Isolated left sternocleidomastoid pyomyositis: a rare presentation of cervical sepsis.

An elderly gentleman self-presented to A+E with a 7-day history of significant and progressive left-sided neck pain, swelling and fevers, despite oral antibiotics from his general practitioner. Examination revealed a large left-sided neck mass involving levels 2-5 of the neck that was firm to palpate, with erythematous overlying skin.An urgent CT scan demonstrated a large collection throughout the length of the left sternocleidomastoid muscle (SCM), measuring 13×5.5×4 cm, with extensive adjacent inflammatory change. He was subsequently taken to theatre for washout and debridement, during which the collection was found to be loculated and isolated to the SCM, with surrounding structures spared.Postoperatively, he was managed with intravenous fluids and a total of 2 weeks of intravenous antibiotics. The wound partially dehisced during healing and the cavity was packed with flaminal and regularly dressed with input from the tissue viability team. This was then left to heal by secondary intention and the patient was followed up in clinic over the following weeks to ensure resolution.

Opsoclonus-myoclonus paraneoplastic syndrome in nasopharyngeal carcinoma.

Nasopharyngeal carcinoma can present with epistaxis, cervical lymphadenopathy, audiological symptoms secondary to eustachian tube dysfunction, pain, or neurological symptoms from tumours directly invading the skull base. It is unusual for patients to present with indirect systemic manifestations. Paraneoplastic neurological syndrome can precede clinically overt malignancy by up to 5 years; therefore, a combination of thorough clinical, laboratory and radiological investigations is required to reach a diagnosis. Intravenous immunoglobulin and steroids might improve neurological symptoms initially and prevent irreversible neuronal damage, but treatment of the underlying cancer is important for long-term resolution. Our case adds to a small but growing body of literature related to anti-Ri antibodies, opsoclonus-myoclonus syndrome presentations, and is the first reported association of this combination with nasopharyngeal carcinoma.

Effects of tumor staging and treatment modality on functional outcome and quality of life after treatment for laryngeal cancer.

BACKGROUND: An earlier stage of primary disease at diagnosis is associated with better survival from laryngeal cancer. It remains unproven whether earlier stage is also associated with improved end-organ function and quality of life after treatment. METHODS: Questionnaire packs were posted to 250 patients with laryngeal cancer treated between January 2006 and December 2008 within the West of Scotland. Packs contained the Voice Symptom Scale (VoiSS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life Questionnaire (UW-QOL). RESULTS: One hundred forty-seven eligible patients provided data for analysis (59% of original cohort). Patients with an earlier stage of primary disease reported significantly better VoiSS, MDADI, and UW-QOL scores (p < .05). No differences were found between scores of patients with T1 laryngeal disease treated with endoscopic laser resection (ELR) and radiotherapy. CONCLUSION: An earlier stage at diagnosis is associated with significantly better end-organ function and quality of life after treatment for laryngeal cancer.

Audit of CT scanning of paranasal sinuses in patients referred with facial pain.

BACKGROUND: Computed tomography (CT) scans are performed by some clinicians in the belief that they are a useful primary investigation in patients with facial pain. OBJECTIVE: To assess the appropriateness and outcome of sinuses CT scans in patients with facial pain based on the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps (EPOS) 2007 guideline and International Headache Society (IHS) criteria for diagnosing and investigating rhinosinusitis. METHODOLOGY: The first cycle of audit was performed on 50 patients with facial pain who underwent CT scanning. The findings on nasal endoscopy, Lund-Mackay scores (LMS) of the scans and management of these patients were analysed. Following implementation of the IHS and EPOS criteria, 50 consecutive patients were re-audited. RESULTS: In the first cycle, 16% of patients had positive nasal endoscopic findings. Thirty patients had LMS of 0 and only 9 showed significant changes (LMS ≥ 8) on their scans. In the second cycle, only 10 patients underwent CT imaging as per EPOS guideline and 4 of them showed significant changes. The remaining 80% of patients in this cycle were diagnosed and treated for non-sino- genic causes. CONCLUSION: Applying the IHS and EPOS criteria has reduced the number of inappropriate CT scans requests and allowed consideration of non-sinogenic aetiologies.

Voice, swallowing, and quality of life after total laryngectomy: results of the west of Scotland laryngectomy audit.

BACKGROUND: The purpose of this study was to determine the effects of radiotherapy and surgical voice restoration on functional outcome after total laryngectomy. METHODS: Questionnaire packs were posted to all 258 laryngectomy patients in the West of Scotland Managed Clinical Network. Packs contained the Voice Symptom Scale (VoiSS), MD Anderson Dysphagia Inventory (MDADI), and University of Washington Quality of Life Questionnaire (UW-QOL). RESULTS: Significantly better VoiSS and MDADI scores were reported by patients undergoing laryngectomy alone in comparison with patients receiving adjuvant radiotherapy and patients undergoing salvage laryngectomy (p < .02). Patients using tracheoesophageal voice reported significantly better VoiSS scores than patients using other communication methods (p < .005). CONCLUSION: Radiotherapy has a highly significant and detrimental effect on voice and swallowing outcome after total laryngectomy. Surgical voice restoration confers significant benefit in terms of self-reported voice outcome. These findings have implications for patients with advanced laryngeal cancer considering laryngectomy and organ preservation.