The SNOT-22 could be used in routine clinical practice to highlight the impact of nasal disease in each patient and to measure the outcome and the effectiveness of the surgical intervention.

Objectives:To evaluate the medium-term outcome of cricothyroid approximation and subluxation (CTAS) with postoperative speech therapy for pitch elevation in male-to-female transsexuals. Study Design: Retrospective study of male-tofemale transsexuals who underwent pitch-raising surgery between November 1996 and August 2001.Methods: Twenty-one male-to-female transsexuals opted for surgical feminization of their voices after inadequate improvements with speech therapy alone. Electrolaryngographic measurements were obtained by a single speech therapist of modal fundamental frequencies and the percentage of irregularities before, at 2 weeks, and 6 months after surgery. All 21 patients underwent CTAS, and 20 underwent simultaneous cosmetic thyroid chondroplasty by a single surgeon. Results: Electrolaryngographic results 2 weeks after surgery showed an average postoperative gain in modal frequency of free speech of 71.05 Hz (95% confidence interval [CI]: 42.9 -99.2, P < .001). There was a concomitant average rise in irregularities of 9.9% (95% CI 0.7-18.5, P ‫؍‬ .03). At median follow-up of 6 months after six sessions of speech therapy (n ‫؍‬ 15), there was a decrease in irregularities to preoperative levels. The overall gain at 6 months in modal frequency of free speech was 56.9 Hz (95% CI 38.3-75.4, P < .001).Smoking and age did not predict a worse outcome. Conclusions: Cricothyroid approximation effectively raises pitch in male-to-female transsexuals.There is a concomitant rise in voice irregularities that is effectively addressed by speech therapy.

Routine suction drainage after uncomplicated elective thyroid and parathyroid surgery appears unnecessary, and prolongs in-patient stay.

The authors report a novel treatment of a case of type I laryngeal cleft diagnosed in an adult. They describe a technique of endoscopic obliteration of the posterior commissure defect. Initially, a test implant of starch and adrenaline was used, followed by permanent staged injections of Bioplastique to the posterior commissure. This rare congenital anomaly usually presents in childhood but late presentation should be considered when adults present with lifelong dysphonia especially when associated with gastro-oesophageal reflux disease.

This is the first publication to undertake a historical study of the ensemble of surgeon inventors responsible for the instruments in the tonsillectomy tray as it is today. In furthering knowledge of our forbearer surgeon inventors, who have shaped the tonsillectomy procedure as it is safely performed today, we enrich our understanding of the history of our profession and build appreciation for the instruments employed daily. We may even be inspired to continue the tradition of evolving the craft.

Background: We aim to validate a clinical scoring system of external nasal valve collapse. External nasal valve collapse is a rare and challenging condition. We attempted to simplify the examination of the external valve, the surgical planning and the outcome measure. To validate our external valve score, we first assessed its reliability (inter-rater agreement and test-retest repeatability). We secondly considered the clinical relevance by using our scoring system in patients undergoing septorhinoplasty for external valve collapse. Methodology: For validation, 16 Rhinologists scored patients separately on two occasions. For the clinical relevance, 26 patients with external valve collapse were scored pre- and post-operatively (responsiveness). The external valve score was correlated to peak nasal inspiratory flow. Results: The devised scoring system was reliable (substantial agreement between 16 surgeons with reproducibility over time). All patients in our prospective series showed significant improvement in their external valve score. The quality of life measured by the SNOT-22 tool showed significant improvement after surgery. Conclusion: External nasal valve collapse can be diagnosed and graded using this simple scoring system in the outpatient clinic. This paper reinforces the pivotal role of septorhinoplasty surgery in nasal airway reconstruction and the ongoing need to quantify success.

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