Tinnitus, that is defined as ’ringing in the ear’, is and has probably always been a very common phenomenon in the health history of mankind. A variety of pathomechanisms for its onset has been proposed in the past and this trend sees no stopping. Precise pathomechanisms still remain unclear. From the historical point of view, tinnitus is a very interesting topic but there is a lack of scientific enquiries. As its earliest historic reference, the Papyrus Ebers is often cited. By reviewing the original source, however, it is very unlikely that this contains the earliest historic reference of tinnitus. It is rather likely indeed that tinnitus was a known symptom in the ancient Egypt but it has never been exclusively been written down. This article reviews data provided by this fascinating historical period on the questionable reference and highlights the impact of history on the modern status of tinnitus.

Chemical perfusion of the inner ear is an increasingly popular treatment for Ménière’s disease. The authors report on the long-term results of 22 patients treated with gentamicin delivered via a round window micro-catheter. Patients with Ménière’s disease underwent continuous, low dose (10 mg/ml) gentamicin infusion at 5 microlitre per hour for 10 days, through a micro-catheter placed into the round window niche. Vertigo was controlled in 95 per cent, whilst preserving hearing in 77 per cent. Hearing improved in three patients. Three patients with pre-operative serviceable hearing (PTA < 50 db) demonstrated reduced hearing; two patients with pre-operative non-serviceable hearing developed a dead ear. Tinnitus and aural fullness remained unchanged or improved in 86 per cent and 68 per cent respectively. Long-term vertigo control can be achieved using low dose gentamicin, whilst preserving hearing and vestibular function in the majority of patients. This procedure appears to stabilize the vestibular function, enhancing the chance of effective vestibular rehabilitation.

Modiolar deficiency has been reported as representing the mildest form of cochlear dysplasia. In this study the authors aimed to determine baseline values of the mid-modiolar area and modiolus volume in normal subjects. In this way they aimed to improve the detection of previously underdiagnosed subtle cochlear dysplasia in patients with sensorineural hearing loss.

Prostaglandins and leukotrienes are implicated in conditions of both the upper and lower airways. In the former they are deranged in nasal polyposis, intrinsic rhinitis and allergic rhinitis while in the latter they are involved in the pathogenesis of asthma. The aim of the present study was to measure mucosal eicosanoid levels in the three types of rhinitis and compare with controls. In addition, the effect of topical steroids on eicosanoid levels in rhinitis was examined.

The levels of prostaglandins E2 (PGE2) and D2 (PGD2) and of leukotrienes E4 (LTE4) and B4 (LTB4) were measured in nasal biopsies from the inferior turbinates of patients suffering from perennial rhinitis and a control group. Rhinitis patients were classified into three categories: perennial allergic rhinitis (PAR), non-allergic rhinitis with eosinophilia (NARES) and noneosinophilic non-allergic rhinitis (NENAR) on the basis of symptoms, secretion eosinophilia, nasal resistance and allergy testing. Patients with rhinitis were randomized into two groups. One received fluticasone propionate nasal spray (FPANS) and the other a placebo (PNS) over a period of six weeks prior to the biopsies.

One hundred and one patients with PAR, NARES or NENAR were recruited sequentially and the control group consisted of 21 patients with no evidence of rhinitis but with nasal obstruction due to septal deviation.

Untreated rhinitics had significantly lower levels of PGE2, PGD2 and LTE4 than non-rhinitic controls. Six-weeks’ treatment with FPANS significantly increased the levels of those eicosanoids in patients with PAR and NARES but they were still significantly below normal. Levels of LTB4 in all three rhinitis groups were not significantly different from controls and treatment with topical steroids had no effect. Their findings are contrary to current thinking that increased levels of eicosanoids, in particular cysteinyl-leukotrienes, play an important role in the pathogenesis of chronic, non-infective upper airway inflammation.

Adduction arytenopexy was designed as an innovation to arytenoid adduction, however the pragmatic issues regarding patient selection for these procedures has not been comprehensively assessed.

A prospective examination was performed on 100 consecutive patients who had undergone laryngoplastic phonosurgical reconstruction for paralytic dysphonia. Seventy-seven of 100 (77 per cent) were judged pre-operatively to gain potentially significant phonatory enhancement from an arytenoid procedure. Fifty-six of 77 (73 per cent) underwent adduction arytenopexy; 17 of 77 (22 per cent) were judged pre-operatively to have inadequate respiratory abduction of the contralateral arytenoid and two out of 77 (three per cent) had athletic aerodynamic requirements. In another two out of 77 (three per cent), there was a chance of favourable reinnervation and thus it was not the preferred method.

The majority of patients were judged pre-operatively to gain potentially substantial phonatory enhancement from an arytenoid procedure. However, in this series, approximately 25 per cent of the patients were considered to be unsuitable candidates for an arytenoid medializing procedure, primarily because it was deemed that the operation could result in an inadequate airway.

The aim of this study was to systematically identify the type and severity of all comorbid conditions in a cohort of 180 patients with laryngeal squamous cancer. The authors retrospectively surveyed the notes using the Adult Comorbidity Evaluation −27 index (ACE−27) and applying a systematic process of data abstraction that had previously been shown to be accurate and reliable. The results provided insight into the distribution, site and extent of decompensation caused by comorbidity. It was found that 116 (64.4 per cent) of 180 patients in the study population had some form of comorbid illness, with the cardiovascular and respiratory systems being the top two body systems affected in 43.9 per cent and 24.1 per cent respectively. One-quarter (25.8 per cent) of these 116 patients had comorbid illnesses in more than one body system. Concurrent neurological disease is associated with high mortality. The ACE − 27 is a comprehensive instrument that codes all forms of comorbid diseases in the head and neck cancer setting excepting malnutrition. This study suggests that routine collection of comorbidity will be important in future outcomes analysis and in comparing treatment results between centres. Apparent improvements in treatment outcome following newer therapeutic modalities will have to take into account any changes in the comorbidity type and burden over time.

The principal reason for performing investigations in patients with globus pharyngeus is to detect a pharyngeal or upper oesophageal malignancy presenting this way. There is uncertainty regarding both the necessity for investigation in globus patients and the first line investigation of choice in the screening of such patients. The authors therefore undertook a retrospective study of 699 patients who presented with globus sensation. Of these, 451 patients (64.5 per cent) had a typical history and in these patients, outpatient examination, including fibre-optic nasendoscopy was able to detect all pathologies, except one insignificant pharyngeal pouch, which required no intervention and one patient with a distal peptic stricture. In patients with atypical symptoms the combination of fibre-optic nasendoscopy and barium swallow identified all pathologies (five aerodigestive tract malignancies) except one distal peptic stricture. The authors concluded that if out-patient examination is adequate, no further investigation of typical globus symptoms is required. Such a policy would produce significant savings for both out-patient and radiology services.

This study was undertaken to assess the impact on patients of proposals to centralize head and neck oncology services in the UK. A retrospective audit of the 2001–2002 head and neck cancer database at South Devon district general hospital identified 85 patients (50 males: 35 females; median age 66 years; range 29–93) diagnosed with head and neck cancer. The total number of hospital visits for diagnostic, therapeutic and other management services were recorded (median number of visits 28; range 1–78). Using this data, the extra distance required to travel to a potential regional cancer centre located in Bristol during the first six months of management was extrapolated. It was calculated that each patient would have to travel on average an extra 5333 miles (median 5658; range 185–13 759). Published documents advocating centralization of oncology services make no reference to the patient burden of geographic relocation of medical services. Agencies involved with restructuring oncology services must recognize the non-clinical impact of centralization and make some provision to overcome the burden facing patients and their carers.

Primary salivary adenocarcinoma of the head and neck is rare. In cases where cervical metastases are evident or suspected, neck dissection is likely to play a role in management. However, there is little data in the literature regarding the findings and outcome of neck dissection in these patients. The present study comprised a review of 12 patients with high-grade salivary adenocarcinoma (salivary ductal carcinoma or adenocarcinoma, not otherwise specified (NOS). Eight underwent neck dissection (four modified radical, four selective). Histological examination showed evidence of cervical metastases in five. The prevalence of occult metastases in the N0 neck was 40 per cent. Computed tomography (CT) and magnetic resonance imaging (MRI) were not useful in detecting occult neck disease. Five patients had no evidence of disease at the most recent follow up. Neck dissection is indicated in patients with high-grade salivary adenocarcinoma, and may provide information for planning adjuvant treatment.

The thyroid gland is the second most common site for malignancy in the head and neck region. Quality of life (QOL) of thyroid cancer patients has not been studied directly. The QOL of long-term thyroid carcinoma patients was investigated. A standardized set of questions based on the University of Washington QOL questionnaire for head and neck cancer with specific domains associated with thyroid disease was created. This questionnaire was mailed to patients who underwent total thyroidectomy for well-differentiated cancer in the department of Otolaryngology-Head and Neck surgery at the Chaim Sheba Medical Centre in Israel between the years 1994–2000.

Seventy-eight patients undergoing total thyroidectomy were identified. Forty-eight patients were excluded and 20 out of the 30 remaining patients responded to the questionnaires. Six were male and 14 female, 12 were under the age of 45 (these 12 patients were staged as stage 1). Eleven patients underwent neck dissection. General health and QOL were significantly better for the younger age group and so was the calcium balance score. General health and QOL were significantly better for patients undergoing neck dissection. The overall QOL score was 3.8 conforming with ‘good’ in the questionnaire. Surgery and initial radioiodine treatment scored 6.75 and 6.9 respectively in the distressing scale (0–10 range: 10 = most distressing). The highest distress was encountered during withdrawal from thyroid hormone. Women rated the importance of proper replacement therapy significantly higher than men. Global low scores were found for employment and for effective L-thyroxine replacement therapy.

Overall, QOL in these patients was good although lower than expected when compared with other forms of cancer. Age and gender-related differences were noted. Better QOL in neck dissection patients is probably associated with age under 45 years. High distress scores for hormone withdrawal during periodical imaging correspond with former reports and supports use of Thyrogen®. Better hormone balance is warranted for this group.

One of the most challenging types of nasal fracture is when the nasal pyramid, comprising of the upper and lower lateral cartilages and septum including the vomer, is fractured, impacted and has rotated into the face. This paper describes a technique to elevate the nasal complex and hold it forwards using a Kirschner wire.

Ear drops containing neomycin only rarely cause ototoxicity. The authors report on three patients with a tympanic membrane perforation who developed severe ototoxicity after use of eardrops containing 0.35 per cent neomycin. Mitochondrial DNA analysis revealed that there was no A1555G point mutation in these patients. This finding indicates that application of low concentration neomycin to the middle ear can cause severe inner ear damage even in humans who are not hyper-susceptible to aminoglycosides.

Chondrosarcomas (CSA) of the temporal bone are rare primary malignant tumours that are slow growing, but locally aggressive. The management of CSAs involving the temporal bone is challenging and necessitates a multidisciplinary approach in a tertiary referral unit well practised in skull base surgery. Their management with particular reference to modes of presentation and treatment strategies has been reviewed here.

Atrophic rhinitis is a chronic inflammatory disease of the nose. The aetiology of primary atrophic rhinitis is not yet known, although secondary atrophic rhinitis is known to be associated with chronic granulomatous diseases such as tuberculosis and leprosy. The authors report a case of atrophic rhinitis, which was a presenting feature of a rare genetic disorder known as Christ-Siemens-Touraine syndrome, also known as anhidrotic ectodermal dysplasia.

The authors report clinical experience in managing an 82-year-old female presenting with long-standing bilateral nasal obstruction resulting from a nasopharyngeal mass. The patient had undergone a number of treatments including surgery. The previous examinations, investigations and treatment had all been performed within the previous 10 years and although examination had been documented there was no evidence on review of the notes that the nasopharynx had been inspected either by nasendoscopy or indirectly. The mass was removed via a combined nasal and oral approach. Histopathological examination of the specimen was consistent with mesenchymal hamartoma. In addition to describing a rare presentation the authors believe this case highlights the importance of complete examination in all patients with nasal symptoms

Life-threatening conditions following dental infections have been rare since antibiotics were introduced into the world of medicine. However, infections spreading through the soft tissues of the head and neck are encountered occasionally and mortality is still reported as a result of sepsis or airway embarrassment. A case of Ludwig’s angina from odontogenic infection that progressed into mediastinitis and pericarditis is presented. The steps adopted in the management of this case highlight the significance of early recognition and diagnosis of the source of deep cervical infections, the importance of securing the airway, effecting surgical drainage and aggressive intravenous antibiotic therapy.

This is a report of a case of a rare congenital midline cervical cleft and a description of the surgical approach.

Congenital midline cervical cleft is a very rare developmental anomaly. It represents a failure of the branchial arches to fuse in the midline and presents at birth with a ventral midline defect of the skin of the neck. Associated clinical features could include mandibular spurs, cleft mandible, microgenia, thyroglossal cyst, cleft lip or bronchogenic cysts.

The authors present a case of a midline cervical cleft that was diagnosed and managed at an early age. They discuss the clinical presentation and embryological development of this rare condition. The operative findings, surgical excision and repair of the long vertical defect by Z-plasty are discussed in detail.

The authors report a very satisfactory result following excision and Z-plasty closure of this rare congenital anomaly.

Head and neck swellings are common referrals to the otolaryngology department, with a wide range of aetiologies. Internal jugular vein thrombosis presenting as swelling in the neck is a rare occurrence. The authors report a case of bilateral internal jugular vein thrombosis secondary to malignant lymphadenopathy of unknown origin. The patient presented with a short history of a diffuse swelling in the neck with neck stiffness. Examination revealed palpable cervical and axillary lymphadenopathy. Causes of spontaneous internal jugular vein thrombosis were discussed.

Necrotizing fasciitis (NF) is a very aggressive infection with associated high mortality. Risk factors of acquiring this infection may include diabetes mellitus, surgery, trauma, and infection. This infection necessitates prompt recognition and aggressive management in order to avoid its unfavourable outcomes. Associated nerve paralysis may indicate the involvement of deeper tissue.

The present report highlights a case of cervical NF that was complicated by facial nerve paralysis, a feature that has rarely been reported.

Malignant external otitis (MEO) is a severe infection of the external auditory meatus caused by Pseudomonas aeruginosa. Classical features include unrelenting deep otalgia, otorrhoea and granulations in the floor of the ear canal. Treatment is generally protracted antibiotic therapy and monitoring of inflammatory markers; the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Traditionally computed tomography (CT) has been the imaging modality of choice. The authors present a case where magnetic resonance imaging (MRI) has been crucial in the diagnosis and follow up of a patient with MEO.