A New Clinical Trial of Neoadjuvant Chemotherapy Combined With Transoral Robotic Surgery and Customized Adjuvant Therapy for Patients With T3 or T4 Oropharyngeal Cancer.

BACKGROUND: A prospective clinical trial of combination neoadjuvant chemotherapy, transoral robotic surgery (TORS), and customized adjuvant therapy for patients with locally advanced oropharyngeal cancer was conducted. METHODS: Between July 2009 and October 2016, 31 patients were enrolled in this clinical trial. RESULTS: The primary lesions were located in the tonsils of 27 patients and in the base of the tongue of 4 patients. Of the 31 patients, 16 (51.6%) were classified as T3 and 15 patients (48.4%) as T4a. Three patients (9.7%) had stage 3 disease, and 28 (90.3%) had stage 4 disease. The 5-year overall survival rate was 78.7%; the 5-year disease-specific survival rate was 85%; and the 5-year disease-free survival rate was 80.8%. At the final follow-up visit, 26 patients were alive with no evidence of disease, and 1 was alive with disease. Four patients died during the study: two of tumor-node-metastasis (TNM)-related disease and two of another condition. All the patients tolerated an oral diet at an average of 7.4 days postoperatively. At the subjective swallowing evaluation using the Functional Outcome Swallowing Scale score, 83.9% of the patients exhibited favorable outcomes. No patient was permanently dependent on a feeding tube. All the patients breathed and phonated in the absence of a permanent tracheotomy at the final follow-up evaluation. CONCLUSIONS: The treatment strategy in this study afforded good oncologic and functional outcomes for patients with locally advanced oropharyngeal cancer. Although future large-scale multicenter studies with longer follow-up periods are needed, this study showed that neoadjuvant chemotherapy combined with TORS is useful for treating advanced oropharyngeal cancer.

Anti-adhesive effect of solid mixture of sodium hyaluronate/carboxymethylcellulose in murine nasal cavities.

The purpose of the study was to evaluate the effect of a solid mixture of sodium hyaluronate and carboxymethylcellulose (S-HA/CMC) for the prevention of adhesions after iatrogenic mucosal injury in murine nasal cavities. We introduced iatrogenic adhesions into the bilateral nasal cavities of 20 male Sprague-Dawley rats. S-HA/CMC was applied to the left nasal cavity, while no packing was placed in the right nasal cavity as a control. At 1, 2, and 4 weeks post-procedure, we examined the number of adhesions, the ratio of the longest cross-sectional length of adhesion to septal cartilage length (RAC), and the degree of fibrosis. S-HA/CMC significantly reduced the number of adhesions when compared to the control group in total (p = 0.031), but not at each individual time point. The S-HA/CMC group showed significantly shorter RAC than the control group in total (p = 0.044), but not at each individual time point. The total fibrosis score was less severe in the S-HA/CMC group than in the control group (p < 0.001), with a significant difference between the two groups at the second week (p = 0.001). Therefore, in an animal model, S-HA/CMC can prevent post-injury mucosal adhesions suggesting a potential for clinical applications in endoscopic sinus surgery. Further clinical trials are needed to determine the safety and efficacy of S-HA/CMC as nasal packing after endoscopic sinus surgery.

Impact of Non-Pharmaceutical Interventions on the Incidence and Treatment of Chronic Rhinosinusitis during the COVID-19 Pandemic: A Nationwide Retrospective Cohort Study.

Many countries have implemented non-pharmaceutical interventions (NPIs) to prevent the spread of COVID-19. However, the impacts of NPIs on the epidemiology and treatment of chronic rhinosinusitis (CRS) remain unclear. We analyzed 671,216 patients to investigate changes in the incidence rate and treatment frequency of CRS using Korean nationwide health insurance data between 2017 and 2021. The incidence rate (p < 0.001) and the number of outpatients (p < 0.001), patients hospitalized (p < 0.001), and patients prescribed antibiotics (p < 0.001) or steroids (p = 0.024) were significantly lower in the pandemic period than in the pre-pandemic period; however, the number of patients who underwent surgery was not different (p = 0.205). Additionally, the frequency of surgeries per patient was significantly lower in patients during the pandemic period (p < 0.001). In the interrupted time series analysis, the trends in the number of outpatients (p < 0.001), patients hospitalized (p < 0.001), patients who underwent surgery (p < 0.001), and patients prescribed antibiotics (p < 0.001) or steroids (p < 0.001) significantly changed after the onset of the COVID-19 pandemic. In summary, NPI implementation during the COVID-19 pandemic was associated with a reduction in the incidence and treatment of CRS.

Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma.

OBJECTIVES: Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. METHODS: A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. RESULTS: In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. CONCLUSION: Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.

The long-term oncological and functional outcomes of transoral robotic surgery in patients with hypopharyngeal cancer.

OBJECTIVE: We conducted a prospective clinical trial of transoral robotic surgery in patients with hypopharyngeal cancer and herein report the long-term oncological and functional outcomes. MATERIALS AND METHODS: Between April 2008 and March 2014, 45 patients diagnosed with hypopharyngeal cancer participated in this prospective study. RESULTS: All patients were male with a mean age of 66.7years. The median follow-up period was 60months. Patients were classified using the staging system of the American Joint Commission on Cancer, as follows: Stage I, 7.9%; Stage II, 5.3%; Stage III, 15.8%; Stage IV, 71.1. Of all 38 patients, 17 (44.7%) were alive with no evidence of disease at the last follow-up. Seven patients (18.4%) died of TNM-related disease and fourteen (36.8%) from other causes. The 5-year disease-specific survival rate of stage I and II patients was 100.0%, and that of stage III and IV patients was 74.0%. The 5-year disease-free survival rate was 100.0% for stage I and II patients and 68.6% for stage III and IV patients. CONCLUSIONS: Patients who underwent TORS exhibited oncological outcomes comparable to those of conventional therapies and rapid functional recovery with low surgical morbidity. TORS and simultaneous neck dissection, with or without adjuvant therapy, may be effective alternatives to existing treatment methods.

The relationship between chronic rhinosinusitis and metabolic syndrome.

BACKGROUND: This study aimed to investigate the correlation between metabolic syndrome and chronic rhinosinusitis (CRS), with related risk factors for CRS according to data from the Korean National Health and Nutrition Examination Survey (KNHANES). METHODS: The KNHANES surveyed individuals >19 years of age from January 2010 to December 2011. CRS encompassed "symptom-based CRS" as defined by the European Position Paper on Rhinosinusitis and Nasal Polyps 2012. Metabolic syndrome was diagnosed according to the American Heart Association/National Heart Lung and Blood Institute criteria. A χ2 analysis, univariate analysis, and multivariate analysis were conducted. RESULTS: A total of 12,015 individuals were analyzed in this study. The prevalence of CRS in the patients with metabolic syndrome (high triglyceride level, reduced high-density lipoprotein level, and elevated blood pressure) was significantly higher than that in patients without metabolic syndrome (14.15 versus 10.16%) (p < 0.05). Allergic rhinitis was the only significant risk factor for CRS found to be associated with metabolic syndrome (p < 0.05). CONCLUSION: CRS was more prevalent in patients with metabolic syndrome, especially those with allergic rhinitis, than in patients without metabolic syndrome. Accordingly, CRS should be considered in patients with metabolic syndrome and allergic rhinitis.

Correlation between symptoms and objective findings may improve the symptom-based diagnosis of chronic rhinosinusitis for primary care and epidemiological studies.

BACKGROUND: In primary care and epidemiological studies of chronic rhinosinusitis (CRS), symptom-based diagnosis is common, yet limited, because endoscopic and radiological signs are not considered. OBJECTIVES: To evaluate the correlation between symptoms and objective findings of CRS to improve its symptom-based diagnosis for primary care and epidemiological studies by using data from a large-scale nationwide epidemiological study, the Korean National Health and Nutrition Examination Survey (KNHANES). DESIGN: Cross-sectional study. SETTING: Data from 2008 to 2012 KNHANES. PARTICIPANTS: 29,225 Adults aged >19 years. OUTCOME MEASURES: Questionnaires targeted two major (nasal blockage and anterior/posterior nasal drip) and two minor (facial pain/pressure and reduction or loss of smell) symptoms. Nasal polyps or mucopurulent discharge from the middle meatus was defined as positive endoscopic findings for diagnosing CRS. RESULTS: Of the four symptoms, reduction or loss of smell was the symptom most significantly related to positive endoscopic findings in multivariable analysis (OR=1.936 (95% CI 1.604 to 2.337)). The combinations of symptoms showed higher ORs than individual symptoms and combinations of reduction or loss of smell with other symptoms were statistically more reliable for positive endoscopic findings than other combinations. CONCLUSIONS: Our results show that reduction or loss of smell was the symptom most significantly related to positive nasal endoscopic findings. Therefore, symptom-based diagnosis of CRS can be improved by considering reduction or loss of smell as an important symptom for positive endoscopic findings of CRS.