Injection laryngoplasty during transoral laser microsurgery for early glottic cancer: a randomized controlled trial.

BACKGROUND: Transoral laser microsurgery is widely used for treating T1/T2 glottic cancers. Hyaluronic acid (HA) is commonly used in vocal cord augmentation. We investigated the impact of intra-operative injection laryngoplasty on voice outcomes in early glottic cancer. METHODS: Twenty patients were randomized to the treatment group receiving HA injection to the vocal cord contralateral to the lesion; or the control group, receiving no injection. Patients had a Voice Handicap Index-10 (VHI-10) questionnaire and a Maximum Phonation Time (MPT) measurement preoperatively and at 3, 12 and 24 months post-operatively. Mean change in VHI-10 and MPT, compared to baseline and between time points, were compared. Survival estimates were calculated. RESULTS: Mean VHI-10 scores improved over time amongst all patients. There were no changes in mean VHI-10 from pre-operative values to 3, 12 or 24 months post-operatively. There were no significant differences when comparing various timepoints between groups. There were no significant changes in MPT amongst the groups, or the time-points compared. Two-year overall survival was 91.7%; disease free survival was 80.9%; no difference in recurrence free survival was seen between the groups. CONCLUSION: Subjective voice scores improved over time in both groups; there were no improvements in VHI-10 or MPT scores in the injection group, over control, at any time points. We saw no significant impact for intra-operative HA injection laryngoplasty on subjective or objective voice outcomes following surgery for early glottic cancers.

Laryngology in Canada: results of a national survey.

OBJECTIVE: Laryngology is a rapidly evolving and growing field in Canada. Recent technologies and trends, including endoscopic techniques, KTP and pulsed dye lasers, injection materials, and in-office procedures, are changing the nature and depth of services offered to patients. Our objective was to understand the current state of laryngology practice in Canada. DESIGN: Survey. SETTING: Adult laryngology practices in Canada. METHODS: We identified otolaryngologists working in Canada who self-identified as having a significant laryngology practice. We then asked them to complete an anonymous survey, with questions regarding composition of practice time, endoscopic equipment, electromyography, vocal cord medialization techniques, laser technologies, and plans for the future. MAIN OUTCOME MEASURES: Practice composition and use rates of available technology. RESULTS: Ten of 11 respondents reported that laryngology represents at least 20% of their practice (mean  =  53%). All employed rigid laryngoscopy, stroboscopy, and exclusively CO2 laser. Six used distal chip endoscopes, whereas three perform transnasal esophagoscopy. CONCLUSIONS: The survey results demonstrate that laryngology practice in Canada is approaching state of the art and that most laryngologists plan to increase the breadth and scope of their practice as newer technologies become available. Limited funding and national regulations limit the adoption of some cutting-edge techniques.

Survey of nasopharyngoscope decontamination methods in Canada.

BACKGROUND: nasopharyngoscopes are essential tools in modern otolaryngology practice. Owing to their frequent and diverse use, it is important to ensure that they can be efficiently and thoroughly cleaned. To date, there are no official national guidelines provided by the Canadian Society of Otolaryngology-Head and Neck Surgery (CSOHNS) for decontamination of nasopharyngoscopes. OBJECTIVE: to compare flexible nasopharyngoscope decontamination practices across Canada. METHODS: a questionnaire regarding nasopharyngoscope cleaning procedures was distributed online to all otolaryngologists registered with the CSOHNS. The survey was anonymous. Topics addressed province, practice type, maintenance, operations, ventilation, and process development. RESULTS: thirty-five percent of the 505 Canadian otolaryngologists contacted participated in the survey. Automated sterilization of nasopharyngoscopes is employed by 16% of participants, of which the majority of this use is in hospital settings. Over 61.3% of participants use a multistep decontaminating soak for cleaning. Decontamination procedures were created within the department in 59% of cases, and over 28.3% of participants are unsure as to whether their procedures adhere to infectious disease and industry standards. CONCLUSION: various procedures are employed throughout Canada owing to a lack of standardization. Survey responses indicate that Canadian otolaryngologists would appreciate a national standard for the cleaning of flexible nasopharyngoscopes, particularly for nonhospital practices.

Informed consent in otologic surgery: prospective study of risk recall by patients and impact of written summaries of risk.

OBJECTIVES: To evaluate how much patients remember of the risks discussed with them about their otologic surgery and to evaluate whether a simple intervention, the addition of an information handout, improves recall. STUDY DESIGN: A prospective, randomized trial was undertaken in the setting of an academic tertiary care centre. METHODS: Fifty patients undergoing a variety of otologic procedures, including mastoidectomy, tympanoplasty, ossiculoplasty, and stapedectomy, were verbally consented by the operating surgeon with a standard checklist of potential surgical complications and side effects. Two surgeons participated in the study (40 patients and 10 patients). Patients were stratified into two groups: a higher education group and a lower education group. Within each group, patients were randomized to either a control group, consisting of a verbal explanation only, or an intervention group, which added a written handout to the verbal explanation. A follow-up telephone interview was conducted at an average of 20.6 days (range 14-53) to survey for recall of the complications discussed. MAIN OUTCOME MEASURES: The main outcome measure is risk recall. This is analyzed by education level and written sheet intervention. Other parameters examined are patient demographics, time elapsed from when the consent was obtained, and surgeon obtaining the consent. RESULTS: All 50 patients were interviewed in follow-up. Twenty-two patients received the handout (intervention arm), and 28 patients served as the control group. Overall recall, expressed as a percentage of risks explained, was 54% for the entire study group. For those who received the handout, the recall rate was 51%, whereas the rate was actually higher, at 56%, for those who did not receive the handout. This difference was not statistically significant. Of the specific risks discussed, patient recall was consistently high for the complications of facial nerve paralysis, 88%, and for complete hearing loss, at 88%. Other risks, such as dizziness, 31%, and change in taste, 36%, were not as commonly recalled. Receiving the handout made only a significant difference with one complication, facial nerve paralysis. CONCLUSION: The addition of a handout did not significantly alter recall of potential complications of otologic surgery with the exception of facial nerve paralysis.