The limited evidence for each mucosal finding should be considered in making the diagnosis of LPR. Further quality research in to mucosal findings in LPR is needed.

This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It provides recommendations on the assessments and interventions for this group of patients receiving palliative and supportive care.Recommendations• Palliative and supportive care must be multidisciplinary. (G)• All core team members should have training in advanced communication skills. (G)• Palliative surgery should be considered in selected cases. (R)• Hypofractionated or short course radiotherapy should be considered for local pain control and for painful bony metastases. (R)• All palliative patients should have a functional endoscopic evaluation of swallowing (FEES) assessment of swallow to assess for risk of aspiration. (G)• Pain relief should be based on the World Health Organization pain ladder. (R)• Specialist pain management service involvement should be considered early for those with refractory pain. (G)• Constipation should be avoided by the judicious use of prophylactic laxatives and the correction of systemic causes such as dehydration, hypercalcaemia and hypothyroidism. (G)• Organic causes of confusion should be identified and corrected where appropriate, failing this, treatment with benzodiazepines or antipsychotics should be considered. (G)• Patients with symptoms suggestive of spinal metastases or metastatic cord compression must be managed in accordance with the National Institute for Health and Care Excellence guidance. (R)• Cardiopulmonary resuscitation is inappropriate in the palliative dying patient. (R)• ‘Do not attempt cardiopulmonary resuscitation’ orders should be completed and discussed with the patient and/or the family unless good reasons exist not to do so where appropriate. This is absolutely necessary when a patient's care is to be managed at home. (G)

Thyroid surgery has been traditionally a general surgical practice, but recently more otolaryngologists have been offering a thyroid service. We have quantified thyroid surgery performed by the different specialties, and looked more closely at the practice of otolaryngologists. Data was obtained from the Department of Health for UK thyroid surgery in all specialties for the year 1998-99 and validated against a survey of members of the British Association of Otolaryngologists-Head & Neck Surgeons (BAO-HNS). The use of investigations of a simple clinical case (solitary thyroid nodule) was compared with best practice. General surgeons still perform the majority of thyroid surgery (83%) but ENT surgeons now perform significant numbers (15.4% of all cases), which translates to 1499 cases per annum. A total of 102 BAO-HNS members were performing thyroid surgery with an average case-load of 19.1 per year. In total, 35% of ENT surgeons see thyroid patients in multidisciplinary clinics. The choice of investigation is consistent with European guidelines. ENT surgeons are doing significant amounts of thyroid surgery and the numbers appear to be increasing. The formation of multidisciplinary teams including general surgeons and otolaryngologists who are committed to subspecialization can only improve both training and treatment outcomes.

Objective: We report a rare case of a 51-year-old woman with ocular and nasal infestation by Oestrus ovis.Method: Clinical case report and review of current literature regarding nasal and ophthalmomyiasis. Results: Myiasis is infestation of the tissues and organs of vertebrates by certain dipteran fly larvae. Oestrus ovis myiasis is endemic in the region from North Africa to South Asia, but few cases are reported within the UK. A 51-year-old patient presented and was treated successfully in Sunderland Royal Hospital for combined ocular and nasal infestation with Oestrus ovis.Conclusions: Oestrus ovis has a largely subtropical distribution; however, it is important to remember the diversity of disease which can present within the UK from an external source. This point is illustrated by this rare case, which highlights the fact that prompt treatment can avoid poor outcomes for our patients.

Tumors of the larynx, whether benign or malignant, can present with significant symptoms because of their anatomic location encroaching on the airway and interfering with function. 1 Truly benign neoplasms of the larynx are rare. The majority of benign nonneoplastic laryngeal lesions are vocal cord polyps.Cancer of the larynx accounts for approximately 2% of all reported cases of malignant disease. 1 Laryngeal cancer in the United Kingdom accounts for 40% of all registered head and neck malignancies. Data from the Birmingham Cancer Registry during the period from 1957 to 1985 shows evidence of an overall increase in the incidence of laryngeal cancer with an increasing incidence in women. 2 Cancer of the larynx predominantly affects men, with a sex ratio of 8:1. 1 However, cancer of the larynx can occur at any age. For men the mean age of presentation is 50 to 60 years; women are usually a decade younger. 1 Squamous cell carcinoma is the most common malignant neoplasm of the larynx, irrespective of age, and accounts for the majority of cases. Nonepithelial carcinomas account for about 2% of laryngeal tumors. 3 A report from the Royal Marsden Hospital (1948Hospital ( to 1977 showed that 19 (0.68%) of 2784 new patients with laryngeal cancer had nonsquamous tumors. 1 In a study of 40 nonsquamous laryngeal malignancies presenting at the Cleveland Clinic, no case of leiomyosarcoma was reported. 4 Ten cases of leiomyosarcoma of the larynx have been reported in the English literature. [5][6][7][8][9][10][11][12] Data are available in only eight cases. Two further cases, which were recently diagnosed at University Hospital, Nottingham, England, are presented with a review of the available literature. CASE REPORTS

Salivary ductal carcinomas (SDCs) are extremely rare and aggressive malignancies, accounting for approximately 6% of all salivary gland malignancies. One distinct feature is their resemblance to ductal carcinomas of breast. A significant percentage of SDCs overexpress Her2 and the use of targeted therapy with trastuzumab can be considered in these patients. We report a rare case of long term disease control with trastuzumab in Her2 positive metastatic parotid ductal carcinoma. Our case also highlights that isolated brain metastasis should be managed aggressively to allow optimal local control when systemic disease is under remission with trastuzumab. We have also reviewed the published literature on the use of trastuzumab in SDCs.

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Surgical voice restoration service provision varies within and between cancer networks. There is a need for a national management and care protocol, an educational programme for out of hours service providers, and a review of current speech and language therapist staffing levels in England.