First bite syndrome: our experience of laser tympanic plexus ablation.

INTRODUCTION: First bite syndrome is a condition characterised by severe facial pain brought on by the first bite of each meal. This can severely affect the patient's ability to eat. METHODS: We present a 70-year-old woman for whom we performed a laser ablation of the left ear tympanic plexus, as treatment of first bite syndrome. A permeatal approach was used to raise a tympanomeatal flap. The tympanic plexus was identified on the promontory and a 4 mm2 area of the plexus was ablated using CO2 laser. The flap was repositioned and a dressing was placed with topical antibiotics. RESULTS: At two-month follow up, there was full resolution of the patient's symptoms. DISCUSSION: First bite syndrome carries a high morbidity; treatment options are variable, and often unsuccessful. We describe the first documented case of laser tympanic plexus ablation, with a very effective initial response. This procedure represents a useful therapeutic option for first bite syndrome.

Is there a difference in quality of life, comparing summer and winter, in patients who have undergone total laryngectomy?

INTRODUCTION: Several studies have implied that patients' quality of life stabilises six months after undergoing total laryngectomy. However, these studies may well have overlooked persistent short term variations in patients' quality of life. The aim of this study was to assess the impact of seasonal change (i.e. summer vs winter) on the quality of life of patients following total laryngectomy. METHODS: A prospective, cross-sectional study of recurrence-free laryngectomy patients was performed, using the European Organization for Research and Treatment of Cancer (version three) QLQ-C30 questionnaires (EORTC QLQ-C30), during January 2004 (i.e. winter), August 2004 (summer) and January 2005 (winter). RESULTS: Thirty-six patients were entered into the study. The response rate was 70.3 per cent. Patient's time elapsed since surgery varied from six months to 12 years. In all questionnaire domains, responses seemed remarkably consistent over time. CONCLUSION: No statistically significant differences were found between summer and winter scores in all the domains analysed by the EORTC QLQ-C30.

Alendronate-induced chemical laryngitis.

Alendronate is a bisphosphonate used in treating osteoporosis. Its recognized side-effects include oesophageal irritation and ulceration. The authors describe a case of laryngitis induced by transient contact of this medication with the laryngeal mucosa. Successful management of this case is also detailed.

Papilloedema, an unusual complication of mastoidectomy.

We report a very unusual case of a patient with a previously undiagnosed congenital absence of the left dural venous drainage system and a prominent system on the right. Due to its prominence it was at risk during a cortical mastoidectomy performed as part of an endolymphatic sac decompression procedure. Manipulation of the lateral venous sinus resulted in partial occlusion of the already compromised venous drainage. The result was a rise in intra-cranial pressure and papilloedema, from which the patient recovered. The abnormality was only detected on post-operative imaging.

Carcinoid tumour of the larynx (a case report and review of the literature).

Carcinoid tumours of the larynx are extremely rare, only 13 cases having previously been reported in the world literature. A case is reported here with the unusual complication of skin metastases. The true diagnosis is seldom made on the original biopsy, which is commonly reported as poorly differentiated carcinoma. A review of the literature is made with a discussion of the histological diagnosis and treatment modalities.

Surgical salvage in postcricoid cancer.

Twenty-one total pharyngo-laryngectomies have been performed at the Manchester Royal Infirmary between 1968 and 1982. A variety of methods of repair have been used, gastric transposition being the most common. Seventeen patients had received previous radiotherapy to the area, fourteen radical, two palliative and one to a supraglottic carcinoma 12 years before. Four had tumours judged to be too large to benefit from radiotherapy. Of the patients who received radiotherapy, fourteen had a good response with palliation for an average of ten months before symptoms began to return. Four patients survived over five years post-operatively and ten died following surgery.