K. MacKenzie

Paediatric neck masses : a diagnostic dilemma

Three hundred and sixty children who had a head and neck mass excised during 1987 to 1992 at the Royal Hospital for Sick Children, Glasgow were studied. There were 210 males and 150 females with a mean age of 60.7 months (0.5 to 198 months). Pilomatrixomata/sebaceous cysts (34 per cent), thyroglossal cysts (13 per cent), branchial remnants (nine per cent) and dermoids (nine per cent) accounted for almost two-thirds of the 264 non-lymphadenomatous benign lesions excised. Ninety-three lymphadenopathy masses consisted of 60 with reactive hyperplasia, 21 with Mycobacterium infection and 12 lymphomas. There were three solid malignant tumours, two were rhabdomyosarcomata and one disseminated round cell tumour. The correlation between clinical diagnosis and histopathology of benign non-lymph node masses and solid tumours was 90 per cent and 100 per cent respectively, in benign lymph nodes, 66 per cent, but was poor in differentiating lymph node content. The mean time from presentation of a swelling to its excision was almost a year and the mean in-patient stay for excision of a mass was almost five days. The role of fine needle aspiration cytology (FNAC) in arriving at a diagnosis and reducing patient morbidity is discussed.

Hypoglossal nerve paralysis following tonsillectomy.

While tonsillectomy is the commonest operation performed by otolaryngologists, paralysis of the hypoglossal nerve following tonsillectomy is not well recognized in the otolaryngology text or literature. We report a case of hypoglossal nerve paralysis following tonsillectomy and discuss the theories on the pathoaetiology as described in the predominantly anaesthetics literature. The likely causes of nerve injury are described and precautions are suggested to help avoid this problem.

Reliability of perceptions of voice quality: evidence from a problem asthma clinic population

INTRODUCTION Methods of perceptual voice evaluation have yet to achieve satisfactory consistency; complete acceptance of a recognised clinical protocol is still some way off. MATERIALS AND METHODS Three speech and language therapists rated the voices of 43 patients attending the problem asthma clinic of a teaching hospital, according to the grade-roughness-breathiness-asthenicity-strain (GRBAS) scale and other perceptual categories. RESULTS AND ANALYSIS Use of the GRBAS scale achieved only a 64.7 per cent inter-rater reliability and a 69.6 per cent intra-rater reliability for the grade component. One rater achieved a higher degree of consistency. Improved concordance on the GRBAS scale was observed for subjects with laryngeal abnormalities. Raters failed to reach any useful level of agreement in the other categories employed, except for perceived gender. DISCUSSION These results should sound a note of caution regarding routine adoption of the GRBAS scale for characterising voice quality for clinical purposes. The importance of training and the use of perceptual anchors for reliable perceptual rating need to be further investigated.

Negative pathology following endoscopic resection of T1a squamous carcinoma of the glottis.

Endoscopic CO(2) laser excision for T(1a) glottic cancer is a recognized treatment modality producing equivalent disease-free and voice results to external beam radiotherapy. On reviewing a series of 15 patients who had undergone endoscopic resection of a T(1a) glottic squamous cancer, it was noted that five patients had negative excisional pathology following the initial biopsy of an invasive squamous carcinoma. The histopathology of each patients resected specimen was reviewed by a second pathologist who confirmed the accuracy of the results in all cases. We conclude that a significant number of early squamous carcinomas of the glottis present with very small localized, minimally invasive disease and that a proportion may be treated by biopsy alone.

Teleconferencing in the management of head and neck cancer.

• Teleconferencing can be used as part of the integrated management of head and neck cancer.

Vocal function following discharge from intensive care

INTRODUCTION There is growing interest in the long term outcomes of critical care. The degree of vocal morbidity suffered by patients surviving intensive care admission has not previously been reported. OBJECTIVE To determine the degree of subjective, patient-reported vocal morbidity following discharge from intensive care. MATERIALS AND METHODS A prospective study was undertaken of patients admitted to intensive care. A total of 273 consecutive admissions were assessed; 181 patients were suitable for inclusion. MAIN OUTCOME MEASURE The Voice Symptom Scale questionnaire. RESULTS Eighty-three patients responded. Twenty-seven patients (33 per cent) reported a degree of vocal morbidity greater than that suffered by patients treated for early laryngeal cancer. Thirteen patients (16 per cent) reported a degree of morbidity greater than that suffered by patients attending voice clinics. CONCLUSION Up to one-third of patients who survived admission to an intensive care unit reported suffering significant vocal morbidity. The Voice Symptom Scale could be used in an intensive care follow-up setting to identify and ensure the referral of such patients.

Minimum dataset for endolaryngeal surgery: pilot study.

INTRODUCTION Airway endoscopy carries a risk of detrimental effects. We aimed to develop a minimum endolaryngeal surgery dataset, for use in laryngology practice as an audit tool. MATERIALS AND METHODS A minimum dataset was designed, incorporating pre- and post-operative clinical, surgical and patient-reported data. We prospectively recruited 272 consecutive patients between May 2007 and May 2009. The Voice Symptom Scale was used to assess patient-reported vocal morbidity. RESULTS Complete clinical and surgical details were obtained for 272 patients (100 per cent). Thus, information on diagnosis, procedure type and procedure aim was obtained for all patients. The Voice Symptom Scale was completed pre-operatively by 250 patients, and three months post-operatively by 169 patients (68 per cent). A statistically significant improvement in Voice Symptom Scale score was observed in patients undergoing surgery to improve their voice, compared with pre-operative measurements (p = 0.01). DISCUSSION We developed a minimum dataset to characterise endolaryngeal surgical activity and outcomes. This dataset could be used to determine best practice, and to audit endolaryngeal surgery outcomes for surgeon recertification and revalidation.

A prospective evaluation of the feasibility of day-case microlaryngeal surgery

An increasing number of surgical procedures are being performed on a day-case basis. In the UK otolaryngologists have been reluctant to introduce same day discharge in microlaryngeal surgery (MLS). The reason for this is the perceived risk to the airway from bleeding and oedema after MLS. The aim of this study was to investigate the feasibility of establishing a same day discharge service for MLS patients. One hundred consecutive patients under the care of one consultant otolaryngologist were recruited. A clinical street-fit assessment and objective measures of peak expiratory flow rate (PEFR) and oxygen saturation (SaO2) were recorded pre- and post-operatively. Results indicate that the PEFR and SaO2 did not change significantly during the course of the study. The street-fit criteria for discharge were satisfied in 80 per cent of patients following surgery. By combining the ASA score (American Society of Anaesthesiologists) with street-fitness 63 per cent of our patients were eligible for same day discharge.

Histiocytosis: an unusual cause of dysphagia, hoarseness and stridor

We present a patient with established histiocytosis who developed dysphagia, retching, regurgitation, hoarseness and stridor. These symptoms were managed with carbon dioxide laser vaporization, electively on three occasions, and once as an urgent procedure, while awaiting radiotherapy, to control her airway. Histiocytosis is a rare cause of a number of otolaryngological syndromes, but there has been no previous record of this disease causing laryngopharyngeal symptoms. This paper discusses the classification of histiocytosis, and describes our management of this rare and intriguing case.