Impact of treatment modality on quality of life of head and neck cancer patients: Findings from an academic medical institution

Purpose

The objective of this pilot study was to determine how different treatment modalities (surgery, radiation, and chemotherapy) impact quality of life (QOL) in a population of head and neck cancer (HNC) survivors.

Neurofibromatosis tipo ii y sus manifestaciones en cabeza y cuello: revisión bibliográfica y estudio poblacional en la Comunidad de Cantabria y la provincia de Las Palmas

Introduction and objectivesNeurofibromatosis type 2 (NF2) is an infrequent autosomal dominant disease characterised by the appearance of viii nerve schwannomas, meningiomas and ocular abnormalities. Incidence of 1:25,000 and prevalence above 1:80,000 are estimated in general. The objectives of our study were to determine current prevalence of NF2 in the Community of Cantabria and the province of Las Palmas, and its head and neck manifestations.Material and methodsThis was a population-based, retrospective study in 3 tertiary hospitals.ResultsThe study population showed prevalence of 1:600,000 in the Community of Cantabria and 1:280,000 in the province of Las Palmas. The most frequently diagnosed tumour was acoustic neuroma (n = 15), followed by trigeminal neurinoma (n = 2) and vagus (n = 1).ConclusionsCases of NF2 are infrequent in Cantabria and Las Palmas, lower than that reported in the literature. The most frequently described head and neck tumour in the literature is acoustic neuroma, followed by schwannoma of cranial nerves v and x. Other tumours such as nasal, laryngeal, chorda tympani or cranial nerve vii schwannomas are also described. The most frequent ENT manifestation is hearing loss, especially unilateral, followed by cervical mass, tinnitus and headache. Early diagnosis and multidisciplinary management in specialised centres could improve life expectancy and quality of life for these patients.     

The impact of sentinel lymph node biopsy on the quality of life in patients with oral cavity squamous cell carcinoma

IntroductionSentinel lymph node biopsy is a proven method for staging the neck in patients with early oral cavity squamous cell carcinoma because it results in less comorbidity than the traditional method of selective neck dissection, with the same oncological results. However, the real effect of that method on the quality of life of such patients remains unknown.ObjectiveThe present study aimed to evaluate the quality of life of patients with oral cavity squamous cell carcinoma T1/T2N0 submitted to sentinel lymph node biopsy compared to those that received selective neck dissection.MethodsCross-sectional study including 24 patients, after a 36 month follow-up, 15 of them submitted to the sentinel lymph node biopsy and 9 to selective neck dissection. All patients answered the University of Washington quality of life questionnaire.ResultsThe evaluation of the questionnaires showed a late worsening of the domains appearance (p = 0.035) and chewing (p = 0.041), as well as a decrease of about 10% of general quality of life (p = 0.025) in patients undergoing selective neck dissection ??in comparison to those undergoing sentinel lymph node biopsy.ConclusionPatients with early-stage oral cavity squamous cell carcinoma undergoing sentinel lymph node biopsy presented better late results of general quality of life, mainly regarding appearance and chewing, when compared to patients submitted to selective neck dissection.     

The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study

IntroductionThe cuff of an endotracheal tube seals the airway to facilitate positive-pressure ventilation and reduce subglottic secretion aspiration. However, an increase or decrease in endotracheal tube intracuff pressure can lead to many morbidities.ObjectiveThe main purpose of this study is to investigate the effect of different head and neck positions on endotracheal tube intracuff pressure during ear and head and neck surgeries.MethodsA total of 90 patients undergoing elective right ear (Group 1: n = 30), left ear (Group 2: n = 30) or head and neck (Group 3: n = 30) surgery were involved in the study. A standardized general anesthetic was given and cuffed endotracheal tubes by the assistance of video laryngoscope were placed in all patients. The pilot balloon of each endotracheal tube was connected to the pressure transducer and standard invasive pressure monitoring was set to measure intracuff pressure values continuously. The first intracuff pressure value was adjusted to 18.4 mmHg (25 cm H₂O) at supine and neutral neck position. The patients then were given appropriate head and neck positions before related-surgery started. These positions were left rotation, right rotation and extension by under-shoulder pillow with left/right rotation for Groups 1, 2 and 3, respectively. The intracuff pressures were measured and noted after each position, at 15th, 30th, 60th, 90th minutes and before the extubation. If intracuff pressure deviated from the targeted value of 20–30 cm H₂O at anytime, it was set to 25 cm H₂O again.ResultsThe intracuff pressure values were increased from 25 to 26.73 (25–28.61) cm H₂O after left neck rotation (p = 0.009) and from 25 to 27.20 (25.52–28.67) cm H₂O after right neck rotation (p = 0.012) in Groups 1 and 2, respectively. In Group 3, intracuff pressure values at the neutral position, after extension by under-shoulder pillow and left or right rotation were 25, 29.41 (27.02–36.94) and 34.55 (28.43–37.31) cm H₂O, respectively. There were significant differences between the neutral position and extension by under-shoulder pillow (p < 0.001), and also between neutral position and rotation after extension (p < 0.001). However, there was no statistically significant increase of intracuff pressure between extension by under-shoulder pillow and neck rotation after extension positions (p = 0.033).ConclusionAccessing the continuous intracuff pressure value measurements before and during ear and head and neck surgeries is beneficial to avoid possible adverse effects/complications of surgical position-related pressure changes.     

Taste function after section of chorda tympani nerve in middle ear surgery

ObjectiveTo investigate prospectively the clinical manifestations and the functional recovery of taste after section of chorda tympani nerve (CTN) during middle ear surgery, the subjective and objective study on the patients was performed.MethodsThirty-five patients underwent surgery with unilateral (n = 32) or bilateral (n = 3) section of CTN between January 2000 and April 2002. The patients were asked about taste symptoms before surgery and 2 weeks and 2 years after surgery. The CTN function was also measured with electrogustometry (EGM) at the same time points.ResultsIn unilateral section of CTN, 19/32 (59.4%) complained of taste disorder and 11/32 (34.4%) tongue numbness. Most of these taste symptoms disappeared within 2 years although the EGM threshold did not recover. 16/17 patients (94.1%) who used to cook everyday had little difficulty in flavoring dishes. In bilateral section of CTN, the patients had no problem of taste at 2 years after surgery, either.ConclusionThese findings help explain the potential complications to the patients before surgery, although the number of cases was small in this series.     

Lung ultrasonography as a tool to guide perioperative atelectasis treatment bundle in head and neck cancer patients undergoing free flap reconstructive surgeries: a preliminary observational study

IntroductionGeneral anesthesia causes pulmonary atelectasis within few minutes of induction. This can have significant impact on postoperative outcome of cancer patients undergoing prolonged reconstructive surgeries.ObjectiveThe purpose of this study was to evaluate the impact of sonographically detected perioperative atelectasis on the need for postoperative oxygen supplementation, bronchodilator therapy and assisted chest physiotherapy in patients undergoing free flap surgeries for head and neck carcinoma.MethodsTwenty eight head and neck cancer patients underwent bilateral pulmonary ultrasonographic assessments before and after lung surgery. Lung ultrasound scores, serum lactate, and PaO₂/FiO₂ ratio were measured both at the beginning and at end of the surgery. Patients were scanned in the supine position and the number of single and confluent B lines was noted. These values were correlated with the need for oxygen therapy, requirement of bronchodilators and total weaning time to predict the postoperative outcome. Other factors affecting weaning were also studied.ResultsAmong twenty eight patients, seven had mean lung ultrasound score of ≥10.5 which correlated with prolonged weaning time (144.56 ± 33.5 min vs. 66.7 ± 15.7 min; p = 0.005). The change in lung ultrasound score significantly correlated with change in PaO₂/FiO₂ ratio (r = ?0.56, p = 0.03). Elevated total leukocyte count >8200 μL and serum lactate >2.1 mmoL/L also predicted prolonged postoperative mechanical ventilation.ConclusionThis preliminary study detected significant levels of perioperative atelectasis using point of care lung ultrasonography in head and neck cancer patients undergoing long duration surgical reconstructions. Higher lung ultrasound scores highlighted the need for frequent bronchodilator nebulizations as well as assisted chest physiotherapy and were associated with delayed weaning. We propose more frequent point of care lung ultrasonographic evaluations and use of recruitment maneuvers to reduce the impact of perioperative pulmonary atelectasis.     

Improved clinical outcomes with multi-modality therapy for sinonasal undifferentiated carcinoma of the head and neck

ObjectiveTo examine outcomes among patients treated for sinonasal undifferentiated carcinoma (SNUC) of the head and neck.Study designRetrospective review.MethodsThe records of 16 consecutive patients with newly diagnosed, non-metastatic SNUC were analyzed. Initial treatment consisted of: surgery alone (6 patients), surgery with post-operative chemoradiotherapy (4 patients), and primary radiation therapy with concurrent chemotherapy (6 patients).ResultsThe median survival for patients treated by surgery followed by postoperative chemoradiotherapy was 30 months compared to 7 months and 9 months for patients treated by surgery alone and upfront chemoradiotherapy, respectively (p = 0.20). The 2-year locoregional control was 18% for patients treated with upfront chemoradiotherapy, 37% for patients treated with surgery alone, and 78% for patients treated with surgery plus chemoradiotherapy (p = 0.49).ConclusionWhile the potential role of selection bias must be considered, multi-modality therapy using surgery and post-operative chemoradiotherapy yielded the most favorable outcomes for SNUC and should be recommended whenever feasible.     

Observational study of the long-term impact of donor-site sequelae after head and neck reconstruction by free anterolateral thigh flap

ObjectiveFree anterolateral thigh flap has many applications in head and neck reconstruction surgery. The aims of the present study were: (1) to assess functional and esthetic sequelae of harvesting for oncologic purposes; and (2) to assess long-term impact of harvesting on quality of life according to patient and to physician.Materials and methodsForty-one patients undergoing reconstruction by free anterolateral thigh flap following oncologic head and neck surgery were assessed by questionnaire at > 6 months postoperatively. Donor site sequelae were assessed in consultation. Harvesting impact was assessed on 5-point Likert scales by patient and by surgeon.ResultsThirty nine percent of patients showed ≥ 1 sequelae. Donor site sequela impact on sport, daily living and work was assessed by patients as none or mild in 94%, 98% and 100% of cases, respectively. Sixty-one percent of patients and 58.5% of surgeons considered scar esthetics to be discreet or very discreet.ConclusionMorbidity related to anterolateral thigh flap harvesting was low, and functional sequelae at the donor site were well tolerated. The scar was only moderately satisfactory, but could easily be hidden.     

Rehabilitation following total laryngectomy: Oncologic,functional, socio-occupational and psychological aspects

GoalTo review rehabilitation following total laryngectomy by an analysis of epidemiological, oncologic and functional data.Materials and methodsThis retrospective observational study focused on patients having undergone total laryngectomy or pharyngolaryngectomy between January 1, 2005 and December 31, 2016. Oncologic data notably comprised survival and relapse and predictive factors. The impact of the procedure on quality of life and the voice was analyzed by self-administered questionnaires (EORTC QLQ-C30 and H&N35, VHI 30). A satisfaction questionnaire was also sent to patients.ResultsOne hundred and thirty three patients were included. Overall specific 5-year survival was 65%. The relapse rate was 32%. Factors influencing survival were WHO performance status ≥ 2 (P < 0.05), tumor location (P = 0.07), metastatic lymphadenopathy (P = 0.017) and positive resection margins (P = 0.01). Quality of life was moderately degraded (global EORTC QLQ-C30 status: 61.4 ± 23.9). Type of rehabilitation (P = 0.03), tube feeding (P = 0.03) and relapse (P < 0.01) influenced quality of life. There were no differences in voice quality according to rehabilitation method, and no predictive factors for failure of voice rehabilitation. More than 90% of patients were satisfied with their hospital stay; 43%, however, were not satisfied with community caregiver training for laryngectomy patients.ConclusionRehabilitation of laryngectomized patients is a current therapeutic challenge. A therapeutic education tool was designed to better meet patient expectations.     

Non-tuberculous mycobacterial head and neck infections in children: Analysis of results and complications for various treatment modalities

ObjectivesAnalyze the results and complications of various surgical interventions in a large cohort of children with non-tuberculous mycobacterial (NTM) head and neck infections and suggest a heuristic treatment protocol for managing this condition while aiming to maximize cure and minimize complications.MethodsRetrospective chart review of 104 consecutive patients diagnosed with head and neck NTM at a tertiary paediatric hospital between January 1994 and December 2013 inclusive.Results104 patients ranged in age between 8 months to 15 years (mean age 27 months) were reviewed and 97 patients were included in the final analysis. 6 patients excluded due to lack of follow-up and one excluded due to systemic immunocompromised condition. Sub-sites of NTM infections were submandibular (n = 48, 46%), cervical (n = 40, 38%), parotid (n = 18, 17%) and submental (n = 4, 4%). Some patients had more than one lesion so counted twice. Higher cure rates were demonstrated for primary excision (81%, p < 0.01) versus incisional interventions (44%, p < 0.01). Marginal mandibular nerve palsy following surgery was seen in 7 patients (7.2%). This was permanent in 4 patients (4%) and temporary in 3 patients (3%). All children who were complicated with marginal mandibular palsies had lesions in the submandibular region. The rate of palsy for submandibular disease alone was 15%, while 8% presented permanent palsy and 6% temporary. Marginal mandibular nerve palsy was more likely following excisional compared to incisional procedures (6 versus 1 patient, p < 0.01). Hypertrophic scarring occurred in 7 patients: 3 patients following excision and 4 patients after an incisional procedure. One patient suffered long term spinal accessory nerve damage presented as winged scapula.ConclusionsExcision of NTM provides better cure rates compared to incision although at the expense of long term post-surgical morbidity. Excision should probably be the first line of treatment when the risk for neural damage is low. Incision and drainage with or without antimycobacterial treatment may be the preferred option for at-risk sub-sites (submandibular or parotid) in order to reduce long term morbidity.     

Preservación de órgano tras un tratamiento con quimioterapia de inducción en pacientes con carcinomas localmente avanzados (T3-T4) de cavidad oral y orofaringe

Introduction and objectivesWith the goal of achieving functional preservation, one of the treatment strategies for patients with locally advanced squamous cell carcinomas of the head and neck is to initiate treatment with induction chemotherapy (CT) and decide the second therapeutic manoeuvre depending on the response. The objective of this study is to evaluate organ preservation capacity based on this therapeutic approach in patients with tumours of the oral cavity and oropharynx.MethodsA retrospective study of 246 patients with locally advanced carcinomas of the oral cavity or oropharynx (cT3-T4) initially treated with induction CT.ResultsAfter induction CT 28% of patients achieved a complete response of the primary location of the tumour, 43.1% a partial response greater than 50%, and 28.9% a reduction less than 50% or persistence. After the induction CT treatment 70 patients (28.5%) underwent surgical treatment, and 176 (71.5%) radiotherapy (RT) or chemoradiotherapy (CRT). Considering the patients treated non-surgically (n = 176), organ preservation for patients with a complete response (n = 66) was 65.2%, for those patients with a partial response greater than 50% (n = 75) it was 30.7%, and for patients with a partial response less than 50% or persistence (n = 35) it was 14.3%.ConclusionThe response to treatment with induction CT has prognostic value in patients with locally advanced carcinomas of the oral cavity and oropharynx. Patients who are candidates for conservative treatment with RT or CRT would be those who achieve a complete response after induction treatment.     

Capacidad pronóstica de la densidad ganglionar en los carcinomas escamosos de cabeza y cuello

Introduction and objectivesLymph node density or lymph node ratio (LNR), defined as the quotient between the total number of positive lymph nodes and the total number of dissected lymph nodes, has demonstrated a prognostic capacity in several tumour models, including patients with head and neck squamous cell carcinomas (HNSCC). The aim of the present study is to analyse the prognostic value of LNR in a wide cohort of patients with HNSCC.MethodsWe carried out a retrospective study of a cohort of 1,311 patients with HNSCC treated with unilateral or bilateral neck dissections. Of the patients included in the study, 55.0% had lymph node metastases (pN + ). We proceeded to calculate the value of the LNR, and its categorization through a recursive partition analysis considering specific survival as the dependent variable.ResultsThree categories were defined according to the value of the LNR with a cut-off point at the values < of .025 and .118. The 5-year specific survival for patients with an LNR less than .025 (n = 654, 49.8%) was 87.2%, for patients with a LNR .025-.118 (n = 394, 30.1%) it was 51.6%, and for patients with a LNR greater than .188 (n = 263, 20.1%) it was 27.3% (P=.0001). According to the results of a multivariate analysis, the LNR significantly related to specific survival.ConclusionThe LNR can be a prognostic variable to be considered in the pathological staging of the lymph nodes.     

Tissue expression,serum and salivary levels of vascular endothelial growth factor in patients with HNSCC

IntroductionVascular endothelial growth factor is thought to be an important angiogenic factor involved in tumor growth, progression, and metastasis.ObjectiveThe present study evaluated the relation between tissue expression, serum and salivary levels of vascular endothelial growth factor in head and neck squamous cell carcinomas, and their correlation with clinicopathologic features.MethodsSamples were collected from 30 patients with head and neck squamous cell carcinomas and 24 healthy volunteers. Immunohistochemical analysis was used for tissue expression and enzyme-linked immunosorbent assay was employed to measure serum and salivary levels.ResultsNo vascular endothelial growth factor staining was observed in normal tissues, whereas vascular endothelial growth factor expression was seen in 6 patients (20%). Mean serum level of VEGF was 83.7 ± 104.47 in patients and 50.04 ± 32.94 in controls. Mean salivary level of vascular endothelial growth factor was 174.41 ± 115.07 in patients and 149.58 ± 101.88 in controls. No significant difference was found by Mann–Whitney test between controls and patients (p = 0.411, p = 0.944, respectively). No correlation was found between vascular endothelial growth factor tissue expression and its serum and salivary level.ConclusionOverexpression of vascular endothelial growth factor was found in head and neck squamous cell carcinoma patients, suggesting its role in the pathogenesis of head and neck squamous cell carcinoma, but no relation was found between tissue expression, serum levels, and salivary levels of this marker.     

Resultados oncológicos de la laringectomía de rescate en pacientes con carcinomas escamosos de laringe

ObjectiveTo analyse the oncological results of a salvage total laryngectomy in patients with a laryngeal carcinoma.Material and methodsRetrospective review of a cohort of 241 patients treated with a salvage laryngectomy after a local recurrence. The initial treatment received by these patients was radiotherapy (n = 201, 83.4%), chemoradiotherapy (n = 19, 7.9%), and partial surgery (n = 21, 8.7%),ResultsTotal laryngectomy as salvage treatment achieved local control of the disease in 81.3% of cases, with a 5-year specific survival of 65.3%. The variables related with specific survival in a univariate analysis were the location of the primary tumour, the local extension of the initial tumour and of the recurrence, the resection margins, and the pathological status of the neck dissections. According to the results of a multivariate analysis, the variables related to specific survival were the status of the resection margins, the presence of simultaneous regional recurrence, and the local extension of the recurrence.ConclusionThe 5-year specific survival of patients treated with a salvage laryngectomy was 65.3%. The variables related with the control of the disease were the status of the resection margins, the presence of simultaneous regional recurrence and the local extension of the recurrence.     

Factors associated with incomplete surgical margins in basal cell carcinoma of the head and neck

IntroductionCutaneous basal cell carcinoma recurrence is associated with inadequate surgical margins. The frequency of and the factors associated with compromised or inadequate surgical margins in head and neck basal cell carcinoma varies.ObjectiveThe purpose of this study was to evaluate the clinical and pathological factors associated with inadequate surgical margins in head and neck basal cell carcinoma.MethodsWe developed a cross-sectional study comprising all patients who had undergone resection of head and neck basal cell carcinoma from January 2017 to December 2019. Data on age, sex, head and neck topography, histopathological findings, and staging were retrieved and compared. Each tumor was considered an individual case. Compromised and close margins were termed “inadequate” or “incomplete”. Variables that were significantly associated with the presence of incomplete margins were further assessed by logistic regression.ResultsIn total, 605 tumors from 389 patients were included. Overall, sixteen cases (2.6%) were classified as compromised, 52 (8.5%) as close, and 537 (88.7%) as free margins. Presence of scleroderma (p = 0.005), higher Clark level (p < 0.001), aggressive variants (p < 0.001), invasion beyond the adipose tissue (p < 0.001), higher T stage (p < 0.001), perineural invasion (p = 0.002), primary site (p = 0.04), multifocality (p = 0.01), and tumor diameter (p = 0.02) showed association with inadequate margins. After Logist regression, multifocality, Clark level and depth of invasion were found to be independent risk factors for inadequate margins.ConclusionGross clinical examination may be sufficient for determining low prevalence of inadequate surgical margins when treating head and neck basal cell carcinoma in highly experienced oncologic centers. Multifocality, Clark level and depth of invasion were found to be independent risk factors for incomplete margins.     

Salvage surgery for recurrence of laryngeal and hypopharyngeal squamous cell carcinoma: A retrospective study from 2005 to 2013

ObjectivesSalvage surgery is the gold-standard treatment for locoregional recurrence of laryngeal and hypopharyngeal cancer following radiation therapy. Imperfect oncologic and functional results, however, require patient selection. The main objective of the present study was to determine preoperative factors for survival. Secondary objectives were to study 5-year overall and disease-free survival, general and locoregional complications, and functional results in terms of feeding and tracheotomy closure.Patients and methodA retrospective multicenter study included 52 patients treated by salvage surgery for recurrence of laryngeal or hypopharyngeal squamous cell carcinoma after radiation therapy between 2005 and 2013.ResultsFactors associated with improved 3-year overall survival on univariate analysis comprised laryngeal primary (P = 0.001), laryngeal recurrence (P = 0.026), rT1, rT2 or rT3 rather than rT4 tumor (P = 0.007), previous chemotherapy (P = 0.036), and neck dissection during salvage surgery (P = 0.005), the last of these being confirmed on multivariate analysis. Five-year overall survival was 36.0% (range, 27.6–44.4%), for a median 23.04 months (95% CI, 19.44–26.64). Five-year disease-free survival was 23.5% (range, 16.0–31.0%), for a median 8.04 months (95% CI, 2.04–14.04).ConclusionSalvage surgery for laryngeal or hypopharyngeal cancer is difficult, and survival is not good. Laryngeal primary and recurrence location, moderate tumor volume and extension (< T4), prior chemotherapy and neck dissection during salvage surgery were associated with better overall and disease-free survival, which should enable better patient selection.     

Nerwiaki nerwu twarzowego

IntroductionEvaluation of diagnostic, surgical technique, treatment results facial nerve neurinomas and its comparison with literature was the main purpose of this study.Method and materialsSeven cases of patients (2005–2011) with facial nerve schwannomas were included to retrospective analysis in the Department of Otolaryngology, Medical University of Warsaw. All patients were assessed with history of the disease, physical examination, hearing tests, computed tomography and/or magnetic resonance imaging, electronystagmography. Cases were observed in the direction of potential complications and recurrences.ResultsNeurinoma of the facial nerve occurred in the vertical segment (n = 2), facial nerve geniculum (n = 1) and the internal auditory canal (n = 4). The symptoms observed in patients were analyzed: facial nerve paresis (n = 3), hearing loss (n = 2), dizziness (n = 1). Magnetic resonance imaging and computed tomography allowed to confirm the presence of the tumor and to assess its staging. Schwannoma of the facial nerve has been surgically removed using the middle fossa approach (n = 5) and by antromastoidectomy (n = 2). Anatomical continuity of the facial nerve was achieved in 3 cases. In the twelve months after surgery, facial nerve paresis was rated at level II-III° HB. There was no recurrence of the tumor in radiological observation.ConclusionFacial nerve neurinoma is a rare tumor. Currently surgical techniques allow in most cases, the radical removing of the lesion and reconstruction of the VII nerve function. The rate of recurrence is low. A tumor of the facial nerve should be considered in the differential diagnosis of nerve VII paresis.     

Sensitivity to structure in the speech signal by children with speech sound disorder and reading disability

PurposeChildren with speech sound disorder (SSD) and reading disability (RD) have poor phonological awareness, a problem believed to arise largely from deficits in processing the sensory information in speech, specifically individual acoustic cues. However, such cues are details of acoustic structure. Recent theories suggest that listeners also need to be able to integrate those details to perceive linguistically relevant form. This study examined abilities of children with SSD, RD, and SSD + RD not only to process acoustic cues but also to recover linguistically relevant form from the speech signal.MethodTen- to 11-year-olds with SSD (n = 17), RD (n = 16), SSD + RD (n = 17), and Controls (n = 16) were tested to examine their sensitivity to (1) voice onset times (VOT); (2) spectral structure in fricative-vowel syllables; and (3) vocoded sentences.ResultsChildren in all groups performed similarly with VOT stimuli, but children with disorders showed delays on other tasks, although the specifics of their performance varied.ConclusionChildren with poor phonemic awareness not only lack sensitivity to acoustic details, but are also less able to recover linguistically relevant forms. This is contrary to one of the main current theories of the relation between spoken and written language development.Learning outcomes: Readers will be able to (1) understand the role speech perception plays in phonological awareness, (2) distinguish between segmental and global structure analysis of speech perception, (3) describe differences and similarities in speech perception among children with speech sound disorder and/or reading disability, and (4) recognize the importance of broadening clinical interventions to focus on recognizing structure at all levels of speech analysis.     

Surgical management of chronic salivary aspiration

Aim of the studySialorrhoea and chronic salivary aspiration are a major problem in many neurologically impaired children causing embarrassment, skin issues and recurrent lower respiratory tract infections (LRTI). The aim of this study was to assess the efficacy of salivary gland surgery in the treatment of chronic salivary aspiration in such children.ObjectivesTo compare admission rates for LRTI per annum before and after surgical intervention.MethodsRetrospective review of all patients who underwent salivary management surgery for chronic aspiration under Princess Margaret Hospital's (PMH) Otolaryngology department from 2006 until 2013.ResultsTwelve patients were included in this review. Their ages ranged from 3 to 21 years (mean = 11.4). Their genders were equally distributed. Two patients had underlying congenital disorders; one had an acquired brain injury, while the majority (n = 9, 75%) had cerebral palsy secondary to a sustained perinatal injury.Most patients (n = 11, 91.7%) had bilateral submandibular gland excision and parotid duct ligation as a primary procedure. One patient had a laryngotracheal separation. Two patients went on to have a second procedure. The mean follow up time was five years. Using Wilcoxon Signed-Rank test we showed that the median rate of admission per annum for LRTI pre-operatively was 1.0. This was reduced to 0.5 post-operatively, which was statistically significant (p ≤ 0.05).ConclusionsWe hypothesize that the combination of bilateral submandibular gland excision and bilateral parotid duct ligation is effective in reducing admissions with aspiration pneumonia in neurologically impaired children, and therefore improves the quality of life in these patients.