Long-Term Care and Follow-Up in Laryngeal Cancer Patients: A Multicenter Retrospective Analysis.

PURPOSE: We conducted an outcome analysis on surgically treated laryngeal squamous cell carcinoma (LSCC) patients. METHODS: A multicenter retrospective study with 352 patients was analyzed. A new nomogram that incorporates age, T- and N-classification, and treatment was created. RESULTS: Recurrence was observed in 65 (18.5%) patients after a mean time of 16.5 months. After 60 months, 91 (25.9%) of patients developed secondary primary tumors (SPT), most commonly in the lungs (n = 29; 8.2%) followed by other head and neck cancers (n = 21; 6.0%). Notably, the mean time to occurrence of secondary head and neck cancers was twice that of lung cancer (101.1 vs. 47.5 months). CONCLUSION: Recurrent disease is less common in LSCC patients and appears much earlier than SPT. Because one in every four laryngeal cancer patients develops SPTs within 5-10 years, long-term care and follow-up, including imaging studies, are highly recommended. The nomogram was useful for estimating survival.

Perioperative substitution testosterone therapy in patients with advanced head and neck squamous cell carcinoma.

Testosterone replacement therapy is becoming more and more popular in men as "anti-aging medicine". Testosterone has beneficial effects on body mass and muscle gain, and much research has examined testosterone in palliative cancer therapy for oncology patients. In addition to direct effects on weight gain, testosterone improves mood and self-confidence, strength, libido, muscle mass, bone density, and cognitive functions and reduces the risk of cardiovascular disease. Lower testosterone levels are found in 65 % of male patients with progressive tumors compared to only 6 % of men in the general population. We hypothesize that perioperative substitution testosterone therapy (PSTT) together with a balanced diet, may be more effective than balanced diet alone in the overall treatment outcome of patients with head and neck squamous cell carcinomas. Therefore, PSTT in combination with a balanced diet should be considered as an additional tool for head and neck carcinoma treatment.

Posttraumatic Vernet syndrome without fracture: A case report and short literature review.

RATIONALE: The aim of this case is to emphasize the need to include nerve traction in the differential diagnosis of nerve deficits associated with Vernet syndrome. This mechanism of injury has been described only once, but must not be overlooked and should be considered and included as a possible cause in diagnostic algorithms. PATIENT CONCERNS: A patient presenting with dysphagia, extreme hoarseness, and limited shoulder movement after head injury was admitted to the emergency department. DIAGNOSES: Multidisciplinary evaluation was performed, and nerve traction-induced Vernet syndrome was established as a running diagnosis. INTERVENTIONS: Intensive swallowing and speech exercises, assisted by a specialist, were performed. OUTCOMES: Swallowing and speech exercises significantly and objectively improved the patient's swallowing and voice, with mild hoarseness of voice remaining as the main symptom. Spectral acoustic analysis went from a voice pitch of 163.77 Hz to normal (187.77 Hz), jitter improved from 17.87% to 0.86% and shimmer values decreased from 39.86% to 19.60%. Breathiness during phonation measuring 2.91% was reduced to 1.08% and appropriate average intensity of voice (63.95 dB) was achieved. Initial dysphagia and fluid retention in the right piriform sinus, along with tracheal aspiration, were not observed in control fiberoptic endoscopic evaluation of swallowing. LESSONS: According to our knowledge and literature data, this is the second reported case of posttraumatic Vernet syndrome without radiologically confirmed jugular foramen fracture, induced by nerve traction. Such patients need a prompt multidisciplinary approach in diagnosis and timely posttraumatic rehabilitation therapy for favorable clinical evolution and retrieval of nerve function.

Undifferentiated pleomorphic sarcoma in oropharyngeal mucosa of patients with multiple basal cell carcinomas.

Malignant mesenchymal tumors of oropharyngeal mucosa are rare. Those with fibroblastic and histiocytic differentiation in the skin are called atypical fibroxanthoma (AFX) and in the soft tissue undifferentiated pleomorphic sarcoma (UPS). Here we present a case of an older patient with a history of multiple basal cell carcinomas and recently with a rapidly growing polypoid lesion in the mucosa of posterior oropharyngeal wall with AFX/UPS morphology. The differential diagnosis, histological pitfalls of this poorly characterized mesenchymal lesions, and the challenges associated with treatment are discussed.

New insights into erythropoietin and erythropoietin receptor in laryngeal cancer tissue.

ABSTRACT: To investigate whether laryngeal cancer cells express erythropoietin (Epo) and erythropoietin receptor (EpoR) and what is their possible relationship with clinical and pathological features of the tumor.We performed immunohistochemical analysis of Epo and EpoR expression on 78 tissue samples of invasive and in situ squamous cell laryngeal carcinoma.The statistical analysis showed a weak positive and statistically significant correlation of EpoHS and EpoR HS expression levels. Epo HS and EpoR HS levels did not correlate with patient sex or age, type of diagnosis, cancer stage, histological tumor grade, presence or absence of disease recurrence, type of oncologic cancer therapy provided, or results of selected laboratory blood work. The results show a statistically significant difference in Epo expression with respect to survival.We confirmed the presence of Epo an EpoR in malignant laryngeal tumors and demonstrated the correlation between Epo expression and survival. Further studies are needed to more precisely define the role of Epo and EpoR in treatment of patients with laryngeal cancer.

Middle east tuberculosis in an immunocompromised patient: Case report and review of the literature.

Tuberculosis is an airborne disease caused by Mycobacterium tuberculosis. In 15-20% cases of active disease extrapulmonary tuberculosis may occur, most commonly in the head and neck region. Tuberculous otitis media accounts for 0,1% of the total number of tuberculosis patients. This paper provides insight into current state of literature of tuberculous otitis media. It also includes the case of a 53-year-old patient with tuberculous otitis media. The patient had a liver transplantation and she showed an atypical manifestation of the disease including acute otitis media and coinfection with Achromobacter xylosoxidans. The paper describes in detail the methods of diagnosis and the infection treatment. Considering the polymorphic clinical presentation of tuberculous otitis media in cases with long lasting otorrhoea differential diagnosis should include an infection with Mycobacerium tuberculosis.

Inhalation Aerosol Therapy in the Treatment of Chronic Rhinosinusitis: A Prospective Randomized Study.

The purpose of the study was to compare treatment of chronic rhinosinusitis (CRS) with topical glucocorticoids and saline irrigation versus aerosol inhalation therapy. Patients diagnosed with CRS were randomly divided into 2 groups. In the first group, patients were treated with topical glucocorticoids (mometasone furoate, 100 µg in each nostril once daily) and saline irrigation (150 mL twice a day) for 2 weeks. In the second group, patients were treated with inhalation aerosol therapy composed of essential oils, saline, glucocorticoids, and antibiotics, once daily 5 times per week (Monday through Friday), for 2 weeks. The effect of the treatments was compared between the 2 groups. In the first group there was no significant improvement in the Glasgow Health Status Inventory (GHSI) (P = .29). In the second group the improvement in GHSI score was significant (P = .037). It was shown that in the first group the Glasgow Benefit Inventory score was significantly lower than in the second group (P = .002), which means that the improvement in the health status after the therapy was better in the second group. A Lund-Kennedy score showed statistical improvement in both groups (both P < .001). Improvement was also compared between the groups. The results were not significant (P = .11). The authors concluded that, in this preliminary research, inhalation aerosol therapy composed of essential oils, saline, glucocorticoids, and antibiotics led to better subjective results than intranasal glucocorticoid therapy and saline irrigation in the treatment of CRS. Further investigations with more participants, longer periods of treatment, and different validation tools are needed to confirm our results.

Pathological and non-pathological irregularities of nystagmus.

Irregularities of nystagmus can be found almost in every electronystagmographic record, but only a few are pathological. In this investigation, the authors try to define the border line between pathological and nonpathological irregularities of nystagmus and according to this measure the diagnostic use of findings of irregularities of nystagmus.

Full thickness cartilage palisade tympanoplasty with malleus interposition: a study of the long term results.

The aim of this retrospective study is to review long term results of full-thickness cartilage palisade tympanoplasty (FTCPT) with malleus head interposition performed on 51 patients (56 ears); 36 women and 15 men (7-73 years, 44 years average). The pathology of ears which encourages this technique of tympanoplasty is presented. On average 12 years after surgery we have elaborated anatomic and functional results. Anatomic results were categorized based on empiric evaluation of the new tympanic membrane status: 40 (71%) tympanic membranes without anatomic irregularities, 14 (25%) with irregularities and 2 (4%) with secondary perforation. Functional results (tonal audiogram) are based on pure tone average air-bone gap (PTA-ABG) at 4 frequencies. Main functional results of 51 ears (51 audiograms performed): pre- and post-operative average PTA-ABGs were 27.07 +/- 9.98 and 10.77 +/- 7.85 dB (t = 10.36; p < 0.001). In the group of ears with a tympanic membrane with no anatomic irregularities, pre- and post-operative average PTA-ABGs were 27.30 +/- 10.56 and 10.82 +/- 8.33 dB (t = 8.09; p < 0.001). In the group of ears with cartilage resorption, pre- and post-operative PTA-ABGs were 24.92 +/- 8.19 and 9.33 +/- 6.58 dB (t = 6.21; p < 0.001). The differences between the two groups are irrelevant. Postoperative PTA-ABG values of ears after first surgery (N = 34) and revision surgery (N = 17) was significantly different (8.75 +/- 5.75 and 15.16 +/- 9.62 dB) (t = 2.60; p = 0.016). In spite of the thickness of the new tympanal membrane, FTCPT is a successful technique for solving advanced ear pathology.

Mucormycosis of the nasal ala in a leukemic (M7 AML) child. Is surgery of the nasal defect indicated?

Anterior tamponade with Surgicel (oxidized cellulose) was performed on a 5-year-old girl with megakaryoblastic leukemia (M7 AML) and epistaxis. Several days later necrosis of the nasal ala occurred. Debridement was performed and mucormycosis caused by Rhizopus was found in the material. Having cured mucormycosis, a defect of the complete nasal ala remained. The question of a surgical resolution of the disfiguring nasal defect arises.

Cartilage palisade tympanoplasty in children and adults: long term results.

OBJECTIVE: To show long-term anatomic and functional results of full thickness cartilage palisade tympanoplasty in children and adults. METHODS: In 51 patients (56 ears); 9 children (12 ears) and 42 adults (44 ears) full thickness cartilage palisade tympanoplasty and interposition with malleus head autograft was performed. On average 11 years after the tympanoplasty, an otomicroscopy and a tonal audiogram were done to assess anatomic and functional results. RESULTS: Anatomic results of 56 ears: 40 (71.43%) tympanic membranes have no anatomic irregularities; 14 (25.00%) have cartilage resorption (11 of them minor and 3 major resorptions), 2 (3.57%) have secondary perforation. In the group of children all ears tympanic membrane were with no or minor resorption and no perforations. Functional results (51 audiograms performed: in children 12 and in adults 39): pre- and post-operative average pure tone average air-bone gaps were 27.29 ± 10.26 and 10.73 ± 7.90 dB, respectively. In the group of children pre- and post-operative average pure tone average air-bone gaps were 29.44 ± 10.30 and 6.81 ± 3.47 dB, respectively. In the group of adults pre- and post-operative pure tone average air-bone gaps were 26.63 ± 10.30 and 11.93 ± 8.50 dB, respectively. The differences between the two groups preoperatively (z=0.733; p=0.463) and postoperatively are irrelevant (z=1.723; p=0.085). The hearing gain is bigger in children (F=4.788; p=0.033). CONCLUSION: The full thickness cartilage palisade tympanoplasty with malleus autograft interposition is also nowadays a successful method in solving of an advanced ear pathology also in children.

The use of ultrasound in determining the length of the Provox II voice prosthesis.

The use of speech prosthesis after total laryngectomy has become an international standard for voice restoration today. Provox II voice prosthesis is not permanently inserted, and as such, it must meet the criterion of achieving prolonged retention time within the walls of tracheo-esophageal fistula (TEF). Complications after the insertion of speech prosthesis are familiar and anticipated but efforts are being made in order to reduce them. Part of the complications is caused by inadequate choice of the length of the prosthesis. The Department of Otorhinolaryngology and Head and Neck Surgery in Rijeka conducted a study which included 91 patients in the period from 01.01.2004. to 31.12.2010. We used ultrasound and computerized neck tomography on 58 (63.7%) patients in preoperative procedure through which we determined the length of the subsequent TE fistula. At the same time we used this opportunity to specify the length of the speech prosthesis we have inserted primarily or secondary. The number of respondents who had complications, and with whom we used neck ultrasound during preoperative procedure in order to determine the length of the prosthesis, was significantly smaller than the number of respondents who had complications but with whom we did not use the above mentioned procedure (5.6% vs. 15.5%, p = 0.042). Comparing our results to other studies, we believe that we managed to reduce the number of complications caused by inadequate length of the prosthesis, by routine preoperative use of neck ultrasound. This procedure has extended the median retention time of the prosthesis within the TE fistula, thus improving the results of speech restoration using voice prosthesis on laryngectomized patients.

The role of videofluoroscopy and ultrasound in assessing pharyngoesophageal muscle tone after laryngectomy.

The aim of this study was to compare the respective value of videofluoroscopy and ultrasound for assessment of the tonicity of the neoglottis and determination of the exact neolaryngeal segment of hypertonicity. We examined twelve patients who had developed inadequate tracheoesophageal voice following total laryngectomy and installation of tracheoesophageal prosthesis. We assumed that the cause of the unsatisfactory voice quality in our patients was neolaryngeal muscle spasm. After determining the exact hypertonic segment, we administered lidocaine intramuscularly and tried to act on the hypertonic segment. By means of videofluoroscopy as gold standard for comparison with ultrasound examination, we followed the passage of contrast through the neo-larynx and watched for dilatation of the segment during swallowing, phonation and at rest to determine whether there were any tonus disturbances or differences before and after lidocaine injection. In conclusion, a combination of the two methods could yield better results in voice restoration. Videofluoroscopy is the method of choice for initial assessment and determination of the hypertonic segment, while ultrasound is the method to apply to facilitate administering the drug more precisely.

Juvenile angiofibroma of the maxillary sinus.

Juvenile angiofibromas are benign fibro-vascular tumours of the nasopharynx that develop in prepubertal and adolescent males. Typical symptoms are longstanding unilateral nasal obstruction occasionally followed by epistaxes and frequent severe intraoperative haemorrhage of the discovered mass. We report the case of a 14-year-old boy histologically diagnosed with a juvenile angiofibroma in spite of the atypical localisation of the polyploid mass of the left maxillary sinus.

The clinical status of the eardrum: an inclusion criterion for the treatment of chronic secretory otitis media in children.

OBJECTIVE: To investigate if the clinical status of the eardrum could be an inclusion criterion for the therapy of chronic secretory otitis media (CSOM). To compare the results of treating CSOM by adenoidectomy and by adenoidectomy in combination with tympanostomy tubes in two groups of patients chosen according to that criterion. METHODS: 161 ears in 87 children were treated for CSOM. An otomicroscopic examination showed there were no pathological changes on the tympanic membrane (signs of adhesive process, malleus rotation, and dangerous attic retractions). The patients were randomly divided into two groups: the first group of 59 ears was treated by myringotomy and tympanostomy tubes and adenoidectomy, while the other group of 102 ears was treated only by adenoidectomy. At least 6 months after the treatment, otomicroscopy and audiological assessments were performed in order to show the resolution of the middle ear effusion (MEE), audiological results and incidence of clinical sequelae of the eardrum. RESULTS: The resolution of MEE by adenoidectomy alone was not significantly different from the results of treatment by adenoidectomy and tympanostomy tubes (z=1.565; p=0.0587). There were no differences in pure tone audiometry between the two methods of treatment. Only at the frequency of 2000 Hz (t=2.173; p=0.031) in treatment with adenoidectomy and tympanostomy tubes the values of air-bone gap (ABG) were lower. Sequelae: scars of the eardrum (chi-square=28.107; ss=1; p<0.001) and attic retractions (chi-square=4.592; ss=1; p=0.032) were more often in treatment with tubes. The incidence of clinical sequelae on the eardrum after treatment by tubes was commented on. CONCLUSION: A criterion that could influence the approach to the therapy of CSOM in children.

Quantitative analysis of nasal vascularization in allergic patients treated with mometasone furoate.

The purpose of this study was to compare vascularization of the nasal mucous membrane among non-allergic, non-treated allergic and allergic patients treated with mometasone furoate, by means of the stereology method in quantitative analysis. Three groups of patients (GP), each containing 10 patients were examined. The first group (GP 1) had a negative inhalatory allergen test while the second (GP 2) and third (GP 3) group both had positive results with the same test. GP 3 included allergic patients treated with mometasone furoate for 15 days before analysis, when a small piece of the nasal mucous membrane was taken from the frontal pole of the lower nasal shell. The specimens were examined immunohistochemically for expression of CD31 and VEGF-C. Vascular phase was determined by using length density (L(v)). Differences in CD31 and VEGF-C expression were compared using one-way ANOVA and Tukey HSD post-hoc tests. CD31 expression in GP 1 had significantly lower values than in the GP 2 and GP 3 groups (p < 0.001). VEGF-C expression in GP 1 was significantly lower than in GP 2 (p = 0.007), but not in GP 3 (p = 0.292). We have shown that 15-day treatment with mometasone furoate results in a significant reduction of the density of vascular elements in allergic patients.

The contribution of electromyography to the diagnostics of some rare palatal anomalies.

The paper presents the electromyographic (EMG) findings of the soft palate in three patients: a patient with Mohr syndrome and cleft palate, a patient with palatal asymmetry and rhinolalia and a patient with vertical oro-ocular facial cleft with marked asymmetry of the cleft palate. In the first patient, electrical silence was registered in one half of the palate. In the second patient, moderate loss of active motor units was registered in the hypoplastic part of the palate. In the third patient, in spite of asymmetry, the EMG finding was normal on both sides of the palate.

Gastroesophageal reflux and sequelae of chronic tubotympanal disorders in children.

OBJECTIVE: To compare sequelae of chronic tubotympanal disorders in children with and without gastroesophageal reflux (GER). MATERIAL AND METHODS: In 32 patients with chronic tubotympanal disorders GER was studied by means of 24-h continuous esophageal pH monitoring. After a period of 2-6 years (mean 4 years) sequelae of the tubotympanal disorders were examined, together with the clinical status of the ears and hearing status. The criteria for classification into mild, moderate and severe sequelae were based on the clinical status of the ear. Hearing was determined using tonal audiograms. Conductive hearing loss was classified as either slight (< or = 35 dB hearing loss in speech frequencies) or severe (>35 dB hearing loss in speech frequencies). RESULTS: In the group of 16 patients (mean age 6.1 years) with GER, sequelae were observed in 29 ears (mild, n=11; moderate, n=5; severe, n=13). Hearing impairment was determined in 20 ears (mild, n=8; severe, n=12). In the group of 16 patients (mean age 7.1 years) without GER, sequelae were observed in 17 ears (mild, n=11; moderate, n=1; severe, n=5). Hearing impairment was determined in 10 ears (mild, n=6; severe, n=4). CONCLUSION: The total number of ears with sequelae and the total number of ears with conductive hearing impairment were significantly higher in patients with GER.

Combined anomalies of the palate in Mohr syndrome: is preoperative electromyography of the palate useful?

The authors present a girl with typical characteristics of oral-facial-digital syndrome type II (Mohr syndrome) with a cleft soft palate and pendulous tongue nodules. Because of feeding difficulties, electromyography was performed of both morphologically identical halves of the soft palate. One half showed a normal muscle action potential and in the other half electrical silence was registered. Exploratory surgery during palatoplasty showed a fatty hamartoma in the half of the palate in which no electric potentials had been registered.

The quantitative analysis of the vascularization following two basic auditory canal skin incisions.

Three groups of nine patients each were analyzed. The first two groups consisted of those that underwent tympanoplastic due to chronic inflammation of middle ear. Two different standard auditory canal skin incisions were applied, i.e. tympanomeatal flap (TMF) or vascular strip (VS). The third control group consisted of non-operated patients. All the operated patients were subjected to a quantitative analysis of the auditory canal revascularization by means of the Weibel stereological test method, i.e. the B 100 double network system. The density of capillaries, arterioles, venulolymphatic spaces and a total volume density of all vascular elements of the auditory canal skin were measured. The obtained results of vascularization were compared with those of the target control group. It was found out that there were no significant differences in vascularization of auditory canal skin between TMF and VS patients from one side and the control group on the other side.