bluuebunny/crossref_metadata_2025 huggingface dataset:
The ADVANCE II Study: A Prospective, Randomized, Multi‐center Study to Assess the Safety and Efficacy of a Bioabsorbable Steroid‐Eluting Sinus Implant
Authors: Marple Bradley F. , Gould Andrew R. , Han Joseph , Jampel Henry , Smith Timothy L. , Mugglin Andrew S.
Published: September 2011

Objective

Endoscopic sinus surgery (ESS) for chronic rhinosinusitis (CRS) may be compromised by postoperative inflammation, polyposis, and adhesions, often requiring subsequent intervention. To address this issue, we investigated the safety and effectiveness of controlled delivery of mometasone furoate to the sinus mucosa via bioabsorbable implants deployed at the time of ESS.

Method

A prospective, multicenter, randomized, double‐blind trial was performed on 105 patients with CRS under‐going ESS, comparing the effect of drug‐eluting to non‐drug‐eluting stents. Postoperative interventions, polyposis, and adhesions were assessed postoperatively. Efficacy was determined through independent analysis of randomized video‐endoscopies by 3 blinded sinus surgeons. Safety assessments included ocular exams.

Results

Implants were successfully deployed in all 210 sinuses. Compared with control sinuses, the drug‐eluting stent provided a 29% relative reduction in postoperative interventions (P =. 0280), a 52% (P =. 0053) decrease in lysis of adhesions, and a 29% (P =. 0881) decrease in oral steroid prescriptions. The relative reduction in frank polyposis was 45% (P =. 0023). Similar reductions were observed in real‐time grading performed by the clinical investigators. No clinically significant changes from baseline in intraocular pressure or cataracts were observed.

Conclusion

Continual postoperative application of topical corticosteroids applied via drug‐eluting stent deployed at surgery was studied to assess its impact upon ESS outcomes. This study strongly suggests that steroid‐eluting implants are effective at improving surgical outcomes by reducing the need for postoperative interventions, with negligible ocular safety risk.
All‐Cause Mortality and Obstructive Sleep Apnea Revisited
Authors: Rich Jeremy , Raviv Ayelette , Raviv Nataly , Brietzke Scott
Published: September 2011

Objective

Obstructive Sleep Apnea Syndrome (OSAS) is a pervasive problem that affects millions worldwide. OSAS is strongly linked to hypertension, coronary artery disease, and stroke. However, its association with mortality is not clearly quantified. A large database of patients who underwent sleep testing was explored for associations with all‐cause mortality.

Method

Over 77,000 patients who underwent a validated, portable sleep study (SNAP Test, SNAP Diagnostics Inc, USA) were matched to the Social Security Death File to establish mortality. Measures of OSAS severity and other major confounding factors were correlated to all‐cause mortality using survival analysis with multivariate Cox proportional hazards regression.

Results

As expected, increasing age (adjusted HR = 1.08095%CI = 1.074‐1.086 P <. 0001), BMI (HR = 1.042 95%CI = 1.033‐1.051 P <. 0001), and male sex (HR = 1.378 95%CI = 1.190‐1.595 P <. 001) were associated with increased all‐cause mortality. Epworth sleepiness score was also associated with mortality (HR = 1.015 95%CI = 1.005‐1.025, P =. 002). Apnea Hypopnea Index (AHI) was NOT associated with mortality after adjustment for age (HR = 1.001 95%CI = 0.998‐1.004, P =. 416). However within 10‐year age subgroups, desaturation index (41‐50 year olds, adjusted HR = 1.217 95%CI = 1.014‐1.461, P =. 035), Apnea Index (21‐30 year olds, HR = 1.632 95% CI = 1.053‐2.532 P =. 028), and AHI (31‐40 year olds, HR = 1.222 95% CI = 1.010‐1.478 P =. 039) were significantly associated with all‐cause mortality in younger patients. In older patients (over 50 years), age, sex, and BMI were dominantly associated with mortality.

Conclusion

Increasing OSAS severity as measured by a validated home sleep test and quantified by AHI, Apnea index, and pulse oximetry desaturation index, is independently associated with a modestly increased all‐cause mortality in younger patients (less than age 50 years) after adjustment for major confounding factors.
Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea Treatment
Authors: Kezirian Eric J. , Kezirian  , Palme Carsten , Goding George , Campbell Matthew , Hee Geoffrey , Park Steven Y. , Huntley Tod C.
Published: September 2011

Objective

Reduced upper airway muscle activity during sleep contributes to obstructive sleep apnea (OSA) pathogenesis. A novel therapy (HGNS, Apnex Medical, Inc) is designed to address this issue by stimulating the hypoglossal nerve synchronous with respiration during sleep. This study evaluated the safety and effectiveness of HGNS for OSA treatment.

Method

From 2009‐2010, 32 subjects with moderate to severe OSA underwent implantation of the HGNS system. Subjects had objective assessment using laboratory polysomnography (PSG) and subjective symptom assessment using validated questionnaires. Preliminary analyses are presented. The primary outcome variable was the change in apnea hypopnea index (AHI).

Results

HGNS was used on a median of 97% of nights, with a mean use of 5.1 ± 1.7 hours per night. Thirty‐one/32 subjects had PSGs at the 3‐ and/or 6‐month interim time points. Treatment with HGNS therapy resulted insignificant improvement in AHI (45.4 ± 17.5 to 23.2 ± 18.50; P <. 05). Symptoms also improved (all P <. 05): Epworth Sleepiness Scale (12.0 ± 4.6 to 8.3 ± 3.9), Functional Outcomes of Sleep Questionnaire (14.2 ± 2.0 to 16.6 ± 2.3), and Pittsburgh Sleep Quality Index (10.5 ± 3.0 to 8.4 ± 4.1). There was no change in body mass index.

Conclusion

HGNS therapy was associated with a significant decrease in AHI and improvement in symptoms, and compliance was high. Based on the results of this feasibility trial, the HGNS System will be evaluated in a randomized pivotal trial.
Quantifying Osteotome Sharpness: Comparing the Major Manufacturers
Authors: Ransom Evan R. , Becker Daniel , Bloom Jason D. , Antunes Marcelo B.
Published: September 2011

Objective

1) Develop a method for quantification of osteotome sharpness in a rhinoplasty model, using artificial bone; 2) demonstrate changes in osteotome sharpness over multiple uses; and, 3) compare sharpness of osteotomes from different manufacturers at baseline and after multiple uses.

Method

Osteotomes were passed through synthetic bone blocks. Sharpness was measured using the Instron Universal Tester (force required to cut #2 Prolene suture) at baseline and after 1, 4, 7, and 10 osteotomies. Changes in sharpness over time were assessed using within‐sample t tests. Comparison of manufacturers was performed with multiway ANOVA.

Results

A novel, prospective surgical model was developed. Osteotomes from 5 manufacturers were tested (Nextedge, Black & Black, Storz, Miltex, and Biomet). Baseline measurements showed that the Storz osteotome was sharpest (1.74 lbs, P <. 001), followed by Miltex and Biomet (2.50 lbs, 2.68 lbs), and Nextedge and Black & Black (3.48 lbs, 3.40 lbs). All osteotomes except Nextedge (P =. 098) demonstrated a significant decrease in sharpness over time (P =. 02 to P <. 001), though relative changes and absolute sharpness varied widely between instruments. ANOVA showed the Storz osteotome was significantly sharper across all uses and timepoints (P <. 001). The greatest decrease in sharpness over time was seen with Black & Black (‐1.28 lbs).

Conclusion

Otolaryngologists use osteotomes in cosmetic and functional rhinoplasty. Millimeter‐level accuracy in these procedures is essential to maximize outcome and minimize complications. Multiple similar‐appearing instruments are available, but their relative efficacy is infrequently tested. We have demonstrated that, at least in the case of osteotomes, not all instruments are created equally.
Polysomnographic Evaluation of Drug Induced Sleep Endoscopy (DISE)
Authors: Valera Fabiana , Braga Adriano , Küpper Daniel , Rabelo Fabio , Sander Heidi H. , Fernandes Regina
Published: September 2011

Objective

DISE is increasingly being used to localize the obstructive site in OSAS patients. The objective of this study is to determine if propofol changes sleep parameters in polysomnography.

Method

Thirty subjects (6 controls/24 with OSAS) underwent 2 diurnal polysomnographies, with/without the use of propofol, controlled by target‐controlled infusion pump (Diprifusor). The examinations were compared regarding the presence of snoring, AHI, oxygen desaturation, and sleep architecture. Endoscopies with the patients sleeping and awake were also compared.

Results

The use of propofol did not induce snoring in the control subjects, whereas 100% of the OSAS patients snored. Propofol increased N3 sleep and abolished totally REM sleep (P2 did not differ significantly between the 2 examinations (P >. 05). The minimum SaO2 were significantly reduced during propofol sedation.

Conclusion

Propofol changed the sleep architecture, but not the main respiratory parameters in OSAS. DISE was shown to be safe and more reliable to determine the sites of obstruction, supporting the view that this examinations is promising for the management of this disease.
Soft Palate Radiofrequency for Snoring: One vs Multiple Steps
Authors: Blumen Marc B. , Oker Nathalie , Chabolle Frederic , Buchet Isabelle , Vezina Jean‐Philippe
Published: September 2011

Objective

Evaluate the need for multiple sessions of soft palate radiofrequency (RF) to treat snoring.

Method

Retrospective study of patients with simple snoring or mild sleep apnea treated with RF. Efficacy on snoring and RF tolerance were compared in 3 protocols consisting of 1 or 2 RF sessions combined with an uvulectomy, performed during the first or second RF session or alone during a third session.

Results

A total of 97 patients were included. Mean age, body mass index (BMI), and apnea hypopnea index (AHI) respectively were 53.2 ± 10.1 years, 25 ± 3.9 Kg/m2 and 10.8 ± 9.1. The 2 groups were comparable in terms of age, BMI, AHI and preoperative snoring score on the visual analog scale. Postoperative snoring score was comparable among the 3 groups (P =. 77). Tolerance was poorer when uvulectomy was performed. It was more painful when it was performed during the first session compared with the second session or third session.

Conclusion

Soft palate radiofrequency can be effective in one session but induces greater pain.
The Impact of Uvulopalatopharyngoplasty on Metabolic Syndrome in Patients with Obstructive Sleep Apnea
Authors: Kanotra Sohit P. , Krespi Yosef P.
Published: September 2011

Objective

Obstructive sleep apnea (OSA) has been associated with metabolic syndrome (MS) and its various components. However, the impact of successful treatment of OSA on MS is still unclear. This study analyzes the prevalence of metabolic syndrome and its various components in patients with OSA and evaluates the impact of uvulopalatopharyngoplasty (UPPP) on MS.

Method

A 3‐year retrospective chart review of patients referred to an otolaryngology department for sleep disordered breathing. A total of 134 patients met the inclusion criterion. The diagnosis of MS was established according to National Cholesterol Education Program Adult Treatment Panel III.

Results

According to the AHI, the patients were divided into OSA (mean AHI = 64) and controls (mean AHI = 4.46). The incidence of MS was significantly higher in patients with OSA (72.5%) v/s controls (39.5%). The components of MS which showed significance were fasting glucose (P =. 002) and blood pressure (P <. 032). The prevalence of MS before and 6 months after UPPP was 71.0% and 60.87% which was not statistically significant. The only component of MS showing significant improvement was blood pressure. (P <. 001).

Conclusion

There is a high incidence of metabolic syndrome in patients with OSAS. Although UPPP improved respiratory parameters, it did not have a significant effect on the prevalence of MS. The only component which showed a significant improvement was blood pressure.
Strength of Titanium Intramedullary Implants vs Traditional Miniplate Fixation of Mandibular Condyle Fractures
Authors: Frake Paul C. , Wagner Mark J. , Joshi Arjun S. , Howell Rebecca J.
Published: September 2011

Objective

Test the strength of internal fixation of mandibular condyle fractures repaired with titanium miniplates vs titanium intramedullary implants.

Method

Condylar osteotomies were created in 40 urethane hemimandible models and 24 human cadaveric specimens. Half of the samples in each group were repaired with traditional miniplates and the other half were repaired with intramedullary titanium pins. Anteroposterior and mediolateral loads were applied and the displacement across the fracture site was calculated.

Results

When subjected to physiologic and supraphysiologic loads, titanium intramedullary implants provided more resistance to bone fragment displacement than traditional miniplates. This was true for both the urethane model and the cadaveric mandible experimental groups. Mechanical failures in the miniplate groups were due to plate bending and/or screw extrusion. However, a 1.65 mm diameter titanium intramedullary pin did not mechanically fail in any of the cases. Intramedullary implantation failures were due to secondary fracture of the adjacent cortical bone under high forces or rotation of the smooth pin implant.

Conclusion

Mechanical failures which were encountered under physiologic forces with miniplate fixation were not seen with titanium intramedullary implants. These intramedullary implants provide stronger and more durable fixation of mandibular condyle fractures than traditional miniplates in both urethane and cadaveric laboratory models.
The SNaP Wound Care System for Head and Neck Wound Closure
Authors: Stucken Chaz L. , Reino Anthony J.
Published: September 2011

Objective

Vacuum‐assisted closure of head and neck wounds has been previously described. Negative pressure wound therapy, although efficacious, has practical limitations in the outpatient setting. The purpose of this study is to describe a novel method of treating complex head and neck wounds using an ultraportable mechanical vacuum wound care system.

Method

A cohort study at 2 tertiary care centers. All head and neck patients with complex, low to moderately exudative wounds were treated by the senior author using the SNaP Wound Care System. Patient comorbidities, wound etiology, site, length of treatment, outcomes, and ancillary procedures were recorded.

Results

A variety of wounds was treated with this system and included mucocutaneous fistulas, a tracheocutaneous fistula, soft tissue defects of the head and neck, and tendon exposure of a radial forearm free flap donor site. Outpatient SNaP therapy was utilized in five patients with 6 small‐ to medium‐sized wounds. This system was successful in obtaining wound closure in all patients. These patients were able to complete routine activities of daily living, participate in public social settings, and tolerate therapy without adverse events. One patient required an adjunctive procedure of split thickness skin grafting.

Conclusion

This study demonstrates a novel use of the first FDA‐approved ultraportable, mechanical negative pressure device in the treatment of several complex head and neck wounds. The device has utility in the outpatient setting for adjunctive closure of wounds with minimal disturbance to patients’ activities of daily living and lifestyle.
Classification of Posttonsillectomy Hemorrhage
Authors: Sarny Stephanie , Ossimitz Guenther , Habermann Walter , Stammberger Heinz
Published: September 2011

Objective

Apply a new classification of postoperative hemorrhage using a clear definition and seven grades (A1, A2, B1, B2, C, D, and E) depending on severity and based on the intensity of treatment needed. Postoperative hemorrhage was defined as every bleeding after extubation.

Method

Grade A: anamnestic recorded blood‐tinged sputum; A1 dry wound, no coagulum; A2 coagulum, dry wound after removal. Grade B: bleeding actively under examination; B1 noninvasive treatment; B2 treatment in local anaesthesia. Grade C: hemorrhage needing treatment in general anesthesia. Grade D: dramatic hemorrhage requiring blood transfusion. Grade E: fatal hemorrhage.

Results

Of the 4594 patients undergoing tonsillectomy within 9 months evaluation period, 818 bleeding episodes had been recorded (17.8%). A1 bleeding episodes were recorded for 146 patients, A2 for 274 patients, B1 for 104 patients, B2 for 65 patients, C for 221 patients, and D for 8 patients. No fatal hemorrhage occurred. Surgical treatment was necessary in 4.6% of all patients. About half of all bleeding episodes have been anamnestic recorded. For patients with multiple bleeding episodes, light bleedings (grade A1 to B2) increased the risk for severe bleedings of grade C or D (P <. 05).

Conclusion

Postoperative hemorrhage is strongly related to the definition of bleeding episodes. A new classification could have been approved for the first time in a large study population.
Epidemiology and Burden of Recurrent Acute Rhinosinusitis
Authors: Bhattacharyya Neil , Grebner Jeff , Martinson Noel G.
Published: September 2011

Objective

1) Learn about the epidemiology of recurrent acute rhinosinusitis (RARS). 2) Understand healthcare costs attributable to RARS as a potentially underdiagnosed form of chronic rhinosinusitis.

Method

Medical claims data (2003‐2008) from a large payer database were analyzed. Adult patients with RARS (defined as at least 4 acute rhinosinusitis [ARS] claims each with a filled oral antibiotic prescription in a 12‐month period) were extracted. Diagnostic procedures, surgery rates, and medical costs were determined.

Results

A total of 4,588 patients were identified (mean age, 43.5 years; 72.1% female) among 13.1 million patients, for a point prevalence of 0.035%, which remained consistent across years. After 1, 2, and 4 years, 2.4%, 5.4%, and 9.2% of patients subsequently received nasal endoscopy and 11.4%, 23.5%, and 39.9% received paranasal sinus computed tomography, respectively. Similarly, 0.2%, 2.0%, and 4.1% underwent endoscopic sinus surgery at these same intervals. Average total healthcare costs related to RARS averaged $1207/patient‐year. Antibiotic and nasal prescription costs averaged $210 and $452, and an average of 3.8 antibiotics were filled per patient‐year with RARS.

Conclusion

RARS may affect approximately 1 in 3000 adults. Despite significant health care costs over $1000/year per individual patient with RARS, nasal endoscopy and computed tomography are not commonly obtained early after potential diagnosis. RARS is likely an underdiagnosed condition warranting further study.
Office‐Based Laser Surgery of the Larynx: A Cost Analysis
Authors: Halum Stacey L. , Kuo Connie
Published: September 2011

Objective

While office based laser surgery (OBLS) for benign laryngeal disease is cost‐effective for the patient, the financial impact on the office offering the service has not been characterized. We hypothesize that OBLS offers a savings to the patient which is not widely realized because the technology poses a financial liability.

Method

A 2‐part cost analysis study was performed. First, cost and reimbursements for 50 patients undergoing OBLS was compared with 50 patients undergoing operative direct laryngoscopy with laser (DLL). Second, detailed financial comparison was done on a self‐paired series of patients who had each undergone both OBLS and DLL.

Results

When compared with DLL, there was over $5,000.00 per case cost savings to the patient/third party payer for OBLS. Mean total reimbursement per DLL was $6,453.44, including hospital, anesthesiologist, and surgeon reimbursements of $5,150.00, $745.66, and $357.78, respectively. Based on a mean hospital DLL cost of $2,069.15, the hospital profited over $3000 per case. For OBLS in a nonfacility office setting, mean total reimbursement was $643.08 with mean procedure and laser fiber reimbursements of $596.52 and $46.56, respectively. Based on mean office expenses of $1,388.06 for equipment expenses and nursing staff, the office lost over $500 per OBLS case.

Conclusion

OBLS offers health care cost savings that are not widely realized because of the financial loss incurred by the office. An ideal reimbursement model is proposed that would cover the cost of OBLS, and could lead to nearly $400 million in health care costs savings annually.
Hardware Removal Rates for Mandibular Angle Fractures: Comparing the 8‐Hole Strut and Champy’s Plates
Authors: Moore Evan R. , Bayrak Sinehan , Vural Emre A. , Key J. Michael , Moody Marcus W.
Published: September 2011

Objective

1) Compare the rate of removal of Champy’s plates vs 8‐hole strut plates used for repair of mandible angle fracture. 2) Determine the reason for removal of these plates.

Method

A retrospective chart review was conducted from 2006 to 2010 comparing the removal rate between Champy’s plates and 8‐hole strut plates for internal fixation of traumatic angle mandible fractures at a large adult tertiary care hospital. The reason for removal of each plate was then determined from the clinical record.

Results

A total of 104 patients with a total of 106 angle fractures met the inclusion criteria for this study. A total of 73 angle fractures were treated with the 8‐hole strut and 33 angle fractures were treated with Champy’s plates. There were 6 plates removed in both groups. This resulted in 8.2% of plates removed in the 8‐hole strut plate group and 18.2% in the Champy’s group (P =. 133). Loose hardware was determined to be the cause of plate removal in 1 (2.7%) of the 8‐hole strut plate group compared with all 6 (18.2%) of the Champy’s group (P =. 005).

Conclusion

In our experience, the 8‐hole strut plate has a lower rate of plate removal compared to the Champy’s plate in treating mandible angle fractures. The main reason for plate removal was loose hardware. The rate of removal for loose hardware was higher and statistically significant in the Champy’s group.
High Amylase Levels in the Peritonsillar Abscess Pus
Authors: El‐Saied Sabri , Joshua Benzion , Puterman Marc
Published: September 2011

Objective

Study the relationship between peritonsillar abscess and minor salivary glands surrounding the palatine tonsils.

Method

Prospective study measuring amylase levels in the pus of patients with peritonsillar abscess compared with the Amylase level in the serum and to the amylase level in pus from other abscesses in the neck. Data regarding age, sex, length of hospitalization, and recurrence were additionally recorded.

Results

A total of 40 patients diagnosed with PTA, 19 male (47.5%) and 21 female (52.5%) with an average age of 19 years. The average level of amylase in the pus of the PTA group was 827 u/dl and 9 u/dl in the control group (P <. 001). There were no recurrences in patients with amylase greater than 65 u/dl 0/16 (0%) vs 6/24 (25%) for amylase lower than 65 u/dl (P =. 03).

Conclusion

High amylase in the pus lends further support for involvement of minor salivary glands in the pathogenesis of peritonsillar abscess. However, high recurrence rates related to low amylase in the pus imply an additional pathogenesis possibly related to tonsillar infection.
Mortality after Tracheostomy at a Tertiary Care Hospital
Authors: Rosenthal Eben L. , Kejner Alexandra E. , Castellanos Paul
Published: September 2011

Objective

Hospitals are increasingly being evaluated for postoperative mortality, which includes intensive care patients who succumb to their medical disease after routine tracheostomy. Here we evaluate the expediency of tracheostomy performance and perioperative mortality over a 6‐month period.

Method

Prospective analysis of medical intensive care patients who underwent tracheostomy placement over a 6‐month period at a tertiary care hospital. Variables evaluated were time to tracheostomy, time to death, and cause of death.

Results

There were 76 consultations that resulted in 64 patients receiving tracheostomy. Four (5.3%) patients expired the day prior to or the day of planned tracheostomy. Six (7.9%) were extubated prior to tracheostomy. Many were performed within 24 hours from consultation time (37%), and some were performed on the same day as consultation (9.3%). The overall 30‐day postoperative mortality rate was 11%. Cause of death in all cases was due to pre‐existing conditions and not related to tracheostomy. Thirty‐six (57%) survived to discharge. The mean time from consultation to tracheostomy was 2.5 days (range 0 ‐12).

Conclusion

High rates of mortality after tracheostomy negatively impact hospital postoperative mortality and hospital ratings. Although there were no surgical deaths, only 57% of tracheostomy patients survived to discharge, illustrating the significant disease burden in this patient population and the need to stratify postoperative mortality.
Nasopharyngeal Carcinoma Characteristics in Portugal
Authors: Breda Eduardo L. , Pereira Maria , Monteiro Eurico , Catarino Raquel , Sousa Hugo , Medeiros Rui
Published: September 2011

Objective

1) Learn the histologicdistribution of nasopharyngeal carcinoma (NPC) in a nonendemic European country. 2) Learn epidemiological data of NPC in a nonendemic European country. 3) Understand the implications of some genetic polymorphisms on NPC development.

Method

Using data collected from a retrospective study of 320 NPC patients obtained at the Oporto Portuguese Institute of Oncology during 31 years, a study is made concerning histological characterization, median age, gender profiles, NPC‐EBV relationship, and relevance of concerned genetic polymorphisms on probability of disease and age of onset.

Results

A total of 300 out of 320 patients had nonkeratinizing carcinomas (93.75%), with a mean age of 48 years old and twofold male preponderance. Using PCR analysis, EBV‐DNA was found in 91.7% of 36 tumor tissue samples. Regarding genetic polymorphisms, 2 case‐control studies were performed, including 104 patients and 285 control individuals. TP53 codon 72 pro/pro genotype (P =. 012; OR = 2.67; 95% CI 1.21‐5.90) and A870G cyclin D1 GG genotype (P =. 016; OR = 2.09; 95% CI 1.15‐3.79) were associated with increased risk for NPC development. Moreover, cyclin D1 GG genotype was also correlated with earlier disease onset.

Conclusion

The high relative proportion of nonkeratinizing carcinomas is a relevant finding in this nonendemic European country, and so is the association of EBV‐DNA with NPC. This study may help to understand the biologic mechanisms of NPC and the correlation of EBV infection with disease in a low‐risk nonendemic region.
Novel Regulation of MicroRNAs in Nasal Epithelial Cancer
Authors: Wang Weihua , Upadhyay Daya , Le Wei , Hwang Peter H.
Published: September 2011

Objective

Accumulating studies show the role of microRNAs in multiple human cancers. However, little is known about the role of microRNAs in nasopharyngeal cancers (NPC). Given the role of microRNAs in survival and death pathways in cancers, we hypothesized that the microRNAs may regulate the effects of cancer therapeutic agents.

Method

Tumor specific MicroRNA expressions were studied in vitro in primary human NC cells (CCL‐30) treated with statins. The effects on cell survival, cell cycle, and apoptosis were examined.

Results

Recently, we showed the promising antitumor effects of statins in NPC via HMG Co‐A pathway. Our new study examines the novel role of microRNAs in mediating the effects of statin in the inhibition of survival in NPC. Statins induced apoptosis and decreased survival of NPC. The regulation of tumor suppressor Let‐7a was enhanced in cells treated with statins associated with decrease in the cell viability and proliferation, and increase in apoptosis in these cells. Further, we found that the miR‐21 and miR‐155 played a role in the regulation of apoptotic pathways in NPC.

Conclusion

Tumor‐specific microRNAs, Let‐7a, miR‐21, and miR‐155 play a role in the regulation of the disease process and the effects of cancer therapeutic agents in NPC.
Risk Factors for Multiple Malignancies in Head and Neck
Authors: Mannelli Giuditta , Gitti Gianni , Meccariello Giuseppe , Deganello Alberto , Gallo Oreste
Published: September 2011

Objective

Our aim was to assess the prognostic role of several epidemiological, clinical andbiological factors, related to a higher risk for multiple malignancies in head and neck cancer (HNC) patients.

Method

In 76 consecutive patients treated with curative radiotherapy, p53 gene status, microsatellite instability (MSI) of the index tumor, and inherited chromosome fragility (CF), with epidemiological and clinical characters, were analyzed and correlated with the risk for second primary tumor (SPT). The follow‐up was 77 months in mean (2‐180 months).

Results

SPT was observed in 22 patients (28.9%). p53 mutation was detected in 36 (47.3%) out of 76 first primary HNC analyzed. MSI was documented in the first primary HNC from 22 out of 63 (34.9%). Susceptibility to bleomycin‐induced chromatid breaks (CF+) was found in 26 out of 54 (48.1%). Statistical analysis suggests that MSI, CF and smoking persistence after index tumor treatment were significantly correlated with an increased risk of developing multiple malignancies (P =. 05, P <. 01 and P =. 02).

Conclusion

A genetic susceptibility to DNA damage may play a central role in development of multiple malignancies in HNC patients. Testing for MSI phenotype and CF at the time of the original cancer diagnosis could identify high risk patients.
Simulation in Otolaryngology Education: A Systematic Review of the Peer‐Reviewed Evidence
Authors: Sardesai Maya G. , Kim Sara , Whipple Mark
Published: September 2011

Objective

Systematically synthesize the peer‐reviewed evidence for use of simulation in otolaryngology education.

Method

A systematic review of the peer‐reviewed literature was performed to identify evidence for use of simulation in otolaryngology education. Identified articles were analyzed by three independent coders across 19 parameters encompassing study methodology, simulator information, subject information, skills taught, and outcome measures.

Results

Level V evidence dominates the peer‐reviewed literature. Medical knowledge is the ACGME core competency most frequently taught. Many subspecialties within otolaryngology are underrepresented. Most simulators consist of anatomical models, and most studied simulators are high‐fidelity simulators. Most studies lack a control group, and most do not use validated outcome measures. Education theory is underused. However, most studies conclude that the device employed or described is effective.

Conclusion

While there is a modest amount of peer‐reviewed evidence for the use of simulation in otolaryngology education, there remain many gaps that translate to opportunities for academic otolaryngologists.
Survey on Tobacco‐Cessation Practices and Policies (SToPP)
Authors: Carniol Eric T. , Mahoney Elizabeth , Jalisi Scharukh , McDonough Katie A. , Murthy Namitha
Published: September 2011

Objective

1) Analyze current practices and policies of otolaryngologists on tobacco‐cessation counseling. 2) Analyze the relationship between formal training in tobacco‐cessation and confidence in counseling and prescription therapy behavior by otolaryngologists.

Method

This survey of smoking cessation practices was performed at the American Academy of Otolaryngology‐Head and Neck Surgery (AAO‐HNS) and associated meetings in September 2010. Attendees were surveyed, and the results were compiled. Regression analysis was performed to further assess the effects of training on otolaryngologists’ confidence in counseling.

Results

A total of 207 surveys were collected; 202 respondents indicated training in otolaryngology. A total of 88.5% of otolaryngologists ask most or all of their patients about tobacco use at an initial encounter; 83.7% advise most to all of their patients to quit at this encounter; 64.5% assess most to all of their patients’ interest in quitting; 49.7% assess their reasons to quit; 22.3% arrange support between visits for most to all of their patients. Regression analysis revealed that training during medical school and after residency were independently associated with higher levels of confidence and higher rates of prescribed therapy for patients (all P <. 025).

Conclusion

Otolaryngologists counsel their patients on tobacco at a low rate, and fewer provide patients with the support necessary to assist them in quitting. Formal training in tobacco‐cessation was associated with higher levels of confidence. Further research is indicated to assess the utility and cost‐effectiveness of tobacco‐cessation training programs for otolaryngologists.
Contemporary Morbidity and Mortality in Head and Neck Surgery
Authors: Lin Harrison W. , Bhattacharyya Neil
Published: September 2011

Objective

1) Understand contemporary data for morbidity and mortality in head and neck surgery (HNS). 2) Identify factors that influence length of stay (LOS) to be targeted for quality improvement.

Method

A database specific for patients undergoing inpatient primary head and neck surgical procedures was extracted from the National Hospital Data Survey (2005‐2007). The frequency of perioperative complications, mortality, and LOS were quantified. The influence of these medical complications on mortality and LOS were determined with multivariate statistics.

Results

An estimated total of 330,629 ± 9097 head and neck patient‐procedures were studied (mean age, 53.0 ± 0.6 years; 63% female). The overall medical morbidity and mortality rates were 5.0 ± 0.7% and 0.4 ± 0.2%, respectively. The most common medical complications were hospital‐acquired pneumonia (3.3 ± 0.6%), acute renal failure (0.9 ± 0.2%), stroke (0.6 ± 0.4%), acute myocardial infarction (0.3 ± 0.1%), pulmonary embolism (0.2 ± 0.1%), and deep venous thrombosis (0.1 ± 0.1%). The mean LOS for patients without a major complication was 3.30 ± 0.2 days vs 14.0 ± 1.9 with a major complication (P <. 001). The presence of a major medical complication did not increase mortality odds when adjusted for age, sex, and Charlson comorbidity (P =. 177).

Conclusion

Complication rates for inpatient HNS procedures have declined in the past decade, although complications are still associated with longer LOS. The presence of a postoperative complication is no longer significantly associated with increased mortality. Enhancements in perioperative medical management of HNS inpatients are likely responsible for these improved results.
Crawling Wave Sonoelastography of Benign and Malignant Thyroid Nodules
Authors: Walsh Jonathan M. , Mills Bradley , Rubens Deborah , Parker Kevin , An Liwei , Miller Matthew , Z Hah
Published: September 2011

Objective

The purpose of this study is to determine if Crawling Wave (CrW) Elastography, a novel sonoelastography technique, can be utilized to provide quantitative measurements of thyroid tissue shear velocity (a measure of tissue stiffness) and distinguish between benign and malignant thyroid nodules.

Method

Fresh thyroid specimens (N = 21) with 44 regions of interest were imaged over a 9‐month period in 2010 at a single institution. CrW sonoelastography was performed and shear velocity (SV) estimations with contrast to noise ratios (CNR) were calculated. Histologic diagnosis was correlated with SV and CNR values.

Results

The SV and CNR of Papillary Thyroid Ca (PTC) (N = 11, CNR = 4.04, SV = 2.39 m/s) was significantly higher than benign nodules (N = 22, CNR = ‐0.988, SV = 1.90 m/s) (for CNR pp = 0.003, [95% CI 0.199 ‐ 0.801]). CNR values have a sensitivity and specificity of 100% and 90.9%, respectively, for differentiating PTC from benign nodules. Additionally, SV has a sensitivity and specificity of 81.8% and 68.2%, respectively. Insufficient samples were obtained for SV and CNR comparison of other histologic types.

Conclusion

Crawling wave sonoelastography can provide quantitative estimations of shear velocity (SV) depicting the elastic properties of thyroid nodules. The SV with CNR can differentiate between benign thyroid nodules and papillary thyroid carcinoma. However, prospective in‐vivo studies are needed to verify the accuracy and utility of CrW elastography.
Elevated Urinary 1‐HOP, NNN, and NNAL in Smokers with Head and Neck Squamous Cell Carcinoma
Authors: Khariwala Samir , Hatsukami Dorothy , Stepanov Irina , Hecht Stephen , Fernandes Patricia , Lassig Amy Anne D. , Yueh Bevan
Published: September 2011

Objective

Tobacco metabolites have been shown to be markers of tobacco exposure as well as markers of lung cancer risk. To this point, tobacco metabolites have not been studied in head and neck squamous cell carcinoma (HNSCC). We seek to study tobacco metabolites in smokers with (subjects) and without (controls) HNSCC.

Method

Smokers with head and neck cancer were enrolled after they completed a detailed smoking history questionnaire. Urine samples were collected in standard fashion. Controls consisted of smokers without HNSCC. Urinary levels of total 1‐hydroxypyrene (1‐HOP) and total 4‐(Methylnitrosamino)‐1‐(3‐Pyridyl)‐1‐Butanol (NNAL) and N′‐nitrosonornicotine (NNN) were assayed using high performance liquid chromatography (HPLC).

Results

In this pilot study, NNN data were available in 27 subjects, NNAL in 19 subjects, and 1‐HOP in 18 subjects. Control matching for NNN was done with a 1:1 ratio. Controls were matched on cigarettes per day in a 3:1 ratio for NNAL and 1‐HOP to increase power. T test was used to compare study subjects with controls. Mean levels for subjects (S) and controls (C) were: NNN [S:0.12 pmol/ml, C:0.06 pmol/ml (P =. 06)], NNAL [S:1.53 pmol/ml, C:1.25 pmol/ml (P =. 3)], and 1‐HOP [S:1.88 pmol/ml, C:0.84 pmol/ml (P =. 001)], respectively.

Conclusion

1) Smokers with HNSCC have higher urinary 1‐HOP (significant) and NNN (near significant) compared with matched controls. 2) The data suggest smokers who develop HNSCC process carcinogens differently than smokers without HNSCC. 3) This data is a first step toward understanding why some smokers develop carcinoma while others do not.
Functional Outcomes of Chemoradiotherapy in Patients with Head and Neck Cancer
Authors: Tulunay‐Ugur Ozlem E. , Maddox Anne‐Marie , McClinton Christopher , Penagaricano Jose , Young Zachary , Vural Emre A.
Published: September 2011

Objective

Concurrent chemoradiotherapy has become the treatment of choice for oropharyngeal and hypopharyngolaryngeal cancers in many centers. Although it has increased the rates of organ preservation, there has also been an increase in treatment‐related complications. We aimed to evaluate the functional outcomes of chemoRT in head and neck cancer.

Method

A retrospective study of patients treated with chemoRT at the University of Arkansas for Medical Sciences was performed. Demographic data and treatment outcomes were extracted, specifically feeding tube and tracheotomy dependence, number of esophageal dilatations, and the rate of hypothyroidism.

Results

Of the 243 patients treated with concurrent chemoRT, 152 patients received a feeding tube. The average duration of PEG use was 12 months (range, 1‐96 months). More than 70% of the patients who had a PEG more than 6 months had a T3 or T4 tumor. Thirty‐seven patients underwent esophageal dilatations, with an average of 1.8 times (range, 1‐7). The average duration for a tracheotomy was 11 months and 77% of these patients were treated for hypopharyngolaryngeal cancer. Of note, 42 patients were found to be hypothyroid, with no significant difference between the hypopharyngolaryngeal and oropharyngeal cancers.

Conclusion

Concurrent chemoradiotherapy leads to significant complications that reduce the quality of life of a patient. In this series 71% of the patients were feeding tube dependent despite completion of therapy more than 6 months ago. Prospective studies are needed to determine risk factors leading to increased dysphagia and tracheotomy dependence.
HPV+ Oral Cancer Patients Do Not Have Better QOL Trajectory
Authors: Sharma Arun , Doody David , Mendez Eduardo , Houck John , Lohavanichbutr Pawadee , Futran Neal D. , Yueh Bevan
Published: September 2011

Objective

To determine the role of human papillomavirus (HPV) status on quality of life (QOL) in patients with oral cavity and oropharyngeal squamous cell carcinoma (OSCC). We hypothesized that high risk HPV (HPV‐16, 18, 35, 45) tumors would be associated with better QOL trajectory.

Method

Head and neck‐specific QOL was determined using the University of Washington Quality of Life (UW‐QOL) scale version 4 in patients with newly diagnosed invasive OSSC (n = 296).

Results

Pre‐treatment QOL was higher in patients with high risk HPV tumors compared with patients with HPV negative or low risk HPV (HPV‐11, 32, 53, 66) tumors (P =. 004). This association remained in multivariate analysis. Patients with high risk HPV tumors had larger decreases in QOL from pre‐treatment to immediate posttreatment compared with patients with HPV negative or low risk HPV tumors (P =. 032). There was no association between HPV status and QOL 1 year posttreatment.

Conclusion

Among patients with OSCC, high risk HPV was independently associated with higher pretreatment QOL. The data did not support our hypothesis that patients whose tumors contain high risk HPV have better QOL trajectory. Research exploring patient expectations, treatment effects, and psychiatric comorbidity may provide insight into this finding.
Incidental Thyroid Cancer Found during Surgery for Head and Neck Squamous Cell Carcinoma
Authors: Gilbert Mark Raymond , Kim Seungwon
Published: September 2011

Objective

We aim to determine the clinical significance of incidental thyroid cancer found during surgery for HNSCC. We examined the clinical outcome of these patients with regard to both HNSCC and thyroid cancer to determine the need for treatment of incidental thyroid disease.

Method

Using our head and neck cancer registry, we retrospectively reviewed 2,538 neck dissections performed at our institution over a 15‐year period. We identified 29 patients who had an incidental pathologic finding of thyroid disease at surgery. We reviewed demographics, diagnoses, histopathology, initial and subsequent management, and outcome.

Results

Papillary thyroid cancer was the principal thyroid cancer in every case in our cohort. Fifteen patients died during the period of the study (2.4‐year mean follow‐up), with 14 patients still alive (4.3‐year mean follow‐up). Seven patients received further treatment for their thyroid: 2 with completion thyroidectomy, 2 with I‐131 ablation, and 3 with both. During the follow‐up period, none of the patients developed tissue proven recurrence of thyroid cancer. Cause of death was unrelated to thyroid cancer in all of the patients who died during the follow‐up period.

Conclusion

Thyroid cancer, in general, has excellent prognosis. This study suggests that further management of occult thyroid cancer discovered in patients undergoing surgery for HNSCC may not be necessary.
Juvenile Nasopharyngeal Angiofibromas: Does an External Approach Still Make Sense?
Authors: Herman Philippe , Verillaud Benjamin , Le Clerc Nicolas , Cloutier Tam , Sauveget Elisabeth , Ba‐Huy Patrice Tran , Kania Romain E.
Published: September 2011

Objective

Endoscopic removal has recently become the standard procedure in the case of small juvenile angiofibromas. However, large lesions encroaching the skull base remain a challenge. The aim of this work is to define extensions which at present cannot be addressed reasonably endoscopically.

Method

Retrospective review based on cases treated from 2000 to 2010. Ratio of endoscopically treated patients has been analyzed together with staging and topographic description of these lesions.

Results

Fifty‐nine patients were treated from 2000 to 2010, of whom 31 were treated endoscopically. Ratio of endoscopic procedures raises from 37% (n = 10) for the 2000 to 2005 period to 84% (n = 26) for the 2006 to 2010 period. This trend, analyzed according to the staging following Radkowski, is not related to earlier diagnosis of smaller tumors, since ratio of stage IIIA is similar. Indeed, development of approaches to pterygopalatine fossa, infratemporal fossa, temporal fossa, inferior orbital fissure, orbital apex, and even cavernous sinus allowed control of deep and far‐seated lesions.

Conclusion

Refinement of hemostasis techniques and 4‐hands surgery (Castelnuovo) allows the treatment of lateral‐seated tumors, even if large. Posterior extensions may be reached through a transpterygoid approach. Only lesions which engulf the ICA or the optic nerve need further evaluation to choose between open approach or incomplete, subtotal removal.
Long‐Term Outcome of Tonsil Squamous Cell Carcinoma Managed by Surgery
Authors: Rahmati Rahmatullah , Pyke Owen J. , Kraus Dennis H. , Patel Snehal G. , Ganly Ian , Shah Jatin P.
Published: September 2011

Objective

Analyze our experience in the management of tonsil SCC managed exclusively by surgical resection followed by postoperative radiotherapy (PORT) and to identify factors predictive of outcome.

Method

A retrospective chart review was conducted on 88 patients with tonsil SCC treated with surgery at Memorial Sloan‐Kettering Cancer Center between 1985 and 2005. Overall survival (OS), disease‐specific survival (DSS), recurrence‐free survival (RFS) at 5 years, and predictors of survival were determined.

Results

Forty‐eight percent had advanced T3/T4 stage and 75% had an N positive neck. With a median follow‐up of 74 months, OS, DSS, and RFS at 5 years were 66%, 82%, and 80%, respectively. Age >60 years female gender, advanced T stage, positive margins, and lymphovascular invasion (LVI) were predictive of OS. Only positive margins and LVI predicted DSS while clinical T stage and LVI predicted RFS. The status of the neck was not predictive of outcome (DSS 80% for N0 patients vs 82% for N+, P =. 97).

Conclusion

Advanced stage tonsil SCC patients managed with surgery and PORT had an excellent prognosis with outcome results comparable with those from concurrent chemoradiation. In contrast to advanced stage head and neck SCC at other sites, the pathological stage of the neck does not impact on outcome.
Melanoma Recurrence after Negative Sentinel Lymph Node Biopsy
Authors: Davis‐Malesevich Melinda , Goepfert Ryan , Myers Jeffrey N.
Published: September 2011

Objective

Delineate clinico‐pathologic factors associated with recurrence of cutaneous melanoma of the head and neck region and survival after negative sentinel lymph node biopsy (SLNB).

Method

A retrospective review from January 2000 to June 2009 was conducted at a tertiary referral center. Characteristics and outcomes of 204 patients with head and neck melanoma who underwent negative SLNB were analyzed in a univariant and multivariant fashion. Main outcomes measured included: local, regional, distant recurrences, and survival.

Results

A total of 204 patients with cutaneous melanoma of the head and neck underwent successful SLNB, in which final pathology was negative for nodal metastasis. Fifty‐nine recurrences occurred in 42 patients: local/in‐transit 18, regional 17, and distant metastasis 24. Five recurrences occurred within the same nodal basin that harbored the negative SLN(s). Decreased survival was associated with Breslow thickness (P <. 05) and ulceration (P <. 006). Local recurrence was associated with Clark level, Breslow thickness, and perineural invasion (P <. 05). Regional recurrence was correlated with Breslow thickness (P <. 05). Distant metastasis was associated with Breslow thickness, ulceration, nodular histology, and negative SLN(s) located in level V (P <. 05).

Conclusion

Regional recurrence in a primary echelon nodal basin after negative SLNB is rare (2‐4%) and is associated with increased Breslow thickness (>2.0mm). Thus, sentinel node biopsy is highly effective in assessing the draining nodal basin for metasatic disease and for directing further treatment leading to regional disease control.