bluuebunny/crossref_metadata_2025 huggingface dataset:
Salvage of Recurrent Hypopharyngeal Carcinoma after Primary Curative Treatment
Authors: Yasumatsu Ryuji , Nakashima Torahiko , Toh Satoshi , Komune Shizuo
Published: August 2013

Objectives:

Despite improvements in surgery, radiotherapy and chemotherapy, hypopharyngeal cancer has one of the worst prognoses of head and neck malignant disease. In this study, the efficacy of salvage treatment of recurrent hypopharyngeal squamous cell carcinoma (Hypo SCC) after primary curative treatment was evaluated.

Methods:

The management outcome of 49 patients who had recurrent Hypo SCC between January 2002 and December 2010 at Kyushu University Hospital was reviewed.

Results:

The mean time of detection of recurrence from the initial treatment was 10 months (range:2‐61 months). The total salvage rates of recurrence were 45% (local: 89%, nodal: 29%, distant: 17%). The 1 and 3‐year tumor‐free actuarial survival rates of those patients who received salvage treatment were 96% and 79%. There was no 3‐year survivor of any patient without salvage treatment.

Conclusions:

There was a moderate chance of cure after surgical salvage of recurrent Hypo SCC. However, surgical salvage was only feasible for early recurrent tumor. Close follow‐up surveillance of early recurrence is essential after primary treatment of patients.
Submandibular Triangle Masses
Authors: Dalgic Abdullah , Karakoc Omer , Hidir Yusuf , Gamsizkan Mehmet , Karahatay Serdar , Birkent Hakan
Published: August 2013

Objectives:

Retrospectively analyze patients operated due to submandibular triangle mass over 10 years.

Methods:

The charts of adult patients who underwent surgical intervention for submandibular triangle mass between January 2000 and November 2010 were reviewed. The medical history, age, sex, duration of symptoms, clinical presentation, preoperative investigations, and histopathologic findings were reviewed.

Results:

The study included 66 subjects who had a surgical intervention for submandibular triangle mass lesion. There were 12 patients (18.2%) with submandibular gland sialolithiasis, 18 patients (27.2%) with submandibular gland sialadenitis, 10 patients with lymphadenitis (15.1%) and 17 patients (25.7%) with neoplasia. Benign tumors of submandibular gland comprised 22.7% of all submandibular triangle masses, while malign tumors of submandibular gland comprised 3%. The most common benign tumor of submandibular gland was pleomorphic adenoma. The main symptom was a painless mass. The range of symptoms duration time was 3‐48 months. Ultrasonography was the most common preoperative diagnostic tool. Fine‐needle aspiration biopsy (FNAB) was performed in 26 patients with a correct diagnosis rate of 88%.

Conclusions:

Submandibular gland lesions are the most common masses located in the submandibular triangle. A detailed medical history, physical and endoscopic examinations, radiologic and histopathologic investigations should be performed for differential diagnosis in order to prevent unnecessary surgeries.
Submandibular (Undescended) Ectopic Parathyroid Glands: Elusive to Surgeons and Localization Studies
Authors: Alam Suhyla , Volsky Peter G. , Silverberg Marc , Wadsworth J. Trad , Karakla Daniel W.
Published: August 2013

Objectives:

High cervical parathyroid adenomas, known as undescended adenomas, occur with a frequency of less than 0.1%, but account for 7% of failed parathyroidectomies. Such cases are scarce in the otolaryngology‐head and neck surgery literature. Preoperative localization of undescended adenomas using Technetium 99‐c sestamibi scintigraphy (sestamibi) is difficult due to uptake and retention of sestamibi by salivary gland tissue.

Methods:

We present a review of the literature and two surgeons’ experience involving undescended parathyroid glands complicating the treatment of patients with primary (cases 2,3) and secondary (case 1) hyperparathyroidism. In case 1, a 52‐year‐old dialysis‐dependent male experienced recurrent secondary hyperparathyroidism, requiring three operations over two years to excise all parathyroid glands. The right inferior gland was localized to the submandibular region prior to the final operation. In case 2, two sestamibi–single‐photon emission computed tomography scans were proven incorrect when a contralateral undescended adenoma was located in a 54‐year‐old female at surgical exploration. In case 3, a 49‐year‐old male with a non‐localizing scan underwent a failed neck exploration, complicated by acute pancreatitis postoperatively. The surgeon's suspicion of an undescended adenoma was confirmed by computed tomography; the adenoma was excised.

Results:

When sestamibi scans are inconclusive, the contour and symmetry of uptake in and around the submandibular glands should be scrutinized. Thallium‐pertechnetate subtraction scanning (TPSS) as a second line modality may be useful. Undescended glands must be considered during an unyielding, thorough parathyroid exploration.

Conclusions:

Surgeons should consider the possibility of undescended adenoma, and use the aforementioned localization techniques when sestamibi scans are inconclusive.
Synchronous and Metachronous Tumors in Head and Neck Cancer: Analysis of the SEER Database
Authors: Chinn Steven B. , Spector Matthew E. , Prince Mark E. , Sun Gordon H.
Published: August 2013

Objectives:

1) Describe the prevalence of synchronous and metachronous second primary tumors in head and neck cancer patients. 2) Determine the overall survival rate of patients with second primary tumors based on location of index tumor, number of accumulated tumors, and synchronicity or metachronicity.

Methods:

Population based study (1973 to 2008) using the Surveillance, Epidemiology, and End Results (SEER) database. Inclusion criteria were patients with non‐esophageal mucosal head and neck squamous cell carcinoma (HNSCC) and no previous diagnosis of cancer. Synchronous tumors were defined as diagnosed within 6 months of identification of the index tumor, while metachronous tumors were diagnosed more than 6 months after the index tumor.

Results:

There were 58,363 HNSCC patients (M:F 42,794: 15,569) in the SEER database. Eleven percent (6,855) developed a second primary. The prevalence of head and neck and non‐head and neck second primary tumors was 3.2% (1,885) and 8.5% (4,970), respectively. Of the 1,885 patients with a second primary in the head and neck, 32% (602) were synchronous, 68% (1,283) were metachronous. Of the 4,970 patients with a non‐head and neck second primary, 21% (1056) were synchronous and 79% (3914) were metachronous. Overall survival was significantly worse in patients with second primary tumors and by total number of accumulated tumors (synchronous or metachronous; P = 0.045 and P < 0.001, respectively).

Conclusions:

The majority of patients with head and neck squamous cell carcinoma who developed synchronous or metachronous tumors are of non‐head and neck origin. The development of multiple second neck primaries confers a worse prognosis.
Tc99m Sestamibi Scan in Parathyroid Surgery: Positive Scan Obviates Routine Intra‐operative Parathormone Monitoring
Authors: Gurunathan Ramesh K. , McCadden Luke , McBride Greg , Nadig Shrinath
Published: August 2013

Objectives:

Parathyroid surgery for hyperparathyroidism has moved from traditional four gland exploration to a minimally invasive procedure with advent of better imaging tools, intraoperative parathyroid hormone (PTH0 monitoring, and endoscopic techniques. In our hospital parathyroid operation is accomplished with preoperative sestamibi and serum PTH monitoring at D1 post‐op. Intra‐operative PTH assay is done only in selected patients.

Methods:

Analyze the outcome of parathyroid surgery at our hospital and correlate pre‐operative sestamibi localisation of adenoma with operative findings. Retrospective chart review of 40 patients who had parathyroid operations from 2009 to 2012.

Results:

The majority of referrals came through GP and were seen at Joint Endocrinology and ear, nose, and throat (ENT) clinic but there were occasional referrals from renal, urology, orthopedics and surgical admissions. Half presented with incidental hypercalcemia and other half had varied clinical presentations like calculi, renal failure, fractures, fatigue, dehydration, acute abdomen etc. Majority (30/40) were females. Age ranged from 22 to 88 with mean of 58. Average operating time was 50 minutes with incision length from 2.5 to 4 cms. Two patients needed 2nd exploration. Postoperative PTH and calcium levels returned to normal in 38/40 patients. 36 had sestamibi scan and localization was positive in 24/36 patients (66.6%) and correlated 100% with surgical findings. In patients with negative scan, 4 gland explorations were done. Inferior gland pathology was found in two thirds with left inferior in majority.

Conclusions:

In our view, a preoperative sestamibi scan is sufficient in majority of patients. 4 gland explorations with intraoperative PTH assay are useful in selective patients with negative scan.
Total Laryngectomy following Successful Chemoradiation Therapy for Advanced Laryngeal Carcinoma
Authors: Sappington Joshua M. , Borrowdale Richard W.
Published: August 2013

Objectives:

1) Describe the Loyola University Medical Center experience of total laryngectomies performed for a non‐functional larynx following successful chemoradiation therapy for advanced laryngeal malignancies. 2) Recognize the impact surgical as well as non‐surgical therapy has on head and neck cancer patients quality of life.

Methods:

A retrospective study was conducted using chart review to identify patients who underwent total laryngectomy between 2004 and 2012 at LUMC, an academic tertiary medical center. Patients that completed chemoradiation therapy and subsequently underwent total laryngectomy were identified and divided into two groups. The first group underwent total laryngectomy for a non‐functional larynx and the second group underwent surgery for persistent or recurrent disease. Only patients with squamous cell carcinoma of the larynx were included in this study.

Results:

A total of 143 total laryngectomies were performed at LUMC between 2004‐2012. Seven patients were identified that underwent total laryngectomy following successful chemoradiation. All seven patients were tracheostomy and/or gastrostomy tube dependent prior to their laryngectomy. This patient population accounted for approximately 5% of all total laryngectomies performed at LUMC since 2004.

Conclusions:

This study identifies a patient population not previously described in the literature: those who underwent successful chemoradiation for advanced laryngeal carcinomas but failed organ preservation therapy due to a non‐functional larynx. These patients suffered a significant impact on their quality of life and underwent a surgery they initially strived to avoid.
Trans‐axillary Robotic Thyroidectomy: Avoiding the Chest Port
Authors: Wilson Meghan N. , Dileo Michael D. , Walvekar Rohan R.
Published: August 2013

Objectives:

Describe modification of port placement for the four‐arm technique for robotic thyroidectomy to avoid a chest incision and eliminate crowding of the working space provided by the trans‐axillary incision.

Methods:

Description of port placement modification to avoid chest incision as well as report of two cases and appropriate literature review.

Results:

Placement of four arms via a trans‐axillary incision requires expertise. Transitioning from a chest port for placement of the fourth arm to a single‐incision surgery, avoiding a visible chest incision, can be challenging. We describe this technique and two cases of trans‐axillary robotic hemithyroidectomy (TART) using a trans‐axillary incision and a separate 1 cm incision in the anterior axilla, 2.5 centimeters below the trans‐axillary incision, for placement of the fourth arm. This design allowed for a more ergonomic placement of the fourth arm while not compromising the working space provided by the trans‐axillary incision. Additionally this port is used for surgical drain placement.

Conclusions:

Robot‐assisted trans‐axillary thyroidectomy poses several challenges in the early surgical learning curve. One roadblock to exposure and efficiency is appropriate port and arm placement. Our modification offers an alternative where a four‐arm technique is made possible without a chest port and without occupying the restricted working space provided by the trans‐axillary incision. Use of this inferior axillary port is cosmetically acceptable, surgically efficient, and allows avoidance of a visible chest incision for placement of the fourth arm.
Transoral Robotic Surgery versus External Approach: Oncologic Results and Comparison of the Cost of Treatment
Authors: Moriniere Sylvain , Hammoudi Karim , Beutter Patrice , Pinlong Eric
Published: August 2013

Objectives:

Compare functional outcomes, oncologic outcomes and treatment costs between a group of consecutive patients operated by transoral robotic surgery (TORS) for squamous cell carcinoma of the upper aero‐digestive tract (UADT) and a matched group of patients operated by CC.

Methods:

21 patients who underwent TORS from December 18, 2008 to January 21, 2012, were matched on age, sex, TNM stage, tumor location, type of neck dissection realized and operator with 21 patients operated by CC from July 19, 2005 to May 22, 2008 (before the arrival of the robot in our center).

Results:

In each group there were 3 T1 tumors, 16 T2 and 2 T3. The number of tracheotomy was significantly lower in the TORS group (3 vs18, respectively 14 and 86%, P < 0.001). The average length of feeding by NT and hospitalization were shorter in the TORS group (respectively, 9 vs 16 days, P = 0.01 and 11 vs 19 days, P = 0.001). There was no significant difference in the rate of recurrence‐free survival at 3 years between the 2 groups (89% for the TORS group and 85% in the CC group, P = 0.76). The average treatment cost was reduced by 5488 euros for the TORS group (P = 0.03).

Conclusions:

Robotic technology allows the treatment of T1‐T2‐T3 selected squamous cell carcinoma of the UADT, reducing morbidity and treatment costs while providing an equivalent cancer control at 3 years. Prospective and longitudinal studies could confirm these encouraging results.
Treatment of Cutaneous Head and Neck Squamous Cell Carcinoma Metastatic to the Parotid Gland
Authors: Lin Jiahui , Kuhel William I. , Parashar Bhupesh , Voigt Erich P. , Cohen Marc A. , Kutler David I.
Published: August 2013

Objectives:

1) Recognize challenges in managing metastatic squamous cell carcinomas (SCC) to the parotid gland. 2) Describe our 5‐year experience of treating metastatic SCC of the parotid gland.

Methods:

Retrospective case series of 22 consecutive patients undergoing parotidectomies for treatment of metastatic SCC to the parotid gland between August 2006 and December 2011 at Weill Cornell Medical College. Interventions included parotidectomy and radiation therapy (RT). Outcome measures included complications, survival, and locoregional recurrence.

Results:

Seventy‐seven percent of patients were male, with a mean age of 77 years (range 46 ‐ 93 years). Eighteen patients underwent superficial parotidectomy, four received total parotidectomy, and 16 underwent neck dissection. Fifteen patients received post‐operative RT, and 1 patient had neoadjuvant radiation 4 months prior to surgery. Median dose of radiation delivered was 6300 cGy at 200 cGy per fraction. Overall 2‐year survival was 77.4%, and 2‐year disease‐free survival was 33.3%. Recurrence rate was 54.5%, with a median time to recurrence of 14 months. The 2‐year survival rate was 32% and 80% in patients with positive versus negative margins, respectively (P =. 01). The 2‐year survival rate was 56% and 100% in patients with positive versus negative cervical lymph nodes, respectively (P = 0.03). Five of 6 patients receiving conventional RT developed severe skin toxicity or could not complete treatment; none receiving intensity‐modulated radiation therapy (IMRT) developed such complications.

Conclusions:

Positive lymph nodes in neck dissection specimens are an important prognostic factor in treating patients with metastatic SCC to the parotid gland. IMRT is better tolerated compared to conventional RT techniques.
Tumor Grade and Immunohistochemical Expression for Predicting Nodal Disease in Early‐Staged Oral Squamous Cell Carcinomas
Authors: Anderson Donald W. , Liu Kelly Yi Ping , Berean Ken , Poh Catherine
Published: August 2013

Objectives:

1) Categorize oral squamous cell carcinoma (OSCC) patients according to nodal status at and after surgery. 2) Determine demographics, clinicopathological and histological factors contributing to nodal disease. 3) Investigate biomarkers to predict nodal status.

Methods:

Using the BC Cancer Registry Database, 303 primary OSCC patients who received primary curative surgical treatment from 2003 to 2007 with at least 5 years of follow‐up were identified. Patients were categorized based on nodal status at and after surgery. Demographics, clinico‐pathological details, treatment modalities and time to outcomes were collected and compared among groups. Immunohistochemistry (IHC) was performed on a pilot tissue microarray (n = 21) for p16, cyclin D1 (CD‐1), Ki‐67, p53, and pRB.

Results:

Patients with nodal diseases (n = 303) at the time of surgery or during the FU has a pivotal impact on the 5‐year survival rates (P < 0.0001). Cox proportional hazard models identified usage of adjuvant radiotherapy and presence of nodal disease as significant predictors for poor survival (hazard ratio [HR]: 6.53, 95% confidence interval [CI], 2.86‐14.91, P < 0.0001; 2.43, 95%CI, 1.18‐5.02, P = 0.02, respectively). Among the 205 N0‐at‐surgery, one in four of them developed nodal disease and with 76% at the first 18 months post‐surgery. Among those markers examined, nuclear CD‐1 expression is a negative predictor for nodal disease (100% vs. 58%, P < 0.05).

Conclusions:

The data strongly support aggressiveness of neck metastasis either at‐time‐of surgery or during follow‐up. Effective pathological or IHC markers to predict nodal disease pre‐surgery can benefit high‐risk patients receiving early intervention and avoid unnecessary ND for the low‐risk patients.
Use of FDG‐PET/CT Response Evaluation after Chemoradiotherapy in HPV+ Oropharyngeal Cancer
Authors: Vainshtein Jeffrey M. , Spector Matthew E. , Stenmark Matthew , Carey Thomas E. , Chepeha Douglas B. , Wong Ka K. , Eisbruch Avraham
Published: August 2013

Objectives:

Evaluate the use of 3‐month positron emission tomography (PET)/computed tomography (CT)–response assessment post‐chemoradiotherapy (CRT) in predicting locoregional failure (LRF) in HPV+ oropharyngeal cancer (OPC).

Methods:

101 consecutive patients with stage III/IV HPV+ OPC who received definitive carboplatin/paclitaxel‐based CRT from 2005‐2010 and underwent PET/CT pre‐treatment and at 3‐months post‐therapy were retrospectively identified. PET/CT‐response was reported as complete (CR), near‐complete (nCR), or partial (PR); nCR was classified as CR at the primary site and as PR in the neck. CT‐response for the neck was graded per RECIST‐1.1. Test characteristics for predicting 3‐year local failure (LF) and regional failure (RF) were calculated.

Results:

Among 98 patients with an evaluable primary, LF occurred in 2/67 patients with CR, 0/20 with nCR, and 1/11 with PR. For LF, PET/CT demonstrated 88% accuracy, 33% sensitivity, 90% specificity, 9% positive predictive value (PPV), and 98% negative predictive value (NPV). Among 91 patients with evaluable necks by RECIST, RF occurred in 6/67 with CR, 2/11 with nCR, and 0/7 with PR. For RF, PET/CT demonstrated 76% accuracy, 25% sensitivity, 81% specificity, 11% PPV, and 92% NPV, which compared favorably with CT characteristics of 56%, 38%, 45%, 6%, and 88%, respectively. Quantitative SUVmax thresholds did not improve the predictive accuracy of 3‐month PET/CT for LRF. Overall, PET/CT surveillance was 92% and 89% accurate for detecting LF and RF.

Conclusions:

In this largest reported study to‐date of post‐CRT response assessment by PET/CT for HPV+ OPC, 3‐month PET/CT demonstrated high negative predictive value for LRC. PET/CT surveillance was highly accurate for detecting LRF.
The 4‐Hour Rule: An ENT Perspective
Authors: Ha Jennifer , Lu Png H. , Chapman Kate , Friedland Peter
Published: August 2013

Objectives:

The pervasive theme in Western Australian medicine in 2011/2012 was the newly introduced 4‐hour rule in emergency departments. This article approaches the various issues and problems from an ear, nose, and throat (ENT) perspective, with subsequent recommendations.

Methods:

We performed a retrospective audit looking at the most commonn ENT diagnoses according to the ICD‐10‐AM classification: acute pharyngitis, streptococcal tonsillitis, acute tonsillitis, and peritonsillar abscess. Patients looked at included those who presented 6 months before and after the 4‐hour rule implementation.

Results:

We found a decreased diagnostic accuracy (41.2% vs 28.6%), reduced intravenous hydration commencement (94.1% vs 64.3%), and reduced intravenous antibiotics commencement (70.6% vs 50.0%).

Conclusions:

Although positivity has been seen within certain aspects of patient outcomes since the introduction of the 4‐hour rule, certain inherent issues must be acknowledged. Recommendations and modifications have been suggested as possible alternatives.
The West Scotland Experience of Using 18FDG‐PET Scans in Head and Neck Malignancy
Authors: Oozeer Nashreen B. , MacKenzie Kenneth
Published: August 2013

Objectives:

Fluorodeoxyglucose Positron Emission Tomography (FDG‐PET) scans are increasingly being adopted in head and neck cancer (HNC) practice in the United Kingdom. The aim of this study is to review the West of Scotland (WoS) HNC reasons for requesting FDG‐PET.

Methods:

A prospective database of FDG‐PET requested by HNC teams was reviewed. All scans between January 2008 and December 2011 were examined recording the indications compared to the National Health Service NHSScotland PET‐CT clinical indications guidelines.

Results:

Over the study period, 299 scans with a HNC indication were requested including 180 pre‐treatment. The current indications in our region are assessing primary site (possible primary in 52.3% of 132 “unknown primary” cases), identification of recurrence (16%), distant metastasis (16%) and treatment response (13%). The latter two are not current NHSScotland indications. The proportion of scans following national recommended guidelines improved over time from 39% to 75%.

Conclusions:

NHSScotland PET recommendations should be modified to include our current indications, closely reflecting recent Royal College of Radiologists evidence‐based indications for use of PET‐CT in the UK.
3D Measurement of Paralyzed Larynx in Japanese Using Cone Beam CT
Authors: Yabe Haruna , Saito Koichiro , Uno Kosuke , Momoshima Suketaka , Ogawa Kaoru
Published: August 2013

Objectives:

Precise measurement of human organs with an error by less than one millimeter was realized by cone beam computed tomography (CBCT) imaging technology. The purpose of this study was to measure the shape/size of paralyzed larynges in Japanese patients with multiple parameters using CBCT.

Methods:

Eighty‐nine Japanese patients who referred to our institution with unilateral vocal fold paralysis from April 2007 to November 2011 were incorporated in this case series study. There were 54 males and 35 females, and the mean age was 59.9 years. Laryngeal CBCT images were taken in 2 conditions: 1) patients sitting relaxed (R image), and 2) patients applying pressure at their diaphragm (P image). Lengths of bilateral vocal folds, bilateral horizontal glottal angles, and sizes of gaps from a median plane of each larynx were measured in R images. Vertical gaps of bilateral vocal folds were measured in P images.

Results:

Mean lengths of non‐diseased vocal folds (males, 18.5 mm; females, 12.9 mm) were significantly longer compared with diseased side (males, 17.7 mm; females, 12.4 mm) in both males (P =0.011) and females (P = 0.001). Glottal angles were significantly wider in no diseased side (16.1°) compared with diseased side (9.4°, P = 0.0011). Vertical gaps were normalized with the lengths of non‐diseased vocal folds with mean value of 0.057.

Conclusions:

Our study showed the first correct measurement of paralyzed larynx in live Japanese patients. These data will contribute to the improvement of diagnosis and surgical procedures for the patients with laryngeal paralysis in the future.
Comparative Assessment on Laryngeal Function after Radiotherapy and Laser Surgery against Early Glottic Cancer
Authors: Kono Takeyuki , Saito Koichiro , Yabe Haruna , Uno Kosuke , Ogawa Kaoru
Published: August 2013

Objectives:

Comparatively assess the laryngeal function and quality of life (QOL) of the patients after laser surgery and radiotherapy against early glottic cancer.

Methods:

Sixty‐seven patients with T1 glottic cancer treated in our institution with radiotherapy (RT, n=30) or CO2 laser surgery (LS, n=37) were incorporated in this retrospective cohort study. LSs were performed following the type II subligamental cordectomy concept. Patients in LS group were categorized into subgroups for further analyses. Twenty‐seven patients had vaporization of the lesion with defocused mode, and a residual 10 patients had cancer excision with focused mode using relatively lower power (LS‐EX group). GRBAS subjective voice assessment scale, maximum phonation time, and acoustic parameters were measured as vocal parameters. Voice‐Related Quality of Life Measure and Voice Handicap Index were used to evaluate post‐therapeutic QOL. Laryngeal videostroboscopic images were further examined to assess post‐therapeutic laryngeal pliability. The mean follow‐up period was 46 months.

Results:

Compared with their pre‐therapeutic scores, worse GRBAS scores were observed at the end of the treatments in 20% and 60% of RT group and LS group respectively. Although these scores recovered 1 year after treatment, abnormal stroboscopic findings remained in 40% and 95% of RT group and LS group respectively. Interestingly, further subgroup analysis proved no significant difference of post‐therapeutic vocal parameters and QOL between RT group and LS‐EX group.

Conclusions:

Early glottic cancer could be treated with equivalent post‐therapeutic laryngeal function and QOL with either radiotherapy or focused low power CO2 laser surgery.
Effects of a KTP Laser on Commonly Used Endotracheal Tubes in Head and Neck Surgery
Authors: Coughlan Carolyn A. , Verma Sunil P.
Published: August 2013

Objectives:

The effects of modern KTP lasers on endotracheal tubes (ETTs) have not been formally examined. In this study we investigated the interaction of the Aura XP 532 nm KTP and commonly used ETTs.

Methods:

An Aura XP 532 nm KTP laser with a 600 nm fiber was used in pulsed and continuous modes. The laser beam was focused at a distance of 0.5 cm from the shaft and balloon of three laser safe ETTs and a standard polyvinylcholoride (PVC) ETT. Time to penetrate through the ETT and cuff was recorded in seconds (s).

Results:

The KTP laser did not penetrate any of the laser resistant ETTs or standard PVC ETTs within 90s of contact in either mode. The beam did react with the black markings on the PVC ETT by producing smoke. The KTP laser was nonreactive with all cuffs except in one of three trials with the outer balloon cuff of a Rusch Lasertubus ETT in continuous mode.

Conclusions:

This is the first report documenting the effects of a KTP laser on ETTs. The bodies of all ETTs were found to be resistant to the KTP laser, while only the black markings on the shaft of a PVC ETT reacted with the laser beam. This study demonstrates that there are a number of options that may be used safely during transoral laser microsurgery with a KTP laser.
Eosinophilic Angiocentric Fibrosis of the Subglottis
Authors: Kraft Shannon M. , Patel Neil , Sauer David , Hamilton Bronwyn , Schindler Joshua S.
Published: August 2013

Objectives:

Eosinophlic angiocentric fibrosis (EAF) is a rare disorder that belongs to the spectrum of IgG4‐related diseases (IgG4‐RD). We review a case of EAF presenting as a subglottic stenosis.

Methods:

We discuss the pertinent clinical, radiographic, and histological findings, demonstrating the diagnostic challenges associated with EAF. We review the literature on respiratory tract EAF and discuss the associated management dilemmas when this otherwise benign disease affects critical structures. A 44 year‐old female presented a twelve‐month history of progressive dyspnea and stridor. A pulmonary function test (PFT) showed flattened inspiratory and expiratory flow loops suggestive of subglottic stenosis. Pre‐operative computed tomography (CT) revealed a subglottic mass with cricoid erosion. During endoscopy, a submucosal lesion was noted to involve the conus elasticus and cricoid. The airway was temporized with CO2 laser resection of the mass and dilation.

Results:

Histology showed an inflammatory infiltrate composed of lymphocytes, plasma cells, and eosinophils. Fibrosclerosis was organized around thickened vessels in an onionskin pattern. Immunohistochemical revealed a minor IgG‐4 plasma cell component. Staining was negative for beta‐catenin and ALK‐1. The specimen was found to be consistent with EAF. Serum IgG‐4 was mildly elevated at 117 mg/dL. The patient has been managed with oral steroids, and her airway remains stable.

Conclusions:

EAF is a subtype of inflammatory fibrosclerosis that belongs in the spectrum of IgG4‐RD. Most commonly reported in the orbit or sinonasal tract, EAF lesions of the laryngotracheal complex are exceedingly rare. Although benign, EAF pseudotumors can be locally destructive, requiring a multidisciplinary approach to care.
A1555G Polymorphism and Aminoglycoside‐induced Hearing Loss from Intratympanic Gentamicin Therapy
Authors: Wan Tan‐Kuai , Huang Chi‐Jung , Wang Pa‐Chun
Published: August 2013

Objectives:

Intratympanic gentamicin (ITG) treatment has become a standard modality in treating patients with Ménière's disease (MD) with high success rate. However, 30% of the ITG patients may suffer from further hearing recession. The relation of a genetic variation in the mitochondrial rRNA gene, A1555G, and aminoglycoside‐induced hearing loss (AIHL) remains unknown. The aim of the present study was to evaluate whether the presence of A1555G polymorphism in the mitochondrial rRNA gene can predispose to the AIHL in MD patients following ITG.

Methods:

33 Ménière's disease patients received ITG therapy. Genomic DNA was extracted from their blood samples. Target fragment within mitochondrial rRNA gene was amplified by polymerase chain reaction, and genotyped by direct sequencing to search for 1555 A‐to‐G substitution.

Results:

33 patients (13 males and 20 females; mean age: 56.2 years old) met the inclusion criteria. None of the subjects demonstrated this specific A‐to‐G substitution. Whether the patients will suffer from AIHL is independent of the presence of A1555G polymorphism.

Conclusions:

ITG treatment for intractable Ménière's disease appears to be effective in the relief of vertigo. However, we disagree with the relationship between A1555G polymorphism and antibiotic‐induced ototoxicity reported by Prezant et al. There might be different significant single nucleotide polymorphisms that may predispose to the hearing loss following ITG treatment. Further genotypes involving in this treatment must be analyzed in various populations.
Fibrovascular Polyps of the Hypopharynx and Esophagus
Authors: Salazar Esperanza F. , Donovan Donald T. , Ongkasuwan Julina
Published: August 2013

Objectives:

Fibrovascular polyps of the hypopharynx and esophagus are rare, and the majority of the literature is comprised of case reports. The goals of this study are: 1) Present one of the largest series of patients from a single institution that presented with fibrovascular polyps; 2) Describe their presentation focusing on airway management and clinical demographics; 3) Discuss our surgical management and demonstrate how it has evolved from open to endoscopic approaches.

Methods:

A retrospective review was conducted with four patients that presented to a tertiary medical center with fibrovascular polyps between 1990 and 2012. Patient demographics, clinical presentations, surgical approaches, and diagnostic studies were analyzed.

Results:

The average age at presentation was 72 years (range 59 to 85 years). Among the four patients, two presented with airway compromise requiring tracheotomy. All patients had removal of the polyp shortly after presentation; two underwent transcervical approaches with lateral pharyngotomy/esophagotomy; and the other two had endoscopic removal. The polyps arose from the hypopharynx in three patients and upper esophagus in one. Three patients had complete resolution of their symptoms and remained disease free. One patient had recurrence of the polyp two years later and is currently being observed.

Conclusions:

Fibrovascular polyps are rare tumors of the hypopharynx/esophagus that occur among older patients. Although benign, they can cause life threatening airway compromise that may necessitate tracheotomy. We present four cases of fibrovascular polyps and discuss our evolving surgical management. We demonstrate that endoscopic removal is a viable option for these tumors.
Inflammatory Myofibroblastic Tumor of the Larynx
Authors: Smith Danielle P. , Coughlin Andrew M. , Qiu Suimin M. , Underbrink Michael P.
Published: August 2013

Objectives:

1) Describe a case of inflammatory myofibroblastic tumor (IMFT) of the larynx. 2) Analyze the literature regarding the disease process. 3) Discuss appropriate management options and prognosis.

Methods:

Retrospective review of a single case of IMFT involving the subglottic region at the University of Texas Medical Branch.

Results:

Here we present IMFT of the larynx, a benign condition often believed to be a malignancy due to its aggressive proliferative nature. The majority of extra‐laryngeal cases are pulmonary; however, only 25 cases in the larynx have been described. Involvement of the subglottis is even rarer, representing only 5 cases. The origin is still unknown; however, many believe IMFT to be of clonal origin with chromosomal rearrangements of 2p23 and the ALK1 gene. These abnormalities are found in up to 47% of cases either immunohistochemically or using fluorescence in situ hybridization. Microsuspension laryngoscopy with laser excision has been the mainstay of treatment, and long term results have been excellent. Our patient's tumor was ALK1 positive on immunohistochemistry, confirming the diagnosis. As observed in previous cases, our patient has responded well to conservative resection with no recurrence at this time.

Conclusions:

IMFT is an aggressive tumor of the larynx. However, conservative excision is adequate for tumor control and good long term survival. Knowledge of the disease is important to prevent overtreatment.
Influence of Age on Treatment with Proton Pump Inhibitor in Patients with Laryngopharyngeal Reflux Disease
Authors: Lee Young‐Chan , Kim Seung‐Woo , Kwon Kee‐Hwan , Eun Young Gyu
Published: August 2013

Objectives:

The influence of age in severity and response to proton pump inhibitor (PPI) in patients with laryngopharyngeal reflux (LPR) is unclear. Thus, we conducted a prospective cohort study to assess the difference in severity and response to PPI according to age in patients with LPR.

Methods:

Two hundred twenty‐nine patients with LPR who were referred to the otolaryngology clinic from November 2010 to February 2012 were enrolled in the study. All of the enrolled patients were prescribed 15mg of Lansoprazole (PPI) twice daily for three months. Data, including the Reflux Symptom Index (RSI), Reflux Finding Score (RFS), and LPR‐Health related quality of life (LPR‐HRQOL), were collected from patients at the baseline visit and at 1 and 3 months post‐baseline.

Results:

The older patients group (60‐79 years) showed a higher score in RSI (P < 0.001) and LPR‐HRQOL (p<0.001) at baseline than the younger subgroups. However, the RFS score showed no significant difference among age subgroups. Within each age subgroup, RSI, RFS, and LPR‐HRQOL showed significant improvement with PPI therapy; however, no difference in improvement of RSI, RFS, or LPR‐HRQOL was seen among the subgroups. The responders who had changes in RSI score at three months were found significantly more often in the younger group than the older group (P = 0.002).

Conclusions:

Age appears to affect the subjective symptoms and resulting impact on their QOL but not laryngeal finding in patients with LPR. Furthermore, the clinician should be aware that older patients are more likely to not respond to PPI.
Intracordal Hyaluronic Acid Injection during Spontaneous Reinnervation Stage for Unilateral Recurrent Laryngeal Nerve Paralysis
Authors: Fang Tuan‐Jen
Published: August 2013

Objectives:

The effect of intracordal hyaluronic acid (HA) injection is considered an effective temporary treatment for acute unilateral vocal fold paralysis (UVFP),but its long term benefit is not concluded. This project proposed to evaluate the long term benefit from HA injection. Study design: Prospective randomized case study.

Methods:

From August 2011 to January 2013, 40 consecutive subjects diagnosed with acute UVFP were enrolled. The subjects were randomized into two groups. Group A accepted transcervical HA injection at 6 months from symptoms appearing. Group B subjects accepted the conventional observation policy. All patients had performed serial videostroboscopy, acoustic voice measurements, and two questionnaires (Voice Outcome Survey and SF‐36) till 12 months.

Results:

Thirty‐five patients were evaluated completely and followed up regularly. Three of them returned their vocal fold motion, and one within adequate injection were excluded. There were 16 cases in group A and 15 cases in group B. At the last visit, the vocal cord position, evidenced by normalized glottal gap area; maximal phonation time, jitter, H/N, VOS showed significant improvement in both groups compared to initial evaluation. In SF‐36 measurements, 3 of 8 domains including role limitation due to physical health, vitality, and mental health improved in group A but not in group B. Data comparison between groups showed no significant differences at the end of follow‐up.

Conclusions:

Intracordal HA injection is an effective therapy for acute UVFP. However, the long term result is not significantly different from conventional observation policy.
Is There Any Correlation between Aerodynamic and Vocal Cord Vibration Parameters?
Authors: Matsuzaki Hiroumi , Makiyama Kiyoshi , Takane Tomoyuki , Suzuki Hirotaka
Published: August 2013

Objectives:

Investigate the correlation between vocal cord vibration parameters and aerodynamic parameters.

Methods:

We examined 13 patients with various voice disorders. Using the phonatory function analyzer PS77E, we measured sound pressure level (SPL), mean flow rate (MFR), expiratory lung pressure (EP), and airway resistance (EP/MFR). We used a high‐speed video (HSV) system to observe the vocal cord vibration. We obtained the image data at a speed of 2000 frames/sec, while each subject was vocalizing the vowel sound /a/. We analyzed the predetermined area using Kay Image Processing Software (KIPS) with regard to the following: 1) maximum or minimum area, maximum or minimum opening at the midpoint of the glottis from a montage with glottal area waveform (GAW) analysis, and 2) maximum or minimum opening of the glottis, dominant amplitude or frequency of the opening variation of the vocal fold, and ratio of time of glottal total closure to the entire time domain in the calculation using kymograph edge analysis (KEA). Spearman's rank correlation was used to determine correlations.

Results:

A correlation existed between sound pressure and posterior glottal vibration as assessed by KEA (left: P = 0.0199 and right: P = 0.0372) and central glottal vibration (left: P = 0.022 and right: P = 0.0438). Neither GAW nor KEA was correlated with both expiratory flow rate and expiratory pressure. A negative correlation was seen between airway resistance and GAW minimum opening (P = 0.0256).

Conclusions:

The results of the present study suggest that vocal cord parameters correlate with aerodynamic parameters.
Using Nurse Practitioners and Physician Assistants in an Academic Otorhinolaryngology Practice
Authors: Ziebarth Michelle T.
Published: August 2013

Objectives:

1) Recognize the value of the Nurse Practitioner/Physician Assistant (NP/PA) in an otorhinolaryngology practice. 2) Describe application of care models to achieve improved outcomes for patients and increased job satisfaction for providers.

Methods:

Single institutional evaluation of NP/PA provider integration into an academic otorhinolaryngology practice.

Results:

Healthcare in the United States is at a crossroads. The number of insured patients seeking care will rise dramatically over the next 2 years. The number of medical doctors is declining, and based on Accreditation Council for Graduate Medical Education (ACGME) recommendations, resident work hours are decreasing. In otorhinolaryngology accommodating the increasing needs of the population will require improved use of resources, including personnel to provide high quality, compassionate healthcare. Nurse practitioners and physician assistants are well educated and highly motivated to work alongside a collaborating physician(s) to provide this care. At Mayo Clinic, the otorhinolaryngology department employs 7 NP/PA providers. These NP/PA providers work with a variety of staff surgeons, resident surgeons, nurses, and ancillary health providers to maintain high quality, highly accessible healthcare. The care model of each individual NP/PA and collaborating physician vary in otorhinolaryngology at Mayo Clinic. However, the care models work based on the needs of the practice, the patient, and the providers.

Conclusions:

The NP/PA providers perform a variety of services for the patient and the collaborating physician. The care models used allow each provider (MD, NP/PA) to use their time to the best of their ability, increasing job satisfaction and thereby providing high quality, cost effective care.
Age Differences in Taste Thresholds
Authors: Ye Mikyung
Published: August 2013

Objectives:

The sense of taste is one of the most important human senses and plays a critical role in an individual's food preferences and the nutritional status. Proper gustatory function in older people is important for quality of life and enjoyment of food. The objective of this study was to investigate the effect of age on gustatory function and to establish the normative values in Korean subjects.

Methods:

One hundred sixty normal volunteers without smell and taste disorders were investigated. Each subject was given a questionnaire for smoking, medicine, and menstruation. Whole mouth taste test was performed with successive solutions of sucrose, sodium chloride, citric acid, and quinine hydrochloride.

Results:

Older subjects (over 50 years) showed worse taste sensitivity compared with younger subjects (age 20‐29 years). The detection threshold of all four basic tastes and the recognition threshold of salty taste of elderly participants were significantly higher than those of young participants.

Conclusions:

Gustatory sensitivity was found to decrease with age. Older subjects appeared to have a reduced perception of salt, which can alter eating habits, such as intake of more salty foods. Our data provide preliminary normative values for future investigation of chemosensation in the Korean population.
Objective Analysis of Motor Speech Performance in Children with Cochlear Implants
Authors: Eskander Antoine , Gordon Karen , Tirado Yamilet , Hopyan Talar , Russell Laurie , Papsin Blake C. , Campisi Paolo
Published: August 2013

Objectives:

Objectively analyze speech and articulation in children with longstanding experience using unilateral cochlear implants.

Methods:

Cross‐sectional study design at a tertiary pediatric hospital. Sixteen subjects (aged 8‐17 years) using unilateral cochlear implants were studied. The subjects had a median of 7 years of cochlear implant experience, with excellent audiogram and speech perception scores. Speech was objectively assessed with the Motor Speech Profile (MSP) software and Computerized Speech Lab model 4500 (KayPentax, Lincoln NJ). Results were compared to previously published normative pediatric data.

Results:

Diadochokinetic rates were within normal limits for 69% of children with /pa/pa/pa/ and 73% of children with /pa/ta/ka/ spoken tasks. The magnitude and rate of the second formant transition were within normal limits for 56% and 83% of children, respectively. The variability in amplitude of intonation stimulability was within normal limits for 100% of children, but variability in frequency was within normal limits in 44% of children only. The syllabic rate and duration were both within normal limits for 88% of children. Overall, subjects demonstrated excellent articulation and timing but poor frequency intonation stimulability.

Conclusions:

Although the majority of the measured characteristics of speech were normalized after cochlear implantation, variability in frequency during intonation stimulability testing remained outside of the normal range in 56% of subjects even with long term cochlear implant use. This limitation may be perceived as a dampening of emotional expression during speech. Novel cochlear implant software programming and auditory verbal therapy strategies may be needed to address this finding.
A Rare Cause of Hoarseness: Primary Laryngeal Aspergillosis in a Postpartum Patient
Authors: Villanueva Jose C. R. , Opulencia Alejandro , Lim William L. , Calavera Kenneth
Published: August 2013

Objectives:

1) Present a rare cause of hoarseness in a seemingly healthy, immunocompetent, postpartum patient. 2) Discuss the probable contributing factors leading to the unusual presentation of the disease process.

Methods:

Case report study conducted from January‐December 2012. Subject: A 28 year old, immune competent female diagnosed with primary laryngeal aspergillosis.

Results:

Aspergillus is a saprophyte known to be weakly pathogenic and opportunistic in human beings. For centuries since its discovery, it has mostly been regarded as a disease of the immuno‐compromised. When it does cause disease it most commonly affects only the lungs and tracheo‐bronchial tree with subsequent systemic dissemination and involvement of other organs during its fulminant stage. Primary laryngeal aspergillosis is uncommon, and an even greater rarity is to have the disease manifest in a patient with an intact immune system. Here we present a case of a young female presenting with cough and hoarseness immediately postpartum which later was identified as a case of primary Aspergillosis of the larynx. Initially she was managed with antibiotics, PPIs, and corticosteroids, but this did not resolve her symptoms. Direct suspension micro‐laryngoscopy with excision of TVF mass revealed tissue sections with characteristic appearance of Aspergillus sp.

Conclusion:

There has been an increasing number of reported cases of primary laryngeal aspergillosis in the immunocompetent. The possibility of a primary laryngeal aspergillosis should be one of the differential diagnoses when dealing with patients who respond poorly to conventional treatment. It should also not be quickly dismissed merely on the basis of the patient's good immune status.