for tumour size, treated from 1997 to April 2007 (n = 115).

Change to more functional surgical approach.

Primary outcome: facial nerve status. Secondary outcome: tumour recurrence in less-than-total tumour excision.

Facial nerve preservation: 77 per cent House–Brackmann grade I–II in functional group at 12 months, versus 57 per cent grade I–II in excisional group (p = 0.027). Tumour recurrence: 1 per cent in total excision group, 2 per cent in near-total group and 40 per cent in sub-total group.

A functional approach to vestibular schwannoma surgery improves facial nerve preservation outcomes and reduces the requirement for facial nerve rehabilitative interventions. Tumour recurrence rates are low in near-totally excised lesions but significant if only sub-total excision is achieved.

To assess the efficacy of anterior tagging of graft material with respect to graft uptake and hearing results, in type I tympanoplasty.

Prospective, randomised, cohort study.

Sixty patients with chronic otitis media of the mucosal type, with pars tensa perforations, were included in the study. Patients were randomly allocated to two groups: group one underwent type one tympanoplasty with anterior tagging, while group two underwent type one tympanoplasty without anterior tagging. Follow up included evaluation of graft uptake and hearing improvement.

There were 33 patients in group one and 27 patients in group two. The overall incidence of successful graft uptake was 96.96 per cent in group one and 81.5 per cent in group two. Closure of central and posterior perforations was successful in 100 per cent of both groups. Closure of anterior and subtotal perforations was successful in 95.45 per cent of group one and 54.54 per cent of group two.

Type one tympanoplasty with anterior tagging of graft material is a suitable technique for anterior and subtotal perforations.

To analyse patients with cholesteatoma undergoing canal wall down mastoidectomy together with ossicular reconstruction with a titanium prosthesis, in order to identify factors associated with hearing outcomes.

Retrospective review of 97 cases undergoing single-stage surgical management.

All patients underwent canal wall down mastoidectomy. Kurz titanium ossicular prostheses were used for ossicular chain reconstruction. Pre-operative and post-operative air conduction and bone conduction hearing thresholds were obtained at 500, 1000, 2000 and 3000 Hz.

The mean pure tone average improved from 46.02 ± 14.54 dB pre-operatively to 29.32 ± 14.64 dB post-operatively, for both total and partial ossicular replacement prosthesis groups combined. The mean air–bone gap improved from 30.38 ± 11.12 dB pre-operatively to 15.62 ± 9.65 dB post-operatively, for both groups combined.

Reconstruction with a titanium prosthesis offers good functional results when performed during canal wall down surgery for advanced cholesteatoma, as a single-stage procedure.

Tympanostomy tube (grommet) insertion is a common procedure, with little guidance in the current literature regarding post-operative surveillance. Our institution implemented a protocol to follow up post-surgical grommet patients via audiology at six weeks.

A retrospective audit of all patients less than 16 years old who had undergone grommet insertion during a three-month period.

A total of 149 patients had grommets inserted. Exclusion criteria left a cohort of 123 individuals; 82 (67 per cent) were followed up by audiology. Of these, 13 (11 per cent) did not attend follow up, and were discharged; 53 (43 per cent) were discharged from audiology with normal thresholds; and 16 (13 per cent) were referred back to a consultant. Therefore, the overall reduction in patients followed up by an otolaryngologist was 54 per cent.

We recommend a six-week follow up with audiology following grommet insertion, allowing for referral back to ENT services in the event of related complications.

To determine potential prognostic factors for survival in patients with mucosal malignant melanoma of the sinonasal tract.

Patients managed between 1991 and 2008 were assessed retrospectively. The seventh edition Union for International Cancer Control (7th UICC) tumour-node-metastasis classification was used for tumour staging. Kaplan–Meier and log rank tests were used for survival analysis.

Twenty-five patients were studied (six were tumour stage three, eight tumour stage four(a) and 11 tumour stage four(b)). Surgery was performed on 23 patients (92 per cent). Fifteen received post-operative radiotherapy. Mean follow up was 31.3 months (range, two to 99 months). Three-year disease-free survival was improved in patients with stage four tumour arising from the nasal fossa, versus other sites, and in those with stage four tumour treated with surgery plus adjuvant radiotherapy, versus other treatments.

Patients with melanoma of the nasal cavity have very poor survival rates. Treatment is still based on adequate surgical resection with safe margins. In this study, post-operative radiotherapy improved local control only for stage four tumours.

To investigate differences in orbital involvement in patients with invasive versus non-invasive fungal sinusitis.

One hundred consecutive cases of fungal sinusitis were assessed clinically and by computed tomography scan to evaluate orbital involvement.

Clinical orbital involvement was more common in invasive (73.5 per cent) than non-invasive (12.1 per cent) fungal sinusitis (p = 0.000). Computed tomography scanning showed similar orbital involvement in both groups, except for erosion of the floor of the orbit, which was more common in patients with invasive fungal sinusitis (p = 0.01). Extra-ocular muscle enlargement (44.4 vs 4 per cent, p = 0.01) and optic atrophy (44.4 vs 0 per cent, p = 0.003) were more common in chronic than acute invasive fungal sinusitis. Four patients (16 per cent) with acute invasive fungal sinusitis had no evidence of orbital involvement on scanning, despite clinical evidence of optic atrophy.

Orbital involvement is more common in invasive than non-invasive fungal sinusitis. The difference is more evident clinically than on computed tomography scanning. Patients with acute invasive fungal sinusitis may have limited evidence of orbital involvement on scanning, despite extensive clinical disease.

Paediatric tonsillectomy is a common ENT operation. The use of day-case surgery is increasing, in order to improve efficiency in healthcare.

A prospective audit spiral was carried out from January 2006 to December 2008 for all children undergoing day-case tonsillectomy at Huddersfield Royal Infirmary.

There was a haemorrhage rate of 2.6 per cent over three years. The most common complication was nausea and vomiting, seen in 5.3 per cent of patients.

For a well selected group of children, day-case tonsillectomy in a district hospital setting is a safe and efficient alternative to an in-patient stay. A dedicated day-case team, good anaesthetic technique, adequate post-operative analgesia and on-site paediatric in-patient facilities are essential.

We undertook a study to ascertain what factors general practitioners consider important when referring children for tonsillectomy, and to compare these views with those of consultant ENT surgeons.

Web-based questionnaire study.

A total of 141 general practitioners and 146 consultants responded. Tonsillectomy in children was regarded as a useful operation by 65 per cent of general practitioners and 98 per cent of consultant ENT surgeons. This difference was statistically significant (p < 0.001, chi-square test). In 1994, Donnelly et al. found that 92 per cent of general practitioners considered tonsillectomy in children a useful operation; our results were significantly different (p < 0.001, chi-square test).

There is a good level of awareness and agreement on the currently accepted indications for paediatric tonsillectomy in both groups. However, there were important areas of difference between the two groups with regard to ‘glue ear’, recurrent ear infections and snoring. Standardised indications for tonsillectomy should be effectively disseminated to general practitioners.

To study the effect of a new technique for closed reduction of dislocated arytenoids.

The study included 21 females (72.4 per cent) and eight males (27.6 per cent) with a diagnosis of arytenoid dislocation. There were 18 cases of left arytenoid dislocation and 11 of right arytenoid dislocation.Twenty-eight cases had anteromedial dislocation and one had posterolateral dislocation. All patients were treated with closed reduction using custom-made metal rods and an operating microscope, under general anaesthesia.

Post-operatively, 21 patients’ voices returned completely to normal (including full vocal fold mobility), five had an improved voice and three failed to show any improvement. There were no post-operative complications.

This new closed reduction technique is a safe procedure for patients with dislocated arytenoids. It is repeatable and the outcome is reliable and effective. Closed reduction can be a useful treatment for arytenoid dislocation.

There is currently controversy over the association between serum interleukin-4 and -10 levels and head and neck squamous cell carcinoma in patients of different ethnicity. This study aimed to investigate serum levels of these cytokines in Iranian patients with this pathology, and to analyse correlations with tumour location and tumour stage at diagnosis.

Serum cytokines levels were quantified using commercial enzyme-linked immunosorbent assays.

Study groups comprised 93 untreated patients and 53 healthy donors.

Serum interleukin-4 levels were significantly increased in patients compared with controls (p < 0.000), but were not significantly associated with tumour stage. Serum interleukin-10 levels were not raised in patients, nor associated with tumour stage.

Serum levels of interleukin-4, but not -10, were increased in Iranian head and neck squamous cell carcinoma patients. These data do not support an association of these cytokines with tumour progression; this is consistent with previous findings.

Few studies have examined the association between ABO blood grouping and head and neck cancer. This retrospective review examined the association between blood group and laryngeal cancer incidence and patient mortality.

Of 271 patients treated for squamous cell laryngeal carcinoma (1997–2002), 143 patients with supraglottic, glottic and subglottic tumours were included; 128 patients were excluded. The blood group characteristics of patients and healthy blood donors were compared.

There was no significant correlation between blood type and laryngeal carcinoma incidence or mortality. Type A blood was commoner in African Americans with laryngeal cancer than Caucasian patients, but not significantly so. As expected, five-year survival rates were lower in patients with more advanced stage cancer (p < 0.0001).

Although our findings show no association between blood group and five-year survival, these results are inconclusive, and warrant further study of the association between blood type and laryngeal (and other) head and neck cancers.

Botulinum toxin is a widely accepted, effective treatment for Frey's syndrome. While some patients need only one injection, others require repeated treatments. We aimed to describe the clinical features of patients with a more challenging treatment course.

Literature review and retrospective analysis of eight consecutive patients treated at a university hospital.

These patients' treatment responses were categorised (using our own system) and compared with those of 25 published cases.

Combined analysis identified no significant correlation between treatment response and age, gender or the extent of primary salivary gland surgery. There was no significant correlation between botulinum toxin dosage and time between treatments.

Frey's syndrome should be viewed as a dynamic process in which the stimulus for aberrant reinnervation of parasympathetic nerve fibres can be reduced, in some patients, with higher botulinum toxin dose injections to the treated areas. However, responses are unpredictable, and relapses may occur at different time points and in different areas.

Obstructive sleep apnoea syndrome has been linked to obesity, nasal obstruction and adenotonsillar hypertrophy, but rarely to large thyroid goitres.

To study the possible association between multinodular retrolaryngo-pharyngeal or retrosternal goitres and obstructive sleep apnoea syndrome.

Retrospective case series at a tertiary referral centre (2000–2010). Study parameters included body mass index, Epworth sleep score and polysomnographic index.

Five patients were diagnosed with obstructive sleep apnoea syndrome and managed with nasal continuous positive airway pressure ventilation. Computed tomography showed a retrolaryngo-pharyngeal or retrosternal goitre with significant tracheal compression, displacement and laryngeal oedema. After total thyroidectomy, obstructive sleep apnoea resolved in all patients.

Large, multinodular goitres with retrolaryngo-pharyngeal extension can cause obstructive sleep apnoea syndrome due to laryngeal compression and oedema. In such cases, total thyroidectomy enables resolution of symptoms. Patients with obstructive sleep apnoea syndrome should be screened for thyroid goitre.

To evaluate the presence of Helicobacter pylori in healthy laryngeal mucosa.

Prospective analysis of Helicobacter pylori colonisation in healthy laryngeal mucosa, using the 13C urea breath test and polymerase chain reaction analysis.

Twenty randomly chosen men (28–78 years) without laryngeal pathology or gastrointestinal disease were investigated. All subjects were scheduled for elective operative procedures, under general, endotracheal anaesthesia. Cytobrush samples were taken for Helicobacter pylori DNA detection. Nested polymerase chain reaction testing was performed on DNA solutions using two primer pairs from the urease A gene of the Helicobacter pylori genome. The 13C urea breath test was performed on two exhalation samples.

Eight (40 per cent) of the subjects were positive for urease on urea breath testing; none were positive for Helicobacter pylori DNA on polymerase chain reaction testing.

Based on these results, we do not consider Helicobacter pylori to be a normal constituent of healthy laryngeal microflora.

We report the case of a rare angiosarcoma, retiform haemangioendothelioma, in an 18-year-old young man, which presented as a recurrent ulcerating lesion of the left pinna.

Case report and literature review of retiform haemangioendothelioma. This is a low grade angiosarcoma with a high local recurrence rate and low metastasis rate, and was first described in 1994 by Calonje et al.

This patient represents only the third report of lymph node metastasis in a case of retiform haemangioendothelioma. To date, 31 cases of the tumour have been reported. Histological diagnosis of this group of vascular neoplasms can be challenging, as their histopathological appearance is intermediate between haemangioma and angiosarcoma.

Surgical excision remains the primary treatment modality, with adjuvant radiotherapy recommended in patients with large tumour size, local recurrence and lymph node metastasis, as seen in this case.

To report a case of Wegener's granulomatosis mimicking skull base osteomyelitis.

A case of Wegener's granulomatosis is reported in a diabetic woman presenting with facial palsy and hearing loss. The clinical course of the disease was very similar to that of skull base osteomyelitis, especially since the patient was diabetic and the ear swab was positive for pseudomonas. The definitive diagnosis was made based on clinical presentation, imaging and serum antineutrophil cytoplasmic antibody testing. The patient was started on immunosuppressants, and her hearing loss and facial palsy recovered.

Wegener's granulomatosis is a systemic disease with various manifestations. A high index of clinical suspicion is required to reach the correct diagnosis. The clinician should be alerted to the possibility of Wegener's granulomatosis in the presence of: systemic upset out of proportion to the apparent intensity of the local lesion; middle-ear disease failing to respond to conventional treatment; and a consistently raised erythrocyte sedimentation rate.

Wegener's granulomatosis is a rare but well recognised autoimmune necrotising vasculitis. Presentation of disease in the head and neck is common and mostly consists of nasal crusting, blockage and bloody discharge. Neurological presentation is very uncommon.

We report a patient who presented to the medical emergency services with signs and symptoms of meningitis, but who was eventually diagnosed with Wegener's granulomatosis. A literature search on this topic was carried out using Medline and Embase (1996 to 2011), searching for ‘Wegener's granulomatosis’ and ‘meningitis’.

After thorough neurological and medical investigation, a combination of brain computed tomography, lumbar puncture, nasal biopsy and laboratory results refuted the diagnosis of meningitis and confirmed the diagnosis of Wegener's granulomatosis.

To the best of our knowledge, this is the first English-language case report of a patient with Wegener's granulomatosis presenting with symptoms of meningitis unconfirmed on computed tomography and lumbar puncture.