Head and neck cancer is the sixth most common cancer worldwide. Advances in management have not greatly altered overall survival. Over the last decade, there have been significant scientific advances in our knowledge of cell cycle regulation and the complex oncogenic processes. MicroRNAs are small, non-coding RNAs which are integral to the regulation of gene expression and which play a part in carcinogenesis. The literature on the role of microRNA in head and neck cancer is reviewed.

To introduce the role and significance of microRNAs in head and neck cancer.

The possibilities of incorporating microRNAs into clinical practice are discussed, including their potential role in diagnosis, prognosis, prediction of metastatic spread, therapy and tumour surveillance.

Discoveries in expression profiling of microRNA in head and neck oncology promise advancements in the diagnosis, prognosis and therapy of these cancers.

This systematic review aims to advise on the effectiveness of the active middle-ear implant in patients with sensorineural hearing loss, compared with external hearing aids.

A systematic search of several electronic databases, including PubMed and Embase, was used to identify relevant studies for inclusion.

Fourteen comparative studies were included. Nine studies reported on the primary outcome of functional gain: one found that the middle-ear implant was significantly better than external hearing aids (p < 0.001), while another found that external hearing aids were generally significantly better than middle-ear implants (p < 0.05). Six of the seven remaining studies found that middle-ear implants were better than external hearing aids, although generally no clinically significant difference (i.e. ≥10 dB) was seen.

Generally, the active middle-ear implant appears to be as effective as the external hearing aid in improving hearing outcomes in patients with sensorineural hearing loss.

The incidence of papillary thyroid cancer is rising, with an increase in the number of microcarcinomas being discovered. There is controversy in the literature regarding the optimal management of these tumours. This study aimed to review our institution's experience with the presentation and management of papillary thyroid microcarcinoma.

Retrospective analysis from the Sydney Head and Neck Cancer Institute, from 1987 to 2009.

A total of 228 patients were analysed. Papillary thyroid microcarcinomas were discovered incidentally in 116 (50.9 per cent) patients and non-incidentally in the remaining 112 (49.1 per cent) patients. Amongst the non-incidental group, 11.6 per cent of patients presented with lateral cervical lymph node involvement. Non-incidental microcarcinomas were significantly associated with younger age (<45 years) (p = 0.007) and larger tumours (5–10 mm) (p < 0.001). Only four patients in the incidental group suffered recurrent disease (locoregional). No patient developed distant metastatic disease or died during follow up.

Papillary thyroid microcarcinomas present both incidentally and non-incidentally, with equal prevalence. Non-incidental tumours not infrequently present with cervical lymph node disease. The patient outcome is generally excellent.

This study aimed to validate the use of the Adelaide Disease Severity Score for the assessment of chronic rhinosinusitis.

A prospective cohort study supplying level 2b evidence.

Forty-eight patients, scheduled for endoscopic sinus surgery for failed management of chronic rhinosinusitis, completed the Sino-Nasal Outcome Test 22 and the Adelaide Disease Severity Score tool (the latter assessing symptoms (i.e. nasal obstruction, rhinorrhoea, post-nasal drip, headache or facial pain, and olfaction) and quality of life). Lund–Mackay computed tomography scores and Lund–Kennedy endoscopic scores were also recorded. The Adelaide Disease Severity Score results were then compared with those of the other three tools to assess correlation.

Mean scores (95 per cent confidence intervals) were 22.31 (21.47–24.15) for the Adelaide Disease Severity Score and 30.6 (27.15–34.05) for the Sino-Nasal Outcome Test 22; there was a statistically significant correlation (Spearman coefficient = 0.45; p = 0.0015). A statistically significant correlation was also noted with the Lund–Mackay score (p = 0.04) and with the Lund–Kennedy score (p = 0.03).

The Adelaide Disease Severity Score is a simple, valid tool for clinical assessment of chronic rhinosinusitis, which correlates well with the Sino-Nasal Outcome Test 22, Lund–Mackay and Lund–Kennedy tools.

Effective tissue removal techniques are essential in endoscopic skull base surgery. Improvements in technology permit more accurate application of CO2 laser and coblation during endonasal procedures. This study assessed the thermal injury patterns associated with fibre CO2 laser and coblation.

Fresh frozen cadaveric heads were used. Mucosal removal was performed at the ethmoid roof. Structured lesions were created using either CO2 laser or coblation. The corresponding thermal injury patterns on dural tissue were assessed and compared between the two groups.

Five cadaveric heads were obtained; five sides received CO2 laser lesions and five coblation lesions. Forty per cent (n = two sides) of the CO2 specimens had macroscopic foci of grey-black discolouration on the dural aspect. No macroscopic dural changes were seen in the coblation specimens.

Dural injury was seen following CO2 laser use despite attempts to avoid it. Both CO2 laser and coblation have their advantages; however, the lower thermal working power of coblation and superior depth control may make it more suitable for endoscopic endonasal periorbital and peridural surgery.

Numerous techniques have been described to manage the skin and other soft tissues during bone-anchored hearing aid insertion. Previously, generally accepted techniques have sometimes led to distressing alopecia and soft tissue defects. Now, some surgeons are rejecting the originally described split skin flap in favour of a less invasive approach.

To investigate bone-anchored hearing aid placement utilising a single, linear incision with either no or minimal underlying soft tissue reduction.

Thirty-four adults were prospectively enrolled to undergo single-stage bone-anchored hearing aid placement with this modified technique. A small, linear incision was used at the standard position and carried down through the periosteum. Standard technique was then followed with placement of an extended length abutment. Patients were reviewed regularly to assess wound healing, including evaluation with Holgers' scale.

Only 14.7 per cent of patients had a reaction score of 2 or higher. Most complications were limited to minor skin reactions that settled with silver nitrate cautery and/or antibiotics. None required revision surgery for tissue overgrowth, and there were no implant failures.

Our results suggest this to be a simple and effective insertion technique with favourable cosmesis and patient satisfaction.

Treatment for metastatic cutaneous head and neck squamous cell carcinoma is usually multimodal and associated with morbidity. This study aimed to evaluate the impact of treatment on patients' quality of life.

Cross-sectional survey of 42 patients (35 men, 7 women) at least 6 months after metastatic cutaneous head and neck squamous cell carcinoma treatment, using two standardised quality of life questionnaires: the Functional Assessment of Cancer Therapy – Head and Neck questionnaire and the Facial Disability Index, with statistical analysis to identify potential predictors of outcome.

Female gender correlated with significantly lower Facial Disability Index physical function scores (p = 0.017). Alcohol consumption correlated with significantly better scores for Functional Assessment social well-being (p = 0.016), general total score (p = 0.041) and overall total score (p = 0.033), and for Facial Disability Index physical function (p = 0.034). Marital status, education, employment, chemotherapy, time from last treatment, parotidectomy and facial nerve sacrifice did not affect quality of life. The commonest patient complaints were dry mouth (76 per cent), altered voice quality and strength (55 per cent), and physical appearance (45 per cent).

Female gender predicts worse quality of life, while alcohol consumption (versus none) predicted for better quality of life.

To report an unusual case of a primary mastoid cyst (congenital or developmental) in a patient without otological symptoms.

Case report and review of the English language literature.

Primary mastoid cyst is a newly reported and very rare pathological entity. Mastoid cysts usually occur secondary to chronic infection, inflammation or trauma. Review of the medical literature highlights the rarity of this condition.

This report describes the experience gained by the diagnosis and management of this patient. It emphasises the importance of clinical vigilance so that proper treatment may be instituted in a timely manner.

Osteonecrosis is a benign condition characterised by necrotic exposed bone, and is associated with bisphosphonate use. Osteonecrosis of the external auditory canal is rare, with only a few reported cases.

Two case reports of temporal bone osteonecrosis are presented.

A 64-year-old man with a history of immunoglobulin G kappa multiple myeloma developed a right external auditory canal ulcer 6 years after commencement on clodronate. A 72-year-old woman taking alendronate for osteoporosis, initially diagnosed and treated for right-sided otitis externa, was found to have underlying exposed bone in the right external auditory canal, with a computed tomography scan confirming destruction of the temporal bone.

With increasing use of both oral and intravenous bisphosphonates in the community for benign conditions such as osteoporosis and for malignant conditions such as breast cancer and multiple myeloma, the diagnosis of bisphosphonate-associated osteonecrosis should always be considered in patients with a temporal bone lesion, and a relevant drug history taken.

Laryngeal cryptococcosis is a rare condition. In this report, we describe the findings for and treatment of a 58-year-old man with Cryptococcus gattii infection of the right vocal fold.

Case report and review of the relevant English language literature.

The patient presented with persistent hoarseness of voice. Laryngoscopy demonstrated an irregular, red lesion on the right vocal fold. Histopathological examination identified cryptococcus. The patient was treated with oral fluconazole 400 mg/day for eight weeks.

Laryngeal involvement by Cryptococcus gattii can result from prolonged inhaled corticosteroid therapy and proximity to eucalyptus trees. The clinical presentation, laryngoscopic findings and imaging results of laryngeal involvement may mimic a neoplasm. Histopathological examination can demonstrate the causative organism. Management consists of advice from an infectious disease specialist together with adequate treatment by antifungal agents.

To report a case of sigmoid sinus dehiscence presenting with pulsatile tinnitus and treated successfully with resurfacing.

This patient presented with pulsatile tinnitus due to sigmoid sinus dehiscence. This was successfully treated using only soft tissue resurfacing.

Sigmoid sinus dehiscence is a rare but treatable cause of pulsatile tinnitus. It can occur in the absence of a diverticulum, and is not necessarily limited to the transverse sigmoid junction. When resurfacing, care must be taken not to significantly alter the extraluminal diameter of the sigmoid in a dominant sinus, as this raises the risk of post-operative hydrocephalus.