bluuebunny/crossref_metadata_2025_split huggingface dataset:
Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis
Authors: Franco Ramon A. , Husain Inna , Reder Lindsay , Paddle Paul 
Published: October 2017

Objectives/HypothesisThe fibrotic/erythematous appearance of the subglottis in idiopathic subglottic stenosis (iSGS) hints that it might respond to repeated intralesional steroid treatment similar to keloids.Study DesignRetrospective cohort study.MethodsThirteen iSGS subjects (six treated in‐office with serial intralesional steroid injections [SILSI] versus seven treated endoscopically in the operating room [OR] followed by awake SILSI) between October 2011 and April 2017. Forced spirometry was performed before injections and at each follow‐up visit (peak expiratory flow [%PEF] and peak inspiratory flow). Steroids were injected via transcricothyroid or transnasal routes. Injections were grouped into rounds of four to six injections separated by 3 to 5 weeks.ResultsThirteen subjects with a mean follow‐up of 3 years (3.3 years for SILSI and 2.7 years for OR). Awake‐only SILSI subjects had a mean improvement/round of 23.1% %PEF (range, 65.4%–88.6%), whereas the OR‐treated subjects had a mean %PEF improvement/round of 25.1% (range, 57.4%–82.5%). Both groups had improved breathing, and the improvements were statistically equal (P = .569). SILSI subjects underwent 5.3 injections/round in 1.3 rounds, whereas OR subjects had 5.9 injections/round over 2.1 rounds. Statistically significant improvement was seen in %PEF for both groups (SILSI P = .007, OR P = .002). Overall, SILSI achieved sustained %PEF above 80% in 83% (5/6) and OR + SILSI 86% (6/7).ConclusionsSILSI in the awake outpatient setting can improve the airway caliber in iSGS and is equivalent to endoscopic OR treatment. We believe iSGS can be viewed as a chronic scarring/inflammatory condition that can benefit from steroid scar‐modification therapy.Level of Evidence4. Laryngoscope, 128:610–617, 2018
Treatment, survival, and costs of oropharyngeal cancer care in the elderly
Authors: Gourin Christine G. , Fakhry Carole , Quon Harry , Kang Hyunseok , Kiess Ana P. , Herbert Robert J. , Eisele David W. , Frick Kevin D. 
Published: October 2017

Objectives/HypothesisTo examine associations between treatment, survival, and costs in elderly patients with oropharyngeal squamous cell cancer (OPSCC).Study DesignRetrospective cross‐sectional analysis of Surveillance, Epidemiology, and End Results–Medicare data.MethodsWe evaluated 666 patients diagnosed with OPSCC from 2004 to 2007 using cross‐tabulations, multivariate logistic and generalized linear regression modeling, and survival analysis.ResultsThe majority of patients were nonsmokers (79%), had advanced‐stage disease (59%), and received chemoradiation (38%) or radiation (28%). Surgery with postoperative radiation (hazard ratio [HR]: 0.33 [95% CI: 0.20‐0.53]) and chemoradiation (HR: 0.45 [95% CI: 0.29‐0.71]) were associated with improved survival, whereas stage IV disease was associated with poorer survival (HR: 1.95 [95% CI: 1.13‐3.38]). Additional cancer‐directed treatment after primary treatment was more likely following chemoradiation (odds ratio [OR]: 3.44 [95% CI: 1.78‐6.63]). Salvage surgery was performed in 25% of patients undergoing subsequent additional cancer‐directed treatment, and was associated with high‐volume hospitals (OR: 2.81 [95% CI: 1.07‐7.74]). Additional radiation (HR: 0.47 [95% CI: 0.31‐0.72]) and salvage surgery (HR: 0.61 [95% CI: 0.38‐0.99]) were associated with improved overall survival when performed >6 months following initial treatment, whereas salvage neck dissection alone was not significantly associated with survival after controlling for time to salvage (HR: 0.38 [95% CI: 0.05‐2.78]). Treatment and 5‐year overall costs were highest for chemoradiation, surgery with postoperative radiation, and additional cancer‐directed treatment.ConclusionsMultimodality treatment in elderly OPSCC patients was associated with improved survival and increased costs. Chemoradiation was associated with an increased likelihood of additional cancer‐directed treatment. Salvage surgery was centralized at high‐volume hospitals, and was associated with improved survival when performed >6 months after last initial treatment date, but was performed in <20% of patients undergoing additional treatment.Level of Evidence2c. Laryngoscope, 128:1103–1112, 2018
Positive fresh frozen section margins as an adverse independent prognostic factor for local recurrence in oral cancer patients
Authors: Szewczyk Mateusz , Golusinski Wojciech , Pazdrowski Jakub , Masternak Michal , Sharma Neil , Golusinski Pawel 
Published: October 2017

ObjectivesTo access 1) the value of further surgical resection (completion surgery) in cases with a positive intraoperative margin analysis, and 2) whether cancers that undergo completion surgery following positive intraoperative margin analysis with subsequent negative margins should be considered true margin‐negative (R0) resections in terms of adjuvant treatment planning.Study DesignRetrospective analysis of patients with primary oral cancer.MethodsOne hundred and fifty‐one patients underwent primary surgical resection of oral squamous cell carcinoma with intraoperative margin examination. In all cases for which frozen section margin analysis was positive, an extended resection was performed. Only patients with clear final margins were included in the study.ResultsThe intraoperative analysis of surgical margins revealed that cancer‐free margins were achieved in 123 cases (81.5%). In 28 specimens (18.5%), the surgical margins were positive. Local recurrence was observed in 28 (18.5%) patients, whereas regional recurrence developed in 30 (19.9%) patients. Factors significantly (P < 0.05) increased the risk of local recurrence: advanced stage of the disease (III/IV), node N‐positive status, lymphovascular invasion and positive fresh frozen surgical margins. On multivariate analysis, only positive fresh frozen surgical margins remained significant independent adverse factors.ConclusionOur study demonstrates that positive fresh frozen margins, regardless of re‐resection to R0 status, could be a powerful adverse factor that determines an aggressive nature of the tumor. This feature should be taken into consideration in adjuvant treatment planning. The greatest impact this could have is in borderline clinical situations for which the indication for adjuvant treatment may be questionable.Level of Evidence4. Laryngoscope, 128:1093–1098, 2018
Survival of renal cell carcinoma metastatic to nonthyroid head and neck region: A systematic review
Authors: Liou Tzyy‐Nong , Scott‐Wittenborn Nicholas R. , Kallogjeri Dorina , Lieu Judith E. , Pipkorn Patrik 
Published: October 2017

ObjectiveMetastasis of renal cell carcinoma to nonthyroid head and neck region is rare. Survival benefit for complete metastasectomy of more common renal cell foci has been reported in the literature. It is uncertain whether metastasectomy in nonthyroid head and neck region would provide a similar benefit.Data SourcesWe conducted a retrospective review of all renal cell metastases to the head and neck region treated in the past 15 years at an academic hospital, and a systematic review of all relevant reports with survival data in the literature between 1960 and 2016.Review MethodsAn analysis of pooled data was performed to estimate overall survival.ResultsSix cases from our institution and 260 independent cases reported in the literature were included in the survival analyses (n = 266). The median follow‐up time was 12 months (range 0–180 months). The overall median survival was 36 months (95% confidence interval [CI] 23.7–48.3). The median survival for those who underwent complete metastasectomy in the head and neck was significantly higher at 60 months (95% CI 41.1–78.9) than those who had incomplete or no metastasectomy (12 months, 95% CI 9.5–14.5). Multivariable Cox proportional hazards model estimated that, after controlling for potential confounders, complete metastasectomy remained associated with reduced risk of death (hazard ratio 0.44, 95% CI 0.29–0.69).ConclusionComplete metastasectomy was associated with 4‐year longer median overall survival than incomplete metastasectomy or no metastasectomy. Laryngoscope, 128:889–895, 2018
Upper esophageal sphincter augmentation reduces pharyngeal reflux in nasogastric tube–fed patients
Authors: Jiao Hongmei , Mei Ling , Liang Chenyang , Dai Yun , Fu Zhifang , Wu Lihong , Sanvanson Patrick , Shaker Reza 
Published: October 2017

Objectives/HypothesisAspiration of gastric refluxate is one of the most commonly observed complications among long‐term nasogastric tube (NGT) fed patients. The upper esophageal sphincter (UES) pressure barrier is the main defense mechanism against pharyngeal reflux of gastric contents. Our objective was to investigate the efficacy and safety of the UES assist device (UES‐AD) in preventing gastric reflux through the UES in long‐term NGT‐fed patients.Study DesignSelf‐Controlled Case series.MethodsWe studied 10 patients (mean age = 90.6 ± 3.4 years, four females) with dysphagia caused by stroke or dementia who were fed for 0.5 to 5 years (median = 3 years) by NGT. External pressures of 20 to 30 mm Hg were applied by using a handmade UES‐AD, which was started 2 hours after the beginning of NGT infusion and was alternated between periods of 2 hours on and 2 hours off, for a total of 12 hours. Placement of the impedance sensors within the UES was guided by high‐resolution manometry. Trans‐UES and intraesophageal reflux events were recorded by using 24‐hour combined pH‐impedance measurements.ResultsNo aspiration pneumonia events were noted in the period 1 month before or during the study in any of the cohort. Baseline UES pressure averaged 17.5 ± 9.4 mm Hg and was increased to 38.9 ± 11.9mm Hg after application of the UES‐AD. Overall frequency of trans‐UES reflux decreased significantly with the UES‐AD compared to without (0.8 ± 0.9 vs. 3.3 ± 2.8, P < .05 for the 12‐hour study period). There was no effect of the UES‐AD on esophageal reflux events (7.4 ± 4.4 vs. 6.4 ± 3.0, P > .05).ConclusionsUES‐AD significantly decreases the number of trans‐UES reflux events and can potentially reduce the aspiration risk associated with NGT feeding.Level of Evidence4. Laryngoscope, 128:1310–1315, 2018
Clinical outcomes and prognostic factors of sialendoscopy in salivary duct stenosis
Authors: Choi Jeong‐Seok , Choi Yoon‐Gi , Kim Young‐Mo , Lim Jae‐Yol 
Published: October 2017

Objectives/HypothesisThis study aimed to analyze the clinical outcomes of sialendoscopy in patients with salivary duct stenosis and to investigate factors associated therewith.Study DesignRetrospective case series.MethodsThis study included 47 patients with salivary stenosis who underwent sialendoscopy between January 2014 and December 2015. Subjective symptom, salivary flow rate, salivary scintigraphy, and radiologic evaluation using magnetic resonance (MR) sialography were performed preoperatively; direct ductal findings were evaluated during sialendoscopy. Univariate and multivariate analyses of factors influencing the patient‐reported outcomes (complete, partial, or no improvement at 3 months after sialendoscopy) were conducted.ResultsStenosis severity was graded according to sialendoscopic findings. Seventeen patients were classified with grade I stenosis, 18 patients with grade II stenosis, and 12 patients with grade III stenosis. Symptoms completely disappeared in 21 patients (44.7%) after sialendoscopic procedures. In 19 patients (40.4%), symptoms were partially improved. Seven patients (14.9%) showed no improvement or worsening of symptoms. In univariate analysis, symptom score, stimulatory salivary flow rate, Tmin (time interval from stimulation to minimal count on salivary scintigraphy), type of stenosis on MR sialography, and sialendoscopic grade were found to be significantly associated with treatment outcomes. In multivariate analysis, Tmin, stenosis type of MR sialography, and sialendoscopic grade remained significantly associated with outcomes after sialendoscopy.ConclusionsSialendoscopic procedures were found to be clinically satisfactory for relieving the symptoms of patients with salivary stenosis. Factors related to the severity of ductal stenosis such as Tmin, stenosis type of MR sialography, and sialendoscopic grade were significantly associated with the success of sialendoscopic treatment for salivary duct stenosis.Level of Evidence4. Laryngoscope, 128:878–884, 2018
Hearing loss on social media: Who is winning hearts and minds?
Authors: Crowson Matthew G. , Tucci Debara L. , Kaylie David 
Published: October 2017

Objectives/HypothesisTo analyze specific patterns of Twitter usage using common references to hearing loss, and characterize the virtual public that comprises the hearing loss community to inform hearing loss stakeholders for opportunities for engagement and outreach.Study DesignSocial media network analysis.MethodsTwitter tweets were sampled from July 2016 to September 2016 using #hearing, #hearingloss, #deaf, #hearingimpairment, #hardofhearing, #deafness, #hearingmatters, #hearinghealth, and #hearingimpaired tags. User and Twitter social community metrics were examined including temporal trends, tweet content, user activity, tweet reach, and an analysis of the tweets' social network.ResultsWe identified and analyzed 49,208 tweets from July 2016 to September 2016 with tags relevant to hearing loss. Of the 100 most active Twitter accounts, organizations owned 67% compared to 33% owned by individuals. Commercial/for profit and informational organizations were the most common organization account owners (26% and 16%, respectively). Five unique tweets were identified as each having a reach of over 100,000 Twitter users, with the greatest reach exceeding 250,000 users. Temporal analysis identified marked retweet outliers (>300 retweets per hour) that corresponded with a widely publicized event involving the dismissal of a deaf employee from a fast‐food chain store.ConclusionsTwitter accounts owned by organizations outnumbered individual accounts, and commercial/for profit user accounts were the most frequently active organization account type. Tweets pertaining to hearing loss may have a broad reach to a large community base. Analyses of social media use can be helpful in discovering issues of interest to the hearing loss community, as well as determining which users and organizations are dominating social network conversations.Level of EvidenceNA. Laryngoscope, 128:1453–1461, 2018
Primary surgery versus primary radiation‐based treatment for locally advanced oropharyngeal cancer
Authors: Kamran Sophia C. , Qureshi Muhammad M. , Jalisi Scharukh , Salama Andrew , Grillone Gregory , Truong Minh Tam 
Published: October 2017

ObjectiveRandomized data comparing surgery to radiation for locally advanced oropharyngeal cancer (OPC) are lacking. This study evaluated practice patterns and overall survival outcomes from the National Cancer Database.MethodsA total of 22,676 patients with stage III to IV, locally advanced OPC were treated between 2004 to 2013 with primary chemoradiation (CRT) or surgery with adjuvant radiotherapy with or without chemotherapy (aRT ± CT). Survival rates were estimated using the Kaplan‐Meier method. Crude and adjusted hazard ratios (HR) were computed using Cox regression modeling.ResultsMedian follow‐up was 40.7 months; 8,555 and 14,121 patients received surgery with aRT ± CT and CRT, respectively. Corresponding 3‐year survival was 85.4% and 72.6% (P < 0.0001). On multivariate analysis, adjusting for age, gender, race insurance status, median income, percentage with no high‐school degree, Charlson‐Deyo score, clinical tumor and node stage, tumor grade, facility type, treatment at > 1 facility, and human papillomavirus (HPV) status, surgery with aRT ± CT had a reduced hazard of death, HR, 0.79 (95% confidence interval 0.69–0.91), P = 0.001.ConclusionPrimary surgery with aRT ± CT for locally advanced OPC has an improved survival compared to primary radiation‐based treatment even when stratified by HPV status.Level of Evidence2c. Laryngoscope, 128:1353–1364, 2018
Malignant fibrous histiocytoma: Database review suggests a favorable prognosis in the head and neck
Authors: Borucki Robert B. , Neskey David M. , Lentsch Eric J. 
Published: October 2017

ObjectiveThe malignant fibrous histiocytoma (MFH) is the most common soft tissue sarcoma of the head and neck. Currently, most of the data on this tumor relies on small retrospective studies. The objective of this study is to use the Surveillance, Epidemiology, and End Results (SEER) database to compare characteristics of this tumor based on location to better understand its prognosis in the head and neck region. This article represents the largest study analyzing prognosis of this tumor in the head and neck to date.Study DesignRetrospective analysis of SEER database.MethodsUsing the SEER database, 395 patients with MFH of the head and neck were compared with 3,968 patients with MFH of the trunk and extremities. Disease‐specific survival was carried out comparing these two cohorts, as well as univariate and multivariate analysis to determine hazard ratios.ResultsHead and neck MFH had a significantly higher disease‐specific survival compared with trunk and extremity disease. However, head and neck tumors were more frequently a smaller size (P < .0001) and lower grade (P < .0001). Larger tumors and grade III and IV tumors conferred a worse prognosis (P < .0001).ConclusionHead and neck malignant fibrous histiocytoma presents at a smaller size and lower grade, likely due to earlier presentation in this region. Because of this, head and neck malignant fibrous histiocytoma represents a more favorable survival prognosis compared with trunk and extremity disease.Level of Evidence4. Laryngoscope, 128:885–888, 2018
A prospective crossover trial of botulinum toxin chemodenervation versus injection augmentation for essential voice tremor
Authors: Estes Christine , Sadoughi Babak , Coleman Rachel , Sarva Harini , Mauer Elizabeth , Sulica Lucian 
Published: October 2017

Objectives/HypothesisBotulinum toxin chemodenervation (BTX) is used to treat essential voice tremor (EVT), but results are not uniformly satisfactory. This study sought to assess the comparative utility of injection augmentation (IA) for EVT.Study DesignProspective crossover treatment study.MethodsPatients with EVT underwent BTX. After washout patients underwent IA. Multidimensional assessment carried out prior to and 30 days after each treatment included 1) videostroboscopy graded by the Vocal Tremor Scoring System (VTSS), 2) acoustic and aerodynamic assessment (cepstral peak prominence, cepstral spectral index of dysphonia, cepstral peak prominence fundamental frequency, airflow, peak air pressure and intensity, maximum phonation time, and amplitude/frequency of tremor), 3) audio‐perceptual assessment via Consensus Audio‐Perceptual Evaluation of Voice (CAPE‐V), and 4) patient self‐assessment via Voice Handicap Index‐10 (VHI‐10) and Percent of Normal Function (PNF) scale. Findings were analyzed via paired t tests and Wilcoxon rank sum tests.ResultsSeven patients (five female and two male; mean age 67 years old; range, 46–82 years old) participated. VTSS grading showed divergent outcomes for certain individual sites of tremor, but without significant differences. Airflow increased following BTX and decreased following IA, and VHI‐10 scores indicated slight improvement post‐BTX (26.29–23.57), and decline post‐IA (25.86–29.86), although differences were not significant. Only changes in audio‐perceptual ratings of loudness achieved significance, which decreased with BTX and increased with IA. Five patients chose to resume BTX; two elected long‐term IA. No findings supported patient preferences.ConclusionsIA demonstrated no advantage over BTX in the treatment of EVT.Level of Evidence2b. Laryngoscope, 128:437–446, 2018
The effect of vocal fold augmentation on cough symptoms in the presence of glottic insufficiency
Authors: Litts Juliana K. , Fink Daniel S. , Clary Matthew S. 
Published: October 2017

ObjectiveTo determine the effect of injection augmentation of the vocal folds on chronic cough symptoms in patients with glottic insufficiency.MethodsMedical records from 146 consecutive patients who underwent vocal fold injection augmentation by a fellowship‐trained laryngologist between 2013 and 2015 were reviewed. Twenty‐three patients (12 male) met inclusion criteria of a vocal fold augmentation injection, cough symptoms lasting more than 8 weeks, and glottic insufficiency as determined by shortened closed phase on stroboscopy. Exclusion criteria included lack of cough complaints, diagnosis of vocal fold immobility, previous history of vocal fold augmentation, and incomplete data sets. Data collected included age, gender, pre‐ and 1‐month postinjection Cough Severity Index (CSI) scores, location of injection (unilateral or bilateral), and patient statement of percent change in symptoms that was recorded at 1‐month postinjection visit.ResultsPaired t test indicated a significant decrease in CSI scores from pre‐ (m = 18.5) to 1‐month postinjection (m = 12.1) (P = 0.004). Eighteen patients (78.2%) reported a 50% or greater improvement in cough symptoms at the 1‐month postinjection visit.ConclusionInjection augmentation of the vocal folds in the presence of glottic insufficiency appears to improve cough symptoms, as was reported by CSI in patients who are refractory to other medical and behavioral treatments.Level of Evidence4. Laryngoscope, 128:1316–1319, 2018
Long‐term results of Amatsu tracheoesophageal shunt: Follow‐up of more than 5 years
Authors: Matsui Hidetoshi , Iwae Shigemichi , Hirayama Yuji , Yonezawa Koichiro , Shigeji Jun 
Published: October 2017

Background/ObjectiveThe Amatsu tracheoesophageal shunt (ATES) represents a nonprosthesis surgical option for voice restoration in laryngectomized patients. However, data regarding the long‐term efficacy of ATES are lacking.Study DesignRetrospective, single‐institution study.MethodsBetween 2001 and 2010, 16 patients with laryngeal cancer underwent total laryngectomy with ATES at the Hyogo Cancer Center (Akashi, Hyogo, Japan). Of these, 11 achieved long‐term tracheoesophageal speech that was maintained for a follow‐up exceeding 5 years (range 75–161 months; median 95 months). All patients were male and ranged from 46 to 74 years of age at the time of ATES surgery.ResultsOf 11 eligible patients, eight were able to speak intelligibly with ATES at last follow‐up. Regarding aspiration, three patients experienced no leakage, and six experienced mild leakage of saliva without medical intervention at last follow‐up. Almost all patients maintained an unchanged degree of voice quality (9 of 11) and leakage (8 of 11).ConclusionThe favorable voice restoration and low aspiration rates achieved in this study appear to support the long‐term efficacy of ATES.Level of Evidence4.Laryngoscope, 128:1395–1397, 2018