Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial.

BACKGROUND: Endoscopic endonasal approaches pose the potential risk of olfactory loss. Loss of olfaction and potentially taste can be permanent and greatly affect patients' quality of life. Treatments for olfactory loss have had limited success. Omega-3 supplementation may be a therapeutic option with its effect on wound healing and nerve regeneration. OBJECTIVE: To evaluate the impact on olfaction in patients treated with omega-3 supplementation following endoscopic skull base tumor resection. METHODS: In this multi-institutional, prospective, randomized controlled trial, 110 patients with sellar or parasellar tumors undergoing endoscopic resection were randomized to nasal saline irrigations or nasal saline irrigations plus omega-3 supplementation. The University of Pennsylvania Smell Identification Test (UPSIT) was administered preoperatively and at 6 wk, 3 mo, and 6 mo postoperatively. RESULTS: Eighty-seven patients completed all 6 mo of follow-up (41 control arm, 46 omega-3 arm). At 6 wk postoperatively, 25% of patients in both groups experienced a clinically significant loss in olfaction. At 3 and 6 mo, patients receiving omega-3 demonstrated significantly less persistent olfactory loss compared to patients without supplementation (P = .02 and P = .01, respectively). After controlling for multiple confounding variables, omega-3 supplementation was found to be protective against olfactory loss (odds ratio [OR] 0.05, 95% CI 0.003-0.81, P = .03). Tumor functionality was a significant independent predictor for olfactory loss (OR 32.7, 95% CI 1.15-929.5, P = .04). CONCLUSION: Omega-3 supplementation appears to be protective for the olfactory system during the healing period in patients who undergo endoscopic resection of sellar and parasellar masses.

Prognostic indicators in well-differentiated thyroid carcinoma when controlling for stage and treatment.

OBJECTIVES/HYPOTHESIS: The incidence of thyroid carcinoma is rising. Few studies have examined patient characteristics that influence survival when adjusting for treatment and tumor stage/extent. STUDY DESIGN: Retrospective analysis was performed using the Surveillance Epidemiology and End Results registry data among patients diagnosed with well-differentiated thyroid (WDT) carcinoma during 1988-2009. METHODS: Kaplan-Meir survival curves were used to estimate 5- and 10-year cause-specific and overall survival differences by sociodemographics, clinical characteristics, and treatment. Multivariate Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: A total of 83,985 patients were identified with WDT carcinoma. Blacks had higher hazard of death at 5 years (HR, 1.67; 95% CI, 1.42-1.96) and 10 years (HR, 1.57; 95% CI, 1.37-1.80) when compared to Caucasians, but there were no significant differences in cause-specific deaths. Hispanics had higher overall and cause-specific 5-year and 10-year hazard of death (5-year cause-specific: HR, 1.56; 95% CI, 1.23-1.99). Age was the most significant predictor of cause-specific and overall survival, with risk increasing in a nonlinear fashion. After age 45 years, the HR for 5- and 10-year cause-specific survival rose drastically, reaching an HR of 153 for individuals aged 85 years and older (HR, 153.45; 95% CI, 97.84-240.67). CONCLUSIONS: Age was the strongest factor associated with WDT cancer in our study. African Americans had worse overall survival, although only Hispanics had a significantly worse cause-specific survival. These factors should be taken into account in counseling patients and treatment planning.

Impact of unilateral conductive hearing loss due to aural atresia on academic performance in children.

OBJECTIVES/HYPOTHESIS: This study evaluates the effect of unilateral conductive hearing loss secondary to aural atresia on elementary school children's academic performance. STUDY DESIGN: Case control survey and review of audiometric data. METHODS: One hundred thirty-two surveys were mailed to families of children with aural atresia, and 48 surveys were sent to families of children with unilateral sensorineural hearing loss (SNHL) to identify rates of grade retention, use of any resource, and behavioral problems. Audiometric data of the cohort were tabulated. RESULTS: Of the 40 atresia patients, none repeated a grade, but 65% needed some resources: 12.5% currently use a hearing aid, 32.5% use(d) a frequency-modulated system in school, 47.5% had an Individualized Education Plan, and 45% utilized speech therapy. Compared to the unilateral SNHL group and a cohort of children with unilateral SNHL in an earlier study, children with unilateral atresia were less likely to repeat a grade. Children in both unilateral atresia and SNHL groups were more likely to utilize some resource in the academic setting compared to the unilateral SNHL children in the prior study. CONCLUSIONS: Unilateral conductive hearing loss due to aural atresia has an impact on academic performance in children, although not as profound when compared to children with unilateral SNHL. The majority of these children with unilateral atresia utilize resources in the school setting. Parents, educators, and health care professionals should be aware of the impact of unilateral conductive hearing loss and offer appropriate habilitative services.

Does preoperative hearing predict postoperative hearing in patients undergoing primary aural atresia repair?

OBJECTIVE: The purpose of this study is to explore the correlation between preoperative hearing and early postoperative hearing results in patients undergoing primary aural atresia repair. STUDY DESIGN: Retrospective review of 125 patients. SETTING: Academic tertiary referral center. PATIENTS: One hundred twenty-five patients (5-67 yr old) undergoing 133 primary aural atresia surgeries were included. MAIN OUTCOME MEASURE(S): Spearman correlation coefficients were calculated between preoperative and postoperative (mean, 7.5 wk; range, 3-40 wk after surgery) hearing outcome measures including 3-tone pure-tone average (PTA), speech reception threshold (SRT), speech discrimination scores (SDS), air-bone gap (ABG), change in ABG (ΔABG), and between preoperative SRT and Jahrsdoerfer score. RESULTS: Preoperative PTA, SRT, SDS, and ABG correlated strongly with their respective postoperative values (correlation coefficients rho of 0.356 [p < 0.01], 0.199 [p < 0.05], 0.480 [p < 0.01], and 0.223 [p < 0.05], respectively). Preoperative PTA (0.407; p < 0.01), SRT (0.348; p < 0.01), SDS (-0.247; p < 0.01), and ABG (0.514; p < 0.01) also were correlated with ΔABG. When postoperative results were dichotomized to either normal (SRT, <30dB HL) or abnormal (SRT, ≥30dB HL), preoperative SRT was found to be a positive predictor of normal postoperative hearing (p = 0.05). Probability of normal postoperative hearing was 66% when preoperative SRT was 50 dB HL or lower and 40% when greater than 60 dB HL. Preoperative hearing (SRT) also trended toward a correlation with Jahrsdoerfer score (-0.168 [p = 0.058]). CONCLUSION: Among patients undergoing primary atresia repair, better preoperative hearing strongly predicts better postoperative hearing and correlates with ear anatomy. Preoperative hearing status should be factored when counseling atresia patients on hearing rehabilitation options.

Cyclin D1 and FADD as biomarkers in head and neck squamous cell carcinoma.

OBJECTIVE: Cyclin D1 and FADD (Fas-associated protein with death domain) regulate the cell cycle and apoptosis, respectively, and are located on chromosome 11q13, which is frequently amplified in head and neck squamous cell carcinoma (HNSCC). This study evaluates these proteins as predictors of clinical outcomes for HNSCC. STUDY DESIGN: Historical cohort study. SETTING: Academic tertiary care center. SUBJECTS: Two hundred twenty-two patients with upper aerodigestive HNSCC. RESULTS: Patients with tumors that were strongly positive for cyclin D1 and FADD had reduced overall (OS; P = .003 and P < .001), disease-specific (DSS; P = .039 and P < .001), and disease-free (DFS; P = .026 and P < .001) survival, respectively. Together, the 2 markers effectively stratified OS (P < .001), DSS (P < .001), and DFS (P = .002). Strong FADD staining correlated with greater alcohol consumption and varied significantly with primary tumor site: 56% of hypopharynx tumors expressed high levels of FADD but only 7% of glottis tumors. Using Cox regression analysis, FADD and N stage were significant independent predictors of DSS and DFS, whereas cyclin D1, FADD, and N stage were independently significant for OS. CONCLUSION: Cyclin D1 and FADD may have utility as predictors of long-term outcomes for patients with HNSCC. Further study is needed to determine if these proteins predict response to different treatment approaches or assist in selecting patients for multimodality therapy.