Novel ENT live telehealth and live video-otoscopy clinics in remote Australia: outcomes and comparisons to traditional clinic models.

BACKGROUND: Coronavirus disease 2019 challenged the delivery of healthcare in Australia, disproportionately impacting vulnerable patients, including Aboriginal and/or Torres Strait Islander peoples and those living in remote regions. The otolaryngology service provided to remote Western Australia adapted to these barriers by altering clinical consultations to a digital model. METHODS: A review was undertaken of patients in regional Western Australia. Demographics and clinical outcomes from 20 live telehealth clinics were retrospectively reviewed and compared to 16 face-to-face clinics. RESULTS: The demographics of patients reviewed in both live telehealth and face-to-face clinics were similar, except for a larger proportion of Aboriginal and/or Torres Strait Islander patients utilising telehealth. The outcomes of patients reviewed through each model of care were comparable. Live video-otoscopy provided diagnostic quality images in 92 per cent of cases. CONCLUSION: The findings of our review suggest that, despite its limitations, a large proportion of ENT patients may be safely assessed through a live telehealth model.

Survival and prognosis of surgical head and neck cancer patients aged 80 years and older.

Introduction: Elderly patients (≥80 years of age) with head and neck cancer (HNC) can prove a management challenge due to concerns regarding their suitability for surgery. This study aims to describe the characteristics and outcomes of elderly patients undergoing HNC surgery. Methods: A retrospective review of elderly patients undergoing HNC surgery was conducted. Demographics, comorbidities, tumor characteristics, surgical procedure type, postoperative complications, and disposition were reviewed. Overall survival (OS) in the elderly cohort was compared against younger patients (<80 years). Results: A total of 595 patients were included, of whom 86 were aged >80 years (71% male; mean age 84.8, range 80.0-98.8 years). The overall complication rate was 43%. When compared with younger patients (n = 509), elderly patients had reduced OS (risk ratio: 2.0, 95% CI: 1.3-3.2), higher 90-day mortality (8.1% vs. 2.3%, p = .005), and lower 5-year survival (43.5% vs. 64.1%, p < .001). However, survival was comparable to age-specific life expectancy. There was no difference in OS, 90-day mortality, and 5-year survival when comparing >85 (n = 33) and 80-85 (n = 53) age groups. Conclusions: Chronological age alone should not negatively influence decision-making in HNC surgery the elderly. With careful preoperative selection and optimization, surgery can be performed at acceptable risk with good outcomes in elderly patients. Level of evidence: IV.

Improvement in lung function following medialisation thyroplasty in a postbilateral lung transplant patient.

A 59-year-old man underwent external medialisation thyroplasty for his left unilateral vocal cord paralysis (UVCP) secondary to recent thoracic surgery. The patient had undergone bilateral lung transplant for idiopathic pulmonary fibrosis and was referred to the ear, nose and throat surgical team with new-onset voice hoarseness. Examination confirmed left UVCP, and after failing conservative management a decision was made to perform external medialisation thyroplasty. Following an uneventful procedure, the patient's phonation returned to normal, and remarkably on spirometry there was evidence of significant improvement in lung function. Despite case series demonstrating subjective improvement in respiration, this is the first documented case, to our knowledge, of significant improvement in spirometry following this procedure.

Performance of an automated, remote system to detect vocal fold paralysis.

OBJECTIVES: The aim of this project was to evaluate the diagnostic accuracy of an automated, remote system for correctly identifying vocal fold paralysis. METHODS: Consecutive patients presenting for vocal analysis at the Beaumont Hospital Voice Clinic were enrolled in this prospective, blinded study. Control patients were enlisted from routine otolaryngology clinics. All patients were assessed by standard history, clinical examination, and flexible laryngoscopy or videostroboscopy. The subjects were blindly assessed by remote voice analysis. Sustained phonation was recorded over a standard telephone network. Each recording was subjected to automated, remote analysis of extracted features, including measures of pitch perturbation, amplitude perturbation, and harmonics-to-noise ratio. The presence or absence of a vocal fold paralysis as determined by the automated classifier was recorded and correlated with clinical findings. RESULTS: Seventy-eight consecutive patients were enrolled in the study. The automated speech analysis system demonstrated 92% sensitivity and 75% specificity for detecting vocal fold paralysis. CONCLUSIONS: This pilot study, assessing an automated system that analyzes audiological data remotely over the standard telephone network, suggests that with further "training" it may become a reliable, simple, and convenient means for screening patients for voice disorders.

Analysis of the saliva proteome from patients with head and neck squamous cell carcinoma reveals differences in abundance levels of proteins associated with tumour progression and metastasis.

The objective of this study was to identify differentially expressed proteins in saliva from HNSCC patients compared to a control group. Saliva samples from eight individuals with non-malignant conditions of the head and neck region were employed as a control group and compared to saliva from eight patients with HNSCC using 2D DIGE analysis and subsequent mass spectrometry identification of candidate proteins. Beta fibrin (+2.77-fold), S100 calcium binding protein (+5.35-fold), transferrin (+3.37-fold), immunoglobulin heavy chain constant region gamma (+3.28) and cofilin-1 (+6.42) were all found to be significantly increased in the saliva from HNSCC samples compared to the control group whereas transthyretin (-2.92-fold) was significantly decreased. The increased abundance of one of the proteins identified (S100 calcium binding protein) was confirmed by immunoblot analysis. Many of these proteins are involved in tumour progression, metastasis and angiogenesis. The proximity of saliva to the developing tumour is undoubtedly a major factor in facilitating detection of these proteins and such a strategy may lead to the development of a panel of biomarkers useful for therapeutic monitoring and for early detection of HNSCC.