OBJECTIVES

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HYPOTHESIS:

To evaluate the long-term outcome of patients with vocal fold nodules treated by surgery alone, or by a combination of surgery and voice therapy and to identify factors associated with long-term recurrent dysphonia.

STUDY DESIGN:

Retrospective study.

METHODS:

All patients who had undergone surgery for vocal fold nodules in a tertiary care hospital between 1996 and 2006 were contacted. After giving their consent, they were evaluated by videostroboscopic examination of vocal fold nodules and by a subjective questionnaire including the Voice Handicap Index (VHI).

RESULTS:

Sixty-two out of 90 patients (69%) (60 women, 2 men with a mean age of 33 years) answered the questionnaire at a mean interval of 9.5 years after surgery. Recurrent dysphonia was observed in 19 patients (30%) at a mean interval of 5.2 years after surgery and new benign vocal fold lesions (nodules or Reinke's edema) were observed in 11 patients (18%). Absence of postoperative voice therapy was significantly associated with a higher recurrence rate (P = 0.02) (56% of recurrent dysphonia without voice therapy versus 22% with voice therapy).

CONCLUSIONS:

Postoperative voice therapy decreases the risk of recurrence. Vocal fold nodules can recur over a period of 5 years, consequently requiring follow-up for at least 5 years in clinical practice and in future prospective studies.

LEVEL OF EVIDENCE:

2b (Individual retrospective cohort study). Laryngoscope, 2013.

Objective:

To identify or confirm any new or suggested independent histopathological predictors in Merkel cell carcinoma (MCC) of the head and neck (HN) correlated with outcome.

Study design:

Retrospective chart and pathology review.

Methods:

Between 1990-2010, 58 patients with HNMCC were identified for study. Pathologic specimens were reviewed and evaluated for independent prognostic factors and correlated with locoregional recurrence and disease specific survival.

Results:

The 2- and 5-year disease-specific survival (DSS) rates were 72.7%, and 63.6%, respectively. The local and regional recurrence rates were 12.0% and 24.1%, respectively. 25.9% of the patients developed distant metastases during follow-up. Tumor size (<1cm vs. >1cm) and the presence of a positive deep resection margin were independently found to be significantly associated with regional recurrence (p=0.01, and p=0.04, respectively). No other prognostic factors could be identified.

Conclusion:

Adjuvant radiotherapy cannot remediate a positive resection margin. Given these results consideration for revision surgery should be considered for a positive deep margin. Frozen section analysis may help to define the margins in this invasive and aggressive disease.

We report a case of a 24-year-old male with a history of allergic fungal sinusitis, who experienced an intraoperative retroorbital fluid dissection after frontal minitrephine placement. Although minitrephination of the frontal sinus is a useful technique that is frequently employed during endoscopic sinus surgery it has potential complications. The purpose of this report is to discuss a previously unreported complication of frontal minitrephination and its management.

Objective/Hypothesis: Acinic cell carcinoma (AciCC) is a rare salivary gland malignancy that most commonly arises in the parotid gland. Characteristics of AciCC are slow-growth and a long clinical course. As a rare tumor, population based studies are limited. We analyzed the incidence and survival for AciCC using a national population-based database.

Study Design:

Retrospective analysis.

Methods:

The United States National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) registry was utilized to calculate incidence and disease-specific survival trends for AciCC between 1973 and 2009. Patient data were stratified according to age, gender, race, grade, and extent of disease. Incidence trends were studied across the last 30 years and long-term disease specific-survival outcomes were compared across the different demographic parameters.

Results:

1,129 cases of AciCC were identified, comprising of 672 (59.52%) females. Incidence trend analysis revealed significant changes in yearly incidence rates from1973 to 2009 for male gender and white and "others" races. Overall 5-year survival was 97.15%, 10-year was 93.81%, and 20-year was 89.74%. Significant differences in survival outcomes were noted for extent of disease. Patients exhibiting distant metastasis displayed the worse long-term prognosis at 21.99% 20-year disease-specific survival. Hazard ratios demonstrated a significant increase in mortality in patients with poorly differentiated, undifferentiated, and metastatic disease.

Conclusion:

Trends in incidence of AciCC are influenced by gender, race and age. Long-term survival of this rare malignant tumor is influenced by gender, grade, race, and extent of disease. Future studies need to be conducted to investigate these dynamic trends related to AciCC.

OBJECTIVES

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HYPOTHESIS:

Childhood obesity, defined as body mass index (BMI) ≥ 95%, is a significant health problem associated with a variety of disorders, and in adults it has been found to be a risk factor for hearing loss. We investigated the hypothesis that obese children are at increased risk of sensorineural hearing loss (SNHL).

STUDY DESIGN:

A complex, multistage, stratified geographic area design for collecting representative data from noninstitutionalized U.S. population.

METHODS:

Relevant cross-sectional data from the National Health and Nutrition Examination Survey, 2005 to 2006, for 1,488 participants 12 to 19 years of age was examined. Subjects were classified as obese if their BMI ≥ 95th percentile. SNHL was defined as average pure-tone level greater than 15 dB for 0.5, 1, and 2 kHz (low frequency) and 3, 4, 6, and 8 kHz (high frequency).

RESULTS:

Compared to normal weight participants (BMI 5%-85%), obesity in adolescents was associated with elevated pure tone hearing thresholds and greater prevalence of unilateral low-frequency SNHL (15.2 vs. 8.3%, P = 0.01). In multivariate analyses, obesity was associated with a 1.85 fold increase in the odds of unilateral low-frequency SNHL (95% CI: 1.10-3.13) after controlling for multiple hearing-related covariates.

CONCLUSIONS:

We demonstrate for the first time that obesity in childhood is associated with higher hearing thresholds across all frequencies and an almost 2-fold increase in the odds of unilateral low-frequency hearing loss. These results add to the growing literature on obesity-related health disturbances and also add to the urgency in instituting public health measures to reduce it.

LEVEL OF EVIDENCE:

2b. Laryngoscope, 2013.

Objective:

The incidence of human papillomavirus (HPV)-positive head and neck cancers (HNCs) is increasing sharply worldwide, whilst their HPV-negative counterparts are showing a decreased frequency. However, epidemiologic data related to these changes are sparse in Korea, which is rapidly adopting more westernized lifestyles.

Study design:

Data from the Korea Central Cancer Registry, a nationwide population-based cancer registry from 1999 to 2009 were retrieved.

Methods:

Age-standardized rates (ASRs), their annual percent changes (APC) and male-to-female incidence rate ratios (IRRs) were analyzed and compared between HPV-related and HPV-unrelated primary sites.

Results:

HPV-related sites (oropharynx) had increased significantly over the period 1999-2009 (APC=2.35%, P=0.017), particularly in young men (30-59 years, APC=2.65%, P=0.031), whereas HPV-unrelated sites such as larynx and hypopharynx, decreased markedly in both sexes. Interestingly, tongue cancer was found to have increased gradually (APC=2.35%, P=0.003) in both sexes. The male-to-female IRRs and the median age of occurrence remained stable.

Conclusions:

Although the cultural and ethnic background differs from the United States, cancers of HPV-related sites are increasing in Korea, whereas cancers of HPV-unrelated sites are decreasing, which is similar to the trends observed in the United States. Greater public awareness in Korea of HPV-related HNCs is therefore warranted.

Objective:

Vocal fold hemorrhage is an acute phonotraumatic injury treated with voice rest; recurrence is a generally accepted indication for surgical intervention. This study aims to identify factors predictive of recurrence based on outcomes of a large clinical series.

Study Design:

Retrospective cohort

Methods:

Retrospective review of cases of vocal fold hemorrhage presenting to a university laryngology service. Demographic information was compiled. Videostroboscopic exams were evaluated for hemorrhage extent, presence of varix, mucosal lesion, and/or vocal fold paresis. Vocal fold hemorrhage recurrence was the main outcome measure. Follow-up telephone survey was used to complement clinical data.

Results:

Forty-seven instances of vocal fold hemorrhage were evaluated (25M:22F; 32 professional voice users). 12 of the 47 (26%) patients experienced recurrence. Only the presence of varix demonstrated significant association with recurrence (p=0.0089) on multivariate logistic regression.

Conclusion:

Vocal fold hemorrhage recurred in approximately 25% of patients. Varix was a predictor of recurrence. Monitoring, behavioral mamanagement and/or surgical intervention may be indicated to treat patients with such characteristics.

OBJECTIVE:

Large defects secondary to oral cancer resection are reconstructed with microsurgical free flaps. Pulmonary complications in these patients are common. Post-operative mobilization is recommended to decrease respiratory complications however many microsurgeons are reluctant to adopt early mobilization protocols due to the perceived risk of flap compromise. The purpose of this study was to determine the incidence of pneumonia among patients undergoing oral cancer resection and immediate free flap reconstruction and to compare the incidence of this complication between patients mobilized early (<4 days post-op) versus later. A secondary goal was to determine whether early postoperative mobilization affected microvascular flap outcome.

STUDY DESIGN:

Retrospective cohort study.

METHODS:

Sixty-two consecutive patients treated between 2005-2009 with oral carcinoma resection and free flap reconstruction were studied. Information pertaining to comorbidities, postoperative care, and complications were collected. Risk factors for development of pulmonary and flap complications were analysed.

RESULTS:

The incidence of pneumonia was 30.6%. Longer ICU stay (p=0.01), tracheostomy decannulation later than 10 days (p=0.04) and longer operative times (p=0.04) were significantly associated with pneumonia. Delayed mobilization (after day 4 postop) was an independent risk factor for pneumonia (OR=4.2, 95% CI: 1.1, 17.1). Early mobilization (before day 4 postop) was not associated with an increased incidence of secondary flap procedures or flap failure.

CONCLUSION:

Late mobilization of free flap patients is an independent risk factor for developing post-operative pneumonia. Earlier mobilization does not increase flap failure rates, is safe, and should be strongly considered in all free flap patients to reduce pulmonary complications.