There are a number of situations where individuals wish to communicate verbally but are unable to use conventional means-so called 'silent speech'. These include speakers in noisy and covert situations as well as patients who have lost their voice as a result of a laryngectomy or similar procedure. This paper focuses on those who are unable to speak following a laryngectomy and assesses the possibility of speech recognition based on a magnetic implant/sensors system. Permanent magnets are placed on the tongue and lips and the changes in magnetic field resulting from movement during speech are monitored using a set of magnetic sensors. The sensor signals are compared to sets of pre-recorded templates using the dynamic time warping (DTW) method, and the best match is identified. Experimental trials are reported for subjects with intact larynx, typically using 500-1000 utterances used for speaker dependant training and testing. It is shown that recognition rates of over 90% are achievable for vocabularies of at least 57 isolated words: sufficient to drive command-and-control applications.

Surgical voice restoration post-laryngectomy has a number of limitations and drawbacks. The present gold standard involves the use of a tracheo-oesophageal fistula (TOF) valve to divert air from the lungs into the throat, which vibrates, and from this, speech can be formed. Not all patients can use these valves and those who do are susceptible to complications associated with valve failure. Thus there is still a place for other voice restoration options. With advances in electronic miniaturization and portable computing power a computing-intensive solution has been investigated. Magnets were placed on the lips, teeth and tongue of a volunteer causing a change in the surrounding magnetic field when the individual mouthed words. These changes were detected by 6 dual axis magnetic sensors, which were incorporated into a pair of special glasses. The resulting signals were compared to training data recorded previously by means of a dynamic time warping algorithm using dynamic programming. When compared to a small vocabulary database, the patterns were found to be recognised with an accuracy of 97% for words and 94% for phonemes. On this basis we plan to develop a speech system for patients who have lost laryngeal function.

This study, performed on 303 healthy volunteers, tested the null hypothesis that normal subjects were unable to assess their nasal patency when compared with objective measurement using peak inspiratory nasal flow rate (PINFR). Subjective assessments were made on a categorical scale and PINFR was measured using an In-Check meter. Analysis of variance showed that the peak inspiratory nasal flow rate, when grouped by the subjective scores, was significantly different.

OBJECTIVES/HYPOTHESIS:The objectives are to determine the frequency of chromosomal aberrations in 22 patients in the United Kingdom with head and neck squamous cell carcinoma and to compare our results with studies reported from western Europe and North America and highlight changes common to all groups, thus enabling focused study of important gene loci.STUDY DESIGN:Prospective experimental, then comparative observational study.METHODS:Comparative genomic hybridization was used to detect regions of chromosomal gain or loss across the entire genome. The aberration frequency was contrasted with other published series, and similarities and differences were highlighted.RESULTS:The most common chromosomal gain in all studies was 3q (50% to 87%). Other common chromosomal gains varied considerably between centers. The most common loss was 3p in three of the studies; one group in the United States reported 19p loss most frequently. The frequency of other losses varied considerably.CONCLUSIONS:Comparative genomic hybridization has highlighted a number of common genetic events in head and neck squamous cell carcinoma. The prevalence of individual aberrations differed between centers. Further cooperative multicenter studies of this technique are warranted.

Squamous cell carcinoma of the larynx can be treated using radiotherapy or surgery, either alone or in combination. Radiotherapy is preferred for early‐stage tumours, as it spares the larynx and therefore preserves speech and swallowing. Unfortunately, approximately 15% of tumours treated this way will prove to be radioresistant, as manifest by tumour recurrence within the original radiotherapy field over the ensuing 12 months. By causing extensive DNA damage, radiotherapy aims to induce apoptosis and tumour regression. Our hypothesis was that defects in the mechanisms that recognise DNA damage, induce cell cycle arrest or control apoptosis, either alone or in combination, may be responsible for radioresistance. We therefore undertook an immunohistochemic analysis of pretreatment biopsies of radioresistant (n = 8) and radiosensitive (n = 13) laryngeal tumours. To minimise the impact of confounding factors, strict inclusion criteria were observed; all tumours were of the glottic subsite and all recurrences developed within 12 months of radiotherapy at the site of the original tumour. The expression of key proteins involved in DNA damage recognition (p53), cell cycle arrest (ATM, p16 and p21/WAF1) and apoptosis (Bcl‐2 and BAX) were studied. Ki‐67 was also assessed as a marker of cell proliferation to exclude low mitotic rate as a cause of radioresistance. A statistically significant correlation was observed between overexpression of Bcl‐2 and radioresistance (p = 0.003, Fisher's exact test). We hypothesise that overexpression of the anti‐apoptotic protein Bcl‐2 allows tumour cells with extensive radiation‐induced DNA damage to continue proliferating; the absence of an appropriate apoptotic response manifests clinically as radioresistance. © 2002 Wiley‐Liss, Inc.

OBJECTIVE:Comparative genomic hybridization was performed on head and neck squamous cell carcinoma and surrounding mucosa to determine whether common chromosomal aberrations could be detected that would predispose an individual to developing a second primary tumor.DESIGN:Biopsy specimens were taken from 19 patients with squamous cell carcinoma of the head and neck, 3 samples from each person: 1 specimen from the tumor site and 1 each from 1 and 5 cm from the macroscopic tumor margin. Samples were snap frozen in liquid nitrogen. A portion of each distant sample and tissue taken from immediately adjacent to the site of the tumor specimen were sectioned and stained with hematoxylin-eosin, either to search by light microscopy for tumor cells or signs of dysplasia in the distant samples, or to determine whether the tumor specimen had substantial non-tumor cell content. Tissue adjacent to the tumor biopsy site was used because the biopsy specimens were relatively small. Comparative genomic hybridization was performed on all samples.SUBJECTS:Nineteen patients with newly diagnosed carcinomas of the head and neck.RESULTS:The tumor biopsy specimens showed no substantial nontumor cell content, and the distant specimens were all histologically normal. The tumors showed multiple mutations: mean (SD) number of deletions, 5.4 (4.3); amplifications, 5.2 (4.6). Deletion of chromosome 3p was seen in 13 of 19 cases and was associated with amplification of 3q in 10 cases. No mutations were seen in the distant biopsy specimens.CONCLUSIONS:Frequently occurring chromosomal aberrations were seen in the tumor cells, suggesting a key role for these mutations in tumor development. Screening histologically normal upper aerodigestive tract mucosa with comparative genomic hybridization does not provide information on early genetic events that predispose a patient to developing a second primary tumor.

The now commonplace wearing of external nasal splints by sportsmen and athletes has never been scientifically evaluated. The present study looks into the effect of both isometric and isotonic exercise on nasal resistance and examines if this is altered by the wearing of an external nasal splint. Twenty subjects who did not suffer from rhinitis were tested. Nasal resistance measurements were recorded using an anterior rhinomanometer before and after exercise, with and without an external nasal splint. Pulse and blood pressure were measured using a Criticare Inc. model 508 physiological monitor before and after exercise. Significant changes were observed in pulse (P < 0.001) and both systolic (P < 0.002) and diastolic (P < 0.001) blood pressure in response to isotonic exercise and pulse (P < 0.0001) and diastolic blood pressure (P < 0.0006) in isometric exercise. Significant differences were seen in nasal resistance when the splint was applied before (P < 0.001) and after exercise in both groups (P < 0.003). No significant difference was observed between the post-isotonic exercise groups with and without the splint (P= 0.167) but significant differences were seen in the isometric group (P < 0.0001). External nasal splints decrease nasal resistance at rest but are of little proven value when performing isotonic exercise however significantly reduce nasal resistance during isometric exercise.

OBJECTIVES: The now commonplace wearing of external nasal splints by sportsmen and athletes has never been scientifically evaluated. The present study looks into the effect of isotonic exercise on nasal resistance, and examines whether this effect is altered by the wearing of an external nasal splint. METHODS: Twenty subjects not suffering from rhinitis were tested. Nasal resistance measurements were recorded using an anterior rhinomanometer before and after isotonic exercise with and without an external nasal splint. Pulse and blood pressure were measured before and after exercise. RESULTS: Significant changes were observed in pulse (p < 0.001) and both systolic (p < 0.002) and diastolic (p < 0.001) blood pressure in response to exercise. Significant differences were seen in nasal resistance when the splint was applied (p < 0.001) and after exercise (p < 0.003). No significant difference was observed after exercise when the splint was worn (p = 0.167). CONCLUSIONS: External nasal splints decrease nasal resistance at rest but are of little value during isotonic exercise.

Vascular endothelial growth factor (VEGF) is a key pro-angiogenic cytokine expressed by most human tumours. Two isoforms, VEGF(121) and VEGF(165), are soluble and can be assayed in serum. Serum VEGF has been shown to be significantly raised in patients with solid tumours and shows some promise as a potentially useful tumour marker. Serum levels of VEGF were assayed in 52 patients with untreated head and neck squamous cell carcinoma (HNSCC) and 104 healthy controls. Serum VEGF is significantly raised in patients with HNSCC (P < 0.001), but there was no association with either tumour stage or specifically the presence of nodal metastases. Sixteen patients (31%) had a higher serum VEGF than 95th centile of controls, suggesting that serum VEGF measurement is of little practical use as an initial diagnostic tool. The finding that patients with HNSCC have significantly raised serum VEGF probably relates to enhanced platelet aggregation in these patients.

The nasal mucosal pH is approximately 5.5-6.5, and increases in rhinitis to 7.2-8.3. This knowledge has not led to the widespread measurement of the nasal mucosal pH as an objective clinical parameter. The purpose of this study was to assess whether repeatable measures of nasal mucosal pH could be obtained in the clinical setting. Fifty-four adults without nasal symptoms were prospectively recruited. Using a semi-disposable antimony pH catheter, the nasal mucosal pH was measured in four specific areas of the nose and each reading repeated three times. The patients' age, sex, smoking habits, nasal anatomical variation and clearest nostril at the time of measurement were also recorded. The data shows that it is possible to obtain reliable and repeatable values for the pH of the nasal mucosa (Spearman-Brown R = 0.84). Analysis shows there is no significant difference between septal and turbinate mucosal pH. Subset analysis implies that nasal mucosal pH is higher in men then women (P < 0.05). The other variables did not affect the nasal mucosal pH significantly.

The operation of tonsillectomy requires the oral cavity to be held open mechanically in an unconscious patient, and intra-oral instrumentation to occur. Angular cheilitis may arise as a result of this after operation. This can cause morbidity and delay the re-establishment of a normal diet. The aim of this study was to identify what factors increase the likelihood of developing this problem postoperatively. Sixty patients were randomly selected in a prospective manner. Preoperative, intraoperative and postoperative variables were recorded. The frequency of development of postoperative angular cheilitis was recorded. The prevalence of the condition was related to the prerecorded variables. Parametric analysis showed that the chance of developing angular cheilitis was directly related to the use of diathermy haemostasis (P = 0.05). Logistic regression analysis showed that the odds ratio of developing this complication if diathermy was used is 3.5 (95% confidence intervals 0.99, 12.4) and operation difficulty may also be a relevant variable. No other recorded variables were found to be significant.

Clinical Otolaryngology & Allied SciencesVolume 24, Issue 4 p. 377-383 Global differences in genetic abberations in squamous cell carcinoma of the head and neck S. R. Ell, S. R. Ell ENT Department, Hull Royal Infirmary, andSearch for more papers by this authorJ. N. E. Ashman, J. N. E. Ashman ENT Department, Hull Royal Infirmary, andSearch for more papers by this authorJ. Greenman, J. Greenman Academic Surgical Unit, University of Hull, Hull, UK)Search for more papers by this authorN. D. Stafford, N. D. Stafford ENT Department, Hull Royal Infirmary, andSearch for more papers by this author S. R. Ell, S. R. Ell ENT Department, Hull Royal Infirmary, andSearch for more papers by this authorJ. N. E. Ashman, J. N. E. Ashman ENT Department, Hull Royal Infirmary, andSearch for more papers by this authorJ. Greenman, J. Greenman Academic Surgical Unit, University of Hull, Hull, UK)Search for more papers by this authorN. D. Stafford, N. D. Stafford ENT Department, Hull Royal Infirmary, andSearch for more papers by this author First published: 25 December 2001 https://doi.org/10.1046/j.1365-2273.1999.00254-12.xRead the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume24, Issue4August 1999Pages 377-383 RelatedInformation

Clinical Otolaryngology & Allied SciencesVolume 24, Issue 4 p. 377-383 Circulating vascular endothelial growth factor in patients with head and neck squamous cell carcinoma J. J. Homer, J. J. Homer (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this authorJ. Greenman, J. Greenman (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this authorS. R. Ell, S. R. Ell (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this authorN. D. Stafford, N. D. Stafford (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this author J. J. Homer, J. J. Homer (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this authorJ. Greenman, J. Greenman (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this authorS. R. Ell, S. R. Ell (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this authorN. D. Stafford, N. D. Stafford (Department of Otolaryngology/Head and Neck Surgery, University of Hull/Hull Royal Infirmary, Hull, UK)Search for more papers by this author First published: 25 December 2001 https://doi.org/10.1046/j.1365-2273.1999.00254-10.xRead the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume24, Issue4August 1999Pages 377-383 RelatedInformation

We report a case of an impacted foreign body in the tonsil presenting as recurrent unilateral tonsillitis. A completely embedded foreign body should be considered in cases of recurrent unilateral tonsillitis.

Authors seem to have misunderstood pharmaceutical price regulation schemeEditor-Maynard and Bloor put forward several remedies to control the cost and availability of NHS medicines. 1

LI, L2 and L3. The incidence of symptomatic vertebral haemangiomas, however, remains unknown4; 100 cases had been reported world wide up to 19946. Primary haemangiomas of the bone are usually solitary. In a necropsy study'0, the tumour was single in 66.5% of cases; in 32.8% of cases there were 2-5 lesions and in 0.7% more than 5. There are very few published cases of symptomatic bony haemangiomas at multiple sites. Karlin and Brower2 reported a patient with involvement of spine, skull and ribs, with symptoms resembling those in our patient. Haemangiomas of bone usually have characteristic radiological features. On plain radiographs a typical striated 'honeycomb' or 'sunburst' appearance is observedl and their resemblance to a metastatic tumour has been remarked before4. In our patient the plain radiographs did not show any specific abnormal changes. Although the MRI showed features compatible with a haemangioma, the bone scan demonstrating 'hot spots' in the ribs favoured the diagnosis of a metastatic lesion. Embolization is a useful treatment in this condition. In some patients it is sufficient in itself; in others, subsequently requiring open surgery, it helps considerably by reducing operative blood loss. This case highlights the value of a plain CT scan in difficult cases, in helping to distinguish multiple primary haemangiomas of bone from metastatic disease. A similar error was made on radiographs in a patient from a series from the National Hospital, with fatal results11. Acknowledgment We thank Mr Spiros Sgouros for providing the photographs and Mr Andre Jackowski, under whose care the patient was treated.