Background: Eponym lists in major sources can give an aura of legitimacy to discredited diagnoses, as exemplified by the case of Barré–Lieou syndrome, a ‘rare’ vestibular disorder.

Methods: A literature review for information on the posterior cervical syndrome of Barré–Lieou.

Results: Barré–Lieou syndrome includes very common symptoms – tinnitus, dizziness, and head or neck pain – attributed to ischaemia caused by cervical sympathetic nerve compression. Its original description brings together many unrelated disorders, and its causative mechanism has been discredited. However, it appears credulously in a number of eponym lists, and references to the syndrome are steadily increasing on the internet in general and on alternative medicine and legal profession websites in particular.

Conclusion: By inclusion in eponym lists, without a disclaimer, a syndrome can be given legitimacy before the general public. A syndrome, such as Barré–Lieou syndrome, that is useless to the medical profession can unfortunately prove to be very useful for litigants and disability claimants.

Thyroid lobectomy with isthmusectomy is the standard surgical technique for removal of unilateral thyroid nodules, and it involves the exposure of the tracheoesophageal grooves. Thyroid isthmusectomy is a surgical procedure that excises only the thyroid isthmus. It allows excision of a lesion without the exposure of the tracheoesophageal grooves.

We aimed to demonstrate that isthmusectomy could be a safe alternative to thyroid lobectomy with isthmusectomy in patients with nodules confined to the isthmus or the pyramidal lobe.

This was a prospective study performed over a five year period from 1999 to 2004. Inclusion criteria for thyroid isthmusectomy were: patients with a single lesion located in the region of the thyroid isthmus or the pyramidal lobe; maximum lesion diameter of 30 mm; and cytological reports of non-diagnostic appearance, follicular cells or suspicion of malignancy.

Nine patients were identified with these criteria. Histology included two colloid nodules, three benign follicular adenomas, two Hurthle cell adenomas and two papillary thyroid carcinomas. There were no recorded complications.

Thyroid isthmusectomy is a safe alternative to thyroid lobectomy with isthmusectomy in patients who have nodules confined to the isthmus and pyramidal lobe. Leaving a cuff of normal thyroid tissue has the advantage of not exposing the tracheoesophageal grooves, thus minimising potential damage to the recurrent laryngeal nerves and parathyroids. Surgeons performing isthmusectomies should be experienced in more complex thyroid surgical procedures.

We set out to examine whether a multidisciplinary out-patient dysphagia referral triage service would shorten the duration of a patient's referral process and direct patients to the correct specialty. A review was carried out of patients referred with dysphagia before and after the introduction of a multidisciplinary out-patient dysphagia service, from February 2001 to April 2001 and from January 2002 to March 2002, inclusive.

One hundred and eight patients were referred in total. The length of time until the first appointment was reduced from four to three weeks (median; range one to 23; p<0.001). The number of instrumental investigations was reduced, with a median of one instrumentation per patient under the new service, compared with two in those under the standard service (p<0.001). Attendance to hospital was also reduced, with 45 per cent of patients under the new service requiring only one appointment, compared with 13 per cent in those under the standard service (p<0.001).

The multidisciplinary out-patient dysphagia service was associated with significant reductions in waiting times, in the number of instrumental investigations and in the duration of the patient's referral process.

We present a unique device for unblocking the sucker during otological surgery. This device can be made cheaply, from parts already available in most hospitals, and is reliable and effective.

We evaluated the relative usefulness of data on head and neck cancer available on the websites of cancer registries in the United Kingdom. Data were analysed to determine the accuracy and completeness of essential information related to the incidence of head and neck cancer.

We found that 16 per cent (2/11) of the registries had some cancer data but none relating to head and neck cancer patients. Seventy-five per cent (9/12) of the registries had selected data on head and neck cancer, but 33 per cent (3/9) of these pooled the various head and neck cancers into a single group. The remainder of registries offering data [66 per cent (6/9)] had a variety of ways of grouping and presenting the various types of head and neck cancer. The overall value and usefulness of head and neck cancer information on these websites were limited, especially when all the sites were considered together.

The cancer registries collectively possess an extremely important asset of immense value to both the medical profession and, possibly, patients with cancer. The accessibility of this data and the overall experience of those seeking information on this subject could be improved. However, this would require significant thought, collaboration and agreement between each registry, which would involve significant extra investment.

We undertook a prospective observational study of 108 consecutive patients with endoscopic paranasal mucopurulent secretions. Only 31 patients (29 per cent) had facial pain. In 20 (65 per cent), the endoscopic site of purulent secretions corresponded to the site of pain. In those with facial pain, 74 per cent had nasal obstruction, 68 per cent had objective hyposmia and 84 per cent had mucopurulent rhinorrhoea. In the 31 patients with facial pain, 19 (61 per cent) became symptom free following medical treatment. The remaining 12 patients underwent surgery and their symptoms resolved, except for one patient with a tension-type headache and another with pain of unknown cause.

Most patients with purulent secretions from the paranasal sinuses do not have facial pain; therefore, chronic rhinosinusitis is not synonymous with pain.

Patients with sinogenic facial pain usually have endoscopic findings that correlate with the site of pain, and the majority also have other nasal symptoms. Chronic infective rhinosinusitis usually responds to medical therapy, and the remainder resolve with surgery.

Understanding of the anatomy and physiology of the vocal folds, availability of better diagnostic tools and precise instruments has spurred the development of newer techniques for the management of benign lesions arising in the vocal folds. As the propensity of the superficial lamina propria to regenerate is minimal, it is of paramount importance to maximally preserve it. Microflap surgery of the vocal folds is based on this principle.

There exists a dichotomy in opinion regarding the role of subepithelial infiltration in microflap surgery; the disadvantages cited being possible confusion of the surgical plane following infiltration and hydrodissection of the normal basement membrane from the superficial layer of the lamina propria. A prospective study was therefore carried out in 30 cases of benign glottic lesions and microflap surgery was performed with and without infiltration in similar pathologic lesions. The vocal outcomes i.e. fundamental frequency, jitter, shimmer and maximum phonation time were audited. The advantages of this technique with a review of the literature are discussed.

We report the case of a 59-year-old man with a two-month history of a fast-growing, left-sided neck mass and a 5 mm nodule over a thyroid mass at the site of fine needle aspiration cytology performed four weeks earlier. Histopathological studies confirmed anaplastic carcinoma of the thyroid and cutaneous needle track seeding of the primary tumour. The patient succumbed to extensive disease 10 weeks after initial diagnosis. To our knowledge, this is a rare report of implantation of anaplastic thyroid carcinoma along the track of fine needle aspiration. Some factors involved in needle track seeding are: needle size; number of passes; withdrawing the needle without releasing suction; injecting the tumour at time of biopsy; and inherent characteristics of the lesion (e.g. number of cells dislodged, adhesiveness of cells, amount of stroma present, enzymes released and immunologic characteristics).

Elongated styloid process is a relatively common cause of facial and neck pain, but it is often misdiagnosed due to its varied clinical presentation. Since an elongated styloid process is often confirmed by radiological means, it would be helpful to find a more accurate mode of depicting the styloid process.

In this prospective study, 39 cases were evaluated. A three-dimensional computed tomography (3D CT) reconstruction of the styloid process was performed in 18 cases. In these patients, we compared the length and medial angulation of the symptomatic styloid process as viewed on an orthopantomogram and a 3D CT reconstruction.

It was noted that a 3D CT reconstruction was more accurate in depicting the styloid process. This investigation can be considered as the ‘gold standard’ in the radiological diagnosis of an elongated styloid process.

Guidance from the Department of Health, published in 2000, stated that, ‘as a matter of right’, communications between clinicians would be copied to patients. In further guidance, the department indicated that, from April 2004, patients would receive copies of correspondence exchanged between healthcare professionals. There has been little research on this issue, and the few existing publications have come from the hospital psychiatric clinic setting.

We examined the attitudes of 100 patients attending an ENT clinic as well as those of 100 parents of children attending a paediatric ENT clinic in a general hospital out-patient setting. At the end of consultations, patients or parents were invited to take part in the survey by completing a short questionnaire. Forty-three per cent of the adult patients and 44 per cent of the parents requested a copy of the clinic letter. These people were followed up by a telephone survey, three weeks after the copy of the clinic letter to the general practitioner was posted to the patient or parent. Eighty-one per cent of the patients and 77 per cent of the parents were successfully contacted for the follow-up telephone survey. Sixty per cent of the adults and 77 per cent of the parents reported that the copy of the clinic letter was helpful. There were no differences in responses between the adult patient and paediatric patient groups.

In this study, less than half of both groups requested a copy of the ENT clinic letter to their general practitioner. To follow Department of Health guidance and copy the letter without patient consent is arguably contradictory to best practice and also to the concept of patient choice. There are significant financial implications in adopting the departmental guidance. We propose patients should be offered a copy of their clinic letter on request.

Eighteen patients underwent a circumferential pharyngolaryngectomy reconstruction post pharyngolaryngectomy. All tumours showed pharyngo-oesophageal junction invasion or circular involvement of the hypopharynx, requiring total, circumferential pharyngolaryngectomy. A pectoralis major myocutaneous flap was directly sutured to the pre-vertebral fascia. A Montgomery® salivary bypass tube was introduced into the oesophagus, and a nasogastric tube was placed within it. No post-operative complications occurred for 14 patients and only minor ones for the other four. Average post-operative stay was 12 days. For 15 patients, feeding returned to normal throughout the follow-up period. No fistulae were noted and neopharyngeal stenosis occurred in three patients (16 per cent). Thirteen had complete resection with normal margins. Thirteen were still alive after one to three years of follow up. The local recurrence rate was 16 per cent.

The use of a pectoralis major myocutaneous flap with Spriano's technique provides a simple, reliable method for circumferential hypopharyngeal resection. It has been applied to a wide range of patients, especially elderly ones and those with poor general status, as well as to cases in which widespread involvement was detected during surgery.

Background: Small defects of the inner canthus can be difficult to repair with an aesthetically satisfactory result, due to the difficulty in matching skin types and the resulting donor site scars.

Methods: We describe a technique which we have employed for repairing skin defects around the inner canthus, using a cutaneous advancement flap from the upper eyelid, based on the superior palpebral artery.

Results: Complete excision of the lesion was possible, and a cosmetically acceptable result was obtained.

Conclusions: By using this technique, skin is moved within one aesthetic unit, thus maximising skin type matching and cosmetic results. In addition, the technique creates a donor site which can be easily hidden within the natural creases of the upper lid, and the arterial supply maximises the chances of flap survival.

Chaperones are used in order to avoid misunderstandings that can lead to false accusations. Consultations and examinations may be a minefield especially if the doctors are accused of sexual misconduct. The allegations may have irreparable effects on their reputation and may lead to removal from the medical register and to criminal charges being brought. We present the results of a questionnaire from 85 patients, exploring patient experience in ENT out-patients particularly with respect to examination of the ear under the microscope. This procedure necessitates close contact between the patient and doctor for several minutes and there may be inadvertent contact with intimate areas on the patient. Up to 30 per cent of patients expressed a preference for a chaperone during the ENT consultation. There was noticeably a greater proportion of men than women patients stating a preference for a chaperone during the consultation. Interestingly, there was a strong positive correlation between the presence of friends/relatives and the preference for a chaperone. Patients should be given the freedom to choose for or against the presence of a chaperone in clinic consultations. The most commonly predicted scenario requiring a chaperone is with the male doctor and female patient. This study shows that based on patient feedback, this scenario, although common is not the exclusive area in which chaperones should be used.

Angiosarcomas rarely arise from schwannomas, but we describe here a case of angiosarcoma that arose from a remnant of a benign vestibular schwannoma that had been removed 10 years earlier. The patient was a 66-year-old man with no sign of neurofibromatosis. Although we attempted surgical resection, we could not totally remove the tumour. The patient died nine months after diagnosis, primarily as result of an abscess in the cerebellum and base of the skull. The histological diagnosis was confirmed by the immunohistochemical findings of positivity for CD34 antigen and S-100 protein in the resected tumour.

A review of the literature revealed four other cases of angiosarcoma with schwannoma, all of which arose from an extracranial nerve. The present case is the first report of an angiosarcoma with schwannoma arising from an intracranial locus.

Globus pharyngeus is a symptom commonly encountered in ENT practice. The usual complaint is that of the sensation of a ball or lump in the throat generally unaccompanied by dysphagia. This sensation is often more pronounced when taking an ‘empty swallow’. The precise mechanism of this remains enigmatic in many cases. Irritant factors such as gastroesophageal reflux, postnasal drip and excessive throat clearing may be contributory factors as may be stress and psychological influences. Although gastric type mucosa occupying the cervical oesophagus has been long recognised, mainly in the specialised gastrointestinal literature, there appears to be more limited awareness of the condition in ENT practice and the clinical significance of such heterotopia is not well established. We present five recent cases of globus pharyngeus encountered in our ENT practice in which rigid pharyngoesophagoscopy and biopsy revealed heterotopic gastric mucosa within the postcricoid and cervical oesophagus constituting a so-called gastric ‘inlet patch’. One case re-presented with invasive adenocarcinoma within a short time. Herein we compare and contrast inlet patch with columnar lined oesophagus, discuss the potential clinical significance of inlet patch and comment upon further management of the condition.

Glossopharyngeal nerve paralysis caused by varicella zoster virus reactivation is rare. We present a case of glossopharyngeal zoster confirmed by direct immunofluorescence staining for virus antigens. A 35-year-old man presented with right-sided, severe swallowing pain and dysgeusia. Physical examination showed a loss of ipsilateral gag reflex. White spots on the posterior wall of the right pyriform sinus were seen by laryngofibroscopy, and a loss of taste on the right posterior part of the tongue was confirmed by gustometry using the filter paper disc method. The varicella zoster virus antigen was revealed by direct immunofluorescence staining by fluorescein isothiocyanate labelled mouse monoclonal antibody specific for varicella zoster virus glycoprotein, using samples obtained from the mucosal lesion by abrasion with a cotton swab. The patient was treated by intravenous administration of acyclovir. His throat pain and dysgeusia completely resolved. We discuss the advantages of direct immunofluorescence staining for varicella zoster virus antigen for the diagnosis of glossopharyngeal zoster.