The effect of anti-reflux treatment on subjective voice measurements of patients with laryngopharyngeal reflux.

OBJECTIVE: To assess the impact of anti-reflux treatment and speech therapy on subjective voice measurements of patients with laryngopharyngeal reflux. METHODS: This paper reports a prospective study of patients seen in a voice clinic over a three-year period who were being treated for laryngopharyngeal reflux. Patients were assessed at presentation using the reflux symptom index and voice symptom scale, and were reassessed at three months and six months post-treatment. Treatment entailed twice daily proton pump inhibitor therapy and speech therapy. RESULTS: The study comprised 74 patients. The reflux symptom index and voice symptom scale scores significantly improved following treatment at both three and six months. There was a correlation between improved reflux symptom index scores and improved voice symptom scale scores. CONCLUSION: Treatment of laryngopharyngeal reflux with twice daily proton pump inhibitors and speech therapy resulted in improved subjective voice measurements for patients.

How good is a chest CT scan at predicting the risk of pulmonary metastatic disease in patients with head and neck cancer? A retrospective observational study.

OBJECTIVES: Our objectives were to assess whether a CT chest, when performed as part of initial staging investigations, is a robust method to identify lung metastases or synchronous primary lung cancers in patients with head and neck squamous cell and whether small nodules are likely to represent metastases in this group of patients. DESIGN: Retrospective observational study performed between 1994 and 2005. SETTING: Head and neck cancer department, Queen Elizabeth Hospital, Birmingham. PARTICIPANTS: All patients that were included had a new head and neck squamous cell carcinoma and underwent a CT chest as part of their staging investigation. MAIN OUTCOME MEASURES: The presence of lung masses on the initial screening CT of the chest as determined by the radiologist's report. The development of lung metastases or primary bronchogenic carcinoma in any patient. RESULTS: Two hundred and thirty-nine patients met the inclusion criteria. 38 (16%) patients had a CT chest report for a lung malignancy (either metastatic or primary bronchogenic), 33 of these 38 (87%) patients actually had a lung malignancy. 32 (13%) patients had a CT chest report for a small nodule, three of these 32 (9%) patients were later diagnosed with a lung malignancy, all at a different site to the nodule. 169 (71%) patients had normal CT chest reports, of these 3 (2%) patients were later diagnosed with a lung malignancy. CONCLUSIONS: The CT chest is a useful screening tool but is not infallible. Small nodules should be taken seriously and monitored, but should not alter the initial decision as to the management of the patient.

Is there a role for flexible oesophagogastroscopy in upper aerodigestive tract squamous cell carcinoma?

INTRODUCTION: There is growing evidence to suggest that reflux (both laryngopharyngeal and gastroesophageal) has a role in the development of upper aerodigestive tract squamous cell carcinoma. This study discusses the role of identifying reflux in this patient group, and its prevalence. METHODS: Prospective review of patients with head and neck cancer undergoing flexible oesophagogastroscopy as part of their diagnostic investigation. RESULTS: Forty-five consecutive patients were identified. All patients were found to have evidence of oesophagitis, with 28 having oesophageal erosions and two Barrett's oesophagitis. CONCLUSION: Flexible oesophagogastroscopy is a useful test in patients with upper aerodigestive tract squamous cell carcinoma.

A haemangiopericytoma of the ethmoid sinus causing oncogenic osteomalacia: a case report and review of the literature.

Oncogenic osteomalacia is a rare cause of osteomalacia. It is caused by a tumour which is generally benign. These tumours, when identified, are often found in the head and neck region. The case is reported here of a haemangiopericytoma isolated in the ethmoid sinus, and the literature regarding tumours at this site is reviewed. Including the present case there are five reported in the world literature of an ethmoid sinus tumour causing oncogenic osteomalacia. The treatment for this disease is excision of the mass, which is where the head and neck specialist's expertise is required.