Endoscopic Posterior Cricoid Split With Graft in an Adult With Posterior Cricoid Fracture.

A 45-year-old man presented with bilateral vocal fold immobility (BVFI) following a remote history of assault. He was found to have a comminuted, telescoped, and ossified posterior cricoid fracture on imaging. Electromyography revealed normal cricothyroid and thyroarytenoid muscle function, but moderate chronic denervation of bilateral posterior cricoarytenoid muscles. The patient underwent endoscopic posterior cricoid split with rib graft (EPCS/RG), and he regained moderate vocal abduction and full vocal adduction, resolution of dysphonia, and was decannulated. This report describes the only case of an adult with BVFI due to a posterior cricoid fracture that was successfully treated with EPCS/RG. Laryngoscope, 128:2864-2866, 2018.

Mobile Applications for Allergic Rhinitis.

OBJECTIVE: To study and review the currently available mobile applications relating to allergic rhinitis. METHODS: The Apple and Google mobile app stores were queried with search terms relating to allergic rhinitis. Apps were assigned to categories and analyzed based on description and characteristics such as popularity, reviews, cost, platform, and physician involvement in development. RESULTS: A total of 72 apps related to allergic rhinitis were identified. Fifty-four apps were unique, with 18 apps found on both operating systems. Forty (55.5%) apps were available in the Apple App store, and 32 (44.4%) apps were available in the Google Play app store. They were grouped into the following categories: patient education (18; 25%), journals (15; 20.8%), symptom tracking (14; 19.4%), clinical/private practice (13; 18.1%), pollen forecast (7; 9.7%), medical education (4; 5.6%), and other (1; 1.4%). The majority of apps were free of charge (67; 93.1%), with paid apps ranging from $1.47 to $4.99. Apps that were reviewed had an average rating of 3.9 out of 5. Physicians were involved in the development of 37 (51.4%) apps. CONCLUSIONS: The collection of mobile apps developed for allergic rhinitis includes those for both educational and clinical use. Mobile apps may have an increasing role in otolaryngic allergy and rhinology practices in the future. Thus, continued research is warranted to determine the best way to ensure the accuracy and quality of app content as well as the extent mobile apps can benefit allergic rhinitis patients.

To Pack or Not to Pack: Inpatient Management of Epistaxis in the Elderly.

BACKGROUND: Epistaxis is common in elderly patients, occasionally necessitating hospitalization for the management of severe bleeds. In this study, we aim to explore the impact of nasal packing versus nonpacking interventions (cauterization, embolization, and ligation) on outcomes and complications of epistaxis hospitalization in the elderly. METHODS: The 2008-2013 National Inpatient Sample was queried for elderly patients (≥65 years) with a primary diagnosis of epistaxis and accompanying procedure codes for anterior and posterior nasal packing or nonpacking interventions. RESULTS: A total of 8449 cases met the inclusion criteria, with 62.4% receiving only nasal packing and 37.6% receiving nonpacking interventions. On average, nonpacking interventions were associated with a 9.9% increase in length of stay and a 54.0% increase in hospital charges. Comorbidity rates did not vary between cohorts, except for diabetes mellitus, which was less common in the nonpacking cohort (26.6% vs 29.0%; P = .014). Nonpacking interventions were associated with an increased rate of blood transfusion (24.5% vs. 21.8%; P = .004), but no significant differences in rates of stroke, blindness, aspiration pneumonia, infectious pneumonia, thromboembolism, urinary/renal complications, pulmonary complications, cardiac complications, or in-hospital mortality. Comparing patients receiving ligation or embolization, no differences in length of stay, complications, or in-hospital mortality were found; however, embolization patients incurred 232.1% greater hospital charges ( P < .001). CONCLUSION: Nonpacking interventions in the elderly do not appear to be associated with increased morbidity or mortality when compared to nasal packing only but appear to be associated with increased hospital charges and length of stay. Embolization in the elderly results in greater hospital charges but no change in outcome when compared to ligation.

Sinonasal adenoid cystic carcinoma: a population-based analysis of 694 cases.

BACKGROUND: Currently, limited literature exists about sinonasal adenoid cystic carcinoma (SNACC). In this study, we analyze the demographics, survival, and treatment efficacy of this rare entity. METHODS: Our study was a retrospective population-based analysis of SNACC in the Surveillance, Epidemiology, and End Results (SEER) database assessing the 40-year time-frame of 1973 to 2013. RESULTS: Six hundred ninety-four SNACC patients were identified; 53.2% were female and 46.8% were male. Caucasians were most commonly affected (77.1%). SNACC most often arose from the maxillary sinuses, followed by the nasal cavity. The majority of SNACC cases presented as stage IV disease. Nodal and distant metastases were present in 3.6% and 7.1% of all cases, respectively. Overall 5-, 10-, and 20-year disease-specific survival (DSS) rates were 66.5%, 41.1%, and 17.6%, respectively. The presence of distant metastasis dropped the 5-year DSS rate from 64.5% to 20.0%. Cases treated with combined surgery and adjuvant radiotherapy had a slightly improved 5-year DSS rate compared with surgery alone (73.5% vs 72.5%). Surgery alone resulted in higher 10- and 20-year DSS rates (54.2% and 36.8%, respectively) when compared with combined therapy (44.2% and 15.5%), radiotherapy alone (10.8% and 0%), and no surgery or radiotherapy (9.3% and 0%). CONCLUSION: This study represents the largest cohort of SNACC patients to date. Factors that confer a survival benefit in SNACC include M0 disease, and presentation primarily in the nasal cavity. Overall low rates of nodal metastasis may not warrant the use of elective neck dissections, unless there is clinical suspicion. Modalities of therapy that include surgery greatly improve survival. Adjuvant radiotherapy appears to slightly improve 5-year disease-free survival but does not impact long-term survival.

Head and neck sweat gland adenocarcinoma: A population-based perspective of a rare entity.

OBJECTIVES: Head and neck sweat gland adenocarcinoma (HNSGA) is an extremely rare malignancy. We present the first population-based analysis regarding this entity. STUDY DESIGN: Retrospective population-based analysis. METHODS: Using the Surveillance, Epidemiology, and End Results registry from 2000 to 2013, we extracted 627 cases of HNSGA. Data were analyzed for incidence trends, demographic and clinicopathologic traits, and predictors of disease-specific survival (DSS). RESULTS: The majority HNSGA cases were white, male, and 60 to 79 years old. The incidence was 0.036 per 100,000 people. Tumors most often presented as localized disease and histological grade II/III. The skin of the face was the most common primary site (43.4%), followed by the scalp and neck (31.6%). Overall 5-, 10-, and 20-year DSS were 94.6%, 89.6%, and 79.8%, respectively. Ethnicity did not affect survival, whereas a younger age at diagnosis and female sex conferred an advantage at 10 years (P = 0.0386) and 5 years (P = 0.0191), respectively. The origin of the HNSGA (apocrine vs. eccrine) did not affect outcomes. Regional and distant disease predicted worse DSS at 5, 10, and 20 years (P = 0.0026, P < 0.001, P < 0.001, respectively). Compared to grade I/II disease, grade III/IV dramatically worsened 5-, 10-, and 20-year DSS (P = 0.0035, P < 0.0001, P = 0.0011, respectively). Scalp and neck HNSGA exhibited the poorest 20-year DSS compared to other primary sites (P = 0.0024). CONCLUSION: We present the largest cohort of HNSGA. Significant poor prognostic indicators include older age, higher tumor grade, greater extent of invasion, and primary site of the scalp or neck. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2757-2762, 2017.

Do geographic differences or socioeconomic disparities affect survival in sinonasal squamous cell carcinoma?

BACKGROUND: Squamous cell carcinoma (SCC) is the most common malignancy in the sinonasal tract. We present the first population-based analysis that examines geographic differences in demographic and clinical characteristics, socioeconomic factors, treatment modality, and disease-specific survival (DSS) of this entity. METHODS: All cases of sinonasal squamous cell carcinoma (SNSCC) were queried using the U.S. Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2013. Patients were stratified by geographic location and characteristics such as demographics (age, gender, race, metropolitan/nonmetropolitan status, and income), stage at diagnosis, and treatment modality. Survival data were generated using Kaplan-Meier regression analysis. RESULTS: In total, 6094 patients were identified; 15.3% were from the East, 16.3% from the Midwest, 19.3% from the South, and 49.1% from the West. Patients from the South were younger (p < 0.001). The South had the highest proportion of patients who were black (p < 0.001), lived in nonmetropolitan areas (p < 0.001), and presented with localized disease (p < 0.001). Southern patients also had the lowest median income (p < 0.05), and were least likely to be treated with both surgery and radiotherapy (p < 0.001). The South exhibited the lowest 20-year DSS compared to all other regions (p < 0.001). CONCLUSION: SNSCC patients from the South had the poorest long-term DSS, despite being most likely to present with localized disease. The South had the highest proportion of patients who were black, resided in rural or urban towns, had the lowest median income, and did not receive standard combination therapy, compared to the East, Midwest, and West.