持续声嘶婴儿117例病因分析

Objective To explore the causes of persistent hoarseness in infants. Methods One hundred and seventeen infants with persistent hoarseness treated in the department of otorhinolaryngology in Children's Hospital of Fudan University between June 2008 and July 2010 were retrospectively analyzed ( all patients received antibiotic therapy for 2 weeks and the symptoms were not relieved after that). The patients were divided into three groups according to the age at first visit: 22 newborns, ＜ 6 months old in 60 cases,＜ 12 months old in 35 cases. All patients had video laryngoscope examinations. Some of them received CT scan, cardiac ultrasonography and pathological examination in additional. The diagnosis was established by clinical history and imaging modalities, and the causes were analyzed subsequently. Results Among the 117 patients, 45 cases were vocal hypertrophy and hyperplasia (37. 81% ), 39 cases were vocal cord paralyses (32. 78% ), 7 cases were laryngeal hemangiomas (5. 89% ), 4 cases were laryngeal webs and cyst (3. 36% ), 2 cases were vocal cord polyps ( 1.68% ), 2 cases were glottic incompetences ( 1.68% ),1 case was laryngeal papillomas(0. 84% ), 1 case was vocal code granulomas (0. 84% ), 1 case was glottis restricted by neck lymphangioma (0.84%); 4 cases were undetermined and 13 cases were no abnormalities. The percentage of patients with congenital heart diseases (19 cases)in vocal cord paralysis was 48. 72%. The proportion of vocal cord paralysis in younger group was higher than that in elder one ,their percentage were 50. 00%, 36. 67% and 17. 14% respectively ( x2 = 7. 18, P ＜ 0. 05). Conclusions A variety of causes can lead to persistent hoarseness in infants. The majority of them are vocal hypertrophy and hyperplasia, followed by vocal cord paralyse. Vocal cord paralysis is more common in younger infants than in elder ones, and the main causes are post-cardiac surgery and congenital heart disease.     

上颌窦鳞状细胞癌60例临床分析

Objective To study the clinical characters, treatment modalities and prognosis of patients with maxillary squamous cell carcinoma. Methods The clinical data of 60 patients with maxillary squamous cell carcinoma treatment between January 1994 and December 2004 were analyzed retrospectively.The patients were treated with three therapy modalities including radiotherapy alone(22 cases) ,radiotheraphy and surgery( R +S, 29 cases)and concurrent chemo-radio-therapy adjuvant surgery (CCR + S, 9 cases).Results The five year survival rate were 18.2%, 51.7% and 33.3% for patients in the radiotherapy alone group, the R + S group and the CCR + S group, respectively. Patients receiving R + S combined modality therapy had a significantly higher five year survival rate than the patients who were treated radiotherapy alone ( λ2 = 15.62, P <0.01 ). The five year survival rate(51.7% ) of patients in R + S group was significantly higher than that (33. 3% ) of patients in CCR + S group ( λ2 = 4. 28, P < 0.05 ), and also higher than that ( 18. 2% ) of patients in radiotherapy group( λ2 =9.49 ,P <0. 01 ). Conclusions The combined therapy of radiation and surgery was a good choice of treatment for the patients with maxillary sinus squamous cell carcinoma. The role of concurrent chemo-radiotherapy adjuvant surgery in the treatment of maxillary sinus squamous cell carcinoma needs further to research.     

上颌窦鳞状细胞癌60例临床分析

Objective To study the clinical characters, treatment modalities and prognosis of patients with maxillary squamous cell carcinoma. Methods The clinical data of 60 patients with maxillary squamous cell carcinoma treatment between January 1994 and December 2004 were analyzed retrospectively.The patients were treated with three therapy modalities including radiotherapy alone(22 cases) ,radiotheraphy and surgery( R +S, 29 cases)and concurrent chemo-radio-therapy adjuvant surgery (CCR + S, 9 cases).Results The five year survival rate were 18.2%, 51.7% and 33.3% for patients in the radiotherapy alone group, the R + S group and the CCR + S group, respectively. Patients receiving R + S combined modality therapy had a significantly higher five year survival rate than the patients who were treated radiotherapy alone ( λ2 = 15.62, P <0.01 ). The five year survival rate(51.7% ) of patients in R + S group was significantly higher than that (33. 3% ) of patients in CCR + S group ( λ2 = 4. 28, P < 0.05 ), and also higher than that ( 18. 2% ) of patients in radiotherapy group( λ2 =9.49 ,P <0. 01 ). Conclusions The combined therapy of radiation and surgery was a good choice of treatment for the patients with maxillary sinus squamous cell carcinoma. The role of concurrent chemo-radiotherapy adjuvant surgery in the treatment of maxillary sinus squamous cell carcinoma needs further to research.     

Stability of computed tomography densitometry in patients with otosclerosis:a two-year follow-up

Objectives:To quantify the progression of otosclerosis in the unoperated ear between two stapedotomy procedures for patients with bilateral otosclerosis which can help to determine whether a HRCT scan should be re-performed before the second surgery for patients who already received HRCT imaging before the initial surgery.Methods:35 patients who underwent bilateral stapedotomy were included.Two rounds of HRCT examination and audiometry were performed at the time of the first surgery and second surgery on the ear that was not operated on during the initial surgery.The relationship between the changes in HRCT densitometry and audiometry over time was analyzed.Results:The second round of HRCT did not add significant information about the changes to the otosclerosis lesions in either the imaging diagnosis or the HRCT density values except for small changes in the HRCT densitometry readings at the area anterior to the inner auditory(P=0.01).While the changes in HRCT manifestation are small,changes near the fissula ante fenestram(FAF)were still positively correlated with the air bone gap(ABG)of patients(p=0.031,r=0.388).Conclusions:The progression of lesions in otosclerosis is slow resulting in small and insignificant changes to the HRCT features.Therefore,a repeat HRCT evaluations prior to surgery is not necessary for patients who have had a previous HRCT evaluation within 2 years of the operation.The small changes in HRCT manifestation near the FAF were still correlated with negative effects on the ABG which could cause worsened hearing thresholds over this timeframe。     

A retrospective analysis of pain and opioid usage in head and neck free flap reconstruction

Objectives: Investigate opioid usage and postoperative pain in patients undergoing head and neck free flap surgery.Methods: A retrospective review of 100 consecutive patients undergoing head and neck free flap reconstruction at two academic centers was performed. Data captured included demographics, postoperative inpatient pain, pain at postoperative visits, morphine equivalent doses (MEDs) administration, medication history, and comorbidities. Data were analyzed using regression models,χ2 tests...     

Square wave manoeuvre for apogeotropic variant of horizontal canal benign paroxysmal positional vertigo in neck restricted patients

Objective:We aimed to describe the clinical features of the apogeotropic variant of horizontal canal benign paroxysmal positional vertigo(HC BPPV-AG)in a cluster of patients with restrictive neck movement disorders and a new therapeutic manoeuvre for its management.Methods:In a retrospective review of cases from an ambulatory tertiary referral center,patients with HC BPPV-AG in combination with neck movement restriction that prevented any classical manual repositioning procedure or who were refractory to canalith repositioning manoeuvres,were treated with a new manoeuvre comprised of sequential square-wave pattern of head and body supine rotations while nystagmus was being monitored,until either an apogeotropic to geotropic conversion or resolution of the nystagmus was observed.Results:Fifteen patients were studied.All but one[14/15 cases]showed a positive therapeutic response to the repositioning procedure in a single session.In two cases,a direct relief of vertigo and elimination of nystagmus was observed without an intermediate geotropic phase.Although in three patients the affected ear was not initially identified,it was ultimately identified and successfully treated by the square wave manoeuvre in all of them.Conclusions:The square-wave manoeuvre is an alternative for HC BPPV-AG treatment in either cases with neck restriction,where the affected side is not well identified at the bedside or when other manoeuvres fail to resolve the HC BPPV-AG.     

持续声嘶婴儿117例病因分析

目的 探讨婴儿持续声嘶的病因.方法 回顾性分析2008年6月至2010年7月间因持续声嘶就诊的婴儿117例(所有患儿均经2周抗炎治疗后声嘶无好转).按初诊年龄分为3组:新生儿组22例,小于6个月龄组60例,小于12个月龄组35例.所有患儿均接受电子喉镜检查,部分患儿行CT、心脏彩超、病理检查,并结合病史分析病因.结果 117例患儿中声带肥厚增生45例次(37.81%),声带麻痹39例次(32.78%),喉血管瘤7例次(5.89%),喉蹼喉囊肿4例次(3.36%),声带息肉2例次(1.68%),声门闭合不全2例次(1.68%),喉乳头状瘤、声带肉芽增生(气管插管后)、颈部淋巴管瘤压迫声门各1例次(各占0.84%);喉镜检查发现占位性病变但未进一步检查确诊者4例,喉镜检查没有发现异常13例.39例声带麻痹患儿伴发先天性心脏病者共19例,占48.72%.年龄越小声带麻痹患儿比率越高,其中新生儿组达50.00%,小于6个月龄组36.67%,小于12个月龄组17.14%,差异有统计学意义(x2=7.18,P＜0.05).结论 引起婴儿持续声嘶的病因以声带肥厚增生最多见,其次为声带麻痹.声带麻痹在小龄婴儿中较大龄婴儿更常见,以先天性心脏病术后及先天性心脏病为主要原因.

Abstract：

Objective To explore the causes of persistent hoarseness in infants. Methods One hundred and seventeen infants with persistent hoarseness treated in the department of otorhinolaryngology in Children's Hospital of Fudan University between June 2008 and July 2010 were retrospectively analyzed ( all patients received antibiotic therapy for 2 weeks and the symptoms were not relieved after that). The patients were divided into three groups according to the age at first visit: 22 newborns, ＜ 6 months old in 60 cases,＜ 12 months old in 35 cases. All patients had video laryngoscope examinations. Some of them received CT scan, cardiac ultrasonography and pathological examination in additional. The diagnosis was established by clinical history and imaging modalities, and the causes were analyzed subsequently. Results Among the 117 patients, 45 cases were vocal hypertrophy and hyperplasia (37. 81% ), 39 cases were vocal cord paralyses (32. 78% ), 7 cases were laryngeal hemangiomas (5. 89% ), 4 cases were laryngeal webs and cyst (3. 36% ), 2 cases were vocal cord polyps ( 1.68% ), 2 cases were glottic incompetences ( 1.68% ),1 case was laryngeal papillomas(0. 84% ), 1 case was vocal code granulomas (0. 84% ), 1 case was glottis restricted by neck lymphangioma (0.84%); 4 cases were undetermined and 13 cases were no abnormalities. The percentage of patients with congenital heart diseases (19 cases)in vocal cord paralysis was 48. 72%. The proportion of vocal cord paralysis in younger group was higher than that in elder one ,their percentage were 50. 00%, 36. 67% and 17. 14% respectively ( x2 = 7. 18, P ＜ 0. 05). Conclusions A variety of causes can lead to persistent hoarseness in infants. The majority of them are vocal hypertrophy and hyperplasia, followed by vocal cord paralyse. Vocal cord paralysis is more common in younger infants than in elder ones, and the main causes are post-cardiac surgery and congenital heart disease.     

Necrotising otitis externa: A single centre experience

Introduction:Necrotising otitis externa(NOE)is a rare infection of the ear canal with frequent bone erosion.This study’s objective is to describe the different features of NOE as well as its management in an ear-nose-throat department.We also tried to identify the particularities of the fungal infection.Patients and methods:It is an observational cohort that included all the patients hospitalised for the management of NOE.The study was carried out in the ear-nose-throat Department of Mahdia University Hospital in Tunisia between January 2006 and december 2019.Results:A total of 40 patients were included.The mean age was 65±12.9 years and the sex ratio was 0.9.Ninety percent of the patients included were diabetics.The most common signs found were oedema of the external canal(97.5%)and auricular discharge(92.5%).The main pathogen isolated was Pseudomonas aeruginosa(61.7%).Fungi were isolated in 9 cases(26.47%).Computed tomography was performed for 32 patients(80%).Bone erosion was seen in 26 cases(81.3%).The main complications were cerebral venous thrombosis,retropharyngeal abscess and cerebral empyema.Thirty one patients received only antibiotics,2 received only antifungal treatment,and 7 received both antibiotics and antifungal treatment.All patients had a favorable outcome.Univariate analysis showed a higher median erythrocyte sedimentation rate was associated with fungal infections.No other differences were noted.Conclusion:Our management protocol seems to be efficient since all patients had initial favorable outcome.A higher median erythrocyte sedimentation rate was associated with fungal infections.     

真菌球型鼻窦炎临床分析及术后生活质量调查

ObjectiveTo analyze the clinic characteristics of fungus ball sinusitis, and to observe improvement of quality of life (QOL) in patients after endoscopic sinus surgery.MethodsClinic characteristics of fungus ball sinusitis were investigated via retrospective analysis on clinical data of patients with this disease hospitalized in our department from June 2009 to June 2013. Postoperative QOL survey was performed on data of 38 cases hospitalized from Jan. 2013 to June 2013 at the 6th month after surgery by SNOT 20 and VSA scale.ResultsThe rates of male and female were 30.1% and 69.9% respectively, with the onset age of 54.08±13.86 years. This disease occurred in unilateral maxillary sinus in 85.6%. Of all the patients, 15% suffered from diabetes, which was significantly higher than that of domestic adults (P<0.05). Postoperative QOL survey showed that the scores of SNOT 20 and VSA scale were significantly lessened (P<0.01).ConclusionsFungus ball sinusitis mainly afflicts middle and old female patients, and usually involves single maxillary sinus. Diabetes is one of the risk factors. Endoscopic sinus surgery can improve patients’ QOL significantly.     

鼻腔筛窦鳞状细胞癌146例治疗分析

Objective To evaluate the treatment outcome of different therapeutic modalities for squamous cell cacinoma of the nose and ethmoid sinus and prognostic factors. Methods One hundred and forty-six cases of squamous cell carcinoma of the nose and ethmoid sinus treated from 1990 to 2007 were reviewed. Of the 146 cases,28 were at stage Ⅰ or Ⅱ ;46 stage Ⅲ ;72 stage Ⅳ. Forty-one patients were treated with preoperative radiation plus surgery( R + S) ,22 patients with surgery plus postoperative radiation ( S + R), 5 patients with surgery alone ( SA ), 78 patients with radiotherapy alone (RA). Results The overall 5 year survival rate of 146 patients with squamous cell carcinoma of the nose and ethmoid sinus was 49. 1%. The 5 year survival rate of the patients at stage Ⅰ and Ⅱ was 95. 7% ,while the rate was 59. 8% in the patients at stage Ⅲ and 28. 2% in the patients at stage Ⅳ ( x2 = 24. 15, P < 0. 05). The 5 year survival rate was 57.7% in R+S group,60.4% in S+R group, 100% in SA group,and 38.8% in RA group,respectively(P >0. 05). The 5 years survival rate of N + patients was lower than that of NO( x2 = 12. 326,P < 0. 05). Local recurrence and distant metastasis were main causes of death. Cox analysis showed TNM stage and differentiation of tumor were independent significant prognostic factors. Conclusions The higher survival rate of patients with squamous cell carcinoma of the nose and ethmoid sinus was obtained from combined therapy R + S or S + R. SA gave ideal results for early lesions(stage Ⅰ and Ⅱ ).     

Otorhinolaryngological findings in AIDS patients: a study of 63 cases

Summary Patients with acquired immunodeficiency syndrome (AIDS) frequently show signs and symptoms involving the head and neck. We reviewed the clinical histories of 63 cases with AIDS, with patients treated from 1982 to December 1985, in our hospital. Findings referable to the head and neck were seen in 43 patients. Comparison with a previous study in San Francisco revealed remarkable differences. We found otolaryngological manifestations in 68% of the patients in contrast to 41% in this latter study. We saw more rapidly increasing neck masses, a greater incidence of shortness of breath and chronic cough, and an increased occurrence of candidiasis. The number of cases with Kaposi's sarcoma lesions was equal in both studies.     

Otorhinolaryngological findings in AIDS patients: a study of 63 cases

Patients with acquired immunodeficiency syndrome (AIDS) frequently show signs and symptoms involving the head and neck. We reviewed the clinical histories of 63 cases with AIDS, with patients treated from 1982 to December 1985, in our hospital. Findings referable to the head and neck were seen in 43 patients. Comparison with a previous study in San Francisco revealed remarkable differences. We found otolaryngological manifestations in 68% of the patients in contrast to 41% in this latter study. We saw more rapidly increasing neck masses, a greater incidence of shortness of breath and chronic cough, and an increased occurrence of candidiasis. The number of cases with Kaposi's sarcoma lesions was equal in both studies.     

Pulmonary complications following major head and neck surgery with tracheostomy: a prospective, randomized, controlled trial of prophylactic antibiotics

OBJECTIVE: To test the hypothesis that extended postoperative antibiotic cover would reduce the incidence of pulmonary complications in patients undergoing major head and neck surgery with tracheostomy. DESIGN: A prospective, randomized, controlled trial was carried out to determine the efficacy of an extended course (5 days) of intravenous amoxicillin-clavulanic acid in reducing the rate of atelectasis and pulmonary infections postoperatively. Other possible risk factors that might predispose to pulmonary complications were also evaluated. SETTING: Tertiary referral center for head and neck surgery. PATIENTS: Consecutive patients younger than 80 years with planned surgery for carcinoma of the oral cavity, pharynx, or larynx were enrolled. Patients with diabetes, those who had received antibiotics within 1 week before surgery, and those with preexisting pulmonary disease were excluded. INTERVENTION: Patients were randomly assigned no antibiotics or a 5-day course of intravenous amoxicillin-clavulanic acid postoperatively. MAIN OUTCOME MEASURES: The development of pulmonary complications (pulmonary infection or atelectasis). RESULTS: Eighty-six patients were enrolled; 73 patients met the criteria for analysis. Thirty-four (47%) developed pulmonary complications; 29 (40%) had a pulmonary infection. An extended course of antibiotics did not reduce the rate of pulmonary infections (P =.57). Positive risk factors for a pulmonary infection were presence of preoperative obstructive lung function and postoperative atelectasis. CONCLUSIONS: An extended course of antibiotics did not prevent the development of postoperative pulmonary infections in patients undergoing major head and neck surgery with tracheostomy. Poor pulmonary function and postoperative atelectasis emerged as significant risk factors for pulmonary infection.     

Otolaryngologic and head and neck manifestations of acquired immunodeficiency syndrome (AIDS)

Patients with acquired immune deficiency syndrome (AIDS) frequently present with signs and symptoms referable to the head and neck. Three hundred ninety-nine patients with AIDS presented at the University of California, San Francisco and its affiliated hospitals from 1980 to April 1984. One hundred sixty-five patients (41%) with AIDS presented with, or had on initial evaluation, head and neck manifestations. Of that group, 58 (35%) had cutaneous, oral, and pharyngeal lesions of Kaposi's sarcoma; 51 (31%) had oral, pharyngeal, esophageal, or laryngeal candidiasis; 36 (22%) had chronic cough and shortness of breath; 13 (8%) had rapidly enlarging neck masses; and 7 (4%) had herpes simplex lesions. With the increasing number of cases of AIDS it is important for the otolaryngologist to be aware of these presentations.     

An assessment of risk factors for the development of a second primary malignancy in the head and neck

This retrospective database study of 44,862 patients who had a history of a primary head and neck malignancy was conducted to identify any clinical variables that may predict the occurrence of a second primary head and neck malignancy. During a mean follow-up of 42.2 months, a second head and neck primary developed in 941 of these patients (2.1%). Statistical analyses revealed that a higher incidence of a second primary was associated with increased age and a location of the first primary in the larynx/hypopharynx, the oropharynx, a major salivary gland, or the nasopharynx. A lower incidence was associated with the presence of cervical nodal disease or treatment of the first primary with radiation therapy. Factors that had no effect on the risk of a second primary included sex, the size of the first primary tumor, a first-primary site in the oral cavity, and treatment of the first primary with cancer-directed surgery. The risk of a second primary head and neck cancer remained constant for at least 10 years.     

Histoplasmosis: The otolaryngologist's perspective

Within the upper aerodigestive tract, histoplasmosis often mimics carcinoma, making prompt and accurate diagnosis imperative. More severe and potentially lethal infections with Histoplasma capsulaturn are now being seen as the numbers of patients at the extremes of age, as well as those with compromised immune systems, increase. We reviewed the cases of 115 hospitalized patients with disseminated histoplasmosis. Of these, 9 patients were identified with tolaryngologic manifestations: 4 were infected with human immunodeficiency virus (HIV), 1 was diabetic, and 3 were renal transplant patients. Sites of involvement included the larynx (in 2 cases) and the oral cavity and oral pharynx (in 7 cases). Eight of the 9 patients had a positive biopsy result; the other, a positive culture. Treatment with amphotericin B was generally effective, while the use of newer azole antifungal agents were less effective. As the number of immunocompromised patients continues to increase in modern clinical practice, histoplasmosis will undoubtedly be encountered more frequently in the head and neck area.     

耳鼻咽喉头颈外科医疗纠纷现状分析及防御对策研究

目的 通过分析耳鼻咽喉头颈外科诊疗特点以及医疗纠纷现状,提出针对耳鼻咽喉头颈外科医疗纠纷的防御对策及干预措施.方法 对医务人员和患者医疗纠纷的认识等情况以及既往医疗纠纷病例进行调查分析,提出减少或避免耳鼻咽喉头颈外科医疗纠纷的防御对策,并运用于临床.以2016年全年医疗纠纷数量及患者对医疗满意度等指标为对照组,2017...     

Head and neck lesions caused by systemic progressive ossifying fibrodysplasia (Munchmeyer's disease

Fibrodysplasia ossificans progressiva is a rare hereditary connective tissue disorder due to an unknown mutation conditioning the ossification of striated muscle and soft tissues frequently related to joints and stimulated by traumatisms or aggressive iatrogenic manouvres. It produces stiffness, pain, disability, swelling and fibro-osseus masses disseminated everywhere, with a very spectacular, invalidant and irreversible clinical picture. Affection of head and neck is unusual, excepting lesions in sternocleidomastoid or masticatiry muscles. We show a systemic case of fibrodysplasia osificans progressiva with enhanced clinical and radiological findings in cervical rhachis, pharynx and larynx, oral cavity, facial bones and ear. Association of biphophonates and steroids for a long period of time seems up to now stopping the evolution but not its regression.     

The efficacy of topical antibiotic prophylaxis for contaminated head and neck surgery

This study was undertaken to determine the feasibility of using perioperative topical antibiotics in contaminated head and neck surgery and to standardize the culture methodology (both qualitative and quantitative) which could serve as bacteriologic endpoints for evaluation. Following preliminary studies to establish oral cavity indicator organisms and the impact of a single antibiotic mouthwash dose on oral microflora, 10 consecutive patients undergoing contaminated head and neck surgery were recruited into a clinical trial where clindamycin mouthwash and intraoperative irrigation containing clindamycin were used instead of traditional parenteral antibiotics. The bacteriologic efficacy of topical clindamycin was assessed by comparing the presence of four indicator microorganisms (two aerobic and two anaerobic) cultured from two oral cavity culture sites before and after antibiotic prophylaxis The patients included in the study underwent total laryngectomy plus neck dissection(s) for laryngeal or hypopharyngeal carcinoma from 1991 to 1992 at a large university hospital specializing in head and neck cancer surgery. The main outcome measures used were the development of a postoperative wound infection and quantitative and qualitative bacteriology of the intraoperative neck wound and postoperative oral cavity Two aerobic and two anaerobic organisms proved useful as a practical indicator for bacteriologic efficacy. Preoperative mouthwash resulted in a 99% reduction of both aerobic and anaerobic bacteria in intraoperatively cultured neck sites. Irrigation during surgery with the clindamycin solution further reduced the bacterial neck counts by an additional 90%. There was a consistent overgrowth of Hemophilus species on postoperative oral cavity cultures. No patient developed a postoperative wound infection A topical prophylactic antibiotic alone was efficacious and safe for patients undergoing major contaminated head and neck surgery. Culture methods for assessment of bacteriologic efficacy were reproducible and cost-effective. This pilot study furnishes the ethical and scientific basis for large-scale prospective trials comparing topical versus parenteral antimicrobial agents.     

Head and neck cancer in patients with human immunodeficiency virus-1 infection: incidence, outcome and association with Epstein-Barr virus

Head and neck cancers have been described in patients with human immunodeficiency virus-1 (HIV-1) infection. However the incidence, aetiology and clinical features of the disease remain unclear. Patients with head and neck cancer and HIV were identified from a large HIV centre. The incidence and clinical features were recorded, and the tumours were stained for Epstein-Barr virus (EBV). Head and neck cancer occurred more frequently than in an age-matched control group (1.66 vs 0.55/10,000 patient years respectively p < 0.05). Highly active anti-retroviral therapy has not significantly altered the incidence of the disease. All of the tumours tested were positive for EBV. Patients were moderately immunosuppressed at diagnosis and had aggressive tumours. All but one of the patients died of cancer with a median survival of 28 months. Head and neck cancer occurs more frequently in HIV. It is an aggressive disease and EBV may play a role in its pathogenesis.