Previous studies ha ve evaluated the effe cts of como rbidity on survival in patient s with cance r. We app lied the Charlson comorbidity index (CCl) to a coho rt ofpatients with laryngeal cance r to validate its use and to assess the prognosti c impact of age . Our study p opulation consisted of 152 patients with laryngeal cance r who we re see n ove r a JO-yearperiod. Patient s we re ass igned CCl sco res and were catego rized into low-and high -grade como rbidity groups fo r comparison. Age adjustm ents we re p erformed by adding 1 p oint to the Charl son sco re f or each decad e ove r the median age.Low-vs. highgrade comorbidity was a valid predictor of survival independ ent of TNM (tum or, nodes, and m etastases) stage. Low-grade comorbidity was present in 126 patients; their median survival was 41 months. Highgrade comorbidity was p resent in 26 patients ; their median survival was 8 mon ths (p = 0.0002). The addition of the age factor to the CCl did not improve our prognostic ability. There was no difference in CCI groups with respect to tobacco and alcohol use, gender, treatment modality, or mean time to recurrence. The incidence and severity of complications were also similar in the two groups .We conclude that the CCI is a stro ng predictor of surv ival in patient s with laryngeal cance r. The conf ounding effects of com orbidity sho uld be considere d in the TNM stag ing of laryngeal cance r to improve our p rognosti c ability. Further investigat ions are necessary to assess the validity ofthis ind ex in patients with othe r head and neck cance rs.

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ObjectiveTo review the presentation, symptoms and management associated with low velocity gunshot injuries to the temporal bone.MethodsA retrospective analysis of 26 patients treated for low velocity gunshot injuries to the temporal bone.ResultsInitial presentation included otorrhoea (69 per cent), facial nerve injury (27 per cent), hearing loss (65 per cent), intracranial injuries (50 per cent), and cranial neuropathies (58 per cent). Nine patients (35 per cent) underwent angiography, which showed vascular injury in five of them. Four patients died.ConclusionLow velocity gunshot injuries can be devastating and may result in functional sequelae. Low velocity missiles crush and lacerate surrounding structures, while high velocity missiles cause extensive wound cavity formation. Early aggressive management for intracranial, vascular and facial nerve injury can improve outcome.

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