Patterns of Internet and smartphone use by parents of children attending a pediatric otolaryngology service.

OBJECTIVES: To assess Internet use and the influence of smartphones on health-information seeking by parents and carers of children with ENT conditions. METHODS: A paper-based questionnaire was circulated to parents attending otolaryngology services in both the out-patient and day-case settings at a tertiary referral centre. RESULTS: 79.5% of questionnaires were returned. 29.9% had consulted the Internet for ENT-related information. Factors associated with increased rates of ENT-related online activity included younger age, university education, and access to a smartphone (all p ≤ 0.001). 65.7% and 57.7% had found the information which they had found online to be understandable and helpful, respectively; however, just 25.5% felt that it had influenced the medical decisions they had made for their child. 50.3% had previously or intended to discuss information found online with their surgeon. 9.2% had searched online for information regarding their child's surgeon; 19.6% of these said that this had been a factor in choosing that particular surgeon. On ranking 8 information sources in terms of importance (scale 0-5), the ENT Surgeon ranked as most important (mean=4.63), whilst the Internet ranked lowest (3.10). 48.6% of respondents or their partners had an Internet-enabled smartphone; 45.2% said they would definitely use an iPhone app regarding their child's condition if one was available. 36.1% reported they would definitely use the Internet in the future. CONCLUSIONS: Whilst online sources must increasingly be considered in the dialogue with parents, it is clear that parents still rate the clinical team as most important for information gathering. Clinician-provided websites and smartphone applications may be the key to ensuring the provision of quality information into the future.

Primary hyperparathyroidism in a patient with familial hypocalciuric hypercalcaemia due to a novel mutation in the calcium-sensing receptor gene.

We describe the clinical and genetic findings in pedigree with a novel mutation in the calcium sensing receptor (CaSR) gene and the unusual coexistence of primary hyperparathyroidism (HPT) and familial hypocalciuric hypercalcaemia (FHH) and its clinical management. The occurrence of both FHH and primary HPT in the same patient has been described rarely. Our pedigree has a novel mutation in the CaSR gene. Parathyroidectomy led to a reduction, but not normalization of the calcium levels in the patient identified as having HPT. The coexistence of HPT and FHH was considered in this patient as her calcium and PTH levels were rising with time. Surgical resection of her parathyroid adenoma resulted in reduction of her calcium levels to above normal and significant reduction in her symptoms of fatigue and low mood.

The effectiveness of a voice treatment approach for teachers with self-reported voice problems.

SUMMARY: Teachers are considered the professional group most at risk of developing voice-problems, but limited treatment effectiveness evidence exists. We studied prospectively the effectiveness of a 6-week combined treatment approach using vocal function exercises (VFEs) and vocal hygiene (VH) education with 20 teachers with self-reported voice problems. Twenty subjects were randomly assigned to a no-treatment control (n = 11) and a treatment group (n = 9). Fibreoptic endoscopic evaluation was carried out on all subjects before randomization. Two self-report voice outcome measures were used: the Voice-Related Quality of Life (VRQOL) and the Voice Symptom Severity Scale (VoiSS). A Voice Care Knowledge Visual Analogue Scale (VAS), developed specifically for the study, was also used to evaluate change in selected voice knowledge areas. A Student unpaired t test revealed a statistically significant (P < 0.05) improvement in the treatment group as measured by the VoiSS. There was not a significant improvement in the treatment group as measured by the V-RQOL. The difference in voice care knowledge areas was also significant for the treatment group (P < 0.05). This study suggests that a voice treatment approach of VFEs and VH education improved self-reported voice symptoms and voice care knowledge in a group of teachers.

Detection of bone marrow micrometastases in the rib marrow of head and neck cancer patients: a prospective pilot study.

Flow cytometry has been validated as an objective method of demonstrating and quantifying micrometastases. Micrometastases within bone marrow indicate a poor prognosis in patients with upper gastrointestinal, colorectal and breast epithelial tumours. We prospectively sought to assess the feasibility of testing rib marrow for bone marrow micrometastases in head and neck cancer and to report their frequency in a cohort of patients. Nine patients were enrolled in the study. Bone marrow was obtained before manipulation of the primary tumour. Micrometastatic cells were detected by staining contaminant cytokeratin-18 positive cells and using the twin techniques of immuncytochemistry and flow cytometry. Cellular marrow was retrieved in 100% of cases. Micrometastases were detected in one out of nine epithelial tumours on both flow cytometry and immunocytochemistry. The detection rate appeared to be independent of TN staging. We were unable to culture the cells. Preoperative detection of bone marrow micrometastases may reflect transient shedding of cells, metastatic potential or residual disease. This prospective study confirms the feasibility of using rib marrow in future studies investigating micrometastases in head and neck cancer.

Predictors of survival in early oral cancer.

OBJECTIVE: Despite the substantial rate of neck conversion reported among patients with early oral cancer, a policy of routine elective neck dissection has been criticized on the grounds that it confers little survival advantage while subjecting many to potentially avoidable morbidity. However, the identification of factors predictive of survival may allow for the identification of those patients who are more likely to benefit from elective neck treatment. STUDY DESIGN AND SETTING: The clinical and histologic material of 71 patients with stage I or II squamous carcinoma of the oral cavity were reviewed. Patients were followed up for a minimum of 3 years after their surgery, and the impact of these variables on 3-year survival was assessed. RESULTS: Increased tumor thickness was significantly predictive of decreased survival (P = 0.030). Although having no prognostic value alone, when combined with thickness, both pattern of invasion and gender increased the significance of the latter in predicting outcome. Conclusion and significance Measuring tumor thickness and pattern of invasion in patients with early oral cancer may allow for the identification of those patients with more aggressive disease who are more likely to benefit from elective neck treatment.