Voice outcome after unilateral ELS type III or bilateral type II resections for T1‐T2 glottic carcinoma: Results after 1 year

Abstract

Background

Voice outcome was assessed in patients with extended T1 and limited T2 glottic carcinoma, treated with a unilateral type III or a bilateral type II resection according to the European Laryngological Society (ELS) classification.

Methods

Objective evaluation (acoustic and aerodynamic parameters), perceptual evaluation (GRBAS), and patients' self‐assessment (voice handicap index [VHI]) were performed before and 1 year after treatment. Results were evaluated according to ELS resection type and the involvement of the anterior commissure.

Results

The majority of voice parameters in all resection subgroups showed an improvement of the mean score 1 year postoperatively. Grade of dysphonia varied between 1.15 and 1.66 postoperatively and VHI score varied from 23.3 to 24.5.

Conclusion

Voice outcome after ELS unilateral type III or a bilateral type II resection for extended T1 and limited T2 glottic carcinoma is good with mild to very moderate perceptive dysphonia and low self‐reported voice impairment.

http://bit.ly/2QU2kXF

Significant racial differences in the incidence and behavior of the follicular variant of papillary thyroid carcinoma

Abstract

Background

Increased detection of papillary thyroid cancer (PTC) has led to overtreatment of the largely indolent follicular variant (fvPTC). To guide management of non‐aggressive lesions, we investigated whether race predicts PTC variant and tumor behavior.

Methods

Analysis of 258 973 patients from the National Cancer Database diagnosed with PTC in 2004‐2014. Clinical and tumor information was compared by race. Multivariate logistic regression was used to predict fvPTC, extrathyroidal extension (ETE), and lymph node metastasis (LNM) of fvPTC.

Results

Blacks had the highest fvPTC rate (40% vs white 30%, Hispanic 26%, Asian 25%, P < .001). Blacks had higher odds of fvPTC (aOR = 1.33, 95% CI: 1.28‐1.37) and lower odds of ETE than whites (aOR = 0.90, 95% CI: 0.82‐0.99) (P < .001). Hispanics and Asians had lower odds of fvPTC (aOR = 0.89, 95% CI: 0.86‐0.92 and aOR = 0.81, 95% CI: 0.79‐0.84) and higher odds of LNM and ETE than whites (P < .001).

Conclusions

Racial disparities in fvPTC incidence and behavior should be considered to optimize diagnosis and treatment planning.

http://bit.ly/2VXaItc

Transoral robotic excision of laryngocele: Surgical considerations

Abstract

Background

Transoral robotic surgery (TORS) has emerged as a novel, safe, and feasible procedure for the resection of malignant supraglottic laryngeal cancers. The purpose of this study was to demonstrate the surgical technique with extension of the use of TORS to excise a laryngeal cyst.

Results

Laryngeal cyst resection, along with its tract, was accomplished with preservation of both false and true vocal cords. There was no perioperative or early postoperative complications. The patient was extubated immediately after surgery. Oral diet was initiated within 24 hours. No tracheostomy was required. A video demonstration of the surgical technique is included on Head & Neck's website.

Conclusion

TORS is a safe and feasible procedure for excision of selected laryngeal cysts.

http://bit.ly/2QTMVqo

January is Thyroid Awareness Month

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The post January is Thyroid Awareness Month appeared first on American Thyroid Association.

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A Comment on a Controversial Interpretation of an Apparent Thyroid Phenotype in the Paintings of Henri Matisse

Thyroid, Ahead of Print.


http://bit.ly/2FwTtdp

Impact of Mutation Density and Heterogeneity on Papillary Thyroid Cancer Clinical Features and Remission Probability

Thyroid, Ahead of Print.


http://bit.ly/2FHNYIh

Τhe minimum fascia–tumor distance (MFTD) criterion is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

The Diagnostic Performance of Ultrasonography and Computed Tomography in Differentiating Superficial from Deep Lobe Parotid Tumors

Ping‐Chia Cheng  Chih‐Ming Chang  Chun‐Chieh Huang  Wu‐Chia Lo  Tsung‐Wei Huang  Po‐Wen Cheng Li‐Jen Liao

First published: 12 January 2019 https://doi.org/10.1111/coa.13289

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/coa.13289

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Abstract

Objectives

To validate and compare ultrasound (US) versus computed tomography (CT) criteria in the localization of superficial/deep lobe tumors of the parotid gland.

Design and Setting

This was a retrospective study of diagnostic tests performed from January 2008 to June 2017.

Participants

We included adult patients who were referred for a neck ultrasonography examination due to parotid tumors, and who subsequently underwent parotid surgery.

Main outcome measures

We assessed the location of parotid tumors, comparing the minimum fascia–tumor distance (MFTD) criterion on an US with eight CT criteria. We analyzed receiver operating characteristic (ROC) curves of the MFTD for malignant, benign, and all parotid tumors, and compared the accuracy, sensitivity, and specificity of the optimal MFTD with those of CT anatomical criteria.

Results

A total of 166 parotid tumors were included. The mean (SD) MFTD in superficial lobe tumors was significantly shorter than that of deep lobe tumors (1.2 [0.7] vs 2.8 [1.9] mm, effect size: 1.84; 95% CI, 1.27 to 2.41). The areas under the ROC curve were 0.63 for malignant tumors and 0.88 for benign tumors. The optimal MFTD cut point was 2.4 mm for the 154 benign parotid tumors and the accuracy, sensitivity, and specificity were 90%, 80% and 91%, respectively. For the 136 benign parotid tumors that underwent CT examination, three criteria had an accuracy of over 90% (FNline, tMasseter and Conn's arc), but the sensitivities were all below 50%.

Conclusions

MFTD is more feasible for benign tumors than for malignant tumors for the localization of parotid tumors. For benign parotid tumors, US is enough to guide operations.

Contemporary treatment patterns and outcomes of salivary gland carcinoma: a National Cancer Database review

Abstract

Purpose

Salivary gland carcinomas (SGC) are rare malignancies and data regarding treatment outcomes stratified by histologic subtype are currently limited. This study aims to examine current, national treatment patterns and overall survival (OS) of patients with the major histologic subtypes of salivary gland carcinoma.

Subjects and methods

A review was performed of the National Cancer Database (NCDB) of patients with confirmed diagnoses of mucoepidermoid carcinoma, acinic cell carcinoma, adenoid cystic carcinoma, adenocarcinoma, or carcinoma ex pleomorphic receiving curative treatment between 2004 and 2014. Univariate and multivariate regression modeling were performed to identify risk factors significantly associated with overall survival (OS). Adjusted survival analyses stratified by treatment and staging were performed with the primary outcome of overall survival (OS) and were further stratified based on histologic subtype.

Results

The final analysis included 7342 patients [3547 men (48.3%) and 3795 women (51.7%); mean age 58.3 years (range 18–90 years)]. Mucoepidermoid carcinoma was the most common histology encountered [n = 2669 (36.4%)]. Unadjusted and adjusted analysis demonstrated improved survival with surgery and radiation therapy (RT) for adenoid cystic (HR = 0.69; p = 0.029), adenocarcinoma (HR = 0.61; p < 0.001), high-grade mucoepidermoid carcinoma (HR = 0.70; p = 0.026), and carcinoma ex pleomorphic (HR = 0.64; p = 0.028), while surgery with chemoradiation therapy (CRT) was associated with worse OS regardless of histologic subtype. The impact of advanced stage on survival varied amongst the histologic subtypes but portended the worst prognosis for patients with adenocarcinoma and carcinoma ex pleomorphic.

Conclusions

The results of this NCDB review demonstrate unique treatment patterns and survival outcomes for SGC based on major histologic subtype.

http://bit.ly/2AQ3s9C

Dizziness at a Canadian tertiary care hospital: a cost-of-illness study

Abstract

Background

In the Canadian health care system, determining overall costs associated with a particular diagnostic subgroup of patients, in this case dizzy patients, is the first step in the process of determining where costs could be saved without compromising patient care. This study is the first Canadian study that evaluates these costs at a tertiary care hospital and will allow for the extrapolation of cost data for other similar academic health science centers, regional health initiatives, and provincial healthcare planning structures.

Methods

We conducted a retrospective cohort study of patients of any age presenting to The Ottawa Hospital (TOH), a tertiary care hospital, between January 1st, 2009 and December 31st^, 2014 with a main diagnosis of dizziness or dizziness-related disease.

De-identified patient information was acquired through TOH Data Warehouse and included a patient's sex, age, arrival and departure dates, Elixhauser co-morbidity score, location of presentation (emergency department or admitted inpatient) presenting complaint, final diagnosis code, any procedure codes linked to their care, and the direct and indirect hospital costs linked with any admission.

We derived the mean hospital costs and 95% confidence interval for each diagnosis. We obtained the number of patients who were diagnosed with dizziness within Ontario in year 2015–16 from Canadian Institute for Health Information (CIHI). A simple frequency multiplication was performed to estimate the total cost burden for Ontario based on the cost estimate for the same year obtained from TOH. Cost data were presented in 2017 Canadian dollars.

Results

The average total hospital cost per patient with dizziness for the entire cohort is $450 (SD = $1334), with ED only patients costing $359 (SD = $214). The total estimated hospital cost burden of dizziness in Ontario is $31,202,000 (95% CI $29,559,000 – 32,844,000).

Conclusions

The estimated annual costs of emergency department ambulatory and inpatient dizziness in Ontario was calculated to be approximately 31 million dollars per year. This is the first step in identifying potential areas for cost savings to aid local and provincial policy-makers in allocation of health care spending.

http://bit.ly/2SWl2jp

A randomized controlled trial to test the efficacy of trans-tympanic injections of a sodium thiosulfate gel to prevent cisplatin-induced ototoxicity in patients with head and neck cancer

Abstract

Background

Cisplatin-induced hearing loss is frequent and severe. Antioxidants such as sodium thiosulfate (STS) can neutralize the effects of cisplatin. The objective of the trial was to test the efficacy of trans-tympanic injections of a STS gel to prevent cisplatin-induced ototoxicity.

Methods

Eligible participants were newly diagnosed patients with stage III or IV squamous cell carcinoma of the mouth, oropharynx, hypopharynx, or larynx and scheduled to be treated by concurrent chemoradiation (CCR). Patients with asymmetric hearing were not eligible. The planed treatment included cisplatin 100 mg/m² at days 1, 22 and 43. A baseline pre-treatment complete audiometric evaluation (pure tone at frequencies ranging from 0.5 to 14 kHz, bone conduction at 0.5–4 kHz and DPOAEs) was performed. Adverse effects were noted according to CTCAE.

On the day before the beginning of CCR, eligible and consenting patients were randomized to receive a trans-tympanic injection of the gel either in the left ear or in the right ear. A final post-treatment complete audiometric evaluation was scheduled to be performed 1 month after the end of CCR by audiologists kept blind to the ear assignment.

For the main outcome, the permanent threshold shift (PTS) in decibel (dB) was calculated as the difference between the final and baseline measures at all pure tone frequencies at 0.5–14 kHz for each patient and for each ear. The main outcome was assessed blindly in a mixed linear model with the PTS as the dependent variable and intervention, frequency, their interaction and radiation dose to the cochlea as independent variables.

Results

Between January 2015 and April 2016, 13 patients were randomized. The trial was stopped in June 2016 for poor accrual. The average loss of hearing over all frequencies was 1.3 dB less for treated ears compared to control ears. Although not statistically (p = 0.61) nor clinically significant, the difference was in favor of the treated ears for all frequencies between 3 and 10 kHz.

Conclusions

Our trial suggests that STS deposited on the round window was safe for the middle and inner ears. More work is needed to improve the efficacy of trans-tympanic injections of cisplatin antidotes.

Trial registration

ClinicalTrials.gov, NTC02281006, Registered 3 November 2014.

http://bit.ly/2AOiBrU

Torus mandibularis affects the severity and position‐dependent sleep apnea in non‐obese patients

Abstract

Objective

Various anatomical structures of upper airway and physical differences are known to be risk factors for obstructive sleep apnea (OSA). Torus mandibularis is a structure that can appear on the inside of the mandible. Therefore, it is possible for tori to influence airway volume by occupying the space for tongue, and cause sleep apnea. The purpose of this study is to investigate the effect of torus mandibularis on the severity of OSA as one of the craniofacial risk factors.

Design

Retrospective case‐control study.

Setting

University‐based tertiary medical center.

Participants

Adult patients over 19‐years‐old who visited out‐patient clinics with complaints of sleep‐disordered breathing symptoms between January 2010 and December 2017 were investigated.

Main outcome measures

The presence of torus mandibularis in oral cavity was confirmed by physical examination or CT image. We analyzed demographic findings including age, sex, medical history, previous operation history, physical findings of upper airway, and result of polysomnography. To evaluate the effect of torus mandibularis on OSA, polysomnography data of the two groups according to presence or absence of torus mandibularis were compared and analyzed.

Results

232 OSA patients with BMI less than 25 were divided into two groups, according to either the presence or absence of torus mandibularis. We analyzed 138 patients of control group and 94 of torus mandibularis group. AHI was 18.8 ± 14.9 in control group and 25.1 ± 18.4 in torus mandibularis group (p=0.006). RDI was 23.1 ± 14.7 in control group and 27.9 ± 18.4 in torus mandibularis group (p=0.035). Supine AHI showed 26.6 ± 20.3 in control group and 32.5 ± 22.6 in torus mandibularis group (p=0.039). Patients with torus mandibularis had a trend of increase in proportion according to the severity of sleep apnea, such as AHI (p=0.007) or RDI (p=0.034).

Conclusions

We newly found that the presence of torus mandibularis affects not only severity of OSA and also position dependent OSA. These results support the necessity of torus mandibularis evaluation in OSA patients, and further study is also required to investigate its consequence in the surgical outcome.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MghDcs

Our Experience with a Novel CSF Leak Repair Material in 14 Patients Following Anterior Skull Base Surgery

Abstract

Hemopatch (HE) advanced hemostatic pad composed of collagen and a synthetic, protein‐reactive monomer which polymerises on contact with protein containing body fluids such as blood and CSF to seal tissues.

HE is readily available which shortens the operating time, and may be manipulated intra‐nasally to reconstruct defects of the anterior skull base.

Reconstruction using HE reduces the morbidity compared with traditional facia lata graft harvesting techniques.

Length of stay and operative times might be decreased due to lower morbidity from donor site complications.

This article is protected by copyright. All rights reserved.

http://bit.ly/2stVL4j

Burden of treatment: Reported outcomes in a head and neck cancer survivorship clinic

Objective

With the intensification and utilization of multimodal treatment, acute toxicities have increased; however, the frequency of treatment sequelae in long‐term head and neck cancer (HNC) survivors are poorly described. The purpose of this analysis was to determine the prevalence and predictors of patient‐reported late and long‐term treatment‐related sequelae in HNC survivors.

Methods

We performed a cross‐sectional analysis of patient‐reported outcomes from 228 survivors attending a multidisciplinary HNC survivorship clinic. The primary outcomes comprised quality of life (QOL), symptoms of anxiety and depression, and swallowing dysfunction.

Results

Male gender, tumor sites in the oropharynx and larynx, longer time since treatment, and treatment with surgery alone were associated with higher physical QOL (P < .05). Male gender, longer time since treatment, and treatment with surgery alone were associated with higher social‐emotional QOL (P < .05). A reduction in anxiety symptoms and a higher QOL were related to longer time since treatment; however, a reduction in swallowing dysfunction symptoms was only related to longer time since treatment until approximately 6 years. After 6 years, survivors reported worse swallowing dysfunction (P < .05). One hundred thirty‐two survivors (56%) reported at least three treatment‐related effects that impacted their daily life. Finally, advanced stage disease at diagnosis (stage III–IV) was also associated with severe swallowing dysfunction (P = .004).

Conclusion

These data indicate the remarkable prevalence of treatment‐related effects in HNC survivors. These results highlight the need for de‐intensification of therapies, where appropriate, and for a better understanding of pathophysiology and new approaches to mitigating treatment effects.

Level of Evidence

4. Laryngoscope, 2019

http://bit.ly/2AKmmP5

Vergleich von piezoelektrisch assistierter und konventioneller Osteotomie bei der Rhinoplastik

Zusammenfassung

Hintergrund

Bei der Rhinoplasik werden postoperative periorbitale Ödeme und Ekchymosen v. a. durch die konventionelle nasale Osteotomie mit Hammer und Meißel verursacht. Möglicherweise führt die Piezochirurgie zu einem verbesserten frühpostoperativen Verlauf durch Schonung des Weichgewebes. Ziel dieser Arbeit war eine systematische Übersicht über Methoden und Ergebnisse von Studien zum Vergleich einer konventionellen mit einer piezoelektrischen Osteotomie.

Methoden

Es erfolgte eine systematische Literaturrecherche in den elektronischen Datenbanken PubMed/MEDLINE und Google Scholar. Bei der primären Selektion wurden alle Studien über den Vergleich konventioneller und piezoelektrischer Osteotomie hinsichtlich postoperativer periorbitaler Ödeme und/oder Ekchymosen erfasst. Die sekundäre Selektion umfasste nur Publikationen mit einer Kontrollgruppe.

Ergebnisse

Die primäre Selektion ergab 15 thematisch relevante Publikationen mit deutlicher Zunahme an jährlichen Veröffentlichungen zwischen 2007 und 2017. Es wurden 6 Studien mit Kontrollgruppen sekundär selektiert, die qualitativ und methodisch sehr heterogen waren. Die Ergebnisse von 5 der 6 Studien wiesen auf einen deutlichen Vorteil der Piezotechnik im Vergleich zur konventionellen Osteotomie hin. Nur in einer Studie wurde kein signifikanter Unterschied bezüglich des untersuchten Ergebnisses festgestellt.

Schlussfolgerung

Nach piezoelektrischer Osteotomie fand sich eine geringere Neigung zu postoperativer Ödembildung und Ekchymose als bei konventioneller Osteotomietechnik. Derzeit sollten die Ergebnisse als Trend interpretiert werden. Eine abschließende Empfehlung zur Überlegenheit einer Methode kann erst bei Vorliegen von mehr Studien mit größeren Patientenzahlen erfolgen.

http://bit.ly/2FCH5b5