To review the aetiopathogenesis, clinical characteristics, immunohistochemical profile, prognosis and treatment options for primary thyroid squamous cell carcinoma, and to compare it with squamous cell carcinoma metastatic to the thyroid, thus providing the reader with a framework for differentiating primary and secondary disease.

Review of English language literature from the past 25 years.

A search of the Medline, Embase and Cochrane databases (April 1984 to April 2009) was undertaken to enable a comprehensive review.

After applying strict criteria for the diagnosis of primary thyroid squamous cell carcinoma, 28 articles were identified reporting 84 cases. When reviewing secondary thyroid squamous cell carcinoma, we only analysed cases of squamous cell carcinoma metastatic to the thyroid gland, and found 28 articles reporting 78 cases.

It is possible to differentiate between primary and secondary thyroid squamous cell carcinoma, on the basis of combined evidence from clinical examination and endoscopic, pathological and radiological evaluation. Such differentiation is important, as the prognosis for primary squamous cell carcinoma is uniformly poor irrespective of treatment, and the most suitable option may be supportive therapy. Treatment for secondary squamous cell carcinoma of the thyroid varies with the site and extent of spread of the primary tumour.

Imaging of cholesteatomas can be useful especially in cases of recurrent disease. Computed tomography scans have been recommended before primary surgery, but cholesteatoma tissue looks similar to inflammatory tissue. Diffusion-weighted magnetic resonance imaging is both sensitive and specific in detecting cholesteatoma, which appears as a bright signal on a dark background. Non-echo-planar diffusion-weighted magnetic resonance imaging is superior to routine echo-planar diffusion-weighted magnetic resonance imaging as it minimises susceptibility artefacts; however, the addition of this facility involves expensive magnetic resonance scanner upgrading.

To avoid the cost of such upgrading, we modified our echo-planar diffusion-weighted magnetic resonance imaging parameters and then scanned 15 consecutive cases of suspected cholesteatoma or suspected recurrent cholesteatoma.

Imaging results correlated well with clinical and/or operative findings.

These results indicate that software adjustments can enable echo-planar diffusion-weighted magnetic resonance imaging to detect cholesteatomas reliably, and as effectively as non-echo-planar diffusion-weighted magnetic resonance imaging. This discovery has the potential to facilitate reliable delayed post-operative screening of canal wall up mastoidectomies, avoiding the need for a ‘second look’ procedure.

To describe the pattern of ear injuries sustained by all British servicemen serving in Iraq and Afghanistan between 2006 and 2009; to identify all servicemen evacuated to the Royal Centre for Defence Medicine following blast injury; to ascertain how many underwent otological assessment; and to calculate the incidence of hearing loss.

A retrospective analysis of data obtained from the Joint Theatre Trauma Registry and the Defence Analytical and Statistics Agency, together with audiometry records from the University Hospitals Birmingham National Health Service Trust.

Ear damage was present in 5 per cent of all British servicemen sustaining battle injuries. Tympanic membrane rupture occurred in 8 per cent of personnel evacuated with blast injuries. In 2006, 1 per cent of servicemen sustaining blast injury underwent audiography; this figure rose to 13 per cent in 2009. Fifty-three per cent of these audiograms were abnormal.

The incidence of tympanic membrane rupture was higher than that found in previous conflicts. Otological assessment prior to and following military deployment is required to determine the incidence of ear injury amongst British servicemen following blast trauma.

To assess the diagnostic utility of using television volume as a marker for hearing loss.

Prospective study using a self-administered questionnaire.

ENT and audiology out-patient departments in the north of England.

One hundred and seventeen patients with a history of hearing loss, undergoing pure tone audiometry for the first time.

sensitivity, specificity, diagnostic accuracy, and positive and negative predictive value of television volume as a marker of hearing loss.

The data indicated that if the patient (or their partner or parent) reported viewing television with an increased volume, then there was a 68 per cent chance of the patient having a hearing loss of 25 dB or more. Patients reporting increased television volume had a mean hearing loss of 35 dB. Increased television volume had a sensitivity of 81 per cent and a specificity of 52 per cent as a predictor of hearing loss. Patients who increased their television volume to watch news programmes had an average hearing loss of 41 dB; increased television volume for news programmes had a sensitivity of 75 per cent and a specificity of 71 per cent as a predictor of hearing loss.

Television volume is a useful marker of hearing loss in situations where audiometry is unavailable, for instance in a primary care setting. However, it is not a very specific test.

To determine the frequency of cholesteatoma in a population of patients with chronic suppurative otitis media, and to determine whether this frequency is affected by ethnicity.

The study included 6005 patients with chronic suppurative otitis media seen during the course of 30 charitable surgical ‘ear camps’ in Nepal.

Proportion of patients with each subtype of disease, and their ethnicity. A secondary outcome measure was concordance of surname with Nepalese ethnic affiliation.

A total of 762 patients were grouped as being of Tibeto-Mongolian origin, and 4875 as Indo-Caucasian. The rate of chronic suppurative otitis media with cholesteatoma, expressed as a proportion of the rate of all chronic suppurative otitis media subtypes, was 17.8 per cent in Tibeto-Mongolian patients and 18.6 per cent in Indo-Caucasian patients (p > 0.05). The effect of other risk factors (i.e. age, gender and geographical district) on disease distribution was also non-significant. Analysis of secondary outcome measures indicated that patients' surnames were a reliable predictor of ethnicity in this Nepalese population.

There is almost complete concordance in proportions of patients with significant genetic, cultural, and even geographical heterogeneity, suggesting that, in Nepal, the aetiology of cholesteatoma owes little to these factors.

Deafness is a major problem in developing countries. Rural communities tend to be affected more than urban ones, and chronic otitis media is common. The World Health Organization has proposed primary ear care as a method of providing otological services in developing countries. This study aimed to assess the diagnostic otoscopy skills of community ear assistants in rural Western Nepal.

Community ear assistants undertook the pre-operative evaluation of 92 patients selected for middle-ear surgery in an ‘ear camp’ setting. The otoscopy skills of community ear assistants were also assessed by means of an otoscopy quiz. Consultant otologists and trainee otolaryngologists underwent an identical assessment.

The community ear assistants' selection of patients for middle-ear surgery concurred with the consultant otologists' opinion in 87 of 92 patients (94.5 per cent). The level of community ear assistants' otoscopy skills was between that of junior and senior otolaryngology trainees.

With intensive training, medically unqualified community ear assistants can develop otoscopy skills comparable to those of medically qualified otolaryngology trainees. These results support the development of primary ear care in poorer countries where access to specialist otological services is difficult or impossible.

Chronic rhinosinusitis is commonly treated by functional endoscopic sinus surgery involving excision of the uncinate process and opening of the osteomeatal complex.

Computational fluid dynamics were used to compare nasal airflow after two different surgical interventions which involved opening the paranasal sinuses, excising the ethmoid sinus, and excising or preserving the uncinate process, in a cadaveric head model. Cross-sectional computed tomography images were obtained before and after the interventions. Imaging data were used to prepare computer simulations, which were used to assess the airflow characteristics of the nasal cavities and paranasal sinuses during inspiration and expiration, before and after intervention.

Significantly larger nasal cavity airflow velocity changes were apparent following the uncinate process excising procedure. Nasal cavity airflow distribution remained relatively unchanged following the uncinate process preserving procedure. There was a significantly greater increase in airflow volume following the uncinate process excising procedure, compared with the uncinate process preserving procedure.

Preservation of the uncinate process may significantly reduce the alteration of nasal cavity airflow dynamics occurring after functional endoscopic sinus surgery for chronic rhinosinusitis.

Epistaxis can be caused or exacerbated by anticoagulant and antiplatelet therapy. This prospective study assessed the prevalence of epistaxis in patients taking anticoagulant and antiplatelet medication, and monitored differences in patients’ clinical courses.

Prospective data were collected for consecutive patients referred with epistaxis from the emergency department over a seven-month period. Emergency department records were used to investigate prevalence and referral rates.

Over the study period, 290 patients presented to the emergency department with epistaxis; this represented 0.9 per cent of all emergency attendances. Of these patients, 119 (39 per cent) were referred on to the ENT department, 62 per cent of whom were currently taking anticoagulant or antiplatelet medication. Patients taking anticoagulant and antiplatelet medication were a significantly older group (relative risk 1.50 (1.08–2.28), p = 0.01) requiring longer in-patient stays (relative risk 2.50 (1.01–4.97), p = 0.01) and more aggressive local haemostasis measures. Most patients taking warfarin had an international normalised ratio outside the appropriate range for their disease. Hypertension was not a factor in these patients’ clinical course.

Increasingly, emergency and ENT departments are being presented with epistaxis in patients taking anticoagulant or antiplatelet medication. A better understanding of such medication and its effects may enable more effective management of these patients.

Balloon sinuplasty is a new technology which has only recently been introduced in the UK. We review the current literature, and we present our first year's results for the technique together with a description of indications, outcomes and problems.

Retrospective case note review of 27 consecutive patients undergoing sinuplasty alone in the first year in which this procedure was performed. The main outcome measures used were subjective improvement and Sino-Nasal Outcome Test (SNOT-22) score.

Dilatation was successful in 98 per cent of sinuses in which it was attempted; however, subjective improvement was noted in only 62 per cent of patients thus treated.

We believe that balloon sinuplasty has a place in routine rhinology practice but that its applications are limited, and that its additional costs must be considered. We present advantages and possible limitations of the technique.

To evaluate the results of conventional adenoidectomy, using rigid endoscopy of the nasopharynx, and to establish the role of such evaluation in facilitating complete adenoid removal via the curettage technique.

Descriptive rigid endoscopic evaluation of the nasopharynx before and after adenoid curettage, and following subsequent endoscopy-assisted adenoidectomy.

Tertiary referral centre.

Forty-one consecutive children with symptomatic adenoid hypertrophy scheduled to undergo adenoidectomy.

Rigid endoscopic evaluation indicated that conventional curettage, used alone, failed to completely remove adenoid tissue from the superomedial choanae and anterior vault in all cases; incomplete removal was also seen in other parts of the choanae (in 67.2 per cent of patients), the eustachian tube opening (63 per cent), the nasopharyngeal roof (61.78 per cent) and the fossa of Rosenmuller (61 per cent). Subsequent rigid endoscopy-assisted adenoidectomy successfully removed the residual adenoid tissue from all nasopharyngeal sites, except the eustachian tube opening in two cases.

Conventional curettage adenoidectomy misses a substantial amount of adenoid tissue. Rigid endoscopy-assisted adenoidectomy improves this result by enabling localisation of any residual adenoid tissue.

This study calculated the comparability of two throat symptom assessment scales devised to evaluate either laryngopharyngeal reflux or globus.

United Kingdom hospital out-patient departments.

A total of 334 subjects, with and without throat symptoms, completed the Reflux Symptom Index and/or the Glasgow and Edinburgh Throat Scale. The following were calculated for the resultant data: Cronbach's α coefficient, principal component analysis, Kaiser normalisation, varimax and oblimin rotation, and eigenvalues.

Analysis of data from the Reflux Symptom Index and the Glasgow and Edinburgh Throat Scale revealed clearly similar symptom domains regarding (1) coughing and blockage, and (2) globus or postnasal drip or throat-clearing, as did combined analysis of their amalgamated items. Both instruments had good overall internal consistency (α = 0.75 and 0.81, respectively). The ‘heartburn or reflux’ item in the Reflux Symptom Index mapped poorly to each underlying factor.

The most commonly used laryngopharyngeal reflux and globus assessment questionnaires appear to detect very similar symptom clusters. The management of throat disorders may previously have been over-reliant on the presenting pattern of throat symptoms. Our findings indicate a need to revisit the traditional clinical classification of throat symptoms.

We undertook collagen injection laryngoplasty to achieve arytenoid augmentation in patients with dysphagia and persistent aspiration following partial laryngectomy, and we evaluated the efficacy of arytenoid augmentation in aiding neoglottic closure and ensuring airway safety.

Two patients with persistent swallowing impairment after partial laryngectomy were studied. Swallowing was evaluated using fibre-optic endoscopy, and modified barium swallow study. Collagen was then injected into the arytenoid mucosa to achieve neoglottic competence.

The patients were followed up for up to two years. Both patients showed a marked improvement in neoglottic competence, as evaluated by fibre-optic and flexible endoscopy at three-month and one-year follow-up appointments.

Arytenoid augmentation by injection laryngoplasty can be considered a safe and effective surgical tool for the treatment of dysphagia with persistent aspiration following partial laryngectomy.

Patients with nasopharyngeal carcinoma may have residual cervical lymphadenopathy after definitive treatment of the primary tumour and regional cervical nodal disease. Whether such lymphadenopathy truly represents persistent disease is unclear. There are few published studies addressing this clinical problem.

We retrospectively and systematically reviewed the clinical records of 12 patients with nasopharyngeal carcinoma who had presented to a tertiary academic hospital, over an 11-year period, with suspected persistent cervical nodal disease after definitive radiotherapy or concurrent chemoradiotherapy. Findings on fine needle aspiration cytology and computed tomography scanning were correlated with final histopathological results.

The incidence of negative neck dissection was 41.7 per cent. The positive and negative predictive values of fine needle aspiration cytology in identifying disease were 100 and 42.9 per cent, respectively. Computed tomography scanning had a positive predictive value of 58.3 per cent in identifying disease.

In patients treated definitively for nasopharyngeal carcinoma, residual cervical lymphadenopathy may not represent persistent disease. Head and neck surgeons involved in the management of these patients should bear in mind the current limitations of fine needle aspiration cytology and computed tomography in confirming the diagnosis pre-operatively. Salvage neck dissection may over-treat some of these patients.

To describe our technique of endaural meatoplasty for mastoid surgery, and to publish an online video demonstration.

After the endaural incision, a skin incision is accurately marked over the anterior conchal bowl, identified by pushing the anti-helix anteriorly. This should meet the line of the endaural incision superiorly and extend inferiorly to the lower anterior edge of the conchal cartilage. After performing the incision, a segment of conchal cartilage is removed. The soft tissue meatoplasty is facilitated by resecting a triangular segment of skin and underlying soft tissue medial to the conchal incision (on which it is based). The free edges are closed with absorbable sutures after the (attico)mastoidectomy.

We have used this method on 64 patients over the past two years. Satisfactory functional and cosmetic outcomes were achieved in all.

Our technique is simple, easy to learn, quick and effective in helping to achieve our goal of a dry mastoid cavity with an adequate meatoplasty.

Precise delineation of the extent of frontal sinus pneumatisation is a crucial step in osteoplastic flap frontal sinus surgery. The authors present a novel method of achieving this objective.

First, models of the frontal area are generated using three-dimensional printing based on pre-operative computed tomography image data. These models are then used to create an onlay template of the frontal sinus, which is used intra-operatively.

In a series of 10 patients undergoing osteoplastic flap frontal sinus surgery, the described frontal sinus templates were consistently accurate to within 1 mm.

Frontal sinus templates are potentially useful adjuncts to current techniques employed to guide frontal sinus surgery.

Cylindrical cell papillomas are rare tumours which usually arise in the sinonasal region.

We report a case of a nasopharyngeal cylindrical cell papilloma in a 56-year-old man who presented with a four-month history of right-sided hearing loss, otalgia, vertigo and tinnitus. Investigation revealed a soft, nodular lesion obstructing the pharyngeal opening of the right eustachian tube; this was treated by wide endoscopic excision.

Cylindrical cell papilloma is a possible cause of eustachian tube obstruction in adults. Effective treatment of these lesions usually requires wide endoscopic excision, in order not to miss coexistent carcinoma.

To demonstrate the need for computed tomography imaging of the temporal bone in patients clinically suspected of otosclerosis who present with atypical symptoms or audiological findings.

We present two patients with bilateral conductive hearing loss and suspected otosclerosis in whom third mobile window lesions were revealed. The first patient had bilateral large vestibular aqueducts and bilateral fenestral otosclerotic foci. Computed tomography imaging of the second case revealed bilateral superior semicircular canal dehiscence and bilateral cochlear clefts, mimicking an otosclerotic focus in the fissula ante fenestram.

Differentiating third mobile window lesions from otosclerosis as the cause of a conductive hearing loss is essential before considering stapes surgery, as such treatment would be unnecessary and potentially harmful.

We report a rare case of cervical necrotising fasciitis arising from poorly managed acute tonsillitis.

A 23-year-old woman presented with a two-week history of fever and an eight-day history of painful neck swelling. Nine days before presentation, she had received digital manipulation of her throat by a neighbour, which had worsened her throat pain. There was associated progressive generalised neck swelling, odynophagia, dysphagia and dyspnoea. An X-ray of the neck soft tissue showed multiple gas collections.

Cervical necrotising fasciitis is rare and usually odontogenic in origin. It is associated with a high mortality rate. Our patient responded to aggressive daily bedside wound debridements and dressings, appropriate intravenous antibiotics and high-protein nutritional support. In this way, exploration under general anaesthesia was avoided, in a developing country with limited facilities.

We describe a rare case of an ectopic submandibular gland associated with atrophy of the ipsilateral floor of the mouth muscles.

Case report and review of the world literature regarding ectopic submandibular glands.

The reported patient had an ectopic submandibular gland associated with atrophy of the ipsilateral anterior digastric and mylohyoid muscles. This implies maldevelopment of these muscles in the floor of the mouth and arrest of the normal migration of the submandibular gland. The condition was diagnosed using magnetic resonance imaging and conventional submandibular gland sialography.

Submandibular gland ectopia in the floor of the mouth is a rare phenomenon. The described case represents the first report of an ectopic submandibular gland associated with atrophy of the ipsilateral floor of the mouth muscles. Radiologists and clinicians should familiarise themselves with this entity and its imaging findings, in order to prevent unnecessary biopsy of this benign condition.