Bilateral Warthin's tumour of the parotid gland: a 16-year retrospective analysis and systematic review.

OBJECTIVE: Warthin's tumours are the second most common benign parotid tumours in the UK. The World Health Organization states that 5-14 per cent of patients have bilateral Warthin's tumours. This study aimed to: assess the presence of contralateral Warthin's tumours in patients who underwent surgery over the past 16 years at a head and neck unit in England, and perform the first systematic literature review on bilateral Warthin's tumours. METHODS: A retrospective analysis was conducted on patients diagnosed with Warthin's tumour based on histology between 2005 and 2020. Additionally, a systematic review (International Prospective Register of Systematic Reviews ('PROSPERO') registration number: CRD42022326846) was performed using PubMed and the Cochrane Library. RESULTS: Among 290 patients diagnosed with Warthin's tumours based on histology following surgery, 24.5 per cent had bilateral Warthin's tumours. The systematic review identified 157 papers, with 14 meeting the inclusion criteria. CONCLUSION: This study revealed that 24.5 per cent of patients had bilateral Warthin's tumours, deviating from the suggested range. These findings are of interest to surgeons discussing the disease with patients.

Spindle Cell Carcinoma of the Larynx with Tracheobronchial Aspergillosis: A Rare Coincidence.

We herein report a rare coincidence and a possible association between laryngotracheal fungal infection and spindle cell carcinoma of the larynx (SpCC). A 79-year-old gentleman presented to the Emergency Department with manifestations of airway obstruction. Flexible nasendoscopy showed pooling of saliva around the larynx and his neck palpation did not show cervical lymphadenopathy. Further imaging showed bilateral transglottic mass mainly in the subglottis along with right pulmonary nodularity. Percutaneous tracheostomy, panendoscopy and biopsy of the laryngeal mass confirmed a diagnosis of SpCC. A few days later, he was admitted and aspergillus fumigatus was found in a biopsy of his tracheal tissue. To the best of our knowledge, the possible correlation between laryngotracheal aspergillosis and such a rare type of cancer larynx (SpCC) has not been highlighted in the literature.

Completing the audit cycle: the impact of an electronic reporting system on the feedback loop in surgical specialties.

INTRODUCTION: The feedback loop of incident reporting is essential in improving patient care. Few studies have followed the loop around its cycle and little data are available concerning the impact of interventions. We investigated the feedback loop before and after the implementation of an electronic reporting system. METHOD: Data were collected before and after our intervention. Data were analyzed in terms of the percentage of incidents evaluated, the percentage of incidents resulting in action, whether correlations demonstrated an increased rate of action taken as incident risk score increased. RESULTS: Prior to our intervention, 43% and 40% of incidents reported were evaluated and acted upon, respectively. Postintervention, the number of incidents reported increased by 198%. All incidents were evaluated and 66% were acted upon. Both pre- and postintervention, no correlations demonstrated an increase in action taken as incident severity increased. CONCLUSION: Our intervention resulted in a considerable increase in the number of incidents reported, evaluated, and acted upon. Such an effect would be expected to improve patient safety, although further studies are needed to definitively confirm this. We therefore recommend the use of electronic systems and further studies to evaluate their impact on patient safety.

Cochlear implantation in patients with vestibular schwannoma: a single United Kingdom center experience.

OBJECTIVES/HYPOTHESIS: To evaluate the outcome of cochlear implantation (CI) in patients with vestibular schwannoma (VS). STUDY DESIGN: A retrospective case series from a tertiary auditory implant center. METHODS: A retrospective case note review was carried out to evaluate patients with bilateral profound hearing loss and VS who underwent unilateral CI within the Auditory Implant Centre at St. Thomas' Hospital, London, between 2000 and 2012. This included both bilateral VS with neurofibromatosis type 2 (NF2) and unilateral sporadic VS. Outcome measures included speech perception with Bamford-Kowal-Bench and City University of New York sentences, sound-field thresholds with warble tones, and the subjective benefits reported by patients. RESULTS: The study included five patients with NF2 and bilateral VS and two patients with sporadic unilateral VS. The standard preoperative audiologic assessment for CI often could not be carried out in NF2 patients. Preoperative testing was more complete in the two patients with sporadic VS. The audiologic outcome was variable. Open-set speech perception was achieved in three out of five NF2 patients, and another reported significant improvement in environmental sound perception and ease of communication. The outcome was overall better in patients with sporadic VS, both of whom were able to use the telephone in their implanted ear. CONCLUSIONS: Good speech perception can be achieved in some cases, and CI should be considered as an option for auditory rehabilitation in patients with VS.

Case report--an iatrogenic foreign body in the airway.

We report a case of an iatrogenic foreign body in the airway. An 80-year-old patient who had undergone major head and neck surgery several weeks early presented as an inpatient with a persistent cough and recurrent chest infections. Fibreoptic nasendoscopy revealed the presence of a nasopharyngeal airway sitting vertically in the airway. This foreign body presented indolently as it was cannulated. We suggest that in such patients, readers should be aware of this possible underlying iatrogenic cause of respiratory complications.

Squamous cell carcinoma in the head and neck.

Head and neck cancers are responsible for 10% of male cancers in the UK, and used to be six or seven times more common in men than women. Now these cancers are only about twice as common among men. This article reviews the presentation and management of these cancers.