Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Abstract

Background

Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC).

Methods

Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD‐RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high‐dose radiation (HD‐RT) as an EQD2 >60 and <70 Gy.

Results

HD‐RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD‐RT was associated with increased mortality (HR1.09; 95%CI 1.02‐1.16). In nonoropharynx or human papillomavirus‐negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD‐RT was still not associated with improved survival (HR 1.01, 95% CI 0.91‐1.12).

Conclusions

There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high‐risk cohort.

http://bit.ly/2SFecSq

Dynamic changes in chemosensitivity immune predictors in patients with hypopharyngeal cancer treated with induction chemotherapy

Abstract

Background

There are currently no data predicting chemosensitivity of induction chemotherapy (ICT) for hypopharyngeal squamous cell carcinomas (SCC).

Methods

Associations between immune cells and overall response (OR) to ICT and changes in immune cells during ICT were observed in 40 patients with hypopharyngeal SCC undergoing ICT.

Results

CD4⁺ and CD8⁺ T‐cell and regulatory T‐cell (Treg) frequencies reached diagnostic accuracy for OR to ICT. OR rate was significantly higher in CD4⁺‐high T cell, CD8⁺‐high T cell, and low Treg groups. A transient reduction in Tregs and increases in Tregs in the non‐OR and OR groups were observed during the course of ICT. Conversely, increases in CD8⁺ T cells and reductions in CD8⁺ T cells in the non‐OR and OR groups were observed.

Conclusion

High CD4⁺ T‐cell, high CD8⁺ T‐cell, and low Treg frequencies can be predictors for high efficacy of ICT in patients with hypopharyngeal SCC.

http://bit.ly/2MXh1sF

Postoperative radiation performed at the same surgical facility associated with improved overall survival in oral cavity squamous cell carcinoma

Abstract

Background

The purpose of this analysis is to evaluate whether postoperative radiotherapy (PORT) at the same facility as surgery portends to better survival outcomes compared to PORT given at a different facility.

Methods

Patients underwent upfront surgery at the National Cancer Database reporting facility followed by PORT. PORT was coded as performed at either the same facility or at a different facility as surgery.

Results

A total of 10 832 patients were selected. Five‐year overall survival (OS) was higher in patients undergoing PORT at the same facility: 52.5% vs 48.4% (P < 0.001). PORT performed at the same facility was associated with improved OS under multivariate (HR, 0.92; P = 0.01) and propensity score matched (hazard ratio, 0.90; P = 0.004) analyses.

Conclusions

OS was better among patients with head and neck cancer who received PORT at the same facility as surgery.

http://bit.ly/2SFe8Ca

The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review

Abstract

Head and neck squamous cell carcinoma (HNSCC) is often diagnosed in advanced stage and therefore requires aggressive, multimodal treatment. Elderly patients are often excluded from standard therapy regimens purely based on age. This clinical review aims to collect all published data in the literature on treatment modality selection in elderly patients and on age‐related adverse events following treatment of HNSCC. We performed a literature search for articles on the treatment of HNSCC in elderly patients. Most of the articles were retrospective studies with the consequent limitations. It can be concluded that age is not an absolute contraindication for intensive treatment and comorbidity is an important predictor of outcome, but not the only one. Despite the existence of multiple tools for pretreatment evaluation, there are not consistent data on their use.

http://bit.ly/2MXgVBj

Outcomes and cost implications of microvascular reconstructions of the head and neck

Abstract

Background

Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost.

Methods

Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400).

Results

Mean charges of hospitalization by donor tissue: radial forearm free flap (RFFF) $127 636 (n = 183), osteocutaneous RFFF (OCRFFF) $125 456 (n = 70), anterior lateral thigh $133 781 (n = 54), fibula $140 747 (n = 42), latissimus $208 890 (n = 24), rectus $169 637 (n = 18), scapula $128 712 (n = 4), and ulna $110 716 (n = 5; P = .16). Mean operative times for malignant lesions stratified by T classification: 6.9 hours (±25 minutes) for T1, 7.0 hours (±16 minutes) for T2, 7.3 hours (±17 minutes) for T3, and 7.8 hours (±11 minutes) for T4 (P < .0001). Complications correlated with differences in mean charges: minor surgical ($123 720), medical ($216 387), and major surgical ($169 821; P < .001). Operations for advanced malignant lesions had higher mean charges: T1 lesions ($106 506) compared to T2/T3 lesions ($133 080; P = .03) and T4 lesions ($142 183; P = .02). On multivariate analysis, the length of stay, operative duration, and type a postoperative complication were factors affecting overall charges for the hospitalization (P < .018).

Conclusion

Conclusion: The RFFF and OCRFFF had the lowest complication rates, length of hospitalization, duration of operation, and mean charges of hospitalization. Advanced stage malignant disease correlated with increased hospitalization length, operative time, and complication rates resulting in higher hospitalization charges.

http://bit.ly/2SAbAW3

Robotic cochlear implantation: feasibility of a multiport approach in an ex vivo model

Abstract

Purpose

A recent clinical trial has shown the feasibility of robotic cochlear implantation. The electrode was inserted through the robotically drilled tunnel and an additional access through the external auditory canal was created to provide for means of visualization and manipulation. To obviate the need for this additional access, the utilization of multiple robotically drilled tunnels targeting the round window has been proposed. The objective of this study was to assess the feasibility of electrode insertion through a robotic multiport approach.

Methods

In four ex vivo human head specimens (left side), four trajectories through the facial recess (2x) and the retrofacial and suprameatal region were planned and robotically drilled. Optimal three-port configurations were determined for each specimen by analyzing combinations of three of the four trajectories, where the three trajectories were used for the electrode, endoscopic visualization and manipulative assistance. Finally, electrode insertions were conducted through the optimal configurations.

Results

The electrodes could successfully be inserted, and the procedure sufficiently visualized through the facial recess drill tunnels in all specimens. Effective manipulative assistance for sealing the round window could be provided through the retrofacial tunnel.

Conclusions

Electrode insertion through a robotic three-port approach is feasible. Drill tunnels through the facial recess for the electrode and endoscope allow for optimized insertion angles and sufficient visualization. Through a retrofacial tunnel effective manipulation for sealing is possible.

http://bit.ly/2UJvyee

Does procalcitonin have a role in the pathogenesis of nasal polyp?

Abstract

Purpose

The aim of this study is to investigate serum and tissue procalcitonin (PCT) levels in patients with nasal polyps.

Methods

The study was designed to be prospectively controlled and included 26 patients chronic rhinosinusitis with nasal polyp (CRSwNP) endoscopically diagnosed and as a control group 25 chronic rhinosinusitis without nasal polyp (CRSsNP). NP specimens, nasal mucosal tissue and venous blood samples of both groups were collected and PCT levels determined by Elisa method. The results were compared statistically.

Results

Serum PCT values were 1319.5 pg/mL in the NP group and 818.8 pg/mL in the control group. The difference between the groups was statistically significant (p = 0.0001). In the NP group, the average PCT value of the polyp tissue was 1521.5 pg/gr, while the mean PCT value of the control group in the nasal mucosa was 414.6 pg/gr. There was a statistically significant difference between the groups (p = 0.0001). The tissue cut-off value of PCT 750 was significant [area under curve 0.940 (0.863–1.00)]. Serum PCT 950 cut-off value was significant [area under curve 0.860 (0.748–0.972)] activity (CI: 95%).

Conclusions

This is the first study of its kind to objectively examine PCT in the polyp and serum of CRSwNP patients. PCT may serve as a diagnostic biomarker in nasal polyps.

http://bit.ly/2MUziXA

Cervical Haematoma Secondary to Spontaneous Bleeding of Parathyroid Adenoma

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Alberto Martínez-Martínez, Jade García-Espinosa

http://bit.ly/2WUb3h4

Macrostomia: The defining feature of the oculo-auriculo-vertebral spectrum

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Mainak Dutta, Indranil Chatterjee

http://bit.ly/2RMTSdq

Digestive Migration and Spontaneous Expulsion of a Montgomery Salivary Derivation Tube

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Pablo Torrico Román

http://bit.ly/2WT1qil

Guideline on Cochlear Implants

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Manuel Manrique, Ángel Ramos, Carlos de Paula Vernetta, Elisa Gil-Carcedo, Luis Lassaletta, Isabel Sanchez-Cuadrado, Juan Manuel Espinosa, Ángel Batuecas, Carlos Cenjor, María José Lavilla, Faustino Núñez, Laura Cavalle, Alicia Huarte

Abstract

Introduction

In the last decade numerous hospitals have started to work with patients who are candidates for a cochlear implant (CI) and there have been numerous and relevant advances in the treatment of sensorineural hearing loss that extended the indications for cochlear implants.

Objectives

To provide a guideline on cochlear implants to specialists in otorhinolaryngology, other medical specialities, health authorities and society in general.

Methods

The Scientific Committees of Otology, Otoneurology and Audiology from the Spanish Society of Otolaryngology and Head and Neck Surgery (SEORL-CCC), in a coordinated and agreed way, performed a review of the current state of CI based on the existing regulations and in the scientific publications referenced in the bibliography of the document drafted.

Results

The clinical guideline on cochlear implants provides information on: (a) definition and description of Cochlear Implant; (b) indications for cochlear implants; (c) organisational requirements for a cochlear implant programme.

Conclusions

A clinical guideline on cochlear implants has been developed by a Committee of Experts of the SEORL-CCC, to help and guide all the health professionals involved in this field of CI in decision-making to treathearing impairment.

Resumen

Introducción

En la última década son numerosos los hospitales que han iniciado su actividad en pacientes candidatos a un implante coclear (IC), y se han producido numerosos y relevantes avances para el tratamiento de la hipoacusia neurosensorial que han desembocado en una ampliación de las indicaciones de los IC.

Objetivos

Ofrecer a los especialistas de otorrinolaringología, de otras especialidades médicas, autoridades sanitarias y a la sociedad en general una guía clínica sobre implantes cocleares.

Métodos

Las comisiones científicas de otología, otoneurología y audiología de la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC), de manera coordinada y consensuada, han llevado a cabo una revisión del estado actual de los IC basándose en las reglamentaciones existentes y en las publicaciones científicas que se referencian en la bibliografía del documento elaborado.

Resultados

La guía clínica sobre implantes cocleares aporta información sobre: a) definición y descripción sobre IC; b) indicaciones de los IC; y c) requisitos organizativos para un programa de IC.

Conclusiones

Se ha elaborado por un comité de expertos de la SEORL-CCC una Guía clínica sobre implantes cocleares que aporta coordenadas de actuación para todos aquellos agentes de la sanidad en la toma de decisiones en el ámbito de los IC como forma de tratamiento de la discapacidad auditiva.

http://bit.ly/2RMTOKI

Diagnosis and Treatment of Otitis Media With Effusion: CODEPEH Recommendations

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Faustino Núñez-Batalla, Carmen Jáudenes-Casaubón, Jose Miguel Sequí-Canet, Ana Vivanco-Allende, Jose Zubicaray-Ugarteche

Abstract

The incidence and the prevalence rates of otitis media with effusion (OME) are high. However, there is evidence that only a minority of professionals follow the recommendations provided in clinical practice guidelines. For the purpose of improving diagnosis and treatment of OME in children to prevent and/or reduce its impact on children's development, the Commission for the Early Detection of Deafness (CODEPEH) has deeply reviewed the scientific literature on this field and has drafted a document of recommendations for a correct clinical reaction to of OME, including diagnosis and medical and surgical treatment methodology. Among others, medication, in particular antibiotics and corticoids, should not be prescribed and 3 months of watchful waiting should be the first adopted measure. If OME persists, an ENT doctor should assess the possibility of surgical treatment. The impact of OME in cases of children with a comorbidity is higher, so it requires immediate reaction, without watchful waiting.

Resumen

La incidencia y prevalencia de la otitis media secretora infantil (OMS) son elevadas, sin embargo, existen evidencias de que solo una minoría de profesionales sigue las recomendaciones de las guías para su manejo clínico. Con objeto de mejorar el diagnóstico y el tratamiento de la OMS, para prevenir y/o reducir sus consecuencias sobre el desarrollo del niño, la Comisión para la Detección Precoz de la Hipoacusia (CODEPEH) ha realizado una amplia revisión de la literatura científica sobre la materia y ha elaborado un documento de recomendaciones para una correcta actitud clínica ante la OMS, abordando métodos diagnósticos y tratamiento médico y quirúrgico. Entre otros, no usar ninguna medicación, especialmente corticoides y antibióticos, siendo la espera vigilada la primera medida a tomar durante 3 meses. Si persiste la OMS, el otorrinolaringólogo valorará el tratamiento quirúrgico. En niños que presentan comorbilidades de diversa entidad, el impacto de la OMS es superior por lo que hay que actuar de forma inmediata, sin espera vigilada.

http://bit.ly/2WUIgbR

Congenital Aural Atresia prevalence in the Argentinian population

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Mario Emilio Zernotti, Carlos A. Curet, Susana Cortasa, Mario Chiaraviglio, Maria Fernanda Di Gregorio

Abstract

Introduction

Congenital Aural Atresia (CAA) or microtia is a malformation that results in esthetic and functional problems. There is little information on prevalence, considering that Latin American is the most affected region in the world.

Objective

To determine the prevalence of microtia, considering the different ethnical structure of the population.

Methods

A retrospective analysis was performed of the clinical reports of newborn infants (public hospitals) in three different regions.

Results

The incidence of CAA in Argentina was 1 case per 7500 new births (i.e. 1.3/10,000). Marked differences were found per geographical area. The means were calculated per year by bilateral parametric estimation, according to the ethnical origins of the population. In the Caucasoid area: 02.47/10,000 (±1.2), in the Mestizo area: 03.99/10,000 (±0.0) and finally in the Amerindian area: 20.93/10,000 (±0.1).

Conclusion

This study shows different incidences according to the demographic features of the population from 1.90/10,000 to 20.9/10,000. This data indicates that CAA is associated with a genetic problem (ethnic differences).

Resumen

Introducción

La atresia aural congénita (AAC) o microtia es una malformación que produce problemas funcionales y estéticos. Existe falta de información de prevalencia en Argentina, teniendo en cuenta además que Latinoamérica es la región más afectada del mundo.

Objetivo

Determinar la prevalencia de microtia, teniendo en cuenta la estructura étnica de la población según las regiones.

Métodos

Análisis retrospectivo de historias clínicas en hospitales públicos de recién nacidos en diferentes zonas del país.

Resultados

La prevalencia de atresia en Argentina fue de uno de cada 7.500 recién nacidos (1,3/10.000). Se encontraron marcadas diferencias de acuerdo al área geográfica. En el área caucásica: 2,47/10.000 (± 1,2), en el área mestiza: 3,99/10.000 (± 0) y en el área amerindia: 20,93/10.000 (± 0,1).

Conclusión

El estudio muestra una diferente incidencia con arreglo a las características demográficas de la población, de entre 1,90/10.000 y 20,9/10.000. Estos datos permitirían asociar la atresia con problemas genéticos (origen étnico).

http://bit.ly/2RRd9dN

Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Rita Chiaramonte, Carmela Di Luciano, Ignazio Chiaramonte, Agostino Serra, Marco Bonfiglio

Abstract

Introduction and objectives

The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time.

Materials and methods

22 patients with bulbar ALS were submitted for voice assessment, ENT evaluation, Multi-Dimensional Voice Program (MDVP), spectrogram, electroglottography, fiberoptic endoscopic evaluation of swallowing.

Results

In the early stage of the disease, the oral tract and velopharyngeal port were involved. Three months after the initial symptoms, most of the patients presented hoarseness, breathy voice, dysarthria, pitch modulation problems and difficulties in pronunciation of explosive, velar and lingual consonants. Values of MDVP were altered. Spectrogram showed an additional formant, due to nasal resonance. Electroglottography showed periodic oscillation of the vocal folds only during short vocal cycle. Swallowing was characterized by weakness and incoordination of oro-pharyngeal muscles with penetration or aspiration.

Conclusions

A specific multidisciplinary clinical protocol was designed to report vocal parameters and swallowing disorders that changed more quickly in bulbar ALS patients. Furthermore, the patients were stratified according to involvement of pharyngeal structures, and severity index.

Resumen

Introducción y objetivos

El objetivo de este estudio fue examinar la función de los diferentes especialistas en el diagnóstico de la esclerosis lateral amiotrófica (ELA), para comprender quèc) cambios se produjeron en cuanto a expresión verbal, dinámica fonatoria y respiratoria, y deglución, en un breve periodo de tiempo.

Materiales y mèc)todos

Se sometió a 22 pacientes con ELA bulbar a evaluación de la voz, examen ORL, programa de voz multi-dimensional (MDVP), espectrograma, electroglotografía y evaluación de la deglución mediante endoscopía de fibra óptica.

Resultados

En la etapa temprana de la enfermedad, el tracto oral y el cierre velofaríngeo se vieron comprometidos. Transcurridos 3 meses de los síntomas iniciales, la mayoría de los pacientes presentó ronquera, voz entrecortada, disartria, problemas de modulación de la afinación y dificultades de pronunciación de las consonantes oclusivas, velares y linguales. Los valores del MDVP se vieron alterados. El espectrograma reflejó un formante adicional, debido a la resonancia nasal. La electroglotografía mostró una oscilación periódica de las cuerdas vocales únicamente durante el ciclo vocal corto. La deglución se vio caracterizada por debilidad y descoordinación de los músculos orofaríngeos, con penetración o aspiración.

Conclusiones

Se diseñó un protocolo clínico multidisciplinar específico para reportar los parámetros vocales y los trastornos deglutorios que experimentan un cambio más rápido en los pacientes con ELA bulbar. Además, se estratificaron los pacientes con arreglo al compromiso de las estructuras faríngeas y el índice de gravedad.

http://bit.ly/2WVlIYu

Predictive Value of EGFR-PI3K-pAKT-mTOR-pS6 Pathway in Sinonasal Squamous Cell Carcinomas

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): María Gabriela Muñoz-Cordero, Fernando López, Cristina García-Inclán, Alejandro López-Hernández, Sira Potes-Ares, Laura Fernández-Vañes, José Luis Llorente, Mario Hermsen

Abstract

Background and objectives

We have previously indicated that EGFR has a role in carcinogenesis in a subgroup of sinonasal squamous cell carcinomas (SNSCC). In addition, EGFR activates 2 of the most important intracellular signalling pathways: PI3K/pAKT/mTOR/pS6 and MAP pathway kinases. The objective of this study was to evaluate the involvement of the EGFR/PI3K/pAKT/mTOR/pS6 pathway and its relationship with clinical–pathological parameters and follow-up of sinonasal squamous cell carcinoma.

Material and methods

The immunohistochemical expression of different components of the PI3K/AKT/mTOR/pS6 pathway and its relationship with various clinical-pathological parameters was studied in a series of 54 patients with SNSCC.

Results

Loss of PTEN expression was observed in 33/54 cases (61%) and pAKT, mTOR and pS6 pre-expression was observed in 19/54 cases (35%), 8/54 cases (15%), and 47/54 cases (87%), respectively. Loss of PTEN expression was related to intracranial invasion and development of regional metastases (P=.005). Overexpression of pS6 was associated with a decrease in survival (P=.008), presence of local recurrences (P=.055), and worsening of overall prognosis (P=.007). No significant relationships were observed between pAKT and mTOR expression and the clinicopathological parameters studied.

Conclusions

Alterations in the expression of EGFR/PI3K/pAKT/mTOR/pS6 pathway components are common in a subgroup of SNSCC. This study reveals that the absence of pS6 overexpression is associated with better clinical outcomes. Therefore, pS6 expression could be considered as an unfavourable prognostic marker.

Resumen

Antecedentes y objetivos

En estudios previos hemos indicado que EGFR tiene un papel en la carcinogénesis en un subgrupo de carcinomas epidermoides nasosinusales (CENS). Además, EGFR activa a 2 de las más importantes vías de señalización intracelular como son la PI3K/pAKT/mTOR/pS6 y la vía MAP-cinasas. El objetivo de este estudio fue evaluar la participación de la ruta de EGFR/PI3K/pAKT/mTOR/pS6 y su relación con parámetros clínico-patológicos y de seguimiento de los CENS.

Material y métodos

La expresión proteica de PTEN, pAKT, mTOR y pS6 fue analizada mediante inmunohistoquímica en 54 CENS. Los resultados fueron relacionados con diversos parámetros clínico-patológicos y la supervivencia.

Resultados

La pérdida de expresión de PTEN se observó en 33/54 casos (61%) y la sobreexpresión de pAKT, mTOR y pS6 se observó en 19/54 casos (35%), 8/54 casos (15%) y 47/54 casos (87%), respectivamente. La pérdida de expresión de PTEN se relacionó con la invasión intracraneal y el desarrollo de metástasis regionales (p = 0,005). La ausencia de sobreexpresión de pS6 se relacionó con una supervivencia específica (p = 0,008) y global (p = 0,007) más favorables y la ausencia de recidivas locales (p = 0,055). No se observaron relaciones significativas entre la expresión de pAKT y mTOR y los parámetros clínico-patológicos estudiados.

Conclusiones

Las alteraciones en la expresión de los componentes de la vía EGFR/PI3K/pAKT/mTOR/pS6 son frecuentes en un subgrupo de CENS. Este estudio revela que la ausencia de sobreexpresión de pS6 se relaciona con mejores resultados clínicos, por lo que la expresión pS6 podría considerarse como un marcador pronóstico.

http://bit.ly/2Sr0rrq

Infectious complications in head and neck surgery: Porto Oncology Centre retrospective analysis

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): Miguel Sá Breda, Joaquim Castro Silva, Eurico Monteiro

Abstract

Objective

To analyze the impact of infectious complications and microbiology in the postoperative period after major oncologic neck surgeries.

Methods

A retrospective study conducted in an oncology center, including all the consecutive patients who developed infectious complications after major neck cancer surgery, from October 2012 to May 2016 (44 months). Among other data, we collected TNM stage, ASA score, body mass index, comorbidities and habits, pre and postoperative hemoglobin levels, albumin serum levels, pre-surgical treatments, length of inpatient stay, isolated microbiological agents and the recorded complications and mortality rate.

Results

In the studied period, 761 major neck surgeries were performed. Of these, 96 patients had complications (12.6%). Pharyngocutaneous fistula (PCF) was the most frequent complication (56%) and nosocomial pneumonia was the most common systemic complication (23%). Pseudomonas aeruginosa was the principal microorganism of the 26 species isolated (15%). 12 deaths were registered. Using multiple linear regression we concluded that flap/cutaneous necrosis and PCF were complications with statistical significance that prolonged inpatient stay. The same complications had significant relative risk for more than 30 days of hospitalization.

Conclusion

The postoperative period is critical for the successful treatment of head and neck oncology patients. PCF and flap/cutaneous necrosis were the principal complications which worsened the outcomes during this critical period. The early recognition and treatment of these complications is crucial.

Resumen

Objetivo

Analizar el impacto de las complicaciones infecciosas en el período posoperatorio de las cirugías oncológicas mayores de cabeza y cuello, y estudio de los agentes microbianos implicados.

Métodos

Estudio retrospectivo realizado en un instituto oncológico, en pacientes que desarrollaron complicaciones infecciosas después de la cirugía oncológica mayor de cuello, entre octubre de 2012 y mayo de 2016 (44 meses). Entre otros se recogieron el estadio TNM, la puntuación ASA, el índice de masa corporal, las comorbilidades, los hábitos tóxicos, los niveles de hemoglobina pre y postoperatoria, los niveles séricos de albúmina, los tratamientos previos a la cirugía, la duración de la hospitalización y los microorganismos aislados, así como las complicaciones sufridas y la tasa de mortalidad.

Resultados

En este período se realizaron 761 cirugías cervicales mayores. De estas, 96 pacientes presentaron complicaciones (12,6%). Las que con mayor frecuencia se registraron fueron la fístula faringocutánea (FFC) (56%) y la neumonía nosocomial (23%). Fueron aislados 26 tipos de microorganismos, siendo la Pseudomonas aeruginosa la más frecuente (15%). Se registraron 12 fallecimientos. Tras el estudio estadístico con regresión lineal múltiple, se detecta que la necrosis cutánea o del colgajo y la FFC fueron las complicaciones con un mayor impacto estadístico en la estancia hospitalaria. Asimismo, fueron los factores que más influyeron en las hospitalizaciones de 30 días o más.

Conclusión

Una buena evolución durante el período postoperatorio es fundamental para obtener éxito en el tratamiento de los pacientes oncológicos de cabeza y cuello. La FFC y la necrosis de colgajo o cutánea constituyeron las principales complicaciones con un mayor impacto en los resultados obtenidos. La detección precoz de estas complicaciones, así como su tratamiento, son cruciales.

http://bit.ly/2DomK6F

Clinical Experience With Patients With Spasmodic Dysphonia and Primary Meige Syndrome

Publication date: January–February 2019

Source: Acta Otorrinolaringologica (English Edition), Volume 70, Issue 1

Author(s): María Fernanda Pedrero-Escalas, Isabel García-López, Susana Santiago-Pérez, Francisco Vivancos, Javier Gavilán

Abstract

Introduction

Meige syndrome (MS) is part of the group of segmental cranial dystonias, which affect more than two cranial muscle groups. Specifically, blepharospasm is associated with another cranial dystonia (oromandibular, cervical or laryngeal). The aim of this paper was to report our experience in patients with spasmodic dysphonia (SD) associated with primary MS.

Material and methods

A retrospective study involving 8 patients between May 2010 and June 2015. Variables recorded were: age, sex, associated dystonia, electromyographic pattern in laryngeal muscles and treatment given. Outcomes after treatment were assessed using GRBAS(i) scale and VHI-30 questionnaire, always provided by the same examiner.

Results

Fifty-six patients with MS were treated in the Neurology Department. Eight patients of 56 were diagnosed with SD (prevalence of 14%). All of our patients had adductor SD. The median age was 71 years. All the patients were treated with intralaryngeal botulinum toxin under electromyographic control. Clinically relevant improvements were found after treatment on both the GRBAS(i) scale and the VHI-30 questionnaire.

Conclusion

In the study of SD, we should always rule out an association with MS. From the point of view of otorhinolaryngology, the joint use of the GRBAS(i) scale and the VHI-30 questionnaire are useful, reliable and efficient methods for assessing progress and response to treatment. Laryngeal infiltration under electromyographic control with botulinum toxin is the therapeutic alternative that provides better results. The management of SD associated with MS does not differ from isolated SD.

Resumen

Introducción

El síndrome de Meige (SM) es considerado una distonía craneal segmentaria que afecta a dos o más músculos craneales. Específicamente, asocia blefaroespasmo a otra distonía craneal (oromandibular, cervical o laríngea). El objetivo de este artículo es presentar nuestra experiencia clínica en pacientes con disfonía espasmódica (DE) asociada a SM primario.

Material y métodos

Estudio retrospectivo realizado entre mayo de 2010 y junio de 2015. Incluyó 8 pacientes. Las variables recogidas fueron: sexo, edad, distonías asociadas, electromiografía laríngea y tratamiento. Los resultados clínicos objetivados fueron realizados, siempre por el mismo investigador, con la escala GRBAS(i) y el cuestionario VHI-30.

Resultados

Cincuenta y seis pacientes fueron tratados de SM por el servicio de Neurología. Ocho pacientes asociaron DE (prevalencia 14%). El 100% de nuestros pacientes tenían DE aductora. La mediana de edad para la aparición de DE fue de 71 años. Todos los pacientes fueron tratados con infiltración intralaríngea de toxina botulínica bajo control electromiográfico. Se objetivó mejoría clínica tanto en la escala GRBAS(i) como en los cuestionarios VHI-30.

Conclusión

En el estudio de la DE siempre debe tenerse presente su posible asociación con el SM. Desde el punto de vista otorrinolaringológico, el uso conjunto de la escala GRBAS(i) y los cuestionarios VHI-30 es útil, fiable y eficiente como método para evaluar evolución y respuesta a tratamiento. La infiltración laríngea de toxina botulínica bajo control electromiográfico es la alternativa terapéutica que provee mejores resultados clínicos. El manejo de la DE asociada al SM no difiere del de la DE aislada.

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The relationship between health-related quality of life and speech in patients with cleft palate

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Laura Bruneel, Kim Bettens, Kristiane Van Lierde

Abstract

Introduction

In health-care, current efforts focus on providing patient-centered care. Specifically for patients with velopharyngeal insufficiency, and by extent patients with cleft palate, the Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) questionnaire (Skirko et al., 2012; 2013) allows the clinician to map the impact of speech and swallowing difficulties on the patient's health-related quality of life (HRQoL). The current study evaluated the hypothesized association between this speech-related HRQoL measure and perceptually and instrumentally assessed speech variables, to provide evidence for the construct validity of the Dutch version of the VELO questionnaire.

Materials and methods

Thirty participants, twenty-five patients with cleft palate and five controls, were enrolled. Perceptual speech assessment was conducted following the recently developed Dutch outcome tool for perceptual speech assessment in patients with cleft palate. In addition, nasalance values and the Nasality Severity Index (NSI) 2.0 were determined. The relationship between these speech outcomes and the scores on the VELO parent report was determined using Spearman rank-order correlation coefficients.

Results

Moderate to strong correlations were found between the total score on the VELO parent report and five speech variables: the VPC-SUM score (r_s= -0.476), speech understandability (r_s= -0.657), passive CSC's (r_s= -0.654), speech acceptability (r_s= -0.591) and the need for C(L)P-related speech therapy (r_s= -0.711). Furthermore, these variables were associated with at least one subscale of the VELO questionnaire.

Discussion and conclusion:Correlations between speech outcomes and the Dutch version of the VELO questionnaire provide evidence for the construct validity of this version of the instrument. Furthermore, insights in these associations may lead the way to efficient therapy approaches, targeting speech features with the greatest impact on the patient's health-related quality of life.

http://bit.ly/2DozI4a

Radiologic Recognition of Cochlear Implant Magnet Displacement- A Case Report

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Madison V. Epperson, Hayley L. Born, John Greinwald

Abstract

Despite various studies that have demonstrated risk of cochlear implant magnet displacement following MRI, minimal literature is available on radiologic recognition of magnet displacement. Current literature emphasizes the status and placement of the electrode component of the implant. This case report examines the consequences of a delay in radiologic diagnosis of a displaced magnet including hospital admission, unnecessary radiation, and prolonged patient discomfort. Additionally, it provides a framework for successful radiologic recognition of a displaced magnet, detailing specific imaging modalities and magnet characteristics that should be evaluated to expedite and facilitate radiologic recognition of displacement.

http://bit.ly/2SnZEY0

Pediatric Tracheostomy First Tube Change: When is it Safe?

Publication date: Available online 8 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): R. Woods, L. Geyer, R. Mehanna, J. Russell

Abstract

Objectives

The first tracheostomy tube change is typically performed on days 5-7 post-operatively, however recent international consensus guidelines suggested that, with maturation sutures, days 3-5 is appropriate. We evaluate whether a first tube change on day 2 post-operatively is safe and effective.

Methods

We carried out a retrospective review of all patients undergoing tracheostomy between 2009 and 2018. Exclusion criteria were patients on whom the senior authors did not operate, operations done elsewhere, cases where maturation sutures were not used or a patient died prior to first tube change. We noted patient details, indication for tracheostomy, the need for long-term ventilation, timing of the first tube change, decannulation and need for surgical closure of persistent tracheocutaneous fistula.

Results

93 patients were identified, of which 83 were included. The age range was 0-16 years, with the youngest day one of life and an overall mean age of 1.91 years. 59% of patients required long-term ventilation due to various co-morbidities. 26 patients (31%) underwent a first tube change on day 2 post-operatively. All these were uneventful and were irrespective of the patient's need for ventilation. Of the 42 patients who have subsequently been decannulated, 33 (79%) were noted to have a persistent tracheocutaneous fistula requiring surgical closure, four of whom needed revision closure.

Conclusions

This study shows that a first tube change on day 2 post-operatively is safe, facilitating earlier discharge from intensive care, allowing shorter length of sedation, earlier start to parent/carer training and wound assessment.

http://bit.ly/2DiUIsY