bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes after Orbital Exenteration
Authors: Golden J. Blake , Sweeny Larissa , Carroll William R. , Magnuson J. Scott , Rosenthal Eben L.
Published: February 2015

Objective

1) To report surgical and oncologic outcomes for patients who underwent orbital exenteration for malignancies involving the orbit. 2) To understand rationale behind choice of reconstruction technique used after orbital exenteration.

Method

A retrospective study of all patients requiring orbital exenteration for malignancy between April 2000 and April 2010 at a tertiary referral academic institution was performed. Demographic data, treatment details, reconstructive outcomes, and survival/recurrence rates were compiled and disease characteristics predictive of poor outcomes were identified.

Results

There were 52 patients requiring orbital exenteration for surgical management of malignancy. Malignant etiology was cutaneous squamous cell carcinoma (SCC) in 24 (46%), sinonasal SCC in 15 (29%), and non‐SCC histology in 13 (25%). Recurrence rate at 1 year was 47% for all histologies after orbital exenteration. The majority of recurrences were local (65%). Average time to recurrence was 8.3 months. Surgical margin status had no effect on overall recurrence rate. Radiation therapy was part of the treatment for 73% of patients, with 23% of the overall group having received previous XRT and 50% of the group receiving postoperative radiation. The surgical defect created a communication between the sinonasal cavity and the orbital wound 77% of the time, which correlated with a higher rate of late wound complications (P =. 02). Free flap reconstruction was performed in 83% of patients, with rectus myocutaneous flap being the most common. Overall wound complication rate was 44%.

Conclusion

Malignancy requiring orbital exenteration is a complex disease, requiring aggressive and specialized management of both healing and oncologic issues.
Outcomes for Parotid Carcinoma in a Teaching Hospital
Authors: Brodskyn Fabio , Manoel Evandro M. , Guilherme Luiz Henrique , Palumbo Marcel D. N. , Cervantes Onivaldo , Abrahao Marcio
Published: February 2015

Objective

1) Analyze the epidemiological, clinical, surgical and histologic characteristics of patients submitted to surgery for parotid carcinoma in a teaching hospital.

Method

A retrospective study of patients’ records diagnosed with parotid carcinoma between 2003 and 2010. We included only the patients submitted with a parotidectomy for primary parotid carcinoma with no previous treatment.

Results

A total of 20 patients were included, with a median follow‐up of 29.6 months. The median age at diagnosis was 42.6 years, with a male:female rate of 1:1. The most prevalent histological type was the low grade mucoepidermoid carcinoma (35%). There was a balance between patients with pathologic stage I (40%) and IV (40%). Treatment involved total parotidectomy, neck dissection and post‐operative radiotherapy in, respectively, 75%, 45%, and 45%. Four patients (20%) presented lymph node cervical metastasis, which was the same rate of patients with locoregional recurrence.

Conclusion

The patients presented similar characteristics to the literature, although the average age at diagnosis was lower than other studies.
Outcomes in Salvage Laryngectomy with Free Tissue Transfer
Authors: Jorgensen Jeffrey B. , Showmaker Jason A.
Published: February 2015

Objective

1) Report the incidence of complications and feeding outcomes in salvage laryngectomy performed with free tissue transfer compared to primary closure. 2) Evaluate factors that may be associated with an increased rate of complications.

Method

Retrospective case series from a single institution between 2007 to 2012. Thirty‐two patients met the following inclusion criteria: patients undergoing salvage laryngectomy with primary wound closure (16 patients) and those patients undergoing salvage laryngectomy with wound closure augmentation by microvascular free tissue transfer (16 patients).

Results

We performed a retrospective case series comparing complications in salvage laryngectomy closed primarily vs repair with free tissue transfer. Smoking status at surgery was similar between the 2 groups. In the primary closure group we report major fistula in 37.5%, minor fistula in 19%, dysphagia requiring dilatation in 25%, and feeding tube dependence in 14% of patients. In the free tissue transfer group we report major fistula formation in 12.5%, dysphagia requiring dilatation in 12.5%, and feeding tube dependence in 8% of patients. Minor fistula did not occur in the free tissue transfer group.

Conclusion

Multiple factors were compared and preliminary data suggests that free tissue transfer reduces major and minor fistula rates. Additionally, fewer patients required dilatation and fewer patients were feeding tube–dependent in the free tissue transfer group. Formal statistical analysis will be performed.
Pressure Ulcer Prevention Strategies in Prolonged Surgery
Authors: Alrasheed Abdulaziz S. , Aldhahri Saleh , Kennedy Linda , Ferreras Benson
Published: February 2015

Objective

1) To determine the incidence of pressure ulcers (PU) post‐prolonged head and neck surgery. 2) To determine the outcome of interventional strategies on PU development.

Method

A prospective study between June 2008 and March 2011.Using the FOCUS‐PDCA model, an improvement plan was developed in KFMC for patients undergoing surgery of 4‐hour duration. A patient monitoring protocol was developed including a full demographic database, a preoperative risk assessment, an intraoperative prevention method with a skin integrity check list, and a postoperative skin assessment handover. The patients were monitored for signs of PU for the next 7 days. Possible risk factors along with pressure ulcer reduction interventions were evaluated.

Results

During the study 230 H&N patients were monitored. The initial incidence of PU was 23.5%. After implementation of the specialty mattress, it decreased to 10%. With the use of additional mattresses, intra‐ and postoperative PU prevention documentation the incidence deceased to 5%. The PUs that developed were stage I or II; none of them progressed. Duration of surgery was the most important risk factor (P <. 05). The site of PU was in the back in 50% (scapula 29%) of patients. Increased length of stay was associated with PU development (P <. 05).

Conclusion

Patients undergoing prolonged H&N surgery are at higher risk of developing PU than patients going for other types of surgeries. Downward trends in PU development were related to the implementation of interventional strategies. The high level of awareness and continuous monitoring prevented further progression of early stage PU.
Protection of Radiotherapy‐Induced Xerostomia with Vitamin E+C Complex
Authors: Park Ki‐Nam , Son Young‐Ik , Baek Chung Hwan
Published: February 2015

Objective

Salivary tissues are easily damaged by radiotherapy (RT) and therefore xerostomia becomes the most common complaint in patients who receive RT in the head and neck area. This study aimed to elucidate the effective of antioxidant vitamin E and C complex on the protection of RT‐induced xerostomia.

Method

A trial group received a vitamin E (200 IU) + C (500 mg) complex for 3 months of peri‐RT period. A control group took placebo which had no inner contents. Subjective questionnaires, objective grading by a nurse‐specialist, and scintigraphs were obtained before and after 1 and 6 months of RT.

Results

Sixty‐five patients were initially enrolled and 39 patients completed the study as scheduled. There were no differences in age, sex, RT dosage, tumor staging, and treatment modality between the 2 groups. The trial group reported less discomfort in 2 items of subjective evaluation; “impaired speech” and “difficulty of mastication” (P <. 05). Pre‐ and poststimulatory oral salivary scan were higher in the trial group (P <. 034 and P <. 026, respectively). In the trial group, maximum accumulations in submandibular gland were significantly higher at 1 month as well as at 6 months after RT (P <. 041 and P <. 004, respectively).

Conclusion

Short‐term administration of antioxidant vitamin E and C complex during the period of RT has protective roles against xerostomia. Higher oral activity in the trial (vitamin E+C) group is probably based on the protection of accumulatory function of the SMG.
Results from the Swedish Head and Neck Cancer Register for Oral Cancer
Authors: Hammerlid Eva B. , Holmberg Erik , Högmo Anders , Laurell Göran , Niklasson Magnus , Wennerberg Johan , Westerborn Anders
Published: February 2015

Objective

The Swedish Head and Neck Cancer Register (SweHNCR) started in 2008. The purpose was to register all new patients with head and neck cancer and collect data about tumor stage, planned and received treatment, relapse and survival. Data for oral cancer from the first 3 years will be presented.

Method

The SweHNCR is covering more than 95% of all HN cancers in Sweden. Between 2008 and 2010, 3701 new cases were registered including 1029 of oral cancers (28%). The most common location was tongue (42%), followed by gingival (21%), buccal mucosa (19%), floor of the mouth (14%), and hard palate (3%). Less than 10% were treated with palliative intent.

Results

Sixty percent of all gingival cancers were diagnosed as T4 while 70% of the tongue cancers were diagnosed as T1‐T2. A total of 25% had lymphnode metastasis, range 27% (tongue) to 12% (hard palate). Surgery was the most common treatment (38%), followed by combinations of surgery and radiotherapy (36%), 19% were treated with radiotherapy alone or combined with chemotherapy, and 7% did not receive any treatment. The 2‐year survival was 69% (hard palate 83%, buccal mucosa 74%, gingival 70%, tongue 69%, and floor of the mouth 63%). Data regarding treatment and stage of the disease will be further analyzed together with survival data.

Conclusion

Oral cancer is the most common HN cancer location in Sweden. Almost all patients are given curative treatment (90%) consisting of surgery alone or in combination with radiotherapy (70%). The 2‐year survival rate varied between 63% to 83%. Different treatment policies and survival rate was found within the country.
Robotic‐Assisted Thyroidectomy: The First UK Experience
Authors: Arora Asit , Sharma Sunil D. , Garas George , Awad Zaid , Darzi Ara , Tolley Neil S.
Published: February 2015

Objective

To review our initial experience of robotic thyroidectomy, describe modifications for a Western population, and establish a robust framework for implementation in the UK.

Method

Prospective feasibility study (n = 15) performed in a tertiary referral center over 18 months. Procedure‐related measures included conversions to open, operative time and the learning curve. Patient‐related measures included biometrics, trans‐axillary dissection area, voice and swallow function, pain, scar cosmesis, and global quality of life using validated assessment tools.

Results

Thyroid lobectomy was performed in 15 patients with no conversions to open. The average BMI was 25.6 (range, 19‐35). Mean operative time was 200 minutes. A larger trans‐axillary dissection area increased the total operative time. The average size of the excised nodule was 2.5 cm (range, 1.5‐6.5 cm). All patients were discharged within 24 hours. No permanent complications occurred. There was 1 temporary brachial plexus neuropraxia which resolved within 5 days. The mean follow‐up time was 7 months. The mean scar cosmesis score significantly improved from 56% on day 1 postoperatively to 98% at 12 months (P =. 01).

Conclusion

Robotic thyroidectomy is feasible for selected patients in the UK. The primary advantage is avoidance of a neck scar. Optimal arm position which minimizes brachial plexus injury is crucial. Validated training methods are necessary for safe adoption. A randomized clinical study will establish the clinical efficacy compared with conventional surgery.
sLeX, Biomarker of Metastatic Head and Neck Carcinomas
Authors: Czerwinski Michael J. , Papagerakis Silvana , Athanassiou‐Papaefthymiou Maria , Shkeir Omar , Knibbs Randal , Lapadatescu Cezar
Published: February 2015

Objective

Among the clinical challenges of head and neck squamous cell carcinomas (HNSCC), the morbidity and mortality of advanced oral cancer (OC) remains paramount. The molecular mechanism controlling OC progression and metastasis are thus key to the improvement of clinical outcomes. Metastatic dissemination begins with adhesion of circulating tumor cells to the E‐selectin‐expressing endothelium with high levels of the main E‐selectin ligand, sLeX, having been implicated in various carcinomas. Our study represents the first investigation of the sLeX involvement in HNSCC dissemination.

Method

A panel of stage‐ and anatomic site‐specific primary and metastatic HNSCC cell lines was examined by flow cytometry to quantify cell‐surface sLeX expression. Secreted sLeX expression was measured by Western‐blot in serum‐free conditioned medium. Quantitative real time PCR (qRT‐PCR) was used to identify the fucosyl‐transferases involved in sLeX neosynthesis in HNSCC. HNSCC invasive and migratory abilities were evaluated by Matrigel assays according with their sLeX expression levels.

Results

HNSCC originating from oral cavity (OC) expressed high sLeX that increased with advanced stage; it was highest in cells from recurrent (HNSCC14B) and metastatic (UMSCC103) tumors with known poor clinical outcomes. The expression of secreted sLeX was also high in OC supernatants. sLeX‐positive tumor cells exhibited higher invasive potential than sLex‐negative HNSCC.

Conclusion

Among various sites HNSCC, both cell‐bound and soluble sLeX was predominantly expressed in OC carcinomas and associated with recurrent and metastatic tumors. The mechanism of sLeX involvement in OC progression is under investigation. A better understanding of the HNSCC dissemination will positively impact the clinical management.
Supraglottic Tumor Biopsy in a Patient with Spinal Stenosis
Authors: Bedrosian Jeffrey , Liu Jeffrey C.
Published: February 2015

Objective

1) To discuss the management of head and neck cancer in the setting of spinal stenosis. 2) To demonstrate a novel use of the GlideScope to facility direct laryngoscopy and biopsy in a patient with severe spinal stenosis.

Method

In this case report, we present a 53 year‐old woman with a 1.5‐cm mass rising from the left aryepiglottic fold and severe narrowing of the C5‐C6 spinal canal. Using a GlideScope to obtain indirect visualization, we successfully completed this procedure with the cervical spine in the neutral position.

Results

A survey of the anesthesia literature demonstrates the benefit of the GlideScope for visualization of the larynx while maintaining the cervical spine in the neutral position. This technique allowed successful direct laryngoscopy and biopsy in a patient with moderate to severe spinal stenosis.

Conclusion

Our novel approach allowed reasonable visualization and biopsy of this supraglottic tumor while maintaining cervical spine stabilization.
The Role of Estrogen on Rat Parotid Gland after Menopause
Authors: Tatlıpınar Arzu , Oysu Cagatay , Uslu Ünal , Yiğit Alev , egül Verim Ayş
Published: February 2015

Objective

To determine the histopathological changes of estrogen deficiency and estrogen replacement treatment in parotid gland of ovariectomized rats.

Method

Female albino rats were divided into 3 groups: sham, ovariectomized, and ovariectomized with estrogen replacement. Histopathological evaluation of rat parotid glands were done by using the diameter of acinus and striated duct (SD), height of SD, and interacinar connective tissue thickness. Apoptosis in parotid gland were examined by TUNEL staining.

Results

Except interacinar connective tissue thickness, there were no significant differences between the sham‐operated control and ovariectomized group in terms of the diameter of acinus and striated duct (SD) and height of SD. Estrogen replacement resulted in significant increase in the height of SD and interacinar connective tissue thickness. Apoptotic index was higher in both ovariectomized and estrogen replacement group compared to sham‐operated control.

Conclusion

Although estrogen replacement did not reduce apoptotic index in parotid gland of overiectomized rat, it may have some positive influence on saliva secretion by increasing interaciner connective tissue thickness.
The Transfusion Dilemma in Free Tissue Transfer
Authors: Greene Scott M. , Shockley Ross L. , Rohde Sarah L.
Published: February 2015

Objective

Despite the NIH recommendation for transfusions based on the individual patient, many microvascular surgeons continue to use a trigger point to guide transfusion criteria in patients undergoing free tissue transfer. Our objective is to learn the effects of blood transfusion on complications in free tissue transfer patients.

Method

A retrospective study of patients undergoing free tissue transfer with and without blood transfusions from June 2005 through May 2011 at a single tertiary care center. Outcome measurements include flap failure, hematoma, fistula rate, respiratory failure and cardiovascular events.

Results

A total of 225 patients underwent free tissue transfer during the study period. One hundred twenty‐one patients received either intraoperative or postoperative blood products. When compared to a group of 100 patients similar in age, BMI and pre/post‐operative hematocrit levels, there was a statically significant difference in total hospital length of stay (7.8 vs 9.5 days, P =. 01) and total rate of complications (9 vs 33.8%, P =. 0002). Specific post‐operative complication rates were as follows; flap failure (2% vs 5.7% failure rate), respiratory failure (0 vs 12.6% patients required prolonged ventilatory support), and hematoma rates of 2% and 12%, respectively.

Conclusion

For patients undergoing free tissue transfer, transfusion of blood products is associated with a statistically significant increase in postoperative morbidity. We propose basing transfusion criteria on an individual basis rather than by means of a trigger point.
Thyroid Papillary Carcinoma and Liver Fibrosis Interaction
Authors: Muhanna Nidal , Doron Sarit , Amer Johnny , Sichel Jean‐Yves , Safadi Rifaat
Published: February 2015

Objective

A high prevalence of thyroid papillary cancer has been reported in Hepatitis C virus (HCV) positive patients. The aims of our study are to: 1) Investigate the mechanistic role of liver injury in thyroid malignancy progressions. 2) Study the immune‐modulatory interactions between thyroid papillary carcinoma and hepatic‐fibrosis.

Method

In vivo: Hepatic‐fibrosis and thyroid carcinoma cell line were induced in nude mice. Fibrotic profile was estimated using RT‐PCR and Western blots. Lymphocytes were stained for NK‐activity. Liver injury, tumor mass, serum VEGF, estradiol, and T4 levels were assessed. Ex‐vivo: Thyroid cell line was analyzed for proliferations by CFSE.

Results

Tumor groups excreted higher serum T4 levels. Hepatic‐fibrosis increased tumor weight and size and serum T4 levels. In addition, animals with both tumor and hepatic‐fibrosis had increased NK activity. Therefore, animals with tumors increased fibrosis in spite of increased NK activity; probably due to a direct effect through increased serum‐free T4 excretions. Serum VEGF levels were significantly increased in the fibrotic groups. In vitro, lymphocytes harvested from fibrotic animals with thyroid tumors induction co‐cultured with tumor cells led to a decrease in their proliferations as compared to tumor cells alone. This decrease could be attributed to the increase in NK activity.

Conclusion

Our results propose immune‐modulatory interactions with hepatic fibrosis and T4 excreting thyroid tumor. Advanced fibrosis and tumor activity propagate each other in the presence of the anti‐ tumor and anti fibrotic effects of the increased NK activity. This interplay may explain increased risk of thyroid tumors in chronic HCV patients.
A Review of 2399 Ears for Postmyringotomy Tube Otorrhea
Authors: Chen Sharon , Cheng Leah , Chen Timothy , Cheng Jeremiah , Cheng Rebecca , Cheng David
Published: February 2015

Objective

To review consecutive myringotomy tube surgeries from 2005 to 2011.

Method

Retrospective chart analysis of the last 2399 consecutive ears for myringotomy tube surgery from July 2005 to December 2011.

Results

Out of 2399 total ears reviewed, the total rate of otorrhea was 4.1% with 5.7% with no intervention developing immediate postmyringotomy tube otorrhea, 2.3% with ointment coated onto the tube developing otorrhea, 3.8% with ofloxacin instilled at time of surgery developing otorrhea, and 4.6% with cortisporin instilled at time of surgery developing otorrhea. Purulent middle ear effusions developed immediate postmyringotomy tube otorrhea in 7.3% of the ears, but no middle ear effusions developed otorrhea in only 2.8% of the ears. Sheehy collar button tube had the least amount of postmyringotomy tube otorrhea at 1.9%.

Conclusion

Early postmyringotomy tube otorrhea is a frequent complication of myringotomy tube insertion with a rate of 4%, and the type of intervention at time of surgery with ointment or drops along with the type of tubes placed made a difference in the incidence of postmyringotomy otorrhea.
Transantral Approach to the Lateral Orbit
Authors: Van Rompaey Jason , Carrau Ricardo L. , Solares C. Arturo
Published: February 2015

Objective

Depending on the type of pathology and location, various methods of access have been developed to overcome the obstacle of accessing the orbit. The endoscope provides minimally invasive surgical access to the medial and inferior orbit. Expanding endoscopic access to the lateral orbit transantrally could create a minimally invasive corridor.

Method

Using late injected cadavers, endoscopic dissections of the infero‐lateral orbit were undertaken. A sublabial transmaxillary ostomy was created and an endoscope was advanced into the sinus. The contents of the orbit were dissected laterally to the inferior optic nerve. Photographic evidence was obtained for review.

Results

A 45° endoscope was required to adequately visualize the anatomy. The perpendicular nature of the corridor necessitated the use of angled instrumentation. This also created a challenge as the dissections were completed superiorly. Dissection was found to be facile until revealing the lateral rectus muscle. Proceeding superiorly past this point was limited by the length of the instruments. Tools of dissection with greater length could possibly overcome this limitation. Overall the transantral endoscopic approach to the orbit provided an adequate surgical window inferiorly and to a limited extent laterally. The relevant anatomy was identified without difficulty.

Conclusion

An endoscopic transantral approach to the infero‐lateral orbit is anatomically feasible. The morbidity associated with an open approach could possibly be avoided, improving patient outcomes. Further understanding of the endoscopic anatomy of the orbit can allow for advances in surgery with improved safety and efficacy.
Transhyoid Approach for Tongue Base Cancer
Authors: Cotulbea Stan , Marin Alin Horia , Lupescu Stelian , Balica Nicolae C. , Ruja Andreea S.
Published: February 2015

Objective

Cancer of the base of the tongue presents much less frequently than cancer of the mobile part of the tongue. Squamous cell carcinomas at the base of the tongue are usually diagnosed in advanced stages, and the optimal treatment has not been established.

Method

Retrospective study from 1998 to 2007. A base of the tongue transhyoid resection was performed in 37 previously untreated patients. Epiglotectomy or horizontal supraglottic laryngectomy was also included in 14 cases (37.83%) and in 23 cases (62.17%). Bilateral neck dissections were performed in all cases. All of these patients underwent postoperative radiotherapy.

Results

The postoperative and posttherapeutic evolution in 37 patients was favorable at 3 years (81.10%) and 5 years (75.67%), without signs of locoregional reccurences. The tumor‐specific 3‐ and 5‐year survival rates were: pT2 100%, pT3 87.5%, pT4a 71.42% and 57.14%, and pT4b 50%, respectively 25%. The stage‐specific 3‐ and 5‐year survival rates were: stage II 100%, stage III 85.71%, stage IVA 83.33%, and 79.16%, and stage IVB 50% and 25%, respectively.

Conclusion

While the prognosis for squamous cell carcinomas of the base of the tongue is poor, especially in advanced stages, cancer resection using the transhyoid approach is a feasible procedure which permits excellent tumor control over a long period of time with limited postoperative morbidity.
US‐FNA and CNB in Cervical Lymphadenopathy Diagnosis
Authors: Liao Li‐Jen , Wang Chi‐Te , Cheng Po‐Wen
Published: February 2015

Objective

We aimed to characterize sonographic findings of various malignant cervical lymphdenopathy (MCL) and to compare the effectiveness between ultrasound‐guided fine‐needle aspiration(US‐FNA) and core‐needle biopsy (US‐CNB) in achieving their diagnosis.

Method

A total of 113 MCL patients, receiving real‐time US‐FNA or US‐CNB, were rectrospectively reviewed from July 2007 to Dec 2011. Results of FNA cytology and CNB pathology were categorized as being false negative, suspicous, and positive for malignancy. The US features, time from needle biopsy to diagnosis were also recorded and compared statistically.

Results

The US‐FNA with false‐negative rate 50% (7/14) for lymphomatous nodes (LYM) was significantly higher than those of nonthyroid primary carcinoma (META; 0%; 0/60), papillary thyroid carcinoma (PAP; 8.3%;1/12), and US‐CNB for LYM (0%; 0/13) and META (0%;0/14). Comparing time from needle procedure to diagnosis among META‐FNA, LYM‐FNA, PAP‐FNA, META‐CNB, and LYM‐CNB, US‐FNA had the longest time to diagnosis (P <. 01, Log‐rank test). Discriminating US indicators included internal echo, S‐axis/L‐axis ratio, hilar echogenicity, calcification, and cystic formation.

Conclusion

Sonographic finding are valuable for MCL diagnosis and in deciding whether US‐FNA or US‐CNB should be done. US‐FNA can be a diagnostic tool for most MCL. US‐CNB, however, should be performed if malignant lymphoma is suspected.
A Survey of Steroid Use in Otolaryngology
Authors: Govil Nandini , Paul Benjamin , Amin Milan R. , Branski Ryan C.
Published: February 2015

Objective

Glucocorticoids are commonly used treatments in otolaryngology, but guidelines about their use are vague and irregular. We sought to assess clinical practices with regard to glucocorticoid use for patients with laryngeal disease and to ascertain factors driving clinician drug choice.

Method

A web‐based survey was distributed to otolaryngologists via email using the Ear, Nose, and Throat (ENT) Journal database. This survey was composed of 20 questions and collected the following data from respondents: 1) indications for the use of glucocorticoids in their practice, 2) decision‐making process influencing the choice of glucocorticoid, 3) background and demographics.

Results

Two hundred eight otolaryngologists completed the survey, with 99% (n = 196) reporting that glucocorticoids were valuable to their practice. “Previous experience/results,” “familiarity,” and “use in practice” (n = 144, 114, and 79, respectively) were commonly cited reasons for choosing a particular glucocorticoid, whereas pharmacokinetic profile and “academic literature” were infrequently cited concerns. Only 54.4% (n = 106) of respondents said that they were more likely to prescribe glucocorticoids for vocal performers as compared to other patients. Additionally, most respondents said side effects only “occasionally” prevented them from prescribing glucocorticoids to patients.

Conclusion

These results suggest that glucocorticoid prescription practices vary greatly between otolaryngologists, and drug choice is driven primarily by clinician preference rather than more objective factors. These findings indicate a need for further research about this powerful class of drugs, and the importance of establishing clear, appropriate guidelines regarding their use.
Validating Tobacco Use with Cotinine in Cancer Patients
Authors: Hatcher Jeanne L. , Tooze Janet , Sterba Katherine , Weaver Kathryn , Day Terry A. , Sullivan Christopher A.
Published: February 2015

Objective

Tobacco use may be a risk factor for poor outcomes following surgery for head and neck cancer patients. We sought to determine the prevalence of tobacco exposure prior to head and neck surgery using both patient report and urinary cotinine.

Method

Patients with squamous cell carcinoma of the upper aerodigestive tract undergoing a major head and neck procedure were recruited from 2 academic medical centers from 2011 to date. We assessed preoperative tobacco use by self‐report and by cotinine level, a nicotine metabolite, in urine using a semiquantitative test strip.

Results

We have recruited 49 patients to date (mean age, 60 years), 71.4% male, 85.7% non‐Hispanic white, 60.0% stages III‐IV. In the 48 hours before surgery, 11 patients (22.5%) reported tobacco use; 18 (36.7%) were identified by intraoperative urine cotinine. In sum, 57.1% of women and 28.6% of men tested positive for cotinine (P =. 06). Of those who denied tobacco use, 7 out of 38 (18.4%) were positive for cotinine (>2); sensitivity for self‐report was 61.1%. Secondhand exposure was reported by 6 of 38 (15.8%) nonusers, 2 being cotinine positive. There was no association between secondhand exposure and positive cotinine (Fisher’s Exact, P =. 30).

Conclusion

Tobacco is a major risk factor for head and neck cancer. The use of a urine cotinine screening test demonstrated that self‐report may fail to identify a significant number of tobacco users. Implementation of cotinine screening could facilitate precise understanding of tobacco use patterns and opportunities for intervention.
Acute Tonsillitis: Do We Always Need a Monospot?
Authors: El‐Shunnaz Suliman , Holmes Holly , Stobbs Emily , Salem Hesham
Published: February 2015

Objective

Patients presenting with tonsillitis are tested for glandular fever. Studies suggest a high lymphocyte–white cell ratio is a useful screening test for glandular fever. The purpose of our study was to ascertain the usefulness of testing patients for glandular fever if they have normal lymphocyte counts and blood films.

Method

Retrospective review of blood results and discharge summaries of all patients presenting to a university teaching hospital with a diagnosis of acute tonsillitis or peritonsillar abscess over a 3‐year period from 2008 to 2011. Data were collected for age, sex, blood results, and EBV testing and analyzed in Excel.

Results

Seven hundred forty‐three patients were identified with a diagnosis of tonsillitis or peritonsillar abscess. Four hundred seventy‐two (63.5%) were tested for glandular fever, and of those tested, 32 (6.78%) patients tested positive. Thirty (93.8%) of the confirmed glandular fever patients had deranged lymphocytes.

Conclusion

Patients with acute tonsillitis presenting without a lymphocyte derangement on blood film are unlikely to test positive for glandular fever. However, given the clinical implications of a positive glandular fever test, it is advisable to perform a monospot test in all patients presenting with tonsillitis.
Initial Dosing of Botox A in Adductor Spasmodic Dysphonia
Authors: Rosow David E. , Vivero Richard J. , Parikh Punam , Casiano Roy R. , Lundy Donna
Published: February 2015

Objective

1) Assess effect on voice improvement and duration of breathiness based on initial dose of BotoxA in management of adductor spasmodic dysphonia. 2) Compare voice outcomes for initial bilaterally injected doses of 1.25 units Botox A (Group A) versus 2.5 units (Group B).

Method

A retrospective chart review was undertaken of all adductor spasmodic dysphonia patients treated at a tertiary care facility between 1990 and 2011. Demographic data (age and sex), voice rating, duration of voice improvement, and breathiness were evaluated and compared between Groups A and B using Student’s t test and chi‐square analysis.

Results

Of 478 patients identified, 305 (group A: 223; group B: 82) patients met inclusion criteria. The average age of group A was 56.2 years and group B was 57.4 years (P =. 5). The female/male ratio was 2.91 for group A versus 3.56 for group B (P =. 61). Good voice outcomes (grade 3 or 4) were reported by 91% of group A patients versus 94% of group B (P =. 75). The average duration of voice improvement was 99.7 days for group A and 108.3 for group B (P =. 54). The average duration of breathiness was 10.88 days for group A versus 15.42 for group B (P =. 02).

Conclusion

Patients injected with 1.25 units bilaterally had a statistically significant shorter duration period of breathiness without a statistically significant difference in clinical effectiveness or voice outcome. It is therefore recommended that a relatively low initial Botox dose be used with subsequent titration to achieve improved voice outcomes.
Laryngeal EMG for Unilateral Vocal Fold Paralysis
Authors: Wang Chen‐Chi , Chang Ming‐Hong
Published: February 2015

Objective

1) Examine the accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of using laryngeal electromyography (LEMG) to predict the prognosis of unilateral vocal fold paralysis (UVFP). 2) Provide better evidence support for using LEMG to predict the prognosis of UVFP via a prospective long‐term study.

Method

Sixty‐six patients with UVFP were prospectively collected from 2007 to 2011. LEMG findings were dichotomized to negative (good prognosis) or positive (poor prognosis). The motions of paralyzed vocal folds were followed by videolaryngoscopy at least 3 months after LEMG. and the association with LEMG findings were analyzed.

Results

The mean duration of LEMG after symptoms onset and follow up after LEMG were 3.4 months and 12 months, respectively. Fifty‐seven patients had positive findings (less than 80% of normal motor unit recruitment or presence of fibrillations) in LEMG and 55 patients remained UVFP in the follow‐up. Nine patients had negative findings (80%‐100% motor unit recruitment) in LEMG and 3 patients recovered vocal fold motion. LEMG findings are significantly associated with the outcome of UVFP (P =. 016; Fisher’s exact test). The accuracy, sensitivity, specificity, PPV, and NPV of LEMG were 87.9%, 90.2%, 60%, 96.5%, and 33.3%, respectively.

Conclusion

This study confirms that LEMG can reliably offer prognostic information for UVFP. Especially for patients with positive finding of LEMG, the chance of recovery of vocal fold motion will be very low.
Low‐Fidelity Simulation of Airway Emergencies
Authors: Ramakrishnan Yujay , McNeill Emma , Killick Neil , O’Neill Suzanne
Published: February 2015

Objective

Junior trainees are commonly expected to manage airway emergencies with very little prior experience. The aim of this simulation training is to: 1) Be able to increase the confidence of participants in managing airway emergencies with respect to tracheostomies. 2) Learn the principles of performing a surgical cricothyroidomy.

Method

Design: Survey. Tertiary otolaryngology center. Junior doctors otolaryngology and anaesthesia. A half‐day program in managing airway emergencies. Surgical cricothyroidotomy was taught (Killick artificial larynx). Algorithms on 2 complete airway scenarios (blocked/displaced tracheostomy and “can’t intubate, can’t ventilate”) were completed. Confidence in managing airway emergencies was evaluated (Likert scale).

Results

Previous exposure to airway emergencies was variable between the trainees. Universally, the trainees described a marked improvement in confidence following the practical and moulage sessions. Videos from these sessions will be available online to serve as a future teaching resource. The low‐fidelity airway simulation has since been rolled out through regional hospitals led by senior residents, highlighting the utility of delivering basic airway training in a cost‐effective manner.

Conclusion

A low‐fidelity simulation‐based training of airway emergencies can be effective in improving junior otolaryngology residents’ confidence, knowledge and technical skills. Further reinforcement of clinical and decision‐making skills in realistic training scenarios may be achieved through high‐fidelity simulation training.
Analgesic Regimen and Readmission following Tonsillectomy
Authors: Kishikova Lyudmila , Smith Matthew D. , Fleming Jason
Published: February 2015

Objective

To define the analgesic regimen given following tonsillectomy in a large otolaryngology center and correlate this with readmission for secondary complications.

Method

Case notes for patients undergoing tonsillectomy were collected between February and August 2011. Information was collated and entered into a database including age, gender, operation type, indication, medications on discharge, and details of readmission. Data were assessed for correlations, particularly that between readmission and analgesic regimen given following tonsillectomy.

Results

One hundred twenty‐five patients underwent tonsillectomy during the six‐month period (mean age of 13.8 years, range 3 months to 65 years). The most common indication for surgery was recurrent tonsillitis and with most carried out by bipolar dissection. A total of 64.8% of patients were discharged as day cases. Seventeen different postoperative analgesic regimens were identified with the most common being acetaminophen and ibuprofen in combination (26.4%). Of the patients, 20.0% had no documented analgesia on discharge. Thirteen patients (10.4%) were readmitted following discharge from hospital postoperatively, 4 (3.2%) for issues related to pain. There was no correlation between analgesic regimens and readmission, including those without formal analgesic prescriptions.

Conclusion

No apparent link between readmission and analgesic regimen was identified. The lack of opioid analgesics does not appear to affect readmission rates. However the vast variation of analgesic regimens and lack of formal instructions for those advised over‐the‐counter analgesics has prompted development of a formal step‐based protocol.
Applicability of Narrow Band Image to Diagnose Laryngopharyngeal Reflux Disease
Authors: Niwa Hideo , Horihata Satoshi , Makiyama Yasuhide
Published: February 2015

Objective

1) To develop the applicability of nasopharyngeal epithelial cell with Narrow Band Image (NBI) to diagnose laryngopharyngeal reflux disease (LPRD). 2) Estimate a correlation between a new questionnaire (Frequency Scale for the Symptom of the GERD; FSSG) and LPRD.

Method

We have 88 patients who underwent NBI using FSSG. Because of the pattern of nasopharyngeal epithelial cell NBI image, we distinguished grade 1: nothing, grade 2: moderate, and grade 3: severe. All patients answered the FSSG questionnaire and were administered a PPI (rabeprazole10 mg). Student t test was used to compare each category out of 12 questions of FSSG for LPRD patients.

Results

Average age of patients was 59.3 years old. Sixty‐nine (78%) patients were detected with grade 2 (46 pts) and grade 3 (23 pts). Nasopharyngeal epithelial cell with NBI showed a specific feature, which nasopharyngeal epithelial round cells were modulated capillary cells raised among LPRD patients. We presumptively call the pattern mackerel cloud pattern. Patients who indicated grade 3 showed higher score in FSSG. “Do you have an unusual (eg, burning) sensation in your throat?” category of 12 questions of FSSG showed a significant difference.

Conclusion

We could show that nasopharyngeal epithelial cell pattern with NBI would be a useful and specific feature to diagnose the LPRD. FSSG is not only used for GERD; it also may be used for LPRD clinically.We are currently confirming nasopharyngeal epithelial cell images using digital image analyzer (Wavelet analyzer).
Acquired Occipital Neuralgia following Skull Base Surgery
Authors: Burgette Ryan C. , Leonetti John P. , Marzo Sam J. , Driscoll Bridget
Published: February 2015

Objective

Skull base surgery may cause traction, thermal injury, or scar encasement of the occipital nerve. This may result in delayed or persistent pain in this region. We will outline our findings and long‐term results in patients who underwent decompression of the occipital nerve following various approaches to skull base tumors.

Method

A retrospective review of 10 patients was performed. 6 of these patients underwent occipital nerve decompression while the remaining 4 were treated with local anesthetic injections. Primary outcomes were subjective relief of pain. The electronic health records, operative reports, and medications were reviewed from July 2000 to February 2012.

Results

Ten patients were reviewed. Six of these patients underwent surgical occipital nerve decompression. Following surgery, 3 of these patients had complete pain relief, 1 with marked improvement, 1 with slight improvement and 1 with only 4 days of pain resolution. All 6 patients had some degree of scar encasement during exploration. Of the 4 patients undergoing local injections, one patient had multiple injections while the remaining 3 only had 1 injection. This relief lasted a maximum of 1 month. The patient requiring multiple injections also went on to undergo radiofrequency ablation of the nerve with 50% pain relief.

Conclusion

Skull base surgery carries a risk of occipital headaches due to potential nerve injury or adjacent scarring. There are options for the treatment of these pains but the majority are temporary. A surgical option of occipital nerve decompression should be presented to those looking for a more permanent option.
Aging and Linguistic Factors Influence on Speech Audiometry
Authors: Richard Celine , Tordella Laurent , Martin Christian H. , Roy Sandrine , Moulin Annie
Published: February 2015

Objective

1) Assess the influence of word familiarity, phonological neighborhood, and acoustic patterns on speech audiometry variability. 2) Evaluate the interaction between those factors and patients’ age and years of education.

Method

Patients (n = 160) underwent otoscopy, tympanometry, pure‐tone, and speech audiometry. At an intensity level corresponding to a speech score between 40% and 60%, patients were presented 6 lists of 10 spondees, taken from a standard material used in France. Linguistic characteristics of the spondees and spectral acoustic patterns were characterized. PLS regression analysis was used to determine the factors influencing the percent score recognition for each word (PC).

Results

PC varied from 18% to 92%. PC rose significantly with word familiarity (r = 0.38, P =. 005) and 1 kHz frequency band amplitude of each word’s acoustic spectrum (r = 0.60, P =. 001). The percentage variability due to linguistic factors decreased significantly with age (from 30% below 50 years old to less than 10% above 60 years old), and with number of educational years (NEY; from 40% for NEY under 10 down to 18% for NEY above 10, for patients less than 50 years old). PC was significantly lower for spondees with large phonological neighborhood (F(1, 51) = 12, P =. 002), word familiarity being equal) for patients with NEY above 10.

Conclusion

When taken independently from hearing loss, variability in PC was explained mostly by linguistic factors, combined with age and years of education, hence the need of carefully considering those factors when conceiving speech audiometry material.
Demonstrating True DPOAE Modulation by the Efferent Pathway
Authors: Husain Inna
Published: February 2015

Objective

1) To isolate the distortion product otoacoustic emission (DPOAE) components using an ipsilateral and individualized suppressor tone. 2) To demonstrate the modulation of DPOAEs by the medial olivocochlear efferent pathway once component interference has been eliminated.

Method

DPOAE (2f1‐f2 ) recordings using a frequency‐sweep paradigm with ipsilateral suppressor tones and CAS were made on 8 normal‐hearing subjects in a sound‐treated audiology booth from January to February 2012. Estimates of DPOAE level and phase were obtained using fast Fourier transform and least‐squares‐fit techniques.

Results

Fine structure depth was significantly reduced with the use of an ideal ipsilateral suppressor tone, demonstrating the effectiveness of the suppressor tone at separating DPOAE components. In addition, once the DPOAE components were separated to remove phase interference, MOC activation resulted in consistent suppression of DPOAE level as compared to nonseparated DPOAE level which showed enhancement as well as suppression. These results help to support the theory of DPOAE component interference leading to enhancements often seen with efferent activation and to demonstrate a more consistent way to view DPOAE modulation by the efferent pathway.

Conclusion

This study demonstrates that DPOAE fine structure enhancement seen with activation of the MOC pathway is likely due to DPOAE component interference as opposed to true DPOAE modulation. In addition, the results show that DPOAE component isolation can be achieved by an ipsilateral suppressor tone, however it must be individualized.
Diagnosis of Early Endolymphatic Hydrops
Authors: El Garem Hani F. , Mourad Mona
Published: February 2015

Objective

To evaluate ear fullness as an early symptom of endolymphatic hydrops by relating it to enhanced SP/AP ratio on electrocochleography.

Method

The study that was conducted between January 2010 and January 2011 included 2 groups. Group I (20 patients) with normal hearing and complaint of ear fullness with no eustachian dysfunction and group II (10 persons) as healthy controls. Basic audiologic assessment and electrocochleography were done for both groups.

Results

In group I, 100% of the patients had an enhanced SP/AP ratio in the ears with ear fullness in comparison to controls of group II. In group I, the SP/AP ratio ranged in 35 affected ears from 0.3 to 1.85 with a mean of 0.655 ± 0.325. In group II, the SP/AP ratio ranged in 20 ears from 0.25‐0.29 with a mean of 0.27 ± 0.11.

Conclusion

Ear fullness can be an early sign of endolymphatic hydrops confirmed by electrocochleography leading to its early management.
Comparing Mannequin Upper Airway Anatomic Fidelity
Authors: Woo Jennifer A. , Malekzadeh Sonya , Malloy Kelly M. , Deutsch Ellen S.
Published: February 2015

Objective

Evaluate the anatomic fidelity of pediatric and adult mannequins commonly used in upper airway procedure training. Develop assessment criteria for future anatomic fidelity studies conducted among otolaryngologists and other airway specialists.

Method

Experienced otolaryngologists assessed the anatomic fidelity of 8 mannequins (lettered A‐H) in a passive state (eg, no electronic augmentation), using rigid and flexible endoscopy and a 5‐point rating scale (5 = best). Ratings of the nasal cavity, nasopharynx, oral cavity, oropharynx, larynx, trachea, esophagus, and neck are displayed in a “spidergram.”

Results

Eleven faculty otolaryngologists evaluated the realism of upper airway passive anatomic fidelity of 3 adult and 5 pediatric mannequins, during a 1‐day course. Mean scores and standard deviations were tabulated for each mannequin at each anatomic site, and displayed in “spidergrams.” Differences in scores allow comparison of mannequin anatomic fidelity by site (maximum range, 2.8 for nasopharynx) and by mannequin (maximum range, 2.1). Because of the small number of responses in this pilot study, mannequins are deidentified.

Conclusion

Ratings by survey participants demonstrated variation in the anatomic fidelity of a range of commercially available mannequins. Spidergram display of the results may allow instructors to select mannequins with the best anatomic fidelity for their specific educational purposes and may contribute to recommendations for improving mannequin fidelity.