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Rossi Meyer MK, Most SP. Quantifying the Subjective Experience of Nasal Obstruction: A Review. Facial Plast Surg 2024; 40:336-340. [PMID: 37625460 DOI: 10.1055/a-2160-4998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
Nasal obstruction is an exceedingly common problem and challenging to treat due to its multifactorial etiology. Therefore, measuring treatment outcomes of nasal obstruction can be equally complex yet vital to appropriately assessing symptom improvement or resolution. Both physiologic and anatomic assessments of the nasal airway exist in addition to validated patient-reported outcome measures (PROMs), which objectify subjective nasal obstruction and sinonasal symptoms. Correlation between objective and subjective treatment outcome measures is controversial with clinical guidelines favoring the use of PROMs for surgical treatment of nasal obstruction. In this review, the anatomic and physiologic measurements of the nasal airway and validated PROMs will be discussed, as well as the rationale for implementing PROMs into the rhinoplasty surgeon's practice.
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Affiliation(s)
- Monica K Rossi Meyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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Ta NH, Gao J, Philpott C. A systematic review to examine the relationship between objective and patient-reported outcome measures in sinonasal disorders: recommendations for use in research and clinical practice. Int Forum Allergy Rhinol 2021; 11:910-923. [PMID: 33417297 PMCID: PMC8248036 DOI: 10.1002/alr.22744] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 11/01/2020] [Accepted: 11/12/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Common sinonasal disorders include chronic rhinosinusitis (CRS), allergic rhinitis (AR), and a deviated nasal septum (DNS), which often coexist with shared common symptoms including nasal obstruction, olfactory dysfunction, and rhinorrhea. Various objective outcome measures and patient-reported outcome measures (PROMs) are used to assess disease severity; however, there is limited evidence in the literature on the correlation between them. This systematic review aims to examine the relationship between them and provide recommendations. METHODS A search of MEDLINE and EMBASE identified studies quantifying correlations between objective outcome measures and PROMs for the sinonasal conditions using a narrative synthesis. RESULTS In total, 59 studies met inclusion criteria. For nasal obstruction, rhinomanometry shows a lack of correlation whereas peak nasal inspiratory flow (PNIF) shows the strongest correlation with PROMs (r > 0.5). The Sniffin' Stick test shows a stronger correlation with PROMs (r > 0.5) than the University of Pennsylvania Smell Identification Test (UPSIT) (r < 0.5). Computed tomography (CT) sinus scores show little evidence of correlation with PROMs and nasal endoscopic ratings (weak correlation, r < 0.5). CONCLUSION Overall, objective outcome measures and PROMs assessing sinonasal symptoms are poorly correlated, and we recommend that objective outcome measures be used with validated PROMs depending on the setting. PNIF should be used in routine clinical practice for nasal obstruction; rhinomanometry and acoustic rhinometry may be useful in research. The Sniffin' Sticks test is recommended for olfactory dysfunction with UPSIT as an alternative. CT scores should be excluded as a routine CRS outcome measure, and endoscopic scores should be used in combination with PROMs until further research is conducted.
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Affiliation(s)
- Ngan Hong Ta
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Jack Gao
- ENT Department, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Carl Philpott
- ENT Department, James Paget University Hospital NHS Foundation Trust, Great Yarmouth, UK
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Abstract
Methods of measuring nasal obstruction outcomes include both objective anatomic and physiologic measurements, as well as subjective patient-reported measures. Anatomic measurements include acoustic rhinometry, imaging studies, and clinician-derived examination findings. Physiologic measures include rhinomanometry, nasal peak inspiratory flow, and computational fluid dynamics. Patient-reported outcome measures (PROMs) are self-reported assessments of disease-specific quality-of-life outcomes. Several studies attempted correlation of these outcome measures; however, few show strong correlation. Expert opinion favors determining successful surgical outcomes using PROMs. This review provides a summary of current nasal obstruction outcome measures.
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Affiliation(s)
- Emily Spataro
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA
| | - Sam P Most
- Division of Facial Plastic and Reconstructive Surgery, Stanford University School of Medicine, 801 Welch Road, Stanford, CA 94305, USA.
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A 3-Dimensional Analysis of Nasal Cavity Volume After Maxillary Le Fort I Osteotomy. J Oral Maxillofac Surg 2018; 76:1344.e1-1344.e7. [PMID: 29406258 DOI: 10.1016/j.joms.2017.12.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/24/2017] [Accepted: 12/31/2017] [Indexed: 11/23/2022]
Abstract
PURPOSE Two- and 3-dimensional studies on changes of the pharyngeal airway after a Le Fort I osteotomy have been conducted, but there are few studies on the change of nasal structure. The nasal cavity is the first passage through which air enters during respiration. Movement of the maxilla by Le Fort I osteotomy affects the shape of the nasal cavity and the shape of other parts of the airway. This study compared preoperative and postoperative changes of the nasal cavity volume after a maxillary Le Fort I osteotomy. MATERIALS AND METHODS Pre- and postoperative computed tomograms of 32 patients were assessed for nasal cavity volume according to the direction of maxillary movement. RESULTS Thirty-two patients (22 men and 10 women) were classified according to the direction of maxillary movement: maxillary impaction (group I; 8 men and 6 women) and maxillary impaction and advancement (group II; 14 men and 4 women). Nasal cavity volume was markedly decreased after the Le Fort I osteotomy in groups I and II. Group I showed a positive correlation between the ratio of impaction and the ratio of volume difference. Group II showed no correlation between the ratio of impaction or advancement and the ratio of volume difference. CONCLUSION Impaction and advancement of the maxilla decreased nasal volume.
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Validity of Acoustic Rhinometry in the Evaluation of Patients With Adenoid Hypertrophy. J Craniofac Surg 2014; 25:1230-5. [DOI: 10.1097/scs.0000000000000882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Wandalsen GF, Mendes AI, Solé D. Correlation between nasal resistance and different acoustic rhinometry parameters in children and adolescents with and without allergic rhinitis. Braz J Otorhinolaryngol 2013; 78:81-6. [PMID: 23306573 PMCID: PMC9446352 DOI: 10.5935/1808-8694.20120038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Accepted: 09/02/2012] [Indexed: 01/15/2023] Open
Abstract
Acoustic rhinometry and rhinomanometry are important tests used to assess nasal function. The degree to which the parameters of these tests are correlated is yet to be established. Objective This paper aimed to study the correlations between nasal resistance (NR) and acoustic rhinometry parameters in children and adolescents with allergic rhinitis and controls. Method Twenty patients with allergic rhinitis and 20 controls were enrolled. NR, volumes (V4, V5, V2-5), and minimal cross-sectional areas (MC1, MC2) were measured in three moments: baseline, after induction of nasal obstruction and after topical decongestant administration. Results Patients with allergic rhinitis had significant correlation between NR and all volumes (V5: r = -0.60) and with MC2. Among controls, MC1 was the parameter with the strongest correlation with NR at baseline (r = -0.53) and after decongestant administration. In the combined analysis, V5 had the highest correlation coefficients at baseline (r = -0.53), after obstruction (r = -0.58) and after decongestant (r = -0.46). Conclusions Our data showed that NR and acoustic rhinometry parameters have negative and significant correlations. Nasal volumes are, in general, better correlated than minimal cross-sectional areas. V5 was the parameter with the highest correlation in the rhinitis group and in the combined analysis.
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Affiliation(s)
- Gustavo Falbo Wandalsen
- Allergy, Clinical Immunology and Rheumatology Program, Department of Pediatrics, Federal University of São Paulo, Rua dos Otonis no. 725, Vila Clementino, São Paulo
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Manestar D, Braut T, Kujundžić M, Malvić G, Velepič M, Donadić Manestar I, Matanić Lender D, Starčević R. The effects of disclosure of sequential rhinomanometry scores on post-septoplasty subjective scores of nasal obstruction: a randomised controlled trial. Clin Otolaryngol 2012; 37:176-80. [PMID: 22564336 DOI: 10.1111/j.1749-4486.2012.02490.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We sought to evaluate the effects of awareness of rhinomanometric results on subjective sensation of nasal breathing in patients after septoplasty. DESIGN Prospective randomised study. SETTING Clinical Hospital Rijeka. PARTICIPANTS A study of 60 patients (45 M, 15 F) who underwent septoplasty was performed at the ENT Clinic, Clinical Hospital Rijeka. The patients were randomised into two groups; group A was shown their rhinomanometry scores at 3 months postoperatively, while group B remained unaware of their rhinomanometry results. MAIN OUTCOME MEASURE The assumption is that in the same settings patients aware of their rhinomanometric results have better performances of their Nasal Obstruction Symptom Evaluation (NOSE) scale and thereby a better quality of life (QOL) after septoplasty. RESULTS The differences in rhinomanometric results and NOSE scale prior and after septoplasty were statistically significant (P < 0.001), all patients achieving better results after the operation. There was no statistically significant difference in resistance (F = 0.004; P = 0.948) and improvement of rhinomanometry results in postoperative measurements (F = 0.110; P = 0.896) between groups A and B. The symptoms measured by the NOSE scale were the same in both groups preoperatively and 1 month after septoplasty (F = 2.906; P = 0.094). Three months postoperatively in group A, the NOSE scale score was lower (M = 11.67; sd = 12.34) than in group B (M = 27.50; sd = 18.04). CONCLUSIONS The results suggest that disclosing information to patients about their post-septoplasty rhinomanometry results may improve subjective nasal breathing, and thus improve their QOL.
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Affiliation(s)
- D Manestar
- Clinic of Otorhinolaryngology, Head and Neck Surgery Clinic of Ophthalmology Clinic of Pulmology, University Hospital Rijeka, Rijeka, Croatia
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Abstract
The cause of nasal obstruction can often be attributed to pathologic conditions of the nasal valve. The key physical examination finding in nasal valve compromise is inspiratory collapse of the nasal sidewall. Validated subjective and objective measures evaluating nasal obstruction exist, although with weak correlation. Functional rhinoplasty encompasses the surgical techniques used to address obstruction occurring in this area. These techniques aim to increase the size of the nasal valve opening and/or strengthen the lateral nasal wall and nasal ala, preventing dynamic collapse. Much of the supporting evidence for functional rhinoplasty consists of observational studies that are universally favorable.
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Affiliation(s)
- Daniel E Cannon
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, USA.
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Zhao K, Blacker K, Luo Y, Bryant B, Jiang J. Perceiving nasal patency through mucosal cooling rather than air temperature or nasal resistance. PLoS One 2011; 6:e24618. [PMID: 22022361 PMCID: PMC3192719 DOI: 10.1371/journal.pone.0024618] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 08/16/2011] [Indexed: 12/02/2022] Open
Abstract
Adequate perception of nasal airflow (i.e., nasal patency) is an important consideration for patients with nasal sinus diseases. The perception of a lack of nasal patency becomes the primary symptom that drives these patients to seek medical treatment. However, clinical assessment of nasal patency remains a challenge because we lack objective measurements that correlate well with what patients perceive.The current study examined factors that may influence perceived patency, including air temperature, humidity, mucosal cooling, nasal resistance, and trigeminal sensitivity. Forty-four healthy subjects rated nasal patency while sampling air from three facial exposure boxes that were ventilated with untreated room air, cold air, and dry air, respectively. In all conditions, air temperature and relative humidity inside each box were recorded with sensors connected to a computer. Nasal resistance and minimum airway cross-sectional area (MCA) were measured using rhinomanometry and acoustic rhinometry, respectively. General trigeminal sensitivity was assessed through lateralization thresholds to butanol. No significant correlation was found between perceived patency and nasal resistance or MCA. In contrast, air temperature, humidity, and butanol threshold combined significantly contributed to the ratings of patency, with mucosal cooling (heat loss) being the most heavily weighted predictor. Air humidity significantly influences perceived patency, suggesting that mucosal cooling rather than air temperature alone provides the trigeminal sensation that results in perception of patency. The dynamic cooling between the airstream and the mucosal wall may be quantified experimentally or computationally and could potentially lead to a new clinical evaluation tool.
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Affiliation(s)
- Kai Zhao
- Monell Chemical Senses Center, Philadelphia, Pennsylvania, United States of America.
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Eccles R, Doddi NM, Leong S. Re: Correlation between subjective and objective evaluation of the nasal airway. Clin Otolaryngol 2010; 35:149; author reply 150. [PMID: 20500589 DOI: 10.1111/j.1749-4486.2010.02101.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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André RF, Vuyk HD, Ahmed A, Graamans K, Nolst Trenité GJ. Correlation between subjective and objective evaluation of the nasal airway. A systematic review of the highest level of evidence. Clin Otolaryngol 2010; 34:518-25. [PMID: 20070760 DOI: 10.1111/j.1749-4486.2009.02042.x] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND There is no consensus about the value of objective measurements of nasal patency. OBJECTIVE To assess the correlation between the subjective sense of nasal patency and the outcomes found with rhinomanometry and acoustic rhinometry. TYPE OF REVIEW Structured literature search. SEARCH STRATEGY AND EVALUATION METHOD: Review of English-language articles in which correlations were sought between subjective nasal patency symptoms and objective scores as found with rhinomanometry [nasal airway resistance (NAR)] and acoustic rhinometry [minimal cross-sectional area (MCA)]. Correlations were related to unilateral or combined assessment of nasal passages and to symptomatic nasal obstruction or unobstructed nasal breathing. RESULTS Sixteen studies with a level of evidence II-a or II-b fit the inclusion criteria and were further analysed. Almost every possible combination of correlations or lack thereof in relation to the variables included was found. However, when obstructive symptoms were present, a correlation between the patency symptoms with nasal airway resistance and minimal cross-sectional area was found more often than in the absence of symptoms. In cases of bilateral assessment a correlation was found almost as often as it was not between patency symptoms and total nasal airway resistance or combined minimal cross-sectional areas, while in the limited amount of studies in which unilateral assessment was done a correlation was found each time between patency symptoms and nasal airway resistance. CONCLUSIONS The correlation between the outcomes found with rhinomanometry and acoustic rhinometry and an individual's subjective sensation of nasal patency remains uncertain. Based on this review, it seems that the chance of a correlation is greater when each nasal passage is assessed individually and when obstructive symptoms are present. There still seems to be only a limited argument for the use of rhinomanometry or acoustic rhinometry in routine rhinologic practice or for quantifying surgical results.
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Affiliation(s)
- R F André
- Department of Otolaryngology/Facial Plastic Surgery, Rijnland Hospital, Simon Smitweg 1, Leiderdorp, The Netherlands.
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Inferior turbinate surgery and nasal airflow: evidence-based management. Curr Opin Otolaryngol Head Neck Surg 2010; 18:54-9. [PMID: 19915466 DOI: 10.1097/moo.0b013e328334db14] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review will discuss the evidence-based management of enlarged inferior turbinate by considering methods of assessing nasal airflow, controversies surrounding patient selection and surgical outcomes. RECENT FINDINGS There is currently no consensus on patient selection for turbinate surgery. Patients are empirically offered surgery on the basis of subjective complaint of nasal obstruction and surgeon's clinical examination. Few authors have utilized objective measurements of nasal airflow such as rhinomanometry to select suitable patients for surgery. There is a small body of evidence suggesting that more robust criteria of selecting patients, using a nasal decongestant test and rhinomanometry, may have some influence on the surgical outcome. Although most surgical techniques demonstrate improvement in postoperative nasal airflow and subjective scores, it is impossible to draw conclusions as to which technique is best suited for treating inferior turbinate enlargement. The heterogeneous study cohorts, differing patient selection criteria and outcome measures used do not allow meta-analysis of outcomes and comparison between surgical techniques. SUMMARY Inferior turbinate surgery is an evolving operative concept and the evidence supporting the efficacy of the various techniques remains undecided. More prospective controlled studies are needed with both objective and subjective outcome measures.
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Zhao K, Dalton P. The way the wind blows: implications of modeling nasal airflow. Curr Allergy Asthma Rep 2007; 7:117-25. [PMID: 17437682 DOI: 10.1007/s11882-007-0009-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Nasal airflow is important for the many physiological functions of the nose, which include the warming and humidifying of inspired air; the filtration of airborne pollutants; and the sense of smell and nasal pungency. Until recently, airflow properties in the nose could only be understood using qualitative in vitro models of humans or in vivo studies in rodents. Recent advances in constructing three-dimensional geometric models of human nasal passages from CT scans, coupled with computational fluid dynamic modeling, has been a valuable tool for quantifying airflow and transport of gases, heat, particles, and aerosols in the human nose. Additionally, these techniques hold significant promise for evaluating and predicting the impact and successful remediation of a variety of clinical conditions on olfaction and nasal patency and setting guidelines for safe levels of exposure to inhaled materials.
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Affiliation(s)
- Kai Zhao
- Monell Chemical Senses Center, 3500 Market Street, Philadelphia, PA 19104-3308, USA
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Lam DJ, James KT, Weaver EM. Comparison of anatomic, physiological, and subjective measures of the nasal airway. ACTA ACUST UNITED AC 2007; 20:463-70. [PMID: 17063739 DOI: 10.2500/ajr.2006.20.2940] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Studies comparing different categories of nasal measures have reported inconsistent results. We sought to compare validated measures of the nasal airway: anatomic (acoustic rhinometry), physiological (nasal peak inspiratory flow), and subjective experience (Nasal Obstruction Symptom Evaluation Scale and a visual analog scale [VAS]). METHODS This prospective cross-sectional study of 290 nonrhinologic patients included upright and supine rhinometry (minimum cross sectional area [MCA] and volume) and flow (mean and maximum) measurements, as well as subjective measures. Associations between measures were evaluated with Spearman correlations and multivariate linear regression, adjusting for age, sex, race, body mass index, and smoking history. RESULTS Correlations between objective (rhinometry and flow) and subjective categories of nasal measures ranged from -0.16 to 0.03 (mean correlation, -0.07 +/- 0.05), with 0 significant correlations of 16 tested. Correlations between anatomic (rhinometry) and physiological (flow) categories ranged from 0.04 to 0.15 (mean correlation, 0.10 +/- 0.03), with 0 significant correlations of 16 tested. In contrast, within each category (rhinometry, flow, and subjective), all correlations were significant (13 correlations, all p < 0.001) and ranged from 0.62 to 0.99. Of 16 adjusted associations between objective and subjective measures, 14 were not significant (p > 0.05); only upright and supine MCAs were significantly associated with the VAS (both, p < 0.05). CONCLUSION Validated anatomic, physiological, and subjective nasal measures may assess different aspects of the nasal airway and provide complementary information. Future studies should be directed at developing a composite measure including components from all three categories of nasal measurement.
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Affiliation(s)
- Derek J Lam
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, 98108, USA
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Abstract
PURPOSE OF REVIEW Patients with advanced head and neck cancer are being treated with chemo-radiotherapy, and life is being prolonged, with or without persistent disease, for longer than was previously. Hypercalcaemia may present in patients with advanced or disseminated head and neck cancer, and, as such, these patients may present to a larger variety of clinicians for advice concerning their symptoms and illness. Modes of presentation of hypercalcaemia and treatment strategies are reviewed. RECENT FINDINGS There were previously few large series of head and neck cancer patients diagnosed with hypercalcaemia, which may or may not have been related to their cancer being treated. Investigations, by way of blood/serum calcium level, may identify such patients. Patients with cancer-related hypercalcaemia have a poor prognosis, but many may respond temporarily to treatment when offered, with an improvement of their quality of life and death. SUMMARY Hypercalcaemia should and must be considered in all patients who have or possibly have a diagnosis of a head and neck cancer and who present unwell with symptoms of fatigue, lethargy and somnolence. Investigation must include serum calcium (corrected for serum albumin binding) and parathyroid hormone level. Patients may be treated by a combination of rehydration and bisulphonate therapy until the serum calcium is reduced to a level below 3 mmol/l. The majority of patients diagnosed with hypercalcaemia due to head and neck malignancy die of their diseases in the short term, but some may enjoy a prolongation of life with reasonable quality if diagnosed and treated aggressively.
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Affiliation(s)
- Patrick J Bradley
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Nottingham, UK.
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