A 56-year-old female with a background of metastatic rectal adenocarcinoma presented with a subglottic mass causing biphasic stridor. Transoral laser microsurgery and the use of fibrin glue prevented the need for tracheostomy. Six months postoperatively there was no evidence of recurrence. Laryngeal metastasis of colorectal adenocarcinoma, although remarkably rare, is perhaps more prevalent than commonly perceived and the presence of laryngeal symptoms in a patient with colorectal adenocarcinoma should raise concern. This case is presented to aid physicians should they encounter a similar presentation of metastasis to the subglottis.

Objective:To determine the prevalence of occult hearing loss in elderly inpatients, to evaluate feasibility of opportunistic hearing screening and to determine subsequent provision of hearing aids.Materials and methods:Subjects (>65 years) were recruited from five elderly care wards. Hearing loss was detected by a ward-based hearing screen comprising patient-reported assessment of hearing disability and a whisper test. Subjects failing the whisper test or reporting hearing difficulties were offered formal audiological assessment.Results:Screening was performed on 51 patients aged between 70 and 95 years. Of the patients, 21 (41%) reported hearing loss and 16 (31%) failed the whisper test. A total of 37 patients (73%) were referred for audiological assessment with 17 (33%) found to have aidable hearing loss and 11 were fitted with hearing aids (22%).Discussion:This study highlights the high prevalence of occult hearing loss in elderly inpatients. Easy two-step screening can accurately identify patients with undiagnosed deafness resulting in significant proportions receiving hearing aids.Key sentencesApproximately 14% of the elderly population use hearing aids despite a reported prevalence of deafness in up to 55%.The use of hearing aids is associated with an improvement in physical, emotional, mental and social well-being.An easy screening test for hearing loss consists of patient-reported hearing loss and a whisper test.Opportunistic screening of elderly inpatients resulted in referral of 73% of screened patients for formal audiology.Of the screened patients, 22% were provided with hearing aids.

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A man aged 37 years from Indian descent presented to an inner city London hospital with hoarseness of voice, fatigue, night sweats and a 2 kg weight loss. Laryngoscopy demonstrated a left vocal fold palsy. Extensive investigations were undertaken with disseminated malignancy being primarily investigated. CT/MRI scanning showed non-specific necrotic mediastinal lymph nodes. Tuberculin skin testing, cytology and PCR were eventually undergone. Tests yielded results consistent with tuberculosis (TB) infection and the patient was started on standard TB treatment protocol, with excellent results. TB infection can result in multiple atypical presentations of disease, including hoarseness of voice secondary to vocal cord paralysis. This is a rare but important presentation for community clinician's to consider, especially in populations where TB is epidemiologically thought to be prevalent.