Effect of Sentinel Lymph Node Biopsy and LVI on Merkel Cell Carcinoma Prognosis and Treatment

xlomafota13 shared this article with you from Inoreader Effect of Sentinel Lymph Node Biopsy and LVI on Merkel Cell Carcinoma Prognosis and Treatment Via The Laryngoscope Objective Prognostic factors and optimal treatment approaches for Merkel cell carcinoma (MCC) remain uncertain. This study evaluated the influences of sentinel lymph node (SLN) biopsy and lymphovascular invasion (LVI) on treatment planning and prognosis. Study Design Retrospective cohort study. Methods Stage 1 to 3 MCC patients treated 2005 to 2018. Predictors of nodal radiation were tested using logistic regression. Predictors of recurrence‐free, disease‐specific, and overall survival were tested in Cox proportional hazard models. Results Of 122 patients, 99 were without clinically apparent nodal metastases. Of these, 76 (77%) underwent excision and SLN biopsy; 29% had metastasis in SLNs, including 20% of MCCs 1 cm or less. Primary tumor diameter, site, patient age, gender, and immunosuppressed status were not significantly associated with an involved SLN. Among patients who underwent SLN biopsy, 13 of 21 (62%) MCCs with LVI had cancer in SLNs compared with 14 of 44 (25.5%) without LVI (P = .003). Although local radiation was common, nodal radiation was infrequently employed in SLN negative (pathologic N0) patients (21.8% vs. 76.2% for patients with SLN metastases, P = .0001). Survival of patients with positive SLNs was unfavorable, regardless of completion lymphadenectomy and/or adjuvant radiation. After accounting for tumor (T) and node (N) classification, age, immunosuppression, and primary site, a positive SLN and LVI were independently associated with worse survival (LVI/recurrence‐fr ee survival [RFS]: hazard ratio [HR] 2.3 (1.04–5, P = .04; LVI/disease‐specific survival [DSS]: HR 5.2 (1.8–15, P = .007); N1a vs. pN0/RFS HR 3.6 (1.42–9.3, P = .007); DSS HR5.0 (1.3–19, P = .17). Conclusion SLN biopsy assists in risk stratification and radiation treatment planning in MCC. LVI and disease in SLNs, independently associated with worse survival, constitute markers of high‐risk disease warranting consideration for investigational studies. Level of Evidence III Laryngoscope, 131:E828–E835, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Evaluation of Upper Airway in Children with Obstructive Sleep Apnea Using Cone‐Beam Computed Tomography

xlomafota13 shared this article with you from Inoreader Evaluation of Upper Airway in Children with Obstructive Sleep Apnea Using Cone‐Beam Computed Tomography Via The Laryngoscope Objective Cone‐beam computed tomography (CBCT) offers three‐dimensional structures in assessing upper airway of patients. This study aims to compare the cone‐beam computerized tomography scan measurements between children with obstructive sleep apnea (OSA) and primary snoring. Study Design Case–control study. Methods This prospective study was conducted in a tertiary referral center. Thirty‐six children with moderate‐to‐severe OSA (with apnea‐hypopnea index [AHI] > 5 events/hour) and 36 age‐, gender‐, and obesity‐matched children with primary snoring (AHI <1) were enrolled. The measurements in CBCT parameters were compared between children with moderate‐to‐severe OSA and primary snorers by conditional logistic regression model. Results A total of 72 children (mean age, 7.9 ± 2.8 years; 64% male) were included. Children with moderate‐to‐severe OSA had a significantly smaller nasopharyngeal (2900 ± 1400 vs. 3800 ± 1800 mm3, P = .017) and oropharyngeal airway volume (5600 ± 2700 vs. 7400 ± 4000 mm3, P = .026) than those with primary snoring. Children with moderate‐to‐severe OSA, as compared to primary snorers, also had a significantly smaller minimal airway area in nasopharynx (77.4 ± 37.7 vs. 107.7 ± 52.0 mm2, P = .006) and oropharynx (66.6 ± 61.9 vs. 101.6 ± 65.8 mm2, P = .023). Moreover, the airway length was not significantly different between children with moderate‐to‐severe OSA and primary snoring. Conclusions The three‐dimensional CBCT airway analysis could be used as a useful tool to evaluate upper airway in children with OSA. Level of Evidence 3 Laryngoscope, 131:680–685, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐Term Outcomes of Cochlear Implantation in Irradiated Ears of Nasopharyngeal Carcinoma Patients

xlomafota13 shared this article with you from Inoreader Long‐Term Outcomes of Cochlear Implantation in Irradiated Ears of Nasopharyngeal Carcinoma Patients Via The Laryngoscope Objectives To evaluate the safety and feasibility of cochlear implantation (CI) in irradiated ears of nasopharyngeal carcinoma (NPC) patients. Study Design A retrospective study. Methods From 2008 to 2017, 10 adults with binaural severe or profound sensorineural hearing loss subsequent to radiotherapy for NPC underwent CI in our center. The mean follow‐up was 63.2 months. Hearing and speech performance were evaluated pre‐ and postoperatively with audiometric and speech discrimination testing, Category of Auditory Performance, Speech Intelligibility Rating, and Chinese version of Nijmegen Cochlear Implant Questionnaire. Results According to the severity of radioactive osteomyelitis of temporal bone, patients were classified into three categories: mild, moderate, and severe. Patients in mild category underwent routine CI. Patients in moderate category underwent extended radical mastoidectomy and CI simultaneously. Patients in severe category underwent subtotal temporal bone resection, external auditory canal elimination, and CI simultaneously or by stage. There was no massive hemorrhage, facial paralysis, or nonunion of incision after operation. One suffered from radiation encephalopathy 13 months postoperatively; since then, the cochlear implant has been idle. The other nine patients demonstrated encouraging results of hearing and speech performance. Conclusion CI for postirradiated ears of NPC is safe and feasible. Strict control of operative indications and extra care during surgery are required. Individual surgical plan should be made according to the severity of radioactive osteomyelitis. Choose one‐stage surgery as much as possible in severe cases to avoid the risk of difficulty in locating round window in second‐stage surgery. Level of Evidence 4 Laryngoscope, 131:649–655, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Anesthesia Management and Postanesthetic Recovery Following Endoscopic Sinus Surgery

xlomafota13 shared this article with you from Inoreader Anesthesia Management and Postanesthetic Recovery Following Endoscopic Sinus Surgery Via The Laryngoscope Objectives Delayed anesthesia recovery following endoscopic sinus surgery (ESS) can be an indicator of immediate complications and negatively impact healthcare efficiency. This study aims to examine clinical factors with a focus on improving clinical practice. Methods Medical records of patients undergoing ESS under general anesthesia from 2014 to 2018 were reviewed. Based on the interquartile range of anesthesia recovery for the cohort, patients in the upper quartile were categorized as "prolonged" and the lowest three quartiles as "goal" recovery. Patient and surgical characteristics were investigated. Results Analyzing 416 patients who underwent ESS, the median anesthesia recovery time was 48 [35–66] minutes. Prolonged recovery was associated with higher body mass index (odds ratio 1.50 [95% confidence interval 1.03–2.18] per 10 kg/m2, P = .03) and surgical duration (1.37 [1.10–1.72] per hour, P < .01). Inversely, goal recovery was associated with preoperative acetaminophen (0.61 [0.38–0.98], P = .04) and intraoperative remifentanil (0.55 [0.32–0.93], P = .03). Patients with prolonged recovery had higher rates of severe pain (33 (31.7%) vs. 25 (8.0%), P < .01), respiratory depression (7 [6.7] vs. 2 [0.6], P < .01), oversedation (39 [37.5] vs. 39 [12.5], P < .01), and the need for rescue opioids (52 [50] vs. 71 [22.8], P < .01). In addition to reduced postanesthesia recovery time, patients who were administered preemptive acetaminophen had lower rates of severe p ain (OR 0.55 [0.31–0.98], P = .04) and nausea and vomiting (0.39 [0.17–0.87], P = .02). Conclusion Our findings substantiate the use of acetaminophen and remifentanil in ESS, facilitating anesthesia recovery. Broadly consideration of preemptive acetaminophen could further increase postoperative comfort in ESS. Level of Evidence 4 – Retrospective. Laryngoscope, 131:E815–E820, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A Population‐Based Analysis of Mucoepidermoid Carcinoma of the Oral Cavity

xlomafota13 shared this article with you from Inoreader A Population‐Based Analysis of Mucoepidermoid Carcinoma of the Oral Cavity Via The Laryngoscope Objectives To identify survival outcomes for patients with mucoepidermoid carcinoma (MEC) of the oral cavity and the effects of different prognostic factors on survival. Study Design Retrospective cohort study using a national database. Methods Retrospective, population‐based cohort study of patients in the Surveillance, Epidemiology and End Results (SEER) database who were diagnosed with MEC of the oral cavity from 1973 to 2016. Overall survival (OS) and disease‐specific survival (DSS) were calculated. Results A total of 1693 patients with MEC of the oral cavity were included. Of those, there are 696 males and 997 females, the average age at diagnosis being 52.4 years. The vast majority of cases (86.4%) presented with stage I and stage II disease. A total of 206 patients had received both surgical and radiation therapy (RT), while 1338 patients just had undergone only surgery and 149 with no treatment. On multivariate analysis, advanced age, stage, and histologic grade were associated with worse OS and DSS. Surgical therapy was an independent favorable predictor of OS and DSS. For radiotherapy, multivariate analysis showed that it was associated with worse DSS, whereas there was no significant difference in OS. Conclusion MEC of the oral cavity is associated with a generally favorable prognosis. Advanced age, stage, and histologic grade were independent negative prognostic factors for survival, and surgery was the main treatment to improve survival. Level of Evidence 4 Laryngoscope, 131:E857–E863, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐term Impact of Middle Ear Effusion in Pediatric Tympanostomy Tubes

xlomafota13 shared this article with you from Inoreader Long‐term Impact of Middle Ear Effusion in Pediatric Tympanostomy Tubes Via The Laryngoscope Objectives/Hypothesis Bilateral myringotomy and tympanostomy tube placement (BMT) is the most common pediatric surgery in the United States. Intraoperative middle ear effusion (MEE) is a risk factor for future BMTs in children with recurrent acute otitis media (RAOM). However, the impact of the type of MEE is unknown. Here, we assess otologic outcomes based on intraoperative MEE type and indication for surgery. Study Design Case series chart review. Methods After institutional review board approval, we performed a review of children undergoing BMTs between 2008 and 2009. Included patients had their first BMT, preoperative visit, and an operative report. Patients with cleft palate or Down syndrome were excluded. Indications for surgery included RAOM and chronic otitis media with effusion (COME). Other variables evaluated were future BMT, acquired cholesteatoma, and otorrhea. Logistic regression was used for statistical analysis. Results Out of 1,045 patients reviewed, 680 were included and underwent their first BMT. There were 619 patients who had RAOM. Serous effusions were present in 22.2%, mucoid in 31.3%, purulent in 12.9%, undocumented or bloody in 2.3% of patients, and 31.2% of patients had dry middle ears. Moreover, 22.7% of patients underwent future BMTs. In RAOM patients, serous effusions decreased odds of perforation (odds ratio [OR]: 0.195, 95% confidence interval [CI]: 0.0438‐0.867, P = .032), and purulent effusions increased the odds of in‐office otorrhea suctioning (OR: 2.13, 95% CI: 1.20‐3.77, P = .010) compared to dry. Mucoid effusions had no significant effect on outcomes in COME or RAOM patients. Conclusions Intraoperative MEEs were noted in 68.7% of cases; purulent effusions increase the odds of in‐office suctioning in RAOM patients. Level of Evidence 4 Laryngoscope, 131:E993–E997, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Neutron Therapy for High‐Grade Salivary Carcinomas in the Adjuvant and Primary Treatment Setting

xlomafota13 shared this article with you from Inoreader Neutron Therapy for High‐Grade Salivary Carcinomas in the Adjuvant and Primary Treatment Setting Via The Laryngoscope Objectives/Hypothesis Our primary objective was to compare differences in survival of patients with high‐grade salivary gland carcinomas (SGCs) receiving adjuvant neutron versus photon radiotherapy using a hospital‐based national cohort and restricted mean survival time (RMST) analysis. Our secondary objective was to compare survival of similar patients treated with primary neutron versus photon radiation. Study Design Multicenter, retrospective population‐based study of patients within the National Cancer Database from 2004 to 2014. Methods One thousand eight hundred forty‐four patients were selected on diagnosis of high‐grade parotid and submandibular malignancies. One thousand seven hundred seventy‐seven patients receiving photon and 67 patients receiving neutron therapy were identified who met inclusion criteria. Patients were then categorized as having primary surgery with adjuvant radiation or primary radiation without prior surgery. Bivariate analysis was performed to assess for differences between groups, and RMST analysis was performed at 1‐, 2‐, and 5‐year timepoints with controlling for available covariate data. Results There was no significant difference in RMST for patients receiving neutrons over photons at 1, 2, and 5 years in the adjuvant setting. Among patients undergoing primary radiotherapy, there was a difference in RMST of 2.29 months at 1 year and 5.05 months at 2 years for neutrons over photons, though this benefit was not observed at 5 years post‐therapy. Conclusions For patients with high grade SGCs undergoing adjuvant photon versus neutron radiotherapy, there was no difference in RMST. There was observed to be a significant difference in RMST at 1 and 2 years among patients undergoing primary neutron therapy of up to 5 months. Given the benefit observed with primary neutron therapy, it should be considered in both the primary and adjuvant treatment setting. Level of Evidence 4 Laryngoscope, 131:541–547, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Coverage for Gender‐Affirming Voice Surgery and Therapy for Transgender Individuals

xlomafota13 shared this article with you from Inoreader Coverage for Gender‐Affirming Voice Surgery and Therapy for Transgender Individuals Via The Laryngoscope Objectives/Hypothesis To determine insurance coverage for gender‐affirming surgery and voice therapy for individuals who seek to align their voice with their gender identity, and to analyze differences based on state‐by‐state transgender equality. Study Design Cross‐sectional study. Methods Policies from the top three commercial insurers per state in 2019 were reviewed. Coverage status was determined by web‐based search, telephone interviews, and email inquiries. A state‐by‐state equality score was calculated based on the number of laws and policies relating to the transgender community. Correlation between number of preauthorized procedures and state equality scores was assessed. Results Of the 150 insurance companies reviewed, only four (2.7%) held favorable policies, whereas 113 (75.8%) provided no coverage. Endoscopic surgery, open surgery, individual voice therapy, and group voice therapy interventions were equally excluded (n = 93, 62.4%). Coverage was not correlated with laws driving transgender equality (P = .782). Conclusions Gender‐affirming voice interventions are seldom covered by commercial insurance companies. Despite established medical necessity and years of experience in practice, gender‐affirming interventions for voice have not yet been fully considered by third‐party payors. Further investigation regarding cost‐effectiveness and treatment efficacy is warranted to improve insurance coverage of voice‐related gender‐affirming care. Level of Evidence NA Laryngoscope, 131:E896–E902, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

An Open‐Source Three‐Dimensionally Printed Laryngeal Model for Injection Laryngoplasty Training

xlomafota13 shared this article with you from Inoreader An Open‐Source Three‐Dimensionally Printed Laryngeal Model for Injection Laryngoplasty Training Via The Laryngoscope Objectives/Hypothesis A limited number of three‐dimensionally (3D)‐printed laryngeal simulators have been described in the literature, only one of which is specifically designed for percutaneous injection laryngoplasty (PIL) training and is currently of limited availability. This study describes the development and evaluation of a high‐fidelity, open‐source, low‐cost 3D‐printed simulator for PIL training, improving on existing models. Study Design Simulator design and survey evaluation. Methods Computed tomography scans of the upper airways were processed with 3D Slicer to generate a computer model of the endolarynx. Blender and Fusion 360 were used to refine the mucosal model and develop casts for silicone injection molding. The casted endolaryngeal structures were inserted into a modified version of a publicly available laryngeal cartilage model. The final models were evaluated by 10 expert laryngologists using a customized version of the Michigan Standard Simulation Experience Scale. Internal consistency and interrater reliability of the survey were evaluated using Cronbach's α and intraclass correlation, respectively. Results Expert laryngologists highly rated the model for measures of fidelity, educational value, and overall quality (mean = 4.8, standard deviation = 0.5; 1 = strongly disagree, 5 = strongly agree). All reviewers rated the model as ready for use as is or with slight modifications. The filament needed for one cartilage model costs $0.96, whereas the silicone needed for one soft‐tissue model costs $1.89. Conclusions Using 3D‐printing technology, we successfully created the first open‐source, low‐cost, and anatomically accurate laryngeal model for injection laryngoplasty training. Our simulator is made freely available for download on Wikifactory with step‐by‐step tutorials for 3D printing, silicone molding, assembly, and use. Level of Evidence NA Laryngoscope, 131:E890–E895, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO‐IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat

xlomafota13 shared this article with you from Inoreader IVORY Guidelines (Instructional Videos in Otorhinolaryngology by YO‐IFOS): A Consensus on Surgical Videos in Ear, Nose, and Throat Via The Laryngoscope Objectives/Hypothesis Otolaryngology instructional videos available online are often of poor quality. The objective of this article was to establish international consensus recommendations for the production of educational surgical videos in otolaryngology. Study Design DELPHI survey. Methods Twenty‐seven international respondents participated in this study from 12 countries. Consensus was reached after three rounds of questionnaires following the Delphi methodology. The proposals having reached the 80% agreement threshold in the third round were retained. Results The main recommendations are as follows: 1) Ethics: patients must be anonymized and unrecognizable (apart from plastic surgery if necessary). A signed authorization must be obtained if the person is recognizable. 2) Technical aspects: videos should be edited and in high‐definition (HD) quality if possible. Narration or subtitles and didactic illustrations are recommended. 3) Case presentation: name of pathology and procedure must be specified; the case should be presented with relevant workup. 4) Surgery: surgical procedures should be divided into several distinct stages and include tips and pitfalls. Pathology should be shown if relevant. Key points should be detailed at the end of the procedure. 5) Organ‐specific: type of approach and bilateral audiometry should be specified in otology. Coronal plane computed tomography scans should be shown in endonasal surgery. It is recommended to show pre‐ and postoperative videos in voice surgery and preoperative drawings and photos o f scars in plastic surgery, as well as the ventilation method in airway surgery. Conclusions International recommendations have been determined to assist in the creation and standardization of educational surgical videos in otolaryngology and head and neck surgery. Level of Evidence 5 Laryngoscope, 131:E732–E737, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach

xlomafota13 shared this article with you from Inoreader Long‐term Outcomes for Revision Endoscopic Dacryocystorhinostomy—The Effect of the Primary Approach Via The Laryngoscope Objectives/Hypothesis Revision endoscopic dacryocystorhinostomy (END‐DCR) is the preferred approach for failed primary surgeries, yet quality data on long‐term outcomes are lacking. This study aimed to evaluate three aspects of revision END‐DCR: 5‐year success rates, patient satisfaction, and the primary surgical approach's possible impact on revision. Methods This retrospective study included all revision END‐DCRs conducted at Kaplan Medical Center between the years 2002 and 2015. For long‐term follow‐up analysis, two subgroups of first and second revision END‐DCRs with a minimum of documented 5‐year follow‐up after surgery were defined. Data were analyzed according to the primary surgical approach. Surgical success was defined by either anatomical (observed patent lacrimal flow) or functional (symptoms cessation) success. Patient satisfaction was measured by a questionnaire. Results After exclusions, a total of 45 eyes from 38 patients who underwent revision END‐DCR surgeries were included in the study. The yearly success rates from immediate to 5 years following the first revision were 93.3%, 75.5%, 71.1%, 68.9%, 68.9%, and 68.9% for the entire cohort, respectively. Immediate and 5‐year success rates following the second revision were 88.8% and 77.8%, respectively. Primary END‐DCR showed favorable 5‐year success rates and patient satisfaction over primary external dacryocystorhinostomy (EXT‐DCR) in both first and second revisions, but this did not reach significance. Conclusions Revision END‐DCR carries an excellent short‐term success rate, which decreases mainly throughout the first 2 years following surgery. Postoperative follow‐up should be maintained within this timeframe. Revision END‐DCR following either primary endoscopic or EXT‐DCR produces comparable surgical outcomes and patient‐reported satisfaction. Level of Evidence 3b Laryngoscope, 131:E682–E688, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.