The histologic risk model is a useful and inexpensive tool to assess risk of recurrence and death in stage I or II squamous cell carcinoma of tongue and floor of mouth

Surgery is the mainstay of treatment for low-stage (stage I/II, ie, T1N0/T2N0) squamous cell carcinoma of oral cavity. However, a significant percentage of low-stage squamous cell carcinoma of oral cavity will develop local recurrence and disease-related mortality. In this study, we stratified 64 patients with low-stage of oral tongue and floor of mouth patients into high-, intermediate- and low-risk categories based on existing histologic risk model. The classification of these risk categories was based on presence or absence of perineural invasion and evaluation of tumor-host junction for worst pattern of invasion and lymphocytic host response. We correlated risk category and other variables with recurrence and death. In a univariate model, high-risk category tumors had a significantly higher rate of recurrence and death due to recurrence compared with low/intermediate-risk categories (P=0.000 and P=0.047, respectively). Controlling for margin status and T-stage, high-risk category had a 12.4 odds ratio of later recurrence when compared with low/intermediate-risk categories, with a P-value of 0.001. In conclusion, we found low-stage oral cavity squamous cell carcinoma patients with high-risk category have a significantly higher risk for recurrence when compared with patients in the low- or intermediate-risk category, even when controlling for margin status and T-stage. These patients may be suitable candidates for adjuvant treatment to decrease morbidity and mortality associated with a recurrence. Our results indicate that the histologic risk model is a useful and simple tool to assess risk of recurrence in stage I or II squamous cell carcinoma of oral cavity.

Patient preferences in early glottic cancer treatment

Patients with early-stage glottic cancer are primarily treated with one of three options: endoscopic laser excision, external-beam radiation, or open conservation surgery. We sought to determine patient preferences for treatment when presented with a choice between CO2 laser resection and radiation (open conservation surgery was not offered because the endoscopic approach is preferred at our institution). This prospective cohort study was conducted at the Dalhousie University Faculty of Medicine in Halifax, Canada. Our patient population was made up of 54 men and 10 women, aged 30 to 84 years (mean: 65.0 ± 11.2). Their disease were staged as follows: carcinoma in situ, n = 11; T1a = 21; T1b = 6; and T2 = 26. Patients were quoted identical cure rates for the two treatment modalities. The controversial issue of voice outcomes was discussed, but no leading information was given to the study cohort. All 64 patients chose CO2 laser resection as opposed to radiation therapy for definitive treatment.

Can otoplasty impact hearing? A prospective randomized controlled study examining the effects of pinna position on speech reception and intelligibility

OBJECTIVES

Otoplasty is a commonly performed surgical procedure that restores the ideal position of the pinna. Although the pinna is a well-recognized component of the auditory apparatus, no studies have assessed the audiological effects of this procedure. We sought to quantify the impact of pinna repositioning on speech intelligibility and reception.

METHODS

Eighteen adults with normal hearing and pinnae were recruited and the pinna positions were randomized in each participant. Intracanal acoustical analysis was performed to calculate the Speech Intelligibility Index (SII). Hearing In Noise Test (HINT) with two azimuth speaker arrangement was also performed. The outcome measures were compared using paired t-tests for both pinna positions.

RESULTS

The SII significantly improved with the pinna in forward position (49.3 vs. 45.8, p<0.001). HINT thresholds also improved with the pinna forward (-6.43 dB vs. -5.08 dB, p=0.0003).

CONCLUSIONS

Pinna position affects audiological performance, in both speech intelligibility and speech reception in noise. These are novel findings that may impact the informed consent process and decision to treat for patients undergoing otoplasty.

Laryngology in Canada: results of a national survey

OBJECTIVE

Laryngology is a rapidly evolving and growing field in Canada. Recent technologies and trends, including endoscopic techniques, KTP and pulsed dye lasers, injection materials, and in-office procedures, are changing the nature and depth of services offered to patients. Our objective was to understand the current state of laryngology practice in Canada.

DESIGN

Survey.

SETTING

Adult laryngology practices in Canada.

METHODS

We identified otolaryngologists working in Canada who self-identified as having a significant laryngology practice. We then asked them to complete an anonymous survey, with questions regarding composition of practice time, endoscopic equipment, electromyography, vocal cord medialization techniques, laser technologies, and plans for the future.

MAIN OUTCOME MEASURES

Practice composition and use rates of available technology.

RESULTS

Ten of 11 respondents reported that laryngology represents at least 20% of their practice (mean  =  53%). All employed rigid laryngoscopy, stroboscopy, and exclusively CO2 laser. Six used distal chip endoscopes, whereas three perform transnasal esophagoscopy.

CONCLUSIONS

The survey results demonstrate that laryngology practice in Canada is approaching state of the art and that most laryngologists plan to increase the breadth and scope of their practice as newer technologies become available. Limited funding and national regulations limit the adoption of some cutting-edge techniques.