Esophageal pathology in patients after treatment for head and neck cancer

OBJECTIVE: To determine the prevalence of esophageal pathology following treatment for primary head and neck cancer (HNCA).

STUDY DESIGN: Case series with planned data collection.

SETTING: Academic medical practice.

SUBJECTS AND METHODS: Subjects comprised HNCA survivors. Esophagoscopy was prospectively performed on 100 patients at least three months after treatment for HNCA. Patient demographics including cancer stage, cancer treatment, use of reflux medications, symptoms surveys, and esophageal findings were prospectively determined.

RESULTS: The mean age of the cohort was 64 (± 10) years; 75 percent were male. The mean time between the end of treatment and endoscopy was 40 (± 51) months. Eighty-one percent of HNCA was advanced stage (3 or 4). The distribution of site of the primary HNCA was as follows: oropharynx (38%), larynx (33%), oral cavity (17%), unknown primary (10%), hypopharynx (1%), and nasopharynx (1%). Treatment modalities included surgery alone (15%), surgery with radiation (34%), radiation alone (6%), chemoradiation alone (24%), and chemoradiation with surgery (20%). The findings on esophagoscopy included peptic esophagitis (63%), stricture (23%), candidiasis (9%), Barrett metaplasia (8%), gastritis (4%), and carcinoma (4%). Only 13 percent had a normal esophagoscopy.

CONCLUSION: Esophageal pathology is extremely common in patients treated for HNCA. These findings support routine esophageal screening after HNCA treatment.

© 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation. All rights reserved.

Validity and Reliability of the Eating Assessment Tool (EAT-10)

Objectives:

The Eating Assessment Tool is a self-administered, symptom-specific outcome instrument for dysphagia. The purpose of this study was to assess the validity and reliability of the 10-item Eating Assessment Tool (EAT-10).

Methods:

The investigation consisted of 4 phases: 1) line-item generation, 2) line-item reduction and reliability, 3) normative data generation, and 4) validity analysis. All data were collected prospectively. Internal consistency was assessed with the Cronbach alpha. Test-retest reliability was evaluated with the Pearson product moment correlation coefficient. Normative data were obtained by administering the instrument to a community cohort of healthy volunteers. Validity was assessed by administering the instrument before and after dysphagia treatment and by evaluating survey differences between normal persons and those with known diagnoses.

Results:

A total of 629 surveys were administered to 482 patients. The internal consistency (Cronbach alpha) of the final instrument was 0.960. The test-retest intra-item correlation coefficients ranged from 0.72 to 0.91. The mean (±SD) EAT-10 score of the normal cohort was 0.40 ± 1.01. The mean EAT-10 score was 23.58 ± 13.18 for patients with esophageal dysphagia, 23.10 ± 12.22 for those with oropharyngeal dysphagia, 9.19 ± 12.60 for those with voice disorders, 22.42 ± 14.06 for those with head and neck cancer, and 11.71 ± 9.61 for those with reflux. The patients with oropharyngeal and esophageal dysphagia and a history of head and neck cancer had a significantly higher EAT-10 score than did those with reflux or voice disorders (p < 0.001). The mean EAT-10 score of the patients with dysphagia improved from 19.87 ± 10.5 to 5.2 ± 7.4 after treatment (p < 0.001).

Conclusions:

The EAT-10 has displayed excellent internal consistency, test-retest reproducibility, and criterion-based validity. The normative data suggest that an EAT-10 score of 3 or higher is abnormal. The instrument may be utilized to document the initial dysphagia severity and monitor the treatment response in persons with a wide array of swallowing disorders.

Utilization of the LifeStat Emergency Airway Device

Objectives:

Management of the airway in an emergency may be a harrowing experience. The equipment necessary to perform this procedure is often inaccessible. The LifeStat emergency airway is a portable device approved by the US Food and Drug Administration in 1997 for emergency cricothyrotomy. It is small enough to secure to a keychain, thus allowing instantaneous access at all times. We present a retrospective case series to report the experience of clinicians who have used the LifeStat device.

Methods:

A survey instrument was sent to a convenience sample of health-care professionals who purchased the LifeStat emergency airway. The survey queried device use, user demographics, and the success, ease, complications, and location of use.

Results:

One thousand surveys were distributed, and 100 individuals responded. Fifteen percent (15 of 100) reported use of the device on 17 occasions. The LifeStat was used successfully in all 17 cases. Eighty-two percent (14 of 17) of emergency use was in hospitals. In all cases the device was positioned successfully on the first attempt. No complications were reported.

Conclusions:

The LifeStat device provides a relatively safe and effective means of performing emergency cricothyrotomy. The majority of emergency situations in which the device was deployed occurred in hospital settings.

Long-term outcome analysis of endoscopic sinus surgery for chronic sinusitis

BACKGROUND

The purpose of this study was to determine long-term subjective outcome of endoscopic sinus surgery (ESS) for chronic sinusitis (CS) and to evaluate prognostic indicators for surgical treatment failure.

METHODS

This is a prospective study of patients who underwent ESS for CS. Symptom assessment was performed using a visual analog scale at a pretreatment interview and then at regular intervals post-ESS for up to a 3-year period. The indicators for symptom scoring were nasal obstruction, facial pain, postnasal drip, anterior discharge, and anosmia/hyposmia.

RESULTS

Data analysis indicates that ESS improves symptom scoring early on, but the effects begin to dissipate over time. Anosmia/hyposmia is the most severe symptom overall for all patient subgroups and recurs to a greater degree 3 years postoperatively in Samter's Triad sufferers (p = 0.006), asthmatic patients (p = 0.002), and those with a worse CT scan at presentation (p = 0.04). In addition, Triad sufferers who complain of nasal obstruction and anterior nasal discharge have a significant recurrence of their symptoms postoperatively (p = 0.04 and 0.001, respectively).

CONCLUSION

Individuals must be warned that ESS may not be a long-term solution for CS because of its chronic nature. Patients are relieved of their symptoms initially; however, these tend to recur over a 3-year period. Samter's Triad is the strongest determinant of long-term treatment failure. Asthma also is a determinant of treatment failure, which lends credence to the notion of combined airway disease. Allergy was not a strong determinant of treatment failure in our study.

Sinonasal paraganglioma: endoscopic resection with a 4-year follow-up

BACKGROUND

Paragangliomas are uncommon neuroendocrine tumors. In the head and neck, they are most commonly seen at the carotid body, the temporal bone, or along the vagus nerve. Sinonasal paragangliomas are extremely rare. Most cases reported describe management by open surgical resection, with sublabial and/or transfacial approaches.

METHODS

We present a case of a large sinonasal paraganglioma successfully managed by endoscopic resection.

RESULTS

The patient has no evidence of recurrence after 4 years of follow-up.

CONCLUSIONS

This case demonstrates that sinonasal paragangliomas might be amenable to endoscopic resection. However, the most important priority to consider when selecting a surgical technique is whether adequate excision with clear margins can be obtained. Furthermore, because of the aggressive nature of these tumors, regardless of the surgical approach, long-term follow-up is recommended.