Heat shock protein-mediated protection against Cisplatin-induced hair cell death.

Cisplatin is a highly successful and widely used chemotherapy for the treatment of various solid malignancies in both adult and pediatric patients. Side effects of cisplatin treatment include nephrotoxicity and ototoxicity. Cisplatin ototoxicity results from damage to and death of cells in the inner ear, including sensory hair cells. We showed previously that heat shock inhibits cisplatin-induced hair cell death in whole-organ cultures of utricles from adult mice. Since heat shock protein 70 (HSP70) is the most upregulated HSP in response to heat shock, we investigated the role of HSP70 as a potential protectant against cisplatin-induced hair cell death. Our data using utricles from HSP70 (-/-) mice indicate that HSP70 is necessary for the protective effect of heat shock against cisplatin-induced hair cell death. In addition, constitutive expression of inducible HSP70 offered modest protection against cisplatin-induced hair cell death. We also examined a second heat-inducible protein, heme oxygenase-1 (HO-1, also called HSP32). HO-1 is an enzyme responsible for the catabolism of free heme. We previously showed that induction of HO-1 using cobalt protoporphyrin IX (CoPPIX) inhibits aminoglycoside-induced hair cell death. Here, we show that HO-1 also offers significant protection against cisplatin-induced hair cell death. HO-1 induction occurred primarily in resident macrophages, with no detectable expression in hair cells or supporting cells. Depletion of macrophages from utricles abolished the protective effect of HO-1 induction. Together, our data indicate that HSP induction protects against cisplatin-induced hair cell death, and they suggest that resident macrophages mediate the protective effect of HO-1 induction.

Inner ear supporting cells protect hair cells by secreting HSP70.

Mechanosensory hair cells are the receptor cells of hearing and balance. Hair cells are sensitive to death from exposure to therapeutic drugs with ototoxic side effects, including aminoglycoside antibiotics and cisplatin. We recently showed that the induction of heat shock protein 70 (HSP70) inhibits ototoxic drug-induced hair cell death. Here, we examined the mechanisms underlying the protective effect of HSP70. In response to heat shock, HSP70 was induced in glia-like supporting cells but not in hair cells. Adenovirus-mediated infection of supporting cells with Hsp70 inhibited hair cell death. Coculture with heat-shocked utricles protected nonheat-shocked utricles against hair cell death. When heat-shocked utricles from Hsp70-/- mice were used in cocultures, protection was abolished in both the heat-shocked utricles and the nonheat-shocked utricles. HSP70 was detected by ELISA in the media surrounding heat-shocked utricles, and depletion of HSP70 from the media abolished the protective effect of heat shock, suggesting that HSP70 is secreted by supporting cells. Together our data indicate that supporting cells mediate the protective effect of HSP70 against hair cell death, and they suggest a major role for supporting cells in determining the fate of hair cells exposed to stress.

Classifying human audiometric phenotypes of age-related hearing loss from animal models.

Age-related hearing loss (presbyacusis) has a complex etiology. Results from animal models detailing the effects of specific cochlear injuries on audiometric profiles may be used to understand the mechanisms underlying hearing loss in older humans and predict cochlear pathologies associated with certain audiometric configurations ("audiometric phenotypes"). Patterns of hearing loss associated with cochlear pathology in animal models were used to define schematic boundaries of human audiograms. Pathologies included evidence for metabolic, sensory, and a mixed metabolic + sensory phenotype; an older normal phenotype without threshold elevation was also defined. Audiograms from a large sample of older adults were then searched by a human expert for "exemplars" (best examples) of these phenotypes, without knowledge of the human subject demographic information. Mean thresholds and slopes of higher frequency thresholds of the audiograms assigned to the four phenotypes were consistent with the predefined schematic boundaries and differed significantly from each other. Significant differences in age, gender, and noise exposure history provided external validity for the four phenotypes. Three supervised machine learning classifiers were then used to assess reliability of the exemplar training set to estimate the probability that newly obtained audiograms exhibited one of the four phenotypes. These procedures classified the exemplars with a high degree of accuracy; classifications of the remaining cases were consistent with the exemplars with respect to average thresholds and demographic information. These results suggest that animal models of age-related hearing loss can be used to predict human cochlear pathology by classifying audiograms into phenotypic classifications that reflect probable etiologies for hearing loss in older humans.

Role of stromal cell-derived factor-1 expression in the injured mouse auditory nerve.

OBJECTIVE: The degeneration of hair cells and spiral ganglion neurons (SGNs) is an important pathologic process in the development of sensorineural hearing loss. In a murine model, predictable and reproducible damage to SGNs occurs through the application of ouabain to the round window. Recent evidence has shown that the chemokine stromal cell-derived factor-1 (SDF-1) is a potent chemoattractant of hematopoietic stem cells (HSCs) and provides trophic support to injured tissues during development and maturation. The hypothesis for the current study is that expression of SDF-1 plays an important role in protecting SGNs and preventing further degeneration in the setting of cochlear injury. STUDY DESIGN: Prospective, controlled. SETTING: Academic research laboratory. SUBJECT AND METHODS: Auditory brainstem response (ABR) and the expression of SDF-1 mRNA and protein were examined 1, 3, 7, 14, and 30 days after application of ouabain in 35 adult mice. RESULTS: Following ouabain application, real-time reverse-transcription polymerase chain reaction for SDF demonstrates increased mRNA expression following ouabain injury in nontransplanted mice. A significant increase in SDF protein expression was also observed using immunolabeling techniques and Western blot analysis. CONCLUSIONS: SDF-1 expression is increased in the auditory nerve following cochlear injury. Further knowledge about the cochlear microenvironment, including SDF-1, is critical to maximizing HSC engraftment in the injured cochlea and providing a therapeutic option for sensorineural hearing loss.

Middle ear dimensions in congenital aural atresia and hearing outcomes after atresiaplasty.

OBJECTIVE: To determine if middle ear dimensions in congenital aural atresia (CAA) patients can predict early postoperative audiometric outcomes in order to establish specific parameters that facilitate stratification of surgical candidates. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: Twenty-five patients with CAA (28 atretic ears and 22 nonatretic ears) and 12 controls (24 ears). INTERVENTION: Primary repair of congenital aural atresia. MAIN OUTCOME MEASURES: Measure and compare middle ear dimensions in controls, atretic ears, and nonatretic ears in unilateral CAA. Determine correlations between the dimensions and best speech reception threshold during the first postoperative year (SRT-1). RESULTS: The epitympanic depth, medial canal diameter, and the mesotympanic height, area, and estimated volume measurements in atretic ears differ significantly with those in control ears. The mesotympanic length, area, and estimated volume measurements each correlate significantly with SRT-1. Atretic ears with a mesotympanic volume estimate measurement greater than or equal to 42 mm3 are 24 times more likely to have an SRT-1 of 25 dB or better than those measuring less than 42 mm3 (odds ratio = 24.5; 95% confidence interval, 2.826-212.4; Fisher's exact test, p = 0.0022). CONCLUSION: Middle ear measurements in appropriately selected patients may help predict successful early hearing outcomes after atresiaplasty, thus offering a valuable tool for the surgical decision-making process.

Randomized controlled trial of hyaluronic acid/carboxymethylcellulose dressing after endoscopic sinus surgery.

OBJECTIVE: To determine if a hyaluronic acid/carboxymethylcellulose (HA/CMC) sinus dressing reduces the rate of postoperative scarring. METHODS: In a randomized, matched-controlled, single-blinded study, following the completion of surgery, an HA/CMC dressing was randomly assigned to one side with the opposite unpacked side serving as a control. RESULTS: Fifty-three patients underwent surgery for chronic rhinosinusitis (CRS; 39 patients) or CRS with nasal polyposis (14 patients). At the 8-week follow-up, there was no difference in synechiae on the HA/CMC side compared to the control (p = 0.09). HA/CMC-treated sinuses, however, demonstrated fewer synechiae in the first 2 weeks postoperatively compared to the control (p = 0.01), and were associated with significantly less nasal congestion at the 4-week (p = 0.02) and 8-week follow-up visits (0.03). CONCLUSION: There was no long-term difference in the rate of synechiae in the HA/CMC-treated sinus compared to the control. However, less severe nasal congestion and synechiae in the initial postoperative period may reduce the need for aggressive sinus debridement.

Hsp70 inhibits aminoglycoside-induced hearing loss and cochlear hair cell death.

Sensory hair cells of the inner ear are sensitive to death from aging, noise trauma, and ototoxic drugs. Ototoxic drugs include the aminoglycoside antibiotics and the antineoplastic agent cisplatin. Exposure to aminoglycosides results in hair cell death that is mediated by specific apoptotic proteins, including c-Jun N-terminal kinase (JNK) and caspases. Induction of heat shock proteins (Hsps) can inhibit JNK- and caspase-dependent apoptosis in a variety of systems. We have previously shown that heat shock results in robust upregulation of Hsps in the hair cells of the adult mouse utricle in vitro. In addition, heat shock results in significant inhibition of both cisplatin- and aminoglycoside-induced hair cell death. In this system, Hsp70 is the most strongly induced Hsp, which is upregulated over 250-fold at the level of mRNA 2 h after heat shock. Hsp70 overexpression inhibits aminoglycoside-induced hair cell death in vitro. In this study, we utilized Hsp70-overexpressing mice to determine whether Hsp70 is protective in vivo. Both Hsp70-overexpressing mice and their wild-type littermates were treated with systemic kanamycin (700 mg/kg body weight) twice daily for 14 days. While kanamycin treatment resulted in significant hearing loss and hair cell death in wild-type mice, Hsp70-overexpressing mice were significantly protected against aminoglycoside-induced hearing loss and hair cell death. These data indicate that Hsp70 is protective against aminoglycoside-induced ototoxicity in vivo.

Titanium versus nontitanium prostheses in ossiculoplasty.

OBJECTIVES/HYPOTHESIS: To compare the hearing outcomes and complications observed using either titanium or nontitanium prostheses in a 7-year consecutive series of ossiculoplasties performed by a single surgeon. STUDY DESIGN: Retrospective. METHODS: : A database of ossicular reconstruction surgeries was reviewed for preoperative and postoperative audiometric data including air and bone conduction thresholds at four frequencies and speech reception thresholds. Outcomes were evaluated at time points less than and greater than 6 months postoperatively. Baseline demographic and surgical characteristics and postoperative complications were also noted. RESULTS: A total of 105 cases had sufficient audiometric data available for analysis, including 80 performed with titanium and 25 with nontitanium implants. Follow-up ranged from 1.2 to 74.2 months, with a mean of 14.9 months. Mean air-bone gap at initial follow-up was 21.7 dB in the nontitanium group and 15.4 dB in the titanium group; this difference was significant (P = .01). Postoperative air-bone gap of less than 20 dB at initial follow-up was achieved in 50.0% of nontitanium cases and 77.1% of titanium cases (P = .012). This difference in "success" rates persisted at longer follow-up but did not achieve statistical significance. Mean speech reception thresholds at <6 months was 29.7 dB in the nontitanium group and 22.6 dB in the titanium group (P = .049). Extrusion was observed with two nontitanium prostheses (8.0%) and three titanium prostheses (3.8%) (P > .05). CONCLUSIONS: Titanium ossicular prostheses provide hearing outcomes superior to those of nontitanium prostheses when evaluated within 6 months after ossiculoplasty.

Clinical course following endoscopic repair of type 1 laryngeal clefts.

OBJECTIVES: Treatment of type I laryngeal clefts (T1LCs) remains controversial. We present our experience with 16 endoscopic T1LC repairs to evaluate the effect of patient characteristics and surgical technique on outcomes. METHODS: A retrospective study was performed. Diagnosis of T1LC was made by interarytenoid palpation during operative microlaryngoscopy. Two surgeons performed endoscopic repair using either microflap reconstruction or laser demucosalization and reapproximation. All patients received preoperative and postoperative modified barium swallow (MBS) studies. Improved MBS at 3-5 months determined success of repair. Factors contributing to success of repair were analyzed statistically. RESULTS: No intraoperative complications occurred. One T1LC repair dehisced after 3 months. Overall, 11 of 16 repairs (68.8%) were successful. Mean age at repair was 23.3 months. Length of stay for microflap repair was significantly shorter than for laser reapproximation (0.89 days vs. 4.6 days, p<0.001, two-tail t-test). The difference in patient age between failures and successes (21.3 months vs. 24.2 months) was non-significant (p=0.661, two-tail t-test). Success for the nine patients receiving microflap reconstruction (77.8%) vs. the seven receiving laser reapproximation (57.1%) is comparable (p=0.596, Fisher's exact test). No correlation between comorbidities and failure was found (p>0.05, Fisher's exact test). CONCLUSIONS: This series matches the largest reported series of endoscopic T1LC repairs. Success rates were lower than in previously reported studies, and comorbidities were higher. However, comorbidities did not contribute to surgical failure. No difference in outcome was seen between the two endoscopic techniques. Microflap repair may require a shorter hospital stay.

Hsp70 inhibits aminoglycoside-induced hair cell death and is necessary for the protective effect of heat shock.

Sensory hair cells of the inner ear are sensitive to death from aging, noise trauma, and ototoxic drugs. Ototoxic drugs include the aminoglycoside antibiotics and the antineoplastic agent cisplatin. Exposure to aminoglycosides results in hair cell death that is mediated by specific apoptotic proteins, including c-Jun N-terminal kinase (JNK) and caspases. Induction of heat shock proteins (Hsps) is a highly conserved stress response that can inhibit JNK- and caspase-dependent apoptosis in a variety of systems. We have previously shown that heat shock results in a robust upregulation of Hsps in the hair cells of the adult mouse utricle in vitro. In addition, heat shock results in significant inhibition of both cisplatin- and aminoglycoside-induced hair cell death. In our system, Hsp70 is the most strongly induced Hsp, which is upregulated over 250-fold at the level of mRNA 2 h after heat shock. Therefore, we have begun to examine the role of Hsp70 in mediating the protective effect of heat shock. To determine whether Hsp70 is necessary for the protective effect of heat shock against aminoglycoside-induced hair cell death, we utilized utricles from Hsp70.1/3 (-/-) mice. While heat shock inhibited gentamicin-induced hair cell death in wild-type utricles, utricles from Hsp70.1/3 (-/-) mice were not protected. In addition, we have examined the role of the major heat shock transcription factor, Hsf1, in mediating the protective effect of heat shock. Utricles from Hsf1 (-/-) mice and wild-type littermates were exposed to heat shock followed by gentamicin. The protective effect of heat shock on aminoglycoside-induced hair cell death was only observed in wild-type mice and not in Hsf1 (-/-) mice. To determine whether Hsp70 is sufficient to protect hair cells, we have utilized transgenic mice that constitutively overexpress Hsp70. Utricles from Hsp70-overexpressing mice and wild-type littermates were cultured in the presence of varying neomycin concentrations for 24 h. The Hsp70-overexpressing utricles were significantly protected against neomycin-induced hair cell death at moderate to high doses of neomycin. This protective effect was achieved without a heat shock. Taken together, these data indicate that Hsp70 and Hsf1 are each necessary for the protective effect of heat shock against aminoglycoside-induced death. Furthermore, overexpression of Hsp70 alone significantly inhibits aminoglycoside-induced hair cell death.

Longitudinal changes in speech recognition in older persons.

Recognition of isolated monosyllabic words in quiet and recognition of key words in low- and high-context sentences in babble were measured in a large sample of older persons enrolled in a longitudinal study of age-related hearing loss. Repeated measures were obtained yearly or every 2 to 3 years. To control for concurrent changes in pure-tone thresholds and speech levels, speech-recognition scores were adjusted using an importance-weighted speech-audibility metric (AI). Linear-regression slope estimated the rate of change in adjusted speech-recognition scores. Recognition of words in quiet declined significantly faster with age than predicted by declines in speech audibility. As subjects aged, observed scores deviated increasingly from AI-predicted scores, but this effect did not accelerate with age. Rate of decline in word recognition was significantly faster for females than males and for females with high serum progesterone levels, whereas noise history had no effect. Rate of decline did not accelerate with age but increased with degree of hearing loss, suggesting that with more severe injury to the auditory system, impairments to auditory function other than reduced audibility resulted in faster declines in word recognition as subjects aged. Recognition of key words in low- and high-context sentences in babble did not decline significantly with age.

Delayed initiation of the pharyngeal swallow: normal variability in adult swallows.

PURPOSE: The purpose of this investigation was to determine bolus head timing and location relations with the onset of hyoid movement at the initiation of the pharyngeal swallow and at the onset of swallow-related apnea. METHOD: Bolus head timing and location and the timing of swallow-related apnea were recorded from frame-by-frame analyses of 5-ml single liquid swallows using dual-modality videofluoroscopy and nasal airflow recordings in 82 consecutive, healthy volunteers. The presence, depth, and response to airway entry were also recorded and related to the bolus head location and the onset of hyoid movement. RESULTS: The majority of participants-80% on at least 1 trial-produced the onset of hyoid movement at pharyngeal swallow initiation after the bolus head passed the posterior angle of the mandible. There was a trend in older participants for later onset of hyoid movement and onset of apnea relative to bolus head arrival at the posterior angle of the mandible. CONCLUSION: Although entry of the bolus head into the pharynx prior to hyoid movement may result in a threat to the laryngeal airway, these data demonstrate that a "delay" by itself cannot be assumed to indicate a disordered swallow without coexisting impairments of swallowing physiology.

Head and neck cancer recurrence and mortality in nonselective cyclooxygenase inhibitor users.

OBJECTIVE: To determine whether ongoing use of a cyclooxygenase (COX) inhibitor is associated with a reduction in mortality and disease recurrence after head and neck cancer treatment. DESIGN: Retrospective case-control study. Patients A total of 325 potential subjects with head and neck squamous cell carcinoma were identified using an electronic patient database. Main Outcome Measure The rate of COX inhibitor use among patients who had died or whose disease had recurred (cases) was compared with the rate of use among survivors or those without recurrence (controls). The comparison was controlled for tumor site, tumor stage, treatment received, age, sex, race, smoking, and alcohol use. RESULTS: The 325 patients were compared by logistic regressions, with recurrence rate and survival status as the dependent variables. There was no difference in COX inhibitor exposure between patients with recurrence and those with no recurrence (P = .42) or between survivors and those who died of disease (P = .66). The median survival of COX inhibitor users, however, was 96 months, compared with 47 months in nonusers. The only independent variable with a significant impact on recurrence and survival was tumor stage at the time of diagnosis. CONCLUSIONS: Although preliminary in vitro studies suggest an antitumor effect of COX inhibitors in head and neck cancer, this study found no difference in head and neck cancer recurrence or survival in nonselective COX inhibitor users vs nonusers. A randomized, double-blinded controlled trial is needed to determine if COX inhibitors are an effective chemopreventive therapy in patients with head and neck cancer.

Incidence of skull base and orbital erosion in allergic fungal rhinosinusitis (AFRS) and non-AFRS.

OBJECTIVE: To compare the incidence of bony erosion associated with allergic fungal rhinosinusitis (AFRS) with the incidence of bony erosion seen in other types of inflammatory sinusitis. STUDY DESIGN: Retrospective review. RESULTS: AFRS was diagnosed in 27 patients, and 15/27 (56%) had bony skull base or orbital erosion. Non-AFRS chronic sinusitis required surgery in 158 patients, but only 8 (5%) had bony skull base or orbital erosion (P < 0.01). AFRS patients were 12.6 times (P < 0.01) more likely to have bony erosion than non-AFRS patients. African American males were 15.0 times (P < 0.01) more likely to have bony erosion than whites and African American females combined. CONCLUSION: Bony erosion with intracranial and intraorbital extension is much more common in AFRS than all other types of inflammatory sinusitis combined. African American males have a higher incidence of AFRS, as well as intracranial and intraorbital extension. EBM RATING: C-4.

Laryngeal penetration and aspiration during swallowing after the treatment of advanced oropharyngeal cancer.

OBJECTIVE: To determine whether laryngeal penetration and aspiration in oropharyngeal cancer survivors differ by treatment group. DESIGN: Cross-sectional study of patients with stage III or IV oropharyngeal squamous cell carcinoma who were at least 12 months removed from combined modality therapy and clinically free of disease. SUBJECTS: Potential subjects were stratified by tumor site and tumor T stage to achieve a similar comparison between chemoradiotherapy (n = 10) and surgery/radiotherapy (n = 11) groups. Validated instruments used to evaluate swallowing included the Penetration-Aspiration Scale and the M. D. Anderson Dysphagia Inventory. RESULTS: Patients with oropharyngeal cancer treated with chemoradiotherapy demonstrated greater airway protection according to Penetration-Aspiration Scale scores than those treated with surgery and radiotherapy on 5-mL (P = .02), 10-mL (P = .04), and 20-mL (P = .04) liquid barium swallows. Also, the oropharyngeal chemoradiotherapy group had better self-perceived swallowing ability than the surgery-radiotherapy group on the basis of the M. D. Anderson Dysphagia Inventory (P = .02). CONCLUSION: The present study suggests that patients with oropharyngeal cancer who successfully complete chemoradiotherapy protocols without surgical salvage retain greater airway protection during swallowing and better swallowing-related quality of life than patients treated with primary surgery and radiotherapy.

Longitudinal study of pure-tone thresholds in older persons.

OBJECTIVE: Pure-tone thresholds for conventional and extended high frequencies were analyzed for 188 older adult human subjects (91 females, 97 males). The objectives were to study longitudinal changes in thresholds as well as the effects of initial threshold levels, age, gender, and noise history on these longitudinal changes. DESIGN: At the time of entry into the study, subjects' ages ranged from 60 to 81 years, with a mean age of 68 years. Subjects had between 2 and 21 visits (mean = 9.81 visits) over a period of 3 to 11.5 years (mean = 6.40 years). Conventional pure-tone thresholds at 0.25 to 8 kHz were measured during most visits. Extended high-frequency (EHF) thresholds at 9 to 18 kHz were measured every 2 to 3 years. The slope of a linear regression was used to estimate the rate of change in pure-tone thresholds at 0.25 to 18 kHz for each ear. A questionnaire was used to identify those subjects with a positive noise history. RESULTS: The average rate of change in thresholds was 0.7 dB per year at 0.25 kHz, increasing gradually to 1.2 dB per year at 8 kHz and 1.23 dB per year at 12 kHz. The rate of change for thresholds increased significantly with age, at 0.25 to 3, 10, and 11 kHz for females and at 6 kHz for males. After adjusting for age, females had a significantly slower rate of change at 1 kHz but a significantly faster rate of change at 6 to 12 kHz than males. For 0.25 and 1 kHz, subjects with more hearing loss at higher frequencies had a faster rate of change at these frequencies, whereas for 6 and 8 kHz, subjects with more hearing loss at mid and high frequencies had a slower rate of change at these frequencies. The rates of threshold change for subjects with a positive noise history were not statistically different from those with a negative noise history. CONCLUSIONS: On average, hearing threshold increased approximately 1 dB per year for subjects age 60 and over. Age, gender, and initial threshold levels can affect the rate of change in thresholds. Older female subjects (> or =70 years) had faster rate of change at 0.25 to 3, 10, and 11 kHz than younger female subjects (60 to 69 years). Older male subjects had faster rate of change at 6 kHz than younger male subjects. Females had a slower rate of change at 1 kHz and a faster rate of change at 6 to 12 kHz than males. Subjects with higher initial thresholds at low and mid frequencies tended to have faster rate of threshold change at 0.25 to 2 kHz in the following years. Subjects with higher initial thresholds at mid and higher frequencies tended to have slower rate of change at 6 to 8 kHz in the following years. Noise history did not have a significant effect on the rate of threshold changes.

Swallowing-related quality of life after head and neck cancer treatment.

OBJECTIVES: To determine the role of treatment modality in swallowing outcome after head and neck cancer treatment and to identify potential risk factors for posttreatment dysphagia. STUDY DESIGN: Cross-sectional survey of patients with no evidence of disease 12 months or more after the treatment of a stage III or IV squamous cell carcinoma of the oropharynx, larynx, or hypopharynx. METHODS: Potential subjects were stratified by tumor site and tumor T-stage to achieve a balanced comparison between chemoradiation (n = 18) and surgery/radiation (n = 22) groups. Outcome measures included a dysphagia risk factor survey, the MD Anderson Dysphagia Inventory (MDADI), and the Short-Form 36 (SF-36). RESULTS: Patients who received chemoradiation for oropharyngeal primaries demonstrated significantly better scores on the emotional (P =.03) and functional (P =.02) subscales of the MDADI than did patients who underwent surgery followed by radiation. There were no significant differences between chemoradiation and surgery/radiation groups for laryngeal and hypopharyngeal primaries. Additional risk factors for posttreatment dysphagia include prolonged (>2 weeks) nothing by mouth (NPO) status (P =.002) and low SF-36 Mental Health Subscale score (P =.002). CONCLUSION: The study suggests that chemoradiation may provide superior swallowing outcome to surgery/radiation in patients with oropharyngeal primary. Patients with depressed mental health and prolonged feeding tubes may be at higher risk of long-term dysphagia.

Obstructive sleep apnea: a comparison of black and white subjects.

OBJECTIVE: To determine if the severity of obstructive sleep apnea syndrome (OSA) differs by racial group. STUDY DESIGN: Cross-sectional retrospective review. SETTING: University-based sleep disorders laboratory. METHODS: The study reviewed the results of 280 adult (>18 y) patients diagnosed with obstructive sleep apnea syndrome by overnight polysomnogram between July 1, 1999, and June 30, 2000. Factors analyzed included age, sex, race, presence of hypertension, body mass index (kg/m2), respiratory disturbance index (RDI), and lowest oxygen saturation level. RESULTS: Blacks with OSA are significantly more obese and have significantly higher rates of hypertension than white subjects with OSA. Black females with OSA are significantly younger than white females at the time of diagnosis (P =.005). Black males with OSA have significantly lower oxygen saturations than white males (P =.025). CONCLUSION: Black males who present to the otolaryngologist-head and neck surgeon for evaluation of sleep-disordered breathing may be at increased risk of severe OSA.