Frederic W.-B. Deleyiannis

Quality of life of disease‐free survivors of advanced (stage III or IV) oropharyngeal cancer

This study assessed the quality of life (QOL) of patients with advanced oropharyngeal cancer (stage III or IV) who were disease‐free at 1 year posttreatment.

Quality of life after laryngectomy: Are functional disabilities important?

The purpose of this study was to determine the functional disabilities and overall quality of life (QOL) of patients successfully treated (ie, without evidence of disease at two years) for laryngeal or hypopharyngeal cancer by a total laryngectomy.

Results with sphincter pharyngoplasty and pharyngeal flap

OBJECTIVE To evaluate speech outcomes and complications of sphincter pharyngoplasty and pharyngeal flap performed for management of velopharyngeal insufficiency (VPI). DESIGN Case series. SETTING Tertiary care childrens hospital. PATIENTS All patients who underwent pharyngeal flap or sphincter pharyngoplasty from 1990 to 1995. METHODS Perceptual speech analysis was used to assess severity of VPI, presence of nasal air emissions and quality of nasal resonance (hyper, hypo, or normal). Pre-operative measures of velopharyngeal function were based upon nasendoscopy and videofluoroscopic speech assessment. Recommendations for management were made by the attending surgeon. Complications of hyponasality and obstructive sleep symptoms (OSS) were noted. Patient characteristics were compared using univariate analysis. RESULTS Sixteen patients underwent sphincter pharyngoplasty and 18 patients underwent superiorly based pharyngeal flap. Patients were similar in terms of lateral pharyngeal wall medial motion and palatal elevation. The groups were also similar with regard to VPI severity, though there was a trend for more severe VPI in patients undergoing sphincter pharyngoplasty than pharyngeal flap (50 vs. 33.3%, respectively). Patients with pharyngoplasty had a higher rate of resolution of VPI than those who had pharyngeal flap (50 vs. 22.2%, respectively), although this was not statistically significant. Post-operative hyponasality and obstructive sleep symptoms were present in both groups. However, only patients who underwent PF and had postoperative OSS had obstructive sleep apnea (OSA). CONCLUSIONS There were no detectable anatomic differences between treatment groups implying that treatment selection during the study period was not guided by strict anatomic criteria. Sphincter pharyngoplasty may have a higher success rate with a lower risk of OSS.

Quality of life in head and neck cancer

Because treatments for patients with cancer of the head and neck can have major impact on physical, social, and psychological function, the collection of quality of life (QOL) data in this group of patients is critical for our specialty. The University of Washington Quality of Life data have been collected and analyzed on three subsets of cancer patients. Information learned from these patients is summarized and strategies for future projects are outlined.

Effectiveness of Surgical Management of Epistaxis at a Tertiary Care Center

A retrospective review is presented of 44 consecutive patients requiring hospitalization for epistaxis at a tertiary care center. The study had the following objectives: 1. to identify predictors of surgical treatment, and 2. to compare the effectiveness of different surgical treatments. Length of stay, complications, and cost analysis are also presented. Eighteen patients were successfully treated nonsurgically, whereas 26 patients received surgical treatment. Posterior epistaxis (P<0.05) and an admission hematocrit less than 38% (P<0.05) were significant predictors of surgical treatment. The rebleed rate after first surgical therapy was 33% for embolization, 33% for endoscopic cautery, and 20% for ligation. Since embolization, ligation, and endoscopic cautery may have nearly equivalent failure rates, other factors, such as cost and institutional expertise, should guide the selection of surgical treatment.

Outcomes research in head and neck oncology

The goals of outcomes research are the determination of treatment effectiveness and the use of that information as an aid in clinical decision making. Methods used in outcomes research include observational studies, secondary data analysis, structured literature review, and meta-analysis. In head and neck oncology, outcome measures have expanded to include quality of life and cost-effectiveness in addition to more traditional outcomes, such as survival and recurrence. A standard, and more inclusive, set of tumor- and patient-based variables has been proposed. With a better framework for the clinical study of head and neck cancer, outcomes research has the potential to identify the subgroups of patients who will benefit from treatment.

Reconstruction of the Concha to Restore Hearing After Cartilage Harvest for Rhinoplasty

Conchal cartilage is widely used in aesthetic and reconstructive rhinoplasty. Preoperatively, patients must be counseled concerning possible postoperative donor site complications. These include visible scarring and changes in ear position (the distance that the ear protrudes from the side of the head) and shape (the volume and depth of the conchal bowl). To my knowledge, this report provides the first case of a documented hearing loss secondary to cartilage harvest and the subsequent conchal reconstruction done to restore hearing.