Otolaryngology–Head and Neck Surgery

OBJECTIVE: To assess outcomes for patients with chronic rhinosinusitis.

STUDY DESIGN AND SETTING: Prospective, multicenter study; 31 otolaryngologists enrolled 276 adult patients with chronic rhinosinusitis; patients completed surveys at 3-month intervals, and physicians provided clinical and treatment data. The primary outcome measure was the Chronic Sinusitis Survey-Duration (CSS-D).

RESULTS: One hundred seventeen adult patients completed 12-month follow-up. Most patients reported sinus symptoms lasting longer than 3 years (74%). Patients showed significant improvement (group P < 0.0001) in the CSS-D score at each follow-up interval. Baseline CSS-D (P < 0.0001), surgical intervention (P < 0.003), and Lund-McKay score (P < 0.04) were predictive of clinical success in regression analysis.

CONCLUSIONS: Patients referred to an otolaryngologist have a severe sinus illness. Treatment by an otolaryngologist was associated with significant improvement in sinus-related symptoms.

SIGNIFICANCE: The study demonstrated the feasibility of multicenter outcome studies in chronic rhinosinusitis and generated testable hypotheses for future investigation. EBM rating: C.

OBJECTIVE: Outcomes for patients with otitis media were assessed in this prospective, multicenter study.

STUDY DESIGN AND SETTING: Thirty-one otolaryngologists enrolled 272 pediatric patients with otitis media; caregivers completed surveys at 3-month intervals, and clinical and treatment data was also collected. The Otitis Media 6 (OM-6) was the primary outcome measure.

RESULTS: One hundred seventy-seven patients (mean age 2.0 years) completed 3-month follow-up. One hundred thirty-seven patients underwent tympanostomy tube placement. Large improvements in disease-specific quality of life (QOL) were seen up to 9 months of follow-up. Baseline OM-6 score was the best predictor of clinical success in regression modeling.

CONCLUSIONS: Patients referred to an otolaryngologist for treatment of otitis media see large improvements in disease-specific QOL regardless of treatment rendered.

SIGNIFICANCE: The study demonstrates the feasibility of multicenter outcomes studies and confirms appropriate triage of patients with otitis media into surgical versus medical interventions. EBM rating: C.

BACKGROUND: Psychiatric disorders are associated with increased symptom burden when combined with chronic medical conditions. However, there are no reports of how psychiatric distress influences outcomes with surgical treatment for chronic rhinosinusitis (CRS). We hypothesized that subjects with psychiatric distress (somatization, anxiety, and depression) would report more severe long-term sinus symptoms and worse quality of life (QOL) than subjects without psychiatric distress.

METHODS: This is a community-based, prospective, observational cohort study of patients diagnosed with CRS presenting for surgery. Patients were interviewed before surgery; CT scans were reviewed, and questionnaires were completed about sinusitis-related symptoms (SNOT-16), general health status and QOL (SF-36), and psychiatric distress (BSI and PHQ). Outcomes were also assessed 1, 3, 6, and 12 months postoperatively.

RESULTS: Ninety-five patients had complete records for analysis. Psychiatric distress was prevalent, with 31% screening positive for somatization, 17% positive for anxiety, and 25% positive for depressive disorders. Subjects with somatization had significantly worse SNOT-16 scores at each time point compared with those without somatization (P < 0.05). Subjects with depression reported more severe symptoms at 6 and 12 months after surgery than those without depression (P < 0.05). The presence of somatization preoperatively was also independently associated with worse symptom severity 12-months after surgery, even after adjusting for prior sinus surgery, CT stage, Charlson Index, and deviated septum. In addition, subjects with psychiatric distress reported significantly worse SF-36 physical and mental component summary scores 12-months after surgery than subjects without psychiatric distress.

CONCLUSIONS: Psychiatric distress is associated with worse reported sinus symptoms and lower QOL throughout surgical management of chronic rhinosinusitis. Despite this, subjects with psychiatric distress report a similar degree of improvement in sinus symptoms after surgery compared with those without distress.

CLINICAL SIGNIFICANCE: Psychiatric distress should be considered in patients with persistent symptoms after surgery. Psychiatric distress should also be considered in efforts to design a chronic sinusitis staging system.

OBJECTIVE: To develop a questionnaire to evaluate preferences for attributes of intranasal corticosteroids (INSs) in clinical trials with allergic rhinitis (AR) patients.

STUDY DESIGN AND SETTING: Established questionnaire development practices were used, including performance of a literature review and use of patient and physician focus groups, cognitive debriefing interviews, and pilot testing before validation.

RESULTS: Findings from patient and physician focus groups suggest that sensory attributes are relevant to AR patients when choosing INSs. Physician focus groups identified the need for 2 distinct preference instruments, a clinical trial patient preference questionnaire (CTPPQ) and a clinical practice preference questionnaire (CPPPQ). A pilot study suggests that the CTPPQ is capable of discriminating between 2 INSs in the clinical trial setting.

CONCLUSIONS: Initial findings suggest that items in the CTPPQ and CPPPQ are easy to understand and relevant to patients. Further validation studies with larger sample sizes are needed to assess the psychometric properties of both questionnaires. EBM rating: B-20.

OBJECTIVES: The advances in endoscopic sinus surgery have made it the procedure of choice for treatment of cerebrospinal fluid rhinorrhea (CSFR). To analyze the efficacy of endoscopic closure of CSFR was the objective of the present study.

METHODS: We treated 267 patients with CSFR endo-scopically. Diagnosis was achieved with the help of CT with or without cisternography, MRI, beta-2 transferrin levels. Fascia lata and fat were used to plug the defects. The patients were followed up for a minimum period of 6 months.

RESULTS: CSFR was successfully plugged in 258 patients. Nine patients required revision surgery. Six could be plugged successfully endoscopically and 2 patients by a neurosurgical approach.

CONCLUSIONS: In our experience with 267 patients of endoscopically treated CSFR, the results of achieving the closure was 96.63% in the first instance and 98.88% after revision surgery.

SIGNIFICANCE: The transnasal endoscopic approach has excellent results in the treatment of CSFR. We recommend it as the optimum surgical approach for both primary and revisional surgical management of CSFR.

PURPOSE: This article demonstrates technique and results of a 3-layer repair of nasoseptal defects using bilateral bipedicled advancement flaps and an autogenous cartilage graft.

METHOD: After an extensive bilateral elevation of the mucosa from the entire septum, the nasal dome and the nasal floor bipedicled advancement flaps are created. The mucosal defects are sutured and an autogenous cartilage graft is interposed between the sutured mucosal flaps.

RESULTS: Until now this technique has been applied in 403 patients. The success rate (complete closure) was 92.5%. Thirty-four patients redeveloped defects; 28 were <5 mm and did not cause complaints.

CONCLUSION: Results show that the described technique is a most reliable method with the following advantages: 1 stage procedure, no visible scars, high success rate, and low complication rate. In case of an incomplete closure, the redeveloped defect will generally be considerably smaller than the original one and asymptomatic.

OBJECTIVE: Caldwell and Luc described the Caldwell-Luc operation more than 100 years ago as the surgical treatment for maxillary sinus disease. During the last decades less radical interventions using endoscopic approach have mainly replaced the classical procedures done for chronic and recurrent maxillary sinusitis.

STUDY DESIGN AND SETTING: Between 1991 and 2002, 62 patients had the Caldwell-Luc approach for different indications.

RESULTS: Twenty (32%) patients had chronic sinusitis, 16 (26%) patients had inverted papilloma, 9 (15%) patients had suffered from nasal polyposis, 4 patients (6%) had dentigerous cyst, 4 (6%) patients had fungal ball, and 9 (15%) patients were operated for other indications.

CONCLUSIONS: The use of this surgical approach is rational in cases of fungal disease and in endoscopic medial maxillectomy for treating inverted papilloma. In all other cases, the preferred approach should now be endoscopic.

OBJECTIVE: Some uncommon anatomic variations would be encountered with the increasing number of patients with chronic paranasal sinusitis who have undergone functional endoscopic sinus surgery. The correct identification and proper treatment for these variations are important.

STUDY DESIGN AND SETTING: A retrospective study of serial computed tomography scan images was conducted in 100 patients collected randomly. Uncommon anatomic variations were recorded and clinical features were analyzed.

RESULTS: Five (5%) cases with uncommon anatomic variations were found. These variations included bilateral pneumatization of uncinate process (1%), large uncinate process mimics the middle turbinate (1%), nontraumatic protrusion of orbital contents through dehiscence of lamina papyracea (1%), and nasal septal pneumatization (2%). Two of these 5 cases caused some modifications of routine functional endoscopic sinus surgery procedures and another 2 variants commanded further caution during routine uncinectomy.

CONCLUSION AND SIGNIFICANCE: Uncommon anatomic variations, though unusual, are not rare in chronic paranasal sinusitis patients. Procedures should be tailored for most of these special conditions.

OBJECTIVE: To evaluate the success and complications of various treatment options of congenital subglottic hemangioma.

STUDY DESIGN AND SETTINGS: Reported cases were grouped by treatment modalities and corresponding outcome evaluated.

RESULTS: From 1986 through 2002, 372 patients were reported in 28 series. Carbon dioxide laser had 88.9% success rate yet 5.5 % significant subglottic stenosis. It shortened the tracheotomy duration by 13.7 months. Corticosteroids were not that beneficial (useful in only 24.5%) with 12.9% side effects. Intralesional corticosteroids were successful in 86.4% with 5.6% complication rate. Surgical excision (as young as 2.5 months), was useful in 98% with 10% complication rate, using cartilage grafts in 34%. Other modalities were less popular.

CONCLUSION: Treatment should be individualized. Guidelines are suggested. Priority is given to secure the airways. The CO₂ laser is useful when used cautiously. Steroids may be beneficial. Excision is for stubborn cases.

OBJECTIVE: To review the role of open laryngotracheal reconstruction (LTR) in congenital laryngeal webs and atresias.

STUDY DESIGN AND SETTING: A retrospective chart review was undertaken in a specialist otorhinolaryngology unit in an academic tertiary referral paediatric hospital. Twenty-one patients with congenital laryngeal subglottic stenosis (SGS) underwent LTR between 1993 and 2003. Two groups were identified; one group had SGS alone (n = 6) and the other group had SGS associated with a laryngeal web (n = 15). Information recorded included presenting features, classification of lesion, surgery performed, and whether decannulation was achieved.

RESULTS: All grades of stenosis (Myer-Cotton classification) and webs of type 2, 3, and 4 (Cohen's classification) were recorded. Fifteen patients had a staged reconstruction and 6 patients had a single-stage LTR. Complications included 2 revision procedures, 3 tracheocutaneous fistulas, and 1 death (cause unrelated). All appropriate patients were successfully decannulated at between 3 and 18 months post-LTR (median, 5 months).

CONCLUSION: This series illustrates the effective role of open LTR in both congenital SGS alone and that in association with glottic webbing.

BACKGROUND: Fat is theoretically the ideal implant for vocal fold augmentation because it is soft, easily available and biocompatible. However, reabsorption is a frequent cause of long-term failure.

OBJECTIVE: We prospectively tested Coleman's “li-postructure” technique used for facial recontouring in the treatment of glottic incompetence.

STUDY DESIGN AND SETTING: Fourteen patients (aged 18–74 years, mean 48) with breathy dysphonia secondary to laryngeal hemiplegia (7) or anatomical defects (7) underwent vocal fold lipoinjection. Fat harvested by liposuction was centrifuged, and the fat cell layer injected into the vocalis muscle. The patients underwent pre- and postoperative videolaryngostroboscopy, maximum phonation time (MPT) measurements, GRBAS perceptual evaluations, and Voice Handicap Index (VHI) self-assessments.

RESULTS: Voice quality improved soon after surgery and remained stable over 3–26 months (mean 10.6), being confirmed by the GRBAS, MPT and VHI evaluations (P < 0.005). The results were best in the seven patients with paralytic dysphonia.

CONCLUSION: Lipostructure is a valuable technique for voice rehabilitation in glottic incompetence.

OBJECTIVES: It is sometimes impossible to obtain an adequate laryngeal view during rigid endoscopic laryngoscopy. This may be due to a high tongue base. Our study seeks to determine a correlation between tongue base level and the adequacy of laryngeal view obtained with a 70-degree rigid endoscope.

STUDY DESIGN AND SETTING: Over a period of 4 months, patients from a voice clinic were gathered and categorized into class I to III according to Mallampati et al (1985). Rigid laryngo-videostroboscopy was conducted to assess the larynx and the adequacy of the view was recorded.

RESULTS: 74 patients were recruited. The number of adequate views were: class I = 18/20 (90%); class II = 20/33 (60.6%); class III = 7/21 (33.3%). χ² analysis demonstrated significance trend in all 3 classes.

CONCLUSION: The level of the tongue base correlated well with the adequacy of laryngeal view obtained from a 70-degree rigid endoscope. This can be used to predict the success of obtaining adequate views during rigid laryngoscopy.

The operation of simultaneous bilateral posterior cordectomy by CO₂ laser was performed in 22 cases of bilateral vocal fold paralysis. The success rate was up to 92% with good airway and voice quality. The procedure is simple, cost-effective with virtually no complications. Problems related to deglutition, aspiration, or granuloma formation were not reported.

OBJECTIVE: To present a nonwalled all-detachable retractor that simultaneously exposes the mouth, pharynx, and larynx.

STUDY DESIGN AND SETTING: The proposed instrument is composed of a mouth-gag with a set of 5 interchangeable angled tongue blades, and a pharyngeal lever that provides internal laryngo-pharyngeal distension. Sixty-five patients were submitted to tonsillectomy, adenoidectomy, and endolaryngeal surgery with the workspace provided by the manufactured scope.

RESULTS: Proper exposure of the upper aerodigestive tract was achieved in all patients. Naked eye, varied endoscopes, and special curved instruments were used to examine, lase, and manipulate tissues. Bimanual surgery was possible due to self-retaining adjustment and a clamp for endoscopes.

CONCLUSION AND SIGNIFICANCE: This instrument allowed for an ample exposure from mouth to glottis in adults and children. Opposed to linear laryngoscopes in which the patient adapts to the instrument, its unique design adjusts to patients’ anatomy and to many clinical situations.

OBJECTIVE: We tested whether polysomnography (PSG) indexes were associated with sleepiness, quality of life, or reaction times at baseline and as outcome measures following surgical or sham treatment for patients with obstructive sleep apnea syndrome (OSAS).

STUDY DESIGN AND METHODS: Mild-moderate OSAS subjects were measured before and 8 weeks after surgical or sham treatment in this prospective longitudinal study. Measures included standard PSG indexes, sleepiness, quality of life, and reaction times. Associations were examined with Spearman correlations and multivariate linear regression.

RESULTS: Correlations between baseline PSG and non-PSG measures ranged from −0.22 to 0.25 (n, 87 subjects; mean correlation, 0.00 ± 0.11), with one positive association significant of 56 tested (arousal index and SF36 Mental Component Summary, r, 0.25; P = 0.03). Correlations between change in PSG and non-PSG measures ranged from −0.37 to 0.35 (n, 54 subjects; mean correlation, −0.05 ± 0.19), with no significant positive association of 56 tested. Regression analyses confirmed these results.

CONCLUSIONS: PSG indexes are not consistently associated with sleepiness, quality of life, or reaction time, both at baseline and as outcome measures in patients with mild-moderate OSAS. PSG indexes may not quantify some important aspects of OSAS disease burden or treatment outcome. Clinically important outcomes should be measured directly. EBM rating: A.

OBJECTIVE: We retrospectively investigated the effect and predictability of preoperative polysomnography (PSG) on the postoperative course of younger pediatric patients undergoing adenotonsillectomy.

STUDY DESIGN AND SETTING: A retrospective chart review was performed for patients 3 years of age and younger who had undergone adenotonsillectomy between July 1997 and July 2002 at the Children's Hospital of Wisconsin.

RESULTS: Two hundred eighty-two patients were identified. Forty-three patients had preoperative PSG. No correlation between the severity of PSG results and postoperative course was identified.

CONCLUSIONS: The role of PSG in upper airway obstruction and OSA remains controversial. This study suggests that although the complication rate may be higher in this younger population, these complications do not appear to have a large impact on their length of stay.

SIGNIFICANCE: This study suggests that the 3-years-and-younger group, in the absence of other comorbidities, can safely undergo adenotonsillectomy without undergoing preoperative PSG. EBM raing: C.

OBJECTIVES: To correlate polysomnographic findings with clinical history of apnea, the degree of obstruction caused by tonsillar hypertrophy, and to age group.

STUDY DESIGN AND SETTING: 267 children with a clinical diagnosis of obstructive sleep apnea (OSAS) were evaluated. Patients were divided into preschool- and school-age categories, and subdivided in 3 additional groups, according to tonsillar hypertrophy. Polysomnographic findings were compared within groups.

RESULTS: 34% of children had history of OSAS and normal polysomnographic findings. Tonsillar hypertrophy was correlated to more severe apnea among preschool-age children, but not among school-age children. Among children with tonsillar hypertrophy, more severe apnea was observed in preschool-age children than in school-age children.

CONCLUSIONS: There is little correlation between polysomnographic and clinical findings in children with OSAS.

SIGNIFICANCE: Adenotonsillar hypertrophy leads to more severe polysomnographic patterns in preschool-age children. More severe apnea is observed in younger children with adenotonsillar hypertrophy than in older ones.

OBJECTIVE: To compare the postoperative recovery of patients receiving Coblation-assisted (Arthrocare, Sunnyvale, CA) intracapsular tonsillectomy with that of patients receiving traditional subcapsular electrocautery tonsillectomy.

STUDY DESIGN AND SETTING: This was a prospective, randomized, double-blinded, controlled study. One hundred one children, aged 2 to 16 years, were randomized to Coblation or to conventional electrocautery tonsillectomy. Only patients with the operative indication of obstructive sleep apnea were entered into the study. Intracapsular tonsillectomy was performed on the Coblation group, and traditional subcapsular dissection was performed on the electrocautery group. Adenoidectomy was performed with the curette in both groups. Outcome measures were assessed on days 1, 3, and 5 after surgery. These included child and parental rating of pain by using the Wong Faces pain scale, analgesic use, oral intake, and activity level. Patients, parents, and the nurse practitioner obtaining the outcome data were blinded to treatment arm.

RESULTS: Treatment groups were similar in age, gender, and weight. Surgical time and estimated blood loss were similar. There were no complications in either group. Coblation patients had less pain and greater oral intake at all 3 time points. Percentage of normal activity level returned to >70% earlier and more frequently in Coblation patients. There was slightly decreased analgesic use on postoperative day 5 in the Coblation group.

CONCLUSIONS AND SIGNIFICANCE: Children with obstructive sleep apnea undergoing tonsillectomy and adenoidectomy demonstrate significantly better postoperative recovery after Coblation-assisted intracapsular tonsillectomy.

OBJECTIVE: To evaluate potential risk factors and the incidence of bleeding following adenoidectomy or tonsillectomy, with or without adenoidectomy requiring surgical treatment under general anesthesia.

STUDY DESIGN AND SETTING: Retrospective chart review of 15,218 patients who underwent surgery between January 1, 1988, and September 30, 2001, at our institution (St. Anna Hospital, Duisburg).

RESULTS: A total of 229 patients experienced post-operative bleeding (1.5%). Patients of male gender and 70 years of age or older were significantly at risk for post-tonsillectomy hemorrhage. The incidence of bleeding increased with age. Of the bleeding episodes, 76% occurred on the day of surgery; immediate abscess-tonsillectomy was not associated with an increased risk of bleeding.

CONCLUSIONS: Hemorrhage following tonsillectomy and adenoidectomy is rare and predominantly occurs early after surgery. Male patients, 70 years of age or older, infectious mononucleosis, and a history of recurrent tonsillitis were identified as risk factors for post-tonsillectomy hemorrhage. Delayed hemorrhage has the potential to be life-threatening.

OBJECTIVE: To evaluate the efficacy and safety of celecoxib and ketoprofen in pain management during tonsillectomy in 120 patients.

STUDY DESIGN AND SETTING: The study was randomized, double-blind, and placebo-controlled with parallel groups. Sixty minutes before anesthesia induction and 12 hours after, the patients received a 200-mg celecoxib, a 100-mg ketoprofen, or a placebo capsule. After discharge, patients were prescribed either celecoxib or ketoprofen capsules to be taken every 12 hours.

RESULTS: During the first 24 hours, the need for rescue analgesic was less in the ketoprofen-group (5 (1-9)) doses (median (range)) than in the placebogroup (6 (1-13)) (P = 0.021), but similar to the cele-coxib-group (5 (2-14)). After discharge, the cessation of pain during eating occurred earlier in the celecoxib-treated patients, after 10 (1-17) days, than in the ketoprofen-treated patients, after 12 (1-21) days, (P = 0.008). One celecoxib-treated patient and 6 ketoprofen-treated patients (P = 0.013) needed electrocautery to stop postoperative bleeding.

CONCLUSION: Ketoprofen provided a better initial analgesic efficacy but after discharge the recovery with celecoxib was faster and the incidence of secondary hemorrhages was lower.

SIGNIFICANCE: Celecoxib seems to be more effective and safe than ketoprofen for pain management after discharge in patients with tonsillectomy.

OBJECTIVES: To evaluate the distribution and scope of papers published in the world in otolaryngology (ORL) journals and to compare the impact of this research among different countries.

METHODS: Papers published in the 29 ORL journals screened by the Institute for Scientific Information (ISI, Philadelphia, PA, USA) in the 6-year period 1995–2000 were considered. The journal impact factor (IF), the source country population, and gross domestic product (GDP) were recorded. All key words, both those assigned by the authors and those attributed by ISI, were identified and their frequency was calculated using a special-purpose program.

RESULTS: The total number of papers in the ORL literature during the period 1995–2000 increased from 2036 to 3705. A percentage varying between 47.7% (1995) and 36.1% (2000) was published by EU authors whereas the USA accounted for a percentage varying between 28.1% (1995) and 38.8% (2000). In 2000, the leading countries were the USA, the EU, Japan, Canada, and Australia. In Europe the UK (28.5% of papers), Germany (26.2%), Italy (7.2%), Sweden (5.8%), France (5.5%), and the Netherlands (4.9%) showed a very good performance trend. In the same year, the mean IF of EU papers was 0.8 in comparison with 1.1 for Australia and the USA and 0.9 for the world. In 1997, 1341 key words attributed by the authors and 696 attributed by ISI appeared in the ORL literature. Less than a tenth of them were cited more than twice. The leading key words were “cancer” for disease and “surgery” for treatment.

CONCLUSIONS: Bibliometric findings are useful to follow research trends. Our data show high scientific production of relatively small countries. Dispersion of key words should be avoided and journal editors should promote their standardization.

OBJECTIVE: To analyze the epidemiologic patterns and survival rates for patients with nasopharyngeal carcinoma over the last three decades.

METHODS: The National Cancer Institute (NCI) Surveillance, Epidemiology, and End Results (SEER) program tumor registries were used to identify patients with nasopharyngeal carcinoma in the United States from 1973 to 1999. Incidence and survival rates for each decade were then determined according to age, gender, race, histological type, and stage using the SEER statistical program.

RESULTS: From 1973 to 1999, 4680 cases of patients with nasopharyngeal carcinoma in the United States were sampled by the NCI/SEER database. Overall incidence rates for each decade essentially remained unchanged over time (0.7/100,000). Asians exhibited the highest incidence rates (3.0–4.2), followed by blacks (0.7–1.1) and then whites (0.4–0.7). In contrast, survival rates have gradually improved over time for all stages and histological types (35.7% 5-year survival in the 1970s vs. 44.1% in the 1980, and 51% in the 1990s). With respect to race, Asians demonstrated the best 5-year survival rate (62.9%) followed by whites (42.6%) and then blacks (36.2%). However, this may be due to histology, because Asians were also found to have a greater proportion of World Health Organization (WHO) type III cases (27.6%) in comparison to the other 2 groups (22.4% for blacks and 15% for whites).

CONCLUSIONS: Although the incidence rates of nasopharyngeal carcinoma have remained essentially unchanged in the United States in the last 3 decades, survival rates for each stage and histological subtype have exhibited considerable improvement over time. The higher survival rates in Asians may be partially attributed to the more favorable histology (type III) often seen in this group. EBM rating: B-3.

OBJECTIVE: Determine the effect on prognosis of Langerhans cell infiltration in cancer of the larynx.

STUDY DESIGN AND SETTING: Retrospective review of 72 surgically treated patients with T1–3 lesions. The streptavidin-biotin method to determine Langerhans cell infiltration, which was graded as 1+, 2+, and 3+.

RESULTS: A higher degree of Langerhans cell infiltration was significantly associated with less cervical lymph node metastasis, longer disease-free survival, less locoregional recurrence, and less clinical N-positivity (P < 0.05). According to multivariant analysis, Langerhans cell infiltration was independently related to disease-free survival and recurrence (P < 0.05).

CONCLUSIONS: Langerhans cell infiltration is prognostically important in cancer of the larynx. More intense infiltration is significantly related to prolonged disease-free survival, less locoregional recurrence, less cervical lymph node metastasis, and less clinical N-positivity.

SIGNIFICANCE: Langerhans cell infiltration may be determined on a biopsy specimen and this information may be useful in deciding about elective neck dissection. Patients with mild infiltration may have a higher risk of locoregional recurrence, shorter disease-free survival, and therefore they suggest a poor prognosis.

PURPOSE: Curcumin, a potential chemopreventive agent, was found to inhibit cancer cells in S/G2M phases of the cell cycle, when radiation is more effective. The purpose of the current study was to investigate whether curcumin can sensitize squamous cell carcinoma (SCC) cells to the ionizing effects of irradiation.

METHODS: Curcumin (3.5 μM) was added for 48 hours to an SCC cell line prior to irradiation. Cell growth (counts) and colony-formation (colonogenic assay) were examined after radiation.

RESULTS: Incubation with curcumin only (3.75 μM) for 48 hours did not decrease the number of cells or the ability to form colonies in the absence of radiation. However, in plates that were exposed to 1–5 Gy of radiation, cell counts dropped significantly if pretreated with curcumin with a maximal effect at 2.5 Gy (where the cell counts dropped from 1240 to 1017, P < 0.001). The colonogenic assay revealed a significant decrease in the ability to form colonies following pretreatment with curcumin in all radiation doses (P < 0.05).

CONCLUSIONS: Given the appropriate doses, curcumin exhibits radio-sensitizing effects on SCC cells in vitro.

OBJECTIVE: To determine whether tympanostomy tube (TT) inner diameter or shaft length impacts the rate of mucoid plug clearance.

STUDY DESIGN AND SETTING: Ex vivo model. Silicone TTs with different inner-diameters (ID) and shaft-length (SL) pairings (1.14 mm ID × 12 mm SL versus 1.14 mm ID × 1 mm SL; 1.14 mm ID × 4.8 mm SL versus 1.32 mm ID × 4.8 mm SL) were plugged with middle-ear mucus (n = 15 per group) and placed in a model ear chamber. Ofloxacin otic solution was instilled into the chamber to cover the plugged TT, and the time to clearance of each plug was recorded.

RESULTS: TTs with larger IDs (P = 0.019) and greater SLs (P = 0.033) cleared plugs more rapidly. However, the difference in the percentage of tubes that unplugged was not significant (P = 0.151).

CONCLUSIONS: Rate of ex vivo TT plug clearance may be altered by changing TT ID and SL.

OBJECTIVE: Facial palsy secondary to acute otitis media is rarely encountered today. The aim of the present study was to review the characteristics of the disease and propose the proper management.

STUDY DESIGN: File review.

SETTING: University-affiliated tertiary referral center.

MAIN OUTCOME MEASURES: Disease course, management and outcome were recorded.

RESULTS: Sixty-five children with facial palsy were identified, of whom 13 (20%) had acute otitis media. The otitis media preceded the facial palsy in all cases by 1 to 21 days (average 5 days). House-Brackmann grade ranged from 2 to 5 (average 3.5). The recovery period was varied and unpredictable, ranging in duration from 1 to 180 days (average 68 days). Treatment was conservative, except for insertion of a ventilation tube in 2 cases.

CONCLUSIONS: Considering that all the patients recovered, conservative treatment, including myringotomy and intravenous antibiotics, may be the correct approach to facial palsy associated with acute otitis media.

OBJECTIVE: Cysts of the thoracic duct located in the supraclavicular region are uncommon. To date only 12 cases in this topographic area have been described in the literature. Between 1998 and 2002, 5 patients presented to our department with the primary symptom of a palpable soft left-supracavicular swelling that could be displaced relative to adjacent structures.

SETTING: In each case, sonography showed a hypoechogenic, almost echo-free, distinctly outlined polycyclic structure with distal echo enhancement at the junction of the left internal jugular vein and the subclavian vein. All 5 patients underwent surgery, the cysts were extirpated, and the numerous communicating lymph vessels localized and meticulously ligated. Pathohistologic analysis of the milky, yellowish fluid obtained by intraoperative puncture confirmed the initial suspicion of a thoracic duct cyst in all patients.

CONCLUSION: In the case of left supraclavicular masses, the rare differential diagnosis of a thoracic duct cyst must be considered as a possibility. Sonography as the imaging method of choice is sufficient for primary diagnosis. In addition, a thorax x-ray should be performed in order to exclude an intrathoracic involvement. Surgical extirpation marks the therapy of choice in treating such cysts.