Concha bullosa is the pneumatisation of intranasal conchae (usually the middle turbinate, and rarely the inferior or superior turbinate); however, the term is generally used to describe aeration of the middle concha. Superior concha bullosa is a rare finding, and only a few cases of inferior concha bullosa have been reported in the medical literature. When symptomatic, concha bullosa may cause various problems including nasal congestion, headache, postnasal drip, anosmia and, sometimes, epiphora.

Computed tomography, following history-taking and physical examination, is a valuable tool in diagnosing turbinate pneumatisation. This article presents a very rare case with bilateral triple conchae pneumatisations.

The symptomatology, diagnosis and treatment options for cases of multiple concha bullosa are discussed. The surgical interventions performed in the presented case are briefly described.

The presented patient had pneumatisation of all six turbinates. In such cases, we propose that this condition be termed ‘conchae bullosis’ rather than ‘conchae bullosa’, in a similar fashion to the use of nasal polyposis as the plural form of nasal polyp.

To describe two cases of profound hearing loss secondary to enterohaemorrhagic Escherichia coli infection, and to report the efficacy of subsequent cochlear implantation.

The first case was a four-year-old girl admitted to hospital with Escherichia coli O157 infection and haemolytic uraemic syndrome. Mild hearing loss was confirmed five months after discharge, progressing to profound loss three months later. At the age of seven years, she underwent cochlear implantation, with remarkable improvement in speech perception and production. The second case was a three-year-old boy admitted with haemolytic uraemic syndrome caused by Escherichia coli O111 infection. One year after disease onset, profound hearing loss was confirmed. Cochlear implantation at the age of five years produced significant recovery of auditory function.

This study represents the first published report of secondary hearing loss after recovery from haemolytic uraemic syndrome caused by enterohaemorrhagic Escherichia coli. It indicates that cochlear implantation can restore hearing function in such patients.

There has been a major evolution in laryngeal surgery, largely due to an improved understanding of disease pathogenesis and advances in technology, especially the introduction of lasers.

Continuous laser plume evacuation during endolaryngeal surgery improves visualisation of the surgical field. Hence, microlaryngoscopes are fitted with smoke evacuation channels on their sides. We have devised a new, simple and efficient suction holder clip for endolaryngeal surgery that has distinct advantages over other suction holders.

To describe a rare case of multiple anatomical variations in the sinonasal skeleton of an adolescent with chronic rhinosinusitis, together with its successful surgical management.

A 15-year-old male adolescent was referred with a 3-year history of nasal blockage and hyposmia. His symptoms did not improve on maximal medical therapy. A pre-operative computed tomography scan revealed numerous anatomical variations in his nose and paranasal sinuses. He underwent neuronavigation-assisted endoscopic sinus surgery without complication, and with subsequent resolution of his symptoms at 10 months.

Chronic rhinosinusitis in children offers its own set of unique surgical challenges. The effectiveness and safety of sinus surgery in this population can be improved through the knowledge of anatomical variants, and is aided by the use of image guidance systems.

To describe a case of giant cell reparative granuloma of the temporal bone which extended into the middle-ear cavity, and which was successfully treated surgically via a transmastoid approach, with hearing preservation.

A 37-year-old man presented with a one-year history of right-sided hearing loss, complicated by a three-month history of otalgia and a sensation of aural fullness. Computed tomography and magnetic resonance imaging demonstrated an osteolytic tumour lesion in the right temporal bone. The diagnosis was confirmed by biopsy from the mastoid lesion.

Pure-tone audiometry, computed tomography and magnetic resonance imaging were conducted, followed by total resection.

The giant cell reparative granuloma of the temporal bone was completely resected, with preservation of hearing.

Although this patient's giant cell reparative granuloma of the temporal bone extended into the middle-ear cavity, total resection was achieved, with preservation of hearing. To the best of our knowledge, hearing preservation following resection of giant cell reparative granuloma of the temporal bone has not previously been reported.

To report a case of life-threatening epistaxis in a pregnant patient, describe the links between pregnancy and epistaxis, and discuss the management of such cases. Life-threatening epistaxis in pregnancy is rare, and there are no specific evidence-based guidelines regarding the management of these patients.

A 31-year-old primigravida presented with severe epistaxis in the second trimester of her pregnancy. Conservative measures failed, thereby necessitating surgical intervention.

This case illustrates the importance of a multidisciplinary approach in the management of a pregnant patient presenting with severe epistaxis, and highlights the surgical challenges presented in such a situation.

We report two extremely rare cases of symptomatic nasopharyngeal branchial cleft cyst treated by powered instrument assisted marsupialisation.

Case report and literature review concerning nasopharyngeal branchial cleft cyst and surgical treatment methods.

The first case was a two-year-old boy with a 1 × 2 cm, cystic, oropharyngeal mass, who also had severe snoring and sleep apnoea. The second case was a 56-year-old man with right nasal obstruction and a sensation of fullness in the right ear. In both cases, we performed endoscopic marsupialisation using a powered instrument. There was no recurrence in either case over two years of follow up.

Powered instrument marsupialisation is a simple, effective and less invasive technique for the treatment of nasopharyngeal branchial cleft cyst.

This paper describes and discusses the case of an oesophageal foreign body, in which the patient presented with primarily respiratory clinical signs.

A 17-month-old child, who had ingested a watch battery, presented to emergency services on multiple occasions with upper respiratory tract symptoms. Subsequent radiographs showed the battery in the oesophagus impinging on the trachea. The battery was removed successfully under a general anaesthetic.

Large oesophageal foreign bodies can impinge on the trachea causing upper respiratory tract signs. In such cases, anteroposterior and lateral chest films are imperative to make a correct diagnosis.

To report and discuss the outcome of a treatment algorithm for patients with tumour stage 1 glottic squamous cell carcinoma.

A retrospective outcome analysis study was performed using data from a tertiary referral centre.

Sixty-nine patients were treated with radiotherapy and 26 with surgery, in accordance with the treatment algorithm. Five-year overall survival rates were the same for both treatment groups (92 per cent). Five-year disease-specific survival rates were 100 per cent for surgery, 98 per cent for radiotherapy and 99 per cent overall. The overall 5-year laryngeal preservation rate was 89.1 per cent, being 95.7 per cent for surgery patients and 86.7 per cent for radiotherapy patients (p = 0.502). There was no significant association between laryngeal preservation rates and age (p = 0.779), anterior commissure involvement (p = 0.081), tumour stage (1a or 1b) (p = 0.266) or treatment modality (surgery or radiotherapy; p = 0.220). There was no significant difference in local recurrence rates between the two treatment groups (19.3 per cent for radiotherapy vs 10.0 per cent for surgery; p = 0.220). The overall 5-year regional recurrence rate was 1.2 per cent.

Tumour stage 1 glottic carcinoma can be managed with different treatment modalities, following an individualised treatment algorithm, with results comparable to published outcomes.

To outline the management options and neurological complications associated with repeated traumatic falls that cause intrusion of bone-anchored hearing aid abutments.

A three-year-old boy with coloboma, heart defects, atresia of nasal choanae, retarded growth, genital abnormalities, ear defects and deafness was fitted with a bone-anchored hearing aid for severe conductive hearing loss and congenital ear malformations. Six months later, a traumatic fall caused an intrusion injury which rendered the bone-anchored hearing aid abutment unusable. Without removing the original abutment, a second abutment was inserted on the same side to aid his hearing. Two years later, the child fell again and damaged his second bone-anchored hearing aid abutment. Having been offered a surgical option to repair the area, the parents opted to keep the abutments in situ.

Direct trauma to the fixture of a bone-anchored hearing aid is a relatively common long-term complication in children which can disrupt osseointegration and disable the implant. For young children who are either prone to falling or have behavioural problems, a bone-anchored hearing aid Softband may be more appropriate to non-invasively aid hearing.

To report previously unreported complications of bilateral sphenopalatine artery ligation.

We present the case of a 45-year-old man who underwent bilateral sphenopalatine artery ligation to control intractable posterior epistaxis. After four months, he re-presented with nasal obstruction and crusting.

Examination under general anaesthesia showed posterior septal perforation and bilateral necrosis of the lower parts of the middle turbinates. The necrotic parts were excised. The patient had no more complaints.

Following sphenopalatine artery occlusion, ischaemic necrosis is a potential risk in anatomical areas that receive their only arterial supply from this artery. The staging of bilateral sphenopalatine artery occlusion needs to be studied.

A simple subcutaneous lesion such as an epidermoid cyst can present a challenge when located in the nasal tip, as regards aesthetic surgical management. Even when performed parallel to relaxed skin tension lines, a direct transcutaneous incision (commonly used for epidermoid cyst removal) distorts the nasal tip subunit, resulting in a conspicuous, disfiguring scar. This should be avoided, especially in children.

A 13-year-old girl was referred by her dermatologist for diagnosis and treatment of a slowly progressive dermoid cyst located on the tip of her nose. The cyst was removed using a subcutaneous open rhinoplasty approach, leaving the aesthetic nasal tip subunit intact.

For aesthetic reasons, open rhinoplasty should be considered as a treatment option in patients with subcutaneous lesions in the nasal tip.

Vestibular nerve section is a highly effective procedure for the control of vertigo in patients with Ménière's disease. However, hearing loss is a possible complication. If hearing loss occurs after vestibular nerve section, magnetic resonance imaging should make it possible to establish the presence or absence of an intact cochlear nerve.

Case report and review of the world literature concerning cochlear implantation after vestibular nerve section.

We present a patient who developed subtotal hearing loss after vestibular nerve section. Magnetic resonance imaging was used to verify the presence of an intact cochlear nerve, enabling successful cochlear implantation.

To our knowledge, this is the first reported case of cochlear implantation carried out after selective vestibular nerve section. Given recent advances in cochlear implantation, this case indicates that it is essential to make every effort to spare the cochlear nerve if vestibular nerve section is required. If hearing loss occurs after vestibular nerve section, magnetic resonance imaging should be undertaken to establish whether the cochlear nerve is intact.

This study aimed to evaluate the efficacy of post-operative voice therapy after phonomicrosurgery for vocal polyp removal.

The study retrospectively enrolled 55 consecutive patients who had undergone voice therapy after phonomicrosurgery for vocal polyp removal occurring between June 2010 and June 2011. A historical group of 63 similar patients not receiving voice therapy was used as an external control. We compared voice analysis parameters and Voice Handicap Index scores for the two groups.

Most objective and subjective voice outcome parameters were significantly improved after surgical treatment. Although the study and control groups showed no significant difference regarding objective parameters (using acoustic and aerodynamic analysis) or the subjective parameters assessed using the grade-roughness-breathiness-asthenia-strain scale, the study group had significantly better final Voice Handicap Index scores.

Following surgery for vocal polyps, post-operative voice therapy can improve patients' vocal discomfort, emotional responses and everyday self-perception.

Organised haematomas of the maxillary sinus are rare, non-neoplastic, haemorrhagic lesions which can extend into the nasal cavity and/or the other paranasal sinuses. This study aimed to investigate the pathology of maxillary sinus organised haematoma, and also proposes a new aetiological hypothesis based on the observed pathology.

Biopsies, computed tomography, magnetic resonance imaging and post-surgical histopathological examination of resected specimens were carried out.

Distinct pathological differences were observed between the basal and peripheral portions of organised haematomas. We propose that an organised haematoma originates from the exudation of blood components between vascular endothelial cells. As a result, the basal portion consists of aggregated, dilated vessels around the natural ostium of the maxillary sinus. In addition, pseudovessels, without endothelial cells, arise from endocapillary vessels within the haematoma. Exudation of additional blood components from the pseudovessels advances the growth of the organised haematoma.

Allergic reactions to Prolene are rare. This paper reports a nasal tip abscess which developed in a patient with an adverse skin reaction to Prolene after rhinoplasty.

A 26-year-old woman presented with painful, progressive nasal tip swelling and redness. She had undergone septo-rhinoplasty two years previously. She was initially treated with endonasal drainage of the abscess and antibiotics, but a revision rhinoplasty three months later became necessary because of recurrent abscess formation. Intra-operative findings included granulation tissue with pockets of pus and knotted Prolene sutures at the tip-defining points of the lower lateral cartilages. She was patch-tested with Prolene and a cutaneous Prolene suture was placed on her back; an adverse skin reaction was seen for the latter.

Use of non-absorbable sutures, such as Prolene, in the subcutaneous layer may be a potential, rare risk factor for adverse skin reactions.

The objective of this article was to report a case of isolated, acute, right-sided sphenoid sinusitis that progressed to contralateral cavernous sinus thrombosis in an 18-year-old male patient. We describe the atypical presentation of this case and discuss the relevant anatomy, pathogenesis, presentation, diagnostic evaluation and treatment.

A case report of sphenoid sinusitis leading to contralateral cavernous sinus thrombosis was reviewed and presented along with a comprehensive literature review of the relevant anatomy, pathophysiology, microbiology, diagnostic work-up and treatment options.

Cavernous sinus thrombosis is a rare clinical entity in the antibiotic era. However, limited sphenoid sinusitis may progress to cavernous sinus thrombosis in spite of maximal medical treatment, as highlighted in this case report. The mainstay of treatment includes early diagnosis allowing aggressive intravenous antibiotics and appropriate surgical management.

To report a rare and unique presentation of metastatic breast cancer.

Case report and review of related literature.

A 62-year-old female with metastatic breast cancer, who had been free from recurrence for 4 years, presented with diplopia secondary to lateral rectus palsy. This was due to a sphenoid sinus metastasis, which was eroding into her cavernous sinus, resulting in VIth cranial nerve neuropathy.

All paranasal sinuses and the orbit are potential sites for metastases. Spread to the paranasal sinuses from breast cancer has been documented previously. However, we believe this to be the only reported case with lateral rectus palsy as a result of metastasis to the sphenoid sinus in which this was the only evidence of disseminated disease. Otolaryngology clinicians need to consider metastatic disease to the sinuses in patients with a history of neoplasia, but also recognise that tamoxifen treatment can itself cause visual disturbance.

More than a century has passed since Emil Theodor Kocher first described the use of ‘Kocher's thyroid dissector’ to secure the superior thyroid pedicle.

Despite the technological advances in thyroid surgery, the dissector remains an extremely useful instrument. This paper describes a modified use of the dissector, and reports on how this facilitates safer and easier surgery.

Application of this simple, modified technique can improve the safety and efficiency of thyroid surgery, with negligible financial outlay.

Community-acquired methicillin-resistant Staphylococcus aureus is a growing health concern. Lemierre's syndrome is a septic jugular thrombophlebitis that primarily affects young adults. This paper aimed to identify a possible sub-group of Lemierre's syndrome cases associated with community-acquired methicillin-resistant Staphylococcus aureus.

This paper reports the case of a 16-year-old male who was admitted for increasing fever, tachycardia, tachypnoea and neck pain. The patient was diagnosed with methicillin-resistant Staphylococcus aureus bacteraemia associated with Lemierre's syndrome. A literature review was subsequently conducted.

Following intravenous antibiotic treatment and the sterilisation of blood cultures, the patient improved. The literature review indicated a rise in the past 2 years of Lemierre's syndrome associated with methicillin-resistant Staphylococcus aureus among patients less than 18 years of age.

Community-acquired methicillin-resistant Staphylococcus aureus bacteraemia can lead to pulmonary sequelae. When it is associated with pharyngitis, nasopharyngitis or parapharyngeal lymphadenitis, the affected patient may be predisposed to Lemierre's syndrome. As bacterial carriage is predominantly nasal, pharyngitis may not be present. Methicillin-resistant Staphylococcus aureus should be included as an offending bacterium where there is suspicion of Lemierre's syndrome. It is unclear whether anticoagulation alters the course of the bacterium, and surgery is probably contraindicated.