To report a case of cutaneous tumour seeding following core biopsy of a thyroid malignancy.

This paper presents a case report of cutaneous tumour seeding following core biopsy and a review of the literature concerning the role, and risks, of fine needle aspiration and core biopsy in the diagnostic evaluation of neck lumps.

A 75-year-old woman presented with a left-sided level IV neck lump adjacent to the left lobe of the thyroid. Fine needle aspiration revealed that the neck lump contained follicular epithelial cell groups; however, nuclear grooves and pseudo-inclusions could not exclude a diagnosis of papillary thyroid carcinoma. Subsequent core biopsy confirmed features of a thyroid neoplasm, although abundant necrosis and limited lesional cells within the specimen made histological diagnosis difficult. The patient underwent total thyroidectomy and left-sided selective neck dissection for symptom control. A superficial nodule overlying the core biopsy site was noted at operation and excised; it was found to contain cells of poorly differentiated papillary carcinoma identical to the subsequently confirmed thyroid primary.

This case highlights a rare but important risk associated with sampling neck lumps. Nevertheless, ultrasound-guided sampling is an essential investigative step with great diagnostic accuracy and patient acceptability.

Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication.

A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored.

Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by −13.31 points and −4.16 points, respectively, and the Dizziness Handicap Inventory score by −32.24 and −21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control.

Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.

Totally endoscopic ear surgery and endoscope-assisted microsurgery are still new concepts, with relatively few centres in the UK performing them. Advantages include better visualisation of difficult to reach areas, such as the sinus tympani, and limited external incisions. This paper reports our short-term outcomes for endoscopic middle-ear surgery.

A prospective review was conducted of the first 103 consecutive patients undergoing totally endoscopic ear surgery or endoscope-assisted microsurgery in 1 centre performed by 1 operator. The outcomes assessed were: tympanic membrane healing, audiological data and complications.

Twenty-five patients underwent endoscope-assisted microsurgery, while 78 had totally endoscopic ear surgery. There were no reported cases of dead ear or permanent facial nerve palsy. The average air–bone gap following stapedectomy was 7.38 dB. The tympanic membrane healing rate was 89 per cent.

Our results confirm that endoscopic middle-ear surgery is safe, and the short-term outcomes are comparable with conventional surgery.

Functional voice rehabilitation is becoming increasingly important following total laryngectomy and pharyngolaryngectomy. Tracheoesophageal voice via a shunt valve is currently regarded as the ‘gold standard’ for voice rehabilitation. Traditional techniques usually allow for the replacement of valves in the out-patient setting; however, patient factors such as altered anatomy may occasionally prevent this.

This paper describes a novel approach for speech valve insertion that is safe, quick and cost-effective, and which uses equipment commonly available in ENT wards and the operating theatre.