Multidisciplinary clinic care improves adherence to best practice in head and neck cancer

Purpose

Multidisciplinary team (MDT) care is widely accepted as best practice for patients with head and neck cancer, although there is little evidence that MDT care improves head and neck cancer related outcomes. This study aims to determine the impact of MDT care on measurable clinical quality indicators (CQIs) associated with improved patient outcomes.

Materials and methods

Patients treated for head and neck cancer at Ipswich Hospital from 2001 to 2008 were identified. Comparisons were made in adherence to CQIs between patients treated before (pre MDT) and after (post MDT) the introduction of the MDT. Associations were tested using the Chi-square and Whitney U-test.

Results

Treatment post MDT was associated with greater adherence to CQIs than pre MDT. Post MDT had higher rates of: dental assessment (59% versus 22%, p < .0001), nutritional assessment (57% versus 39%, p = .015), PET staging (41% versus 2%, p < .0001), chemo-radiotherapy (CRT) for locally advanced disease (66% versus 16%, p < .0001) and use of adjuvant CRT for high risk disease (49% versus 16%, p < .0001). The interval between surgery and radiotherapy was shorter in the post MDT group (p = .009) as was the mean length of hospitalization (p = .002).

Conclusions

This study highlights the measurable advantages of MDT care over the standard, less formalized, referral process.     

Oral cavity squamous cell carcinoma in never smokers: Analysis of clinicopathologic characteristics and survival

Purpose

To examine the relationship between tobacco smoking history and the clinicopathologic and survival characteristics of patients with oral cavity squamous cell carcinoma (OCSCC).

Materials and methods

This is a retrospective review of 531 patients treated for OCSCC from January 1998 to December 2009 at a tertiary care medical center.

Results

Thirty-two percent of OCSCC patients were never smokers. There were significant differences in tumor location between ever smokers and never smokers (p < 0.001), with never smokers more likely to have oral tongue tumors. Smokers were significantly (p < 0.001) more likely than never smokers to present with locally advanced (T3 or T4) disease (57.8% vs. 35.4%). Never smokers demonstrated improved overall survival (78.8 months in never smokers vs. 44.7 months in ever smokers, p = .03). However, there were no survival differences when the two groups were compared separately for locally early (T1/T2) or advanced (T3/T4) disease. For T1/T2 tumors, mean survival was 88.2 months for never smokers and 78.5 months for smokers (p = .10). For T3/T4 tumors, median survival was 29.1 months for never smokers and 23.8 months for smokers (p = .09).

Conclusions

Primary tumor location and T-status in OCSCC differed between never smokers and smokers. Compared to smokers, never smokers had fewer locally advanced tumors and better overall survival.     

Radiotherapy for nonadenoid cystic carcinomas of major salivary glands

Purpose

To report outcomes in patients treated with postoperative radiotherapy for nonadenoid cystic carcinomas of the major salivary glands.

Materials and Methods

From 1998–2011, 37 patients with nonadenoid cystic carcinomas of the major salivary gland underwent postoperative radiotherapy. The median radiation dose was 60 Gy (range, 45–70 Gy). TNM distribution included T1–2 (n = 16, 44%), T3–T4 (n = 21, 56%), N0 (n = 19, 51%), and N + (n = 18, 49%). Histologies included adenocarcinoma (n = 13, 35%), squamous cell carcinoma (n = 8, 22%), mucoepidermoid carcinoma (n = 8, 22%), and other (n = 8, 21%). Median follow-up was 4.7 years for all patients (range, 0.3–14.1 years) and 5.0 years for living patients (range, 1.2–12.2 years).

Results

Five-year local-regional control, overall survival (OS), and cancer-specific survival (CSS) were 97%, 76%, and 84%. On univariate analysis, OS was significantly worse for patients ≥ 65 years old (p = 0.04). CSS was significantly worse for positive perineural invasion (p = 0.02), extraparenchymal extension (p = 0.04), and in patients who received no chemotherapy (p = 0.02). Doses > 60 Gy was significantly worse for OS (p = 0.003) and CSS (p = 0.003), although these patients had higher TNM (> T2, p = 0.01) and trended towards a higher rate of extraparenchymal extension (p = 0.08). Four patients (11%) developed ≥ grade 2 toxicities; 3 patients developed early toxicities and one patient developed late toxicities.

Conclusions

Radiotherapy for salivary gland tumors provides excellent local-regional control when combined with surgery. Distant metastasis is the predominant pattern of failure, although chemotherapy seemed to improve cancer-specific survival.     

Facial soft tissues of mouth-breathing children: Do expectations meet reality?

Objective

To quantify the differences between the facial soft tissue morphology of severely obstructed mouth breathing (MB) and that of predominantly nasal breathing (NB) children.

Methods

Soft tissue measurements were performed in the lateral cephalograms of 64 severely obstructed MB children (mean age 6.7 ± 1.6) compared with 64 NB children (mean age 6.5 ± 1.3). Groups were paired by age, gender, skeletal maturation status and sagittal skeletal pattern. Based on the assumption of normality and homoscedasticity, comparison of the means and medians of soft tissue measurements between the two groups was performed.

Results

The facial convexity and anterior facial height ratio of MB were similar to NB children. The upper lip of MB children was protruded, and its base was thinner compared with NB; however, the length was not affected. The lower lip was shorter and more protruded in MB children. The nasolabial angle, nasal prominence, and chin thickness were smaller in MB children.

Conclusions

The facial soft tissue of severely obstructed MB children is different than in NB children. Changes in lips, nasolabial angle, nasal prominence, and chin thickness are associated with severe airway obstruction in children.     

Clinical indicators that predict the presence of moderate to severe obstructive sleep apnea after adenotonsillectomy in children

Objective

To determine if clinical indicators can predict the presence of moderate to severe Obstructive Sleep Apnea (OSA) after Adenotonsillectomy (T&A) in children.

Study Design

Retrospective study.

Setting

Urban Tertiary Care Pediatric Hospital.

Methods

Parents of children (< 18 yrs.) with OSA completed a 55-item questionnaire based on their child’s symptoms at the time of preoperative polysomnography and then again at the follow up polysomnography completed 3 to 6 months after T&A.

Main outcome measures

55 item questionnaire, polysomnography variables.

Results

97 children were included (59 Male and 38 Female). The mean preoperative apnea hypopnea index (AHI) was 30.5 ± 31.6/h and the mean postoperative AHI was 4.4 ± 6.0/h. After T&A, all 97 children had reduction in AHI, and 35 (36.1%) no longer had OSA (AHI < 1/h). The total symptom scores decreased from 15.8 ± 9.4 to 11.3 ± 8.7 after T&A (p < .0001). Fourteen symptoms highly predictive of moderate to severe OSA were identified in the univariate analysis (p < 0.1). Using a cut-point of 4, this 14-item subscale illustrated an overall predictability of 72.2% (73.7% sensitivity and 70.0% specificity) for identifying children with moderate to severe OSA.

Conclusion

A cluster of 14 clinical sleep symptoms are highly predictive of moderate to severe OSA and can serve as clinical predictor for the presence of moderate to severe OSA after T&A.     

Anaplastic thyroid cancer in young patients: A contemporary review

Purpose

Little is known about prognostic factors and treatment outcomes in young patients with anaplastic thyroid cancer (ATC). The goal of this study is to define the clinical features of this subgroup.

Material and methods

Patients age 55 or younger with either ATC or well-differentiated thyroid cancer (WDTC) with anaplastic changes were identified using electronic medical record at the Cleveland Clinic. The same number of patients older than 55 was randomly selected to serve as control. Progression-free survival (PFS), overall survival time (OST) and cause-specific mortality (CSM) were measured against age, tumor histology, extent of disease, and treatment modalities.

Results

Twelve patients age 55 or younger were identified. The median age was 51 years. Four patients had WDTC with anaplastic components — mixed tumor group (MTG). Their median PFS, OST, and CSM at 24 months were 21.5 months, 51 months, and 25%, respectively. For the other 8 patients who had pure ATC, their median PFS, OST, and CSM were 3.5 months, 6 months, and 100%, respectively. Patients in the MTG had better survival compared to the pure ATC and control group in terms of PFS (p = 0.0047 and p = 0.0053), OST (p = 0.0028 and p = 0.0029) and the CSM at 24 months (p = 0.0339 and p = 0.0096). In the pure ATC group, patients with positive cervical lymph node and distant metastases had similar overall survival outcomes (6 vs. 8 months, p = 0.4995).

Conclusion

Prognostic factors favoring survival in young patients with ATC include ATC arising within WDTC. Once full anaplastic transformation occurs, age was not a significant factor in survival.     

Results of Baha® implantation using a small horizontal incision

Purpose

Techniques for Baha® implantation continue to evolve. The Weber technique, utilizing a 1.5 cm horizontal incision for Baha® implantation is evaluated.

Methods

Retrospective review of patients undergoing Baha® implantation by a single surgeon over three years.

Results

33 Baha®s implanted in 30 patients. Fourteen used an Inverted J (IJ) incision with an anteriorly-based skin-flap, 13 with the Weber technique (W). Five were not included as other techniques were used. Demographics and weeks to activation (14.58 vs 13.4, p = 0.12) were similar. There were no differences in the number of patients with minor complications (5 vs 2, p = 0.22) or number of minor complications (20 vs 4, p = 0.09). One patient in the IJ Group required operative revision for overgrowth. There were no infections in the IJ Group, and one requiring oral antibiotics in the W Group. Follow-up was longer in the IJ Group (41 vs 13 weeks, p = 0.016), no complications occurred after 14 weeks post-op. Mean operative times were similar (43 vs 39 min, p = 0.59). There were no cases of skin flap necrosis in either group.

Conclusion

A small incision for Baha® implantation proved as effective, without increased complications as a skin-flap based technique.     

Inferior meatal antrostomy impairs dynamic stability of the orbital walls

Objectives

The medial wall of the maxillary sinus, or the bony buttress, plays an important role in supporting the orbital floor. Since part of the bony buttress is removed in the inferior meatal antrostomy (IMA), it is expected that the IMA makes the orbital floor likely to develop serious fractures in traumatic situations. We conducted the present study to elucidate the effect of the IMA on the vulnerability of the orbital floor.

Methods

After producing CAD (Computer Assisted Design) models simulating twelve skulls, we performed simulation antrostomy for each of the twelve CAD models in both the middle meatus and the inferior meatus. According to the site of the antrostomy, the models were categorized as the MMA (middle meatal antrostomy) or IMA groups. We then applied an impact on the orbital region of each model. Using the finite element method, we calculated the area of the orbital wall fracture induced by the impact. Then we compared the area of the orbital wall fractures between the MMA and IMA groups.

Results

The orbital wall fracture areas were significantly greater in the IMA group than in the MMA group.

Conclusions

The patients who underwent IMA are likely to develop serious orbital fractures if their orbits receive traumatic impacts. Hence, surgeons should be prudent in their indications for IMA.     

Thyroid carcinoma uptake of F-Fluorodeoxyglucose in patients with elevated serum thyroglobulin and negative I scintigraphy

Purpose

To determine if FDG-PET results can predict for outcome in thyroid cancer patients with elevated Tg and negative I-131 imaging.

Materials and methods

We conducted a retrospective review of 76 patients who had elevated serum Tg and negative ¹³¹I scintigraphy and who underwent FDG-PET. After FDG-PET, patients underwent neck dissection or radiation.

Results

The 51 patients with positive FDG-PET had a 5-year survival of 63% compared to 100% (p < 0.049) for the 25 patients with negative PET. Patients with FDG-avid disease isolated to the lymph nodes had 5-year CSS of 91% compared to 32% (p = 0.0033) for those with disease outside the regional lymph nodes. Twenty-nine patients with disease isolated to the regional lymph nodes underwent salvage neck dissection and 22 remain NED after 28 months.

Conclusions

Negative FDG-PET with elevated Tg predicts an excellent outcome. FDG-avid disease isolated to the regional lymph nodes had a low likelihood of death due to thyroid cancer.     

Mohs resection and postoperative radiotherapy for head and neck cancers with incidental perineural invasion

Purpose

To update our experience treating cutaneous squamous cell carcinoma (SCC) and basal cell carcinomas (BCC) of the head and neck with incidental perineural invasion (PNI) using Mohs resection followed by radiotherapy (RT). We compare outcomes between head and neck patients with incidental PNI who received Mohs surgery and those who did not.

Materials and methods

From 1987 to 2009, 36 patients were treated with Mohs resection followed by postoperative RT; 82 patients were treated with resection other than Mohs followed by postoperative RT.

Results

The 5-year overall survival and cause-specific survival rates for patients who received Mohs resection plus RT and those who received a non-Mohs resection plus RT were 53% versus 56% (p = 0.809) and 84% versus 68% (p = 0.0329), respectively. The 5-year local control rates for Mohs and non-Mohs patients were 86% versus 76% (p = 0.0606), respectively. The 5-year local–regional control and freedom from distant metastases rates for the Mohs group were 77% and 92%, respectively. The 5-year overall neck control, neck control with elective neck RT, and neck control without elective RT treatment rates for the Mohs group were 91%, 100%, and 82% (p = 0.0763), respectively. The rate of grade 3 or higher complication in the Mohs group was 22%, which included bone exposure (N = 3), cataract (N = 2), chronic non-healing wound (N = 2), wound infection (N = 1), fistula (N = 1), and/or radiation retinopathy (N = 1).

Conclusions

Mohs surgery appears to result in improved local control and cause-specific survival in patients with incidental PNI who receive postoperative RT. Elective nodal RT improves regional control in patients with SCC.     

Diffuse large B-cell lymphoma of the sinonasal tract: Analysis of survival in 852 cases

Purpose

Diffuse large B-cell lymphomas (DLBCLs) are rare tumors of the head and neck that often have non-specific presentations and significant morbidity and mortality. In this analysis we use a large cohort to compare the demographic and disease-specific parameters affecting survival and incidence of DLBCLs.

Methods

The United States National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) registry was utilized to extract data regarding sinonasal diffuse large B-cell lymphoma between 1973 and 2009. A total of 852 cases of sinonasal DLBCLs were found. Presenting symptoms, demographics, disease specific survival, relative survival and survival by treatment modality were described for this rare tumor.

Results

Overall disease specific survival (DSS) at 1-year was 84.7% and at 5 years was 68.0%. DSS was significantly lower for those not treated with radiation therapy, with 1- and 5-year survival rates of 77.3% and 62.5%, versus those treated with radiation therapy, with 1- and 5-year rates of 89.2% and 71.5% (p < 0.05). Prognosis was significantly better for patients treated with radiation therapy (HR 0.6, p < 0.05) while it was poorer for patients with involvement of multiple sinuses (HR 1.5, 1.8, p < 0.05).

Conclusions

DLBCLs of the sinonasal tract are rare tumors of the head and neck. Survival is significantly improved for those treated with radiation therapy while the involvement of multiple sinuses is a negative prognostic indicator.     

Surgical duration of cochlear implantation in an academic university-based practice

Objective

Establish the time to safely and efficiently perform cochlear implantation (CI) in a university-based academic center.

Study Design

Case series with chart review.

Setting

Academic neurotologic referral center.

Patients

424 patients who underwent CI surgery between 2002 and 2010.

Intervention

Unilateral, bilateral or revision CI using commercially available devices approved for use in the United States.Main outcome measures: mean surgical duration (SD) and mean total operative room time (TORT).

Results

Overall mean SD for all 424 patients was 83 ± 30 min (min) whereas the mean TORT was 135 ± 56 min. The mean SD for unilateral CI was 84 ± 18 min for the first implant and 82 ± 22 min for the second implant (p = 0.55). The SD for primary and revision CI was 83 ± 18 min and 85 ± 36 min, respectively (p = 0.51). The mean SD for pediatric and adult CI was 83 ± 21 min and 83 ± 18 min, respectively (p = 0.92). The mean SD without resident assistance was 74 ± 14 min whereas with the assistance of a resident the mean SD was 84 ± 20 min (p = 0.02). When ossification was encountered the mean SD was 90 ± 32 min compared to 82 ± 19 min when absent (p < 0.001). An association was found between TORT or SD, and the year of surgery, presence of ossification and the involvement of an assistant.

Conclusion

In a university-based academic center, CI surgery can be safely and efficiently performed, supporting future cost-effectiveness analysis of its current practice.     

Elective neck management for high-grade salivary gland carcinoma

Purpose

To determine whether patients with clinically node negative (cNo) high grade salivary gland carcinomas benefit from an elective neck dissection prior to postoperative radiotherapy (RT).

Material/Methods

Between October 1964 and October 2009, 59 previously untreated patients with cNo high-grade salivary gland carcinomas (squamous cell carcinomas were excluded) were treated with curative intent using elective neck dissection (END; n = 41), or elective neck irradiation (ENI; n = 18) at the University of Florida College of Medicine (Gainesville, FL). All patients underwent resection of the primary cancer followed by postoperative RT. The median follow-up period was 5.2 years (range, 0.3–34 years).

Results

Occult metastases were found in 18 (44%) of the 41 patients in the END group. There were 4 recurrences (10%) in the END group and 0 recurrence in the ENI group. Neck control rates at 5 years were: END, 90%; ENI, 100%; and overall, 93% (p = 0.1879). Cause-specific survival was 94% in the ENI group, 84% in the END group, and 86% for all patients (p = 0.6998). There were 3 reported grade 3 or 4 toxicities. Two patients had a postoperative fistula and one patient had a grade 4 osteoradionecrosis that required a partial mandibulectomy.

Conclusions

Patients with cNo high grade salivary gland carcinomas who are planned to undergo surgery and postoperative RT likely do not benefit from a planned neck dissection.     

Clinical characteristics and outcome in patients with isolated sphenoid sinus aspergilloma

Objective

Isolated sphenoid sinus aspergilloma (ISSA) is a rare disorder that is difficult to diagnose in a timely manner. These lesions can also extend to adjacent structures and thereby cause severe complications. ISSA patients with orbital complications typically have a poor prognosis even when surgical interventions have been successful. We here reviewed 30 ISSA cases with respect to clinical characteristics and treatment outcomes.

Methods

A group of 30 patients diagnosed with ISSA between January 1990 and October 2010 were retrospectively reviewed in terms of clinical manifestations, endoscopic findings, radiologic imaging data, and treatment results. We also compared the clinical manifestations and treatment results between patients with and without orbital complications.

Results

Old age (median, 55 years) and a female predominance (23 women in the study) were noted. The most commonly reported symptom was headache (80%) and the average duration of the symptoms before diagnosis was 8.1 months. On radiologic examination, including CT and MRI scans, 13 patients showed bony wall erosions and five patients demonstrated orbital complications including diplopia and visual loss. The appearance of a bony wall erosion on a CT scan and the acute onset of ISSA symptoms were found to be significant factors in the onset of orbital complications (P = 0.003 in each case). Endoscopic sphenoidotomy was performed in all 30 cases. Most of the preoperative symptoms among the patients, including headache, facial pain, and postnasal drip, were improved after surgery. Among the five patients in the study group with orbital complications, diplopia was completely resolved after surgery in each case but there was no improvement in visual loss.

Conclusions

An early diagnosis of ISSA, although not easy, is important to prevent complications arising from extensions of these lesions beyond the sphenoid sinus. Our present study demonstrates that ISSA could be effectively treated with an endoscopic sphenoidotomy, and that timely intervention is needed in patients with a sinus bony wall to prevent irreversible complications such as visual loss.     

Melatonin and cortisol rhythm in patients with extensive nasal polyposis

Purpose

Extensive nasal polyposis is an inflammatory disease which effects 1%–4% of normal population. The mechanism of its formation and the circadian rhythm of cortisol and melatonin in ENP have not investigated.

Materials and methods

Salivary levels of melatonin and cortisol were measured by radioimmunoassay in 31 patients with extensive nasal polyposis and in 27 control subjects matched for age and gender. In both groups none of the subjects did not have obstructive sleep apnea.

Results

The baseline and the peak levels of salivary melatonin in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). However, no differences were found in the acrophase and the peak duration of salivary melatonin between the study and control groups (p > 0.05). The highest values of melatonin were recorded at 04:00 h in both the study and control groups.The amplitude and the 24 h mean levels of salivary cortisol in the extensive nasal polyposis group were significantly lower than in the control group (p < 0.001). The acrophase was delayed by about 8 h in extensive nasal polyposis patients (p < 0.001).

Conclusion

The circadian rhythms of salivary melatonin and cortisol were found to be disrupted in patients with extensive nasal polyposis. These results may be applicable as therapeutic tools in the future and melatonin drugs might be useful in the therapy of nasal polyposis like cortisol drugs.     

A randomized prospective trial of a novel device for measuring perforation size during inlay ‘butterfly’ myringoplasty

Aim

This study introduces a new device to facilitate perforation size measurement during “butterfly” myringoplasty. The purpose of this study is to evaluate the use of ‘otological compass’ on short-term results of inlay cartilaginous ‘butterfly’ tympanoplasty technique in adult patients.

Study design

Prospective, randomized, controlled, blinded.

Patients and methods

This study included 25 patients who underwent inlay cartilage myringoplasty. All operations were performed under general anesthesia by the same surgeon with a microscope-assisted approach. The patients were divided randomly and consecutively into two groups: Group 1 (n = 12) had perforation dimensions and shape measured using the Otologic Compass (OC) and the control group (n = 13) had perforation measured by means of a Fisch elevator. The duration of surgery, number of trials for correct placement of the cartilage graft, results and complications of the surgery were evaluated and compared.

Results

The mean follow-up duration was 6 months. Groups were similar in terms of age and perforation diameters (p > 0.05). Average number of cartilage shaping before satisfactory graft fitting was significantly fewer in the OC group: 1.1 ± 0.3 and 2.2 ± 0.6 trials for OC and control groups, respectively (p < 0.001). Mean duration of preparation and satisfactory graft fitting was 9.6 ± 4.2 minutes in the OC group whereas it was 18.1 ± 5.2 minutes for the control group. Operative duration was significantly shorter in the OC group (p < 0.001). At the end of the follow-up period, successful closure occurred 91.7% and 84.6% patients in the OC and control groups, respectively (p > 0.05). The mean preoperative to postoperative three-tone air-bone gap improved 7.9 dB and 9.0 dB in OC and control groups, respectively (p > 0.05).

Conclusion

This study shows that OC presents as a useful tool that expedites and refines butterfly myringoplasty procedure. The number of cartilage shaping prior to satisfactory graft fitting revealed significantly better results: almost all surgeries in the OC group were complete after a single cartilage shaping attempt.     

Kinezyterapia u pacjentów z obwodowym uszkodzeniem narządu przedsionkowego

Introduction

Kinesitherapy is widely accepted management in patients with vertigo and imbalance, but there has been inadequate evidence that one form of therapy is superior to another.

The aim

of the study was to compare effectiveness of two kinesitherapy protocols in patients with the peripheral vestibular system disorders.

Material and methods

Fifty patients (mean age 46.0 ± 13.1 year) with vertigo and balance instability lasting over 3 months with unilateral vestibular disorder, confirmed in Videnystagmography, were included in the study. Thirty patients underwent supervised and 20 patients home-based exercise programs. All of them were assessed three times at the baseline, after 4 weeks and 3 months, on vertigo intensity and frequency with the Vertigo Syndrome Scale (VSS), Vertigo Visual Analog Scale (VAS) and clinical unsteadiness with tests (Romberg, Amended Motor Club Assesment (AMCA), Eurofit test – standing on one leg.

Results

In both groups the clinical tasks and the intensity of vertigo in VAS significantly decreased. The mean value of VSS (part physical and emotional)score significantly decreased only in supervised group at the end of 4 weeks and 3 months (p = ns). Recovery was more dynamic in supervised group than home-based exercises group, in AMCA test (3.9 vs. 1.3 s, p < 0.05) in Eurofit tests eye open (14.1 vs. 0.9 s, p < 0.05) and eye closed (3.5 vs. 1 s, p < 0.05).

Conclusions

In patients with unilateral peripheral vestibular dysfunction supervised and home-based group kinesitherapy is an effective treatment method. In supervised group patients recovery has been faster.     

Prevalence and associated factors of pulmonary hypertension in Kenyan children with adenoid or adenotonsillar hypertrophy

Objectives

Adenotonsillar hypertrophy is a common condition in childhood, whose serious complications of pulmonary hypertension and cor pulmonale are devastating but local prevalence is unknown. This study determined the prevalence and associated factors of pulmonary hypertension in children with adenoid or adenotonsillar hypertrophy at Kenyatta National Hospital, Kenya.

Methods

This was a cross sectional hospital based survey conducted among children below 12 years of age with clinical and radiological adenoid hypertrophy attending the ear, nose and throat (ENT) outpatient clinic and general pediatric wards. Doppler echocardiography was used to determine pulmonary hypertension defined as a mean pulmonary arterial pressure (mPAP) of ≥25 mm Hg using the Chemla equation. Children with mPAP of ≥25 mm Hg were compared to those with lower pressures and clinical and radiological factors associated with pulmonary hypertension determined using multivariate logistic regression analysis.

Results

Of the 123 eligible children in the study, 27 had pulmonary hypertension giving a prevalence of 21.9% (95% CI 14.64%–29.27%). Independent factors associated with pulmonary hypertension included nasal obstruction (OR = 3.0 [95% CI 1.08–8.44] p = 0.035) and hyperactivity on history (OR = 0.2 [95% CI 0.07–0.59] p = 0.003) and adenoid-nasopharyngeal ratio (ANR) >0.825 on lateral neck radiography (OR = 5.0 [95% CI 1.01–24.37] p = 0.048).

Conclusion

One in five children with adenoid or adenotonsillar hypertrophy had pulmonary hypertension with a 3-fold and 5-fold increased odds in those with nasal obstruction on history and ANR >0.825 on lateral neck radiography respectively and an 80% reduced odds in reportedly hyperactive children.     

Effectiveness of radiofrequency cryptolysis for the treatment of halitosis due to caseums

Objective

To evaluate the effectiveness of radiofrequency (RF) cryptolysis for caseum-induced halitosis.

Study design

Clinical retrospective study.

Setting

Otorhinolaryngology Head and Neck Surgery Department of Konya Training and Research Hospital in Turkey.

Subjects and methods

Thirty-four patients with caseum-induced halitosis were included. Eight were male (23.5%) and 26 were female (76.5%). Their mean age was 28.29 ± 9.3 (range: 17–48) years. The mean duration of complaint of halitosis before RF cryptolysis was 53.41 ± 42.6 months (range: 6–182 months). The Finkelstein test, organoleptic measurements, and visual analog scale (VAS) were performed before and 12 months after RF cryptolysis.

Results

Before RF cryptolysis, all patients had a positive Finkelstein's test result, organoleptic measurements revealed that three (8.82%) had serious halitosis, 24 (70.58%) had average halitosis, and seven (20.58%) had mild halitosis, and the mean VAS score was 6.82 ± 1.45. The follow-up period after RF cryptolysis was 12 months. After the single RF cryptolysis session, 26 patients (76.47%) were negative for Finkelstein's test, organoleptic assessments revealed that 26 (76.47%), six (17.64%), and two (5.88%) showed complete, partial, and no recovery, respectively, (p < 0.001), and the mean VAS score was significantly better at 1.88 ± 2.5 (p < 0.001). Thirty-two patients (94.1%) exhibited a decrease in VAS score.

Conclusion

RF cryptolysis is a cost-effective, safe, and easily applicable modality for the treatment of halitosis due to caseums in the crypts of the palatine tonsils.