It has been suggested that there is considerable unmet need in respect of hearing loss amongst the elderly population, but no routine screening test is currently used in general practice to identify these patients. The aim of this study was to determine whether routine questionnaire screening of the over-65s is a feasible way to identify elderly patients with hearing loss in primary care and whether patients so identified would benefit from hearing aid fitting. A cohort of patients consisting of a sample of 234 individuals aged between 65 and 74, attending a doctor’s surgery over a specified period, received a scored questionnaire to complete based on the Hearing Handicap Inventory for the Elderly Screening test. Hearing aid owners and those with a hearing handicap were identified, and non-aid wearers with handicap offered examination and referral. Those patients who were fitted with aids were assessed after six months for aid usage and persisting handicap. Twenty-five per cent of the patient sample reported a previously undiagnosed hearing handicap. Six months after aid fitting, a reduction in hearing handicap was reported in 79 per cent of these cases and overall aid usage in the population sample had increased from nine per cent to 20 per cent. Routine questionnaire screening in general practice may be worthwhile since it is easy to carry out and the resulting intervention significantly reduces reported hearing handicap.

The two commonly employed methods for tonsillectomy at present are electrodissection and ligature dissection. This study was carried out on 70 patients as a randomized prospective double blind trial to compare the post-operative morbidity of these methods with special reference to pain. The post-operative pain appears to be much less for the ligation dissection technique compared to the electrodissection method except during the first post-operative day. Irrespective of the technique employed for tonsillectomy, the worst pain was experienced on the fifth and sixth post-operative day by almost all of the patients.

Tonsillectomy is a painful procedure with discomfort continuing for days after the operation. We investigated whether topical application of a neurolytic agent (ethanol) to the tonsillar bed following dissection could provide long-term analgesia. Sixty-four patients undergoing tonsillectomy were randomized using matched pairs, to receive topical ethanol applied to the operative site, or saline for three min, in a double-blind study. Endpoints included self-reported pain using a pictorial pain scale, analgesia consumption adjusted for body mass, and weight loss. Follow-up continued until day 7 postoperatively. Both groups received the same analgesic protocol including infiltration of the operative site with ropivacaine. There were no significant differences in pain scores, analgesia requirements or weight loss between groups for any time period. The incidence of severe pain was significantly greater on the third post-operative day compared with day 1 and 2 (p = 0.0096). Topical application of ethanol does not reduce post-operative pain.

The aim of this study was to retrospectively survey patients who had undergone the uvulopalatopharyngoplasty (UPPP) operation over a two-year period, assessing loudness of snoring, sleep quality and patient satisfaction. A total of 271 patients were sent questionnaires to assess snoring and sleeping habits, with additional questions about pain and satisfaction with surgery. Those who did not reply were contacted by telephone. Seventy-four per cent of the target population were surveyed. Taking an improvement in snoring level of 50 per cent or greater, immediately post-operatively the overall success rate was 76 per cent; however, after two years the success rate fell to 45 per cent. Variables such as alcohol consumption and smoking were not found to influence results. On a post-operative pain scale of 1–10 the average was 7.5 and on a satisfaction scale of 1–10 the average satisfaction with surgery was five, 61 per cent of patients stating that they would not have this operation again. This study shows that the UPPP operation is successful in only 45 per cent of patients after long-term follow-up, that the majority of patients experience severe pain and that the overall satisfaction with surgery is low.

Carcinomas of the pharyngo-oesophageal junction continue to be a challenge to head and neck surgeons. We report a series of 30 patients who underwent gastric transposition for advanced pharyngo-oesophageal tumours, with personal insights about the surgical technique and the need for neck and mediastinal node dissection. The median hospital stay was 21.6 days, with resumption of oral feedings around the 16th day in 91.7 per cent of the surgical survivors. Ten patients had multiple primary tumours (33.3 per cent), with 20 per cent of synchronous carcinomas. Serious local and systemic complications occurred in 17 patients (56.7 per cent), the most important being tracheal complications, cervical and systemic infections, fistulas, rupture of major vessels and pulmonary embolus. Post-operative deaths occurred in 20 per cent of the patients. The locoregional control of disease was significant (only 14.2 per cent of deaths from regional recurrence) but 64.2 per cent of the patients died from distant metastasis. Survival without disease was 13.3 per cent at five years. Gastric transposition was judged to be the procedure of choice for palliation or occasional cure in patients with pharyngo-oesophageal tumours.

The phenomenon of multicentricity in head and neck squamous cell carcinoma affects survival rates. We evaluated the use of panendoscopy/triple endoscopy and, in particular, the place of bronchial washings in the initial staging assessment of head and neck tumours. In a prospective panendoscopic study, a second primary rate of 4.8 per cent was discovered. All four bronchial tumours – both index and simultaneous primary cases – were obvious on bronchoscopy and chest X-ray, despite 50 per cent of them being clinically silent. A self-limiting complication rate of 2.4 per cent was encountered. The issue of bronchial washings was debated and our sensitivity (50 per cent) and specificity (97 per cent) results assessed. We advocate the inclusion of bronchoscopy as part of a panendoscopic work-up of head and neck tumours. The rationale for this is discussed. Bronchial washings, although cheap and easy to process, did not change the management of any patient in the study group and contamination could complicate assessment. Overall, panendoscopy is a safe worthwhile procedure.

The aim of this prospective observational study was to estimate the proportion of otolaryngology patients with poor reading skills, as a guide to information provision. The subjects were a consecutive series of 50 adult outpatients attending a general otolaryngology clinic at the Victoria Infirmary, Glasgow, and whose first language was English. Reading skills were estimated using the Rapid Estimate of Adult Literacy in Medicine. For comparison, the SMOG readability formula was used to estimate the reading skills required to understand the Department’s 35 information leaflets, the standard elective admission notification letter and the surgical consent form. Fourteen (28 per cent) patients were found to have poor reading skills (8th grade or less). The surgical consent form required 11th grade reading ability, as did the standard admission letter, and the leaflets required 9th to 15th grade (graduate) reading ability (median 11th grade). Many patients could be expected to have difficulty understanding these written materials. Information must be written in plain English to be suitable for a wide range of patients, including those with poor reading skills.

We have audited our results after changing the management practice in patients with intractable epistaxis. These patients are offered trans-nasal endoscopic sphenopalatine artery diathermy with or without anterior ethmoid artery diathermy instead of conventional surgical procedures. During the first year after the change in practice, 145 patients were treated as inpatients for epistaxis. Ten patients (seven per cent) required a surgical procedure under general anaesthesia due to the recurrent nature of bleeding. All 10 patients had endoscopic sphenopalatine artery diathermy, whereas in four patients anterior ethmoid artery diathermy was also performed concurrently. The post-operative hospital stay ranged from one to three days (mean 2.1 days). The mean follow-up was 10 months. The epistaxis recurred in one patient and this was managed conservatively. There were no complications related to surgery. In the previous year, 132 patients were admitted for epistaxis and eight patients had surgical procedures, which included septoplasty, nasal packing and external carotid artery ligation. The post-operative stay ranged from three to six days (mean 3.9 days). Our audit shows that endoscopic sphenopalatine artery diathermy is a safe, successful and effective management option for patients with refractory epistaxis. The morbidity is reduced and the hospital stay is shortened. The sphenopalatine artery diathermy can be combined with anterior ethmoid surgery, when necessary.

We describe a modified technique for the introduction of the Groningen speech valve. This technique can be used in patients in whom the standard technique is either difficult or impossible.

We report a case of a patient who experienced transient recurrent facial nerve palsies during flights on commercial aeroplanes. Although this condition is well recognized in divers, only six cases have been reported to occur on flying. The pathophysiology of this condition is discussed.

A case of post-traumatic retropharyngeal haematoma causing airway obstruction in an elderly man on anticoagulant therapy is described. The importance of managing the airway, cervical spine and haemostatic problem with the help of a multidisciplinary team is discussed.

Histiocytic necrotizing lymphadenitis, or Kikuchi’s disease, is a self-limiting cervical lymphadenitis of unknown origin. Since no specific treatment has been reported for Kikuchi’s disease to date, once a diagnosis of Kikuchi’s disease has been established, the role of the physician has been limited only to treating the symptoms. Sometimes, however, the clinical manifestations of the disease can be very distressing for the patients. Thus, a more aggressive form of treatment may be required for the patients who suffer from severe and persisting symptoms and recurrence. We present three cases of Kikuchi’s disease that benefited significantly from systemic administration of prednisone.

Fine needle aspiration cytology (FNAC) is commonly used in the diagnostic work-up of head and neck masses. Complications are extremely uncommon. We describe a case of monocular blindness following FNAC of a neck mass. To our knowledge this is the first case described in the literature.

Fracture of the clavicle as a late complication following radical neck dissection is rare, with an incidence of approximately 0.4-0.5 per cent. We report a case where fracture occurred early following a selective neck dissection.

We report a case of thyroid papillary carcinoma lying within a lateral cervical cyst for which no occult primary tumour of the thyroid was identified. We explore the possible diagnoses and include a discussion of how ectopic thyroid tissue may come to lie within a branchial cyst.

Benign substernal goitres usually extend into the upper anterior mediastinum and are easily extractable through a cervical approach. Very infrequently these tumours extend into the thoracic cavity causing compression of mediastinal structures. The authors report a case of pulmonary hypertension and severe cardiac failure secondary to a long-standing substernal goitre, and support the surgical management of this disease.

We report a case of thrombosis of the right internal jugular vein associated with right parotitis. The literature is briefly reviewed.

Despite the dramatic decrease in cuff-related complications with the introduction of high-volume low-pressure devices for intubation and tracheostomy, notable problems can still occur. A case is reported of a patient who developed persistent dilatation of the trachea after prolonged mechanical ventilation. This is an underrecognized, life threatening clinical entity occurring after cuffed intubation for prolonged time. At present there is no definitive treatment regarding the management of a dilated trachea on a ventilator-dependent patient and therefore emphasis is directed at prevention. The patient presented was managed with periodical alterations of the cuff level which although not achieving any reversal of the dilatation, have prevented further progression of tracheal damage. During the follow-up period, regular assessment with flexible endoscopy has provided more reliable information on the condition of the trachea than computed tomography (CT) scanning.