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We present a case of a laryngectomized patient who underwent re-puncture of tracheo-oesophageal fistula for speaking valve voice restoration, resulting in a previously unreported inherent complication of this procedure: extradural abscess of the cervical spine with transient quadriplegia.

The relationship between the upper and lower airways in chronic obstructive pulmonary disease (COPD) is unknown. We examined the prevalence of chronic nasal symptoms and the correlation with lower respiratory symptoms and parameters of severity of COPD such as exacerbation frequency and spirometry. 61 COPD patients from the East London COPD cohort were studied. [Mean (SD) age 70 (6.96) years, FEV1 0.98 (0.38) l, FVC 2.45 (0.72) l, FEV1%Pred 37.0 (12.3), and 47.6 (31.8) smoking pack years, 14 current smokers, 36 males]. COPD patients had a high prevalence of nasal symptoms (75%), more than half reporting nasal discharge (52.5%) and sneezing (45.9%). Associations were found between nasal score and daily sputum production (P = 0.005) and post-nasal drip and sputum production (P = 0.046) with a trend to increased nasal symptoms in frequent exacerbators compared to infrequent exacerbators. No significant relationship was found between nasal symptoms and FEV1 or any other lower respiratory airway symptom. Associations between nasal and respiratory symptoms were found suggesting that there is a relationship between the upper and lower airway in COPD.

This was a prospective study and analysis of the clinical nature and severity of consultation, patient age and sex, place of consultation, grade of attending doctor and management strategy of in-patients referred for a specialist opinion to a Department of Otolaryngology. Internal requests for consultation were evaluated at the North Manchester General Hospital between October 1999 and August 2000 (n = 101). Patients referred to the Otolaryngology department were of a varied clinical nature with head and neck complaints being the largest group. Forty-six of the patients had minor complaints. Patients were found to be predominantly male and older than 50 years of age. The grade of attending doctor was predominantly a Specialist Registrar and the management strategy was most frequently conservative. Many of the requests for consultation were regarding minor problems that could be referred to a routine out-patient clinic. There is a need to improve the indication criteria for internal consultation, as well as the information provided in them.

Lymphangiomas are uncommon congenital lesions of the lymphatic system which usually present in childhood. We report a case of adult lymphangioma, localised in the neck, and discuss the presentation, diagnosis and management of this tumour.

Neurofibromatosis type 1 (NF 1) or Von Recklinghausen's disease is an autosomal dominant condition characterized by multiple skin café-au-lait lesions and multiple neurofibromas. In the head and neck neurofibromas have a predilection to arise in th deep planes of the neck. Surgical management is nearly always required for functional or cosmetic reasons or to exclude the possibility of malignant transformation. We present four cases of neurofibroma of the head and neck and illustrate the difficulties inherent in managing this condition, particularly the age range in which it may occur, the risk of malignant transformation, the possibility of abnormal bleeding and the morbidity that may be associated with the surgical resection. The role of magnetic resonance (MR) scan in the assessment and monitoring of these lesions is highlighted. We also report a unique association of a pharyngeal pouch with NF 1 in a young (25-year-old) patient.

It is always important to treat conditions which may be cancerous with respect and, where there is suspicion, to take biopsies for histological examination. A hoarse voice may, in addition, be a sign of tuberculosis of the larynx, and the clinical appearance can be similar to a carcinoma. Preoperative chest x-ray (not always performed) and an awareness by the histologist of such a possibility are important now that this condition is increasing in frequency in parallel with conditions where immunological status is compromised.