Colonic diverticulitis in the neck: a late complication of laryngopharyngectomy surgery.

We report a case of diverticulitis affecting a colonic segment used as an interposition graft following laryngopharyngectomy. The patient presented as an emergency to our department with a history of a red, swollen and painful neck. She had undergone laryngopharyngectomy for laryngeal cancer in 1967. Computed tomography imaging revealed several diverticula in the colonic graft and associated abscess formation. The patient's clinical condition behaved similarly to that of conventional colonic diverticulitis. The difficulties in reaching a definite diagnosis and management of this unusual complication following laryngopharyngectomy are discussed.

Time trend analysis of otological procedures performed in England, 1989 to 2005.

OBJECTIVE: To observe trends in the number of major otological procedures performed in England, in the context of advances in the understanding of disease. METHODS: The data used were obtained from the Hospital Episode Statistics statistical database, published by the UK Department of Health, for England, 1989 to 2005. Specific otological procedures were identified using the Classification of Surgical Operations and Procedures system (fourth revision) of the Office of Population, Censuses and Surveys. Trend analysis of different procedures was performed using exponential smoothing (using the Statistical Package for the Social Sciences version 13 software). RESULTS: Our study did not confirm any reduction in the number of surgical procedures performed for cholesteatoma or otosclerosis. We noted a sharp decline in the number of endolymphatic sac surgical procedures performed, probably attributable to the increased use of intratympanic therapy. CONCLUSION: The number of major otological procedures (other than endolymphatic sac surgery) was consistent over the period examined. The generally perceived reduction in the number of procedures performed by individual surgeons may be due to a dilutional effect. This can only support the need for subspecialisation, particularly regarding the training of junior surgeons.

Sensorineural hearing loss in linear IgA disease.

A 23-year-old female with progressive sensorineural hearing loss developed widespread blistering eruptions while under evaluation for the hearing loss. The lesions showed findings characteristic of linear IgA disease (LAD) on histochemical studies. Linear IgA disease is a dapsone responsive autoimmune subepidermal blistering disease characterised by linear IgA deposits in the basement membrane zone. The complete spectrum of this systemic disease is still not clear and this is the first report of association between LAD and sensorineural deafness.

Solitary plasmacytoma of the parotid gland.

Extramedullary plasmacytoma involving the parotid gland is a rare occurrence. This report describes a case of solitary extramedullary plasmacytoma arising from the parotid gland of a 60-year-old woman. The importance of thorough follow up for these patients is stressed, as the possibility of multiple myeloma is higher in this group.

An unusual presentation of an encephalocele to the otolaryngologist.

An unusual case of encephalocele causing obstruction of the upper airway in a neonate is described. The patient presented with a large mass in the neck, which extended from the base of the skull to the level of the larynx. Although there was no evidence of a defect of the skull base, subsequent excision and histological examination confirmed an encephalocele.

Acute angle closure glaucoma precipitated by intranasal application of cocaine.

We describe a patient who developed acute angle-closure glaucoma following the application of topical intranasal cocaine. A 46-year-old woman underwent an elective antral washout under general anaesthesia and with local application of 25 per cent cocaine paste to the nasal mucosa. Twenty-four hours post-operatively the patient developed sudden painful blindness which was found to be due to acute glaucoma. Cocaine with its indirect sympathomimetic activity causes mydriasis, that can precipitate acute angle-closure glaucoma in predisposed individuals with a shallow anterior chamber. Although the incidence is rare, otolaryngologists need to be aware of this potential complication.

Tall cell variant of papillary carcinoma arising from ectopic thyroid tissue in the trachea.

Ectopic thyroid tissue within the submucosa of the trachea is a rare cause of upper airway obstruction. Primary neoplasms arising from such thyroid nests are rare. This report describes a case of tall cell variant of papillary carcinoma arising from ectopic thyroid tissue in the trachea.

The effect of previous antibiotic therapy on the bacteriology of the tonsils in children.

The bacteriology of the tonsillar surface and core in 30 children undergoing tonsillectomy was studied. Antibiotics taken in the six months before surgery were recorded. Haemophilus influenzae and Staphylococcus aureus were the commonest isolates; Streptococcus pyogenes was relatively rare. Eight children had received no antibiotics, the others had been prescribed 65 different courses of 13 different types. No relationship between the various antibiotic regimens prescribed and tonsillar bacteriology could be demonstrated, and it would appear that the tonsillar bacteriology at the time of tonsillectomy is not altered by antibiotics prescribed in the previous six months.

Hydralazine-induced lupus and vocal fold paralysis.

Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder that can affect the upper airway. Hydralazine has been known to cause a lupus-like syndrome that can produce the clinical manifestations of SLE. We discuss a case of hydralazine-induced lupus, presenting with acute laryngeal oedema and right vocal fold paralysis. Cessation of hydralazine therapy resulted in reversal of paralysis.