Clinical Otolaryngology

Transcanal endoscopic type I tympanoplasty using nasal septal perichondrium with concomitant septoturbinoplasty: our experience in eighteen patients

28-01-2020 – Yi‐Chan Lee, Wei‐Chieh Chao

Abstract
Tympanoplasty is a standard procedure for the management of chronic otitis media with tympanic membrane perforation; however, a visible cutaneous scar from exposing the surgical field or harvesting the grafting material is usually inevitable and may cause cosmetic concerns for patients.
Eustachian tube dysfunction has been frequently noted in patients with nasal obstruction and may have a negative effect on the success rate of tympanoplasty. Treatment of the nasal obstruction and associated Eustachian tube dysfunction may be considered before tympanoplasty if severe nasal diseases are observed in the same patient.
The present study introduced transcanal endoscopic type I tympanoplasty with nasal septal perichondrial grafts harvested concurrently with septoturbinoplasty. For patients with chronic tympanic membrane perforation and symptomatic nasal obstruction, the combined procedure offers the advantage of avoiding staged procedures and provides excellent cosmesis with adequate surgical results.
By using transseptal suture after septoplasty and inferior turbinate coblation techniques, nasal packing was not needed after surgery. Eustachian tube dysfunction from nasal packing placement can therefore be avoided.
Transcanal endoscopic type I tympanoplasty with nasal septal perichondrial graft and same‐stage septoturbinoplasty is potentially a useful option for patients who need both procedures.

The effect of three‐dimensional visualisation on performance in endoscopic sinusxa0surgery: A clinical training study using surgical navigation for movement analysis in a randomised crossover design

27-01-2020 – Ellen ten Dam, Herman M. Helder, Bernard F. A. M. Laan, Robert A. Feijen, Astrid G. W. Korsten‐Meijer

Journal Article

Abstract
Objectives
Endoscopic imaging techniques and endoscopic endonasal surgery (EES) expertise have evolved rapidly. Only few studies have assessed the effect of three‐dimensional (3D) endoscopy on endoscopic sinus surgery (ESS). The present study aimed to objectively and subjectively assess the additional value of 3D high‐definition (HD) endoscopy in ESS.
Design
A randomized crossover study of endoscopic surgery performance, using five ESS tasks of varying complexity, performed on Thiel embalmed human specimens.
Setting
Simulated surgical environment.
Participants
Thirty participants, inexperienced in ESS.
Main outcome measures
Performance was assessed using video imaging, surgical navigation and questionnaires. Main outcome measures were as follows: efficiency (defined by time to task completion), distance covered inside the nose, average velocity towards target, accuracy (measured by error rate), and subjective assessment of endoscope characteristics.
Results
During ESS tasks, both efficiency and accuracy did not differ significantly between 2D HD and 3D HD endoscopy. Subjectively, imaging characteristics of the 3D HD endoscope were rated significantly better.
Conclusions
ESS performance of inexperienced participants was not significantly improved by the use of 3D HD endoscopy during ESS tasks, although imaging characteristics of the 3D HD endoscope were rated significantly better. Surgical field characteristics and surgical techniques are likely to influence any additional value of 3D HD endoscopy.

“M” line: New anatomical landmark for the maxillary sinus natural ostium

27-01-2020 – Janaina Gonçalves da Silva Leite, Joao Flavio Nogueira, John Pallanch, Ticiana Cabral Costa, Moisés Ximenes Feijão, Raquel de Sousa Lobo Ferreira Querido, Maria Luzete Costa Cavalcante

Journal Article

Abstract
Objective
Describe a reliable anatomical landmark that can be used to locate the maxillary sinus natural ostium (MSNO) during endoscopic surgery, even if the uncinate process is preserved.
Design
Descriptive anatomical.
Setting
An anatomical and radiological study was performed to evaluate the consistency of the landmark, denominated “M” line.
Subjects and Methods
Dissections were performed in 57 cadaver heads (114 sides). In addition, 73 computerised tomography (CT) scans (146 sides) of patients with chronic inflammatory sinonasal disease were analysed using a three‐dimensional (3D) reconstruction computer program.
Results
The “M” line crossed the MSNO in 112 dissected sides (98.2%) and 140 sides at CT 3D reconstruction (95.9%).
Conclusion
The “M” line is a reliable anatomical landmark for predicting MSNO location. As such, it could improve and facilitate endoscopic sinus surgery, using traditional, minimally invasive or uncinate preserving techniques.

Head and Neck Cancer Risk Calculator (HaNC‐RC) – v.2. Adjustments and addition of symptoms and social history factors

27-01-2020 – T Tikka, K Kavanagh, A Lowit, P Jiafeng, H Burns, IJ Nixon, V Paleri, K MacKenzie

Journal Article

Abstract
Objective
Head and neck cancer (HNC) diagnosis through the 2‐week‐wait, urgent suspicion of cancer (USOC) pathway has failed to increase early cancer detection rates in the UK. A Head and neck cancer risk calculator (Ha
NC‐RC) has previously been designed to aid referral of high‐risk patients to USOC clinics (predictive power:77%). Our aim is to refine the Ha
NC‐RC to increase its prediction potential.
Design
Following sample size calculation, prospective data collection was performed from 3531 new patents seen in routine, urgent and USOC head and neck (Ha
N) clinics. Data collected were: demographics, social history, presenting symptoms and signs and HNC diagnosis. Univariate and multivariate regression analysis was performed to identify significant predictors of HNC. Internal validation was performed using 1000 sample bootstrapping to estimate model diagnostics included the area under the receiver operator curve (AUC), sensitivity, specificity.
Results
The updated version of the risk calculator (Ha
NC‐RC v.2) includes age, gender, unintentional weight loss, smoking, alcohol, positive and negative symptoms and signs of HNC. It has achieved an AUC of 88.6% with two recommended triage referral cut‐offs to USOC (cut‐off: 7.1%; sensitivity: 85%, specificity:78.3%) or urgent clinics (cut‐off:2.2%; sensitivity: 97.1%; specificity of 52.9%). This could redistribute cancer detection through USOC clinics from the current 60.9% to 85.2%, without affecting total numbers seen in each clinical setting.
Conclusions
The use of the Ha
NC‐RC v.2 has a significant potential in both identifying patients at high risk of HNC early thought USOC clinics but also improving health service delivery practices by reducing the number of inappropriately urgent referrals.

Expression of inhibitors of apoptosis proteins in salivary gland adenoid cystic carcinoma: XIAP is an independent marker of impaired cause‐specific survival

26-01-2020 – Julia Schnoell, Lorenz Kadletz, Bernhard J. Jank, Felicitas Oberndorfer, Faris F. Brkic, Elisabeth Gurnhofer, Julia Cede, Rudolf Seemann, Lukas Kenner, Gregor Heiduschka

Journal Article

Abstract
Objectives
Inhibitors of apoptosis proteins are crucial to carcinogenesis since their expression results in evasion of apoptosis. Overexpression of inhibitors of apoptosis has repeatedly been associated with resistance to treatment and poor prognosis in various cancers. The role of inhibitors of apoptosis in adenoid cystic carcinoma of the salivary gland is still unclear. The aim of this study was to investigate the expression of inhibitors of apoptosis and their potential prognostic value in adenoid cystic carcinoma.
Design, Setting, Participants
Forty‐nine patients, diagnosed with adenoid cystic carcinoma of the salivary gland between 1996 and 2016, were retrospectively included in this study. The expression of c
IAP1, c
IAP2, XIAP, Birc6, Livin and Survivin was assessed using immunohistochemistry and their association with survival and prognosis was evaluated during a median follow‐up of 6.4 years.
Main outcome measure
Cause‐specific survival and recurrence‐free survival rates.
Results
XIAP, c
IAP2, Livin and nuclear Survivin showed high expression levels in adenoid cystic carcinoma in most patients. There was no significant association for c
IAP1, c
IAP2, Livin, Birc6 and Survivin with outcome. However, high XIAP expression was associated with worse cause‐specific survival and worse response to radiotherapy and proved to be an independent marker in multivariable analysis.
Conclusion
Our data indicate that high expression of XIAP may be used as a prognosticator for poor survival and poor response to radiotherapy in adenoid cystic carcinoma patients.

Interspecialty referral of oesophagogastric and pharyngolaryngeal cancers delays diagnosis and reduces patient survival: a matched case‐control study

26-01-2020 – JH Bird, E Williams, KJ Heathcote, L Ayres, N De Zoysa, EV King, SD Parry, SAR Nouraei

Journal Article

Abstract
Objectives
Pharyngolaryngeal and oesophagogastric cancers present with swallowing symptoms and as such, their clinical evaluation traverses boundaries between different specialties. We studied the incidence and significance of Interspecialty Cancer Referrals (ICRs), that is, pharyngolaryngeal cancers first evaluated by gastroenterology and oesophagogastric cancers first evaluated by otolaryngology.
Design
A subset analysis of our Integrated Aerodigestive Partnerships audit dataset, of all ICR patients, and an equal number of controls matched for age, sex, and cancer subsite.
Main Outcome Measures
Information about the patient age and presenting symptoms were recorded. The relationship between symptoms and ICR risk were examined with binary logistic regression. Referral‐to‐diagnosis latency was compared between ICR and control patients with unpaired Students t‐test. Cox regression was used to identify independent predictors of overall survival.
Results
Of 1130 patients with pharyngolaryngeal and oesophagogastric cancers between 2008 and 2018, 60 diagnoses (5.3%) were preceded by an ICR. Referral‐to‐diagnosis latency increased from 43±50 days for control patients to 115±140 days for ICR patients (p<0.0001). Dysphagia significantly increased the risk of an ICR (odds ratio 3.34; 95% CI 1.30‐8.56) and classic gastrointestinal reflux symptoms (heartburn or regurgitation; OR 0.25; 95% CI 0.08‐0.83) and “distal” symptoms (nausea/vomiting, abdominal pain or dyspepsia; OR 0.23; 95% CI 0.08‐068) significantly reduced the risk. Eleven pharyngolaryngeal cancers (of 26; 42%) were missed by gastroenterology and eight (of 34; 24%) oesophageal cancers were missed by otolaryngology. An ICR was an independent adverse prognostic risk factor on multivariable analysis (hazard ratio 1.76; 95% CI 1.11‐2.73; p<0.02; log‐rank test). Two systemic causes were poor visualisation of pharynx and larynx by per‐oral endoscopy for pharyngolaryngeal cancers, and poor sensitivity (62.5%) of barium swallow for evaluating the oesophageal mucosa.
Conclusions
An Interspecialty Cancer Referral occurs in a significant proportion of patients with foregut cancers. It almost triples the time to cancer diagnosis and is associated with a high incidence of missed cancers and diminished patient survival. It is a complex phenomenon and its reduction requires an integrated approach between primary and secondary care, and within secondary care, to optimise referral pathways and ensure appropriate and expeditious specialist evaluation.

A review of thirty‐nine patients diagnosed with necrotising otitis externa over three years: is CT imaging for diagnosis sufficient?

24-01-2020 – Kimberley Lau, Gianluca Scotta, Kenneth Wu, Mohammed Asim Khan Kabuli, Glen Watson

Journal Article

Abstract1.
Early necrotising otitis externa (NOE) does not always show osseous destruction on CT imaging; therefore complimentary MRI is superior in evaluating anatomical location and extent of the soft tissue involvement.2.
This study showed a high percentage of CT scans with no obvious radiological appearance of NOE (in a group of patients with NOE confirmed with MRI).3.
CT imaging will evaluate bone erosion and demineralization, but early soft tissue findings in NOE are poorly evaluated by CT and are difficult to appreciate.4.
The most helpful MRI sequences are the post gadolinium T1‐Weighted sequences with fat suppression.5.
The most common positive MRI finding in NOE is retrocondylar fat infiltration.

Patient advocacy in head and neck cancer: realities, challenges and the role of the multi‐disciplinary team

23-01-2020 – Camilla Dawson, Heather Starmer, Rebecca Nund, Margaret Coffey, Justin Roe, Roganie Govender, Grainne Brady, J.M. Patterson, Annie Topping, Paul Nankivell, Sat Parmar, Neil Sharma, Paul Pracy

Editorial

Abstract
This paper explores the concept of advocacy in head and neck cancer. We define inherent challenges in the development and success of advocacy within this context, and offer ways to embed it within clinical practice. We outline what advocacy is, ways in which it may benefit people with head and neck cancer and the engagement required from health care professionals to facilitate advocacy to improve outcomes.

Hearing outcome after myringoplasty in Sweden. A nationwide registry‐based cohort study

23-01-2020 – Malin Berglund, Sara Olaison, Åsa Bonnard, Mattias Fransson, Malou Hultcrantz, Rut Florentzson, Christer Dahlin, Per Olof Eriksson, Eva Westman

Journal Article

Abstract
Objectives
To present hearing results after successful primary myringoplasty surgeries registered in the Swedish Quality Registry for Myringoplasty and to evaluate the chance of hearing improvement and the risk of hearing loss.
Design
A retrospective nationwide cohort study based on prospectively collected registry data between 2002 and 2012.
Settings
Registry data from secondary and tertiary hospitals performing myringoplasty.
Participants
Patients with healed tympanic membrane after primary myringoplasty surgery performed from 2002‐2012 in Sweden.
Main outcome measures
Postoperative hearing results, hearing gain and air‐bone gap (ABG).
Results
In 2226 myringoplasties, air conduction audiograms were recorded, and the average preoperative pure tone average (PTA 4) of the group was 28.5 d
B, which improved postoperatively to 19.6 d
B with an average of 8.8 d
B improvement. Bone conduction was measured for 1476 procedures. Closure of the ABG to 10 d
B or less was achieved in 51% of the ears and to less than 20 d
B in 89% of the ears. Sixty‐one percent of patients with preoperatively deteriorated hearing experienced improved hearing, but 3% of all patients experienced deteriorated hearing. After the surgery, 93% of the patients were satisfied.
Conclusions
Hearing results after successful myringoplasty surgery are often favourable, but although the tympanic membrane is healed, hearing improvement is not guaranteed, and hearing deterioration can also occur.

Bimodal stimulation in children with inner ear malformation: One side cochlear implant and contralateral auditory brainstem implant

22-01-2020 – Merve Ozbal Batuk, Betul Cicek Cinar, Mehmet Yarali, Filiz Aslan, Hilal Burcu Ozkan, Gonca Sennaroglu, Esra Yucel, Munir Demir Bajin, Burcak Bilginer, Levent Sennaroglu

Journal Article

Abstract
Objective
To determine audiological outcomes of children who use a cochlear implant (CI) in one ear and an auditory brainstem implant (ABI) in the contralateral ear.
Design
Retrospective case review.
Setting
Tertiary referral hospital.
Participants
Twelve children followed with CI and contralateral auditory brainstem implant (ABI) by Hacettepe University Department of Otorhinolaryngology and Audiology in Turkey. All children were diagnosed with different inner ear malformations with cochlear nerve aplasia/hypoplasia. CI was planned in the ear with better sound detection during behavioural testing with inserted ear phones and with better CN as seen on MRI. Due to the limited auditory and speech progress with the cochlear implant, ABI was performed on the contralateral ear in all subjects.
Main outcome measures
Audiological performance and auditory perception skills of children with cochlear nerve deficiency (CND) who use bimodal electrical stimulation with CI and contralateral ABI.
Results
Mean age of the subjects was 84.00 ± 33.94 months. Age at CI surgery and ABI surgery was 25.00 ± 10.98 months and 41.50 ± 16.14 months, respectively. However, hearing thresholds only with CI and only with ABI did not reveal significant difference, and auditory perception scores improved with bimodal stimulation. The MAIS scores were significantly improved from unilateral CI to bimodal stimulation (P = .002). Pattern perception and word recognition scores were significantly higher with the bimodal condition when compared to CI only and ABI only conditions.
Conclusion
Children with CND showed better performance with CI and contralateral ABI combined. Depending on the audiological and radiological results, bimodal stimulation should be advised for children with CND.

Sino‐Nasal Outcome Test–22: Cross‐cultural Adaptation, and Validation in Russian Speaking Patients

22-01-2020 – Netanel Eisenbach, Sofi Matot, Achia Nemet, Tal Marshak, Ohad Ronen

Journal Article

Abstract
Background
Chronic rhinosinusitis (CRS) is a relatively common disease which significantly affects the patients quality of life (QoL). Sino‐Nasal Outcome Test–22 (SNOT‐22) is a QoL questionnaire which allows quantifying patients complaints. Our aim was to translate and validated the SNOT‐22 into the Russian language.
Methods
Translation and validation of SNOT‐22 questionnaire was performed through forward‐backward translation technique. After proper translation, the translated questionnaire was completed by CRS patients before and after endoscopic sinus surgery (ESS) and by healthy individuals as controls.
Results
Thirty‐four native Russian‐speaking CRS patients completed the Russian version of the SNOT‐22 questionnaire before and after ESS. The internal consistency for reliability assessment was very good (mean Cronbach’s alpha=0.816 for CRS patients). Mean scores for the preoperative, postoperative, and control groups were 67.6, 18.1, and 9.2 respectively (p<0.001), showing validity and responsiveness of the questionnaire.
Conclusion
The Russian version of the SNOT‐22 questionnaire is a valid outcome measure for patients with CRS.

Efficacy of non‐invasive treatment options for single‐sided deafness: A prospective study of 20 patients

20-01-2020 – Young Sang Cho, Yeon Kyoung Park, Hye Yoon Seol, Ji Hyun Lim, Sung Hwa Hong, Il Joon Moon

Journal Article

Abstract
We aimed to ascertain which of the following devices will perform better for individuals with single‐sided deafness (SSD): non‐invasive contralateral routing of signal (CROS) hearing aid (HA) and the new type of bone conduction devices (BCDs) which include ADHEAR and Sound
Arc.
A CROS hearing aid provided some advantage for speech perception in a noisy environment when target speech was directed to the impaired ear side. However, it also showed an adverse effect when the noise was presented to the better ear.
Neither of the adhesive‐type BCDs (ADHEAR or Sound
Arc), showed pseudobinaural benefits in the Hearing in Noise Test (HINT).
Sound localization ability was not significantly affected by any device. However, all devices significantly reduced listening effort in noise conditions
Although there was little enhancement in speech perception in noise with CROS, and the new type of BCDs, all devices significantly reduced listening effort.

Healthcare utilisation, follow‐up of guidelines and practice variation on rhinosinusitis in adults: A healthcare reimbursement claims study in The Netherlands

20-01-2020 – Nina M. Kaper, Mark C. J. Aarts, Robert J. Stokroos, Geert J. M. G. Heijden

Journal Article

Abstract
Objectives
To provide insight into healthcare utilisation of rhinosinusitis, compare data with clinical practice guideline recommendations and assess practice variation.
Design
Anonymised data from claims reimbursement registries of healthcare insurers were analysed, from 1 January 2016 until 31 December 2016.
Setting
Secondary and tertiary care in the Netherlands.
Participants
Patients ≥18 years with diagnostic code “sinusitis.”Main outcome measures
Healthcare utilisation (prevalence, co‐morbidity, diagnostic testing, surgery), costs, comparison with guideline recommendation, practice variation.
Results
We identified 56 825 patients, prevalence was 0.4%. Costs were € 45 979 554—that is 0.2% of total hospital‐related care costs (€21 831.3 × 106). Most patients were <75 years, with a slight female preponderance. 29% had comorbidities (usually COPD/asthma). 9% underwent skin prick testing, 61% nasal endoscopy, 2% X‐ray and 51% CT. Surgery rate was 16%, mostly in daycare. Nearly, all surgical procedures were performed endonasally and concerned the maxillary and/or ethmoid sinus. Seven recommendations (25%) could be (partially) compared to the distribution of claims data. Except for endoscopy, healthcare utilisation patterns were in line with guideline recommendations. We compared results for three geographical regions and found generally corresponding rates of diagnostic testing and surgery.
Conclusion
Prevalence was lower than reported previously. Within the boundaries of guideline recommendations, we encountered acceptable variation in healthcare utilisation in Dutch hospitals. Health reimbursement claims data can provide insight into healthcare utilisation, but they do not allow evaluation of the quality and outcomes of care, and therefore, results should be interpreted with caution.

Pharyngoesophageal reconstruction with the gastric pull‐up: Functional outcomes in a cohort of 49 patients

14-01-2020 – Oleksandr Butskiy, Ronak Rahmanian, S. Danielle MacNeil, Donald W. Anderson

Letter

Effect of liver disease on post‐therapeutic complications of head and neck squamous cell carcinoma. A prospective study of 94 patients

07-01-2020 – Maxime Baert, Caroline Pascual, Vincent Hautefeuille, Eric Nguyen‐Khac, Cyril Page

Letter

The effect of ventilation tube insertion on quality of life in children with persistent otitis media with effusion

06-01-2020 – Leigh N. Sanyaolu, Rebecca Cannings‐John, Christopher C. Butler, Nick A. Francis

Journal Article

Abstract
Objectives
To determine the effect of ventilation tube (VT) surgery on quality of life (QoL) in children with persistent otitis media with effusion (OME).
Design
Secondary analysis of trial data (oral steroids versus placebo for persistent OME), comparing QoL by history of VT surgery performed between 5 weeks and 12 months post‐randomisation. Multilevel regression models were used to identify the association between VT surgery and QoL scores at 12 months, controlling for pre‐exposure risk factors associated with surgery, including pre‐surgery hearing level.
Setting
Ear, nose and throat (ENT), paediatric audiology and audiovestibular medicine (AVM) departments in Wales and England.
Participants
A total of 327 children aged 2‐8 years with OME symptoms for at least three months and audiometry‐proven bilateral hearing loss with VT surgery status.
Main outcome measures
Otitis Media questionnaire (OM8‐30) and Paediatric Quality of Life Inventory (Peds
QL) total and subscale scores, and the Health Utilities Index Mark 3 (HUI3) at 12 months post‐randomisation.
Results
Participants who had VT surgery had no significant difference in OM8‐30, Peds
QL or HUI total scores. OM8‐30 hearing difficulty (HD) subscale scores at 12 months were better in those who had VT surgery (adjusted mean difference (a
MD) = −0.46 (95% confidence interval: −0.69 to −0.23), P < .001), and this varied by when the surgery occurred (a
MD for surgery between 5 weeks and 6 months = −0.4 −0.67 to −0.13, P = .004 and between 6 and 12 months = −0.54, −0.87 to −0.22, P = .001).
Conclusion
Ventilation tube surgery was associated with an improvement in HD‐related functional health status but no change in overall QoL.

Flexible laser Sphenopalatine artery ligation: An alternative to the classic approach

03-01-2020 – Petros D. Karkos, Marios Stavrakas

Journal Article

Prognostic values of preoperative platelet‐to‐lymphocyte ratio and platelet‐related indices in advanced hypopharyngeal squamous cell carcinoma

03-01-2020 – Hui‐Ching Lau, Chi‐Yao Hsueh, Qi Chen, Lei Tao, Liang Zhou, Weiye Deng, Ming Zhang

Journal Article

Abstract
Objectives
To investigate the prognostic values of preoperative platelet‐to‐lymphocyte ratio (PLR) and platelet‐related indices in advanced hypopharyngeal squamous cell carcinoma (HPSCC).
Methods
The data of 247 eligible advanced HPSCC patients were reviewed retrospectively. Pretreatment haematological parameters were categorised into two groups based on the result of X‐tile, and several variates were assessed using chi‐square test, Kaplan‐Meier method, Cox univariate and multivariate analysis.
Results
The optimal cut‐off points of 171.4 for PLR, 260 × 109/L for platelet, 10.4 f
L for mean platelet volume (MPV) and 16.5% for platelet distribution width were defined. The haematological parameters PLR and MPV, postoperative metastasis and internal jugular vein invasion were statistically significant in OS and DFS analyses (P < .05). The high PLR (>171.4) or high MPV (>10.4 f
L) was significantly associated with worse OS and DFS (P < .05).
Conclusions
The preoperative levels of PLR and MPV could be considered as independent prognostic predictors in patients with advanced HPSCC.

Computational fluid dynamics and septal deviations—Virtual surgery can predict post‐surgery results: A preliminary study including two patients

03-01-2020 – Thomas Radulesco, Lionel Meister, Gilles Bouchet, Arthur Varoquaux, Jérome Giordano, Patrick Dessi, Pierre Perrier, Justin Michel

Letter

A novel water occlusion test for disorders causing pulsatile tinnitus: Our experience in 32 patients

03-01-2020 – Shi Nae Park, Jae Sang Han, Jung Mee Park, Ho Jun Jin, Hye Ah Joo, Jin Taek Park, Ja Yoon Koo, Yehree Kim, Min Young Kwak, Ji Won Seo, Chan Il Song, Hong Ju Park

Letter

Technical note: Atraumatic compression of the pinna—An alternative application of the external nasal splint

29-12-2019 – Oliver Wright, Juliet Laycock, Philippe Bowles, Simon Watts

Journal Article

Transoral microscopic cautery‐assisted laser tonsillectomy/tongue base resection (TOMCAT)

29-12-2019 – Kishan Ubayasiri, Ayham Al Afif, Jasmijn Herruer, S. Mark Taylor

Journal Article

Validity and reliability of three‐dimensional costal cartilage imaging for donor‐site assessment and clinical application in microtia reconstruction patients: A prospective study of 22 cases

23-12-2019 – Xiaoyan Mao, Xiaojian Li, James Jia, Deni Kang, Yong Miao, Zijing Lu, Zhiqi Hu

Journal Article

Abstract
Objectives
This study assesses the ability to reconstruct costal cartilage images by using three‐dimensional visualisation software (Mimics) based on semi‐automated segmentation algorithm and to investigate its reliability and validity with an anthropometric analysis.
Design
Observational prospective study.
Setting
Plastic surgery department of a tertiary hospital.
Participants
Twenty‐two microtia patients who underwent autologous ear reconstruction.
Main outcome measures
Preoperative thoracic computed tomography data were processed to Mimics software for three‐dimensional costal cartilage imaging. The length, width, thickness and volume of the 9th costal cartilages were calculated from these images and compared with the direct measurements (DM) obtained intraoperatively.
Results
The intra‐examiner reliability and inter‐examiner reliability were high in terms of all four measurements (intraclass correlation coefficients, ICC: 0.876‐0.984). There were no significant differences between image‐based anthropometry and DM in the linear measurements except for the volume (P < .05). The mean volume calculation error of Mimics was −0.08 ± 0.13 m
L. No correlation was found between the anthropometric variables and the absolute errors (P > .05). Furthermore, Bland‐Altman plots were used to evaluate the agreement between the two methods.
Conclusions
Despite a very small error was found in volume calculation, Mimics software was accurate and reliable in linear calculation. Three‐dimensional costal cartilage imaging was found to be an efficient tool for morphological evaluation of costal cartilages. We believe that with the application of individualised cartilage models based on three‐dimensional printing, the use of customised ear framework carving will be practicable in surgical training.

Developing an innovative office‐based UK rhinology service—Experience and outcomes in 22 patients undergoing office‐based local anaesthetic nasal polypectomy

23-12-2019 – Matthew L. Coates, Alasdair Mayer, Sean Carrie

Letter

Prognostic role of pre‐treatment serum albumin in patients with nasopharyngeal carcinoma: A meta‐analysis and systematic review

23-12-2019 – Huifen Yang, Kai Wang, Zheng Liang, Sitong Guo, Peng Zhang, Yi Xu, Huifang Zhou

Journal Article

Abstract
Background
Pre‐treatment serum albumin (ALB) is a novel index that was identified in recent years and is considered to be closely related to the prognosis of nasopharyngeal carcinoma (NPC). However, the association between ALB and NPC remains controversial.
Objective of Review
To assess the prognostic significance of pre‐treatment serum ALB in patients with NPC.
Type of Review
A systematic review and meta‐analysis.
Search Strategy
We searched PubMed, the Cochrane Library and the Web of Science for studies published up to August 2018. The keywords used were related to albumin, nasopharyngeal carcinoma and prognosis.
Evaluation Method
We extracted the following data from all included studies: author, publication year, country, cancer centre, time points of randomisation, sample size, mean or median age, gender, TNM stage of NPC, cut‐off value of pre‐treatment serum albumin, number of high‐grade cases and duration of follow‐up. Then, we generated the pooled hazard ratios (HR) for overall survival (OS) and distant metastasis‐free survival (DMFS) to perform this meta‐analysis.
Results
Ten studies comprising 7339 cases were included. Lower pre‐treatment serum ALB levels were significantly associated with worse OS (HR = 1.32, 95% CI 1.17‐1.48) and DMFS (HR = 1.40, 95% CI 1.08‐1.80). In general, our findings were further verified in the subgroup analyses based on three features, including cancer stage, cut‐off value and analysis type.
Conclusion
A decreased level of pre‐treatment serum albumin implies a poor prognosis and can be detected to define the risk stratification of NPC patients.

Endoscopic ear surgery: Does it have an impact on quality of life? Our experience of 152 cases

23-12-2019 – Virangna Taneja, Thomas D. Milner, Arunachalam Iyer

Journal Article

The efficacy of statins as otoprotective agents: A systematic review

23-12-2019 – Pattarawadee Prayuenyong, Anand V. Kasbekar, David M. Baguley

Journal Article

Abstract
Objective
This systematic review examined current literature, summarised research findings and identified research gaps regarding the efficacy of statins on audiological outcomes.
Methods
Systematic search of electronic databases and grey literature was performed. Eligibility criteria were the study of a statin drug with report of audiological outcomes such as hearing, tinnitus or balance in either human or animal studies. Data extraction and quality assessment were performed by two independently researchers. The characteristics of the study and research findings were collated and summarised. A narrative synthesis was conducted. Meta‐analysis was not possible due to heterogeneity of the included studies.
Results
Analysis of searches yielded 17 studies meeting the criteria. Included studies had variable drug type and dosage, outcome measures and associated inner ear conditions. Most animal experiments showed promising audiological outcomes after statin treatment, demonstrated by the results of auditory brainstem response, distortion product otoacoustic emissions and inner ear histology. However, no clear effect can be discerned in human trials due to the mixed results, and heterogeneity in research methodology and quality. Audiological outcomes were not always correlated with cholesterol levels.
Conclusions
Statins remain a potential candidate as otoprotective agents which warrant further investigation.

The role of allied healthcare professionals in head and neck cancer surveillance: A systematic review

23-12-2019 – John Rocke, Oliver Mclaren, John Hardman, George Garas, Matthew E Smith, Hiro Ishii, James Constable, Theofano Tikka, Zi Wie Liu, Richard Williams, Integrate (UK ENT Trainee Research Network)

Journal Article

Abstract
Objectives
The roles of Allied Health Care Professionals (AHPs) in Head and Neck Cancer (HNC) are wide ranging but not clearly defined. Inter‐regional variability in practice results from a lack of standardisation in approaches to the Multidisciplinary Team (MDT) make‐up and structure. Traditionally, the follow‐up of HNC patients is clinician led with multiple scheduled follow‐up appointments. The increasing population of HNC patients provides logistical, monetary and efficiency challenges.
This systematic review presents the roles of the multiple AHP sub‐groups in HNC with the aim of presenting how their differing skill sets can be integrated to modernise our approach in follow‐up.
Design
We searched MEDLINE, Embase, the Cochrane Library, NIHR Dissemination Centre, The Kings Fund Library, Clinical Evidence, National Health Service Evidence and the National Institute of Clinical Excellence to identify multiple subgroups of AHPs (Dentists, Speech and Language Therapists, Dieticians, Physiotherapists, Psychologists, Clinical Nurse Specialists) and evidence of their role in HNC follow‐up. Evidence not directly relating to HNC follow‐up was excluded.
Setting and Participants
This Systematic Review was undertaken online by the Integrate (UK ENT Trainee National Collaborative) Head and Neck Subcommittee.
Main Outcome Measures Most evidence was of low‐quality, and the broad nature of the protocol provided a wide variety of study models. Two authors screened the articles for relevance to the topic before final analysis.
Results
The main role identified was improvement in Quality of Life and symptom control rather than detecting recurrence. We also demonstrate that it is possible to stratify HNC follow‐up patients using their received treatment modality and Distress Thermometers to identify groups who will require more intensive AHP input.
Conclusions
HNC follow‐up covers a broad group of patients with differing needs. As such, a blanket approach to this phase of treatment is likely to be less effective than a patient‐led model where the group of AHPs are employed on a needs basis rather than at set time points. This will likely lead to greater patient satisfaction, earlier detection of recurrence and efficiency savings.

Prognosis of oral squamous cell carcinoma with perineural invasion: A comparative study of classification types

23-12-2019 – Jae Park, Anna Megow, Adam Swalling, John‐Charles Hodge, Andrew Foreman, Samuel Boase, Rowan Valentine, Suren Krishnan, Eng H. Ooi

Journal Article

Abstract
Objective
To investigate the histological location and extent of perineural invasion (PNI) as prognostic factors.
Design
Retrospective review of medical records and histological analysis of 116 patients with oral squamous cell carcinoma (OSCC).
Setting
Two major public tertiary hospitals treating head and neck cancer, Royal Adelaide Hospital and Flinders Medical Centre, in South Australia.
Participants
Patients diagnosed with OSCC who underwent primary surgical treatment with curative intent at these two centres from January 1, 2005 through December 31, 2015.
Main Outcome Measures
The primary end points were disease‐free survival (DFS) and disease‐specific survival (DSS).
Results
The presence of PNI as a binary factor alone did not significantly influence the clinical outcomes. Extratumoural (ET) PNI as measured from the tumour edge was associated with worse DFS on multivariate analyses. Multifocal PNI was associated with worse DFS and DSS. DFS in multifocal PNI was worse irrespective of whether adjuvant therapy was administered.
Conclusions
The presence of multifocal and ET PNI in OSCC is associated with poor clinical outcomes. Patients with multifocal PNI were associated with worse DFS even with adjuvant therapy.

The impact of conductive hearing loss on balance

23-12-2019 – Gilad Horowitz, Omer J. Ungar, Yael Levit, Mordechai Himmelfarb, Ophir Handzel

Journal Article

Abstract
Background
Balance is a complex process involving the coordinated activities of multiple sensory, motor and biomechanical components. Balance function may be disturbed in subjects suffering from hearing loss but the impairment has been attributed to the pathology underlying the hearing loss.
Aim
The purpose of the study was to investigate the possible interference of simulated conductive hearing loss with the ability to maintain postural balance.
Methods
Twenty normal‐hearing subjects, 20‐30 years old, underwent the computerised dynamic posturography test battery before and after plugging their external ear canals with earplugs, thus simulating a 40d
B conductive hearing loss.
Results
Eighteen females and two males were tested before and after plugging their ear canals. Average CHL was 40 ± 4.9d
B. The composite equilibrium score was significantly diminished after plugging the ears with an average sway score of 73.5% (P < .05, T = 2.27). The fourth test condition was specifically affected with an average sway score of 72.85% with earplugs (P < .05, T = 2.37).
Conclusions
Conductive hearing loss has a negative effect on balance. This can be theoretically explained by the association between hearing loss and saccular dysfunction.

No impact on the incidence rate of adenoidectomy 1998‐2014 on a national level in Denmark by the use of nasal steroid and the introduction of pneumococcal vaccines

23-12-2019 – Casper Grønlund, Michael Frantz Howitz, Bjarki Ditlev Djurhuus

Journal Article

Abstract
Objective
To describe trends in incidence rates of adenoidectomy in children in Denmark from 1998‐2014 and to look for possible explanatory factors such as intranasal steroids and pneumococcal vaccination.
Design
A nationwide, population‐based, retrospective, interrupted time‐series analysis, using data from Danish registries.
Setting
Hospitals and private Ear, Nose and Throat clinics.
Participants
Children who underwent adenoidectomy from 1998 to 2014 in Denmark.
Main outcome measure
Adenoidectomy.
Methods
The National Patient Register and the National Health insurance Service Register were used to identify all adenoidectomies performed in children. The National Prescription Register supplied data on intranasal steroids.
Results
A total of 174,557 adenoidectomies were identified, distributed among 153 022 children. The annual incidence rate was stable at around 11 per 1000 person‐years from 1998 to 2004. A decrease was seen from 2004 reaching 7.9 in 2009, followed by an increase to 9.1 in 2014. The highest age‐specific incidence rates were seen at 2‐3 years of age. An estimated 14% of children born in 2014 will have had adenoidectomy performed before turning 16 years old. The proportion of adenoidectomies performed in private clinics compared with hospitals was 90%.
Conclusion
From 1998 to 2004 the incidence rate of adenoidectomy in children in Denmark was among the highest in the world with around 11 per 1000 person‐years. A decrease to 7.9 was seen from 2004 to 2009. We found no inverse correlation on a national level between the incidence rates of adenoidectomy and intranasal steroid, nor the introduction of the pneumococcal vaccine. The amount of intranasal steroids used in children in Denmark was negligible compared with adenoidectomy.

Impact of hyperlipidemia as a coexisting factor on the prognosis of idiopathic sudden sensorineural hearing loss: A propensity score matching analysis

23-12-2019 – Chengfang Chen, Mingming Wang, Hongya Wang, Wenping Xiong, Qinglei Dai, Baowei Wang, Xuhui Liang, Haibo Wang

Journal Article

Abstract
Objective
To define the impact of hyperlipidemia as a coexisting factor on the prognosis of Idiopathic Sudden Sensorineural Hearing Loss (ISSHL), we prospectively analysed the Lipid‐lowering therapy Group (LLTG) data compared with Control Group (CG) data to determine the effects of Lipid intervention on the prognosis of sudden hearing loss.
Design
A prospective, non‐randomized study.
Setting
Shandong Provincial Hospital Affiliated to Shandong University, Shandong, China.
Participants
A total of 653 in‐patient SSHL patients were enrolled between January 2014 to August 2018.
Main outcome measures
From January 2014 to August 2018, 653 patients with ISSHL who also had hyperlipidemia as coexisting factor were identified. Patients enrolled in LLTG (n = 200) or CG (n = 453) were compared by a propensity score matching analysis (PSM, caliper = 0.01, n = 2) to balance pre‐existing clinical characteristics. After matching, the effective rate of different hyperlipidemia types and different types of audiogram in both groups were performed by Cochran‐Mantel‐Haenszel test (CMH).
Results
After PSM, 440 patients were studied (146 in LLTG, 294 in CG), and the influence of interference factors was balanced, meanwhile, the final hearing level was better in LLTG than CG (P = .043), and hearing gain was higher in LLTG than CG (P = .006). Cure rate (32.9%), significant improvement rate (22.6%) and the total effective rate (76.0%) in LLTG were better than that in CG group (26.5%, 15.6% and 63.6%) after the Pearson chi‐square test (P < .05). Analysis with the Cochran‐Mantel‐Haenszel test showed that the total effective rate was better in LLTG than CG respectively (P = .009) in each different hyperlipidemia types, and there were statistically significant differences in TG higher group (TG Group; P = .018). Moreover, the total effective rate was better in LLTG than CG (P = .006) for all patterns of audiogram, and there were statistically significant differences in flat audiogram (P = .043).
Conclusions
Lipid‐lowering therapy can improve the curative effect of sudden hearing loss patients combined with hyperlipidemia. There was a significant difference in the total effective rate of TG Group after lipid intervention, suggesting that there might be causal relationship between TG and sudden hearing loss. There was a significant difference in the total effective rate between flat audiogram, which may suggest flat hearing loss was more likely caused by vascular dysfunction.

Role of matrix metalloproteinases and their inhibitors in the development of cervical metastases in papillary thyroid cancer

23-12-2019 – Boris Bumber, Marcel Marjanovic Kavanagh, Antonia Jakovcevic, Nino Sincic, Ratko Prstacic, Drago Prgomet

Journal Article

Abstract
Objective
To investigate the role of matrix metalloproteinases (MMPs) and their inhibitors (TIMPs) in the development of cervical metastases in papillary thyroid cancer. Our hypothesis is that level of expression of MMPs and TIMPs is associated with the development of cervical metastases and the pattern of metastatic process in papillary thyroid cancer.
Design
This research retrospectively investigates the expression of MMP‐1, ‐2 and ‐9 as well as TIMP‐1 and ‐2 in papillary thyroid carcinoma tissue. Tissue specimens were immunohistochemically treated with primary monoclonal antibodies against MMP‐1, MMP‐2, MMP‐9, TIMP‐1 and TIMP‐2.
Setting
Single‐centre study.
Participants
In total, samples of 159 patients were analysed. In all patients, total thyroidectomy was performed, whereas 102 patients underwent selective neck dissection of either central (level VI) or lateral neck (level II‐V). Subjects were divided into four groups.
Main outcome measures
Matrix metalloproteinases and TIMPs expression values were analysed in each group, and groups were compared to each other.
Results
Total number of patients was 159, of which 125 were women and 34 men. Comparing expression levels of MMPs and TIMPs in metastatic (study groups) and non‐metastatic (control group), papillary thyroid carcinomas yielded significant differences in MMP‐1 and TIMP‐1 expression levels, where the highest expression values were found in the group with metastasis in lateral neck. Expression levels of MMP‐2, MMP‐9 and TIMP‐2 did not differ statistically significant among the groups.
Conclusion
Elevated expression of MMP‐1 and TIMP‐1 in tumour tissue can be considered a predictive factor for the development of metastases.

Lymph node ratio as a prognostic marker in advanced laryngeal and hypopharyngeal carcinoma after primary total laryngopharyngectomy

23-12-2019 – Stefan Grasl, Stefan Janik, Thomas Parzefall, Michael Formanek, Matthaeus C. Grasl, Gregor Heiduschka, Boban M. Erovic

Journal Article

Abstract
Background
We evaluated the prognostic value of lymph node ratio (LNR) in patients with advanced laryngeal and hypopharyngeal squamous cell carcinoma.
Study Design
Retrospective chart review.
Methods
Between 1994 and 2018, 79 patients underwent total laryngopharyngectomy and adjuvant therapy. LNR was determined and statistically compared to patients’ overall survival (OS), disease‐specific survival (DSS), disease‐free survival (DFS), locoregional and distant failure.
Results
The 5‐year OS, DSS and DFS rates were 45.6%, 73.4% and 56.9%, respectively. 24.1% and 25.3% developed loco‐ regional failure or distant metastatic disease, respectively. Univariate analyses showed that high LNR (cut‐off >0.07) was significantly associated with distant and locoregional failure. On multivariate analysis, LNR remained an independent predictor for OS (P = .004), DSS (P = .009) and DFS (P = .044).
Conclusion
Increased LNR in patients with advanced laryngeal or hypopharyngeal carcinoma is significantly linked to shortened OS, DSS, DFS and higher locoregional and distant metastatic disease.

Shared decision‐making in older children and parents considering elective adenotonsillectomy

23-12-2019 – Amanda I. MacDonald, Jill Chorney, Michael Bezuhly, Paul Hong

Journal Article

Abstract
Objectives
Shared decision‐making describes a collaborative process in which healthcare providers and patients/families make treatment decisions using the best available evidence, while taking into account the patients values and preferences. The objectives of this study were to assess the level of decisional conflict and shared decision‐making experienced by older children and their parents when considering elective adentonsillectomies.
Design
A prospective cohort study.
Setting
Paediatric otolaryngology clinic in a teaching hospital.
Participants
Participants included 53 children older than 9 years and their parents who underwent consultation for tonsillectomy with or without adenoidectomy.
Main outcomes measures
Children and parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire‐Patient Version (SDM‐Q‐9). Surgeons completed the Shared Decision‐Making Questionnaire‐Physician Version (SDM‐Q‐Doc).
Results
Overall, 10 (19%) parents and 18 (34%) children reported clinically significant decisional conflict. Parents who opted not to proceed with surgery had significantly higher DCS scores than those who decided to proceed with surgery. Both parents and children SDM‐Q‐9 and total DCS scores were significantly negatively correlated. Physician SDM‐Q‐Doc and parent total DCS scores were negatively correlated, while parent and physician SDM scores were positively correlated.
Conclusions
Many older children and parents reported significant decisional conflict when considering elective paediatric otolaryngology surgery. Decisional conflict levels for both children and parents decreased with greater perceived levels of shared decision‐making. Older children did not appear to discern the same levels of shared decision‐making as parents and surgeons. Future research should assess methods to implement shared decision‐making into clinical practice for clinicians, parents and children when appropriate.

Differences in the diagnostic value between fiberoptic and high definition laryngoscopy for the characterisation of pharyngeal and laryngeal lesions: A multi‐observer paired analysis of videos

23-12-2019 – Constanze Scholman, Jeroen M. Westra, Manon A. Zwakenberg, Frederik G. Dikkers, Gyorgy B. Halmos, Jan Wedman, Jan E. Wachters, Bernard F.A.M. Laan, Boudewijn E.C. Plaat

Journal Article

Abstract
Objectives
High definition laryngoscopy (HDL) could lead to better interpretation of the pharyngeal and laryngeal mucosa than regularly used fiberoptic laryngoscopy (FOL). The primary aim of this study is to quantify the diagnostic advantage of HDL over FOL in detecting mucosal anomalies in general, in differentiating malignant from benign lesions and in predicting specific histological entities. The secondary aim is to analyse image quality of both laryngoscopes.
Design
Retrospective paired analysis with multiple observers evaluating endoscopic videos simulating daily clinical practice.
Setting
A tertiary referral hospital.
Participants
In 36 patients, both FOL and HDL videos were obtained. Six observers were provided with additional clinical information, and 36 FOL and HDL videos were evaluated in a randomised order.
Main outcome measures
Sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of observers using both flexible laryngoscopes were calculated for detection of mucosal lesions in general and uncovering malignant lesions. Sensitivities were calculated for prediction of specific histological entities. Image quality (scale 1‐10) was assessed for both flexible laryngoscopes.
Results
HDL reached higher sensitivity compared to FOL for detection of mucosal abnormalities in general (96.0% vs 90.4%; P = .03), differentiating malignant from benign lesions (91.7% vs 79.8%; P = .03) and prediction of specific histological entities (59.7% vs 47.2%; P < .01). Image quality was judged better with HDL in comparison with FOL (mean: 8.4 vs 5.4, P < .01).
Conclusions
HDL is superior to FOL in detecting mucosal anomalies in general, malignancies and specific histological entities. Image quality is considered as superior using HDL compared to FOL.

Standardised Ki‐67 proliferation index assessment in early‐stage laryngeal squamous cell carcinoma in relation to local control and survival after primary radiotherapy

23-12-2019 – Emiel Kop, Geertruida H. Bock, Maartje G. Noordhuis, Lorian Slagter‐Menkema, Bernard F. A. M. Laan, Johannes A. Langendijk, Ed Schuuring, Bert Vegt

Journal Article

Abstract
Objectives
Ambiguous results have been reported on the predictive value of the Ki‐67 proliferation index (Ki‐67 PI) regarding local control (LC) and survival after primary radiotherapy (RT) in early‐stage laryngeal squamous cell cancer (LSCC). Small study size, heterogenic inclusion, variations in immunostaining and cut‐off values are attributing factors. Our aim was to elucidate the predictive value of the Ki‐67 PI for LC and disease‐specific survival (DSS) using a well‐defined series of T1‐T2 LSCC, standardised automatic immunostaining and digital image analysis (DIA).
Methods
A consecutive and well‐defined cohort of 208 patients with T1‐T2 LSCC treated with primary RT was selected. The Ki‐67 PI was determined using DIA. Mann‐Whitney U‐tests, logistic and Cox regression analyses were performed to assess associations between Ki‐67 PI, clinicopathological variables, LC and DSS.
Results
In multivariate Cox regression analysis, poor tumour differentiation (HR 2.20; 95% CI 1.06‐4.59, P = .04) and alcohol use (HR 2.84, 95% CI 1.20‐6.71; P = .02) were independent predictors for LC. Lymph node positivity was an independent predictor for DSS (HR 3.16, 95% CI 1.16‐8.64; P = .03). Ki‐67 PI was not associated with LC (HR 1.59; 95% CI 0.89‐2.81; P = .11) or DSS (HR 0.98; 95% CI 0.57‐1.66; P = .97). In addition, continuous Ki‐67 PI was not associated with LC (HR 2.03; 95% CI 0.37‐11.14, P = .42) or DSS (HR 0.62; 95% CI 0.05‐8.28; P = .72).
Conclusion
The Ki‐67 PI was not found to be a predictor for LC or DSS and therefore should not be incorporated in treatment‐related decision‐making for LSCC.

Estimating vocal fold stiffness: Using the relationship between subglottic pressure and fundamental frequency of phonation as an analog

23-12-2019 – Wen‐Hsuan Tseng, Chi‐Chin Chang, Tsung‐Lin Yang, Tzu‐Yu Hsiao

Journal Article

Abstract
Objective
The stiffness of the vocal folds is an important factor in voice production, yet clinically applicable measurements are still lacking. It has been demonstrated in an in vivo canine model that fundamental frequency (F0) increased linearly as subglottic pressure (Ps) increased, but with a lesser slope for higher levels of vocal fold tension. In this study, the relationship between F0 and Ps was investigated using the airflow interruption method in awake patients non‐invasively.
Design
Healthy volunteers enrolled for evaluation.
Setting
Single‐centre.
Participants
Thirty‐three healthy volunteers aged 20 and older were recruited, with one excluded for a recent asthma attack.
Main outcome measures
The relationships between F0 and Ps, described as the slope (Hz/k
Pa), were investigated when the participants sustained voicing the vowel/o/at 3 incremental frequencies 4 semitones apart in the modal register (F1, F2 and F3).
Results
Thirty‐two healthy volunteers (20 females, 12 males) aged 20‐47 years were enrolled for final analyses. There was a statistically significant difference in the slopes of the linear regression lines of F0‐Ps, depending on the frequency with which the vowel/o/ was produced (P < .001). The slope differed significantly between F2 and F1 (P < .001; P = .015), F3 and F1 (P < .001; P = .002) and F3 and F2 (P < .001; P = .005) for both women and men, respectively.
Conclusions
It was demonstrated that the higher the vocal fold tension, the smaller the slope between F0 and Ps. Using the relationship between F0 and Ps as an analog of vocal fold stiffness is potentially practical for clinical application.

Increase in IL‐17‐positive cells in sinonasal inverted papilloma

23-12-2019 – Chen Cao, Si Fei Yu, Yu Tao Zhou, Xue Xue Guo, Jie Bo Guo, Chang You Wu, Chun Wei Li, He Xin Chen

Journal Article

Abstract
Objective
Neutrophil infiltration in patients with sinonasal inverted papilloma (SNIP) is significantly high. Whether IL‐17, which is a potent factor mediating neutrophilic inflammation, is involved in the neutrophilic phenotype of SNIP is investigated in the current study.
Study design
Laboratorial study.
Participants
Nasal papilloma and inferior turbinate were collected from patients with SNIP (n = 50) and control subjects with septal deviation (n = 15).
Methods
IL‐17 + cells were evaluated in tissues obtained from patients with SNIP and control subjects with septal deviation, by immunohistochemistry and flow cytometry.
Main outcome measures
The IL‐17 + cells were mainly localised in mononuclear cells and neutrophils, and were up‐regulated in the SNIP samples compared with those in the controls. The IL‐17 + T‐cell subsets mainly included CD4+ (Th17, 60.0%) and CD8+ (Tc17, 30.0%), and both subsets were enhanced in the SNIP samples than controls. The total level of IL‐17 + cells was significantly correlated with neutrophil infiltration in the SNIP tissues. Furthermore, the SNIP homogenates could significantly promote IL‐17 production in peripheral blood mononuclear cells.
Conclusions
An increase in IL‐17 + cells is evident in SNIP and may be involved in neutrophil infiltration in local tissues. IL‐17 could be a potential therapeutic target to relieve the neutrophilic pathological change in SNIP.

Impact of insurance on survival in patientsxa0<xa065 with head & neck cancer treated with radiotherapy

23-12-2019 – Mark P. Sittig, Michael Luu, Emi J. Yoshida, Kevin Scher, Alain Mita, Stephen L. Shiao, Diana J. Lu, Jon Mallen‐St. Clair, Allen S. Ho, Zachary S. Zumsteg

Journal Article

Abstract
Objectives
The United States has a heterogenous health insurance landscape for patients <65 years. We sought to characterise the impact of primary payer on overall survival (OS) in insured patients younger than 65 with head and neck squamous cell carcinoma (HNSCC) treated with definitive radiotherapy.
Design/Study/Participants
The National Cancer Database was queried for patients <65 years old diagnosed from 2004 to 2014 undergoing definitive radiotherapy ± chemotherapy for cancers of the nasopharynx, oropharynx, hypopharynx and larynx. Uninsured patients and oropharyngeal cancers without known HPV status were excluded.
Main outcome
Overall survival.
Results
Overall, 27 292 insured patients were identified, including 17 060 (62.5%) with private insurance. Median follow‐up was 52.1 months. In multivariable models, patients receiving Medicaid (HR = 1.66, 95% CI 1.57‐1.75, P < .001), Medicare (HR = 1.64, 95% CI 1.55‐1.73, P < .001) and other government insurance (HR = 1.44, 95% CI 1.29‐1., P < .001) had independently increased mortality in comparison to those with private insurance. In propensity score‐matched cohorts, 5‐year OS was 65.5% vs 50.6% for privately vs government‐insured patients, respectively (P < .001). In multivariable subgroup analysis, private insurance was associated with improved survival in all subgroups. However, the magnitude of this effect was most pronounced in patients with HPV‐positive oropharyngeal cancer vs non‐HPV‐related cancer (interaction P < .001), younger patients (interaction P = .001), and those without comorbidity (interaction P < .001).
Conclusions
Patients <65 with HNSCC undergoing definitive radiation with private health insurance have markedly longer survival relative to patients with government‐sponsored insurance. This illustrates that increasing access to care may be necessary, but is not sufficient, to mitigate the significant disparities in the US healthcare system.

Aetiopathology of paediatric neck masses in a tertiary hospital in Jazan Province, Saudi Arabia

23-12-2019 – Fahd Alharbi, Mohamed Rifaat Ahmed

Letter

Letter to the editor in reference to: “A web‐based prediction score for head and neck cancer referrals”

23-12-2019 – Theofano Tikka, Vinidh Paleri

Letter

Alternate method for designing laryngoplasty implant using actual size CT scan images on a touchscreen device with a stylus

23-12-2019 – Rohan Bidaye, Chadwan Al‐Yaghchi, Guri Sandhu

Letter

The outcome and decision‐making of extracapsular dissection for benign superficial lobe parotid tumours: Our experience in 144 patients

23-12-2019 – Ping‐Chia Cheng, Wu‐Chia Lo, Chih‐Ming Chang, Tsung‐Wei Huang, Po‐Wen Cheng, Li‐Jen Liao

Letter

Subclinical vestibular deficit in six‐canal video head impulse testing (vHIT) in patients with vestibular schwannomas

23-12-2019 – Hiteshkumar Tailor, Margaret Gaggini, Lorna Hastings, Richard Locke, John A. Crowther, Georgios Kontorinis

Letter

Endoscopic pharyngeal pouch stapling: A retrospective study of 55 patients comparing intubation difficulty and body mass index as factors for success

23-12-2019 – Sumrit Bola, Alexander Ashman, Stuart Winter

Letter

Our experience: Quantifying changes in tracheostomy tube position and orientation with repositioning of 14 patients (the Lunar positioning study)

23-12-2019 – Amali N. Chandrasena, Jay Goswamy, Nicholas Calder, Uzma Khalil, Brendan A. McGrath

Letter

Application of augmented reality to surgical practice: A pilot study using the ODG R7 Smartglasses

23-12-2019 – Michael Yong, Julie Pauwels, Frederick K. Kozak, Neil K. Chadha

Letter

Clinical Otolaryngology: Changing of the guard

23-12-2019 – James R. Tysome

Editorial

Issue Information

23-12-2019 –

Survival outcomes for head and neck cancer patients with N3 cervical nodal metastases

23-12-2019 – Jagdeep S Virk, Manasi Ingle, Christine M Podesta, Dorothy M Gujral, Zaid Awad

Journal Article

Abstract
Background
Management of metastatic N3 nodal disease from primary head and neck squamous cell carcinoma (HNSCC) is controversial. Recently, there has been a move to observation of the neck for those who achieve complete response (CR) after chemoradiotherapy (CRT). We sought to determine survival outcomes for N3 nodal disease, particularly for patients with human papilloma virus (HPV) positive HNSCC.
Methods
We carried out a systematic search of Medline and EMBASE for articles between 01/2008 and 12/2017. Articles on N3 nodal disease in HNSCC patients treated with CRT or surgery + adjuvant RT/CRT were included if they reported on oropharyngeal or HPV+ subgroups. Local control (LC), nodal control (NC), distant metastasis‐free survival (DMFS), disease‐free survival (DFS) or overall survival (OS) were assessed.
Results
Nine studies met the inclusion criteria. Eight of these studies (N=5304) allowed further comparison: 4 were on CRT, 2 on surgery + RT/CRT, and 2 on both. Four of these 8 studies and the remaining included study reported on residual nodal disease on histology after neck dissection (ND) following CRT.
Patients treated with CRT achieved LC rates of 77% ‐ 94% at 2‐3 years; those who had a CR had LC of >90%. Better NC was noted in patients who achieved a CR. Three‐year OS was better for HPV+ HNSCC (range 55.2% ‐ 81%). Patients with CR had better survival outcomes (DMFS 77% at 3 years vs 69.8% for HPV+; OS 68.9% at 3 years vs 55.2% for HPV+). Primary surgery demonstrated similar survival for HPV+ versus HPV‐, and better survival in oropharyngeal cancers. Five‐year DFS rates varied from 30% – 87%, and OS from 26.6% ‐ 84%. For patients with non‐CR, positive histology rates varied from 27.3% ‐ 100%, with average positive histology rates of 27.3% in HPV+ patients with non‐CR vs 60% for HPV‐ patients with non‐CR.
Conclusion
The current literature does not support the de‐escalation of treatment with HPV‐ N3 disease. Observation of HPV+ patients who achieve a CR post‐CRT is reasonable but further prospective studies are required given the heterogeneity and risk of bias within these current studies. Planned ND should remain standard of care for non‐CR cohort.

An unmet need: Patients with smell and taste disorders

19-12-2019 – Sally E. Erskine, Carl M. Philpott

Journal Article

Abstract
Objectives
There are large numbers of patients with olfactory disturbance in the UK and shortfalls in assessment and support amongst mainstream practice in both primary and secondary care leading to significant quality‐of‐life impairment and potential missed diagnoses. The aim of this study was to determine the key themes which can be identified from the accounts of anosmia sufferers and to identify important areas to target for future research or service development.
Design
Qualitative analysis of written patient accounts from patients corresponding with a tertiary smell and taste clinic in the UK. This qualitative study utilised unstructured written patient accounts from consenting patients experiencing olfactory disturbances received by the smell and taste clinic. Framework analysis was performed using Nvivo 10 software.
Setting
Tertiary smell and taste clinic.
Participants
Consenting patients who contacted the smell and taste clinic with accounts of their experiences.
Main outcome measures
Themes generated by qualitative analysis with Nvivo software.
Results
Accounts submitted by 71 participants were included in the analysis; age range 31‐80 years, 45 females, 26 males. Themes identified include negative emotional impact, feelings of isolation, impaired relationships and daily functioning, impact on physical health and the difficulty and financial burden of seeking help.
Conclusions
Olfactory disturbances have a wide‐ranging impact on the lives of sufferers, compounded by a lack of knowledge of the disorder amongst clinicians. There is a role for further support and education both for sufferers and for clinicians, as well as a need to improve our understanding of olfactory disturbance.

Balloon dilatation for paediatric airway stenosis: evidence from the UK Airway Intervention Registry

16-12-2019 – Steven Powell, Kim Keltie, Julie Burn, Helen Cole, Adam Donne, Gavin Morrison, Kate Stephenson, Mat Daniel, Sanjeev Gupta, Michelle Wyatt, Hannah Patrick, Andrew Sims

Journal Article

Abstract
Objectives
To assess the safety and efficacy in routine clinical practice of balloon dilatation procedures in the treatment of paediatric airway stenosis.
Design
Observational data collection in prospective online research database
Setting
Acute NHS Trusts with ENT department undertaking complex paediatric airway work
Participants: Children (<18) undergoing balloon dilatation treatment for airway stenosis.
Main outcome measuresairway diameter, complications, hospital resource usage.
Results59 patients had 133 balloon procedures during 128 visits to 10 hospitals. 69 (52%) of balloon procedures were conducted with a tracheostomy. Intra‐operative Cotton‐Myer grade decreased in 43 (57%). The mean pre‐balloon subglottic diameter was 4.2 95% CI: 3.8 to 4.5 mm and its rate of increase was 0.8 0.5 to 1.2 mm per year modelled on 30 patients’ long term data. As the primary treatment of stenosis, the procedural success rate of balloon dilatation (n=52) was 65% (22% with tracheostomy, 88% without tracheostomy), and 71% as an adjunct to open reconstructive surgery (n=7). In the 64 hospital visits where a balloon procedure was conducted with a tracheostomy in place only 1 in‐hospital complication (lower respiratory tract infection) occurred. For those without a tracheostomy in place, in‐hospital complications occurred in 7 of 64 balloon hospital visits, all related to ongoing or worsening stenosis. 6 out‐of‐hospital complications were deemed related to ongoing or worsening stenosis following the procedure and 2 complications were a combination of lower respiratory infection and ongoing or worsening stenosis.
Conclusions
Balloon dilation increases the size of the airway intraoperatively, and is associated with long term increase in airway diameter. Safety outcomes mostly relate to ongoing or worsening stenosis and are more common in patients without a tracheostomy.

Trends in incidence of cancer of oral cavity, oropharynx and hypopharynx in Taiwan: Data from the nationwide cancer registry, 1979‐2016

16-12-2019 – Yi‐Hsien Lin

Letter

Assessment of induction chemotherapy regimen TPF vs GP followed by concurrent chemoradiotherapy in locally advanced nasopharyngeal carcinoma: A retrospective cohort study of 160 patients

13-12-2019 – Hui Guan, Yan He, Zhigong Wei, Jingjing Wang, Ling He, Xiaoli Mu, Xingchen Peng

Letter

Long‐term swallowing outcomes following transoral surgery and adjuvant radiotherapy vs adjuvant chemoradiotherapy for oropharyngeal carcinoma: Our experience in 37 patients

13-12-2019 – Ashleigh Jane Ivy, Sarah Stephen, Diane Goff, Joanne Patterson, Laura Warner, Vinidh Paleri, Rebecca Goranova, Josef Kovarik, Ghazia Shaikh, Charles Kelly, James O’Hara, Shahid Iqbal, David Meikle

Letter

An audit of fifty patients receiving Artiss™ fibrin sealant in lateral selective neck dissections

13-12-2019 – Charles H. Earnshaw, Andrew J. Kinshuck, Christopher Loh, Sankalap Tandon, Shaun R. Jackson, Terry M. Jones, Jeffrey Lancaster

Letter

Predictors for failure of supraglottic superimposed high‐frequency jet ventilation during upper airway surgery in adult patients; a retrospective cohort study of 224 cases

12-12-2019 – Gyorgy B. Halmos, Charlotte M. A. Plate, Grita Krenz, Bouwe Molenbuur, Frederik G. Dikkers, Boukje A. C. Dijk, Jan E. Wachters

Letter

Intranasal trigeminal training in empty nose syndrome: A pilot study on 14 patients

11-12-2019 – Serge‐Daniel Le Bon, Mihaela Horoi, Olivier Le Bon, Sergio Hassid

Letter

Fusobacterium necrophorum, a major provider of sinus thrombosis in acute mastoiditis: A retrospective multicentre paediatric study

10-12-2019 – Aurélie Coudert, Julia Fanchette, Gaëlle Regnier, Justine Delmas, Eric Truy, Richard Nicollas, Mohamed Akkari, Vincent Couloignier, Sonia Ayari‐Khalfallah

Journal Article

Abstract
Objective
To evaluate in children the clinical severity and evolution of otogenic lateral sinus thrombosis (OLST) due to Fusobacterium necrophorum compared with other bacterial otogenic thrombosis and propose a specific management flowchart for Fusobacterium OLST.
Design
A retrospective multicentre cohort study.
Settings
Four French ENT paediatric departments.
Participants
A total of 260 under 18 years old admitted for acute mastoiditis were included. Initial imaging was reviewed to focus on complicated mastoiditis and 52 OLST were identified. Children were then divided into two groups according to bacteriological results: 28 in the “OLST Fusobacterium group” and 24 in the “OLST other bacteria group”.
Results
There was a significant association between F necrophorum and OLST (P < .001). When compared to the OLST other bacteria group, children in the OLST Fusobacterium group were significantly younger (61 months vs 23 months, P < .01) and had a more severe clinical presentation: higher CRP (113 mg/L vs 175.7 mg/L, P = .02) and larger subperiosteal abscess (14 mm vs 21 mm, P < .01). Medical management was also more intensive in the OLST Fusobacterium group than in the OLST other bacteria group: increased number of conservative surgeries (66.7% vs 92.9%, P = .03) and longer hospital stay (13.7 days vs 19.8 days, P = .02). At the end of follow‐up, the clinical course was good in both groups without any neurological sequelae.
Conclusions
Thrombotic complications are very frequent in case of Fusobacterium mastoiditis and clinicians should be aware of the initial severity of the clinical presentation. Under appropriate management, the clinical course of Fusobacterium OLST is as good as that of other bacterial otogenic thrombosis.

Our experience of a paediatrician‐led clinic for the medical management of children with obstructive sleep‐disordered breathing

09-12-2019 – Haytham Kubba, Katherine Rowe, Gideon Pinczower, Robert Sloane, Michelle Waterham, Emma Weiss, Rachel Harwood

Journal Article

Abstract
Background
Obstructive sleep‐disordered breathing (OSDB) is very common in children. Adenotonsillectomy is usually curative, but there is emerging evidence that topical nasal steroids can also be effective for some children and may avoid the need for surgery. The number of children referred for assessment of OSDB is increasing and in some departments, waiting times are long. We established a paediatrician‐led clinic for assessment and initial medical management of OSDB and in this study we report the proportion of children who avoided the need for surgery.
Method
Referral letters to the otolaryngology department were screened and those with suspected OSDB and no significant co‐morbidities were diverted to the paediatrician‐led clinic. We recorded data for a consecutive series of children seen in this clinic with suspected OSDB over a 3‐month period. Parents completed a 5‐item subset of questions from the OSA‐11 questionnaire before and after treatment with 6 weeks of topical nasal steroids.
Results
In the 3‐month study period, 103 children were seen, with a mean age of 6 (range 1‐16). Six (5.8%) had improved spontaneously before clinic attendance. Of the 97 children who were still symptomatic, 17 (17.5%) were referred directly for surgery on the basis of the severity of their symptoms, or because of other coexisting conditions that required surgical treatment (such as recurrent tonsillitis or otitis media). Three declined intranasal steroids. Seventy‐seven had a trial of intranasal steroids, of whom 34 (35%) reported enough improvement to avoid surgery, and 29 (28%) failed to improve and were referred for surgery. Fourteen (14%) failed to attend after the trial of steroids: of these, 5 (5%) were contactable by phone and confirmed improvement after topical steroids. OSA‐5 scores were significantly improved following intranasal steroids.
Discussion
A paediatrician‐led clinic can be an effective way to ease the workload of an over‐stretched otolaryngology service, and judicious use of topical nasal steroids can help around 40% of children with OSDB avoid surgery.

Sarcopenia Results in Poor Survival Rates in Oral Cavity Cancer Patients

26-11-2019 – Sheng‐Chiao Lin, Yaoh‐Shiang Lin, Bor‐Hwang Kang, Chun‐Hao Yin, Kuo‐Ping Chang, Chao‐Chuan Chi, Ming‐Yee Lin, Hsing‐Hao Su, Ting‐Shou Chang, Yun‐Ying She, Yu‐Hsi Liu, Ching‐Chih Lee

Journal Article

Abstract
Objective
This study aimed to determine the impact or survival of low skeletal muscle mass (SMM) among patients with oral squamous cell carcinoma (OSCC) undergoing primary surgery.
Design
This study was a retrospective cohort study.
Setting
OSCC patients treated at our referral center from April 2005 to March 2014 were examined.
Participants
The cohort comprised 276 patients with OSCC undergoing primary surgery.
Main outcome measures
Estimated SMM was measured by calculating the cervical skeletal muscle mass from a CT scan of the head and neck. The 5‐year overall survival (OS) and disease‐specific survival (DSS) were analyzed using a multivariable Cox regression model.
Results
There were 276 patients with a male‐to‐female ratio of 12:1. A low SMM (< 47.5 cm2/m2) was associated with worse survival. After adjustment for other factors, the result remained robust for OS (hazard ratio HR 1.74, 95% confidence interval CI 1.14‐2.67) and disease‐specific survival (HR 1.67, 95% CI 1.04‐2.67). In the subgroup analysis, worse OS and DSS was particularly noted in male patients (HR = 1.90, 95% CI 1.22‐2.97; HR = 1.91, 95% CI 1.27‐3.19) and in those younger than 60 years of age (HR = 1.91, 95% CI 1.14‐3.22; HR = 2.12, 95% CI 1.23‐3.64) with low SMM.
Conclusions
Low SMM was a significant independent factor that was associated with lower survival in patients who have oral cavity cancers and are undergoing primary surgery. Preoperative CT scans of the head and neck could be utilized to evaluate SMM, predict treatment outcomes, and facilitate nutrition management.

Evolution of impedance values in two different electrode array designs following activation of cochlear implants 1xa0day after surgery: A study of 58 patients

08-04-2019 – Hao‐Chun Hu, Joshua Kuang‐Chao Chen, Lieber Po‐Hung Li, William Kuan‐Hua Chen, Mei‐Jui Huang, Chia‐Hsin Yeh, Li‐Ching Chen, Tao‐Hsin Tung