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Deep venous thrombosis (DVT) and pulmonary embolism (PE) are an important cause of morbidity and mortality in the surgical patient. The first guideline produced by the Scottish Intercollegiate Guidelines Network was for the prophylaxis of venous thromboembolism. Patients undergoing major head and neck cancer surgery commonly exhibit risk factors for venous thromboembolism. Currently, however, there are no data on its incidence in these patients. A questionnaire survey was performed to assess the current practice of consultant otolaryngologists regarding DVT prophylaxis in patients undergoing head and neck cancer surgery. Of those respondents who managed these patients, 57 per cent did not use routine DVT prophylaxis while 43 per cent did. A wide variety of techniques were employed among those practising DVT prophylaxis. A consensus is needed concerning the use of thromboembolism prophylaxis in head and neck surgery patients.

A case of sensorineural hearing loss (SNHL) in MELAS syndrome, a variety of mitochondrial cytopathy, is presented. Mitochondrial cytopathies have gone almost unreported in the otolaryngology literature, despite evidence from a recent review that about 60 per cent of such patients suffer from SNHL (Gold and Rapin, 1994). The same review revealed that only one of 117 case reports in the period 1984-1993 contained an audiogram (Swift and Singh, 1988), and none presented sequential audiograms. However, audiometry has since been published on 23 members of a family with a mitochondrial point mutation causing only sensorineural hearing loss with no other symptoms (Vernham et al., 1994). We present a case of mitochondrial cytopathy three years after diagnosis with two sequential audiograms.

Reinke's oedema (RO) of the vocal folds is a condition of unknown aetiology. Cigarette smoking and vocal abuse may contribute to its development. Hypothyroidism has been described as an aetiological factor but, to date, no controlled study has been published confirming this association. This prospective, controlled study compared thyroid function in 61 consecutive RO patients with an age and sex matched control group (n = 65) without laryngeal disease. Thyroid function was assessed by measuring serum thyroid stimulating hormone (TSH), free thyroxine (T4) and tri-iodothyronine (T3). Hypothyroidism was diagnosed when TSH was above normal with a T3 and T4 below the normal range. Four RO patients were hypothyroid at the time of diagnosis, compared to five of the control group. Six RO patients had past or present hypothyroidism compared to seven of the controls. One RO patient and two controls were euthyroid with marginally elevated TSH levels. Although the incidence of hypothyroidism in this group of Reinke's oedema patients is higher than expected in a normal population, it is similar to that in an age and sex matched control group, reflecting the prevalence of hypothyroidism in middle aged women. This study suggests that hypothyroidism is not an aetiological factor in the development of Reinke's oedema.

Pleomorphic adenomas of the salivary gland are usually regarded as benign tumours. We report a case in which a solitary pulmonary metastasis arose from a pleomorphic adenoma of the right parotid gland. The mechanism of metastasis is discussed.

Neurological complications are rare after central venous cannulation. We report a case of right vocal cord paralysis after internal jugular vein cannulation. The mechanism of neural injury is discussed.

Three hundred and ten patients were examined by otoscopy. Age, sex, social class and use of cotton buds for aural toilet were recorded. The incidence of visually occlusive wax plugs in the external auditory canals was not significantly different between users and non-users of cotton buds, either in children or in adults.

In this prospective study of 126 patients attending the ENT outpatient clinic the doctor's and the patient's perception of the consultation were evaluated by questionnaire; 96 patients completed the questionnaire correctly. The results were analysed by scattergram plot and Wilcoxon's matched-pair signed ranks test. There was a statistically significant difference between the doctor's and the patient's perception of the 'history' (p less than 0.01) and the 'explanation of diagnosis and treatment' (p less than 0.05) in the consultation. There was no statistically significant difference between the doctor's and the patient's perception of the 'examination' in the consultation. The results are discussed.

Inverted papilloma is an uncommon benign nasal tumour which usually occurs on the lateral nasal wall and is prone to recurrence and malignant change. Inverted papilloma of the nasal septum is rare. A case of inverted papilloma and coexistent squamous carcinoma of the nasal septum in an adult male is described. The biology and treatment of these lesions are discussed.

Recent studies have shown neuroendocrine-type cells in human spiral prominence epithelium. A light microscopic and ultrastructural study was made on the guinea pig spiral prominence epithelium to try and identify neuroendocrine cells. The study showed that such cells were not present in the guinea pig spiral prominence epithelium. The spiral prominence epithelium was characterized by uniformity of cellular staining with Toluidine blue and the ultrastructural appearance. The morphology of the spiral prominence epithelium was similar to that previously described. The absence of neuroendocrine cells in spiral prominence epithelium in the guinea pig is discussed in relation to species differences.

Primary nasal tuberculosis is rare. We report a case of primary nasal tuberculosis in an elderly lady who presented with symptoms and signs suggestive of a nasal fossa tumour. Histological examination of the lesion revealed the diagnosis. Treatment was with standard anti-tuberculous chemotherapy. The implications of primary nasal tuberculosis are discussed.