Christina Pflug

High‐sensitivity FEES with NBI‐illumination

INTRODUCTION Flexible endoscopic examination of swallowing (FEES) with colored bolus is a routine procedure to assess swallowing function and check for laryngeal penetration and aspiration of colored liquids and solid food. With this method, sometimes it is not easy to decide whether colored bolus can be seen when only small amounts are diffusely spread on the mucosa of the pharynx and larynx or when the colored bolus gets diluted and therefore cannot be seen with enough contrast. Especially coloring of the trachea, which indicates aspiration, might be overlooked because the bolus is too far away to be easily visualized and also because of image resolution and illumination. Narrow band imaging (NBI) is an image enhancement technology that normally is used to improve the visibility of superficial small vessels due to its strong absorption by hemoglobin. As a side effect of NBI illumination, the green color will turn red. This effect can be used in FEES. We describe a technique for enhancing bolus contrast and visualizing even the smallest amounts of penetrated or aspirated bolus. By coloring the bolus with green food colorant and using NBI, the bolus will change its color from green to red; moreover, an enormous contrast enhancement is elicited. Even very thin secretion layers containing food colorant are easily detectable. Thus, with this technique even minor laryngeal penetration and aspiration can be detected, and early treatment can help prevent aspiration pneumonia. MATERIALS AND METHOD Our routine procedure for FEES is bolus coloration using food colorant (light green, E 104 Chinolingelb 1 E 123 Indigotin I, Schreiber-Essenzen GmbH & Co. KG, Barsb€ uttel, Germany). We usually use one part of food colorant for two to three parts of water for liquids. With the new technique, we are able to dilute the bolus color by factor 10. For solid bolus, we add one scoop (15 mL) of instant food thickener to 50 to 100 mL green liquid for thickening of the bolus. While the flexible endoscope is placed transnasally (Flexible Video Endoscope ENT-VH, Olympus Medical Systems Corp., Tokyo, Japan), we ask the patient to swallow 1 teaspoon of liquid and solid bolus, respectively. During FEES, we use white light from preto postdeglutitive endoscopy. During the postdeglutitive respiratory phase, the illumination is switched to NBI mode. All videos are recorded on a Mac (iMac, Apple Inc., Cupertino, CA) for offline image analysis.

Drooling is no early sign of dysphagia in Parkinson′s disease

Dysphagia is frequent and clinically highly relevant in Parkinsons disease (PD). For a rational dysphagia screening predictors are required. Previous investigations suggested that drooling correlates with dysphagia and may serve as its early sign. The aim of this study was to clarify the interrelationship of drooling and dysphagia.

Lack of evidence for prognostic value of epidermal growth factor receptor intron-1 CA repeats for oral carcinomas.

Epidermal growth factor receptor (EGFR) expression is altered in several malignancies, including oral squamous cell carcinoma. A CA-repeat polymorphism in intron-1 (CA-SSR-1) of the EGFR gene is reported to influence EGFR expression and is associated with features of various solid tumors and outcomes of cancer patients. In the present study we evaluated the influence of length and zygosity of CA-SSR-1 on the survival of patients with oral squamous cell carcinoma. The length and zygosity of CA-SSR-1 was obtained through microsatellite analysis in 91 patients with oral cancer, who were treated in the Department of Oral and Maxillofacial Surgery of the University Medical Centre Hamburg Eppendorf, Germany, during the years 1998-2008. Follow up was conducted until 2016. Outcome measures were age, gender, tumor stage, occurrence of metastases, and date of recurrence or death. Statistical analysis was conducted using the chi-square test and the log-rank test. Neither length nor zygosity of the CA-SSR-1 in patients with oral squamous cell carcinoma was significantly correlated with sex, age, tumor size, tumor localization, lymph node involvement, metastasis status, disease-free survival, or overall survival. Length and zygosity of the CA-SSR-1 polymorphism in EGFR is not able to serve as a prognostic biomarker in White European patients with oral squamous cell carcinoma.

EZH2 overexpression in head and neck cancer is related to lymph node metastasis

BACKGROUND Enhancer of zeste homolog 2 (EZH2), the catalytic subunit of the polycomb repressive complex 2, plays an important role in tumor development and progression by interacting with histone and non-histone proteins. EZH2 represents a putative therapeutic target and has been suggested as a prognostic marker in several cancer types. MATERIAL AND METHODS This study investigates the prognostic relevance of immunohistochemical EZH2 expression in head and neck squamous cell carcinoma. Tissue microarray sections with 667 cancers of oral cavity, oro- and hypopharynx and larynx were analyzed for EZH2 expression. RESULTS Nuclear EZH2 staining was recorded in 322 (81.8%) of 394 cases. Staining was weak in 33 (10.2%), moderate in 128 (39.6%), and strong in 103 (32.0%) cancers. The prevalence of EZH2 expression in tumors of the oral cavity and the orohypopharynx was higher as compared to cancers of the larynx (P = .0023). EZH2 expression was correlated to presence of lymph node metastasis (P = .0089) but was unrelated to histological grade, tumor stage, surgical margin, or distant metastasis. EZH2 expression had no impact on patient survival. CONCLUSION The high prevalence of EZH2 expression in head and neck squamous cell carcinoma stresses its capability as a therapeutic target.

Effiziente Schluckdiagnostik in der Praxis

Demografischer Wandel und medizinischer Fortschritt bedingen eine Zunahme chronisch kranker und auch schluckgestörter Patienten. Der folglich steigende Bedarf an fachärztlicher Schluckdiagnostik stellt eine Herausforderung für uns behandelnde Ärzte dar. Dies soll Anlass geben, in diesem Artikel diagnostische Tipps und Tricks für eine effiziente Schluckdiagnostik in der HNO-Praxis aufzuzeigen.

Pin-up Glottoplasty: Feasibility Study of a Novel Approach Medializing or Lateralizing Immobile Vocal Folds

Principles in medializing and lateralizing vocal folds have not changed a lot within the last decades (Isshiki et al, 1974; Bruenings, 1911). We present a feasibility study for a completely new approach to perform medialization and lateralization of immobile vocal folds. The method was tested on 20 human larynges by inserting a 21G needle into the vocal fold, medializing (or, in other cases, lateralizing) the vocal cord and fixing the needle at the cricoid cartilage posteriorly. The anterior and posterior fixation points of the needle allow for a stable positioning of the needle, which we consider necessary in both cases of medialization or lateralization. The needle position was examined visually as well as three-dimensionally via cone beam computed tomography.

High level βIII-tubulin overexpression occurs in most head and neck cancers but is unrelated to clinical outcome

BACKGROUND βIII-tubulin (TUBB3) is an isotype of microtubules, which are involved in crucial cellular roles including maintenance of cell shape, intracellular transport, and mitosis. Overexpression of TUBB3 was found to be associated with poor prognosis and resistance to tubulin-binding drugs and in several solid tumors including head and neck squamous cell carcinomas (HNSCC). Considering the potential high importance of a prognostic biomarker in these cancers, this study aimed to investigate the clinical relevance of immunohistochemical TUBB3 expression in HNSCC. METHODS Tissue microarray (TMA) sections containing samples from 667 cancers of oral cavity, oro- and hypopharynx, and larynx for which follow-up data were available were analyzed for TUBB3 expression by immunohistochemistry. RESULTS Over 90% of our analyzed cancers showed unequivocal cytoplasmic TUBB3 expression. Staining was considered weak in 69 (15.5%), moderate in 149 (33.5%), and strong in 188 (42.2%) of cancers. The frequent TUBB3 overexpression showed no significant correlation with pathological grading, tumor stage, nodal status, or surgical margin and had no impact on patient outcomes. CONCLUSION Despite lacking prognostic utility in HNSCC, the remarkable high prevalence of TUBB3 expression in HNSCC emphasizes its putative relevance as a target for future drugs targeting TUBB3.

Altersbedingte Dysphagie frühzeitig erkennen

Im Alter kommt es physiologischerweise zu Veränderungsprozessen, die alle Phasen des Schluckaktes betreffen, zur sogenannten primären Presbyphagie. Können diese Veränderungen nicht mehr kompensiert werden oder kommen weitere Faktoren wie Erkrankungen oder Medikamente hinzu, führt dies sehr viel schneller zu einer gravierenderen Schluckstörung als in jungen Jahren, zur Presbydysphagie bzw. sekundären Presbyphagie.