Sudden parotid swelling due to spontaneous haemorrhage.

This paper presents an interesting case of a severe spontaneous haemorrhage within the parotid gland in an adult. A rapidly enlarging parotid mass with absence of causative trauma, inflammation or vascular abnormality, raised the suspicion of a neoplasm. Ultrasound, computed tomography (CT) and tissue biopsy, however, have shown only changes suggestive of previous haemorrhage and no evidence of malignancy. A 30-year review of the literature revealed no similar case reported previously.

A clinic for the rapid processing of patients with neck masses.

Neck masses are common and may have serious underlying pathology. There is much anxiety and confusion in primary care as to which hospital department will provide the patient with the best service and the swiftest diagnosis. A clinic was set up at Wexham Park hospital to enable patients with neck masses to be seen early, and to undergo a one-stop specialist evaluation, ultrasound scan and fine needle aspiration biopsy. The clinic has yielded a wide variety of benign and malignant pathology. The first 100 patients are discussed and evaluated.

Congenital anosmia.

Congenital anosmia is well described in conjunction with various sexual and other developmental abnormalities and has been reported to run in families. Congenital anosmia occurring as an isolated defect in a single family member is extremely rare, and tends to present late. We describe a case of a five year old girl with congenital anosmia and we outline the investigations which should be undertaken in such cases.

An assessment clinic for routine paediatric otolaryngological surgery.

In the current climate of medical practice clinicians are under constant pressure to come up with new ways of increasing efficiency and throughput whilst maintaining a high standard of patient care. Assessment clinics are not a new idea and are widely practised in the National Health Service. The novel feature of the clinic we are describing is that all relevant professionals are present: consultant otolaryngologist, audiologist, paediatric nurse, playleader and preassessment nurse. The Wexham Park Paediatric Otolaryngology Preassessment Clinic has now been running for six years, and in this time we have experienced a marked decrease in both the waiting times for surgery and the non-attendance rate.

The incidence and detection of HPV in the upper aerodigestive tract using brush and biopsy techniques.

The association between human papillomavirus (HPV) and squamous carcinoma is well established. In the polymerase chain reaction (PCR) we have an effective technique for detecting small quantities of viral DNA, but the assay requires tissue taken at endoscopy to reveal the presence or absence of HPV. Brushings have been used effectively elsewhere in the body to obtain cytological material. This study set out to ascertain if sufficient viral DNA could be obtained, using a laryngeal brushing and the PCR, to detect the presence or absence of HPV. Six patients with squamous carcinoma of the larynx and seven controls who were having laryngoscopy for other reasons underwent laryngeal biopsy. In addition, in the patients with carcinoma, biopsies were taken at the tumour margins and brushings from both sites. The samples were tested for the presence of HPV types 6, 11, 16, 18 and 31 by means of the PCR. The distribution of HPV types was as expected in the biopsy specimens, but only one brushing detected any HPV type at all. We conclude that laryngeal brushing is an inadequate technique for assessing the presence of HPV in the larynx.