Can the Sino‐nasal Outcome Test (SNOT‐22) be used as a reliable outcome measure for successful septal surgery?

Can the Sino‐nasal Outcome Test (SNOT‐22) be used as a reliable outcome measure for successful septal surgery? Septoplasty and submucous resection are common procedures in the UK. This study looks prospectively at 40 patients undergoing surgery at two hospitals. A pre‐ and postoperative assessment (3 months) was made using the Sino‐nasal Outcome Test. This test was originally designed for rhinosinusitis but our study suggests that it is a useful tool in nasal septal surgery, in that it combines both nasal specific and general health questions, which can be analysed individually or together. Improvements in nasal obstruction (75%), facial pain (33%) and catarrh (10%) were noted.     

A prospective single‐blind randomized‐controlled trial comparing two surgical techniques for the treatment of snoring: laser palatoplasty versus uvulectomy with punctate palatal diathermy

The aim of this study was to compare laser palatoplasty with uvulectomy with punctate palatal diathermy as treatment modalities for snoring. The study design was a prospective, single‐blind, randomized‐controlled trial. Eighty‐three patients entered the trial. After a mean follow‐up period of more than 18 months there was no statistically significant difference between the two groups regarding the patient perception of benefit from surgery or the subjective improvement in snoring. However, there was a statistically significant difference in the degree of pain in the immediate postoperative period (mean difference = 22.14, 95% CI = 7.98–36.31, P = 0.003), with the pain being worse in the laser palatoplasty group. Relative risk of complications for laser palatoplasty was 1.42 (95% CI = 0.93–2.17). The snoring scores and Glasgow Benefit Inventory scores decreased with time in both the groups but there was no statistically significant difference between the two groups.     

Self‐assessment of voice therapy for chronic dysphonia

Self‐assessment of voice therapy for chronic dysphonia The effects of voice therapy in a group of chronically dysphonic patients are determined using two quality‐of‐life (QOL) instruments: the Voice Handicap Index (VHI), and a simple three‐item outcome scale (three visual analogue scales). Both instruments measure changes in the quality of the voice itself and in the extent of impairment resulting from the dysphonia as experienced by the patient in social and occupational settings. Statistical tests conducted on pre‐ and post‐treatment data indicated significant improvements on both instruments for the group as a whole. At the individual level, however, the effects were diverse. For roughly 50% of the subjects, a significant improvement could be established. The positive changes as measured with the three‐item scale were greater than those measured with the VHI. The results suggest that the two QOL instruments measure slightly different aspects of the subjective perception of the therapy effects. In order to obtain a general evaluation of the patient's handicap, it may suffice to ask some simple questions.     

Analysis of Treatment Results for Floor‐of‐Mouth Cancer

Objective This study reports the results of treating floor‐of‐mouth cancer with five different treatment modalities with long‐term follow‐up. Study Design Retrospective study of 280 patients with floor‐of‐mouth cancer treated in the Department of Otolaryngology—Head and Neck Surgery at Washington University Medical School (St. Louis, MO) from 1960 to 1994. Methods Patients with biopsy‐proven squamous cell carcinoma of the floor of mouth who were previously untreated were treated with curative intent by one of five modalities and were all eligible for 5‐year follow‐up. The treatment modalities included local resection alone, composite resection alone (with neck dissection), radiation therapy alone, local resection with radiation therapy, and composite resection with radiation therapy. Multiple diagnostic, treatment, and follow‐up parameters were studied using standard statistical analysis to determine statistical significance. Results The overall 5‐year disease‐specific survival (DSS) was 56% with death due to tumor in 44% of patients. The 5‐year cumulative disease‐specific survival (CDSS) was 0.61 (Kaplan‐Meier probability) with a mean of 8.3 years and a median of 9.7 years. The DSS by treatment modality included local resection (76%), composite resection (63%), radiation therapy (43%), local resection with radiation therapy (61%), and composite resection with radiation therapy (55%). Overall, there was no significant difference in DSS by treatment modality. Recurrence at the primary site (41%) was the most common site of treatment failure. Nineteen percent of patients had recurrence in the neck. Eighty‐eight percent of initial recurrences occurred within 60 months after the onset of treatment. Metastasis to a distant site occurred in 30% of patients. Twenty percent of these patients had second primary cancers, and 53% of these patients died of their second primary cancers. Conclusions Significantly improved 5‐year DSS was seen in the patients with clear margins, early clinical tumor stage, and negative nodes. Significantly decreased 5‐year survival was seen in the patients with involved margins, advanced clinical tumor stage, positive nodes, and tumor recurrence. Patients with no clinically positive nodes (cN0) can be observed safely for regional nodal disease and subsequent positive nodes can be treated as they occur with no adverse affect on survival. Because of high recurrence rates at the primary site and neck, and an increased rate of both distant metastasis and the development of second primary cancers, patients should be monitored closely for a minimum of at least 5 years.     

Outcomes of submandibular duct re‐implantation for sialorrhoea

Drooling is an important factor affecting the quality of lives of neurologically impaired children, and surgery often has to be performed. Submandibular duct relocation is a relatively simple procedure with a low complication rate, and has been carried out on 37 patients at the Sheffield Children's Hospital between 1986 and 1998. To determine the short‐term and long‐term outcome of this procedure, a questionnaire was sent to the parents/wards of the patients. Feedback was also obtained on complications, parents'/carers' perceptions and main concerns about the operation, particularly in those cases which did not improve. Both short‐term (82.4%) and long‐term (76.5%) control rates were high, and there were few complications, none of which had any long‐term adverse effects. The most significant area of parental/carer dissatisfaction and concern in ‘failed’ cases was ‘pain’, and it was felt that proper preoperative counselling about analgesia and chances of failure is very important. We conclude that this is a safe, highly successful procedure which significantly improves the quality of lives of the majority of drooling children.     

814例舌系带过短儿童异常语音的探讨及矫治效果分析

目的探讨舌系带过短儿童的异常语音特点及矫治方法。方法采用启音博士Dr．Speech软件及四川大学华西口腔医院唇腭裂外科语音清晰表对814例确诊为舌系带过短患儿进行语音测评,对有发音障碍的575例按2～4岁、4～6岁、6岁以上分为3组,随机在3组中抽出100例单纯语训,100例单纯手术,375例手术一个月后仍有263例在语音错误,对263例进行语训,然后进行矫治和分组对比。结果舌系带过短导致言语障碍的发生率为70．6％;从发音的位置整理声母错误情况,由高至低依次为舌尖后音、舌根音、舌尖音、舌尖前音、舌面音．唇齿音．双唇音;舌系带过短患儿有语音障碍单纯语训的有效率为67．0％;单纯手术后语音自行康复率为32.0％;手术配合语训的有效率为98．5％。结论准确的干预可以帮助舌系带过短患儿更好地发展语言,手术配合语训是治疗舌系带过短患儿语音异常的最佳治疗方法。     

Psycho‐socio‐economic outcomes in acoustic neuroma patients and their carers related to tumour size

The objective was to explore psycho‐socio‐economic outcomes of a 2‐year cohort of patients having surgery for an acoustic neuroma, and carers and their relationship to tumour size after surgery. The Wessex Patient Carer Questionnaire was designed in conjunction with Patients and Carers, to determine psycho‐socio‐economic outcomes. The results were juxtaposed against clinical profiles. The House–Brackman (HB) scale was used to assess facial function at 6 and 12 months after operation. The cohort contained 102 patients. There were 87% effective responders. Half were aged below 54 years and 30% had school‐aged children. The majority (93%) of patients were operated via the translabyrinthine approach. Patients with large tumours, i.e. greater than 3 cm (28%), had most post‐treatment physical problems, including hearing and balance difficulties, and 42% reported difficulty eating in public. Thirty‐four per cent felt ‘stressed’ and 18%‘depressed’. After 6 months, facial function was recorded as HB scale 5/6 in 21% of patients but by 1 year only 8% of patients were HB 5/6. Patients and carers were generally very satisfied with their in‐patient neurosurgical care, but significantly dissatisfied with post‐discharge care – particularly the shortcoming of the community services. The majority of families felt ‘unsupported’ and only 20% of patients had confidence in their General Practitioner's knowledge. Families faced severe socio‐economic disruption and patients’‘time‐off‐work’ was estimated to cost £954 000. Carers carried considerable post‐discharge psychological burdens and costs to the public purse were calculated to be £52 400.