Journal of Otolaryngology - Head & Neck Surgery最新文献

ImportanceIn different types of carcinoma, sex has a strong impact on risk factors, diagnosis, treatment, and outcomes. Previous studies have reported that female patients with head and neck carcinoma (HNC) have better survival.ObjectiveThis study aimed to analyze sex differences in tumor regression and survival, as well as host- and disease-related factors.DesignA retrospective cohort study.SettingTertiary Care, University Hospital.Participants1115 patients registered in the Head and Neck Tumor Registry of the Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Innsbruck were included.Main Outcome MeasuresSeveral host- and disease-related factors were analyzed to determine possible sex differences.ResultsThis study included 1115 patients with HNC, of whom 78.6% (n = 876) were men and 21.4% (n = 239) were women. There were no differences in tumor regression or incident cases per year in our department between male and female patients with HNC. Statistically significant sex differences were found for tumor site (P < .001), Union for International Cancer Control (UICC) stage (P = .04), treatment modality (P = .027), alcohol consumption (P = .005), and alcohol cessation (P < .001).Conclusions and RelevanceThis study revealed significant sex differences in patients with HNC. Female patients with HNC were characterized by a higher percentage of oral carcinoma, lower UICC tumor stage, single treatment modality, and less alcohol consumption than men.

ObjectiveTo study whether the ability to detect frequency changes or temporal gaps at the early phase postactivation can predict speech perception performance at the late phase postactivation in postlingually deafened cochlear implant (CI) users.MethodPsychophysical tests and event-related potential (ERP) tests were conducted at the third-month postactivation (early phase postactivation, T1) and after 1-year postactivation (late phase postactivation, T2) in 27 postlingually deafened CI users. CI hearing thresholds and speech perception performance were measured at T1 and T2. The frequency change detection threshold (FCDT) and gap detection threshold (GDT) were obtained through psychophysical tests. The evoked threshold, amplitude, and latency of auditory change complex response, evoked by frequency change or temporal gap stimuli, were investigated using ERP tests.ResultsCompared with T1, speech perception performance was significantly better at T2, but there was no significant difference in the psychophysical or ERP test results. Speech perception performance at T2 could be predicted by GDT at T1, but not by FCDT or ERP indicators at T1. Receiver-operating characteristic curve analysis suggested that the GDT at T1 may be moderately accurate in discriminating between good and poor speech perception groups at T2.ConclusionCompared to early phase postactivation, CI users' ability to detect frequency changes or temporal gaps did not change significantly at the late phase postactivation, but speech perception performance improved significantly. The early GDT can predict later speech perception performance of CI users.Level of EvidenceIII.

ImportanceUnlike other head and neck cancers, head and neck soft tissue sarcoma (HN-STS) is staged similarly to sarcomas in the trunk and extremities. The current American Joint Committee on Cancer (AJCC) staging system has limitations that hinder accurate prognosis prediction for HN-STS.ObjectiveWe aimed to develop a novel location-grading-node-metastasis (LGNM) staging system based on the primary tumor location to more accurately stratify prognosis for HN-STS.DesignA retrospective case series from 1990 to 2021.Setting/ParticipantsThis study included 471 patients diagnosed with HN-STS at Sun Yat-sen University Cancer Center between 1990 and 2021.Main outcome measuresIn the primary analysis, we obtained the overall survival (OS) rate. Secondary measures included area under the receiver operating characteristic curve, Harrell's C, Somers' D, Gönen and Heller's K, O'Quigley's ρ2k, Royston's R², the Bayesian information criterion for concordance, and variation in patient outcomes.ResultsThe eighth edition of AJCC T classification for tumor size inadequately conveys prognosis information. In contrast, the primary tumor location and local invasion are prognostic factors for HN-STS and categorized into 4 stages: L1 (low risk: scalp, face, supraclavicular, ear), L2 (intermediate risk: neck, paravertebral, pharynx, tonsil, eye, orbit), L3 (high risk: cavity, lip, palate, buccal mucosa, salivary gland, maxilla, mandible), and L4 (any location with local invasion). The new LGNM staging system effectively distributed patients into stages I to IV, with statistically-significant survival differences among these stages. Five-year OS rates were 96.9% for stage I, 78.4% for stage II, 37.1% for stage III, and 7.1% for stage IV (P < .001). Additionally, the LGNM staging system demonstrated superior predictive ability and concordance compared with the seventh and eighth editions of AJCC staging systems.Conclusions/RelevanceThe LGNM staging system shows better homogeneity and discriminatory power than the AJCC system, improving risk stratification and prognosis prediction in HN-STS.

Importance: Perineural invasion (PNI) is an established prognostic factor in oral squamous cell carcinoma (OSCC), but the impact of its subcategories on survival is not fully understood. This study quantifies the number and diameter of PNI foci to assess their prognostic relevance in OSCC.

Objective: To evaluate the prognostic significance of PNI subcategories, specifically the number and diameter of PNI foci, as predictors of overall survival (OS) and disease-free survival (DFS) in OSCC patients.

Design: Retrospective cohort study, adhering to STROBE guidelines.

Setting: Single-center study at MacKay Memorial Hospital, Taiwan, including patients diagnosed with OSCC from 2005 to 2018.

Participants: Nine hundred twenty-six patients with biopsy-proven OSCC, excluding those with perioperative mortality or incomplete follow-up.

Exposure: Histological evaluation of PNI, including quantifying the number and diameter of invaded nerves, along with clinicopathological features such as tumor stage and lymphovascular invasion (LVI).

Main outcome measures: OS and DFS, assessed via Cox proportional hazards models, Kaplan-Meier survival analysis, and receiver operating characteristic curve analysis for PNI foci subcategories.

Results: PNI was present in 138 (14.9%) patients and was significantly associated with adverse histologic features, advanced tumor stage, nodal involvement, metastasis, and LVI. Multivariate analysis revealed that both the number of PNI foci greater than 4 and nerve diameters exceeding 0.21 mm were significantly associated with poorer OS and DFS (P < .05). After adjusting for clinical variables, PNI remained an independent predictor of worse OS [hazard ratio (HR): 1.37] and DFS (HR: 1.46).

Conclusions and relevance: PNI is a significant independent prognostic factor in OSCC. Patients with more than 4 PNI foci or nerve involvement greater than 0.21 mm in diameter experienced significantly worse survival outcomes. These findings suggest that detailed assessment of PNI subcategories should be incorporated into OSCC management, guiding treatment decisions and potentially informing the need for adjuvant therapies.

Objective: Surgical training programs have a high prevalence of trainee stress and burnout. Formal mentorship programs (FMP) have been shown to alleviate these factors and improve quality of life (QOL) in short-term follow-up. This study aims to determine the long-term effects of an FMP on the well-being of a single-center cohort of surgical trainees.

Methods: A voluntary FMP was established at a surgical training program comprised 8 resident physicians. To quantitatively measure stress and burnout, the Perceived Stress Survey (PSS) and Maslach Burnout Inventory (MBI) were administered at baseline, 3, 6, 9, 12, 18, and 24 months. The World Health Quality of Life-Bref Questionnaire (WH-QOL) was administered at baseline, 12 and 24 months.

Results: Baseline levels of stress and burnout were high among all residents with an average PSS of 18.5 and MBI of 47.6, 50.6, and 16.5 for the emotional, depersonalization, and personal achievement domains respectively. After FMP implementation, PSS was reduced to 7.9 at 12 months (P = .001). These scores were sustained at 24 months (6.8, P = 1). MBI scores improved in emotional exhaustion (14.9, P < .0001), depersonalization (20.1, P < .0001), and personal achievement (40.1, P < .0001) at 12 months. All these benefits were sustained at 24 months. Baseline overall WH-QOL scores reflected low QOL (71.9). These significantly improved at 12 months (37.5, P = .002) with further improvement by 24 months (17.2, P = .03).

Conclusion: Long-term follow-up of a previously successful academic surgical FMP showed lasting improvements in stress, burnout, and overall QOL, despite new life challenges.

ImportanceLong wait times for medical care have been exacerbated following the pandemic in many health systems. Single-entry models (SEMs) have been proposed as a strategy to manage growing surgical backlogs and increase timeliness and quality of care by creating a single queue and centralizing the referral triage process.ObjectiveThe primary objective was to evaluate the perceptions of SEMs among community otolaryngologists for managing surgical backlogs. The secondary objectives were to better understand their experiences with the current system and to investigate their recommendations for implementing an SEM.DesignInterpretive Description.SettingOntario, Canada.ParticipantsNine community-based otolaryngologists.Intervention/ExposuresNot available.MethodsVirtual semi-structured interviews were conducted with study participants. Data were independently analyzed using inductive and deductive methods by multiple team members. Results were triangulated, and a final coding framework was developed collaboratively from which themes were identified.Main Outcome MeasuresPerceptions of SEMs as well as recommendations for design and implementation.ResultsThree thematic domains and 9 subdomains were identified from our interview data: (1) factors affecting the utility of SEMs; (2) opinions and buy-in of physicians; and (3) opportunities to improve equity.Conclusions and RelevanceWe identified a number of factors that should be considered in supporting community-based otolaryngologists to adopt SEMs as a strategy for ensuring timely and equitable access to care. Clinical leaders and specialty organizations play a pivotal role for such changes to succeed. Implementing SEMs may be an important step toward increasing equity, quality, efficiency, and cost-effectiveness in otolaryngology.

ImportanceTinnitus is a prevalent condition among noise-exposed workers, with significant implications for hearing health and quality of life. Identifying associated factors can inform prevention and management strategies.ObjectivesTo identify factors associated with tinnitus prevalence among noise-exposed workers and assess the effectiveness of hearing protection in mitigating tinnitus.DesignCross-sectional study.SettingData from the National Health and Nutrition Examination Surveys database.ParticipantsThis study included 4931 noise-exposed workers (mean age 48.9 ± 0.3 years). Participants were categorized into speech-frequency hearing loss (SFHL; n = 1032, mean age 67.2 ± 0.4 years) and high-frequency hearing loss (HFHL; n = 1634, mean age 62.9 ± 0.3 years) groups based on hearing threshold levels.Intervention or ExposuresNoise exposure duration, hearing loss severity, demographics, and medical history. Hearing protection usage was assessed for its effectiveness in preventing tinnitus.Main Outcome MeasuresPrimary outcome: tinnitus prevalence. Associations were analyzed using logistic regression, with factors including self-reported noise exposure, hearing loss severity, demographics, and medical history.ResultTinnitus prevalence was 32.85% in the group with SFHL and 29.99% in the group with HFHL. Prolonged noise exposure and greater hearing loss severity were associated with tinnitus in both groups. Hearing protection usage was potentially linked to a lower tinnitus prevalence in HFHL but not in SFHL. For SFHL, univariate analysis showed lower tinnitus prevalence in older age and females, while Caucasian ethnicity and higher income were associated with higher prevalence. Multivariate analysis indicated that older age was positively associated with tinnitus (P < .05). In HFHL, factors such as higher BMI, higher educational level, and elevated Patient Health Questionnaire-9 (PHQ9) scores were significantly associated with tinnitus prevalence.ConclusionsProlonged noise exposure and hearing loss severity among noise-exposed workers were associated with tinnitus prevalence in SFHL and HFHL. Hearing protection showed tendency to reduce tinnitus prevalence in HFHL but had a limited effect in SFHL. Higher BMI, higher education levels, and elevated PHQ9 scores were significantly associated with tinnitus in HFHL, warranting further research into protective strategies.RelevanceFuture studies should explore alternative protective strategies for SFHL patients and refine tinnitus prevention approaches in noise-exposed workers.

ImportanceOral cavity squamous cell carcinoma (OCSCC) is rare in patients ≤40 years, and their risk factors, presentation, and outcomes may differ from older patients.ObjectiveTo assess the epidemiology, risk factors, and oncologic outcomes of young patients (≤40 years) with OCSCC compared to those >40 years.DesignA multi-institutional retrospective cohort study.SettingNine Canadian institutions from 2005 to 2019.ParticipantsIn total, 4506 adults with OCSCC, of whom 205 (4.55%) were young and 4301 were older than 40.Interventions or ExposuresThe primary outcomes were overall survival (OS) and disease-free survival (DFS), comparing young and older patients. The identification of risk factors for OCSCC development in young patients was a secondary outcome.Main Outcome MeasuresOS, DFS, and risk factor identification.ResultsOral tongue cancer was the most common subsite (48.9%), with a significantly higher proportion of cases in young patients (73.4% vs 47.7%, P < .01). Young patients were more likely to present at an earlier clinical stage (T1: 44% young vs 31% old, P < .01) and were less likely to smoke (57% young vs 31% old, P < .01) or consume alcohol (72% young vs 58% old, P < .01). Multivariable analysis showed that smoking status, previous head and neck cancer, and advanced stage were significantly associated with decreased OS and DFS (P < .05). No significant differences were found in local (P = .61), regional (P = .67), or distant (P = .50) disease failure between age groups.Conclusions and RelevanceYoung patients with OCSCC were less likely to smoke or drink and presented at earlier stages, but they did not experience improved OS or DFS compared to older patients. These findings emphasize the need for further research into biological differences in OCSCC between young and older patients.

ImportanceChildhood recurrent anterior epistaxis (RAE) commonly coexists with allergic rhinitis (AR), causing significant symptoms and distress to patients; however, treatment remains controversial.ObjectiveTo compare the clinical outcomes of pediatric patients with RAE and AR treated intraoperatively with silver nitrate cauterization (SNC) or radiofrequency coagulation (RFC).Study DesignProspective, randomized controlled study.SettingTertiary referral center.ParticipantsPediatric patients presenting with RAE and AR.Exposure or InterventionPatients received SNC or RFC in a double-blind, prospective cohort study.Main Outcome MeasuresThe Epistaxis Severity Score (ESS) and Visual Analog Scale (VAS) scores for AR-related symptoms were recorded at baseline, 4thweek, 3rd month, and 12th month.ResultsThe rebleeding rate in the SNC group was 18.0% at the 4th week, 46.0% at the 3rdmonth, and 58.0% at the 12th month, whereas the RFC group demonstrated rates of 2.0%, 0%, and 0%, respectively (P < .05). At each follow-up time point, the mean ESS was significantly lower in the RFC group than in the SNC group. In addition, mean VAS scores for nasal crusting and impact on daily life (IDL) were significantly lower in the RFC group at all postoperative time points. Moreover, the RFC group exhibited significantly-lower mean VAS scores for runny nose and itchy nose at the 3rd and 12th month postoperatively. Similarly, the mean VAS score for nasal obstruction was significantly lower in the RFC group at the 12th month postoperatively. No cases of septal necrosis or perforation were observed in the SNC group. However, septal perforation occurred in 1 patient among the 4 who underwent RFC using the ablation mode.Conclusion/RelevanceThe thermocoagulation mode of RFC is a safe and effective treatment modality for bilateral RAE in pediatric patients. It significantly improves epistaxis and alleviates associated nasal symptoms. Furthermore, compared with patients treated with SNC, those receiving RFC exhibited a significantly-prolonged nosebleed-free period and a reduced likelihood of recurrent epistaxis within 1 year of treatment.