The incidence of thyroid dysfunction following radiotherapy for early stage carcinoma of the larynx.

External beam radiotherapy is currently the commonest form of treatment for early laryngeal cancer (T1/2) and thyroid dysfunction is a well recognised complication of this treatment. Overt hypothyroidism is a specific clinical disorder which in most patients will be recognized and treated. The problems associated with subclinical hypothyroidism (elevated TSH with normal T4), however, are only now being recognized and their management is to some extent still controversial. The aims of our study are to determine the incidence of clinical and subclinical hypothyroidism in those who have been treated solely with curative radiotherapy for early laryngeal cancer. We performed a retrospective observational study encompassing all patients who underwent curative radiotherapy for T1/T2 laryngeal cancer between 1998 and 2002. 33 patients were identified (mean 66.85 years, range 48-93). 19 patients had T1 lesions (58%), 14 had T2 lesions (42%) and 27 were N0 (82%). 23 patients were euthyroid post treatment (70%), 2 became overtly hypothyroid (6%) and 8 developed subclinical hypothyroidism (24%). There was no association between tumour stage (p = 0.97), nodal stage (p = 0.46) and thyroid status, however, there was an association between increasing age and deteriorating thyroid function (p = 0.01). Our study showed that of patients with early laryngeal cancers treated solely with curative radiotherapy 24% developed subclinical hypothyroidism and 6% were overtly hypothyroid (Elevated TSH and reduced T4). We feel patients should receive regular thyroid function testing following completion of treatment and should be adequately counselled on the risk of thyroid dysfunction following radiotherapy at pre-treatment visits.

Role of revision adenoidectomy in paediatric otolaryngological practice.

OBJECTIVES: We aimed to determine the need for revision adenoidectomy following the standard technique of blind curettage with digital palpation. METHODS: Within a district general hospital, we undertook a retrospective study of 3231 children who underwent adenoidectomy between 1996 and 2003, 53 of whom required revision adenoidectomy. The main outcome measure was the number of children needing revision adenoidectomy. RESULTS: A total of 53 children required a repeated operation for recurrence of symptoms (1.6 per cent); of these, 42 were for treatment of glue ear, five were for nasal symptoms and six were for adenoidal infection. CONCLUSION: Adenoidectomy performed without vision may be one of the reasons for recurrence of symptoms. Residual adenoids are acknowledged in the literature as one of the complications of the traditional technique. We highlight the fact that the need for revision adenoidectomy is not uncommon and suggest that we should improve our surgical technique in the UK by visualization of the postnasal space either by a mirror or an endoscope.

An unusual case of primary extranodal non-Hodgkin's lymphoma in the muscles of facial expression.

Primary extra-nodal non-Hodgkin's lymphoma (NHL) of the skeletal muscles is a well recognized entity although such occurrences are not very common. Presentation in the muscles of the face has only rarely been described. We present a case of primary extra-nodal NHL in a non-immunocompromised patient involving only the muscles of facial expression and not extending to the oral cavity or sinonasal tract. The patient was subsequently treated with chemotherapy and at the time of writing remained in remission. We suggest that lymphoma should be considered among the causes for malignant infiltration of the muscles of the face.

Immunotherapy for allergic rhinitis--a United Kingdom survey and short review.

Allergic rhinitis (AR) is a common condition which is treated using different modalities, including immunotherapy. The aim of this study was to survey the current management strategies among ENT consultants in the UK in treating AR, and their views on immunotherapy. The study design was a postal questionnaire survey and the setting a university teaching hospital. Participants were consultant members of the British Association of Otolaryngologists - Head and Neck Surgeons (BAO-HNS). The main outcome measures were common treatment modalities adopted by the survey group to treat AR, and the number of consultants practising immunotherapy. The majority (81.1 per cent) of the consultants surveyed practise medical therapy with or without surgery. Immunotherapy is advised by 26 per cent of ENT consultants, but only 6.6 per cent currently administer immunotherapy.

Difficult button battery ear foreign body removal: the magnetic solution.

BACKGROUND: Removing a button battery from the ear can be a tricky and challenging procedure. METHOD AND RESULTS: We describe the innovative use of a magnetic telescopic rod to successfully remove a button battery from the ear canal of a nine-year-old boy. CONCLUSION: We propose that this equipment should be available in ENT clinics and operating theatres to be used for removing foreign bodies made from ferrous materials.

Impacted foreign body in the hypopharynx and oesophagus.

We report a rare case of an unusual impacted foreign body (titanium mesh stent) in the hypopharynx and upper oesophagus of a 66-year-old gentleman. He was a known patient with carcinoma of the mid-oesophagus admitted under the gastroenterologists for dilatation of the carcinomatous stricture with a stent. During the procedure the titanium mesh spring coil got displaced and was impacted in the retropharyngeal space, submucosally in the hypopharynx and upper oesophagus. He was referred to us for surgical removal of the stent, which he underwent successfully. We believe this to be the first case of such an unusual foreign body to be reported in the literature.

Focal myositis of the neck with idiopathic orbital myositis.

Focal myositis (of Heffner) in the right trapezius and paraspinal muscles accompanied by a pseudotumour of the left orbit has not been reported previously. The clinical, pathological and radiological features of these unusual benign pseudotumours of the head and neck are discussed. Computerized tomography (CT) scan of the neck and orbital ultrasound were suggestive of an inflammatory process without an abscess formation. This was followed by fine needle aspiration cytology (FNAC), which confirmed the diagnosis. The patient was treated with intravenous steroids and antibiotics, that led to complete resolution of symptoms, and there was no recurrence at six months follow-up. This report highlights the importance of imaging in inflammatory neck swellings.

Management of nasal injuries: a postal questionnaire survey of UK ENT consultants.

Nasal injuries are one of the commonest conditions seen in ENT out-patients. There is no uniform policy or protocol for the management of this condition. A postal questionnaire was sent to all UK-based ENT consultants. The aim of this study was to ascertain current practice in the management of this common problem. We were also interested to know if consultants believed that the septum should be addressed and dealt with at the same time as manipulation to improve cosmetic and functional results. Manipulation of nasal bones without anaesthesia, under local anaesthesia, and general anaesthesia with digital pressure or using instruments are all practised. The digital pressure under general anaesthesia with use of septal and nasal forceps, if needed, is practised by the majority of consultants (55.8 per cent). Only a minority considered the role of the septum to be important in the initial management of the patient.

Endoscopic trans-sphenoidal removal of cholesterol granuloma of the petrous apex: case report and literature review.

OBJECTIVE: We report a case of cholesterol granuloma of the petrous apex which was surgically treated via an endoscopic trans-sphenoidal approach. METHODS: Case report and review of the literature concerning cholesterol granulomas of the petrous apex and their management. RESULTS: The lesion was approached endoscopically via a bilateral sphenoidotomy with removal of the vomer. A large cholesterol granuloma was evacuated and marsupialised. The patient made an uneventful recovery. CONCLUSION: Trans-sphenoidal access to the petrous apex represents an alternative route for the drainage and ventilation of cholesterol granulomas. This approach is the technique of choice when the cholesterol granuloma abuts the posterior wall of the sphenoid sinus. The trans-sphenoid approach, unlike other lateral approaches to the petrous apex, spares cochlear and vestibular function and allows post-operative endoscopic follow up.

Meningocoele of fallopian canal causing recurrent meningitis.

OBJECTIVE: We report a rare case of meningocoele of the fallopian canal resulting in recurrent meningitis. METHODS: We present a case report together with a review of the world literature concerning meningocoele of the fallopian canal and meningitis. RESULTS: A child developed profound, bilateral, sensorineural hearing loss as a result of meningitis caused by a meningocoele of the fallopian canal. He was treated with bilateral cochlear implantation, with a subtotal petrosectomy and middle ear and eustachian tube obliteration on the affected side. CONCLUSION: Meningocoele of the fallopian canal has rarely been reported. This lesion can present with recurrent meningitis and, rarely, with facial weakness. All children with recurrent meningitis should be investigated for skull base defects. Treatment aims to prevent further episodes of meningitis; we recommend that this is best achieved by the technique of subtotal petrosectomy, with obliteration of the middle ear and eustachian tube.

Adenoidectomy techniques: UK survey.

OBJECTIVES: To determine (1) the preferred adenoidectomy technique among UK ENT consultants, and (2) the need for revision adenoidectomy following the standard technique of blind curettage with digital palpation. METHOD: Postal questionnaire. PARTICIPANTS: We included 539 consultant members of the ENT-UK. MAIN OUTCOME MEASURES: Commonly used adenoidectomy techniques, and whether revision adenoidectomy was considered a problem. RESULTS: The response rate was 66.6 per cent (359 respondents). Twenty-seven respondents did not perform adenoidectomy, while 332 did. A total of 312/332 respondents (94 per cent) believed that adenoidectomy had a role in the treatment of chronic serous otitis media. The majority of respondents (232/332; 69.9 per cent) reported examining the postnasal space digitally at adenoidectomy. The preferred routine adenoidectomy technique was blind curettage for 263 respondents (79.2 per cent), suction diathermy ablation for 27 (8.1 per cent) and curettage under direct vision (using a mirror) for 13 (3.9 per cent). In response to the question 'Do you recognise the need for revision adenoidectomy as a problem?', 205 (61.7 per cent) respondents replied 'never', 39 (11.7 per cent) 'rarely', 54 (16.3 per cent) '< 2 per cent' and 36 (10.8 per cent) '>2 per cent'. CONCLUSIONS: The most commonly used adenoidectomy technique in the UK is digital palpation followed by blind curettage, according to this postal questionnaire survey. Few respondents reported performing adenoidectomy under direct vision: only 10 per cent used a mirror during the procedure and only 8 per cent used an endoscope.

Breathing straws.

Following nasal, septal or endoscopic surgery, it is common practice to insert nasal packs in both nasal cavities to achieve haemostasis, if there has been any bleeding at the end of the procedure. However, such packs make it difficult for patients to breathe, mainly in the first post-operative night which leads to discomfort and poor sleep. To enable patients to breathe better with nasal packs in situ, we describe a simple technique using trimmed straws and wrapped Netcell packs for post-operative care following septal surgery, rhinoplasty and endoscopic sinus surgery. These packs also assist suction of any blood or mucous from the post-nasal space.

Ossiculoplasty: a UK survey.

The aim of this study was to assess and quantify the current surgical practice of ossiculoplasty among British otolaryngology consultants, using a postal questionnaire. Ossiculoplasty is not a very common procedure. It is only performed by otologists with a special interest in ossiculoplasty. Among the 280 respondents (response rate 51.9 per cent), only 179 (63.9 per cent) performed ossiculoplasty. The majority of the consultants (86.5 per cent) used artificial prostheses, and 63.7 per cent used patients' own ossicles (autografts). Most of the consultants (77.6 per cent) performed ossiculoplasty with primary tympanoplasty surgery rather than with primary cholesteatoma surgery (46.3 per cent). The majority of the consultants (50.8 per cent) performed less than 10 ossiculoplasties per year. This is the first survey on ossiculoplasty surgery in the United Kingdom.