Awareness about laryngopharyngeal reflux disease among Chinese otolaryngologists: a nationwide survey.

OBJECTIVES: This study aimed to investigate the status of the current knowledge about laryngopharyngeal reflux disease (LPRD) among Chinese otolaryngologists. DESIGN: Multi-centre cross-sectional survey. SETTING: 220 medical centres in different regions of China. PARTICIPANTS: A total of 2254 otolaryngologists from 220 medical centres in China who were successfully on-site surveyed between November 2019 and December 2020. MAIN OUTCOME MEASURES: Awareness about LPRD included knowledge about risk factors, symptoms, laryngoscope signs, related diseases, current diagnostic methods and treatments. RESULTS: The percentage of participants who had heard of LPRD was 96.4%, with academic conferences as the most common source of information (73.3%). The most commonly known risk factor, symptom, laryngoscope sign, related disease, diagnostic method and treatment were alcohol consumption (44.0%), pharyngeal foreign body sensation (66.9%), hyperaemia (52.4%), pharyngolaryngitis (54.8%), pH monitoring (47.6%) and medication (82.1%), respectively. Only 28.3% of all participants knew that 24 h pH or multichannel intraluminal impedance pH monitoring was the most accurate diagnostic test. As many as 73.1% of all participants knew that proton pump inhibitors were the first-line treatment drugs. An analysis of the overall status of awareness using a scoring system suggested that otolaryngologists were better aware owing to more access, working at 3A hospitals, and postgraduate or above educational background (all p<0.05). CONCLUSION: Although the majority of Chinese otolaryngologists had heard of LPRD, their overall awareness about the disease was not encouraging. More efforts are needed to increase the knowledge about LPRD among this group of physicians. TRIAL REGISTRATION NUMBER: ChiCTR1900025581.

An epidemiological survey of laryngopharyngeal reflux disease at the otorhinolaryngology-head and neck surgery clinics in China.

PURPOSE: Using the Reflux Symptom Index (RSI), this nationwide study aimed to investigate the incidence, diagnostic status, risk factors, and common symptoms of adult laryngopharyngeal reflux disease (LPRD) at otorhinolaryngology-head and neck surgery (OHNS) clinics in China. METHODS: This multicenter cross-sectional survey began at the different institutions ranged from July to October 2017, and the duration was 12 months. A total of 90,440 eligible patients were finally enrolled from 72 medical institutions in China. All these patients completed the questionnaire based on RSI. In this study, LPRD was defined as RSI > 13. RESULTS: There were 9182 with LPRD among the 90,440 eligible participants (10.15%). However, only 1294 had a history of LPRD diagnosis among those with LPRD (14.09%). There were regional differences in the frequency of LPRD (P < 0.001). The proportions of patients with LPRD in males (vs. females), middle- and old-aged patients (vs. young), with current smoking history (vs. no smoking), and current drinking history (vs. no drinking) were significantly higher (all P < 0.001). Middle and old age, current smoking, and drinking history were independent predictors of LPRD (all P < 0.001, OR 1.240, 1.261, and 1.481, respectively). "Sensations of something stuck in throat or a lump in throat", "clearing throat", and "excess throat mucus or postnasal drip" were the most frequent clinical symptoms in patients with LPRD. CONCLUSIONS: LPRD has a high incidence at the OHNS clinics in China. However, the diagnostic status of this disease is not optimistic. Older age, smoking, and drinking history were risk factors for LPRD.

[Clinicopathologic features and risk factors of bilateral cervical lymph node metastasis in head and neck squamous cell carcinoma].

OBJECTIVE: To investigate the clinicopathologic features and associated risk factors for bilateral neck node metastasis (BNM) in head and neck squamous cell carcinoma (HNSCC). METHODS: Two hundred eighty-six cases with HNSCC were retrospectively studied, including 83 cases of oral tongue cancers, 101 cases of hypopharyngeal cancers and 102 cases of supraglottic laryngeal cancers. All patients had unilateral or bilateral cervical lymph node metastasis confirmed by postoperative pathologic examinations. The following factors were evaluated to determine the risk for BNM in HNSCC: T staging, size, location, trans-midline condition, growth pattern, pathologic grading and infiltration of primary tumors; N staging; the size, number and extracapsular spread (ECS) of ipsilateral metastatic nodes; the number of involved levels on the ipsilateral neck. Chi-square test and logistic regression test were used for statistical analysis. RESULTS: BNM was found in 86 (30.1%) of 286 patients with HNSCC, including 52 (18.2%) cases of contralateral occult neck node metastasis. The incidence of BNM was 35.6% (36/101) in hypopharyngeal cancer, 31.4% (32/102) in supraglottic laryngeal cancer and 21.7% (18/83) in oral tongue cancer, respectively. N staging, the number and ECS of ipsilateral metastatic nodes, and the number of involved levels on the ipsilateral neck were important factors contributing to BNM. Multiple logistic regression analysis revealed that midline passing of primary tumor was associated with BNM in oral tongue cancer. The midline passing and ECS of ipsilateral metastatic node were key factors for BNM in hypopharyngeal and supraglottic laryngeal cancers. T staging, size and midline passing of primary tumor were closely related to BNM in oral tongue cancer. T staging and midline passing were associated with BNM in hypopharyngeal cancer. Midline passing was an important factor related to BNM in supraglottic laryngeal cancer. CONCLUSION: Midline passing of primary tumor is the most important factor determining BNM in hypopharyngeal, supraglottic laryngeal and oral tongue cancers, whereas ECS of ipsilateral metastatic node is the most important factor impacting BNM in hypopharyngeal and supraglottic laryngeal cancers.

Value of postoperative radiation therapy for regional control after dissection in head and neck squamous cell carcinoma cases.

OBJECTIVE: We aimed to define clinicopathologic risk factors associated with regional recurrence (RR) and thus the effectiveness of postoperative radiotherapy (PORT) for neck control for head and neck squamous cell carcinomas (HNSCCs) with differing cervical lymph node status. METHODS: A retrospective study was performed in 196 HNSCC patients with pathologically positive neck node (N+) to evaluate the high-risk factors for RR and to define the role of PORT in control after neck dissection and postoperative radiotherapy (PORT). RESULTS: Overall, the RR rate after neck dissection and PORT was 29%. Extracapsular spread (ECS) was confirmed to be the only independent risk factor for RR. There were no significant risk factors associated with RR in the ECS- group. The 5-year disease-specific survival rate was 45%, which descended to 10% with the emergence of RR. CONCLUSIONS: ECS remains a determined risk factor for RR after neck dissection and PORT in patients with N+. PORT alone is not adequate for preventing RR in the neck with ECS after neck dissection. More intensive postoperative adjuvant therapies, especially combined chemotherapy and radiotherapy, are needed to prevent regional failure in HNSCC patients with ECS.

[Preliminary report of laryngeal preservation in the surgical salvage of recurrent laryngeal cancer].

OBJECTIVE: To explore the plausibility of laryngeal preservation in salvage surgery of recurrent laryngeal carcinoma. METHODS: Comprehensive clinical and radiological assessments on a specific group of patients with recurrent laryngeal cancer and their relapsed tumors were carried out to determine the methods and indications of salvage surgery for preservation of laryngeal functions. Salvage surgery with preservation of larynx was performed in a selective of 36 laryngeal cancer patients with relapsed tumors in their larynges after radiotherapy or partial laryngectomies. All patients were regularly followed up after discharge from the hospital. Postoperative survival was calculated by Kaplan-Meier's method. RESULTS: Among various laryngeal preservation regimens given, a second transoral laser surgery was carried out in 4 cases, horizontal hemilaryngectomy in 4 cases, vertical hemilaryngectomy in 13 cases and Majer-Piquet's operation in 15 cases, respectively. Simultaneous neck dissection was conducted in 18 cases. Postoperative complications were encountered in 6 cases, most common of which were local infection and laryngeal fistula with no hospital mortality and other major morbidities. Five cases with immediate postoperative complications were cured with proper management. The remained one case undergone vertical partial laryngectomy for recurrence after tumor resection via laryngeal fissure received postoperative radiation due to positive surgical margin, and complicated laryngeal atresia and obstruction with loss of his laryngeal functions. Local recurrence was observed in 5 cases and simultaneous locoregional recurrence was seen in 1 case, with the resulting local control rate of 83.3% (30/36). The 3-year postoperative survival rate was 80.6%. The cause of death was tumor recurrence in 3 cases, distant metastasis in 3 cases and non-tumor-associated disease (heart attack) in 1 case, respectively. CONCLUSIONS: Salvage surgery with laryngeal preservation can be carried out in the selected cases with early or locally-confined recurrent lesions within the larynx, on the condition that the recurrent tumors be assessed thoroughly and indications for associated surgical techniques be evaluated properly.

[Outcomes of salvage laryngectomy after initial radiation failure in laryngeal squamous cell carcinoma].

OBJECTIVE: To investigate survival outcomes of salvage surgery preformed for laryngeal squamous cell carcinoma that recurred or progressed after radiotherapy alone. METHODS: A review of 72 patients who underwent salvage laryngectomy for laryngeal cancer failed in initial radiation therapy between 1996 and 2005 was performed. The tumor persistence occurred in 50 cases and recurrence in 22 cases. All patients received salvage total laryngectomy and radical neck dissection. Survival analysis was performed by using Kaplan-Meier method, Log-rank test and Cox proportional hazard model. RESULTS: Thirty patients developed a postoperative complication after salvage surgery. Pharyngocutaneous fistula occurred in 15(20.8%) patients. During 5 years after salvage surgery, the rates of tumor recurrence, distant metastasis and second malignancy were 34.7%, 22.2% and 6.9%, respectively. Kaplan-Meier analysis showed that overall 3 year and 5 year survival rates of those patients after operation were 45.8% and 36.1%, respectively. Univariate analysis indicated that N restage, tumor persistence/recurrences after radiotherapy, surgical margin status, level of tumor invasion, pathologic N stage, extracapsular nodal spread and invasion of nonlymphotic structures were significantly associated with overall survival. Multivariate analysis showed the most significant prognostic factors were tumor persistence or recurrence after radiotherapy, surgical margin status and level of tumor invasion. CONCLUSIONS: Surgical salvage remains the gold standard for management after failure of initial radiation therapy. The extent of tumor invasion must be assessed sufficiently before operation, and the surgical margin status must be identified in operation by using a frozen sectioning approach, especially in patients with tumor invasion to muscle/cartilage and tumor persistence after radiotherapy.

[Investigations on salvage surgery-related problems for stomal recurrence after total laryngectomy].

OBJECTIVE: To explore the related issues concerning salvage surgery for stomal recurrence (SR) after total laryngectomy. METHODS: A retrospective study was conducted to analyse the clinical data from 36 patients suffering from SR after total laryngectomy, who were treated by salvage surgery from January 1990 to January 2006. Some related issues concerning salvage surgery for SR were studied and analysed, which include preoperative evaluations, surgical approaches and techniques, management of perioperative complications and outcomes of treatment. RESULTS: After careful preoperative evaluations and predictions, a complete resection of tumor was achieved in 33 out of 36 SR patients. Two patients sacrificed because of ruptures of major vessels including the common carotid eaters and the innominate artery 3 weeks and 2 months after the operation. The overall 1-year, 2-year and 3-year survival of this group of patients were 68.8%, 42.8% and 12.5%, respectively. Besides, postoperative complications comprise 23 cases of hypothyroidisms, 6 cases of wound infection and saliva leakage, 8 cases of donor site complications (including dehiscence of wound in 3 cases, chest wall hematomas in 4 cases, and tumor seeding in 1 case), and hypopharyngeal stenosis in 4 cases, all of which were properly and promptly managed with uneventful outcomes. CONCLUSIONS: SR after total laryngectomy is a dangerous and complicated status with poor prognosis. For the purpose of saving or elongating the patients's lives, the salvage surgery needs to be done on the condition that indicated candidates are properly selected, preoperative evaluations carefully conducted, and perioperative abnormal conditions unerroneously delt with.

[Multi-modalities for reconstruction of circumferential defects in the pharyngoesophageal region].

OBJECTIVE: To investigate the feasibility of multi-modalities in the reconstruction of circumferential defects after resection of cancers in pharyngoesophageal regions, and to compare the pros and cons between different surgical procedures. METHODS: According to the nature and extend of defects, five different methods including pectoralis major myocutaneous flap, laryngeal tube replacement, free jejunum, free forearm flap and gastric pull-up were used to reconstruct the circumferential pharyngoesophageal defects in 72 patients. Function of deglutition and restoration of swallowing was regularly followed up and objectively evaluated. RESULTS: A total of 35 cases of pectoralis major myocutaneous (PM) flaps, 8 cases of laryngeal tube replacement, 12 cases of free jejunum, 12 cases of free forearm flaps and 16 cases of gastric pull-up were performed. Different complications including wound infection, pharyngeal fistula, partial necrosis of PM flap, partial necrosis of gastric wall, stricture of anastomotic site were encountered in 15 cases. All patients survived the operation except one due to partial necrosis of the gastric wall. Two of 4 patients who developed anastomotic stricture can ingest half-liquid food, the remaining cases regained normal deglutition function. The mean postoperative follow-up time was 1. 6 years with 2-year survival rate of 45.3%. CONCLUSIONS: Circumferential defects resulting from resection of carcinomas in pharyngoesophageal region can be reconstructed with different operative techniques depending on the nature and extend of the defects. Once the operative indications are properly selected, the good reconstructive results are to be achieved.

[A long-term observation of 48 cases of tracheoesophageal shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy].

OBJECTIVE: To study the long-term efficacy of tracheoesophageal (TE) shunt phonation by the anastomosis of the membranous portion of the tracheal section with the anterior wall of esophagus after total laryngectomy. METHODS: A questionnaire was designed to follow 48 patients with rehabilitated speech and swallow functions by the above approach. The qualities of phonation and speech, and the degree of aspiration evaluated, together with the survival rate and complications statistically analyzed. RESULTS: The speech level of 35 laryngectomees was similar to the normal laryngeal speech level. Thirty-five cases had longer maximal phonation time and hearing distance and higher speech intelligibility. Other 5 laryngectomees had less effective phonation, but higher speech intelligibility. The total effective rate was 83.3% (40/48). The speech fluency in 40 laryngectomees was not as good as that in the normal people. Forty percent laryngectomees(16/40) had slight liquid food aspiration which did not influence normal eating. Eight patients(8/48) failed to speak and no liquid aspiration occurred after the operation. The effective rate was affected obviously by neck infection and pharyngeal fistula formation. The survival rate was similar to those with single total laryngectomy. CONCLUSIONS: The TE shunt phonation had the advantages of simple, one-stage operation and high success rate. Some laryngectomees had slight liquid food aspiration, but would not influence normal eating. So this TE shunt phonation operation may be useful during laryngeal surgery.

[Observation of aspiration of laryngectomees in TE shunt speech without prosthesis].

OBJECTIVE: To investigate the course of variation and influencing factors on aspiration in laryngectomees who underwent tracheoesophageal (TE) shunt speech without prosthesis. METHOD: Sixteen laryngeal cancer patients who were operated on for TE shunt voice rehabilitation without prosthesis after total laryngectomy. These laryngectomees experienced aspiration in different degrees after the operation. We designed a questionnaire to follow up alteration aspiration. RESULT: Of sixteen laryngectomees, the longest follow-up time was nine years and six months, the shortest time was one year and three months, no one got lost in the follow-up. In the follow-up period, three laryngectomees died, other thirteen still survived. There were three basic aspiration variational courese: Seven patients changed from no leakage to slight leakage. Four patients remained slight leakage. Five patients changed from obvious leakage to slight leakage. Aspiration affect TE shunt speech in four different ways: No leakage, good voice; slight leakage, still good voice. No leakage,hard voice. If speak, take more time and use great effort. However,in some patients, if the slight leakage gradually appeared, the voice seemed to be better. If the slight leakage remained in the same degree,the patient got good voice all the time. Obvious leakage, hard voice. When leakage gradually became slight, voice grew better. There were no laryngectomees had the following situations: obvious leakage all the time, bad voice all the time. It was considered that radiation therapy induced aspiration in six laryngectomees. Neck infection and pharyngeal leak were believed to cause aspiration in five laryngectomees. CONCLUSION: Any surgical procedures with good voice, but no postoperative aspiration is the best choice in voice rehabilitation in laryngectomees. However, if some laryngectomees only have slight liquid food aspiration without interference with their normal diet; at the same time, those laryngectomees have high speech level,we consider the operation is acceptable. Definitely, radiation therapy, neck infection and (or) pharyngeal leak have some influence on aspiration. The variational course of aspiration and phonation change affected by aspiration are complex problems which need further investigation.