Sinonasal risk factors for eustachian tube dysfunction: Cross-sectional findings from NHANES 2011-2012.

BACKGROUND: Sinonasal pathology is frequently cited as a cause of eustachian tube dysfunction (ETD), despite a lack of evidence. Using a large, nationally representative sample, we investigated whether abnormal tympanometry, an objective marker of ETD, was associated with infectious, allergic, and exposure-related sinonasal risk factors. METHODS: Relevant data were extracted from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). Tympanometric types (A, B, and C) were determined using peak pressure and compliance values. Participants with a type B or C tympanogram in at least one ear were classified as having ETD. Demographic and clinicopathologic risk factors with putative associations with ETD were determined. Statistical analysis, including regression modeling, was performed using Stata (version 15.1) to determine the correlation between sinonasal factors and ETD. RESULTS: The final analysis included 1253 subjects and 19 variables. We controlled for demographic data including age, gender, race, and income. In both univariate and multivariate logistic regression, statistically significant correlations were found between abnormal tympanometric values and: (1) having a persistent cold/flu in the last 12 months (univariate: adjusted odds ratio [OR], 2.42; p = 0.006; multivariate: adjusted OR, 2.15; p = 0.006); and (2) experiencing "hay fever" (ie, allergic rhinitis) within the last 12 months (univariate: adjusted OR, 1.95; p = 0.021; multivariate: adjusted OR, 1.71; p = 0.039). CONCLUSION: Using a large, representative data set, we identified significant correlations between ETD and (1) persistent cold/flu symptoms and (2) self-reported allergic rhinitis.

One-Year symptom outcomes after sialolithiasis treatment with sialendoscopy-assisted salivary duct surgery.

OBJECTIVES: For chronic obstructive sialadenitis, there is a paucity of long-term prospective evidence of disease-specific symptom outcomes after sialendoscopy-assisted salivary duct surgery (SASDS). We prospectively assessed patients with sialolithiasis before and at 3 months and 1 year after SASDS using the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire. METHODS: A prospective cohort study of adult patients with sialolithiasis who underwent SASDS and completed the COSS questionnaire over a 1-year follow-up period. The COSS questionnaire consists of 20 disease-specific symptom questions. COSS score outcomes were classified by complete, partial, and nonresolution, as well as by clinically significant improvement. RESULTS: Ninety-six patients underwent SASDS in 110 glands, of which 69 glands (63%) had findings of sialolithiasis. The following median COSS scores were reported for sialolithiasis glands: preoperative, 27.5 (interquartile range [IQR]: 12.5-44); 3 months, 1 (IQR: 0-5); and 1 year, 1 (IQR: 0-5.5). Patients with sialolithiasis reported statistically significant improvements in COSS scores from preoperative to 3 months post-SASDS (P > 0.05). A vast majority of patients maintained this improvement from 3 months to 1 year, indicating durability. Complete resolution of symptoms was attained in 95% and 85% of glands at 3 months and 1 year, respectively. Open/hybrid compared to endoscopic-only sialolithiasis extraction achieved similar 3-month and 1-year COSS outcomes. Potential risk factors for symptom persistence after SASDS included nonreachable parenchymal sialoliths and concurrent inflammatory disease and/or stenosis. CONCLUSION: SASDS for sialolithiasis extraction is associated with durable, long-term benefit regardless of endoscopic or open technique or sialolith location, suggesting that subsequent ductal stenosis from iatrogenic or sialolithiasis-related inflammation fibrosis is unlikely. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:396-402, 2019.

Surgeon-Performed Ultrasound for Chronic Obstructive Sialadenitis Helps Predict Sialendoscopic Findings and Outcomes.

Objective To determine the accuracy of surgeon-performed ultrasound (SP-US) features for predicting intraoperative sialendoscopic findings and to correlate ultrasound features with short-term symptomatic outcomes following sialendoscopy-assisted salivary duct surgery (SASDS). Study Design Case series with chart review. Setting The practices of 2 academic sialendoscopy surgeons. Subjects and Methods Between February 2014 and September 2015, 82 patients with 105 symptomatic glands underwent SASDS, of whom 56 patients (75 glands) met inclusion criteria. SP-US and sialendoscopic findings were reviewed for patients with chronic obstructive sialadenitis who underwent SASDS and who had been prospectively evaluated with the University of California-San Francisco Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire (scored 0-100) administered preoperatively and 3 months postoperatively. Results The positive predictive value (PPV) and negative predictive value (NPV) of SP-US for identifying sialoliths intraoperatively were 94% (33/35) and 91% (39/43), respectively. Of glands with sialoliths on SP-US, 97% (34/35) had complete symptom resolution (COSS ≤10) after SASDS. The PPV and NPV of salivary duct dilation on SP-US for finding a corresponding stenosis on sialendoscopy were 93% (14/15) and 50% (14/28), respectively. Nonsialolith SP-US features with the highest PPV for complete or partial symptom resolution (COSS ≤25) following SASDS included distal duct dilation of all glands (86%; 6/7) and dilation of both distal and proximal parotid ducts (75%; 6/8). Conclusion SP-US has high accuracy for ruling in and ruling out sialoliths, as well as for ruling in but not for necessarily ruling out stenosis presence and location. Ultrasound is helpful in estimating degree of short-term symptom response following SASDS.

Salivary duct stenosis: Short-term symptom outcomes after sialendoscopy-assisted salivary duct surgery.

OBJECTIVES: To prospectively assess short-term symptom change after sialendoscopy-assisted salivary duct surgery (SASDS) for salivary duct stenosis. STUDY DESIGN: Prospective cohort study. METHODS: Patients with obstructive sialadenitis from duct stenosis completed the 20-item Chronic Obstructive Sialadenitis Symptoms (COSS) Questionnaire (scored 0-100) prior to SASDS and 3 months postoperatively. RESULTS: Thirty glands in 19 patients with endoscopically confirmed salivary duct stenosis showed overall symptom improvement, with a mean COSS score reduction of 12.9 points (standard deviation [SD] 13.1) to a mean postoperative score of 25.1 (range 0-75.5) (P < 0.001) with six (20%) glands (5 patients) achieving complete symptom resolution. Symptoms improved significantly for parotid glands (n = 20) by 16.6 points (SD 15.9) (P < 0.0001). For distal duct stenoses (n = 25), significant symptom improvement was seen in cases treated with dilation only (n = 17; partial stenoses) with a mean 20.6 point COSS reduction (SD 19.0) (P < 0.0005) and in cases treated with sialodochoplasty (n = 5; 4 complete, 1 partial stenosis) with a mean 13.8 point reduction (SD 4.7) (P < 0.005). Symptom scores did not improve after SASDS in proximal stenoses (n = 3) and distal stenoses cases not amenable to treatment (n = 3). CONCLUSION: SASDS for salivary duct stenosis often can improve obstructive salivary symptoms; however, many patients report persistent symptoms after surgery. Partial duct stenoses or distal duct stenoses are associated with the greatest improvements in COSS scores after SASDS. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2770-2776, 2017.

Sialadenitis without sialolithiasis: Prospective outcomes after sialendoscopy-assisted salivary duct surgery.

OBJECTIVES: To prospectively assess symptoms before and after sialendoscopy-assisted salivary duct surgery (SASDS) in patients with symptomatic sialadenitis without sialolithiasis. STUDY DESIGN: Prospective cohort study. METHODS: Patients with chronic obstructive sialadenitis without sialolithiasis (COSWS) completed the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire prior to SASDS and 3 months postoperatively. RESULTS: Of 80 consecutive patients in a 20-month period, 20 surveyed patients underwent SASDS for COSWS in 37 symptomatic glands. Major symptom improvement (> 10 COSS score reduction) was reported in 24 of 37 (65%) of all glands, including 14 of 21 (67%) of radioactive iodine (RAI)-induced cases and 10 of 13 (77%) of idiopathic sialadenitis cases. A significant reduction in postoperative mean COSS scores was seen overall (12.6 points, standard deviation [SD] 19.3, P < 0.05 to a post-SASDS mean score of 26.6). However, 19 of 37 (51%) glands demonstrated postoperative COSS scores above 25, denoting persistent disease. Mean COSS score reductions in RAI-induced sialadenitis (12.4 points, SD 22.7, P < 0.05) and idiopathic sialadenitis (16.3 points, SD 13.7, P < 0.005) groups were significant, with post-SASDS COSS mean scores of 30.6 (SD 19.8) and 20.8 (SD 13.8), respectively. Ducts with stenoses treated with dilation or sialodochoplasty showed significant COSS improvements of 21.1 (SD 17.9) and 12.4 points (SD 10.7), respectively (P < 0.05). In a multivariate analysis, both the presence of stenosis and sialodochoplasty were independent predictors of complete or partial resolution (post-COSS score < 25) and major symptom improvement (P < 0.05). CONCLUSION: SASDS provides short-term symptom reduction in patients with COSWS; particularly in RAI-induced and idiopathic sialadenitis, and in duct stenosis amenable to dilation or sialodochoplasty. However, approximately half of the glands did not achieve meaningful symptom resolution. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:1073-1079, 2017.

Sialendoscopy-assisted surgery and the chronic obstructive sialadenitis symptoms questionnaire: A prospective study.

OBJECTIVES/HYPOTHESIS: To prospectively assess symptoms of obstructive sialadenitis before and after sialendoscopy-assisted salivary duct surgery (SASDS) using the chronic obstructive sialadenitis symptoms (COSS) questionnaire to determine and predict impact of interventions. STUDY DESIGN: Prospective cohort study. METHODS: Adult patients with chronic obstructive sialadenitis who underwent SASDS were asked to complete the COSS questionnaire and the Short-Form-8 (SF-8) quality-of-life (QOL) survey prior to surgery and 3 months postoperatively. Chronic obstructive sialadenitis symptoms surveys were scored on a scale from 0 to 100. RESULTS: Forty patients undergoing SASDS, including 54 glands, completed preoperative and postoperative surveys. Overall, the mean COSS score improved from 36.1 (standard error of the mean [SEM] 2.6) preoperatively to 13.5 (SEM 2.4) 3 months postoperatively (p < 0.001). Submandibular gland cases had a significant mean score reduction of 27.8 (from 38.1 to 10.3; p < 0.005). Parotid gland cases had a significant mean score reduction of 13.6 (from 32.6 to 19.0; p < 0.0001). Patients with sialolithiasis-related sialadenitis had greater COSS score improvement after surgery than those with radioactive iodine- or inflammatory-related disease. An improvement in symptoms was seen for 100% and 47% of patients with sialolithiasis and inflammatory etiologies, respectively. The pre- and post-SASDS SF-8 QOL scores were not significantly different. CONCLUSIONS: Obstructive sialadenitis-related symptoms significantly declined 3 months after SASDS. The COSS questionnaire was able to measure changes in sialadenitis symptoms not captured in the SF-8 QOL survey. This is the first study to prospectively survey sialadenitis-specific symptoms to determine impact of surgical interventions. LEVEL OF EVIDENCE: 4. Laryngoscope, 126:1343-1348, 2016.

The Chronic Obstructive Sialadenitis Symptoms Questionnaire to assess sialendoscopy-assisted surgery.

OBJECTIVES/HYPOTHESIS: Introduce the Chronic Obstructive Sialadenitis Symptoms (COSS) questionnaire to quantify chronic sialadenitis symptoms and assess the impact of sialendoscopic-assisted salivary duct surgery (SASDS). STUDY DESIGN: Retrospective outcome symptoms questionnaire study. METHODS: The COSS questionnaire assesses the severity of sialadenitis symptoms from 0 to 100. Patients who underwent SASDS from April 2006 to December 2013 completed the COSS questionnaire and the ShortForm8 Health Survey (SF-8) based on current symptoms, and reported whether they had complete, partial, or no symptomatic response to SASDS. RESULTS: Sixty-six of the 156 (43%) contacted patients completed the questionnaires who had had symptoms in 26 submandibular ducts and 53 parotid ducts. The mean COSS score was higher for parotid ducts (12.0; interquartile range [IQR] 1.0-20.0) than for submandibular ducts (7.6; IQR 0.5-15.0) but not significantly so (P = 0.20). Thirty-eight (60%) patients reported complete resolution of symptoms, with a mean COSS score of 4.5 (IQR 0-7). Twenty-one (33%) patients reported partial resolution, with a mean COSS score of 18.5 (IQR 11.3-22.8). Five (8%) patients reported no improvement, with a mean COSS score of 25.1 (IQR 15.2-35). Thirty-six (46%) ducts with sialoliths had a significantly lower mean COSS score (5.8; IQR 0-9.5) compared to those without sialoliths (14.2; IQR 4.5-21.5, P = 0.0004). There was no significant difference in SF-8 survey scores between these groups. CONCLUSION: The COSS questionnaire is a novel survey instrument to measure obstructive sialadenitis symptom severity that could be helpful in defining outcomes of SASDS. COSS scores under 10 correlate with complete resolution of symptoms, whereas scores between 10 and 25 correlate with partial resolution.

Elective lymphadenectomy during salvage for locally recurrent head and neck squamous cell carcinoma after radiation.

OBJECTIVE: This study aimed to assess the rate of occult metastases in patients with head and neck mucosal squamous cell carcinoma who have undergone therapeutic neck radiation, and then develop primary site recurrence, without clinical evidence of recurrent neck disease. STUDY DESIGN: Case series with chart review. SETTING: Tertiary care center. SUBJECTS AND METHODS: Head and neck mucosal squamous cell carcinoma patients with N+ necks treated with primary radiation who developed primary site recurrence with radiologically resolved neck lymphadenopathy, treated with salvage primary-site surgery with or without elective cervical lymphadenectomy (ECL). Main outcome measures were rate of occult nodal metastases, complication rates, and disease-free survival. RESULTS: Sixteen patients met inclusion criteria. Of 18 neck sides that underwent either ECL or observation for a mean follow-up of 26 months, 4 (22.2%) were found to have positive occult cervical metastases, all on the ipsilateral side of preradiation neck disease. Patients with advanced T-stage and/or free flap reconstruction were more likely to undergo cervical lymphadenectomy. Patients with persistent (as opposed to recurrent) primary site tumors had the highest rate of occult cervical metastases. CONCLUSION: The risk of occult nodal metastases of 22.2%, in this study, may be too high to justify routinely omitting elective cervical lymphadenectomy in this patient population. Lymphadenectomy should especially be considered in patients with persistent tumors, with advanced recurrent T-stage, and undergoing free flap reconstruction.