Primary thyroid squamous cell carcinoma presenting as a left-sided neck lump.

The elderly patient presenting with a neck lump often raises concerns regarding a malignancy. Thyroid gland malignancies are well recognised and subtype characteristics thoroughly researched, whereas rarer types of thyroid carcinoma are reported infrequently and often behave more aggressively. An 83-year-old woman was referred from the general practitioner (GP) to otolaryngology due to a 7-month history of an unexplained enlarging left-sided neck swelling. A fine-needle aspiration revealed cytology consistent with squamous cell carcinoma (SCC). Staging imaging failed to reveal evidence of a primary foci elsewhere. The definitive diagnosis was that of a primary thyroid SCC: a rare entity with limited citations in the literature. Surgical resection has been found to comprise the optimal treatment for this disease. Recognition of the possibility of primary thyroid SCC in elderly patients presenting with a neck lump, with prompt referral to a head and neck specialist permits a timely progression to potentially curative surgical management, a more promising prognosis and reduced mortality rates.

A rare case of acquired benign tracheoesophageal fistula.

Acquired benign tracheoesophageal fistula (TOF) is a rare medical condition that usually results from trauma, foreign bodies or granulomatous infections. This is an unusual presentation of a male patient with a history of laryngectomy who has had over a period of several years inappropriately and vigorously used valve cleaning brushes to clean tracheal secretions, which has led to the formation of a TOF. Due to the patient's obsessive habit, we could not manage him using conventional surgical methods. Instead, we opted for the placement of a salivary bypass tube, which yielded good results and recovery. To the best of our knowledge, no other case of similar aetiology has been published. We would like to highlight the importance of appropriate patient selection and education prior to performing a tracheoesophageal puncture to avoid developing life-threatening complications as demonstrated in our case report.

Paraneoplastic effects on neurophthalmologic function.

OBJECTIVE: Paraneoplastic neurologic syndrome with otoneurophthalmologic manifestations is much less common than direct, metastatic, and treatment-related complications of cancer. Few studies have focused on patients presenting with paraneoplastic syndrome before a cancer is identified. PATIENT: We describe a case of combined paraneoplastic brainstem/limbic encephalitis and Lambert-Eaton myasthenic syndrome in a patient with small cell lung cancer and positive antiamphiphysin antibodies who initially presented with otoneurophthalmologic signs and symptoms to the ears, nose, and throat clinic. To the best of the authors' knowledge, this combined form of disease, confirmed by both clinical and laboratory tests, is one of the rarest cases ever to be reported. Immunoglobulin G polyclonal antibodies directed against amphiphysin have been detected in a few stiff-person syndrome patients, especially those with breast cancer. This case is again unusual in the sense that the patient was positive for antiamphiphysin antibodies, but negative for anti-Hu antibodies. CONCLUSION: Patients initially presenting with otoneurophthalmologic signs and symptoms with no detectable lesions in the central nervous system should be promptly and thoroughly investigated and monitored carefully for a possible malignancy elsewhere in their bodies without waiting for the actual malignancy to manifest itself at a later stage, thus increasing the prospect of detecting the malignancy and optimizing the treatment modalities at an earlier stage.

Double-blind randomised controlled trial comparing Merocel with Rapid Rhino nasal packs after routine nasal surgery.

INTRODUCTION: Nasal packing after routine nasal surgery is commonly practiced in the UK. The most popular pack appears to be Merocel, however this can be associated with significant pain on its removal. AIM: To test the efficacy of a relatively new nasal pack--the Rapid Rhino Goodman pack--introduced to our department, which claims to reduce pain and bleeding after nasal surgery. METHODS: Fourteen patients undergoing routine nasal surgery were recruited into a randomised controlled trial. One nasal cavity was packed with a Merocel pack and the other with a Rapid Rhino Goodman pack. Patients were asked to record pain levels on each side using a visual analogue scale. RESULTS: We found no difference between packs whilst in-situ, with all patients recording low to moderate pain scores. There were significantly higher pain levels associated with Merocel pack removal than with Rapid Rhino pack removal (average pain scores 5.64 vs 1.64, p < 0.001) and less bleeding overall. CONCLUSIONS: Rapid Rhino (Goodman pack) is associated with significantly less pain on removal than Merocel pack, causes less bleeding and is not more painful whilst in-situ. We therefore recommend its use in routine nasal surgery.

Idiopathic bilateral auricular petrification.

Auricular petrification is a rare diagnosis and presents an interesting therapeutic challenge. Fewer than 160 cases have been reported in the literature since the first description by Bochdalek in 1866. The most common etiology is ectopic calcification. It may also result from injurious processes including frostbite, physical trauma, inflammatory conditions, and various endocrinopathies. We report an incidental finding of idiopathic bilateral auricular petrification in a 40-year-old man presenting with idiopathic unilateral sensorineural deafness.