The recurrence of head and neck cancer (HNC) is most prevalent during the initial two years following curative treatment, underscoring the criticality of regular surveillance for HNC survivors. This study aims to evaluate the effectiveness of computed tomography (CT) imaging and clinical physical examination (CE) in HNC surveillance, assessing whether these imaging protocols meet the current treatment limitations confronting HNC specialists.
Methods
Retrospective chart review of a 9-year experience with head and neck cancer patients at a single, academic tertiary care center. Demographic data was collected along with data regarding whether the recurrences were detected primarily through CE, flexible endoscopic exam (scope exam), or CT or CT/PET scan. Subsets of the data were analyzed and compared by sensitivity, specificity, and negative predictive values.
Results
264 HNC patients were identified. 72 total recurrences (27 %) were noted. The method of initial detection spurring further investigation was imaging in 42 (58.3 %) patients, CE (33.3 %) in 24 patients, scope exam in 6 (8.4 %) patients. Overall, 65 (90.3 %) patients had imaging that showed recurrence regardless of method of initial detection. Sensitivity, (87.1 % vs 70.5 %), and specificity (93.95 % vs 96.9 %) were noted for CT and CE respectively. Combined sensitivity and specificity for CT and CE was 96.2 % and 91.05 % respectively.
Conclusion
The data suggests that imaging could provide sufficient methods of HNC surveillance despite limitations the COVID-19 pandemic presents.
目的：头颈癌（HNC）的复发多发生在治愈性治疗后的最初两年，这突出了对HNC幸存者进行定期监测的重要性。本研究旨在评估计算机断层扫描（CT）成像和临床体格检查（CE）在HNC监测中的有效性，评估这些成像方案是否符合HNC专家目前面临的治疗限制：方法：对一家学术性三级医疗中心头颈癌患者 9 年的病历进行回顾性分析。收集了人口统计学数据以及复发主要是通过CE、柔性内窥镜检查（镜检）还是CT或CT/PET扫描发现的数据。通过灵敏度、特异性和阴性预测值对数据的子集进行分析和比较。共发现 72 例复发（27%）。最初发现导致进一步检查的方法是：42 名患者（58.3%）采用成像检查，24 名患者（33.3%）采用 CE 检查，6 名患者（8.4%）采用范围检查。总体而言，65 名患者（90.3%）的影像学检查结果显示复发，与最初的检测方法无关。CT 和 CE 的灵敏度（87.1% 对 70.5%）和特异性（93.95% 对 96.9%）分别有所提高。CT 和 CE 的综合敏感性和特异性分别为 96.2 % 和 91.05 %：这些数据表明，尽管 COVID-19 大流行会带来一些限制，但成像仍能提供足够的 HNC 监测方法。
{"title":"Head and neck cancer surveillance: The value of computed tomography and clinical exam","authors":"Soroush Farsi, J. Reed Gardner, Deanne King, Jumin Sunde, Mauricio Moreno, Emre Vural","doi":"10.1016/j.amjoto.2024.104469","DOIUrl":"10.1016/j.amjoto.2024.104469","url":null,"abstract":"<div><h3>Purpose</h3><p>The recurrence of head and neck cancer (HNC) is most prevalent during the initial two years following curative treatment, underscoring the criticality of regular surveillance for HNC survivors. This study aims to evaluate the effectiveness of computed tomography (CT) imaging and clinical physical examination (CE) in HNC surveillance, assessing whether these imaging protocols meet the current treatment limitations confronting HNC specialists.</p></div><div><h3>Methods</h3><p>Retrospective chart review of a 9-year experience with head and neck cancer patients at a single, academic tertiary care center. Demographic data was collected along with data regarding whether the recurrences were detected primarily through CE, flexible endoscopic exam (scope exam), or CT or CT/PET scan. Subsets of the data were analyzed and compared by sensitivity, specificity, and negative predictive values.</p></div><div><h3>Results</h3><p>264 HNC patients were identified. 72 total recurrences (27 %) were noted. The method of initial detection spurring further investigation was imaging in 42 (58.3 %) patients, CE (33.3 %) in 24 patients, scope exam in 6 (8.4 %) patients. Overall, 65 (90.3 %) patients had imaging that showed recurrence regardless of method of initial detection. Sensitivity, (87.1 % vs 70.5 %), and specificity (93.95 % vs 96.9 %) were noted for CT and CE respectively. Combined sensitivity and specificity for CT and CE was 96.2 % and 91.05 % respectively.</p></div><div><h3>Conclusion</h3><p>The data suggests that imaging could provide sufficient methods of HNC surveillance despite limitations the COVID-19 pandemic presents.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104469"},"PeriodicalIF":1.8,"publicationDate":"2024-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896521","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 : 2024-08-03DOI: 10.1016/j.amjoto.2024.104458
Matthew E. Lin , Oluwatobiloba Ayo-Ajibola , Ryan Davis , Tyler J. Gallagher , Carlos X. Castellanos , Jonathan D. West , Margaret Nurimba , Niels C. Kokot , Tamara Chambers
Objective
Understand vaccination knowledge and barriers to vaccination among minority adults.
Study design
Cross-sectional survey.
Setting
Otolaryngology clinics at a safety net hospital and a tertiary academic center and a head and neck cancer screening event.
Methods
Survey was administered to consenting patients. Descriptive statistics and significance testing were used to characterize the data, with non-minority respondents as controls. Multivariate logistic regression was used to understand factors associated with vaccination.
Results
HPV vaccination among our 241 respondents (n = 41, 17.67 %) and their qualifying children (n = 52, 33.55 %) was low. Non-vaccinated minorities were significantly more likely to express interest in HPV vaccination (28.66 % vs 8.66 %, p = 0.016). Minority patients were significantly less knowledgeable about HPV causing cervical (88.64 % vs 72.45 %, p = 0.024) and head and neck (68.18 % vs 44.90 %, p = 0.005) cancer and were also less aware of HPV infection (95.45 % vs 81.12 %, p = 0.020) among non-women. Lack of knowledge about the HPV vaccine was the most cited reason why minority patients did not or were uninterested in vaccination for themselves or their children. In a multivariable logistic regression of factors associated with HPV vaccination, only increased age demonstrated a significant association with vaccination likelihood (OR = 0.91, 95 % CI = [0.88–0.95], p < 0.001).
Conclusion
Reported HPV vaccination rates were low for both white and minority patients but did not significantly vary on univariate or multivariate analysis. However, minority respondents were significantly less knowledgeable about HPV and its manifestations; they most often cited inadequate knowledge as why did not receive or were uninterested in HPV vaccination. As such, HPV vaccination educational interventions may raise vaccination rates among minority populations.
{"title":"Knowledge of HPV vaccination and associated HNC and treatment decision-making among minority populations","authors":"Matthew E. Lin , Oluwatobiloba Ayo-Ajibola , Ryan Davis , Tyler J. Gallagher , Carlos X. Castellanos , Jonathan D. West , Margaret Nurimba , Niels C. Kokot , Tamara Chambers","doi":"10.1016/j.amjoto.2024.104458","DOIUrl":"10.1016/j.amjoto.2024.104458","url":null,"abstract":"<div><h3>Objective</h3><p>Understand vaccination knowledge and barriers to vaccination among minority adults.</p></div><div><h3>Study design</h3><p>Cross-sectional survey.</p></div><div><h3>Setting</h3><p>Otolaryngology clinics at a safety net hospital and a tertiary academic center and a head and neck cancer screening event.</p></div><div><h3>Methods</h3><p>Survey was administered to consenting patients. Descriptive statistics and significance testing were used to characterize the data, with non-minority respondents as controls. Multivariate logistic regression was used to understand factors associated with vaccination.</p></div><div><h3>Results</h3><p>HPV vaccination among our 241 respondents (n = 41, 17.67 %) and their qualifying children (n = 52, 33.55 %) was low. Non-vaccinated minorities were significantly more likely to express interest in HPV vaccination (28.66 % vs 8.66 %, p = 0.016). Minority patients were significantly less knowledgeable about HPV causing cervical (88.64 % vs 72.45 %, p = 0.024) and head and neck (68.18 % vs 44.90 %, p = 0.005) cancer and were also less aware of HPV infection (95.45 % vs 81.12 %, p = 0.020) among non-women. Lack of knowledge about the HPV vaccine was the most cited reason why minority patients did not or were uninterested in vaccination for themselves or their children. In a multivariable logistic regression of factors associated with HPV vaccination, only increased age demonstrated a significant association with vaccination likelihood (OR = 0.91, 95 % CI = [0.88–0.95], p < 0.001).</p></div><div><h3>Conclusion</h3><p>Reported HPV vaccination rates were low for both white and minority patients but did not significantly vary on univariate or multivariate analysis. However, minority respondents were significantly less knowledgeable about HPV and its manifestations; they most often cited inadequate knowledge as why did not receive or were uninterested in HPV vaccination. As such, HPV vaccination educational interventions may raise vaccination rates among minority populations.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104458"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905576","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 : 2024-08-03DOI: 10.1016/j.amjoto.2024.104482
Noah N. Slater , Soroush Farsi , Ashton L. Rogers , Lindsey Herberger , Jose Penagaricano , Steven McKee , Deanne King , Santanu Samanta , Jumin Sunde , Emre Vural , Mauricio A. Moreno
<div><h3>Objectives</h3><p>Patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) have a poor prognosis and limited therapeutic alternatives. While reirradiation is feasible, it is usually associated with high treatment toxicity and is not yet considered the standard of care. Based on current NCCN guidelines, in the context of very advanced head and neck cancer (recurrent and/or persistent disease), surgical intervention is explored initially with/without adjuvants while unresectable disease is approached with radiation and/or systemic therapies. Specific and reliable prognostic indicators for both -oncologic and functional outcomes- have yet to be defined for this population.</p></div><div><h3>Methods</h3><p>Retrospective chart review of 54 patients treated with reirradiation at a tertiary academic institution between January of 1998 and January of 2024. Only patients with non-metastatic recurrent, and second primary HNSCC were included in the series. Demographics, staging, radiation dose and technique, additional therapy, histopathologic variables, EORTC toxicity, pre- and post-treatment PEG/tracheotomy dependency and oncologic outcomes were retrieved.</p></div><div><h3>Results</h3><p>The study cohort consisted of 54 patients (37 males, 17 females) with HNSCC, averaging 62.7 years in age. Initial tumors were locally advanced in over 42 % of cases, with 58 % being node-negative. The head and cutaneous regions (24.5 %) and tongue (20.8 %) were the most common tumor sites. Primary surgical resection and adjuvant radiation were performed in 47.2 % of cases, and concurrent chemotherapy was used in 40.7 %. Reirradiation was mainly for local or regional recurrence (88.9 %), often following salvage surgery (68.5 %), with a mean dose of 5623 Gy over 52.5 fractions. Positive surgical margins were present in 29.4 % of cases, and extracapsular spread in 59.5 %. No significant differences were found between the salvage surgery and definitive reirradiation groups except for tumor site (<em>P</em> = 0.022). Median follow-up was 52.6 months, with 27 deaths reported. Lymphovascular invasion was significantly correlated with overall survival (<em>P</em> = 0.017), while initial tumor T-stage and neck disease involvement were linked to local-regional control (<em>P</em> = 0.030 and <em>P</em> = 0.033, respectively). Reirradiation increased tracheotomy and PEG-tube dependency by 20 % (<em>P</em> = 0.011) and 23 % (<em>P</em> = 0.003), respectively.</p></div><div><h3>Conclusions</h3><p>Reirradiation is a feasible therapeutic alternative in recurrent head and neck SCC. Oncologic outcomes observed in this series compare favorably to most published reports. Complete response and perineural invasion were independent prognostic factors for survival and locoregional control. While no mortality directly associated with treatment was observed in this series, reirradiation had a significant impact in functional outcomes in terms of increased risk of tra
{"title":"Reirradiation in head and neck squamous cell carcinoma; prognostic indicators, oncologic and functional outcomes","authors":"Noah N. Slater , Soroush Farsi , Ashton L. Rogers , Lindsey Herberger , Jose Penagaricano , Steven McKee , Deanne King , Santanu Samanta , Jumin Sunde , Emre Vural , Mauricio A. Moreno","doi":"10.1016/j.amjoto.2024.104482","DOIUrl":"10.1016/j.amjoto.2024.104482","url":null,"abstract":"<div><h3>Objectives</h3><p>Patients with recurrent squamous cell carcinoma of the head and neck (HNSCC) have a poor prognosis and limited therapeutic alternatives. While reirradiation is feasible, it is usually associated with high treatment toxicity and is not yet considered the standard of care. Based on current NCCN guidelines, in the context of very advanced head and neck cancer (recurrent and/or persistent disease), surgical intervention is explored initially with/without adjuvants while unresectable disease is approached with radiation and/or systemic therapies. Specific and reliable prognostic indicators for both -oncologic and functional outcomes- have yet to be defined for this population.</p></div><div><h3>Methods</h3><p>Retrospective chart review of 54 patients treated with reirradiation at a tertiary academic institution between January of 1998 and January of 2024. Only patients with non-metastatic recurrent, and second primary HNSCC were included in the series. Demographics, staging, radiation dose and technique, additional therapy, histopathologic variables, EORTC toxicity, pre- and post-treatment PEG/tracheotomy dependency and oncologic outcomes were retrieved.</p></div><div><h3>Results</h3><p>The study cohort consisted of 54 patients (37 males, 17 females) with HNSCC, averaging 62.7 years in age. Initial tumors were locally advanced in over 42 % of cases, with 58 % being node-negative. The head and cutaneous regions (24.5 %) and tongue (20.8 %) were the most common tumor sites. Primary surgical resection and adjuvant radiation were performed in 47.2 % of cases, and concurrent chemotherapy was used in 40.7 %. Reirradiation was mainly for local or regional recurrence (88.9 %), often following salvage surgery (68.5 %), with a mean dose of 5623 Gy over 52.5 fractions. Positive surgical margins were present in 29.4 % of cases, and extracapsular spread in 59.5 %. No significant differences were found between the salvage surgery and definitive reirradiation groups except for tumor site (<em>P</em> = 0.022). Median follow-up was 52.6 months, with 27 deaths reported. Lymphovascular invasion was significantly correlated with overall survival (<em>P</em> = 0.017), while initial tumor T-stage and neck disease involvement were linked to local-regional control (<em>P</em> = 0.030 and <em>P</em> = 0.033, respectively). Reirradiation increased tracheotomy and PEG-tube dependency by 20 % (<em>P</em> = 0.011) and 23 % (<em>P</em> = 0.003), respectively.</p></div><div><h3>Conclusions</h3><p>Reirradiation is a feasible therapeutic alternative in recurrent head and neck SCC. Oncologic outcomes observed in this series compare favorably to most published reports. Complete response and perineural invasion were independent prognostic factors for survival and locoregional control. While no mortality directly associated with treatment was observed in this series, reirradiation had a significant impact in functional outcomes in terms of increased risk of tra","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104482"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905590","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 : 2024-08-03DOI: 10.1016/j.amjoto.2024.104481
Zaid Shareef , Robert M. Conway , Trevor Creaman , Seilesh C. Babu
Study design
Review of database.
Setting
Tertiary care neurotology center.
Patients
Patients undergoing adverse events.
Intervention
MAUDE database evaluation of Eustachian tube balloon dilation (ETBD) for the treatment of Eustachian tube dysfunction.
Main outcome measures
Medical device reports (MDRs) from the MAUDE database were analyzed for adverse patient events (AE) and device malfunctions (DM) among different devices for ETBD. The objective of this analysis is to assess AE rates and compare them across different devices. Sales data was also used to calculate AE rates.
Results
There were 18 MDRs noted in the MAUDE database for patients undergoing ETBD out of an initial 23 results. When separated into devices, the Aera had 9 total MDRs (50 %), Xpress had 8 (44.4 %) and Audion had 1 (5.6 %). There were 10 AE and 8 DM. When separated by device, Aera had 4 AEs and 5 DMs, Xpress had 5 AEs and 3 DMs, and Audion had 1 AE. The most common AE was subcutaneous emphysema (n = 4), in the head and neck region with one report of mediastinal involvement. Using this sales data, the Aera balloon has an MDR rate of 0.0128 % is established, with a rate of AE at 0.0058 %. The Audion balloon had an MDR and AE rate of 0.0164 %.
Conclusions
ETBD is a safe procedure with minimal complications, with subcutaneous emphysema being the most commonly reported adverse event, consistent with literature findings. A comprehensive analysis of AE, coupled with sales data, indicates a commendably low MDR rate of 0.0128 % for the Aera balloon while the Audion balloon had an MDR rate of 0.0164 %. These findings offer valuable insights on post-procedure expectations and engaging in informed consent discussions with patients, highlighting the overall safety of ETBD as an intervention.
{"title":"MAUDE database and Eustachian tube balloon dilation: Evaluation of adverse events and sales data","authors":"Zaid Shareef , Robert M. Conway , Trevor Creaman , Seilesh C. Babu","doi":"10.1016/j.amjoto.2024.104481","DOIUrl":"10.1016/j.amjoto.2024.104481","url":null,"abstract":"<div><h3>Study design</h3><p>Review of database.</p></div><div><h3>Setting</h3><p>Tertiary care neurotology center.</p></div><div><h3>Patients</h3><p>Patients undergoing adverse events.</p></div><div><h3>Intervention</h3><p>MAUDE database evaluation of Eustachian tube balloon dilation (ETBD) for the treatment of Eustachian tube dysfunction.</p></div><div><h3>Main outcome measures</h3><p>Medical device reports (MDRs) from the MAUDE database were analyzed for adverse patient events (AE) and device malfunctions (DM) among different devices for ETBD. The objective of this analysis is to assess AE rates and compare them across different devices. Sales data was also used to calculate AE rates.</p></div><div><h3>Results</h3><p>There were 18 MDRs noted in the MAUDE database for patients undergoing ETBD out of an initial 23 results. When separated into devices, the Aera had 9 total MDRs (50 %), Xpress had 8 (44.4 %) and Audion had 1 (5.6 %). There were 10 AE and 8 DM. When separated by device, Aera had 4 AEs and 5 DMs, Xpress had 5 AEs and 3 DMs, and Audion had 1 AE. The most common AE was subcutaneous emphysema (<em>n</em> = 4), in the head and neck region with one report of mediastinal involvement. Using this sales data, the Aera balloon has an MDR rate of 0.0128 % is established, with a rate of AE at 0.0058 %. The Audion balloon had an MDR and AE rate of 0.0164 %.</p></div><div><h3>Conclusions</h3><p>ETBD is a safe procedure with minimal complications, with subcutaneous emphysema being the most commonly reported adverse event, consistent with literature findings. A comprehensive analysis of AE, coupled with sales data, indicates a commendably low MDR rate of 0.0128 % for the Aera balloon while the Audion balloon had an MDR rate of 0.0164 %. These findings offer valuable insights on post-procedure expectations and engaging in informed consent discussions with patients, highlighting the overall safety of ETBD as an intervention.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104481"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896522","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 : 2024-08-03DOI: 10.1016/j.amjoto.2024.104464
Alejandro R. Marrero-Gonzalez , Evan S. Chernov , Shaun A. Nguyen , Brian A. Keith , Madelyn N. Stevens , Alexandra E. Kejner
Introduction
While the presence of human papillomavirus (HPV) is known to affect the outcomes of oropharyngeal squamous cell carcinoma (OPSCC), there is a significant gap in research regarding the potential sex-based differences. This systematic review-metanalysis (SR-MA) aims to evaluate if sex is a prognostic factor in HPV-associated OPSCC.
Methods
A systematic review and meta-analysis was performed. COCHRANE Library, CINAHL, PubMed, and Scopus were searched for English-language articles from 1966 to October 2023. Studies with multivariable analysis of overall survival (OS) based on sex were included. Adjusted hazard ratios (aHRs) with a 95 % confidence interval (CI) were presented for the reported outcome. A meta-analysis of single means, proportions, and aHRs with a 95 % CI was conducted.
Results
This SR-MA included 24 studies (n = 101,574). The proportion of female patients was 16.6 % [15.4 %–17.8 %]. A meta-analysis of all included studies with OS showed no significant difference in survival between male and female patients. In US-based studies, no significant difference in OS is observed between male and female patients. International studies reported a better OS for female patients (aHR = 0.68, 95 % CI, 0.48–0.95).
Conclusion
This meta-analysis suggests that sex does not represent a significant prognostic factor for patients affected by HPV associated OPSCC. When stratified by geographic location, findings suggests that female patients from the US with HPV OPSCC have similar OS than male patients but in international studies it suggests male patients have worse OS.
{"title":"Sex and human papillomavirus in oropharyngeal cancer: A systematic review and meta-analysis","authors":"Alejandro R. Marrero-Gonzalez , Evan S. Chernov , Shaun A. Nguyen , Brian A. Keith , Madelyn N. Stevens , Alexandra E. Kejner","doi":"10.1016/j.amjoto.2024.104464","DOIUrl":"10.1016/j.amjoto.2024.104464","url":null,"abstract":"<div><h3>Introduction</h3><p>While the presence of human papillomavirus (HPV) is known to affect the outcomes of oropharyngeal squamous cell carcinoma (OPSCC), there is a significant gap in research regarding the potential sex-based differences. This systematic review-metanalysis (SR-MA) aims to evaluate if sex is a prognostic factor in HPV-associated OPSCC.</p></div><div><h3>Methods</h3><p>A systematic review and meta-analysis was performed. COCHRANE Library, CINAHL, PubMed, and Scopus were searched for English-language articles from 1966 to October 2023. Studies with multivariable analysis of overall survival (OS) based on sex were included. Adjusted hazard ratios (aHRs) with a 95 % confidence interval (CI) were presented for the reported outcome. A meta-analysis of single means, proportions, and aHRs with a 95 % CI was conducted.</p></div><div><h3>Results</h3><p>This SR-MA included 24 studies (n = 101,574). The proportion of female patients was 16.6 % [15.4 %–17.8 %]. A meta-analysis of all included studies with OS showed no significant difference in survival between male and female patients. In US-based studies, no significant difference in OS is observed between male and female patients. International studies reported a better OS for female patients (aHR = 0.68, 95 % CI, 0.48–0.95).</p></div><div><h3>Conclusion</h3><p>This meta-analysis suggests that sex does not represent a significant prognostic factor for patients affected by HPV associated OPSCC. When stratified by geographic location, findings suggests that female patients from the US with HPV OPSCC have similar OS than male patients but in international studies it suggests male patients have worse OS.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104464"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141896534","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 : 2024-08-03DOI: 10.1016/j.amjoto.2024.104465
Snehitha Talugula , Richard Chiu , Sharmilee M. Nyenhuis , Kamal Eldeirawi , Victoria S. Lee
Objectives
Chronic rhinosinusitis (CRS) is a widely prevalent condition, however its degree of severity according to sex requires further study. The literature shows that sex-based differences exist in the severity of asthma and allergic airway disease in the population. These findings point to a potential hormonal cause for this difference, but there is no study suggesting the role of sex in CRS with nasal polyps (CRSwNP). The purpose of this study was to examine the association of sex and CRSwNP severity in the United States.
Methods
This study was conducted on data gathered from 181 participants in the NAVIGATE I and NAVIGATE II randomized control trials within the OPTINOSE database. Participants were analyzed based on sex controlling for airway-related comorbidities, including history of asthma, race, and ethnicity. SNOT-22 scores were assessed as a quality-of-life outcome measure for CRS. The association between sex and SNOT-22 scores was determined using multiple linear regression.
Results
There were 81 female and 100 male participants. SNOT-22 scores were significantly higher in females. The average reported SNOT-22 score was 53.8 ± 16.5 in females and 46.8 ± 18.8 in males. On adjusted regression, the association of sex and SNOT-22 scores approached but didn't reach significance (β: −4.97; 95 % CI: −10.68–0.73; p = 0.09).
Conclusions
On average, females had more severe manifestations of CRSwNP in comparison to males, with the adjusted association approaching statistical significance. Further studies, potentially looking at hormones as a cause of pathogenesis, are needed to better elucidate the role of sex in CRSwNP.
{"title":"Sex-based differences in severity of chronic rhinosinusitis as reported by SNOT-22 scores","authors":"Snehitha Talugula , Richard Chiu , Sharmilee M. Nyenhuis , Kamal Eldeirawi , Victoria S. Lee","doi":"10.1016/j.amjoto.2024.104465","DOIUrl":"10.1016/j.amjoto.2024.104465","url":null,"abstract":"<div><h3>Objectives</h3><p>Chronic rhinosinusitis (CRS) is a widely prevalent condition, however its degree of severity according to sex requires further study. The literature shows that sex-based differences exist in the severity of asthma and allergic airway disease in the population. These findings point to a potential hormonal cause for this difference, but there is no study suggesting the role of sex in CRS with nasal polyps (CRSwNP). The purpose of this study was to examine the association of sex and CRSwNP severity in the United States.</p></div><div><h3>Methods</h3><p>This study was conducted on data gathered from 181 participants in the NAVIGATE I and NAVIGATE II randomized control trials within the OPTINOSE database. Participants were analyzed based on sex controlling for airway-related comorbidities, including history of asthma, race, and ethnicity. SNOT-22 scores were assessed as a quality-of-life outcome measure for CRS. The association between sex and SNOT-22 scores was determined using multiple linear regression.</p></div><div><h3>Results</h3><p>There were 81 female and 100 male participants. SNOT-22 scores were significantly higher in females. The average reported SNOT-22 score was 53.8 ± 16.5 in females and 46.8 ± 18.8 in males. On adjusted regression, the association of sex and SNOT-22 scores approached but didn't reach significance (β: −4.97; 95 % CI: −10.68–0.73; p = 0.09).</p></div><div><h3>Conclusions</h3><p>On average, females had more severe manifestations of CRSwNP in comparison to males, with the adjusted association approaching statistical significance. Further studies, potentially looking at hormones as a cause of pathogenesis, are needed to better elucidate the role of sex in CRSwNP.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104465"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0196070924002515/pdfft?md5=8b9957d8e7cd4194c114b7d9a8464218&pid=1-s2.0-S0196070924002515-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141911343","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 : 2024-08-03DOI: 10.1016/j.amjoto.2024.104459
Laurence Gascon , Sarah Benyo , Radhika Duggal , Daniela Schmulevich , Rebecca C. Nelson , Michael S. Benninger , Paul C. Bryson , William S. Tierney
Objective
To identify, group and document the surgical management of idiopathic subglottic stenosis (iSGS) in pregnant women among North American centers with expertise in the treatment of airway stenosis.
Background
Idiopathic subglottic stenosis is a rare airway disease that primarily affects women in their third to fifth decade of life. Symptoms of iSGS often worsen during pregnancy and can present as a threat to optimal maternal and fetal health; however there is a lack of evidence addressing the management of iSGS in pregnancy.
Study design
Cross-Sectional Survey Study.
Methods
A twenty-four question survey was designed to query the surgical management, ventilation, and perioperative considerations for pregnant patients with iSGS. Twenty-nine North American academic tertiary care centers with airway surgery expertise were identified. A designated surrogate for each center was contacted by email to distribute and obtain results of the survey.
Results
17 centers responded. Most centers include differences in perioperative assessment such as frequency of consultation with a maternal/fetal medicine specialist. There is occasional use of a tocometer and rarely a non-stress test. Ventilation with intermittent jet ventilation or high-flow nasal cannula is favored. The surgical protocols include positional modifications, with pregnant patients in the left lateral decubitus position. The preferred timing for intervention is in the second or third trimester.
Conclusion
This is the first national survey describing surgical and perioperative considerations for the pregnant patient with iSGS among centers with airway expertise in the United States and Canada.
{"title":"Surgical management of iSGS in pregnant patients: Survey among North American expertise centers","authors":"Laurence Gascon , Sarah Benyo , Radhika Duggal , Daniela Schmulevich , Rebecca C. Nelson , Michael S. Benninger , Paul C. Bryson , William S. Tierney","doi":"10.1016/j.amjoto.2024.104459","DOIUrl":"10.1016/j.amjoto.2024.104459","url":null,"abstract":"<div><h3>Objective</h3><p>To identify, group and document the surgical management of idiopathic subglottic stenosis (iSGS) in pregnant women among North American centers with expertise in the treatment of airway stenosis.</p></div><div><h3>Background</h3><p>Idiopathic subglottic stenosis is a rare airway disease that primarily affects women in their third to fifth decade of life. Symptoms of iSGS often worsen during pregnancy and can present as a threat to optimal maternal and fetal health; however there is a lack of evidence addressing the management of iSGS in pregnancy.</p></div><div><h3>Study design</h3><p>Cross-Sectional Survey Study.</p></div><div><h3>Methods</h3><p>A twenty-four question survey was designed to query the surgical management, ventilation, and perioperative considerations for pregnant patients with iSGS. Twenty-nine North American academic tertiary care centers with airway surgery expertise were identified. A designated surrogate for each center was contacted by email to distribute and obtain results of the survey.</p></div><div><h3>Results</h3><p>17 centers responded. Most centers include differences in perioperative assessment such as frequency of consultation with a maternal/fetal medicine specialist. There is occasional use of a tocometer and rarely a non-stress test. Ventilation with intermittent jet ventilation or high-flow nasal cannula is favored. The surgical protocols include positional modifications, with pregnant patients in the left lateral decubitus position. The preferred timing for intervention is in the second or third trimester.</p></div><div><h3>Conclusion</h3><p>This is the first national survey describing surgical and perioperative considerations for the pregnant patient with iSGS among centers with airway expertise in the United States and Canada.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104459"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S019607092400245X/pdfft?md5=c80abee7139fde3f98e7a62cbc9aaa30&pid=1-s2.0-S019607092400245X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142011211","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 our study is to reduce the complications of pain and chest wall deformity by modifying conventional costal cartilage graft harvesting.
Method
In this method while the superior part of the costal cartilage is removed completely, medial, lateral, and inferior parts are excised incompletely and used as a graft. Hence, continuity of the costal cartilage is maintained inferiorly.
Results
Nineteen primary and 28 revision rhinoplasty patients were included in the study. There were no donor site complications in the early postoperative period or during one-year follow-up.
Conclusion
The modified costal cartilage graft harvesting technique we described is a safe conservative surgical method.
{"title":"U shaped costal cartilage resection to reduce donor site morbidity","authors":"Erol Senturk , Nurtac Dagistanli , Orhan Ozturan , Erkan Soylu","doi":"10.1016/j.amjoto.2024.104468","DOIUrl":"10.1016/j.amjoto.2024.104468","url":null,"abstract":"<div><h3>Objective</h3><p>The aim of our study is to reduce the complications of pain and chest wall deformity by modifying conventional costal cartilage graft harvesting.</p></div><div><h3>Method</h3><p>In this method while the superior part of the costal cartilage is removed completely, medial, lateral, and inferior parts are excised incompletely and used as a graft. Hence, continuity of the costal cartilage is maintained inferiorly.</p></div><div><h3>Results</h3><p>Nineteen primary and 28 revision rhinoplasty patients were included in the study. There were no donor site complications in the early postoperative period or during one-year follow-up.</p></div><div><h3>Conclusion</h3><p>The modified costal cartilage graft harvesting technique we described is a safe conservative surgical method.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104468"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141888194","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 : 2024-08-03DOI: 10.1016/j.amjoto.2024.104477
Ho Yun Lee, Seung-Ho Shin, Sung Wan Byun
Objectives
This study aimed to explore the electrophysiological characteristics of patients with chronic tinnitus through electrocochleography (ECochG) findings and determine if these findings correlate with specific audiological patterns that could differentiate tinnitus patients from those without this condition.
Materials and methods
A retrospective analysis of medical records from patients who visited a tinnitus clinic at a tertiary university hospital between March 2020 and December 2023 was conducted. Inclusion criteria were non-pulsatile subjective tinnitus lasting over three months, and ECochG performed at initial evaluation. Audiological assessments and ECochG results were analyzed, with the SP/AP ratio being a focal point.
Results
Among 256 patients, an elevated SP/AP ratio was observed in 37.5 % of patients. No significant difference in ECochG outcomes was noted based on tinnitus laterality. Patients with an elevated SP/AP ratio reported more sleep disturbances, higher depression scores, attention problems, and aural fullness. These patients also exhibited lower loudness discomfort levels and low-frequency hearing losses. Significant correlations were found between elevated SP/AP ratios and DPOAE responses.
Conclusions
The findings highlight the SP/AP ratio in ECochG as a valuable biomarker for assessing clinical and psychological aspects of tinnitus, indicating its potential utility in tailoring treatment strategies. Elevated SP/AP ratios were associated with sleep disturbances, depression, attention problems, aural fullness, hyperacusis, and low-frequency hearing loss, suggesting a complex interplay between cochlear pathology and tinnitus perception. This study underscores the need for a nuanced understanding of ECochG results in the clinical evaluation of tinnitus, potentially guiding more personalized management approaches.
{"title":"The tinnitus handicap inventory is a better indicator of the overall status of patients with tinnitus than the numerical rating scale","authors":"Ho Yun Lee, Seung-Ho Shin, Sung Wan Byun","doi":"10.1016/j.amjoto.2024.104477","DOIUrl":"10.1016/j.amjoto.2024.104477","url":null,"abstract":"<div><h3>Objectives</h3><p>This study aimed to explore the electrophysiological characteristics of patients with chronic tinnitus through electrocochleography (ECochG) findings and determine if these findings correlate with specific audiological patterns that could differentiate tinnitus patients from those without this condition.</p></div><div><h3>Materials and methods</h3><p>A retrospective analysis of medical records from patients who visited a tinnitus clinic at a tertiary university hospital between March 2020 and December 2023 was conducted. Inclusion criteria were non-pulsatile subjective tinnitus lasting over three months, and ECochG performed at initial evaluation. Audiological assessments and ECochG results were analyzed, with the SP/AP ratio being a focal point.</p></div><div><h3>Results</h3><p>Among 256 patients, an elevated SP/AP ratio was observed in 37.5 % of patients. No significant difference in ECochG outcomes was noted based on tinnitus laterality. Patients with an elevated SP/AP ratio reported more sleep disturbances, higher depression scores, attention problems, and aural fullness. These patients also exhibited lower loudness discomfort levels and low-frequency hearing losses. Significant correlations were found between elevated SP/AP ratios and DPOAE responses.</p></div><div><h3>Conclusions</h3><p>The findings highlight the SP/AP ratio in ECochG as a valuable biomarker for assessing clinical and psychological aspects of tinnitus, indicating its potential utility in tailoring treatment strategies. Elevated SP/AP ratios were associated with sleep disturbances, depression, attention problems, aural fullness, hyperacusis, and low-frequency hearing loss, suggesting a complex interplay between cochlear pathology and tinnitus perception. This study underscores the need for a nuanced understanding of ECochG results in the clinical evaluation of tinnitus, potentially guiding more personalized management approaches.</p></div>","PeriodicalId":7591,"journal":{"name":"American Journal of Otolaryngology","volume":"45 6","pages":"Article 104477"},"PeriodicalIF":1.8,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0196070924002631/pdfft?md5=8e5e567163666b5ff1930db15951e516&pid=1-s2.0-S0196070924002631-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905591","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}
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