Long-term results of open cordectomy for the treatment of T1a glottic laryngeal carcinoma

Objective

To assess the long-term results and prognostic factors in patients who have undergone open cordectomy (OC) for the treatment of T_1a glottic laryngeal carcinoma.

Methods

One hundred four epidermoid cancer patients operated from January 1989 through December 1999 were included in the study. Clinical parameters, postoperative complications, and postoperative stay were retrospectively evaluated in all cases.

Results

Mean survival for the patients included in the study was 61.5 ± 24.8 months after the date of operation (range: 11–121 months). Ninety-four patients did not have recurrent tumor (90.4%). Local, regional and distant recurrence were linked with a statistical negative impact on survival rates (p < 0.05). Only sero-hematoma was significantly related to local recurrence (p < 0.05), whereas the remainder complications did not. None of the complications was associated with neck recurrence or distant metastasis (p > 0.05).

Conclusions

Open cordectomy is nowadays a valid technique for the surgical treatment of T_1a glottic laryngeal carcinoma. Its results are comparable with those of other more recent techniques.     

Management of laryngeal precancerous lesions

Objective

The identification of precancerous lesions is the basis of an early diagnosis, and of a treatment that allows, in the great part of cases, the preservation of organ functions. The aims of this study were: the evaluation of the less invasive treatment for precancerous lesion of the larynx to minimize the recurrences, the estimation of number of further operation required.

Methods

A prospective study was done on patients with clinical diagnosis of laryngeal precancerosis. The patients were treated by a transoral endoscopic approach with direct microlaryngoscopy (DML) doing an excision-biopsy with cold blade, consisting in excision of the whole visible lesion with vocal ligament preservation.

Results

A recurrence of a clinically evident precancerous lesion was present in 13.2% of patients that had a laryngeal intraepithelial lesion (LIN) 1 lesion and in 28.95% of patients that had a LIN 2 lesion.

Conclusion

In order to achieve a control of a precancerous lesion, we suggest: excisional biopsy/subepithelial cordectomy (type 1 cordectomy) for LIN 1 lesions and subligament cordectomy (type 2 cordectomy) in case of LIN 2 cases. In case of recurrences of LIN 1 lesion we suggest directly a type 2 cordectomy.     

Clinical outcome of early glottic carcinoma in Serbia

Objective

Proposed methods for treating early glottic carcinoma are cordectomy through laryngofissure, laser cordectomy, and radiotherapy. The aim of the study was to conduct comprehensive study to evaluate oncological and functional results of different treatment modalities for Tis and T1 glottic carcinoma, identify prognostic factors for the outcome of treatment and decide where we stand in applying worldwide standards of early glottic carcinoma treatment.

Methods

Prospective study was conducted on 221 patients treated with Tis and T1 glottic carcinoma from 1998 to 2003 (72 patients were treated endoscopically with CO₂ laser, 75 patients with cordectomy through laryngofissure and 74 with radiotherapy), with follow-up period from 38 to 107 months. Important demographic and clinical variables were analyzed. Voice quality after the treatment was assessed using multidimensional voice analysis.

Results

Comparing oncological results of three modalities of treatment, there were no significant differences. Functional results of treatment were better after laser cordectomy and primary radiotherapy than following the open cordectomy. Five-year survival rate was almost identical in all three groups of patients, and important prognostic factors for survival were age and histological grade of the tumor.

Conclusion

Considering that the choice of treatment in our country is also greatly influenced by other paramedical factors, such as distance from treatment facility, reliability of follow-up, significant time delay of radiotherapy because of small number of radiology centers and strong patients’ surgeon and treatment preference, we consider endoscopic laser surgery highly efficient and preferred choice of treatment for early glottic carcinoma.     

Diagnosis of congenital cervical cysts using carcinoembryonic antigen levels in cyst fluid

Objective

To investigate whether carcinoembryonic antigen (CEA) levels in the fluid of median or lateral cervical cysts can improve diagnosis.

Methods

Cyst fluid CEA levels in 10 cases of median cervical or lateral cervical cysts based on pathological diagnoses (congenital cervical cyst group) were measured. These results were compared with the CEA levels of the control group comprising 10 cases of other head and neck cyst disorders.

Results

The CEA levels in nine out of ten cases in the congenital cervical cyst group were ≥10,000 ng/mL. The CEA level in the remaining case was 8290 ng/mL. In contrast, the CEA levels were low in the control group (>1000 ng/mL). The optimal cut-off level between these groups was 8290 ng/mL in the receiver operating characteristic curve (p < 0.01).

Conclusion

Cyst fluid CEA levels may assist in the diagnosis of median and lateral cervical cysts.     

p53 expression in concurrent chemoradiotherapy with docetaxel for head and neck squamous cell carcinoma

Background

The current study aimed to evaluate the significance of an immunohistochemical assessment of tumor suppressor p53 as a prognostic marker in head and neck squamous cell carcinoma (HNSCC) patients treated with docetaxel and radiotherapy.

Methods

The expression of tumor suppressor p53 and its phosphorylated form at the Ser392 residue was retrospectively evaluated by immunohistochemistry in 51 Stage T1-3N0-2M0 (except T1N0 glottis) HNSCC patients who were treated with 10 mg/m²/week docetaxel four to six times and received concurrent chemoradiotherapy.

Results

Kaplan–Meier univariate analysis revealed that no difference in rates for overall and disease-free survival (DFS) between patients with p53-positive and -negative tumors (p = 0.786 and p = 0.924, respectively). The prognostic significance of phosphorylated p53 at the Ser392 residue was neither observed.

Conclusions

An immunohistochemical assessment of the expression of p53 and its phosphorylated form might not be of clinical use in defining subgroups of patients with poor prognosis.     

Rotation vectors of slow and quick phase of caloric nystagmus

Objective

The purpose of this study was to elucidate the rotation axes of the slow and quick phase of the caloric nystagmus using the video-oculograhic technique.

Methods

Subjects were placed in a supine position and cold-water stimulation was applied to the right ear canal. The eye movements were recorded in complete darkness by a high-speed infrared CCD camera. The sampling time of the camera was 132 Hz with 640 × 480 effective pixels.

Results

The rotation vectors were calculated from the printed-out chart of the 3D analysis data of the caloric nystagmus. The directions of the rotation vector of the quick phase of the nystagmus were almost opposite to those of the slow phase. The average planer equations of the slow and quick phase of the nystagmus in all subjects were 0.399x + 0.1477y − 0.8656z = 0 and −0.3970x − 0.1940y + 0.8559z = 0, respectively.

Conclusion

We demonstrated that the slow phase and quick phase of the vestibular nystagmus are along with the same axes in human subjects.     

Patterns of intracranial hemorrhage in petrous temporal bone fracture

Objective

To study the relationship pattern of intracranial hemorrhage in cases of traumatic petrous temporal bone fracture.

Methods

All head injury cases admitted to the Emergency Department, Hospital Tengku Ampuan Afzan, Pahang, Malaysia in 2008 were assessed. Computerized tomography (CT) scan of the skull base was performed in indicated cases. Patients with a petrous temporal bone fracture were included in the study. Subsequent magnetic resonance imaging (MRI) was performed. Intracranial hemorrhages incidence, management and outcome were recorded.

Results

From 1421 cases of head injury, 49(3.4%) patients were diagnosed to have a petrous bone fracture from the CT scan. Only 46 cases underwent MRI scan and were included in this study. Of these, 36(78.3%) cases had associated intracranial hemorrhages (p < 0.01). Intracranial hemorrhage was associated with the longitudinal types of petrous fracture (p < 0.05). Subdural hematoma was the most prevalent type of bleed (55.6%). There was no association between the types of intracranial bleeding (extradural, subdural, subarachnoid or intracerebral hemorrhage) and the types of petrous bone fracture (longitudinal, oblique or transverse). The mortality rate was 17.4%. The mortality cases were associated with the presence of other skull bone fractures (p < 0.05).

Conclusions

Petrous fracture is significantly associated with intracranial hemorrhage. There was no association between the types of petrous fracture and the types of intracranial hemorrhages in our material.     

Reduced E-cadherin expression is associated with lymph node metastases in laryngeal squamous cell carcinoma

Objective

To investigate the expression of E-cadherin and its relationship with clinicopathological parameters in laryngeal squamous cell carcinoma (LSCC).

Methods

Sixty-four patients who had previously undergone complete resection of tumor for LSCC were studied retrospectively. The level of E-cadherin expression in tumor tissues and paired nontumor tissues were determined by immunohistochemistry.

Results

The expression of E-cadherin in tumor tissues was significantly lower than nontumor tissues (P < 0.001). Reduced E-cadherin expression was significantly correlated with lymph node metastases (P < 0.001). Kaplan–Meier survival estimates showed a significant correlation between E-cadherin expression and patient survival rate (log-rank P < 0.05). Multivariate Cox proportional hazards model analysis confirmed that lymph node metastases (P = 0.001) and tumor stage (P = 0.013) were statistically significant, independent predictor of prognosis.

Conclusion

Expression of E-cadherin is an independent predictor of lymph node metastases in LSCC. However, it does not appear to be a better prognostic predictor than other established markers in LSCC.     

The first case of osteoma in the false vocal fold

Objectives

This article reports the first evidence of a larynx osteoma of the false vocal fold.

Study design

Case report and literature review.

Methods

Case report and review of previously published cases of larynx osteomas.

Results

A 79-year-old patient was referred to our institution for dysphagia and hoarseness. Fibrolaryngoscopy showed a regular surface tumefaction of the false fold and the left ventricle, with preserved cordal motility. Patient underwent direct laryngoscopy with CO₂ laser excision of the lesion. Pathologic examination of the lesion (1.6 cm × 1 cm) showed features consistent with an osteoma. Complete regression of symptoms was observed after surgery, with no lesions found on routine 1-year follow-up.

Conclusions

Osteomas are benign, slow growing tumors of the craniofacial bone area, very rarely located in the larynx. Although the etiology is unknown, accepted theories point to embryologic, post-traumatic and infectious causes. Surgical excision is indicated only in symptomatic cases. This case report is the fourth evidence of laryngeal osteoma and, to our knowledge, the first finding of a false vocal fold osteoma.     

Plasma antidiuretic hormone in cases with the early onset of profound unilateral deafness

Objective

The p-ADH level in cases of juvenile unilateral profound deafness (JUPD) and the timecourse of the level were examined to investigate whether or not an increase of p-ADH is involved in the development of delayed endolymphatic hydrops (DEH) in JUPD.

Materials and methods

In 90 consecutive patients with unilateral profound or total sensorineural deafness with the onset in early childhood, pure-tone audiometric examination and the measurement of p-ADH and plasma osmolality (p-OSM) were followed up once or twice a year as far as possible. At every testing, we performed careful history-taking about episodic vertigo/dizziness, fluctuant hearing loss, and tinnitus in order to find out whether patients had experienced these clinical signs of the development of DEH.

Results

Means and standard deviation (S.D.) of p-ADH level and osmolality in all samples tested (n = 368) were 7.3 ± 7.0 pg/mL (0.7–52.0 pg/mL), and 288.6 ± 4.4 mOsm/L (273–306 mOsm/L), respectively. The mean of p-ADH level was much higher than those previously reported in children and adolescents. High levels of p-ADH (over 5.0 pg/mL) were often observed in subjects between 6 and 19 years of age, but not so frequently in subjects of 20 years of age or older. Long-term follow-up of p-ADH levels revealed that DEH frequently developed in cases with persistent elevation of p-ADH.

Conclusions

The elevation of p-ADH is likely to promote the development of DEH in cases of JUPD, although the underlying mechanism remains to be elucidated.     

Bacterial biofilms in chronic rhinosinusitis and their relationship with inflammation severity

Aims

To identify the presence of bacterial biofilms on mucosal specimens from chronic rhinosinusitis (CRS) patients, and evaluate their relationship with severity of CRS.

Methods

A prospective study of biofilms presence on 24 CRS patients compared with 12 controls was designed. The presence of biofilms was determined by scanning electron microscopy (SEM), and associations with the preoperative Lund–MacKay CT scores, Johansson endoscopic scores, and the history of ESS were assessed.

Results

Biofilms were found in 13/24 CRS patients (54.2%) but in only 1/12 controls (8.3%; P < 0.01). CRS patients with and without biofilms had similar preoperative Lund–MacKay CT and Johansson endoscopic scores (P > 0.05). Patients with revision ESS showed a tendency of higher biofilms incidence (5/7, 71.4%) than those undergoing their first procedure (8/17, 47.1%), but did not reach a significant difference (P > 0.05).

Conclusions

The higher incidence of biofilms in CRS patients suggests a role in the pathogenesis of CRS, but no correlation with severity of CRS.     

The Korean version of the Sniffin' stick (KVSS) test and its validity in comparison with the cross-cultural smell identification test (CC-SIT)

Objective

The Korean Version of the Sniffin’ stick (KVSS) is the first olfactory test for Koreans. Although we adopted the Sniffin’ Stick, we modified it to make it more suitable for Koreans. KVSS I is a screening test, and KVSS II a more comprehensive test. The aims of this study were to apply the KVSS test and assess its clinical validity and reliability in comparison to CC-SIT.

Methods

One hundred and seventy-four healthy volunteers and 206 patients with subjective decreased olfaction participated. Each participant was tested with both the CC-SIT and KVSS tests and then the correlation between these two tests was analyzed.

Results

The correlation between CC-SIT and KVSS I was 0.720 (p < 0.01) and 0.714 between the CC-SIT and KVSS II total scores (p < 0.01). When the degree of olfaction based on the KVSS I was used, the mean CC-SIT score was 8.6±1.8 for normosmia, 7.3±2.2 for hyposmia, and 4.2±2.3 for anosmia. When the KVSS II total was applied, the mean CC-SIT score was 8.4±1.8 for normosmia, 7.3±2.0 for hyposmia, and 3.7±2.0 for anosmia. The means of the three group differed significantly in both cases (p < 0.01).

Conclusion

Thus, the KVSS test demonstrates validity and reliability for Korean in comparison with CC-SIT.     

Long-term evaluation after endoscopic sinus surgery for chronic pediatric sinusitis with polyps

Objective

Long-term retrospective evaluation was performed of computed tomography (CT) images and endoscopic findings after endoscopic sinus surgery for 88 cases of chronic pediatric sinusitis with nasal polyps. The objective was to determine the appropriate duration of such postoperative evaluation for children.

Methods

Fifty-one patients had both sinusitis and nasal polyps (BSP group), and the surgical procedure was decided in consideration of each patient's age (for less than 10 years of age, polypectomy (n = 12); for 10–13 years old, anterior ethmoidectomy plus opening of the fontanelle and nasofrontal duct (n = 20); and for serious cases older than 13 years, total sinusectomy (n = 19)). On the other hand, for cases of unilateral sinusitis with antrochoanal polyps (USP group), anterior ethmoidectomy plus opening of the fontanelle was performed regardless of the patient's age (n = 37, 5–15 years old).

Results

The postoperative endoscopic findings indicated that the polyps had been eliminated in approximately 91% of total patients. Good postoperative findings of CT images in most patients of USP group are observed at one year after the operation like the same of the postoperative course of adult chronic sinusitis. On the other hand CT images in BSP group evaluated one year after the operation were rated as unchanged or worsened in approximately half of the patients. However, at 4 years after the operation nearly all the patients were rated as improved or better. In addition, comparison of the age at final observation and the postoperative course found a striking decrease in the proportion of unchanged and worsened patients aged 12 and above.

Conclusion

Accordingly, it was concluded that there is difference of healing process after the operation between USP and BSP group. Postoperative evaluation of BSP group should be performed for 4 years and up to an age of at least 12 years although post-ESS following of USP group is similar to that of adult sinusitis.     

A scoring system for management of acute pharyngo-tonsillitis in adults

Objectives

The aim of this study was to develop and evaluate a scoring system for the management of acute pharyngo-tonsillitis.

Methods

We conducted a prospective study between May 2004 and June 2005. Patients with acute pharyngo-tonsillitis were evaluated for causative pathogens and were assessed clinical symptoms and pharyngo-tonsillar finding by a clinical scoring system.

Results

A total 214 adult patients were enrolled in this study. Streptococcus pyogenes were identified at 13.6%. Thirty-one viruses were also identified by PCR. They were adenovirus (4.8%), influenza virus (1.0%), RS virus (6.3%), and human metapneumovirus (2.9%). Numbers of total white blood cells and levels of C-reactive protein showed a significant positive correlation with clinical scores (p < 0.001) and were also higher in cases with S. pyogenes. The clinical scores rapidly improved after the antimicrobial treatments in moderate cases and severe cases.

Conclusion

The current study strongly suggested that the clinical scoring system reflected disease severity well and would be very useful for evaluating clinical course and decision making for the antimicrobial treatment of acute pharyngo-tonisllitis.     

The efficiency of Nose Obstruction Symptom Evaluation (NOSE) scale on patients with nasal septal deviation

Objective

The aim in this study was to evaluate the efficiency of Nasal Obstruction Symptom Evaluation (NOSE) scale for septoplasty (without turbinate reduction) in comparison with other examination methods.

Methods

Prospective observational study was undertaken in otolaryngology department of university hospital. NOSE scale for quality of life assessment, visual analog scale for examination findings, acoustic rhinometry and coronal computed tomography were performed before and after septoplasty. The efficiency of NOSE scale to assess for septoplasty results and the correlation between NOSE scores and other techniques was analyzed.

Results

Twenty-seven patients underwent septoplasty; there was a very significant improvement in mean NOSE scores of patients (60.2 versus 11.28, p < 0.01). There was no correlation between NOSE scores and acoustic rhinometry. Correlation was found between NOSE scores and examination and computed tomography findings (p < 0.05).

Conclusion

NOSE scale that is well correlated with examination findings and computed tomography, is very useful tool to evaluate the effectiveness of pure septoplasty.     

Effects of benign parotid tumors on unstimulated saliva secretion from the parotid gland

Objective

Salivary tumors can manifest as abnormalities of the gland itself and/or changes in salivary flow. However, effects of salivary tumors on saliva secretion have not been studied in much detail. The aim of the present study was to evaluate effects of benign parotid tumors on unstimulated saliva secretion from the affected gland.

Methods

Unstimulated parotid saliva was collected bilaterally using the swab method in patients with unilateral pleomorphic adenoma (n = 14) or Warthin's tumor (n = 6). Pre-weighted cotton rolls were placed at the opening of each parotid duct for 15 min.

Results

The range of salivary flow was similar to that found in studies on unstimulated parotid saliva. Salivary flow did not differ between the involved and non-involved side. No difference was found between the involved and non-involved side when the patients with pleomorphic adenoma or Warthin's tumor were separately analyzed.

Conclusion

The present results suggest that the most common benign parotid tumors do not alter unstimulated salivary flow from the affected gland.     

Re-implantation of the Rion E-type semi-implantable hearing aid: status of long-term use and hearing outcomes in eight patients

Objectives

The Rion Ehime (E)-type implantable hearing aid (IHA) is the first middle ear implant. We implanted 39 IHAs into 39 patients, and found that the IHA functioned well for >15 years. So far, 28 IHAs have been removed because they stopped functioning. An IHA was re-implanted in 8 of the 28 cases. This study assessed the status of long-term use and hearing outcomes in the eight patients to confirm the safety and advantages of repeated implant operation.

Methods

Current status and operational findings of the eight re-implantees and hearing outcomes were investigated by reviewing the patients’ records.

Results

Four of the eight cases still use their devices; all four originally suffered from cholesteatoma. In the remaining four cases, the devices stopped functioning 2.4–9.4 years after re-implantation; they suffered from chronic otitis media. Preoperative air and bone conduction hearing and IHA hearing 3 months after the first implantation were 61.1 ± 13.1 dB, 40.6 ± 11.3 dB, and 26.9 ± 10.5 dB, respectively (n = 8). At the time of removal, they were 59.4 ± 12.4 dB, 40.2 ± 14.2 dB, and 42.9 ± 14.9 dB, respectively. Three months after re-implantation, they were 60.4 ± 14.6 dB, 37.3 ± 14.7 dB, and 29.4 ± 13.4 dB, respectively.

Conclusions

Re-implantation of an IHA is beneficial and safe for patients. As the absence of active inflammation has a crucial effect on the period of use, re-implantation should be judged carefully after deterioration of the initial implant.     

Quantitative measurement of radiofrequency volumetric tissue reduction by multidetector CT in patients with inferior turbinate hypertrophy

Objective

To objectively assess the efficacy of radiofrequency thermal ablation of inferior turbinate hypertrophy.

Methods

Thirty-five patients with nasal obstruction secondary to inferior turbinate hypertrophy were prospectively enrolled. Radiofrequency energy was delivered to four sites in each inferior turbinate. Patients were evaluated before and 8 weeks after intervention. Subjective evaluation of nasal obstruction was performed using a visual analogue scale (VAS), and objective evaluation of the turbinate volume reduction was calculated using multidetector CT. Volumetric measurements of the preoperative inferior turbinate were compared with postoperative values on both sides.

Results

The great majority of patients (91.4%) exhibited subjective postoperative improvement. Mean obstruction (VAS) improved significantly from 7.45 ± 1.48 to 3.54 ± 1.96. Significant turbinate volume reduction was achieved by the surgery on both right and left sides [(preoperative vs. postoperative, right: 6.55 ± 1.62 cm³ vs. 5.10 ± 1.47 cm³, (P < 0.01); left: 6.72 ± 1.53 cm³ vs. 5.00 ± 1.37 cm³, (P < 0.01)] respectively.

Conclusion

Radiofrequency is a safe and effective surgical procedure in reducing turbinate volume in patients with inferior turbinate hypertrophy. Multidetector CT is an objective method of assessment in detecting radiofrequency turbinate volume reduction.     

Prognostic role of margin status in open and CO2 laser cordectomy for T1a–T1b glottic cancer

Introduction

Cordectomy by laringofissure and transoral laser surgery has been proposed for the treatment of early glottic cancer.

Late complications of radiotherapy for nasopharyngeal carcinoma

Objective

To evaluate and assemble late complications of radiotherapy in cases of nasopharyngeal cancer.

Methods

From October 2003 to January 2005, a prospective cohort study was done in a tertiary center, Chiang Mai University Hospital. Two hundred patients were evaluated for late complication according to the RTOG/EORTC late radiation morbidity scoring criteria.

Results

Of 200 patients, 131 were male (65.5%) and 69 female (34.5%). The mean age was 49.7 ± 13.5 years (11–78). The mean pre- and post-treatment body mass indexes (BMI) were 22.5 ± 4 (15–35.6), and 19.8 ± 3.2 (12.9–34.5; P < 0.05). Mean post-radiation period was 3.6 ± 3.4 years (0.3–18.6 years). The radiation dosage ranged from 60 to 76 Gy (mean 69 Gy). Most of the patients (92%) had undifferentiated (50.5%) and poorly differentiated (41.5%) squamous cell carcinoma. Eighty-eight percent of the patients were in Stage III and IV. Chemotherapy was given to 145 patients (72.5%). The mean post-radiation period in the added chemotherapy group was lower than the group treated with radiation alone (2.9 ± 2.7 years vs. 5.4 ± 4.4 years, P < .05). The most common complication was dryness of mouth (97.5%); followed by hearing impairment (inner ear 82.5%). Added chemotherapy increased the complication severity significantly for the skin (P < 0.05). The mean number of complications was 6.3 ± 2.2 (range from 1 to 12).

Conclusion

In this study, every patient had a more or less adverse reaction to radiation. Doctors need to be aware of these complications in order to prevent serious ones and to improve the patients’ quality of life in the long term.