Oxidative stress damages cochlear hair cells in vitro. However, the effect of systemic inflammation on hearing loss remains unclear. Growing evidence suggests that malnutrition influences the development of hearing loss. In this study, we aimed to investigate the influence of the Glasgow prognostic score (GPS), which is calculated based on systemic inflammatory responses and malnutrition, on auditory threshold increases in patients with cancer.
Methods
This single-center retrospective cohort study included patients with cancer who underwent standard pure-tone audiometry (PTA) between November 2014 and May 2023. Patients with complete data in their electronic medical records within 90 days before undergoing standard PTA were included. Multivariate analysis was performed using auditory threshold as the response variable. Covariates, including GPS, were obtained from blood data and physical data before standard PTA. The GPS was classified into three levels based on serum albumin and C-reactive protein levels.
Results
Standard PTA was performed 14,868 times in 5,462 patients. Of these, 742 had cancer and 384 met the inclusion criteria. Multivariate analysis revealed that older age, creatinine clearance <60 mL/min, and high GPS significantly increased the auditory threshold at frequencies of 500–8,000 Hz. A history of platinum drug use and male sex increased the auditory threshold at frequencies >4,000 and >2,000 Hz, respectively.
Conclusion
The GPS was independently associated with elevated standard PTA thresholds in patients with cancer. These results suggest an association between malnutrition/chronic inflammation and hearing loss and provide new information for planning clinical research on hearing loss prevention.
{"title":"Relationship between hearing loss and Glasgow prognostic score in patients with cancer","authors":"Shin Matsumoto , Yuki Hirose , Ryota Ishii , Masahiro Nakayama , Kazuki Takahashi , Kento Sasaki , Keitaro Fujii , Keiji Tabuchi","doi":"10.1016/j.anl.2024.10.009","DOIUrl":"10.1016/j.anl.2024.10.009","url":null,"abstract":"<div><h3>Objective</h3><div>Oxidative stress damages cochlear hair cells <em>in vitro</em>. However, the effect of systemic inflammation on hearing loss remains unclear. Growing evidence suggests that malnutrition influences the development of hearing loss. In this study, we aimed to investigate the influence of the Glasgow prognostic score (GPS), which is calculated based on systemic inflammatory responses and malnutrition, on auditory threshold increases in patients with cancer.</div></div><div><h3>Methods</h3><div>This single-center retrospective cohort study included patients with cancer who underwent standard pure-tone audiometry (PTA) between November 2014 and May 2023. Patients with complete data in their electronic medical records within 90 days before undergoing standard PTA were included. Multivariate analysis was performed using auditory threshold as the response variable. Covariates, including GPS, were obtained from blood data and physical data before standard PTA. The GPS was classified into three levels based on serum albumin and C-reactive protein levels.</div></div><div><h3>Results</h3><div>Standard PTA was performed 14,868 times in 5,462 patients. Of these, 742 had cancer and 384 met the inclusion criteria. Multivariate analysis revealed that older age, creatinine clearance <60 mL/min, and high GPS significantly increased the auditory threshold at frequencies of 500–8,000 Hz. A history of platinum drug use and male sex increased the auditory threshold at frequencies >4,000 and >2,000 Hz, respectively.</div></div><div><h3>Conclusion</h3><div>The GPS was independently associated with elevated standard PTA thresholds in patients with cancer. These results suggest an association between malnutrition/chronic inflammation and hearing loss and provide new information for planning clinical research on hearing loss prevention.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 1037-1041"},"PeriodicalIF":1.6,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142530968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-25DOI: 10.1016/j.anl.2024.09.009
Hiroaki Iijima , Akihiro Sakai , Koji Ebisumoto , Mayu Yamauchi , Daisuke Maki , Takanobu Teramura , Kosuke Saito , Aritomo Yamazaki , Toshihide Inagi , Ai Yamamoto , Hiroshi Ashida , Yurina Sato , Shota Sato , Kenji Okami
Objectives
In recent years, there has been a notable increase in syphilis cases in Japan and Western countries. Syphilis, a classic sexually transmitted disease caused by treponemas, presents diagnostic challenges due to its diverse clinical manifestations. This study explores the diagnosis of syphilis in patients treated at our hospital.
Methods
We retrospectively reviewed patients who visited our hospital between April 2015 and March 2024. The review focused on the patients' clinical backgrounds, onset times, symptoms, diagnostic processes, and clinical courses.
Results
Our hospital had 45 cases of syphilis. Forty-five cases of syphilis were diagnosed as syphilis in our hospital (13 cases were diagnosed in the Otolaryngology: ENT department). The median age was 40 years, with a significant male predominance (male-to-female ratio of 34:11). The median duration from the onset of subjective symptoms to syphilis diagnosis was 54 days. The timeframe from the initial clinic visit to diagnosis ranged from 1 to 57 days, with a median of nine days. Notably, 47.5% of the patients reported a history of employment or patronage in the sex industry. 73.3% of patients presented to local clinics with any kind of subjective symptoms, but syphilis was often missed in the differential diagnosis. Patients visiting the ENT department were referred to our hospital with a diagnosis of persistent oral ulcer, oropharyngeal carcinoma and neck lymphadenopathy. Histological and cytological evaluation was performed in 33% of patients, but the diagnosis was often difficult to make. Additionally, some patients initially denied using sex services at their first visit but later disclosed this during subsequent visits to the Department of Infectious Diseases, highlighting the critical role of thorough medical history assessments.
Conclusion
Diagnosing syphilis can be challenging unless the physician specifically suspects it. It is crucial to consider syphilis in cases of pharyngeal mucosal inflammation and neck lymphadenopathy. This study highlights the need for heightened awareness and education regarding the signs and symptoms of syphilis, particularly oropharyngeal and skin findings, to ensure timely diagnosis and treatment.
{"title":"A retrospective analysis of syphilis cases with a focus on otolaryngology at a university hospital","authors":"Hiroaki Iijima , Akihiro Sakai , Koji Ebisumoto , Mayu Yamauchi , Daisuke Maki , Takanobu Teramura , Kosuke Saito , Aritomo Yamazaki , Toshihide Inagi , Ai Yamamoto , Hiroshi Ashida , Yurina Sato , Shota Sato , Kenji Okami","doi":"10.1016/j.anl.2024.09.009","DOIUrl":"10.1016/j.anl.2024.09.009","url":null,"abstract":"<div><h3>Objectives</h3><div>In recent years, there has been a notable increase in syphilis cases in Japan and Western countries. Syphilis, a classic sexually transmitted disease caused by treponemas, presents diagnostic challenges due to its diverse clinical manifestations. This study explores the diagnosis of syphilis in patients treated at our hospital.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients who visited our hospital between April 2015 and March 2024. The review focused on the patients' clinical backgrounds, onset times, symptoms, diagnostic processes, and clinical courses.</div></div><div><h3>Results</h3><div>Our hospital had 45 cases of syphilis. Forty-five cases of syphilis were diagnosed as syphilis in our hospital (13 cases were diagnosed in the Otolaryngology: ENT department). The median age was 40 years, with a significant male predominance (male-to-female ratio of 34:11). The median duration from the onset of subjective symptoms to syphilis diagnosis was 54 days. The timeframe from the initial clinic visit to diagnosis ranged from 1 to 57 days, with a median of nine days. Notably, 47.5% of the patients reported a history of employment or patronage in the sex industry. 73.3% of patients presented to local clinics with any kind of subjective symptoms, but syphilis was often missed in the differential diagnosis. Patients visiting the ENT department were referred to our hospital with a diagnosis of persistent oral ulcer, oropharyngeal carcinoma and neck lymphadenopathy. Histological and cytological evaluation was performed in 33% of patients, but the diagnosis was often difficult to make. Additionally, some patients initially denied using sex services at their first visit but later disclosed this during subsequent visits to the Department of Infectious Diseases, highlighting the critical role of thorough medical history assessments.</div></div><div><h3>Conclusion</h3><div>Diagnosing syphilis can be challenging unless the physician specifically suspects it. It is crucial to consider syphilis in cases of pharyngeal mucosal inflammation and neck lymphadenopathy. This study highlights the need for heightened awareness and education regarding the signs and symptoms of syphilis, particularly oropharyngeal and skin findings, to ensure timely diagnosis and treatment.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 1016-1024"},"PeriodicalIF":1.6,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
NF2-related schwannomatosis (NF2) is characterized by bilateral vestibular schwannomas (VS), often causing severe damage to the bilateral auditory function. Auditory brainstem implantation (ABI) provides hearing-impaired patients with an opportunity to reacquire auditory sensation through electrical stimulation of auditory neurons in the cochlear nucleus. However, ABI is not covered by public health insurance in Japan, leading to a large difference in financial burden compared to cochlear implantation (CI). The aim of the present study was to demonstrate the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS.
Methods
To investigate the current situation of ABI and CI for hearing reconstruction in VS patients, we conducted a questionnaire survey of 102 facilities in Japan. Based on the responses to the questionnaire, a multicenter research group consisting of otolaryngologists and neurosurgeons was established. We collected detailed data on patients with VS who underwent ABI (n = 7, all NF2) and CI (n = 14 [nine NF2, and five non-NF2]).
Results
Some sense of hearing was obtained in all patients but one with CI indicating the efficacy of CI and ABI for profound hearing loss caused by VS. The mean hearing levels were 45.4 dB HL in the ABI patients and 32.7 dB HL in the CI patients, indicating that CI was effective as an alternative to ABI.
Conclusion
The results of the present study suggest the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS.
Level of evidence
4.
目的：NF2相关分裂瘤病（NF2）的特征是双侧前庭分裂瘤（VS），通常会对双侧听觉功能造成严重损害。听觉脑干植入术（ABI）通过对耳蜗核中的听觉神经元进行电刺激，为听力受损患者提供了重新获得听觉感觉的机会。然而，在日本，ABI 不在公共医疗保险范围内，因此与人工耳蜗植入术（CI）相比，ABI 的经济负担差异很大。本研究的目的是证明人工耳蜗植入术作为人工耳蜗植入术的替代方案，对因 VS 引起的深度听力损失患者重新获得听力的有效性：方法：为了调查 ABI 和 CI 用于 VS 患者听力重建的现状，我们对日本的 102 家机构进行了问卷调查。根据问卷调查结果，我们成立了一个由耳鼻喉科医生和神经外科医生组成的多中心研究小组。我们收集了接受 ABI（7 人，均为 NF2）和 CI（14 人，其中 9 人为 NF2，5 人为非 NF2）治疗的 VS 患者的详细数据：结果：除一名接受 CI 的患者外，所有患者都获得了一定的听力，这表明 CI 和 ABI 对 VS 引起的深度听力损失具有疗效。ABI患者的平均听力水平为45.4 dB HL，CI患者的平均听力水平为32.7 dB HL，这表明CI可有效替代ABI：本研究结果表明，CI 可有效替代 ABI，帮助 VS 引起的深度听力损失患者重新获得听力：4:
{"title":"Effectiveness of CI as an alternative to ABI for hearing loss in patients with vestibular schwannomas: A multicenter study in Japan","authors":"Mitsuyoshi Imaizumi , Hidehiko Takeda , Shujiro Minami , Naoki Oishi , Daisuke Yamauchi , Shigeyuki Murono , Hirofumi Nakatomi , Kiyoshi Saito , Akio Morita , Masazumi Fujii","doi":"10.1016/j.anl.2024.10.010","DOIUrl":"10.1016/j.anl.2024.10.010","url":null,"abstract":"<div><h3>Objective</h3><div>NF2-related schwannomatosis (NF2) is characterized by bilateral vestibular schwannomas (VS), often causing severe damage to the bilateral auditory function. Auditory brainstem implantation (ABI) provides hearing-impaired patients with an opportunity to reacquire auditory sensation through electrical stimulation of auditory neurons in the cochlear nucleus. However, ABI is not covered by public health insurance in Japan, leading to a large difference in financial burden compared to cochlear implantation (CI). The aim of the present study was to demonstrate the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS.</div></div><div><h3>Methods</h3><div>To investigate the current situation of ABI and CI for hearing reconstruction in VS patients, we conducted a questionnaire survey of 102 facilities in Japan. Based on the responses to the questionnaire, a multicenter research group consisting of otolaryngologists and neurosurgeons was established. We collected detailed data on patients with VS who underwent ABI (<em>n</em> = 7, all NF2) and CI (<em>n</em> = 14 [nine NF2, and five non-NF2]).</div></div><div><h3>Results</h3><div>Some sense of hearing was obtained in all patients but one with CI indicating the efficacy of CI and ABI for profound hearing loss caused by VS. The mean hearing levels were 45.4 dB HL in the ABI patients and 32.7 dB HL in the CI patients, indicating that CI was effective as an alternative to ABI.</div></div><div><h3>Conclusion</h3><div>The results of the present study suggest the effectiveness of CI as an alternative to ABI for hearing reacquisition in patients with profound hearing loss caused by VS.</div></div><div><h3>Level of evidence</h3><div>4.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 1009-1015"},"PeriodicalIF":1.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-23DOI: 10.1016/j.anl.2024.10.002
Mayu Yamauchi, Akihiro Sakai, Koji Ebisumoto, Hiroaki Iijima, Takanobu Teramura, Aritomo Yamazaki, Ryoko Yanagiya, Ai Yamamoto, Yoshiyuki Ota, Hiroshi Ashida, Naoya Kobayashi, Kenji Okami
Anaplastic thyroid cancer (ATC) is an aggressive malignancy with a poor prognosis and limited treatment options. Herein, we report two cases of unresectable ATC treated with a combination of BRAF and MEK inhibitors. The patients were initially treated with other therapies but were switched to BRAF and MEK inhibitors after testing positive for BRAF mutations. This resulted in a partial response, tumor shrinkage, and conversion to resectability in one case. The patient experienced manageable adverse events. BRAF mutations are common in thyroid cancers, and studies have demonstrated the efficacy of combining BRAF and MEK inhibitors for treating advanced or recurrent differentiated thyroid cancer or ATC with BRAF mutations. These cases emphasize the importance of BRAF gene testing at the initial diagnosis and the potential of BRAF and MEK inhibitors as treatment options for unresectable ATC with BRAF mutations. The oral administration and manageable adverse event profiles of these medications make them suitable for outpatient treatment. In conclusion, BRAF gene testing should be performed at the initial diagnosis, and the use of BRAF and MEK inhibitors should be considered in patients with ATC.
{"title":"Combination therapy with BRAF and MEK inhibitors for anaplastic thyroid cancer: A report of two cases","authors":"Mayu Yamauchi, Akihiro Sakai, Koji Ebisumoto, Hiroaki Iijima, Takanobu Teramura, Aritomo Yamazaki, Ryoko Yanagiya, Ai Yamamoto, Yoshiyuki Ota, Hiroshi Ashida, Naoya Kobayashi, Kenji Okami","doi":"10.1016/j.anl.2024.10.002","DOIUrl":"10.1016/j.anl.2024.10.002","url":null,"abstract":"<div><div>Anaplastic thyroid cancer (ATC) is an aggressive malignancy with a poor prognosis and limited treatment options. Herein, we report two cases of unresectable ATC treated with a combination of BRAF and MEK inhibitors. The patients were initially treated with other therapies but were switched to BRAF and MEK inhibitors after testing positive for <em>BRAF</em> mutations. This resulted in a partial response, tumor shrinkage, and conversion to resectability in one case. The patient experienced manageable adverse events. <em>BRAF</em> mutations are common in thyroid cancers, and studies have demonstrated the efficacy of combining BRAF and MEK inhibitors for treating advanced or recurrent differentiated thyroid cancer or ATC with <em>BRAF</em> mutations. These cases emphasize the importance of <em>BRAF</em> gene testing at the initial diagnosis and the potential of BRAF and MEK inhibitors as treatment options for unresectable ATC with <em>BRAF</em> mutations. The oral administration and manageable adverse event profiles of these medications make them suitable for outpatient treatment. In conclusion, <em>BRAF</em> gene testing should be performed at the initial diagnosis, and the use of BRAF and MEK inhibitors should be considered in patients with ATC.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 1003-1008"},"PeriodicalIF":1.6,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reports of endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus are limited. Herein, we present a comprehensive account of the results obtained from performing endoscopic surgery based on the concept of en bloc resection.
Methods
This was a retrospective observational study of patients who underwent nasal endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus at a hospital between July 2018 and December 2021. Primary endpoints were overall survival, relapse-free survival, and local recurrence-free survival. Data on tumor stage, tumor site of origin, postoperative treatment, and papilloma-related status were reviewed. Statistical analyses included the Kaplan–Meier method, Cox regression analysis, and Fisher's exact test.
Results
Twenty-two patients with a median age of 62 (range 27–84) years, comprising 15 male and 7 female, were included in this study, and the median duration of observation was 2.1 (range 0.6–4.3) years. The 2-year overall survival, relapse-free survival, and recurrence-free survival rates were 91.0%, 69.9%, and 79.0%, respectively. Cancer of the nasal cavity was significantly superior to that of the ethmoid sinus in terms of local recurrence-free survival (p = 0.03). The patients who underwent postoperative treatment had significantly worse recurrence-free survival rates than those who did not receive postoperative treatment (p = 0.03).
Conclusions
This study examined the results of the endoscopic treatment for squamous cell carcinoma of the nasal cavity and ethmoid sinus with the concept of en bloc resection. Patients with ethmoid sinus carcinoma had a greater risk for local recurrence, and the prognosis for patients requiring postoperative treatment was poor.
{"title":"Endoscopic surgery for squamous cell carcinoma in the nasal cavity and ethmoid sinus: A retrospective observational study","authors":"Yukio Nishiya , Teru Ebihara , Kazuhiro Omura , Teppei Takeda , Kazuto Matsuura , Nobuyoshi Otori","doi":"10.1016/j.anl.2024.10.006","DOIUrl":"10.1016/j.anl.2024.10.006","url":null,"abstract":"<div><h3>Objective</h3><div>Reports of endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus are limited. Herein, we present a comprehensive account of the results obtained from performing endoscopic surgery based on the concept of en bloc resection.</div></div><div><h3>Methods</h3><div>This was a retrospective observational study of patients who underwent nasal endoscopic surgery for squamous cell carcinoma of the nasal cavity and ethmoid sinus at a hospital between July 2018 and December 2021. Primary endpoints were overall survival, relapse-free survival, and local recurrence-free survival. Data on tumor stage, tumor site of origin, postoperative treatment, and papilloma-related status were reviewed. Statistical analyses included the Kaplan–Meier method, Cox regression analysis, and Fisher's exact test.</div></div><div><h3>Results</h3><div>Twenty-two patients with a median age of 62 (range 27–84) years, comprising 15 male and 7 female, were included in this study, and the median duration of observation was 2.1 (range 0.6–4.3) years. The 2-year overall survival, relapse-free survival, and recurrence-free survival rates were 91.0%, 69.9%, and 79.0%, respectively. Cancer of the nasal cavity was significantly superior to that of the ethmoid sinus in terms of local recurrence-free survival (<em>p</em> = 0.03). The patients who underwent postoperative treatment had significantly worse recurrence-free survival rates than those who did not receive postoperative treatment (<em>p</em> = 0.03).</div></div><div><h3>Conclusions</h3><div>This study examined the results of the endoscopic treatment for squamous cell carcinoma of the nasal cavity and ethmoid sinus with the concept of en bloc resection. Patients with ethmoid sinus carcinoma had a greater risk for local recurrence, and the prognosis for patients requiring postoperative treatment was poor.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 996-1002"},"PeriodicalIF":1.6,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-18DOI: 10.1016/j.anl.2024.10.007
Seraphina Key , Clemente Chia , Marcus Del Rio , Debra Phyland , Charles Giddings
Objectives
Tracheostomy in the setting of head and neck cancer may be performed either electively for prophylactic airway protection in an ablative procedure, or as an emergency due to impending airway obstruction in the setting of an obstructing upper aerodigestive tract malignancy. Tracheostomy care has biopsychosocial implications, which may require a higher level of care from carers, post-acute care, or placement into care facilities. Existing database studies have largely excluded patients with a history of head and neck cancer. This study aims to examine and compare discharge destinations for head and neck cancer patients requiring either elective or emergency surgical tracheostomies.
Methods
Retrospective cohort study (January 2010-December 2019) of adult head and neck cancer patients undergoing surgical tracheostomy in a tertiary Australian hospital network. Primary outcome was discharge destination. Secondary outcomes were mortality, morbidity, and decannulation timing.
Results
Of 188 patients (47 emergency, 141 elective), 83.0 % returned to their pre-morbid accommodation, either directly home (54.6 %), or with additional community-based services (27.7 %). There was a significant difference in post-discharge destination (p = 0.012). Emergency patients were less likely to return home compared to elective patients (OR 0.76, 95 % CI 0.32–1.79), and more likely to require additional supports on discharge(67.6 %) compared to elective(41.9 %) patients. However, these outcomes did not demonstrate statistical significance. Emergency tracheostomy patients were at higher risk of permanent tracheostomy, unplanned readmission within 30 days, and longer time to successful decannulation.
Conclusion
Emergency tracheostomy patients are likely to return to their pre-morbid place of residence but may require additional support.
{"title":"Discharge destination following elective and emergency surgical tracheostomies in head and neck cancer patients","authors":"Seraphina Key , Clemente Chia , Marcus Del Rio , Debra Phyland , Charles Giddings","doi":"10.1016/j.anl.2024.10.007","DOIUrl":"10.1016/j.anl.2024.10.007","url":null,"abstract":"<div><h3>Objectives</h3><div>Tracheostomy in the setting of head and neck cancer may be performed either electively for prophylactic airway protection in an ablative procedure, or as an emergency due to impending airway obstruction in the setting of an obstructing upper aerodigestive tract malignancy. Tracheostomy care has biopsychosocial implications, which may require a higher level of care from carers, post-acute care, or placement into care facilities. Existing database studies have largely excluded patients with a history of head and neck cancer. This study aims to examine and compare discharge destinations for head and neck cancer patients requiring either elective or emergency surgical tracheostomies.</div></div><div><h3>Methods</h3><div>Retrospective cohort study (January 2010-December 2019) of adult head and neck cancer patients undergoing surgical tracheostomy in a tertiary Australian hospital network. Primary outcome was discharge destination. Secondary outcomes were mortality, morbidity, and decannulation timing.</div></div><div><h3>Results</h3><div>Of 188 patients (47 emergency, 141 elective), 83.0 % returned to their pre-morbid accommodation, either directly home (54.6 %), or with additional community-based services (27.7 %). There was a significant difference in post-discharge destination (<em>p</em> = 0.012). Emergency patients were less likely to return home compared to elective patients (OR 0.76, 95 % CI 0.32–1.79), and more likely to require additional supports on discharge(67.6 %) compared to elective(41.9 %) patients. However, these outcomes did not demonstrate statistical significance. Emergency tracheostomy patients were at higher risk of permanent tracheostomy, unplanned readmission within 30 days, and longer time to successful decannulation.</div></div><div><h3>Conclusion</h3><div>Emergency tracheostomy patients are likely to return to their pre-morbid place of residence but may require additional support.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 990-995"},"PeriodicalIF":1.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-16DOI: 10.1016/j.anl.2024.09.006
Hanju Lee , Hyoung Woo Chang , Jeong-Yeon Ji , Jae Hang Lee , Kay-Hyun Park , Woo-Jin Jeong , Wonjae Cha
Objective
Unilateral vocal fold paralysis (UVFP) following open thoracic aortic surgery increases pulmonary complications and hospital stays. An intervention protocol with early injection laryngoplasty (IL) and swallowing maneuvers was developed for acute UVFP following thoracic aortic surgery. This study aimed to compare the incidence of complications and length of medical care between the non-VFP and the IL-UVFP group managed under this protocol.
Methods
Patients who underwent open thoracic aortic surgery from March 2020 to February 2023 were included, excluding those with preoperative VFP or postoperative bilateral VFP. Under the protocol, patients with UVFP and incomplete glottic closure received IL and swallowing maneuvers within one week after diagnosis, while those without a glottic gap started a soft diet along with swallowing maneuvers. Postoperative complications, including reintubation, ICU re-transfer, pneumonia, stroke, delirium, wound infection, and bleeding, as well as hospital and ICU stay, were assessed.
Results
Of the 355 patients included in the study, 51 (14.4%) developed postoperative UVFP, while 304 (85.6%) had normal VF function. In the UVFP group, 42 patients underwent IL, while 9 patients without a glottic gap did not undergo IL. The incidence of complications and length of medical care were analyzed in the non-VFP and the IL-UVFP groups. The IL-UVFP group had a longer median hospital stay compared to the non-VFP group (20.5 vs. 16.0 days), though this difference was not statistically significant (P = .0681). ICU stay (P = .5396) and ICU re-transfer rates (P = 1.00) were also comparable between the groups. There was no significant difference in the incidence of pneumonia between the IL-UVFP group (4.8%) and the non-VFP group (9.5%) (P = .4003). Additionally, no significant differences were observed in the incidence of stroke, delirium, wound infection, or bleeding between the groups. No IL-related complications were reported.
Conclusions
The protocol with early IL appears to help reduce complication rates in acute UVFP patients following thoracic aortic surgery to levels comparable to those in patients without VFP. This protocol could serve as a guideline for otolaryngologists in managing UVFP patients.
{"title":"Early injection laryngoplasty for acute unilateral vocal fold paralysis after thoracic aortic surgery","authors":"Hanju Lee , Hyoung Woo Chang , Jeong-Yeon Ji , Jae Hang Lee , Kay-Hyun Park , Woo-Jin Jeong , Wonjae Cha","doi":"10.1016/j.anl.2024.09.006","DOIUrl":"10.1016/j.anl.2024.09.006","url":null,"abstract":"<div><h3>Objective</h3><div>Unilateral vocal fold paralysis (UVFP) following open thoracic aortic surgery increases pulmonary complications and hospital stays. An intervention protocol with early injection laryngoplasty (IL) and swallowing maneuvers was developed for acute UVFP following thoracic aortic surgery. This study aimed to compare the incidence of complications and length of medical care between the non-VFP and the IL-UVFP group managed under this protocol.</div></div><div><h3>Methods</h3><div>Patients who underwent open thoracic aortic surgery from March 2020 to February 2023 were included, excluding those with preoperative VFP or postoperative bilateral VFP. Under the protocol, patients with UVFP and incomplete glottic closure received IL and swallowing maneuvers within one week after diagnosis, while those without a glottic gap started a soft diet along with swallowing maneuvers. Postoperative complications, including reintubation, ICU re-transfer, pneumonia, stroke, delirium, wound infection, and bleeding, as well as hospital and ICU stay, were assessed.</div></div><div><h3>Results</h3><div>Of the 355 patients included in the study, 51 (14.4%) developed postoperative UVFP, while 304 (85.6%) had normal VF function. In the UVFP group, 42 patients underwent IL, while 9 patients without a glottic gap did not undergo IL. The incidence of complications and length of medical care were analyzed in the non-VFP and the IL-UVFP groups. The IL-UVFP group had a longer median hospital stay compared to the non-VFP group (20.5 vs. 16.0 days), though this difference was not statistically significant (<em>P</em> = .0681). ICU stay (<em>P</em> = .5396) and ICU re-transfer rates (<em>P</em> = 1.00) were also comparable between the groups. There was no significant difference in the incidence of pneumonia between the IL-UVFP group (4.8%) and the non-VFP group (9.5%) (<em>P</em> = .4003). Additionally, no significant differences were observed in the incidence of stroke, delirium, wound infection, or bleeding between the groups. No IL-related complications were reported.</div></div><div><h3>Conclusions</h3><div>The protocol with early IL appears to help reduce complication rates in acute UVFP patients following thoracic aortic surgery to levels comparable to those in patients without VFP. This protocol could serve as a guideline for otolaryngologists in managing UVFP patients.</div></div><div><h3>Level of evidence</h3><div>2b/Individual cohort study.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 984-989"},"PeriodicalIF":1.6,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Febrile neutropenia (FN) is the most serious toxicity in patients with head and neck squamous cell carcinoma (HNSCC) treated with induction chemotherapy (IC). Although it is well-known that sarcopenia is a risk factor for severe toxicity of (chemo)radiotherapy, the data on the association between sarcopenia and FN during IC in HNSCC patients is rare. This study determined the impact of sarcopenia on FN during IC.
Methods
IC-treated patients with HNSCC were enrolled in this study. Skeletal muscle mass (SMM) at the C3 vertebral body was used to define sarcopenia from computed tomography (CT) scans. To determine the predictive effect of low SMM on FN, logistic regression analysis was performed.
Results
In this study, 71 patients were included, of whom 28 had low SMM and 14 experienced FN. In multivariate analysis, low SMM and high CRP were the independent predictive factors for FN. The combination index of sarcopenia and CRP showed a greater odds ratio than sarcopenia alone suggesting a more significant predicting indicator.
Conclusions
Sarcopenia defined by CT imaging is associated with FN in patients with HNSCC treated with IC. The combination of sarcopenia and high CRP is a more significant risk factor, and it helps determine patients at risk of FN during IC.
{"title":"Sarcopenia as a predictive factor for febrile neutropenia during induction chemotherapy in head and neck squamous cell cancer","authors":"Ken Kasahara , Seiji Shigetomi , Yoichiro Sato , Yorihisa Imanishi , Yuichi Ikari , Takanori Nishiyama , Yuki Matsui , Seiichi Shinden , Hiroyuki Ozawa , Takeyuki Kono","doi":"10.1016/j.anl.2024.09.010","DOIUrl":"10.1016/j.anl.2024.09.010","url":null,"abstract":"<div><h3>Objective</h3><div>Febrile neutropenia (FN) is the most serious toxicity in patients with head and neck squamous cell carcinoma (HNSCC) treated with induction chemotherapy (IC). Although it is well-known that sarcopenia is a risk factor for severe toxicity of (chemo)radiotherapy, the data on the association between sarcopenia and FN during IC in HNSCC patients is rare. This study determined the impact of sarcopenia on FN during IC.</div></div><div><h3>Methods</h3><div>IC-treated patients with HNSCC were enrolled in this study. Skeletal muscle mass (SMM) at the C3 vertebral body was used to define sarcopenia from computed tomography (CT) scans. To determine the predictive effect of low SMM on FN, logistic regression analysis was performed.</div></div><div><h3>Results</h3><div>In this study, 71 patients were included, of whom 28 had low SMM and 14 experienced FN. In multivariate analysis, low SMM and high CRP were the independent predictive factors for FN. The combination index of sarcopenia and CRP showed a greater odds ratio than sarcopenia alone suggesting a more significant predicting indicator.</div></div><div><h3>Conclusions</h3><div>Sarcopenia defined by CT imaging is associated with FN in patients with HNSCC treated with IC. The combination of sarcopenia and high CRP is a more significant risk factor, and it helps determine patients at risk of FN during IC.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 971-975"},"PeriodicalIF":1.6,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transoral surgery for early-stage pharyngeal and laryngeal cancer provides good local control and is less invasive than external incisions. Postoperative pathological findings are considered the most important indicators for determining postoperative treatment, but detailed criteria have not been established. In this study, we evaluated the impact of postoperative pathological findings on prognosis of patients undergoing transoral surgery.
Methods
This study included patients with oropharyngeal, hypopharyngeal, and supraglottic cancer who underwent transoral surgery at Gifu University Hospital from April 2016 to December 2023. Resection margins were pathologically evaluated with horizontal and vertical margins, and vascular invasion was evaluated in three categories: lymphatic invasion, venous invasion, and perineural invasion. The correlation between each postoperative pathological finding and prognosis was evaluated.
Results
A total of 70 cases were assessed in this study. Cases of horizontal margin positive were 38.6 %, and cases of vertical margin positive were 27.1 %. Prognoses were comparable to previous reports. Despite the high margin positive rate, the 5-year overall survival rate was 77.1 %. The 5-year disease-specific survival rate was 89.7 %, and the 5-year local control rate was 85.3 %. Notably, when evaluated by margin direction, cases with positive horizontal margins had significantly worse prognoses. Although no significant correlation was found between vascular invasion and prognosis, cases of venous invasion tended to have a higher local recurrence rate.
Conclusion
This study suggests that transoral surgery has good prognosis despite a high positive-margin rate. However, detailed criteria for additional treatment have not been developed, and further case accumulation is required. Intriguingly, positive horizontal margins are correlated with significantly worse prognosis. This result may be related to a high risk of multiple cancers, and careful follow-up after surgery is recommended.
{"title":"Postoperative pathological findings and prognosis of early laryngeal and pharyngeal cancer treated with transoral surgery","authors":"Masashi Kuroki , Hirofumi Shibata , Kazuhiro Kobayashi , Manato Matsubara , Saki Akita , Tatsuhiko Yamada , Rina Kato , Ryota Iinuma , Ryo Kawaura , Hiroshi Okuda , Kenichi Mori , Natsuko Ueda , Tatsuhiko Miyazaki , Takenori Ogawa","doi":"10.1016/j.anl.2024.10.003","DOIUrl":"10.1016/j.anl.2024.10.003","url":null,"abstract":"<div><h3>Objective</h3><div>Transoral surgery for early-stage pharyngeal and laryngeal cancer provides good local control and is less invasive than external incisions. Postoperative pathological findings are considered the most important indicators for determining postoperative treatment, but detailed criteria have not been established. In this study, we evaluated the impact of postoperative pathological findings on prognosis of patients undergoing transoral surgery.</div></div><div><h3>Methods</h3><div>This study included patients with oropharyngeal, hypopharyngeal, and supraglottic cancer who underwent transoral surgery at Gifu University Hospital from April 2016 to December 2023. Resection margins were pathologically evaluated with horizontal and vertical margins, and vascular invasion was evaluated in three categories: lymphatic invasion, venous invasion, and perineural invasion. The correlation between each postoperative pathological finding and prognosis was evaluated.</div></div><div><h3>Results</h3><div>A total of 70 cases were assessed in this study. Cases of horizontal margin positive were 38.6 %, and cases of vertical margin positive were 27.1 %. Prognoses were comparable to previous reports. Despite the high margin positive rate, the 5-year overall survival rate was 77.1 %. The 5-year disease-specific survival rate was 89.7 %, and the 5-year local control rate was 85.3 %. Notably, when evaluated by margin direction, cases with positive horizontal margins had significantly worse prognoses. Although no significant correlation was found between vascular invasion and prognosis, cases of venous invasion tended to have a higher local recurrence rate.</div></div><div><h3>Conclusion</h3><div>This study suggests that transoral surgery has good prognosis despite a high positive-margin rate. However, detailed criteria for additional treatment have not been developed, and further case accumulation is required. Intriguingly, positive horizontal margins are correlated with significantly worse prognosis. This result may be related to a high risk of multiple cancers, and careful follow-up after surgery is recommended.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 976-983"},"PeriodicalIF":1.6,"publicationDate":"2024-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142432354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The aim of this multicenter retrospective study was to analyze the impact of prophylactic neck dissection and adjuvant therapy in transoral surgery for hypopharyngeal cancer.
Methods
We compared the impact of surgical margin assessment, neck dissection, and adjuvant treatment on oncologic outcomes in patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma between 2015 and 2021.
Results
Two hundred and twenty-one patients were included. The 3-year local recurrence-free survival was 89.1 %, and local recurrence did not significantly impact overall survival. Positive vertical margins resulted in 60 % of patients receiving additional treatment, with no increase in local recurrence and a significant increase in regional recurrence (p = 0.007) and distant metastasis (p < 0.001). Half of the patients with regional recurrence after neck dissection also had distant metastases and worse survival (p = 0.069), while those with regional recurrence without prophylactic neck dissection did not have worse survival.
Conclusion
In cases of positive vertical margin, careful surveillance for regional recurrence and distant metastasis is also warranted. Prophylactic neck dissection may not be necessary.
{"title":"A multicenter retrospective study on neck dissection and adjuvant radiotherapy with transoral surgery for hypopharyngeal squamous cell carcinoma","authors":"Koji Ushiro , Yoshiki Watanabe , Yo Kishimoto , Yoshitaka Kawai , Shintaro Fujimura , Ryo Asato , Takashi Tsujimura , Ryusuke Hori , Yohei Kumabe , Kaori Yasuda , Hisanobu Tamaki , Takehiro Iki , Yoshiharu Kitani , Keisuke Kurata , Tsuyoshi Kojima , Kuniaki Takata , Shinpei Kada , Shinji Takebayashi , Shogo Shinohara , Kiyomi Hamaguchi , Koichi Omori","doi":"10.1016/j.anl.2024.10.004","DOIUrl":"10.1016/j.anl.2024.10.004","url":null,"abstract":"<div><h3>Objective</h3><div>The aim of this multicenter retrospective study was to analyze the impact of prophylactic neck dissection and adjuvant therapy in transoral surgery for hypopharyngeal cancer.</div></div><div><h3>Methods</h3><div>We compared the impact of surgical margin assessment, neck dissection, and adjuvant treatment on oncologic outcomes in patients who underwent transoral surgery for hypopharyngeal squamous cell carcinoma between 2015 and 2021.</div></div><div><h3>Results</h3><div>Two hundred and twenty-one patients were included. The 3-year local recurrence-free survival was 89.1 %, and local recurrence did not significantly impact overall survival. Positive vertical margins resulted in 60 % of patients receiving additional treatment, with no increase in local recurrence and a significant increase in regional recurrence (<em>p</em> = 0.007) and distant metastasis (<em>p</em> < 0.001). Half of the patients with regional recurrence after neck dissection also had distant metastases and worse survival (<em>p</em> = 0.069), while those with regional recurrence without prophylactic neck dissection did not have worse survival.</div></div><div><h3>Conclusion</h3><div>In cases of positive vertical margin, careful surveillance for regional recurrence and distant metastasis is also warranted. Prophylactic neck dissection may not be necessary.</div></div>","PeriodicalId":55627,"journal":{"name":"Auris Nasus Larynx","volume":"51 6","pages":"Pages 956-963"},"PeriodicalIF":1.6,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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