Objectives Surgical repair of a tympanic membrane perforation is a common otologic procedure. However, achieving a successful closure can be challenging, especially if the anterior margin of the tympanic membrane is involved. The aim of this study was to systematically review the literature on evidence published in closure of anterior tympanic membrane perforations. Data Sources The following data sources were searched: Cochrane Central Register of Controlled Trials (1997 to August, 3 2017), MEDLINE (February 1948 to August 3, 2017), and Embase (1975 to August 3, 2017). Data Extraction Two authors independently reviewed titles and abstracts. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. For the purpose of this study, the inclusion criteria were as follows; (1) studies reporting surgical technique for closure of anterior tympanic membrane perforations, (2) primary cases only, (3) articles published in the English language, (4) minimum 6-month follow-up, and (5) recorded pre- and postoperative audiometry. The exclusion criteria were non-English language articles, revision surgery, and no audiometric outcomes. Results On initial search, a total of 181 articles were identified (PubMed, n = 136; Cochrane, n = 28; Embase, n = 17). Based on the criteria, 136 articles were excluded. Full text of 45 articles was reviewed, and a further 24 articles were excluded. A total of 21 articles fulfilled the criteria for study inclusion. Conclusions All published evidence is level 4. High-quality controlled studies are required to determine the most effective method for closure of anterior tympanic membrane perforation.

Open surgical management of auricular haematoma has been successful. The technique is simple and reliable, and can be accomplished in a clinical setting under local anaesthesia.

Emergency presentations are increasing annually. Female patients and oropharyngeal cancer showed greater representation compared to male patients and laryngeal cancer.

A 57-year-old Caucasian man, otherwise fit and well, presented with a 2-week history of dysphagia, odynophagia. Two weeks prior to the presentation, he had felt a fishbone stuck in his throat which was self-extruded after 3 days. Subsequently he developed a right anterior neck swelling and hoarseness. Transnasal endoscopic examination of larynx revealed an injected and oedematous right hemilarynx with right vocal cord paresis. An ultrasound examination of the neck confirmed a collection in the neck on the right side, and frank pus was aspirated from the neck abscess and he responded well to conservative management. Subsequent examination in follow-up had shown complete recovery of vocal cord movement. The patient did not seek medical attention immediately after getting a 5 cm fishbone extruded from the throat which resulted in significant morbidity. All patients should be alerted to the possibility of delayed complications and they should be encouraged to seek urgent medical attention.

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Objectives: The link between cigarette smoking and outcome following surgical repair of tympanic membrane perforation is unclear. The objective of this study was to conduct a systematic review on the link between smoking and success rate following surgical repair of tympanic membrane perforations. Materials and Methods: Systematic review performed using the following data sources: 1) Cochrane central register of controlled trials (1997 to April 30, 2018), 2) Medline (February 1948 to April 30, 2018), and 3) Embase (1975 to April 30, 2018). Inclusion criteria for this study was: 1) studies reporting surgical closure of tympanic membrane perforations in smokers, 2)primary and revision cases, 3) English language literature, 4) minimum follow-up period of 6 months, and 5) pre and postoperative audiogram. The exclusion criteria were: 1) no identifiable data on smokers in reported outcomes, 2) less than 6 months follow-up, 3) no audiometric outcomes, and 4) non-English language articles. Results: A total of 75 studies were identified on initial search and 8 were eligible for the study. All studies were of level 4 evidence. In these eight studies, overall surgical closure of tympanic membrane perforation was successful in 512/577 (88.7%) of nonsmokers and 151/197 (76.6%) in smokers. This difference was statistically significant. Conclusions: Smokers may have a lower success rate compared against nonsmokers for surgical repair of tympanic membrane perforations. Our review has limitations and more prospective high-quality controlled trials are required to further study this association.

SUMMARYAn 81-year-old man was referred urgently to the head and neck clinic with symptoms of worsening dysphagia, dysphonia and weight loss. He had a history of chronic lymphocytic leukaemia. On full ear, nose and throat examination, he was found to have fixed vocal cords with pooling of saliva in the bilateral pyriform fossa. Hypopharyngeal malignancy was suspected and further imaging was performed. Imaging also raised the suspicion of malignancy in the hypopharynx. Rigid endoscopic examination under general anaesthesia was carried out which revealed an impacted denture in the cricopharynx and upper oesophagus. The patient was aware of his loss of dentures 3 months ago (corresponds to the onset of his symptoms) but felt that he had mislaid them and had never mentioned this to anyone. We present a case highlighting a delay in diagnosis, a missed diagnosis on CT scan and an unusual presentation leading to bilateral vocal cord paresis. BACKGROUND

A 77-year-old woman presented with a pulsatile blue-tinged mass over the left parotid, present for 5 years, and slowly enlarging. The size of the mass fluctuated during this period and there was no associated pain. The patient reported no history of surgery or trauma. Vascular lesions are rarely encountered within parotid glands in adults. MRI with contrast demonstrated a soft tissue lesion; despite the presence of feeding vessels it was thought unlikely to be an arterial venous malformation or aneurysmal change. The appearance was thought to be in keeping with an enlarged lymph node or sebaceous cyst. Fine-needle aspiration was obtained using ultrasound guidance and yielded bloody fluid. The lesion was closely related to the superficial temporal artery and a diagnosis of a thrombosed pseudoaneurysm was made. The vessel had thrombosed and the decision was made to enact a watchful waiting policy. The patient will be monitored in the outpatient setting.