RESUMEN
The incidence of human papilloma virus-mediated oropharyngeal squamous cell carcinoma (OPSCC) has increased over the past 40 years, particularly among young individuals with a favorable prognosis; however, current therapy often leads to unfortunate side effects, such as dysphagia. Despite the emphasis on dysphagia in previous studies, there is an important research gap in understanding the correlation between neuronal changes and patient-reported and functional outcomes in patients with OPSCC. To address this issue, we examined pathologic tissue samples from patients with OPSCC using multiplex immunofluorescence staining and machine learning to correlate tumor-associated neuronal changes with prospectively collected patient-reported and functional outcomes. We found that tumor enrichment of adrenergic (TH+) and CGRP+ sensory-afferent nerves correlated with poorer swallowing outcomes. Functional electromyography recordings showed correlations between growing (GAP43+) and immature cholinergic (ChAT+DCX+) nerves and denervation patterns in survivors of OPSCC. A murine model of radiation-induced dysphagia further confirmed that immature cholinergic and CGRP+ nerves were correlated with impaired swallowing. Preclinical interventional studies also supported the independent contributions of CGRP+ and cholinergic (ChAT+) nerves to dysphagia in treated mouse models of OPSCC. Our results suggest that CGRP+ and ChAT+ neuronal signaling play distinct roles in tumor- and radiation-induced dysphagia in OPSCC and offer a comprehensive dataset on the neural landscape of OPSCC. These insights may guide early interventions for swallow preservation and the repurposing of neurology-related drugs, such as CGRP blockers, in clinical oncology and survivorship.
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Carcinoma de Células Escamosas , Trastornos de Deglución , Neoplasias Orofaríngeas , Humanos , Neoplasias Orofaríngeas/radioterapia , Neoplasias Orofaríngeas/patología , Animales , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/fisiopatología , Masculino , Ratones , Deglución/efectos de la radiación , Femenino , Persona de Mediana Edad , Resultado del Tratamiento , Péptido Relacionado con Gen de Calcitonina/metabolismoRESUMEN
BACKGROUND: Providers performing endotracheal intubation are at high risk of contracting SARS-CoV-2. The objective was to assess various demographic, exposure and institutional preparedness factors affecting intubators' comfort and fear level during COVID-19 intubations. METHODS: We conducted a cross-sectional, survey-based study during the COVID-19 pandemic from September 2020 to January 2021 at a single academic medical centre in Washington, DC, USA. Inclusion criteria were healthcare providers who had an experience in intubating patients confirmed with or suspected of COVID-19. The survey assessed various factors related to the providers' comfort with intubation and fear during COVID-19 intubations. RESULTS: A total of 329 surveys from 55 hospitals were analysed. Of the respondents, 173 (52.6%) were from emergency medicine providers. Factors that were associated with a higher comfort level of intubating patients with COVID-19 included attending physician position (adjusted OR (aOR)=2.6, 95% CI 1.4 to 4.8; p=0.003), performing more than 20 COVID-19 intubations (aOR=3.3, 95% CI 1.5 to 6.6; p=0.002), participation in an intubation team (aOR=1.6, 95% CI 1.1 to 2.7; p=0.031) and adequate levels of personal protective equipment (PPE) (aOR=4.3, 95% CI 2.0 to 8.8; p<0.0005). Compared with emergency physicians, anaesthesiology providers had higher fear levels of contracting SARS-CoV-2 during both first and subsequent SARS-CoV-2 intubations (first: OR=1.7, 95% CI 1.1 to 2.6, p=0.006; subsequent: OR=2.0, 95% CI 1.4 to3.2, p<0.0005). CONCLUSION: A higher degree of comfort in intubating patients suspected of or confirmed with COVID-19 was demonstrated in more senior physicians, members of intubation teams, providers who performed a higher number of intubations and providers who reported adequate PPE. These findings highlight potential targets for improving the experience of providers in this setting.
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COVID-19 , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Pandemias , Estudios Transversales , Intubación Intratraqueal , MiedoRESUMEN
OBJECTIVES: To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN). MATERIALS AND METHODS: Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009. RESULTS: Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4.40, 95% confidence interval [CI] 1.01-19.27). The adjusted median charge was $343 000, and higher charges were associated with double flap reconstruction (OR 8.15, 95% CI 2.19-30.29) and smoking (OR 5.91, 95% CI 1.69-20.72). Improved swallow was associated with age <67 years (OR 3.76, 95% CI 1.16-12.17) and preoperative swallow (OR 3.42, 95% CI 1.23-9.51). Five-year ORN-recurrence-free survival was 93% while overall survival was 63% and associated with pulmonary disease (HR [hazard ratio] 3.57, 95% CI 1.43-8.94). CONCLUSIONS: Although recurrence of ORN is rare, surgical complications are common and charges are high. Poorer outcomes and higher charges are associated with preoperative factors.
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Osteorradionecrosis , Anciano , Drenaje , Humanos , Mandíbula , Osteotomía Mandibular , Osteorradionecrosis/cirugía , Estudios RetrospectivosRESUMEN
OBJECTIVE: To compare the proportion of applicants who matched to their home otolaryngology program during the COVID-19 pandemic compared to the previous 5 years. METHODS: A "home program match" status was identified for residents in each PGY level and in incoming interns. The "home match proportion" (HMP) was then calculated for each program for each year from 2016 to 2021. The difference in the distribution of home matches between PGY0 and PGY 1, 2, 3, 4, and 5 were analyzed using the chi-square independence test and Fisher's exact test. Statistical significance was declared at P < .05. RESULTS: A total of 1885 residents were identified from 101 otolaryngology residency programs. The distribution of PGY0s who home matched was statistically higher when separately compared to PGY1-5s. (PGY0 vs PGY 1, 2, 3, 4, 5: 96 [30.1%] vs 63 [19.3%] P = .002, 73 [22.9%] P = .048, 50 [16.3%] P < 0.0005, 59 [19.2%] P = .002, 52 [16.9%] P < .0005). There was no statistical difference in any binary combination within PGY1 through PGY5. CONCLUSION: Nearly a third of applicants matched to their home institution for otolaryngology during the 2021 application cycle, a statistically significant increase compared to an average of the previous 5 years. While there are likely many reasons for this increase, we believe that the severely limited nature of away rotations due to the COVID-19 pandemic played a significant role in this outcome.
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COVID-19 , Internado y Residencia , Otolaringología , COVID-19/epidemiología , Humanos , Otolaringología/educación , PandemiasRESUMEN
OBJECTIVES: Recently, the decision was made to transition the United States Medical Licensing Examination (USMLE) Step 1 score from a three-digit numerical score to a pass/fail system. Historically, Step 1 scores have been important for otolaryngology resident applicant selection. The purpose of this study was to understand and evaluate otolaryngology residency program directors' (OPDs) opinions on the impact following the change in Step 1 score reporting. METHODS: A 22-question survey administered through Qualtrics was sent to 113 academic otolaryngology residency program directors in April 2020. Information about demographics, impressions on the new Step 1 score format, anticipated changes in applicant selection, impact on mental health, and importance of various other factors in selecting applicants were queried. Descriptive statistics were used to analyze survey results. RESULTS: A total of 41 out of 113 (36.3%) OPDs completed this survey. A majority of surveyed OPDs (80.5%) do not support the decision to change Step 1 to a pass/fail system. In the absence of a three digit numeric USMLE Step 1 score, OPDs indicated prioritization of away rotations, letters of recommendation (LORs), personal prior knowledge of the applicant, grades in required clerkship, and class ranking or quartile. 53.7% of OPDs anticipate requiring USMLE Step 2 Clinical Knowledge for interview consideration following this change. CONCLUSION: OPDs believe a pass/fail Step 1 score will decrease the importance of this exam and that this change will lead to the implementation and evaluation of additional metrics such as a required Step 2 CK score.
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Internado y Residencia , Otolaringología , Evaluación Educacional/métodos , Humanos , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Background: Tracheal intubation is a hazardous aerosolizing procedure with a potential risk of spreading SAR-CoV-2 between patients and physicians. Aim: The purpose of this study was to explore the impact of COVID-19 specific simulation training in improving provider level of comfort during the intubation of COVID-19 patients. Methods: In this cross-sectional national study, an electronic survey was disseminated using a snowball sample approach to intubators from 55 hospitals across the United States. The survey assessed providers' comfort of intubating and fear of contracting the virus during COVID-19 intubations. Results: A total of 329 surveys from 55 hospitals were analyzed. Of 329 providers, 111 providers (33.7%) reported participating in simulation training. Of those, 86 (77.5%) reported that the simulation training helped reduce their fear of intubating COVID-19 patients. Providers in the simulation training group also reported a higher level of comfort level with intubating both general patients (median [range] no-simulation training group 9 [3-10], simulation training group 9 [6-10]; p = 0.015) and COVID-19 patients (no-ST 8 [1-10], ST group 9 [4-10]; p < 0.0005) than providers in the no-simulation training group. Conclusions: Our study suggests that COVID-19 specific intubation simulation training promotes provider comfort. Simulation training may be implemented as part of airway management training during the current and novel pandemic situations.
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BACKGROUND: Head and neck osteosarcoma (HNOS) is a rare primary bone tumor with limited data to guide treatment approaches. METHODS: The NCDB was used to identify patients diagnosed with HNOS. Kaplan-Meier and Cox multivariate regression were used to examine the impact of each treatment on overall survival (OS). RESULTS: We identified 821 patients diagnosed with HNOS. Utilization of neoadjuvant chemotherapy + surgery increased from zero cases in 2004 to 24% of cases in 2016. Among surgically treated patients, 5-year OS was 55.8% (CI: 51.7-60.1%). No difference was seen in OS between each treatment cohort on multivariate analysis. However, neoadjuvant chemotherapy + surgery + adjuvant chemotherapy had improved 18-month survival compared to surgery alone (95.8% vs. 78.5%, p = 0.031). CONCLUSIONS: Our study demonstrated no survival benefit in perioperative chemotherapy or radiation therapy; however, short-term survival improvement in patients receiving both neoadjuvant and adjuvant chemotherapy displays promise and requires further investigation.
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Neoplasias Óseas , Osteosarcoma , Neoplasias Óseas/terapia , Quimioterapia Adyuvante , Humanos , Terapia Neoadyuvante , Osteosarcoma/terapia , Estudios Retrospectivos , Estados Unidos/epidemiologíaRESUMEN
OBJECTIVES: To characterize patterns of sensorineural hearing loss (SNHL) and tinnitus in patients with idiopathic intracranial hypertension (IIH). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Adult patients diagnosed with IIH via lumbar puncture (LP) between 2010 and 2020 who had available audiograms. The study included a total of 40 patients; 33 women, and 7 men with a median age of 43. INTERVENTIONS: Diagnostic LP and audiogram. MAIN OUTCOME MEASURES: Otologic symptoms, ophthalmologic signs, hearing thresholds, cerebrospinal fluid opening pressures. RESULTS: The most commonly reported symptoms were tinnitus in 28 (70%, 23 pulsatile and 5 tonal), aural fullness in 11 (28%), and vertigo in 10 (25%). Twenty-nine patients had ophthalmologic examinations and 18 had evidence of papilledema. Twenty-five (63%) patients had hearing loss in at least one ear at one frequency range. Patients presented with both unilateral and bilateral hearing loss across low, middle, and high frequency ranges. No significant association was observed between hearing loss threshold and LP opening pressure except for 250âHz in the left ear. After stratification by tinnitus group (pulsatile, tonal, and no tinnitus), no significant difference was found between mean hearing loss threshold at different frequencies. In addition, no significant mean age difference was identified in patients within each tinnitus group. CONCLUSIONS: There was no classic pattern or presentation for hearing loss in our IIH patients. They developed sudden, unilateral, or bilateral SNHL in low, middle, or high frequency range. The degree of hearing loss did not correlate with CSF opening pressure.
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Pérdida Auditiva Sensorineural , Seudotumor Cerebral , Acúfeno , Adulto , Femenino , Pérdida Auditiva Sensorineural/complicaciones , Pérdida Auditiva Sensorineural/epidemiología , Humanos , Masculino , Seudotumor Cerebral/complicaciones , Estudios Retrospectivos , Acúfeno/complicaciones , Acúfeno/epidemiología , VértigoRESUMEN
INTRODUCTION: Tracheal agenesis (TA) is rare and usually fatal. Few survivors with concomitant tracheoesophageal fistulae (TEF) who underwent ligation of the distal esophagus with creation of a spit-fistula and neo-trachea from the proximal esophagus exist. We report a novel surgical technique whereby the esophagus is divided longitudinally to preserve a functional alimentation tract and a parallel neo-trachea. We review the literature of reported cases, including survivors beyond 12 months. METHODS: Case report and literature review. RESULTS: A female infant with prenatal polyhydramnios was born at 35 weeks gestation with immediate respiratory distress and absent cry. Oxygenation was maintained with a laryngeal mask airway. Despite a normal appearing larynx, she could not be intubated and emergent neck exploration disclosed no cervical trachea. The patient was placed on extra corporeal membranous oxygenation (ECMO), and later diagnosed with TA, Floyd Type I. Parental desire for reconstruction but refusal of a spit-fistula necessitated a novel procedure. The esophagus was divided longitudinally via a microstapler to preserve the original alimentary tract and create a parallel neo-trachea originating from the TEF and terminating as a cervical stoma. The healing process was complicated but the baby was ultimately discharged to home where she developed normally neurologically until succumbing one night to accidental decannulation at 16 months of age. CONCLUSION: We describe a novel surgical approach to manage TA. This includes avoiding creation of a spit fistula and preserving the native esophagus. We then survey the literature, reporting the survivorship duration and operative management of 174 reported cases of TA.
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Constricción Patológica/cirugía , Esófago/cirugía , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Tráquea/anomalías , Femenino , Humanos , Recién Nacido , Tráquea/cirugía , Fístula Traqueoesofágica/cirugíaRESUMEN
OBJECTIVES: Recent literature suggests that outpatient head and neck surgery is safe and may decrease costs. This study assesses whether outpatient parotidectomy differs in complication type and rate from inpatient surgery. METHODS: Patients who underwent parotidectomy at our institution from 2011 to 2019 were retrospectively reviewed and divided by inpatient or outpatient status. Complications including infection, seroma, salivary fistula, hematoma, and flap necrosis, as well as readmission rates were tabulated. Drain placement, related to tumor size, was also analyzed using a receiver operating curve. RESULTS: 144 patients had available data for analysis. Nine of the 144 patients had complications. Seven of 98 outpatients and two of 46 inpatients had complications. There was no statistically significant difference in complication rate between the two groups (P = .518). Tumor size ≥4.62 cm3 was associated with drain placement (P = .044). CONCLUSION: Outpatient parotidectomy is a safe and viable alternative for carefully selected patients.
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Adenolinfoma/cirugía , Adenoma Pleomórfico/cirugía , Procedimientos Quirúrgicos Ambulatorios/estadística & datos numéricos , Carcinoma Mucoepidermoide/cirugía , Hospitalización/estadística & datos numéricos , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Neoplasias de la Parótida/cirugía , Complicaciones Posoperatorias/epidemiología , Adenolinfoma/patología , Adenoma Pleomórfico/patología , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Mucoepidermoide/patología , Estudios de Cohortes , Traumatismos del Nervio Facial/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de las Parótidas/cirugía , Neoplasias de la Parótida/patología , Hemorragia Posoperatoria/epidemiología , Estudios Retrospectivos , Cálculos de las Glándulas Salivales/cirugía , Fístula de las Glándulas Salivales/epidemiología , Seroma/epidemiología , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica/epidemiología , Adulto JovenAsunto(s)
Procedimientos Quirúrgicos Orales/métodos , Cálculos del Conducto Salival/cirugía , Conductos Salivales/cirugía , Enfermedades de la Glándula Submandibular/cirugía , Técnicas de Sutura , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cálculos del Conducto Salival/diagnóstico , Cálculos del Conducto Salival/patología , Conductos Salivales/diagnóstico por imagen , Conductos Salivales/patología , Glándula Submandibular/diagnóstico por imagen , Glándula Submandibular/patología , Glándula Submandibular/cirugía , Enfermedades de la Glándula Submandibular/diagnóstico por imagen , Enfermedades de la Glándula Submandibular/patología , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Ultrasonografía , Adulto JovenRESUMEN
BACKGROUND: Patients with COVID-19 who are intubated and require mechanical ventilation have been observed to have oropharyngeal bleeding necessitating otolaryngology intervention. METHODS: We report five cases of oropharyngeal hemorrhage in COVID-19 patients on mechanical ventilation requiring evaluation by otolaryngologists at George Washington University Hospital (GWUH) and Boston Medical Center (BMC) from March to April 2020. Institutional Review Board at both institutions exempted this study from informed consent because there were no identifiable patient characteristics, photographs, or imaging studies included. RESULTS: All five patients were managed conservatively; four required packing with Kerlix gauze by an otolaryngologist. Two patients had the additional requirement of extracorporeal membrane oxygenation (ECMO) and associated anticoagulation. Three patients improved with oropharyngeal packing; two had persistent bleeding. Three patients expired. Endotracheal tubes were repositioned less frequently due to the COVID-19 pandemic. CONCLUSIONS: Intubated patients with COVID-19 may have an increased risk of oropharyngeal hemorrhage. This may be due to anticoagulation, prolonged intubation, or decreased frequency of endotracheal tube repositioning. Otolaryngologists should wear appropriate PPE when managing this hemorrhagic complication.
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Infecciones por Coronavirus/complicaciones , Hemorragia/etiología , Enfermedades Faríngeas/etiología , Neumonía Viral/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/administración & dosificación , Anticoagulantes/efectos adversos , Betacoronavirus , COVID-19 , Oxigenación por Membrana Extracorpórea , Femenino , Hemorragia/terapia , Humanos , Intubación Intratraqueal , Masculino , Persona de Mediana Edad , Pandemias , Enfermedades Faríngeas/terapia , Respiración Artificial , Síndrome de Dificultad Respiratoria/terapia , Síndrome de Dificultad Respiratoria/virología , SARS-CoV-2 , Tampones QuirúrgicosRESUMEN
The Coronavirus Disease-2019 (COVID-19) pandemic has created an unprecedented economic and public health crisis in the United States. Following efforts to mitigate disease spread, with a significant decline in some regions, many states began reopening their economies. As social distancing guidelines were relaxed and businesses opened, local outbreaks of COVID-19 continue to place person on healthcare systems. Among medical specialties, otolaryngologists and their staff are among the highest at risk for becoming exposed to COVID-19. As otolaryngologists prepare to weather the storm of impending local surges in COVID-19 infections there are several practical measures that can be taken to mitigate the risk to ourselves and our staff.
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Instituciones de Atención Ambulatoria/organización & administración , Infecciones por Coronavirus/prevención & control , Control de Infecciones/organización & administración , Otolaringología , Pandemias/prevención & control , Neumonía Viral/prevención & control , Triaje/organización & administración , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Transmisión de Enfermedad Infecciosa de Profesional a Paciente/prevención & control , Enfermedades Profesionales/diagnóstico , Otorrinolaringólogos , Seguridad del Paciente , Equipo de Protección Personal , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Garantía de la Calidad de Atención de Salud , SARS-CoV-2 , Telemedicina , Estados Unidos/epidemiologíaRESUMEN
The COVID-19 pandemic has forced the health care industry to develop dynamic protocols to maximize provider safety as aerosolizing procedures, specifically intubation, increase the risk of contracting SARS-CoV-2. The authors sought to create a quality improvement framework to ensure safe practices for intubating providers, and describe a multidisciplinary model developed at an academic tertiary care facility centered on rapid-cycle improvements and real-time gap analysis to track adherence to COVID-19 intubation safety protocols. The model included an Intubation Safety Checklist, a standardized documentation template for intubations, obtaining real-time feedback, and weekly multidisciplinary team meetings to review data and implement improvements. This study captured 68 intubations in suspected COVID-19 patients and demonstrated high personal protective equipment compliance at the institution, but also identified areas for process improvement. Overall, the authors posit that an interdisciplinary workgroup and the integration of standardized processes can be used to enhance intubation safety among providers during the COVID-19 pandemic.
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Infecciones por Coronavirus/terapia , Comunicación Interdisciplinaria , Intubación Intratraqueal/normas , Participación en las Decisiones/normas , Neumonía Viral/terapia , Mejoramiento de la Calidad/organización & administración , Manejo de la Vía Aérea/normas , Betacoronavirus , COVID-19 , Conducta Cooperativa , Humanos , Pandemias , Equipo de Protección Personal , SARS-CoV-2RESUMEN
BACKGROUND: Optimal treatment and prognostic factors affecting long-term survival in patients with sinonasal adenoid cystic carcinoma (ACC) have yet to be clearly defined. METHODS: We conducted a retrospective review of patients treated with curative intent from 1980-2015 at MD Anderson Cancer Center. RESULTS: One hundred sixty patients met inclusion criteria, including 8 who were treated with radiotherapy alone. Median follow-up time was 55 months. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 67.0% and 49.0%, respectively. The 10-year OS and DFS rates were 44.8% and 25.4%, respectively. Factors that portended for poor survival on multivariate analysis were recurrent disease, any solid type histology, epicenter in the sinus cavity, the presence of facial symptoms, or the original disease not treated with surgery. There was no association between surgical margin status or nodal status and survival. CONCLUSION: In this large cohort of patients with sinonasal ACC with extended follow-up, long-term survival is better than reported in prior literature. Future research should target patients with adverse risk factors.
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Carcinoma Adenoide Quístico/mortalidad , Neoplasias de los Senos Paranasales/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Adenoide Quístico/patología , Carcinoma Adenoide Quístico/radioterapia , Carcinoma Adenoide Quístico/cirugía , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Análisis Multivariante , Estadificación de Neoplasias , Neoplasias de los Senos Paranasales/patología , Neoplasias de los Senos Paranasales/cirugía , Neoplasias de los Senos Paranasales/terapia , Pronóstico , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
BACKGROUND: The purpose of this study was to quantify the relationship among age, pretreatment comorbidity, and survival outcomes in patients with locally advanced laryngeal cancer. METHODS: Baseline comorbidity data were collected and age-adjusted Charlson Comorbidity Index (CCI) was calculated for each case. Kaplan-Meier and Cox proportional hazards modeling were used to determine associations with survival. RESULTS: For 548 patients, with a median age of 59 years (range 31-91 years), 58% were treated with larynx preservation and the rest with total laryngectomy and adjuvant radiotherapy (RT). Two hundred thirty-eight patients (43%) had at least 1 comorbidity each. Cardiovascular diseases were the most common comorbidities (19%). The 5-year overall survival (OS) for patients with CCI ≤3 (n = 442) were superior to CCI >3 (n = 106; 60% vs 41%; P < .0001), although the 5-year disease-specific survival (DSS) rates were not significantly different. The 5-year noncancer CSS was better for age-adjusted CCI ≤3 (88% vs 67%; P < .0001). CONCLUSION: The age-adjusted CCI is a significant predictor of noncancer CSS and OS for patients with locally advanced laryngeal cancer but is not associated with DSS.
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Neoplasias Laríngeas/complicaciones , Neoplasias Laríngeas/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Comorbilidad , Supervivencia sin Enfermedad , Femenino , Humanos , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tasa de SupervivenciaAsunto(s)
Obstrucción de las Vías Aéreas/cirugía , Broncoscopía , Quistes/cirugía , Enfermedades de la Laringe/cirugía , Laringoscopía , Ruidos Respiratorios/fisiopatología , Quistes/diagnóstico , Epiglotis/cirugía , Humanos , Recién Nacido , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/fisiopatología , Ruidos Respiratorios/etiología , Resultado del TratamientoRESUMEN
BACKGROUND: Using patient-reported and objective assessment tools, we sought to quantify cognitive symptoms and objective cognitive dysfunction in patients irradiated for skull base cancer. METHODS: Participants were assessed using the Telephone Interview for Cognitive Status (TICS) and the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN), with subsequent analysis. RESULTS: Of the 122 participants analyzed, the majority (63%) had no frank detectable cognitive impairment by TICS, with frank impairment in 6%. Overall, mean patient-reported problems with memory (MDASImemory ) was 3.3 (SD ±2.66). On recursive partition analysis, the MDASImemory cutoff point of ≥5 was associated with detectable cognitive impairment by TICS (logworth 1.69; P = .02), yet no MDASImemory threshold was associated with unambiguous absence of impairment by TICS. CONCLUSION: Approximately one third of patients had ambiguous results by TICS assessment, for whom more rigorous testing may be warranted. Moderate to severe levels of patient-reported memory complaints on the MDASI-HN module may have utility as a screening tool for cognitive dysfunction in this population.