D. Meikle

Bone-anchored hearing aid quality of life assessed by Glasgow Benefit Inventory.

Objective/Hypothesis The bone‐anchored hearing aid (BAHA) is a well established mode of treatment and many studies show the audiological benefit, but none has assessed the benefit to the quality of life of patients. This study uses the validated Glasgow Benefit Inventory to quantify the changes in quality of life.

A study of haemostasis following tonsillectomy comparing ligatures with diathermy.

The use of diathermy to achieve haemostasis after tonsillectomy remains controversial. We have reviewed the English language literature, and found no convicting evidence that diathermy is any more likely to cause post-operative haemorrhage than the use of ligatures. The results of a prospective, randomized study of 1036 consecutive tonsillectomies are presented. No significant difference was found in post-operative haemorrhage rates when either diathermy or ligatures were used. Diathermy was found to reduce operating time compared to ligatures. The possibilities for day-case tonsillectomy are discussed.

The 2-week rule for suspected head and neck cancer in the United Kingdom : Referral patterns, diagnostic efficacy of the guidelines and compliance

A retrospective audit of 1079 2-week referrals between 1 January 2004 and 31 December 2006 was undertaken. The aims of this audit were to assess compliance of referrals with Department of Health (DoH) guidelines; the effectiveness of the 2-week referral route in detecting head and neck cancers, and to determine whether this route identified more early stage cancers. Of 1079 2-week referrals, 71.5% conformed to DoH criteria. DoH guidelines were found to have a high sensitivity of 83.9% (75.5-89.7%, 95% CI) for head and neck cancer, but a low positive predictive value of 12.8% (10.5-15.3%) and a specificity of 30.0% (27.2-33.1%). Only 10.9% of 2-week referrals were diagnosed with a head and neck cancer. The cancer detection rate was higher amongst referrals that conformed to DoH guidelines (12.8%) compared to those that did not 6.2%. This was statistically significant (Chi square, p<0.01). The guidelines had a positive likelihood ratio of 1.20 (1.1-1.3), suggesting that there is a minimal increase in the likelihood of head and neck cancer when DoH guidelines are correctly applied. The diagnostic odds ratio (DOR) of the DoH referral criteria is 2.21. Most head and neck cancers were diagnosed via routine referral routes, 2-week referrals contributing to only 21.4% of all head and neck cancers diagnosed during the study period. The 2-week referral route did not identify more early stage cancers.

Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature.

Advanced laryngeal and hypopharyngeal squamous cell carcinomas carry an inherent risk of invading thyroid parenchyma leading to the incorporation of a hemithyroidectomy or total thyroidectomy as part of a total laryngectomy. In some centres, thyroid gland removal occurs routinely during surgery for T3 and T4 laryngopharyngeal carcinoma. However, the incidence of invasion is low, and therefore, thyroid‐sparing surgery must be considered for select cases.

Malignant Melanoma of the External Auditory Meatus

Abstract We report a case of malignant melanoma occurring within the external auditory meatus, in a site not exposed to sunlight; only one such case has previously been reported [1].

Baseline swallowing measures predict recovery at 6 weeks after transoral robotic surgery for head and neck cancer.

To explore whether pre‐treatment swallowing measures predict swallowing recovery at 6 weeks after transoral robotic surgery (TORS).

Trans-oral robotic assisted tongue base mucosectomy for investigation of cancer of unknown primary in the head and neck region. The UK experience

The diagnosis of cancer of unknown primary (CUP) in head and neck occurs when the treating clinicians have utilised all available diagnostic tests and failed to identify the origin of the disease. There is no agreed consensus on which diagnostic investigations to use, or the order in which to use them in, although broad recommendations exist. Small tumours arising in the tongue base can be below the limits of resolution of conventional diagnostic techniques. Given the difficulty in targeting the tongue base, current practice involves blind random biopsies, which leads to a variable detection rate. Robotically assisted surgical removal of the tongue base, tongue base mucosectomy (TBM) has been shown to improve diagnostic yield. This study reports the diagnostic hit rate for tongue base primaries using this technique.

Ganglioneuroblastic Transformation in Olfactory Neuroblastoma

Ganglioneuroblastic transformation in olfactory neuroblastoma (ONB) is an exceptionally rare phenomenon. We document the case of a patient with a poorly differentiated sinonasal malignancy that recurred following treatment with chemoradiotherapy and showed ganglioneuroblastic transformation. Although the index tumour showed neuroendocrine differentiation, it did not have the typical clinico-pathological features associated with ONB. We highlight the diagnostic difficulties in establishing an accurate diagnosis for undifferentiated sinonasal tumours and present evidence that the index tumour was an ONB. The current report is only the third case of ONB showing complete ganglioneuroblastic transformation.

Microlaryngoscopic repair of iatrogenic pharyngeal pouch perforations : Treatment of choice?

Endoscopic stapled diverticulostomy (ESD) has become the preferred technique for managing pharyngeal pouches. Iatrogenic perforation, created during stapling, is a rare but serious complication with significant morbidity and mortality. The conventional management in these instances is to convert it to an external procedure and excise the pouch.

Ramsay Hunt syndrome mimicking acoustic neuroma on MRI

The authors present a case of Ramsay Hunt syndrome in which the MRI appearance mimicked that of an intracanalicular acoustic neuroma.