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Although symptoms of laryngopharyngeal reflux (LPR) symptoms are commonly seen in the ENT clinic, their aetiology and prevalence in the population remain unknown. Lifestyle changes have been seen to be effective in symptom relief. We aimed to establish the prevalence of these symptoms and identify any associated factors. Pseudo-random sampling was performed on 2,000 adults that were sent a validated questionnaire containing the Reflux Symptom Index (RSI) and questions on their health and lifestyle. 45.8 % of the 378 responders were male. The mean RSI was 8.3. 30 % had an RSI of more than 10, of which 75 % had symptoms of gastro-oesophageal reflux disease (r = 0.646 at p = 0.01). Patients with depression and irritable bowel syndrome are more likely to have LPR symptoms. LPR symptoms are highly prevalent in the community and may be influenced significantly by the presence of gastro-oesophageal reflux, depression and irritable bowel syndrome.

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This is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. This paper provides recommendations on the pre-treatment clinical assessment of patients presenting with head and neck cancer.Recommendations• Comorbidity data should be collected as it is important in the analysis of survival, quality of life and functional outcomes after treatment as well as for comparing results of different treatment regimens and different centres. (R)• Patients with hypertension of over 180/110 or associated target organ damage, should have antihypertensive medication started pre-operatively as per British Hypertension Society guidelines. (R)• Rapidly correcting pre-operative hypertension with beta blockade appears to cause higher mortality due to stroke and hypotension and should not be used. (R)• Patients with poorly controlled or unstable ischaemic heart disease should be referred for cardiology assessment pre-operatively. (G)• Patients within one year of drug eluting stents should be discussed with the cardiologist who was responsible for their percutaneous coronary intervention pre-operatively with regard to cessation of antiplatelet medication due to risk of stent thrombosis. (G)• Patients with multiple recent stents should be managed in a centre with access to interventional cardiology. (G)• Surgery after myocardial infarction should be delayed if possible to reduce mortality risk. (R)• Patients with critical aortic stenosis (AS) should be considered for pre-operative intervention. (G)• Clopidogrel should be discontinued 7 days pre-operatively; warfarin should be discontinued 5 days pre-operatively. (R)• Patients with thromboembolic disease or artificial heart valves require heparin therapy to bridge peri-operative warfarin cessation, this should start 2 days after last warfarin dose. (R)• Cardiac drugs other than angotensin-converting enzyme inhibitors and angiotensin II antagonists should be continued including on the day of surgery. (R)• Angotensin-converting enzyme inhibitors and angiotensin II antagonists should be withheld on the day of surgery unless they are for the treatment of heart failure. (R)• Post-operative care in a critical care area should be considered for patients with heart failure or significant diastolic dysfunction. (R)• Patients with respiratory disease should have their peri-operative respiratory failure risk assessed and critical care booked accordingly. (G)• Patients with severe lung disease should be assessed for right heart disease pre-operatively. (G)• Patients with pulmonary hypertension and right heart failure will be at extraordinarily high risk and should have the need for surgery re-evaluated. (G)• Perioperative glucose readings should be kept within 4–12 mmol/l. (R)• Patients with a high HbA1C facing urgent surgery should have their diabetes management assessed by a diabetes specialist. (G)• Insulin-dependent diabetic patients must not omit insulin for more than one missed meal and will therefore require an insulin r...

Palatal tremor (formerly palatal myoclonus) is an extremely rare, but potentially treatable cause, of objective tinnitus. The tinnitus is thought to be secondary to rhythmic involuntary movements of the soft palate. Its aetiology is variable and it remains difficult to treat. Many different medical and surgical remedies have been tried but none have demonstrated reproducible success. Botulinum toxin has been used in sporadic cases and seems to produce good results. Ten patients with palatal tremor have presented to this department over the last three years. After discussion with the patients with regard to the management of this condition and possible complications, five opted for botulinum toxin therapy and five declined further intervention. Clinical diagnosis was made on the confirmation of soft palate movements synchronous with an audible clicking noise. Five patients underwent botulinum toxin injection into the insertion of the levator and tensor veli palatini muscles. Of the five that were treated with toxin, four showed complete resolution of symptoms after a course of treatment. Only one patient reported transient side effects. This would suggest that botulinum toxin is a safe and effective first line treatment for palatal tremor.

We recommend radiofrequency ablation as a safe, viable alternative to existing techniques for the treatment of paediatric microcystic lymphatic malformations of the upper aerodigestive tract. Radiofrequency ablation achieves effective debulking of microcysts whilst avoiding excessive bleeding and thermal damage to surrounding tissues. This paper constitutes the first report of successful treatment of airway obstruction due to paediatric laryngopharyngeal microcystic disease, using radiofrequency ablation.

The conservative, surveillance-driven approach recommended by the American Thyroid Association is appropriate for stage I-III disease. However, the more aggressive approach advocated by the British Thyroid Association might provide stage IVa disease patients a greater chance of achieving a biochemical cure.

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