Neck Surgery Clinic Research Articles

Ten Steps to Develop Patient Education Videos for Individuals of All Health Literacy Levels

Objectives: (1) Create a protocol for developing educational videos for patients of all health literacy levels. (2) Describe National Institutes of Health (NIH) guidelines, evidence-based principles of instructional design, and industry best practices related to creating educational videos for patients. Methods: Utilizing (1) NIH guidelines for patient education materials, (2) evidence-based principles of instructional design, and (3) industry best practices, a 10-step protocol was developed for creating video-based patient education materials. As a proof-of-concept, these 10 steps were used to create a short video to help patients understand flexible laryngostroboscopy. Results: Using NIH guidelines, a script was created with text designed for the sixth-grade reading level using the SMOG Readability Formula. Evidence-based principles of instructional design that were incorporated into the video included: the Personalization Principle, Multimedia Principle, Coherence Principle, Contiguity Principle, and Practice Principle. A video was recorded with a high definition camera, and audio narration was recorded separately. A short video describing laryngeal anatomy and showing actual footage laryngostoboscopy was edited on Camtasia Studio 8.0 and produced for optimized viewing on the iPad. The video was pilot tested on patients prior to undergoing flexible laryngostroboscopy at an outpatient otolaryngology–head and neck surgery clinic. Conclusions: There is currently no protocol for creating educational videos for patients with limited health literacy. This 10-step protocol was created to help those creating educational videos incorporate NIH guidelines, evidence-based principles of instructional design, and industry best practices into their projects.

Internet Usage and eHealth Literacy of Patients in an Otolaryngology–Head and Neck Surgery Clinic

Objectives: (1) Investigate whether otolaryngology–head and neck surgery (OHNS) outpatients consult health-related online resources and establish baseline levels of perceived eHealth literacy. (2) Determine which resources patients use to investigate their disease and research treating physicians. (3) Explore relationships between perceived eHealth literacy, demographic data, and internet usage. Methods: A questionnaire was administered to 79 patients in a tertiary care OHNS outpatient setting between December 2013 and February 2014. The questionnaire recorded (1) demographic data, (2) health-related Internet use, and (3) eHealth Literacy Scale (eHEALS), a tool used to measure perceived eHealth literacy. Results: Seventy-five of 79 patients completed the questionnaire. Seventy-six percent (n = 57) of patients had consulted online resources regarding their disease. The most commonly used resources were prompted by search engine results such as Google (88%, n = 51) and health websites such as WebMD (71%, n = 41). Only 14% of this group used the American Academy of Otolaryngology—Head and Neck website. Fifty percent (n = 38) of patients consulted online resources regarding their otolaryngologist prior to their visit. The mean eHEALS score was 3.65/5.0 (95% confidence interval [CI], 3.46-3.84). For patients who search for health-related information online, the odds of using dedicated health websites were 90.8% lower for patients with an eHEALS score below the mean versus above the mean ( P = .017; 95% CI, 35%-98.7%). Conclusions: The majority of patients in this study consulted online resources to learn about their disease and physician. In this cohort, the perceived eHealth literacy influenced the type of website consulted. Patients with lower perceived eHealth literacy were less likely to consult dedicated health websites.

Risk Factors of Otitis Media in Children Associated With Surgical Treatment

Objectives: An analysis of the factors contributing to the risk of repeat ventilation tube placement among patients undergoing ventilation tube placement with adenoidectomy and patients undergoing ventilation tube placement only. Methods: We conducted a retrospective review of the medical records of 66 patients ages 3 to 10 who underwent ventilation tube placement only or adenoidectomy plus ventilation tube placement at Otorhinolaryngology and Head and Neck Surgery Clinic between January 2011 and January 2013. Results: The analysis revealed no significant relationships between the risk factors evaluated and the need for repeated ventilation tube placement. A repeat ventilation tube placement procedure was required in 7.7% of patients in the age 6-10 age group. This rate of incidence was significant relative to the other age groups evaluated. Conclusions: Adenoidectomy during the initial ventilation tube placement procedure may reduce the need for repeat ventilation tube placement in patients of 6 to 10 years of age with otitis media.

Management of cholesteatoma complications: Our experience in 145 cases

Objectives: To assess the incidence, clinical features, diagnosis and treatm ent of complications of cholesteatomatous chronic otitis media (CCOM) seen in the ENT/Head and Neck Surgery Clinic, University Clinical Center of Kosova, Prishtina. Materials and Methods: This is a retrospective study of the medical records of patients with complications of CCOM who had undergone surgical treatment at the ENT Clinic of the University Clinical Center of Kosovo for the period time of 1994 to 2011. Results: From a total of 2765 patients suffering from COM, 502 (18.08%) had cholesteatoma. From this group, in 145 patients had complications. The mean age was 30 years. Eighty-two (56.55%) cases had extracranial complications (ECC) and 49 patients (33.79%) intracranial complications (ICC). For the ECC cases, we found that subperiostal mastoid abscess occurred in 25%, facial nerve palsy was seen in 13% and labyrinthine fistula in 9.6 %. For the ICC cases, meningitis (12%) and perisinusal abscess (11%) were the most common complications. The most frequent radiological diagnostic procedures were mastoid X-rays, which were performed in 70% of the patients, and computed tomography in 20%. Patients with ECC were treated in the ENT Clinic, whereas patients with ICC, after otologgic surgical procedures, were transferred to the Neurosurgery Clinic. In this series, 5 patients (3.4%) died as a result of complications. Conclusions: The incidence of cholesteatoma and its complications in our country still poses a challenge that requires higher dedication. Application of sophisticated diagnostic methods, CT and MRI is going to assist in choosing the adequate surgical approach, especially in cases with intracranial complications

Human Papillomavirus in Head and Neck Cancer: Several Questions

Received April 14, 2013 Accepted May 14, 2013 Address for correspondence Yuh-S. Jung, MD, PhD Department of OtolaryngologyHead and Neck Surgery, Head and Neck Oncology Clinic, Center for Thyroid Cancer, Research Institute and Hospital, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 410-769, Korea Tel +82-31-920-1685 Fax +82-31-920-1157 E-mail jysorl@ncc.re.kr The past decade has seen changes in the global trends for head and neck cancers in terms of incidence, etiologic and demographic patterns. Several case-control studies have consistently shown human papillomavirus (HPV) exposure dramatically increases the occurrence of oropharyngeal cancer. HPV related (+) oropharyngeal cancer has been found to be epidemiologically and clinically distinctive disease, characterized by younger age at onset, and strong association with reproductive behavior. The incidence of this disease is increasing sharply worldwide, whilst HPV negative (-) cancers are declining. HPV(+) cancers have significantly better survival and responses to chemoradiation, than HPV(-) counterparts. Given this superior survival, de-escalated therapies and organ preservation surgeries are being considered and on the clinical trial. Currently available prophylactic virus-like particle vaccines might be efficacious for primary prevention of HPV(+) cancers, although not validated yet. More researches are needed for the effective secondary prevention, through the deeper understanding of precancerous, molecular and pathologic changes. Korean J Otorhinolaryngol-Head Neck Surg 2014;57(3):143-50

Assessment of Plasma Electrolytes, Urea and Creatinine of Patients for Adenotonsillectomy

Objective: Adenotonsillectomy is commonly performed for children with recurrent adenotonsillitis. Electrolyte derangement could be a source of complication or even mortality if not properly corrected. This study was therefore carried out to assess the plasma electrolytes, urea, and creatinine levels of patients for adenotonsillectomy in our hospital. Materials and Methods: This was a prospective study that was carried out at the Ear, Nose, Throat, Head, And Neck Surgery Clinic of the University of Benin Teaching Hospital, Benin City, between January 2009 and February 2012, of patients who underwent adenotonsillectomy. Both a thorough history, to ascertain relevant information, and a specific examination were done for the patients. The patients were tested for plasma sodium, potassium, chloride, bicarbonate, urea, and creatinine levels, using established standardized laboratory assay methods with reference intervals interpreted in accordance with established procedures. Results: 49 patients completed the study, made up of 33 males and 16 females, with a mean age of 6.62 years. 25 patients (51.02%) had normonatremia while 24 (48.97%) had hyponatremia. 41 patients (83.67%) had normokalemia, two (4.08%) had hyperkalemia while 6 (12.24%) had hypokalemia. 11 patients (22.45%) had acidosis, 37 (75.51%) had normal bicarbonate levels while only one (2.04%) had alkalosis. 45 patients (91.84%) had normochloremia, while one (2.04%) each had hyponatremia and another one (2.04%) had hyperchloremia. Low urea was seen in nine (18.37%) and normal urea in 40 (81.63%) patients. Normal creatinine levels were seen in 31 (63.27%) and low creatinine in 10 (20.41%) patients. Conclusion: Electrolytes, urea, and creatinine derangement; especially hyponatremia, exists in patients admitted for adenotonsillectomy, mainly due to their inability to feed properly. These electrolytes should be assessed and corrected before surgery, to avoid fatal complications.

Head and neck cancer patients want us to support them psychologically in the posttreatment period: Survey results

No study systematically has investigated the supportive care needs of general head and neck cancer patients using validated measures. These needs include physical and daily living needs, health system and information needs, patient care and support needs, psychological needs, and sexuality needs. Identifying the unmet needs of head and neck cancer patients is a necessary first step to improving the care we provide to patients seen in our head and neck oncology clinics. It is recommended as the first step in intervention development in the Pan-Canadian Clinical Practice Guideline of the Canadian Partnership Against Cancer (see Howell, 2009). This study aimed to identify: (1) met and unmet supportive care needs of head and neck cancer patients, and (2) variability in needs according to demographics, disease variables, level of distress, and quality-of-life domains. Participants were recruited from the otolaryngology-head and neck surgery clinics of two university teaching hospitals. Self-administered questionnaires included sociodemographic and medical questions, as well as validated measures such as the Supportive Care Needs Survey-Short Form (SCNS-SF34), the Hospital Anxiety and Depression Scale (HADS), and the Functional Assessment of Cancer Therapy-General (FACT-G) and Head and Neck Module (FACT-H&N) (quality of life measures). One hundred and twenty-seven patients participated in the survey. 68% of them experienced unmet needs, and 25% revealed a clinically significant distress level on the HADS. The highest unmet needs were psychological (7 of top 10 needs). A multiple linear regression indicated a higher level of overall unmet needs when patients were divorced, had a high level of anxiety (HADS subscale), were in poor physical condition, or had a diminished emotional quality of life (FACT-G subscales). The results of this study highlight the overwhelming presence of unmet psychological needs in head and neck cancer patients and underline the importance of implementing interventions to address these areas perceived by patients as important. In line with hospital resource allocation and cost-effectiveness, one may also contemplate screening patients for high levels of anxiety, as well as target patients who are divorced and present low levels of physical well-being, as these patients may have more overall needs to be met.

Persistent diplopia and superior oblique muscle dysfunction following dissection of the orbital periosteum in cranial base surgery

Background/aimsPersistent diplopia secondary to a fourth cranial nerve palsy is poorly documented after open cranial base surgery.MethodsSix cases of fourth cranial nerve palsy after cranial base surgery were drawn from...

Abstract 4026: HPV16-positive and HPV16-negative head and neck squamous cell carcinomas display different patterns of expression of genes involved in the control of growth and EMT.

Abstract Up to 60% of oropharyngeal cancers and 25% of head and neck squamous cell carcinomas (HNSCC) are high-risk human papillomavirus (HPV) positive, primarily HPV16. Differences in risk factors, age of presentation and clinical behavior of these tumors indicate that HPV+ and HPV- tumors develop with different molecular mechanisms and are biologically distinct. Based upon a gene expression profile comparison of HPV- and HPV+ HNSCC specimens, obtained from the Medical University of South Carolina ENT/Head and Neck Surgery clinic, we identified 384 candidate genes differentially expressed (125 genes up-regulated and 223 down-regulated) in HPV+ in comparison with HPV- tumors. GO analysis of the microarray data indicated that gene expression changes in HPV+ tumors affected primarily proliferation and cell cycle control, while HPV- tumors showed changes in genes involved in EMT, cell motility, and angiogenesis. We selected five genes (c-MET, TP53, TGF-beta2, BRCA1 and SIX1) for further analysis in a set of 44 tumor and four normal (tonsil and uvula) samples. Seventeen tumor samples were from African American (AA) patients, and 27 from European Americans (EA). The prevalence of HPV infection was 30% in samples from AA patients, and 65% in those from EA patients. Most HPV+ tumor samples (20 of 24) were positive for HPV16 and a subset of the HPV16+ tumor samples (55%) expressed HPV16 E7, as documented by real-time RT/PCR using tumor-derived RNA. The prevalence of active HPV infections (where E7 was expressed) was 17% in AA and 50% in EA patients. These tumor samples were utilized to explore the expression of the selected genes by real-time RT/PCR. Data were normalized to normal human keratinocytes based on three reference genes derived from a panel of seven candidate reference genes, using Normfinder, BestKeeper and GeNorm. Normalized relative quantities for each gene of interest were then calculated using qbasePLUS (Biogazelle.) c-MET was overexpressed, when compared to control tissue, in all tumor samples but levels of c-MET were the highest in HPV- EA samples, and comparatively lower in HPV+ samples. TP53 was overexpressed in HPV+ samples; TGF-beta2 and Six1 were clearly overexpressed in all tumor samples, compared to control tissue samples; and BRCA1 levels were higher in HPV+ samples, compared to HPV- samples and controls. These data are consistent with our microarray results that indicate that HPV- tumors exhibit gene expression profiles indicative of activation of EMT. We are investigating the molecular interactions that lead to overexpression of SIX1, c-MET and BRCA1 in these tumors, and the functional consequences of this overexpression in terms of cell growth and EMT. Citation Format: Swati Tomar, Sangeeta Kowli, Diego Altomare, Christian Graves, Susannah Kassler, Natalie A. Sutkowski, Marion Boyd Gillespie, Saundra H. Glover, Kim E. Creek, Lucia A. Pirisi-Creek. HPV16-positive and HPV16-negative head and neck squamous cell carcinomas display different patterns of expression of genes involved in the control of growth and EMT. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4026. doi:10.1158/1538-7445.AM2013-4026

Abstract 5110: Divergent gene expression profiles in HPV-positive and HPV-negative head and neck squamous cell carcinomas

Abstract Up to 60% of oropharyngeal cancers and 25% of head and neck squamous cell carcinomas (HNSCC) are due to high-risk Human Papillomavirus (HPV), primarily HPV16. Differences in risk factors, age of presentation and clinical behavior of these tumors indicate that HPV+ and HPV- tumors develop with different molecular mechanisms and are biologically distinct. To further investigate the molecular characteristics of these tumors, we compared the gene expression profiles of three HPV- and four HPV+ HNSCC specimens, obtained from the Medical University of South Carolina ENT/Head and Neck Surgery clinic. All HPV+ tumors were positive for HPV16 and expressed E7, as documented by real-time RT/PCR using tumor-derived RNA. Gene expression profiles were determined on Agilent 4x44K human oligonucleotide microarrays. Identification of differentially expressed genes (>2-fold change, p<0.05) and pathway analysis were performed using GeneSifter Software (Geospiza). Overall, 125 genes were up-regulated and 223 were down-regulated in HPV+ in comparison with HPV- tumors. Gene Ontology analysis of the dataset revealed that pathways related to cell cycle control, mitotic checkpoint, regulation of cell proliferation, programmed cell death and DNA metabolism were heavily affected in HPV+ tumors, while pathways affected in HPV- tumors included regulation of cell motility and migration, angiogenesis and integrin-mediated signaling. We confirmed by Real-Time RT/PCR the differential expression of a panel of genes of interest on these samples and several additional HNSCC specimens, and then we extended our follow-up analysis to specimens from over 30 new cases of HNSCC. Among the genes we targeted for follow-up is the MET oncogene, which encodes the hepatocyte growth factor/scatter factor receptor. MET is overexpressed about 5-fold in HPV- tumors, in comparison with HPV+ tumors actively expressing E7. The MET product, which controls growth, invasion and metastasis in cancer cells, has been recently proposed as a new therapeutic target for HNSCC. Supported by grant #P20MD001770 from the NIH/NIMHD. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 5110. doi:1538-7445.AM2012-5110

Ear, Nose, Throat, Head and Neck Surgery Department Functioning as a Team in Nigeria: Any Benefit?

To call attention to the synergistic benefit of working as a team in a clinical department and to encourage others, to emulate this pattern of patients' care for better results. Patients that were seen at the Ear, Nose, Throat, Head and Neck Surgery Clinic of the University of Benin Teaching Hospital, Benin City, Nigeria, who had the benefit of their cases reviewed by more than one consultant were included into the study. Parameters retrieved from the case notes included number of consultants that reviewed each case, age, sex of patients, diagnosis, whether there was controversy, complimentary or synergistic benefit from the team work. 124 patients completed the study. 99 patients (79.84%) were reviewed by two consultants and 25 (20.16%) were reviewed by three of the four consultants available in the department. 79 (63.71%) patients had the benefit of a complimentary management, while 38 (30.65%) had synergistic benefit from the team work. Intradepartmental team work in patient management produces synergistic benefit for patients and more experience among consultant staff.

Prevalence of aural features in asthmatic patients in Nigeria.

Background Whereas it is commonly reported that asthma is closely associated with nasal pathologies (rhinitis, rhinosinusitis), there are no clear-cut aural co-morbidities with asthma. This study was therefore carried out to identify the prevalence of aural features in asthma. Methods It was a prospective study that was carried out at the Chest Clinic and Ear, Nose, Throat, Head and Neck (ENTH & N) Surgery Clinic of the University of Benin Teaching Hospital (UBTH), Benin City, between 1st March 2008 and 28th February 2011. Asthmatic patients who consented to the study had history of aural symptoms taken and signs were elicited. Results 41 patients participated in the study with 15 males and 26 females. The ages ranged from 17 to 83years with a mean age of 48.7 years. Aural itching accounted for 43.18% of symptoms in asthmatic patients. This is attributed to the presence of atopic and accentuated non-atopic 'allergic' aural reactions in asthmatics. Conclusion Bilateral aural itching is the main aural manifestation in asthmatics in this study. It is recommended that this should be treated appropriately. There is the need for a more detailed study of aural manifestations in asthmatics.Keywords: Prevalence, Aural features, Asthmatic patients, Nigeria.

Current state of diagnosis and treatment of allergic rhinitis in China

To investigate the understanding among otolaryngologists and perspectives on the diagnosis and management of allergic rhinitis in major cities in China. A survey among otolaryngologists in mainland China was carried out through questionnaire, including the medical history, diagnosis and pharmacotherapy. The survey was conducted in 508 otolaryngologists. In general otolaryngology head and neck surgery clinic, the patients with allergic rhinitis was about 19% +/- 14%, which was of 35% +/- 17% in rhinological clinic. Most of the otolaryngologists (61% +/- 29%) diagnosed AR based on medical history and nasal examination. Only 35% +/- 28% of the otolaryngologists used skin prick test or specific IgE serum test. 70% +/- 27% of the patients with AR were offered nasal steroids, 49% +/- 32% and 36% +/- 28% of the patients were offered oral or nasal antihistamines respectively. Only 24% +/- 17% of patients realized the importance of follow-up. Allergic rhinitis is a core component in the specialty of otolaryngology head and neck surgery. The diagnosis and management of allergic rhinitis is sub-optimal. Chinese otolaryngologists need continuous education in aspects of diagnosis and management of allergic rhinitis.

Evaluation of laryngopharyngeal reflux in patients with suspected laryngopharyngeal reflux, chronic otitis media and laryngeal disorders

We investigated the prevalence of laryngopharyngeal reflux in patients with signs and symptoms of reflux, chronic otitis media and benign and malignant vocal cord lesions. Three groups of patients in Ankara Ataturk Education and Research Hospital ENT-Head and Neck Surgery Clinics were compared between 2005 and 2006. The first group had patients with signs and symptoms of reflux, the second group consisted of patients with chronic otitis media, and in the third group had patients with laryngeal pathology, i.e. vocal cord lesions. The results of pH monitoring of all the three groups of patients were analyzed for laryngopharyngeal reflux. In the evaluation, two different criteria, based on reflux number and time spent in reflux, were used. It was investigated whether there was a difference in terms of reflux among these three groups. Also, the effects of reflux in etiopathogenesis of chronic otitis media and vocal cord lesions are discussed. A total of 84 patients were studied, with 22 patients with signs and symptoms of reflux in Group 1, 42 patients with chronic otitis media in Group 2, and 20 patients with vocal cord lesions in Group 3. No statistical difference could be detected among the groups in terms of the two criteria mentioned above. The frequency of laryngopharyngeal reflux in patients with chronic otitis media and vocal cord lesions was found to be as high as than in the patients with signs and symptoms of reflux. During the treatment of chronic otitis media and laryngeal disorders, we advise reflux work-up, and in case if there is reflux, we recommend reflux treatment in addition to treatment of primary disease.

Managing chronic otitis media with cholesteatoma: report of 233 patients seen in a 5-year period

To assess the clinical features, diagnosis, and treatment of patients having chronic otitis media (COM) with cholesteatoma seen in the ENT/Head and Neck Surgery Clinic at the University Clinical Center, Prishtina, Kosovo. A systematic review of the medical records of all patients admitted to the ENT clinic having COM with cholesteatoma between January 1999 and December 2003. During this period, 223 patients suffering from COM with cholesteatoma underwent surgical treatment. There were 123 (55%) male and 100 (45%) female patients. Their mean age was 30.7 years, ranging from youngest patient (7-year-old girl) to oldest (73-year-old lady). Thirty-three patients developed complications: 17 patients extracranial complications (EC) and 16 intracranial complications (IC). Leading pathogens in this series were Proteus mirabilis in 52% of cases, Proteus vulgaris in 14% and Staphylococcus aureus in 12%. All patients underwent surgical treatment: 10 patients (4.5%) a canal-wall up (CWU) procedure and 213 (95.5%) a canal-wall down (CWD) procedure. No deaths occurred in this series. Because of possibility of developing life-threatening complications, patients with COM with cholestatoma must diagnosed in time and followed as soon as possible to the center that performs ear surgery, as only adequate treatment option for these patients.

Waist Circumference and Sleep Disordered Breathing

To explore how the different metrics of obesity, specifically body mass index (BMI), Mallampati, neck circumference, waist circumference, and waist-hip ratio, correlate with metrics of sleep disordered breathing (SDB), specifically the apnea/hypopnea index (AHI), and which is/are the most likely to predict and correlate with SDB. Four hundred fourteen patients presenting to the University of California San Diego Head and Neck Surgery Clinic for SDB had a sleep evaluation including a history and physical examination assessing the markers of obesity and a sleep test. Data comparing AHI with BMI, neck circumference, waist circumference, waist-hip ratio, and Mallampati were analyzed by means, standard deviations, and Pearson's correlations. The mean AHI for males was 34, and the mean AHI for females was 24. The mean age was 48 for both sexes. The mean waist circumference for males was 104 cm (41 inches) and for females 99 cm (39 inches). In males and females, waist measurement was most strongly correlated with SDB (males: r = 0.366, P = .00; females: r = 0.445, P = .00). The mean neck circumference for males and females was 43 cm (17 inches) and 38 cm (15 inches) (males: r = 0.358, P = .00; females: r = 0.38, P = .00). The mean waist-hip ratio for males and females was 0.94 and 0.87 (males: r = 0.359, P = .00; females: r = 0.254, P = .03). The mean BMI for males and females was 31 kg/m2 (males: r = 0.325, P = .00; females: r = 0.40, P = .00), and the mean Mallampati for males and females was 2.84 and 2.92 (males: r = 0.176, P = .012; females: r = 0.149, P = .16). A linear regression demonstrated that waist and neck circumference were better correlates of SDB than BMI. Obesity correlates with SDB severity. Waist circumference is a better measure than BMI or neck circumference to predict SDB. Men and women are anthropometrically different. Even with an AHI of 5 or more, only half of SDB patients in this study were clinically obese. An abnormal waist circumference for men and women is 102 cm (40 inches) or more.

Rigid tracheobronchoscopy in the management of airway foreign bodies: 10 years experience in Kosovo

To review the incidence of tracheobronchial foreign body aspiration in the population of Kosovo and to evaluate the clinical features and management of tracheobronchial foreign body aspiration during a 10-year period. Tertiary medical institution, ENT/Head and Neck Surgery Clinic, University Clinical Center, Prishtina, Kosovo. We retrospectively reviewed the medical records of patients with tracheobronchial foreign body aspiration who underwent rigid tracheobronchoscopy between January 1994 and December 2003. During a 10-year period, 244 rigid tracheobronchoscopy procedures were performed when foreign body aspiration was suspected. In 182 patients (75%), a foreign body was found and extirpated. Of these, 107 (59%) were male and 75 (41%) were female; 124 patients (68%) were aged 0-3 years and 36 (20%) were aged 4-7 years. The most commonly extirpated foreign bodies were peanuts (30% of cases) followed by beans (22.5%) and corn kernels (9%). Of 176 plain chest radiographs, 65% showed no signs of foreign bodies. Two patients (1.1%) died as result of complications related to foreign body aspiration. Rigid bronchoscopy represents a safe and effective tool in the management of foreign body aspiration. However, the high percentage of false-negative results on chest radiography in our series warrants further investigation.

Lower-Extremity Liposarcoma Metastatic to the Larynx: Case Report

Distant metastases to the larynx are rare. We describe the case of a 46-year-old man who was referred to our head and neck surgery clinic with a 6-week history of sore throat and otalgia. He was found to have a laryngeal lesion that was consistent with a primary myxoid liposarcoma that had been extirpated from a lower extremity earlier To the best of our knowledge, no case of myxoid liposarcoma metastatic to the larynx has been previously reported in the English-language literature.

Enzyme immunoassay for serum autoantibody to survivin and its findings in head-and-neck cancer patients.

Several proteins associated with malignant transformation of cells can induce autoantibodies (1)(2)(3)(4). These autoantibodies, such as those to p53, are detectable in serum and may serve to monitor tumor progression (4)(5). Survivin, a recently cloned 16.5-kDa apoptosis inhibitor belonging to the IAP3 family (6), is expressed in the G2-M phase of the cell cycle (7). Its overexpression in cancer is thought to overcome an apoptotic checkpoint and favor aberrant progression of transformed cells through mitosis. Survivin is not produced in adult tissues except for the thymus and placenta, but it is abundantly produced in fetal tissues and in various human tumors, including lung, colon, gastric, breast, and bladder cancers as well as high-grade lymphomas (6)(7)(8)(9)(10). We developed an enzyme-labeled assay to measure anti-survivin autoantibody in sera and evaluated the relationship between anti-survivin and clinicopathologic variables. We obtained blood from 294 consecutive patients, before cancer treatment, at the Otorhinolaryngology or Head and Neck Surgery Clinics at Chang Gung Memorial Hospital with written informed consent. The standard treatment was radical surgery for early-stage patients, plus adjuvant radiotherapy for intermediate-risk patients, such as those with close surgical margins or lymph node metastases. Concomitant chemoradiotherapy was given to patients with lymph node metastases and extracapsular spread. All cancers were histologically graded as well-differentiated, moderately differentiated, or poorly differentiated, according to the WHO classification (11). Tumor pathology staging was classified according to the system of the American Joint Committee on Cancer (12). Blood samples from 40 gender- and age-matched healthy individuals were obtained as controls. After centrifugation, the sera were stored at −20 °C until use. Survivin cDNA was obtained by reverse transcription-PCR using total RNA from Jurkat cells with survivin-specific primers. The PCR product was ligated …

Smoking Cessation in Patients Diagnosed with Head and Neck Cancer

To determine patients' smoking status after the diagnosis and treatment of squamous cell carcinoma of the head and neck (SCCHN) and to identify factors associated with smoking cessation. Cross-sectional survey study conducted over a 2-year period. Head and neck surgery clinic of an academic tertiary care hospital. Two hundred thirteen consecutive patients diagnosed with SCCHN were interviewed to ascertain patients' smoking status and the incidence of smoking cessation. Information on demographics, tobacco and alcohol history, disease characteristics, and treatment modality was also collected. The rate of smoking cessation was evaluated, in which smoking cessation is defined as the use of no cigarettes at least 1 month prior to the interview. Possible predictors of smoking cessation were evaluated. One hundred twenty-five patients were found to be smoking at the time of diagnosis. Among these patients, 53.6% stopped smoking after diagnosis or during treatment. In the univariate analyses, tumour site (p = .01), concurrent alcohol use (p = .03), and number of attempts to quit pre- (p = .03) and postdiagnosis (p = .001) were found to be highly predictive of patient smoking cessation. Multivariable modelling showed that gender, tumour site, and number of attempts to quit smoking were significantly and independently related to smoking cessation. Although smoking cessation would be presumed to be high after cancer diagnosis, this study has identified patient subgroups in which postdiagnosis smoking cessation intervention programs need to be made more effective.