Major vascular complications in patients with head and neck cancer have previously been thought of as terminal events. However, it is now possible to intervene in many situations, with benefits for quality of life as well as survival. Endovascular techniques have reduced morbidity and mortality in many situations, both emergency and elective.

We describe the techniques that can be employed in such situations, and present illustrative case reports. Life-threatening haemorrhage, carotid compression and radiation-induced carotid stenosis are all discussed.

It is possible to predict where complications may arise, and to take prophylactic steps to allow treatment to continue. Early intervention can reduce both morbidity and mortality in this high-risk patient group.

Antiplatelet agents such as aspirin and clopidogrel are increasingly encountered in clinical practice. Otorhinolaryngological surgeons are involved in the peri-operative decision of whether to continue treatment and risk haemorrhage or to discontinue treatment and risk thrombosis.

Literature relating to the risk of spontaneous or operative haemorrhage was reviewed. The morbidity and mortality associated with cessation of agents was evaluated. Published guidelines were also evaluated. A protocol for the management of antiplatelet agents in the peri-operative period, with particular reference to ENT operations, is presented.

Significant morbidity and mortality is associated with the premature cessation of antiplatelet agents. Data from cardiac surgery suggest that operative blood loss only marginally increases in patients on aspirin and clopidogrel. However, the management of antiplatelet agents in the peri-operative period should be made after multidisciplinary consultation.

Chronic cough is defined as a cough persisting for more than eight weeks. This condition generates significant healthcare and economic costs. It is associated with a spectrum of disorders across multiple medical specialties and can provide significant challenges for effective evaluation and management. The current literature was reviewed to gain further insight into chronic cough, including its relationship with sinonasal disease.

Within the reviewed literature, there was strong emphasis on post-nasal drip syndrome as a major causative factor.

Cough is the most common complaint for which adult patients seek medical consultation in primary care settings. Chronic cough is associated with a deterioration in the quality of patients' lives. Thorough assessment of a patient with a chronic cough relies on a multidisciplinary approach.

Acute otitis media is very common, but diagnostic criteria and treatment recommendations vary considerably.

Medline, the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials were searched using the key words ‘acute otitis media’ AND ‘diagnosis’ OR ‘diagnostic criteria’ OR ‘definition’, and by combining the terms ‘acute otitis media’ AND ‘guidelines’. PubMed was searched using the key words ‘mastoiditis’ and ‘prevalence’.

The 11 most recently published guidelines unanimously agreed that adequate analgesia should be prescribed in all cases. The majority recommended that routine antibiotic prescription should be avoided in mild to moderate cases and when there was diagnostic uncertainty in patients two years and older. Antibiotics were recommended in children two years and younger, most commonly a 5-day course of amoxicillin (or a macrolide in patients allergic to penicillin).

Level 1A evidence shows that selected cases of acute otitis media benefit from antibiotic prescription.

This review aimed to summarise present knowledge surrounding cochlear implants and neuroplasticity using positron emission tomography.

Cochlear implants are an established device for severe sensorineural hearing loss. However, the outcomes following a cochlear implant are variable and unpredictable. Furthermore, despite increasing numbers of implantations taking place, there are still uncertainties regarding how individuals learn to process speech using an implant. Functional neuroimaging studies using techniques such as positron emission tomography provide an insight into the cortical changes that take place in patients with cochlear implants.

Only when the underlying mechanisms responsible for speech processing in implantees are understood can appropriate rehabilitation for those with poor speech perception be provided and outcomes improved.

This study aimed to assess the quality of information available on the World Wide Web for patients undergoing thyroidectomy.

The first 50 web-links generated by internet searches using the five most popular search engines and the key word ‘thyroidectomy’ were evaluated using the Lida website validation instrument (assessing accessibility, usability and reliability) and the Flesch Reading Ease Score.

We evaluated 103 of a possible 250 websites. Mean scores (ranges) were: Lida accessibility, 48/63 (27–59); Lida usability, 36/54 (21–50); Lida reliability, 21/51 (4–38); and Flesch Reading Ease, 43.9 (2.6–77.6).

The quality of internet health information regarding thyroidectomy is variable. High ranking and popularity are not good indicators of website quality. Overall, none of the websites assessed achieved high Lida scores. In order to prevent the dissemination of inaccurate or commercially motivated information, we recommend independent labelling of medical information available on the World Wide Web.

Mutations in the gap junction protein beta-2 gene (‘GJB2’) are known to be responsible for mild to profound congenital and late-onset hearing loss. This study aimed to investigate the molecular basis of progressive hearing loss compared with non-progressive hearing loss.

Following clinical otorhinolaryngological evaluation, a genetic analysis was performed in a cohort of 72 patients with progressive sensorineural hearing loss.

Pathological genotypes were established in 16 patients (22.2 per cent). Six different gap junction protein beta-2 gene mutations were detected in 15 patients, with the c.35delG mutation responsible for 56 per cent of the mutated alleles. A novel gap junction protein beta-6 gene (‘GJB6’) mutation (p.Met203Val) was observed in one patient with mild progressive hearing loss.

Analyses of gap junction protein beta-2 and -6 genes revealed that similar pathological genotypes, occurring with similar frequencies, were responsible for progressive hearing loss, compared with reported genotypes for non-progressive hearing loss patients. Thus, genotype cannot be used to differentiate non-progressive from progressive hearing loss cases; in this study, patients both with and without an established pathological genotype had a similar clinical course.

To report a case series of elective removal of bone-anchored hearing aid implants, and reasons for removal.

Retrospective review of a prospectively collected database.

Two tertiary referral centres in the Manchester area: Manchester Royal Infirmary and Salford Royal University Hospital.

A series of 499 adults and children who had undergone a total of 602 implant insertions (1984–2008).

Implant removal rates, and reasons.

Twenty-seven of the 602 implants (4.5 per cent) required removal. Of these, 12 were due to pain (2.0 per cent), seven to persistent infection (1.2 per cent), three to failure of osseointegration (0.5 per cent), three to trauma (0.5 per cent) and two to other reasons (0.4 per cent).

Chronic implant site pain represents the main reason why implants are removed electively, and affects 2 per cent of all implants. This complication has important medico-legal implications and should be discussed when obtaining informed consent for implantation.