Oropharyngeal squamous cell carcinoma: p16/p53 immunohistochemistry as a strong predictor of HPV tumor status.

xlomafota13 shared this article with you from Inoreader Oropharyngeal squamous cell carcinoma: p16/p53 immunohistochemistry as a strong predictor of HPV tumor status. Via Laryngologie Related Articles Oropharyngeal squamous cell carcinoma: p16/p53 immunohistochemistry as a strong predictor of HPV tumor status. Histopathology. 2021 Feb 09;: Authors: Benzerdjeb N, Tantot J, Blanchet C, Philouze P, Mekki Y, Lopez J, Devouassoux-Shisheboran M Abstract AIMS: Oropharyngeal squamous cell carcinomas (OPSCC) related to human papillomavirus (HPV) infection have a better prognosis than those without HPV infection. Although p16INK4a overexpression is used as a surrogate marker for HPV infection, 5%-20% of p16-positive OPSCC are described as being unrelated to HPV infection, with worse overall survival compared to OPSCC-related HPV. There is, therefore, a risk of undertreating a proportion of OPSCC patients falsely considered as HPV-driven because of p16 positivity. TP53 mutations are highly prevalent in OPSCC driven by mutagens in tobacco and alcohol. We describe herein a combined p16/p53 algorithm to predict HPV tumor status in OPSCC. METHODS AND RESULTS: 110 OPSCC were identified in the database of the pathology department and were studied using p16 and p53 immunohistochemistry. For p16-positive or p16-negative/wild-type patterns-p53 (WT-p53) cases (n = 63), DNA in-situ hybridization for high-risk HPV was performed and if negative, the HPV status was controlled by HPV DNA PCR (n=19). A significant association between TP53 mutation and pattern of p53 expression was found (WT-p53, 7/16, P<0.001). The p16-positive/WT-p53 was significantly associated with HPV+ tumor status (p16-positive/WT-p53, 50/110, P<0.001). Interestingly, a subset of p16-positive OPSCC was unrelated to HPV (13.5%, 8/59) and showed mutant-type staining of p53 expression. CONCLUSIONS: The p16 protein immunopositivity in conjunction with the mutant-type pattern of p53 staining helped to reclassify a subset of p16-positive OPSCC as OPSCC-unrelated HPV. This approach could be routinely applied by pathologists involved in the management of OPSCC, because of their potential therapeutic implications. PMID: 33560536 [PubMed - as supplied by publisher] View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Olfactory and Gustatory Dysfunction in COVID-19 Patients

xlomafota13 shared this article with you from Inoreader Olfactory and Gustatory Dysfunction in COVID-19 Patients from Northern India: A Cross-Sectional Observational Study Via Otolaryngology Indian Abstract Olfactory dysfunction (OD) and gustatory dysfunction (GD) has been reported as one of the presenting symptoms amongst COVID-19 patients. However the literature available is disjunct on this aspect. This study is conducted to identify the prevalence of olfactory and/or gustatory dysfunction in patients with coronavirus disease in Northern part of India. It's a cross-sectional observation study, conducted over 387 COVID-19 positive patients, at ENT dept of tertiary care hospital. A retrospective survey was conducted using a pre designed questionnaire and details of Olfactory and Gustatory dysfunction was collected. The patient's demographic details, disease course and recovery time for olfactory (OD) and/or gustatory dysfunctions (GD) were collected. A total of 387 patients with COVID-19 completed the study. 228 (58.9%) patients suffered from influenza like illness (ILI) (fever, sore throat, dry cough, malaise, and myalgia). There was significant positive assoc iation seen between with ILI and OD and / or GD. 167/387 (43.15%) patients reported OD, and 153/387 (39.53%) reported GD. 43.71% and 50.3% patients had mild OD & GD respectively. Recovery rates for both OD and GD are high and almost similar, with 161 (96.4%) and 148 (96.73%) patients had complete recovery of smell and taste. Maximum recovery was noticed between 4 and 6 weeks. COVID-19 patients with habits have significantly high probability of developing OD &/or GD. There is a significant correlation between OD and GD and there is high probability that patients who reported to have OD will also have GD or vice versa. Prevalence of OD and GD in Indian population may not be as high as mentioned in western literature, however, both are frequent and early symptoms of COVID-19. Recent onset of these should be considered as red flag symptoms for COVID-19. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Sudden Sensorineural Hearing Loss in Children—Management and Outcomes: A Meta‐analysis

xlomafota13 shared this article with you from Inoreader Sudden Sensorineural Hearing Loss in Children—Management and Outcomes: A Meta‐analysis Via The Laryngoscope Objective To identify which patient characteristics and treatments are associated with hearing improvement in patients with pediatric sudden sensorineural hearing loss (SSNHL). Methods PubMed, Web of Science, Cochrane Library, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature were systematically searched for articles published before February 5, 2019, and references of relevant articles were screened. Original English‐language case series and cohort studies were included if they addressed SSNHL in patients <20 years of age. Study characteristics, patient demographics, symptoms, treatments, and hearing outcomes were extracted. The primary outcome was hearing improvement. Results Thirteen studies were included, totaling 605 patients (670 ears). Hearing did not improve in 46.7% of ears (95% confidence interval [CI]: 34.4% to 59.0%). Imaging (computed tomography and/or magnetic resonance imaging) results were described in three studies, and 24.2% of ears (95% CI: 7.7% to 40.6%) had abnormal findings. The most common serological finding was cytomegalovirus immunoglobulin (Ig)G or IgM (34.3% of ears tested, 95% CI: −2.9% to 71.6%). Unilateral hearing loss (odds ratio [OR]:3.85, P < .001), tinnitus (OR: 2.20, P = .003), age >12 years (OR: 2.11, P = .002), and ascending audiogram (OR: 3.66, P = .005), but not systemic or intratympanic steroids, were associated with increased odds of partial or complete improvement. In contrast, profound hearing loss (OR: 0.29, P < .001) and treatment delay of >6 days (OR: 0.27, P < .001) were associated with decreased odds of improvement. Conclusions Despite treatment, half of patients had no improvement in hearing. Prognostic factors associated with hearing improvement were generally consistent with those established in the adult population. Further research with consistent definitions for hearing improvement is needed to improve the understanding and treatment of pediatric SSNHL. Level of Evidence   Laryngoscope, 131:425–434, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Endoscopic Z‐plasty for Treatment of Supraglottic Stenosis: Experience on Nine Patients

xlomafota13 shared this article with you from Inoreader Endoscopic Z‐plasty for Treatment of Supraglottic Stenosis: Experience on Nine Patients Via The Laryngoscope Objectives Supraglottic stenosis is a rare type of laryngeal stenosis that is caused by congenital laryngotracheal anomalies, iatrogenic instrumentation injuries, autoimmune disorders, infection, irradiation, chemical or thermal burns, and external blunt or penetrating trauma. The author presents his experience on nine patients using this new endoscopic surgical technique for treatment of supraglottic stenosis. Study Design Individual retrospective cohort study, tertiary referral center, university hospital. Methods All cases of supraglottic laryngeal stenosis treated during a 10‐year period at a tertiary academic medical center were reviewed. Nine patients with supraglottic stenosis treated with endoscopic uni‐ or bilateral z‐plasty technique were determined and presented. The etiology of stenosis was iatrogenic surgical trauma in seven patients, laryngeal fracture in one patient, and systemic lupus erythematosus in the other patient. Main outcome measures were respiratory function test results, absence of dyspnea on exertion, and decannulation if tracheotomy was present preoperatively. Results Seven patients with tracheotomy were decannulated 1 month after surgery. All nine patients had adequate airway and were dyspnea‐free. Their preop respiratory function test results improved significantly postoperatively (P < .05). Conclusion For supraglottic stenosis endoscopic surgery using mucosal flaps in the form of z‐plasty should be considered within the available surgical techniques. Although this type of surgery is highly successful, it is technically difficult to apply. Level of Evidence 4 Laryngoscope, 131:E534–E539, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Survival Differences Between Pediatric Head and Neck Versus Body Melanoma in the Surveillance, Epidemiology, and End Results Program

xlomafota13 shared this article with you from Inoreader Survival Differences Between Pediatric Head and Neck Versus Body Melanoma in the Surveillance, Epidemiology, and End Results Program Via The Laryngoscope Objectives/Hypothesis To review the demographics, treatment, and survival of pediatric melanoma of the head and neck and to determine if melanoma of the head and neck has worse survival than melanoma of other body sites. Study Design Retrospective database review. Methods Pediatric patients from 0 to 21 years in the Surveillance, Epidemiology, and End Results 18 registries database were included from 1975 to 2016 based on a diagnosis of melanoma of the skin using the primary site International Classification of Diseases for Oncology, Third Edition codes from C44.0‐C44.9.skin of lip, C44.1‐eyelid, C44.2‐external ear, C44.3‐skin other/unspecified parts of face, C44.4‐skin of scalp and neck, C44.5‐skin of trunk, C44.6‐skin of upper limb and shoulder, C44.7‐skin of lower limb and hip, C44.8‐overlapping lesion of skin, and C44.9‐skin, NOS (not otherwise specified). Results A total of 4,561 pediatric melanomas of the skin were identified. There were 854 (18.7%) cases of melanoma of the head and neck (MHN) and 3,707 (81.3%) cases of melanoma of the body (MOB). The hazard ratio for MHN versus MOB was 1.6 (95% confidence interval: 1.3‐2.1) after accounting for sex, race, and age. Of MHN sites, the hazard ratio for melanoma of the scalp and neck was 2.2 (1.1‐4.7). The 2‐ and 5‐year Kaplan‐Meier overall survival for MHN were 94.6% and 90.7%, respectively, compared with 96.6% and 94.7%, respectively, for MOB (P < .01). Conclusions Survival outcomes of pediatric melanoma are notably related to anatomic site. Children with melanoma of the scalp and neck have the worst survival of all sites. Additionally, children who are older/white/male are at greater risk for worse survival outcomes. Level of Evidence 3 Laryngoscope, 131:E635–E641, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Improving Mortality Attribution in Otolaryngology – Head and Neck Surgery

xlomafota13 shared this article with you from Inoreader Improving Mortality Attribution in Otolaryngology – Head and Neck Surgery Via The Laryngoscope Objective/Hypothesis Mortality attribution can have significant implications for reimbursement, hospital/department rankings, and perceptions of safety. This work seeks to compare the accuracy of externally assigned diagnosis‐related group (DRG)‐based service line mortality attribution in otolaryngology to an internal review process that assigns mortality to the teams that cared for a patient during hospitalization. Study Design Retrospective case series. Methods Mortality events at Vanderbilt University Medical Center (VUMC) from 2012 to 2018 were compared. Included events were assigned to the otolaryngology service line (OSL) via the following methods: an external agency (Vizient) using DRG, utilization management assignment based on the service that provided care at admission (admission service), discharge (discharge service), or throughout hospitalization (major service line), or through the internal VUMC mortality review committee. Internal review was considered the standard for comparison. Results Of the 28 mortality events assigned to OSL by the DRG‐based external method, nine (32%) were actually attributable to OSL. Of the 23 total mortality events attributable to OSL at our institution, external DRG‐based review captured nine (39%). The designation of major service during hospitalization was correct 95% of the time and captured 87% of mortality events. Differences between external and internal attribution methods were statistically significant (P < .001). Conclusions DRG‐based models are frequently utilized but can be inaccurate when attributing mortality for an individual otolaryngology department. Otolaryngology mortalities appear to be captured and assigned more accurately by assigning deaths to the service that renders the majority of care during hospitalization. Level of Evidence 4 Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Otolaryngology Curriculum During Residency Preparation Course Improves Preparedness for Internship

xlomafota13 shared this article with you from Inoreader Otolaryngology Curriculum During Residency Preparation Course Improves Preparedness for Internship Via The Laryngoscope Objectives/Hypothesis Residency preparation courses (RPCs) have become a widely adopted practice to ease the transition of medical students into residency, but these courses often lack training in skills expected of subspecialty interns. To fill this gap, a simulation‐based curriculum in otolaryngology (ORL) was implemented at the University of Michigan Medical School. The curriculum aimed to improve confidence and perceived ability to perform common ORL skills for graduating students prior to internship. Study Design Cross‐sectional study. Methods Six basic simulations (tracheostomy, flexible laryngoscopy, otomicroscopy, myringotomy and tube insertion, epistaxis and peritonsillar abscess management) were included in the first course in 2019. The course was expanded in 2020 with the addition of three advanced simulations (ear foreign body extraction, tracheostomy complications, and "cannot intubate, cannot ventilate" situations). Pre‐ and postsession surveys were collected to assess individual simulations and the course overall. Results A total of 32 students participated in the ORL simulation curriculum in Spring 2019 and 2020. Paired t‐tests showed significant improvement in self‐perception of ability on every simulation. Qualitative feedback revealed that students particularly valued the opportunity for hands‐on learning. Non‐ORL students rated their baseline abilities significantly lower than ORL students on five stations, but they achieved statistically equivalent postsession ratings on all but the otomicroscopy station. Conclusions An ORL‐specific curriculum is a valuable addition to procedural RPCs. The curriculum resulted in increased confidence and perceived ability in skill performance for both students pursuing ORL residencies, as well as those pursuing other procedural specialties. Level of Evidence 4. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life

xlomafota13 shared this article with you from Inoreader Comparing Long‐Term Outcomes in Tracheostomy Placed in the First Year of Life Via The Laryngoscope Objectives//Hypothesis To characterize long‐term outcomes in pediatric patients requiring tracheotomy in the first year of life. Study Design Retrospective case series. Methods A retrospective longitudinal registry of tracheostomy patients was queried for patients who underwent tracheotomy from birth to 11 months. Primary outcomes were decannulation and survival. Secondary outcomes included neurocognitive quality of life assessed with the PedsQL Family Impact Module (scored from worst to best, 0 to 100 points). Results The study included 337 children. Thirty (8.90%) were neonates and 307 (91.10%) were infants. The population was 56.08% male (n = 189), and the racial and ethnicity composition were equally distributed (29.97% White, 31.45% Black, and 31.16% Hispanic). Significant differences between neonates and postneonates included birth weight in grams (2,731.40 vs. 1,950.44, P < .05), extreme prematurity (13.33% vs. 38.88%, P = .01), upper airway obstruction (80.00% vs. 42.67%, P < .05), and the need for mechanical ventilation (40.00% vs. 83.71%, P < .05). Despite these differences, long‐term outcomes were similar: decannulation (X 2 = 2.19, P = .14), death (X 2 = 2.63, P = .11), and neurocognitive quality of life (X 2 = 2.63, P = .27). Having a child with a tracheostomy caused the most problems with being physically tired (mean = 75.32 ± 3.90), emotional frustration (mean = 77.31 ± 5.05), and worry (mean standard deviation = 74.23 ± 6.48). Conclusion There were demographic differences between neonatal and infantile tracheostomy patients, but they did not affect long‐term outcomes. The presence of a tracheostomy caused a significant impact on a family's quality of life. Level of Evidence 3. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review

xlomafota13 shared this article with you from Inoreader Cerebellopontine Angle and Internal Auditory Canal Lipomas: Case Series and Systematic Review Via The Laryngoscope Objectives/Hypothesis Cerebellopontine angle (CPA) and internal auditory canal (IAC) lipomas are rare, benign tumors comprising 0.08% of all intracranial tumors and can be mistaken for other, more common lesions of the CPA/IAC such as vestibular schwannoma. The purpose of this study was to review the literature and assess the evolution of CPA/IAC lipoma diagnosis and management. In addition, we present 17 new lipomas, matching the largest known case series of this rare tumor. Study Design Retrospective case series and systematic review. Methods Systematic review of the literature was performed using PubMed and Google Scholar. References from identified articles were also reviewed to identify potential additional manuscripts. Manuscripts and abstracts were reviewed to identify unique cases. For the case series, the charts of all CPA/IAC lipoma patients seen at a single institution from 2006–2019 were manually reviewed. Logistic regression and chi‐squared analysis were performed where appropriate. Results A total of 219 unique lipomas have been reported in the literature, including 17 presented in this study. Surgical management has been performed in 46% of cases and has been conducted less often in recent decades, likely due to improved radiographic diagnostic capabilities and understanding of surgical outcomes. Surgical management is associated with worse neurologic outcomes (P = .002) and has become less common in recent decades. Although growth is unlikely, it has been demonstrated in patients into their 30s. Conclusions Accurate radiographic diagnosis is imperative for appropriate patient management, as CPA/IAC lipomas should typically be managed through observation and serial imaging whereas vestibular schwannomas and other CPA/IAC lesions may require microsurgical or radiosurgical intervention depending on growth and symptomatology. Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Current Protocol for Aesthetic Scar Management in Thyroid Surgery

xlomafota13 shared this article with you from Inoreader Current Protocol for Aesthetic Scar Management in Thyroid Surgery Via The Laryngoscope Objectives/Hypothesis We compared the scar quality when different protocols were applied, and eventually aim to find the optimal scar management protocol. Study Design We conducted a prospective, randomized, and blinded comparison of different scar management protocols in a single center. Methods We allocated 126 patients who underwent thyroidectomy via collar neck incision randomly into three groups. Patients in group A were treated with tissue adhesive only. Patients in group B were treated by means of subcuticular suturing and early scar management with a non‐ablative fractional laser (NAFL) and intralesional triamcinolone injection (ILI). Patients in group C had skin closure with tissue adhesive and early scar management. At 6 months after the operation, the Patient and Observer Scar Assessment Scale (POSAS) and the width of the final scar were compared. Results Comparing the sum of PSAS, groups B and C showed significant higher satisfaction than did group A (22.81 ± 11.66 in group A, 10.9 ± 5.14 in group B, and 15.19 ± 9.98 in group C). In the sum of OSAS, group B also showed a significant difference than did groups A and C (17.74 ± 6.75 in group A, 10.26 ± 3.60 in group B, and 14.52 ± 6.48 in group C). Also, group B showed a narrower scar width than did groups A and C. Conclusions Our finding suggests that subcuticular suturing using barbed suture material and early treatment with a combination therapy using NAFL and ILI showed a favorable aesthetic outcome for both patients and operators. Based on our algorithmic approach for thyroidectomy scar, we anticipate an optimal aesthetic outcome. Level of Evidence II Laryngoscope, 2021 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Physiologic Voice Rehabilitation Based on Water Resistance Therapy With Connected Speech in Subjects With Vocal Fatigue

xlomafota13 shared this article with you from Inoreader Physiologic Voice Rehabilitation Based on Water Resistance Therapy With Connected Speech in Subjects With Vocal Fatigue Via Journal of Voice The present study aimed to assess the effectiveness of a physiologic voice therapy program based on water resistance therapy (WRT) exercises including connected speech in a group of subjects with voice complaints (vocal effort and fatigue). View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.