Multifocal malignant histiocytoma.

The pathology of malignant histiocytoma has recently been defined and its malignancy confirmed beyond doubt. A unique example of this tumour is described, a search of the literature having failed to find a previously recorded case with a multifocal origin.

Laryngeal rheumatoid arthritis.

The classic sequence of pathologic changes associated with rheumatoid arthritis as they affect the cricothyroid and cricoarytenoid joints of five larynges is described. Although several previous reports have drawn attention to the presence of rheumatoid arthritis in the larnx, the current study emphasizes that the small joints of the larynx may be involved by the full spectrum of pathologic changes and that both cricothyroid and cricoarytenoid joints are equally prone to the various stages of inflammation, joint destruction and ankylosis that characterize the disease elsewhere. Rheumatoid nodules were seen in two cases and granulomatous areas surrounding cricothyroid joints were noted in two others.

Haemangioma of the nasal bones.

A case of haemangioma of the nasal bones is recorded. A search of the world literature has revealed 17 previously reported cases. The clinical and radiological features are reviewed and the aetiology and differential diagnosis discussed. Primary surgery is the treatment of choice and the prognosis is excellent.

Functional voice disorders. A review of 109 patients.

The records of 109 patients, presenting with functional voice disorder during the years 1977-1981, have been reviewed. The mean age was 45 years and the F : M ratio is 2 : 1. Excess voice use was not obviously an aetiological factor. Sixty-one of the 109 patients (56 per cent) were cured by speech therapy, in that their voices returned to their pre-morbid state, and a further 28 (26 per cent) were improved by therapy; seven patients (6 per cent) did not improve and 13 (12 per cent) were lost to follow-up. Of the patients that were 'cured', 54 per cent were discharged after three months' treatment and 72 per cent after six months' treatment. Eight per cent required treatment for more than a year.

Invasive aspergillosis of the paranasal sinuses: a medical emergency.

A rare case of invasive aspergillosis of the paranasal sinuses in a previously healthy individual is presented. The disease caused severe complications and proved fatal. Classification, aetiology and presentation of sinus aspergillosis are discussed. Early diagnosis and management is stressed to avoid the high incidence of morbidity and mortality.

The distribution of neuroglia and schwann cells in the 8th nerve of man.

The 8th cranial nerve has been dissected from 23 adult temporal bones at autopsy and studied histologically. It was found that neuroglial tissue, continuous with that in the brain stem, supported 8th nerve axons to just beyond the mid-point of the nerve. Lateral to this, axons are supported by Schwann cells and neurilemmal sheaths with a short 'junctional zone' intervening. The point at which the transition occurred, from neuroglial to Schwann cell portions, was medial to the porus in 56 per cent of cases, level with the porus in 18 per cent, and within the internal auditory canal in 26 per cent. The relevance of these findings to some aspects of 8th nerve pathology and surgery is discussed.

Post-tonsillectomy pain: the first ten days.

Forty-one adults were entered into a prospective study to investigate the pattern of pain over 10 days after elective dissection tonsillectomy. The severity of pain was scored by the patient on a visual analogue scale. The results confirm that tonsillectomy is a very painful experience and the provision of adequate analgesia is of paramount importance, especially if day-case tonsillectomy is performed.

Thyroglossal duct remnants.

Thyroglossal duct remnants presenting as a lump in the neck are usually called thyroglossal cysts. Meticulous dissection of the cyst and duct, along with the body of the hyoid bone (Sistrunk's operation) is necessary to avoid recurrence. The authors have reviewed the histology of 61 consecutive specimens diagnosed preoperatively as thyroglossal cysts and have found that a true cyst exists in only 46 per cent of cases.

Living on the edge of the post-nasal space: the inhaled foreign body.

We present a previously undescribed event where an inhaled foreign body was propelled into the post-nasal space by the Heimlich manoeuvre. We present figures showing a drop in the mortality following inhaled foreign bodies since the introduction of the Heimlich manoeuvre.

A simple assessment of quality of life in head and neck cancer patients; what can it tell us?

OBJECTIVE: A number of well validated quality of life (QoL) instruments are available. Head and neck cancer patients often find these exhaustive questionnaires too long or bothersome. The purpose of our study was to evaluate a patient self-reported very simple assessment of quality of life and to compare it with the well-validated European Organisation for Research and Treatment of Cancer (EORTC) QoL questionnaire. METHODS: A departmental simple questionnaire was designed consisting of 2 components: 1. A visual analogue scale; 2. A space for patients to enter up to 3 specific problems which prevent quality of life being better. These may be physical, emotional, social or practical problems. 112 patients attending the head and neck oncology clinic completed both questionnaires (half completed the simple questionnaire first and the other half the EORTC questionnaire first). RESULTS: There was a good correlation between the global health scores of the EORTC and the visual analogue scale of the simple questionnaire. There was poor correlation between specific domains in the EORTC questionnaire and the 3 comments mentioned by patients in the simple questionnaire. CONCLUSION: A simple patient assessment of quality of life can be used as a simple outcome tool in head and neck cancer data bases when specific details are not required.

The use of speech therapy in the treatment of globus pharyngeus patients. A randomised controlled trial.

INTRODUCTION: Globus sensation is a common condition accounting for about 4% of new referrals to an ENT clinic. A review of current theories on the cause of globus sensation concludes that no single aetiology is responsible. Wareing et al believed that globus sensation might in part be associated with excessive laryngeal and pharyngeal tension. The aim of this study was to substantiate in a controlled prospective manner the results of a non-controlled study by the same authors that certain speech therapy techniques improved globus symptoms. METHODS: 1. 36 patients with typical globus pharyngeus symptoms were randomised to treatment with speech therapy (Study group) and reassurance by nurse practitioner (Control group). The following data was collated for each patient: duration and type of globus symptoms (sense of a lump in the throat/throat irritation), severity of globus symptoms on a visual analogue scale, fibreoptic laryngoscopy, full blood count, barium swallow. 2. At the end of 3 months, patients in both groups marked on the visual analogue scale the severity of their symptoms. RESULTS: There was a significant improvement in the globus symptom scores in the speech therapy group compared to pre-intervention scores (p < 0.001, Wilcoxon rank test). There was also a significant improvement in globus symptoms in the speech therapy group compared to controls (p < 0.001, Mann-Whitney U test). CONCLUSION: Initial results suggest that patients with globus pharyngeus symptoms benefit from speech therapy.

Trends in the incidence rates of tonsil and base of tongue cancer in England, 1985-2006.

INTRODUCTION: The aim of this study was to investigate whether incidence rates of tonsil and base of tongue cancer in England are increasing using data from the UK cancer registry. SUBJECTS AND METHODS: Cancer registrations for oral cavity and oropharynx cancer from 1985-2006 in England were obtained from the National Cancer Information Service. Population estimates were obtained from the Office for National Statistics. Age-adjusted incidence rates and age-specific incidence rates were calculated. The sexes were considered separately as incidence rates are known to differ significantly between men and women. Linear regression was performed to establish whether there was a relationship between incidence rates and time. RESULTS: There has been an increase in all oral cavity and oropharyngeal cancer in the study period. Linear regression analysis suggests that approximately 90% of the variance in age-adjusted incidence rates for men and women for tonsil, base of tongue and other oral cavity cancer is explained by the passage of time. For other oropharyngeal cancer, the variance is 62% and 46% in men and women, respectively. The estimated annual percentage change from 1985 to 2006 in age-adjusted incidence rates for tonsil and base of tongue cancer is 5.7% and 6.7% for men, and 4.3% and 6.5% for women, respectively. CONCLUSIONS: This study confirms a wide-spread clinical impression that there has been an increase in age-adjusted incidence rates, between 1985 and 2006, in all oral cavity cancer in England. The age range 40-69 years has seen the biggest increases in age-specific incidence rates for tonsil and base of tongue cancer. This reflects the findings of similar studies in other countries.

Angina masquerading as sinusitis.

Facial pain of cardiac origin is rare. There are several references in the world literature to angina referred to the teeth and the mandible. This report describes a patient with facial pain which was thought to be of sinus origin and which was relieved by coronary stenting.

Puncture-site metastasis in a radiologically inserted gastrostomy tube: case report and literature review.

Gastrostomy-site metastases from head and neck cancer have been reported numerous times following endoscopic insertion, with direct implantation being implicated. We present the first reported case of gastrostomy-site metastasis following radiological insertion, and discuss the mechanisms by which this may have occurred. These include: direct implantation, hematogenous dissemination, or the natural shedding of tumor cells into the gastrointestinal tract.

The influence of raised body temperature on auditory evoked brainstem responses.

The influence of raised body temperature on the auditory evoked brainstem responses (BSER) has been investigated in 9 healthy volunteers. Ipsi- and contralateral BSER recordings were obtained before and after raising body temperature by at least 1 degree C by means of a specially constructed heat cradle. In two of the subjects further BSER recordings were obtained after their body temperature had been allowed to fall again to its preheated level. The results for wave V have been analysed in detail: the latency in the 5 men shortened from a mean of 5.84 ms (s.d. 0.193) to a mean of 5.62 ms (s.d. 0.185). For the 4 women the figures were 5.87 ms (s.d. 0.105) and 5.68 ms (s.d. 0.105). Using paired t-tests this change is highly significant (P less than 0.001). Similar changes were observed in the other waves although they were less consistent. In the 2 subjects who were allowed to cool again after heating, the BSER wave latencies returned to their preheated values. It is concluded that nerve conduction rates in the auditory pathway are influenced by body temperature and that this may have to be taken into account when interpreting BSER recordings.

Carcinom of the paranasal sinuses--a review of 158 cases.

One hundred and fifty-eight cases of paranasal sinus cancer have been reviewed retrospectively. The actuarial survival at five years for the whole group was 33%. The American Joint Committee (AJC) classification for maxillary cancer was used. T1 and T2 cases, with an actuarial survival of 44% at five years, had a significantly better prognosis than T3 cases (31%) and T4 cases (10%). Anemia of presentation and the presence of persistent disease when surgery followed pre-operative irradiation were poor prognostic indicators. The policy of combined pre-operative irradiation followed by surgery is advocated; patients with anemia should have this corrected before and during treatment.

A nasal shaver for nasal surgery.

Provision of a nasal field in nasal surgery is hampered by nasal hairs. We recommend the Remington NE4 nasal shaver as a quick, painless, safe, inexpensive method of nasal hair removal, providing a user-friendly surgical field.