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Barlow J, Sragi Z, Rodriguez N, Alsen M, Kappauf C, Ferrandino R, Chennareddy S, Kotz T, Kirke DN, Teng MS, Genden EM, Khan MN, Roof SA. Early feeding after free flap reconstruction of the oral cavity: A systematic review and meta-analysis. Head Neck 2024; 46:1224-1233. [PMID: 38414175 DOI: 10.1002/hed.27684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/28/2023] [Accepted: 02/03/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Traditionally, patients undergoing free flap reconstruction for oral cavity defects have been given nothing by mouth for 6-14 days post-operatively due to concern for orocutaneous fistula development. METHODS Multiple databases were screened for studies assessing the rate of orocutaneous fistula formation in early (≤5 days) versus late (>5 days) feeding groups following oral cavity free flap reconstruction. Fixed- and random-effects meta-analyses were used. RESULTS One randomized controlled trial, one prospective cohort, and three retrospective cohort studies were included. The early feeding group displayed no significant increase in orocutaneous fistula formation (RD = -0.02, p = 0.06) or free flap failure (RD = -0.01, p = 0.39), with a significantly shorter hospital length of stay (mean difference [days] = -2.43, p < 0.01). CONCLUSIONS While further prospective trials are necessary, initiation of oral intake before post-operative day 5 may be appropriate in properly selected patients following oral reconstruction.
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Affiliation(s)
- Joshua Barlow
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zara Sragi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nina Rodriguez
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathilda Alsen
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Catharine Kappauf
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rocco Ferrandino
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susmita Chennareddy
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Tamar Kotz
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marita S Teng
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Laitman BM, Charytonowicz D, Zhu AJ, Lynch K, Varelas EA, Burton M, Andreou C, Kore P, Kirke DN, Chen YW, Beaumont KG, Sebra R, Genden EM, Courey MS. High-Resolution Profiling of Human Vocal Fold Cellular Landscapes With Single-Nuclei RNA Sequencing. Laryngoscope 2024. [PMID: 38415934 DOI: 10.1002/lary.31334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 12/28/2023] [Accepted: 01/23/2024] [Indexed: 02/29/2024]
Abstract
INTRODUCTION The function of the vocal folds (VFs) is determined by the phenotype, abundance, and distribution of differentiated cells within specific microenvironments. Identifying this histologic framework is crucial in understanding laryngeal disease. A paucity of studies investigating VF cellular heterogeneity has been undertaken. Here, we examined the cellular landscape of human VFs by utilizing single-nuclei RNA-sequencing. METHODS Normal true VF tissue was excised from five patients undergoing pitch elevation surgery. Tissue was snap frozen in liquid nitrogen and subjected to cellular digestion and nuclear extraction. Nuclei were processed for single-nucleus sequencing using the 10X Genomics Chromium platform. Sequencing reads were assembled using cellranger and analyzed with the scanpy package in python. RESULTS RNA sequencing revealed 18 global cell clusters. While many were of epithelial origin, expected cell types, such as fibroblasts, immune cells, muscle cells, and endothelial cells were present. Subcluster analysis defined unique epithelial, immune, and fibroblast subpopulations. CONCLUSION This study evaluated the cellular heterogeneity of normal human VFs by utilizing single-nuclei RNA-sequencing. With further confirmation through additional spatial sequencing and microscopic imaging, a novel cellular map of the VFs may provide insight into new cellular targets for VF disease. LEVEL OF EVIDENCE NA Laryngoscope, 2024.
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Affiliation(s)
- Benjamin M Laitman
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | | | - Ashley J Zhu
- Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Katie Lynch
- Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Eleni A Varelas
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Madeline Burton
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Christina Andreou
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Pragati Kore
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Diana N Kirke
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Ya-Wen Chen
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Kristin G Beaumont
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Robert Sebra
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Eric M Genden
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
| | - Mark S Courey
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, New York, 10029, U.S.A
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Kirke DN, Sinclair CF. Recurrent Laryngeal Nerve Monitoring: Nuts and Bolts. Otolaryngol Clin North Am 2024; 57:53-61. [PMID: 37684153 DOI: 10.1016/j.otc.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Intraoperative neuromonitoring (IONM) of the laryngeal nerves has become an important tool for neck endocrine surgery. In this article, the authors review the current evidence behind its use in neck endocrine procedures. The subtypes of IONM, including intermittent IONM, continuous vagal IONM (vagal-CIONM), and laryngeal adductor reflex CIONM, will be discussed. Finally, the authors review recent advances in IONM, and how standardization of outcomes reporting will help minimise conjecture regarding the usefulness of IONM.
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Affiliation(s)
- Diana N Kirke
- Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1189, Annenberg 10-40, New York, NY 10029, USA
| | - Catherine F Sinclair
- Department of Surgery, Monash University, Melbourne, Victoria, Australia; Department of Otolaryngology - Head & Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Melbourne Thyroid Surgery, 159 Wattletree Road, Malvern, Victoria 3144, Australia.
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Bloom JR, Rodriguez-Russo C, Hsieh K, Dickstein DR, Sheu RD, Jain M, Moshier E, Liu J, Gupta V, Kirke DN, Roof S, Misiukiewicz K, Posner M, Bakst R, Sindhu KK, Sharma S. Head and Neck Cancer Patient Population, Management, and Oncologic Outcomes from the COVID-19 Pandemic. Curr Oncol 2024; 31:436-446. [PMID: 38248114 PMCID: PMC10814981 DOI: 10.3390/curroncol31010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/02/2024] [Accepted: 01/05/2024] [Indexed: 01/23/2024] Open
Abstract
The COVID-19 pandemic precipitated drastic changes in cancer care. Its impact on the U.S. head and neck cancer population has yet to be fully understood. This study aims to understand the impact of pandemic-related changes on the head and neck cancer population. An observational study of head and neck cancer patients at a single institution during the spring of 2020 and 2019 was performed. Clinical characteristics and survival outcomes were analyzed. In 2020, 54 head and neck cancer patients were evaluated in the department of radiation oncology vs. 74 patients seen in 2019; 42% of the patients were female in 2019 versus 24% in 2020 (p = 0.036). The median follow-up time was 19.4 and 31 months for 2020 and 2019, respectively. After adjusting for stage, the relapse-free survival probability at 6 and 12 months was 79% and 69% in 2020 vs. 96% and 89% in 2019, respectively (p = 0.036). There was no significant difference in the overall survival, with 94% and 89% in 2020 and 2019, respectively (p = 0.61). Twenty-one percent of patients received induction chemotherapy in 2020 versus 5% in 2019 (p = 0.011); significantly more treatment incompletions occurred in 2020, 9% vs. 0% in 2019 (p = 0.012). Moreover, the stage-adjusted RFS differed between cohorts, suggesting head and neck cancer patients seen during the initial wave of COVID-19 may experience worse oncologic outcomes.
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Affiliation(s)
- Julie R. Bloom
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Carlos Rodriguez-Russo
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kristin Hsieh
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Daniel R. Dickstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Ren-Dih Sheu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Mayuri Jain
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Erin Moshier
- Department of Population Health Science and Policy, Tisch Cancer Institute Biostatistics Shared Resource Facility, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jerry Liu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Vishal Gupta
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Scott Roof
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Krzysztof Misiukiewicz
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Marshall Posner
- Department of Hematology/Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn School of Medicine at Mount Sinai, Tisch Cancer Institute, New York, NY 10029, USA
| | - Richard Bakst
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Kunal K. Sindhu
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA (K.K.S.)
| | - Sonam Sharma
- Department of Radiation Oncology, Summit Health, Berkeley Heights, NJ 07922, USA
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Barlow J, Sragi Z, Rivera-Rivera G, Al-Awady A, Daşdöğen Ü, Courey MS, Kirke DN. The Use of Deep Learning Software in the Detection of Voice Disorders: A Systematic Review. Otolaryngol Head Neck Surg 2024. [PMID: 38168017 DOI: 10.1002/ohn.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To summarize the use of deep learning in the detection of voice disorders using acoustic and laryngoscopic input, compare specific neural networks in terms of accuracy, and assess their effectiveness compared to expert clinical visual examination. DATA SOURCES Embase, MEDLINE, and Cochrane Central. REVIEW METHODS Databases were screened through November 11, 2023 for relevant studies. The inclusion criteria required studies to utilize a specified deep learning method, use laryngoscopy or acoustic input, and measure accuracy of binary classification between healthy patients and those with voice disorders. RESULTS Thirty-four studies met the inclusion criteria, with 18 focusing on voice analysis, 15 on imaging analysis, and 1 both. Across the 18 acoustic studies, 21 programs were used for identification of organic and functional voice disorders. These technologies included 10 convolutional neural networks (CNNs), 6 multilayer perceptrons (MLPs), and 5 other neural networks. The binary classification systems yielded a mean accuracy of 89.0% overall, including 93.7% for MLP programs and 84.5% for CNNs. Among the 15 imaging analysis studies, a total of 23 programs were utilized, resulting in a mean accuracy of 91.3%. Specifically, the twenty CNNs achieved a mean accuracy of 92.6% compared to 83.0% for the 3 MLPs. CONCLUSION Deep learning models were shown to be highly accurate in the detection of voice pathology, with CNNs most effective for assessing laryngoscopy images and MLPs most effective for assessing acoustic input. While deep learning methods outperformed expert clinical exam in limited comparisons, further studies integrating external validation are necessary.
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Affiliation(s)
- Joshua Barlow
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Zara Sragi
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Gabriel Rivera-Rivera
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Abdurrahman Al-Awady
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Ümit Daşdöğen
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Mark S Courey
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
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6
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Gilja S, Barlow J, Kumar A, Berger MH, Khan MN, Kirke DN, Roof SA. Evaluating depth of invasion across oral cavity subsites as part of the AJCC 8th edition T staging criteria for oral cavity squamous cell carcinoma. Head Neck 2023; 45:2780-2788. [PMID: 37698539 DOI: 10.1002/hed.27497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The prognostic impact of depth of invasion (DOI) in American Joint Committee on Cancer 8th edition TNM staging for oral cavity squamous cell carcinoma (OCSCCa) across oral cavity subsites is unknown. METHODS Overall survival of patients with pT1-4a OCSCCa in the National Cancer Database (2010-2017), stratified by tumor size and DOI across eight oral cavity subsites, was evaluated using multivariable-adjusted Cox proportional hazards modeling. RESULTS When stratified by tumor size ≤2 cm and >2 cm, DOI >5 mm and DOI >10 mm were only associated with worse overall survival, respectively, for tumors of the oral tongue (Tumor size ≤2 cm, DOI >5 mm v DOI ≤5 mm: HR: 1.31, 95% CI: 1.12-1.53, p < 0.001; Tumor size >2 cm, DOI >10 mm v DOI ≤10 mm: HR: 1.15, 95% CI: 1.01-1.30, p = 0.03). DOI >5 mm and DOI >10 mm was not prognostic for any other tumor location. CONCLUSIONS These findings suggest that the current staging schema for DOI in OCSCCa may not be prognostic across all oral cavity subsites.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Joshua Barlow
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael H Berger
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mohemmed N Khan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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7
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Gilja S, Kumar A, Vasan V, Roof SA, Genden EM, Kirke DN. The impact of undergoing surgical margin evaluation during endoscopic surgery for early-stage laryngeal squamous cell carcinoma. Head Neck 2023; 45:2680-2689. [PMID: 37642204 DOI: 10.1002/hed.27493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/19/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The impact of evaluating versus not evaluating surgical margins for early-stage laryngeal squamous cell carcinoma (LSCC) has not been evaluated. METHODS Overall survival was compared between patients who underwent endoscopic surgery for cT1-2, N0, M0 LSCC and had surgical margins evaluated versus not evaluated versus unevaluable in the National Cancer Database (2010-2019) using multivariable-adjusted Cox proportional hazards analyses. RESULTS 7597 patients met study eligibility criteria. 4123 (54.3%) patients underwent margin evaluation, 1631 (21.5%) did not undergo margin evaluation, and 1843 (24.3%) had unevaluable margins. Patients undergoing margin evaluation had better overall survival than patients who did not undergo margin evaluation (HR: 0.88, 95% CI: 0.78-1.00, p = 0.044) and patients with unevaluable margins (HR: 0.88, 95% CI: 0.78-0.98, p = 0.021). Patients undergoing margin evaluation received significantly less adjuvant radiation. CONCLUSIONS Surgical margin evaluation is an important prognostic factor for patients receiving endoscopic surgery for early-stage LSCC and should be conducted whenever possible.
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Affiliation(s)
- Shivee Gilja
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arvind Kumar
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vikram Vasan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Scott A Roof
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Eric M Genden
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Rapoport SK, Basharat U, Kirke DN, Courey MS. Positive Predictive Value of Endoscopic Findings to Diagnose Vocal Fold Paresis. Laryngoscope 2022. [PMID: 36259753 DOI: 10.1002/lary.30412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/04/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Laryngoscopy corresponding with laryngeal electromyography (LEMG) is essential in diagnosing vocal fold paresis. However, baseline asymmetry or other diseases oftentimes confound the exam, making diagnosis difficult. There is currently no agreed upon endoscopic criteria proven to reliably correlate with LEMG findings. We define a set of endoscopic findings termed "paresis triad" that, when present together, reliably correlate with LEMG. The paresis triad consists of (1) hypocontraction of the weak side of the larynx with increased ventricular show, (2) hypercontraction of the intact side with bulging of the false fold covering the ventricle, and (3) tilting of the interarytenoid cleft to the weak side. METHODS We performed a retrospective review of patients with laryngeal asymmetry on laryngoscopy. Patients were divided into two groups: those with consistent paresis triad findings across all pitches and intensities, and those without. All patients underwent LEMG by a neurolaryngologist blinded to the laryngoscopic findings. The endoscopies were then rereviewed in a blinded manner by a second laryngologist to assess inter- and intrarater reliability for identification of the triad. RESULTS Twelve patients met inclusion criteria (age 50 +/-15, 7F:5M). Nine had the paresis triad. Three had an inconsistent triad. All patients with the paresis triad had LEMG findings consistent with neurologic injury on the suspected side. All patients with inconsistent triad findings had normal LEMG. CONCLUSIONS Our findings suggest the proposed laryngoscopic paresis triad may be useful objective criteria to diagnose paresis without the need for LEMG. Further prospective studies should examine a larger series of patients. LEVEL OF EVIDENCE 4 Laryngoscope, 2022.
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Affiliation(s)
- Sarah K Rapoport
- Department of Otolaryngology Head & Neck Surgery, Medstar Georgetown University Hospital, Washington, DC, USA.,Department of Surgery, Division of Otolaryngology, Washington DC Veteran Affairs Medical Center, Washington, DC, USA
| | - Usmaan Basharat
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diana N Kirke
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mark S Courey
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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9
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Allisan‐Arrighi AE, Rapoport SK, Laitman BM, Bahethi R, Mori M, Woo P, Genden E, Courey M, Kirke DN. Long‐term upper aerodigestive sequelae as a result of infection with
COVID
‐19. Laryngoscope Investig Otolaryngol 2022; 7:476-485. [PMID: 35434347 PMCID: PMC9008172 DOI: 10.1002/lio2.763] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/06/2021] [Accepted: 01/31/2022] [Indexed: 01/14/2023] Open
Abstract
Objectives Respiratory, voice, and swallowing difficulties after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) may result secondary to upper airway disease from prolonged intubation or mechanisms related to the virus itself. We examined a cohort who presented with new laryngeal complaints following documented SARS‐CoV‐2 infection. We characterized their voice, airway, and/or swallowing symptoms and reviewed the clinical course of their complaints to understand how the natural history of these symptoms relates to COVID‐19 infections. Methods Retrospective review of patients who presented to our department with upper aerodigestive complaints as sequelae of prior infection with, and management of, SARS‐CoV‐2. Results Eighty‐one patients met the inclusion criteria. Median age was 54.23 years (±17.36). Most common presenting symptoms were dysphonia (n = 58, 71.6%), dysphagia/odynophagia (n = 16, 19.75%), and sore throat (n = 9, 11.11%). Thirty‐one patients (38.27%) presented after intubation. Mean length of intubation was 16.85 days (range 1–35). Eighteen patients underwent tracheostomy and were decannulated after an average of 70.69 days (range 23–160). Patients with history of intubation were significantly more likely than nonintubated patients to be diagnosed with a granuloma (8 vs. 0, respectively, p < .01). Fifty patients (61.73%) were treated for SARS‐CoV‐2 without requiring intubation and were significantly more likely to be diagnosed with muscle tension dysphonia (19 vs. 1, p < .01) and laryngopharyngeal reflux (18 vs. 1, p < .01). Conclusion In patients with persistent dyspnea, dysphonia, or dysphagia after recovering from SARS‐CoV‐2, early otolaryngology consultation should be considered. Accurate diagnosis and prompt management of these common underlying etiologies may improve long‐term patient outcomes. Level of evidence 4
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Affiliation(s)
- Annie E. Allisan‐Arrighi
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Sarah K. Rapoport
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Benjamin M. Laitman
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Rohini Bahethi
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Matthew Mori
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Peak Woo
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Eric Genden
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Mark Courey
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
| | - Diana N. Kirke
- Department of Otolaryngology Head and Neck Surgery Icahn School of Medicine at Mount Sinai New York New York USA
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Chang J, Brown SK, Hwang C, Kirke DN, Goldberg L. Predictive values of static endoscopic evaluation of swallowing in adults. Laryngoscope Investig Otolaryngol 2021; 6:1383-1388. [PMID: 34938878 PMCID: PMC8665454 DOI: 10.1002/lio2.615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Static endoscopic evaluation of swallowing (SEES) is an instrumental evaluation developed for in-office identification of patients who may benefit from a modified barium swallow study (MBSS). We aim to determine the predictive value of SEES for evaluating dysphagia. METHODS A retrospective case series was performed on adults evaluated for dysphagia using SEES followed by MBSS at a single tertiary care center. Studies were evaluated by two blinded expert raters. RESULTS Fifty-eight patients were included. Thin liquid penetration on SEES had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 0.86 (95% CI 0.70-0.95), 0.63 (95% CI 0.24-0.91), 0.91 (95% CI 0.76-0.98), and 0.5 (0.19-0.81), respectively, for predicting thin liquid penetration on MBSS, and 1.0 (95% CI 0.59-1.0), 0.29 (95% CI 0.15-0.47), 0.23 (95% CI 0.10-0.41), and 1.0 (95% CI 0.69-1.0) for predicting thin liquid aspiration on MBSS. Thin liquid aspiration on SEES had a sensitivity, specificity, PPV, and NPV of 0.67 (95% CI 0.09-0.99), 0.85 (95% CI 0.66-0.96), 0.33 (95% CI 0.04-0.78), and 0.96 (95% CI 0.79-1.0), respectively, for predicting thin liquid aspiration on MBSS. CONCLUSIONS SEES may be used as an objective in-office test to screen for aspiration and penetration. Thin liquid penetration on SEES is moderately sensitive for predicting penetration on MBSS. Absence of thin liquid penetration or aspiration on SEES has a high NPV for excluding aspiration on MBSS. Abnormalities on SEES or the need to view the entire swallowing mechanism should prompt an MBSS for a more complete evaluation of dysphagia.Level of Evidence: 4.
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Affiliation(s)
- Joseph Chang
- The Permanente Medical Group, Department of Head and Neck Surgery, Kaiser Permanente Santa ClaraSanta ClaraCaliforniaUSA
| | - Sarah K. Brown
- Department of Otolaryngology—Head and Neck Surgery, Division of Laryngology, Mount Sinai Health SystemNew YorkNew YorkUSA
| | - Chaewon Hwang
- Rutgers Robert Wood Johnson Medical SchoolNew BrunswickNew JerseyUSA
| | - Diana N. Kirke
- Department of Otolaryngology—Head and Neck Surgery, Division of Laryngology, Mount Sinai Health SystemNew YorkNew YorkUSA
| | - Leanne Goldberg
- Department of Otolaryngology—Head and Neck Surgery, Division of Laryngology, Mount Sinai Health SystemNew YorkNew YorkUSA
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11
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Rapoport SK, Kirke DN. How can we make better decisions about dystonic voice management? Curr Opin Otolaryngol Head Neck Surg 2021; 29:445-450. [PMID: 34670256 DOI: 10.1097/moo.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The optimal diagnosis and management of dystonic voice disorders are rooted in the nuanced understanding of their phenomenology. Distinguishing between subtypes of vocal dystonia is challenging, not only because the audible and physical presentations of these dystonia's can seem similar, but also because there is a lack of scientific consensus regarding the diagnostic criteria for these conditions. To help improve the clinician's acumen we focus on outlining the classification of the top three neurological voice disorders, notably: spasmodic dysphonia, (2) spasmodic dysphonia with tremor, and essential tremor of the voice. We also provide an algorithmic approach based on current evidence-based literature to guide practitioners through the clinical diagnosis and management of each possible etiology. RECENT FINDINGS Much remains unknown about the subtypes of vocal dystonia, and this gap in our knowledge likely limits our ability to advance clinical management. Still, continued experience evaluating and treating these patients yields refined clinical evaluations and decision making. SUMMARY Improvements in our clinical decision-making can be made by acknowledging that our limited understanding of vocal dystonia may hinder what therapeutic interventions we can offer, yet our ability to accurately diagnose the dystonia is central to providing optimal patient management.
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Affiliation(s)
- Sarah K Rapoport
- Department of Otolaryngology Head and Neck Surgery, Georgetown University Medical Center, Washington, DC
| | - Diana N Kirke
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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12
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Kinberg EC, Kirke DN, Trosman SJ. Modernizing the Otolaryngology Referral Workflow: The Impact of Electronic Consultation. Laryngoscope 2020; 131:E1792-E1796. [PMID: 33320360 DOI: 10.1002/lary.29333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/19/2020] [Accepted: 12/08/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the impact of electronic consultation on the otolaryngology clinic workflow at our high-volume public hospital. STUDY DESIGN Retrospective Observational Study. METHODS This is a retrospective observational analysis study. Operational data regarding clinic volume, referral patterns, and scheduling efficiency were assessed over a 9-month period in 2018 prior to implementation of electronic consultation. The same data were collected for the 9-month period immediately following implementation of electronic consultation in 2019. RESULTS During the pre-implementation (pre-EC) period, 3,243 otolaryngology referrals were made as compared to 4,249 post-implementation (post-EC). 86% of referrals were scheduled for a clinic appointment pre-EC, compared to 61% post-EC (P < .00001) 24.5% of patients were evaluated within 30 days pre-EC compared to 53.6% post-EC (P < .00001). The average time to be seen by an otolaryngology provider declined from 60.8 days pre-EC to 42.8 days post-EC (P = .0029). There was a 50% decline in the percentage of appointments canceled by patients in the post-EC period as compared to pre-EC. CONCLUSIONS In our experience, implementation of electronic consultation significantly reduced both wait times for a clinic appointment and the percentage of no-show or canceled appointments. Electronic consultation may be a valuable tool in improving the efficiency and yield of the modern otolaryngology clinic. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1792-E1796, 2021.
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Affiliation(s)
- Eliezer C Kinberg
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Diana N Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, New York City Health and Hospital System, Elmhurst Hospital, New York, New York, U.S.A
| | - Samuel J Trosman
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A.,Department of Otolaryngology-Head and Neck Surgery, New York City Health and Hospital System, Elmhurst Hospital, New York, New York, U.S.A
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13
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Kirke DN, Sulica L. The Natural History of Vocal Fold Cysts. Laryngoscope 2019; 130:2202-2207. [DOI: 10.1002/lary.28377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Diana N. Kirke
- Department of Otolaryngology Head and Neck SurgeryIcahn School of Medicine at Mount Sinai New York New York U.S.A
| | - Lucian Sulica
- Sean Parker Institute for the Voice, Department of Otolaryngology–Head and Neck SurgeryWeill Cornell Medical College New York New York U.S.A
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14
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Kirke DN, Kaye R, Blitzer A. Impact of an Upper Respiratory Tract Infection on Botulinum Toxin Efficacy in Spasmodic Dysphonia Patients. Laryngoscope 2019; 130:1746-1749. [PMID: 31508822 DOI: 10.1002/lary.28283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 08/03/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine whether the presence of a concomitant upper respiratory tract infection (URI) impacts upon Botulinum toxin (BoNT) efficacy in spasmodic dysphonia (SD) patients. STUDY DESIGN Case series and literature review. METHODS All SD patients with a concurrent URI, presenting for BoNT therapy at a clinical research center from November 2016 to December 2017 were included. A total of 12 patients were identified. Patients were followed for at least two BoNT treatment cycles (approximately 6 months). The primary outcome measure was efficacy of the initial BoNT injection and the secondary outcome measure was the efficacy of the subsequent BoNT injection. RESULTS All subjects had adductor type SD (ADSD). There were 10 females and two males with a median age of 55 years (±19.5). All patients were well established on a consistent BoNT treatment regime, with an average administered dose of 1.0 unit (range 0.2-1.80 units). Bilateral injections were administered to 10 patients. Regarding the primary outcome measure, five failed to have any response to BoNT (41.7%), four had a partial response (33.3%), and three had a positive response to treatment (25.0%). When patients had their follow-up injection in the absence of URI symptoms, 11 patients had a positive response to treatment (91.7%). CONCLUSION While the interplay between illness and BoNT efficacy is yet to be elucidated, we report that some patients are affected. We recommend that SD patients presenting for BoNT administration with a concomitant URI, should be counseled that their treatment might have decreased effect. LEVEL OF EVIDENCE 4 Laryngoscope, 130:1746-1749, 2020.
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Affiliation(s)
- Diana N Kirke
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Rachel Kaye
- Department of Otolaryngology, Rutgers New Jersey Medical School, Newark, New Jersey, U.S.A
| | - Andrew Blitzer
- Head and Neck Surgical Group, New York Center for Voice and Swallowing Disorders, New York, New York, U.S.A.,Department of Otolaryngology Head & Neck Surgery, Columbia University College of Physicians & Surgeons, New York, New York, U.S.A
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15
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Rubin SJ, Wu KY, Kirke DN, Ezzat WH, Truong MT, Salama AR, Jalisi S. Head and Neck Cancer Complications in the Geriatric Population Based on Hospital Case Volume. Ear Nose Throat J 2019; 100:NP62-NP68. [PMID: 31170822 DOI: 10.1177/0145561319856006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To determine whether surgical case volume is a predictive factor of surgical outcomes when managing geriatric patients with head andneck cancer. METHODS A cross-sectional study design was used. Data were obtainedfrom the Vizient Database, which included a total of 93 academicinstitutions. Men and women aged between 65 and 100 years undergoing head and neck cancer surgery during 2009 and 2012,excluding cases of thyroid cancer and skin cancer of the head and neck(n = 4544) were included in the study. Hospital case volume was definedas low (≤21 cases/year), moderate (22-49 cases/year), or high (≥50 cases/year). The frequency of comorbidities and complications wasmeasured by hospital case volume using a χ2 test. Significancewas determined with an α level of .05. RESULTS The largest number of head and neck cancer cases involving comorbidities (90.54%) and the highest rate of overall complications(27.50%) occurred in moderate case volume institutions compared to athe complication rate of 22.89% in low volume hospitals and 21.50% in highvolume hospitals (P < .0001). The most common comorbidities across all3 hospital case volumes included hypertension, metastatic cancer,and chronic pulmonary disease and the most common complicationsincluded hemorrhage/hematoma and postoperative pulmonarycompromise. CONCLUSION With more geriatric patients requiring surgery for head andneck cancer, it would be beneficial to manage the more complex cases at high volume centers and to develop multidisciplinary teams to optimizecase management and minimize complications.
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Affiliation(s)
- Samuel J Rubin
- Department of Otolaryngology - Head and Neck Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Kevin Y Wu
- Department of Otolaryngology - Head and Neck Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, 5944Mount Sinai Health System, New York, NY, USA
| | - Waleed H Ezzat
- Department of Otolaryngology - Head and Neck Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Minh Tam Truong
- Department of Radiation Oncology, 1836Boston Medical Center, Boston, MA, USA
| | - Andrew R Salama
- Department of Oral and Maxillofacial Surgery, 1836Boston Medical Center, Boston, MA, USA
| | - Scharukh Jalisi
- Division of Otolaryngology - Head and Neck Surgery, 1859Beth Israel Deaconess Medical Center, Boston, MA, USA
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16
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Abstract
A 65-year-old female presented with a foreign body sensation following an asthmatic attack associated with severe coughing. Six years earlier, the patient underwent medialization laryngoplasty (ML), which was complicated by a small tear (2 mm) in the right ventricle. One year following this, the patient developed Gore-Tex extrusion but elected only for partial removal. Healing was complete until 5 years later; on examination, the patient had evidence of Gore-Tex extrusion through the right ventricle. Implant extrusion is a recognized complication of ML. This case demonstrates several important surgical steps that can benefit otolaryngologists at all stages of their surgical career. Laryngoscope, 129:1420-1422, 2019.
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Affiliation(s)
- Diana N Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Andrew Blitzer
- Head and Neck Surgical Group, New York, New York, U.S.A.,Department of Otolaryngology- Head and Neck Surgery, Columbia University College of Physicians and Surgeons, New York, New York, U.S.A
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17
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Kirke DN, Qureshi MM, Kamran SC, Ezzat W, Jalisi S, Salama A, Everett PC, Truong MT. Role of adjuvant chemoradiotherapy in T4N0 stage IV head and neck cancer: A National Cancer Database analysis. Head Neck 2018; 40:1174-1184. [PMID: 29417687 DOI: 10.1002/hed.25087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/04/2017] [Accepted: 12/20/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the role of postoperative adjuvant radiotherapy (surgery + adjuvant RT) versus adjuvant chemoradiotherapy (surgery + adjuvant CRT) in patients with T4N0M0, stage IV head and neck squamous cell carcinoma (HNSCC). METHODS Between 1998 and 2011, 3518 and 885 patients were treated with surgery + adjuvant RT and surgery + adjuvant CRT, respectively. Three-year overall survival (OS) rates were determined and crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were computed. RESULTS Median follow-up was 41.8 months with 2193 reported deaths. The 3-year OS was 67.5% for surgery + adjuvant RT and 70.5% for surgery + adjuvant CRT (P = .013). For negative margins, the corresponding 3-year OS was 70.1% and 74.9% (P = .005). For positive margins, the corresponding 3-year OS was 56.0% and 60.6% (P = .079). On multivariate analysis, the beneficial effect for adjuvant CRT over adjuvant RT was not significant (HR 0.90; CI 0.79-1.03; P = .124). CONCLUSION In this cohort of patients with T4N0 HNSCC treated with surgery, there was no observed survival benefit of adjuvant CRT over adjuvant RT on multivariate analysis.
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Affiliation(s)
- Diana N Kirke
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Muhammad M Qureshi
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts
| | | | - Waleed Ezzat
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Scharukh Jalisi
- Department of Otolaryngology - Head and Neck Surgery, Boston Medical Center, Boston, Massachusetts
| | - Andrew Salama
- Department of Oral and Maxillofacial Surgery, Boston Medical Center, Boston, Massachusetts
| | - Peter C Everett
- Division of Hematology Oncology, Department of Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center, Boston, Massachusetts
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18
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Rubin SJ, Kirke DN, Ezzat WH, Truong MT, Salama AR, Jalisi S. Marital status as a predictor of survival in patients with human papilloma virus-positive oropharyngeal cancer. Am J Otolaryngol 2017; 38:654-659. [PMID: 28947344 DOI: 10.1016/j.amjoto.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/16/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Determine whether marital status is a significant predictor of survival in human papillomavirus-positive oropharyngeal cancer. MATERIALS AND METHODS A single center retrospective study included patients diagnosed with human papilloma virus-positive oropharyngeal cancer at Boston Medical Center between January 1, 2010 and December 30, 2015, and initiated treatment with curative intent at Boston Medical Center. Demographic data and tumor-related variables were recorded. Univariate analysis was performed using a two-sample t-test, chi-squared test, Fisher's exact test, and Kaplan Meier curves with a log rank test. Multivariate survival analysis was performed using a Cox regression model. RESULTS A total of 65 patients were included in the study with 24 patients described as married and 41 patients described as single. There was no significant difference in most demographic variables or tumor related variables between the two study groups, except single patients were significantly more likely to have government insurance (p=0.0431). Furthermore, there was no significant difference in 3-year overall survival between married patients and single patients (married=91.67% vs single=87.80%; p=0.6532) or 3-year progression free survival (married=79.17% vs single=85.37%; p=0.8136). After adjusting for confounders including age, sex, race, insurance type, smoking status, treatment, and AJCC combined pathologic stage, marital status was not a significant predictor of survival [HR=0.903; 95% CI (0.126,6.489); p=0.9192]. CONCLUSIONS Although previous literature has demonstrated that married patients with head and neck cancer have a survival benefit compared to single patients with head and neck cancer, we were unable to demonstrate the same survival benefit in a cohort of patients with human papilloma virus-positive oropharyngeal cancer.
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19
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Wong K, Gilad A, Cohen MB, Kirke DN, Jalisi SM. Patient education materials assessment tool for laryngectomy health information. Head Neck 2017; 39:2256-2263. [DOI: 10.1002/hed.24891] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/16/2017] [Accepted: 06/16/2017] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kevin Wong
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
| | - Amir Gilad
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
| | - Michael B. Cohen
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
- Division of Otolaryngology; Department of Surgery, Veterans' Affairs Boston Healthcare System; Boston Massachusetts
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
| | - Scharukh M. Jalisi
- Department of Otolaryngology-Head and Neck Surgery; Boston University Medical Center; Boston Massachusetts
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20
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Jalisi S, Rubin SJ, Wu KY, Kirke DN. Outcomes of head and neck cancer surgery in the geriatric population based on case volume at academic centers. Laryngoscope 2017; 127:2539-2544. [DOI: 10.1002/lary.26750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/06/2017] [Accepted: 05/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Scharukh Jalisi
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Samuel J. Rubin
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Kevin Y. Wu
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
| | - Diana N. Kirke
- Department of Otolaryngology-Head and Neck Surgery; Boston Medical Center; Boston Massachusetts U.S.A
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21
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Rubin SJ, Cohen MB, Kirke DN, Qureshi MM, Truong MT, Jalisi S. Comparison of facility type outcomes for oral cavity cancer: Analysis of the national cancer database. Laryngoscope 2017; 127:2551-2557. [DOI: 10.1002/lary.26632] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Samuel J. Rubin
- Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Michael B. Cohen
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
- Division of Otolaryngology, Department of Surgery; VA Boston Healthcare System; Boston Massachusetts U.S.A
| | - Diana N. Kirke
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
| | - Muhammad M. Qureshi
- Department of Radiation Oncology, Boston Medical Center; Boston Massachusetts U.S.A
| | - Minh Tam Truong
- Department of Radiation Oncology, Boston Medical Center; Boston Massachusetts U.S.A
- Boston University School of Medicine; Boston Massachusetts U.S.A
| | - Scharukh Jalisi
- Department of Otolaryngology Head and Neck Surgery; Boston Massachusetts U.S.A
- Boston University School of Medicine; Boston Massachusetts U.S.A
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22
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Kirke DN, Chitguppi C, Rubin SJ, Truong MT, Jalisi S. Adenoid cystic carcinoma of the base of tongue: A population-based study. Am J Otolaryngol 2017; 38:279-284. [PMID: 28173954 DOI: 10.1016/j.amjoto.2017.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 01/17/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND The objective was to assess demographic and survival patterns in patients with adenoid cystic carcinoma of the base of tongue. METHODS Patients were extracted from the Surveillance, Epidemiology and End Results (SEER) database from 1973 through 2012 and were categorized by age, gender, race, historical stage A, and treatment. Incidence and survival were compared with Kaplan Meier curves and mortality hazard ratios. RESULTS A total of 216 patients were included. After adjusting for age, gender, race and tumor-directed treatment, patients over the age of 70years had a significantly increased mortality [HR=2.847, 95% CI (1.499, 5.404) p=0.0014]. Furthermore mortality among patients with distant disease was significantly increased [HR=2.474 95% CI (1.459, 4.195) p=0.00008]. CONCLUSION By examining the largest collection of patients we have demonstrated that there is a significant difference in mortality based on both the age at diagnosis and in the setting of distant disease.
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23
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Kirke DN, Owen RP, Carrao V, Miles BA, Kass JI. Using 3D computer planning for complex reconstruction of mandibular defects. Cancers Head Neck 2016; 1:17. [PMID: 31093346 PMCID: PMC6460653 DOI: 10.1186/s41199-016-0019-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/21/2016] [Indexed: 01/06/2023]
Abstract
For complex reconstruction of osseous defects of the head and neck, three-dimensional (3D) computer planning has been available for over 20 years. However, despite its availability and recent refinements, it is a technology that has not been widely adopted. While 3D computer planning has been proposed to improve surgical precision, reduce operating time and enhance functional outcomes, the objective evidence supporting these claims is limited. Here we review the recent literature that supports the use of 3D computer planning for complex osseous defects of the mandible. We highlight a case example where 3D modeling played a critical role, particularly during the virtual surgical planning stage. Finally, we propose that routine post-operative 3D analysis become an essential element in determining operative success. Critical evaluation of outcomes will better define its use in complex reconstruction of osseous defects.
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Affiliation(s)
- Diana N Kirke
- 1Department of Otolaryngology Head & Neck Surgery, Boston Medical Center, Boston, MA USA
| | - Randall P Owen
- 2Departments of General Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Vincent Carrao
- 3Oral & Maxillofacial Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Brett A Miles
- 4Otolaryngology Head & Neck Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Jason I Kass
- 1Department of Otolaryngology Head & Neck Surgery, Boston Medical Center, Boston, MA USA.,5Department of Surgery, VA Boston Healthcare System, Jamaica Plain, 150 South Huntington Avenue, Boston, MA 02130 USA
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24
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Kirke DN, Porceddu S, Wallwork BD, Panizza B, Coman WB. Pathologic Occult Neck Disease in Patients With Metastatic Cutaneous Squamous Cell Carcinoma to the Parotid. Otolaryngol Head Neck Surg 2011; 144:549-51. [DOI: 10.1177/0194599810395361] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective. The aim of this study was to document the rate of pathologic neck disease in patients presenting with metastatic cutaneous squamous cell carcinoma (CSCC) to the parotid gland following parotidectomy and neck dissection in the clinically and radiologic negative neck. Study Design. Case series with chart review. Setting. Tertiary referral center. Subjects and Methods. The study involved a retrospective chart review from 1999 to 2008 of patients presenting with metastatic CSCC to the parotid at the Princess Alexandra Hospital, Brisbane, Australia. Results. Eighty-one patients with metastatic parotid disease were identified. A total of 51 (63%) patients had no clinical or radiological evidence of cervical nodal disease. Forty-five patients (88%) were male, median age was 69 (range, 42-91) years, and the median follow-up was 16 (interquartile range, 9-44) months. Thirty-four of these patients underwent a parotidectomy and neck dissection with/without postoperative radiotherapy (RT). Occult pathological cervical nodal disease was found in 5 (14.7%) patients. Of those who received a neck dissection, 3 patients relapsed in the parotid, 1 in the neck alone, and 1 distantly. Conclusion. This series has shown that the rate of pathologically involved neck nodes in patients with metastatic CSCC to the parotid in the clinically node negative neck is low. Given many of these patients warrant postoperative RT to the parotid bed, an elective neck dissection may not be warranted as the parotid and neck may be treated in continuity with RT.
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Affiliation(s)
- Diana N. Kirke
- Department of Otolaryngology Head & Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Benjamin D. Wallwork
- Department of Otolaryngology Head & Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Benedict Panizza
- Department of Otolaryngology Head & Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - William B. Coman
- Department of Otolaryngology Head & Neck Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
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