Mohammed Iqbal Syed

Squamous cell carcinoma of the thyroid gland: primary or secondary disease?

OBJECTIVE To review the aetiopathogenesis, clinical characteristics, immunohistochemical profile, prognosis and treatment options for primary thyroid squamous cell carcinoma, and to compare it with squamous cell carcinoma metastatic to the thyroid, thus providing the reader with a framework for differentiating primary and secondary disease. METHOD Review of English language literature from the past 25 years. SEARCH STRATEGY A search of the Medline, Embase and Cochrane databases (April 1984 to April 2009) was undertaken to enable a comprehensive review. RESULTS After applying strict criteria for the diagnosis of primary thyroid squamous cell carcinoma, 28 articles were identified reporting 84 cases. When reviewing secondary thyroid squamous cell carcinoma, we only analysed cases of squamous cell carcinoma metastatic to the thyroid gland, and found 28 articles reporting 78 cases. CONCLUSION It is possible to differentiate between primary and secondary thyroid squamous cell carcinoma, on the basis of combined evidence from clinical examination and endoscopic, pathological and radiological evaluation. Such differentiation is important, as the prognosis for primary squamous cell carcinoma is uniformly poor irrespective of treatment, and the most suitable option may be supportive therapy. Treatment for secondary squamous cell carcinoma of the thyroid varies with the site and extent of spread of the primary tumour.

Intratympanic therapy in Meniere's syndrome or disease: up to date evidence for clinical practice.

Menieres syndrome or disease (MS/D) is typically characterised by episodic vertigo, aural fullness, tinnitus and fluctuating hearing loss. There are multiple options available for treatment with variation in consensus on the best intervention.

Gamma tubulin: A promising indicator of recurrence in squamous cell carcinoma of the larynx

Objective: Centrosome amplification as detected by gamma tubulin (GT) immunostaining is associated with genetic instability and tumor aggressiveness. We assessed GT for its ability to predict recurrence of squamous cell carcinoma of the larynx (SCCL). Study Design: Case series with chart review. Materials and Methods: Five micron sections of 35 archival SCCL samples were subjected to antigen retrieval and immunostaining with antibody to GT. The keratin antibody CK5 served as a positive control for antigen retrieval, and tonsillar tissue was used as a negative control. Results: Of the 35 tumors analyzed, 22 were associated with recurrence(R) and 13 were not (NR). Fourteen of the 22 R tumors, but 0 of 13 of the NR tumours had a GT staining score of 2+ or 3+ (P < 0.0002). GT was also related to recurrence in node-negative tumors (P < 0.006) but was unrelated to T stage (P = 0.726). Conclusions: GT staining appears to be a better predictor of tumor recurrence than T stage and also predicts recurrence in N0 tumors.

Ménière's Syndrome or Disease: Time Trends in Management and Quality of Evidence Over the Last Two Decades.

Objective To evaluate the evidence and trends in published literature on the treatment of Ménière’s syndrome or disease (MS/D) by comparing studies published in the last two decades. Data Sources A literature search was performed on AMED, EMBASE, HMIC, MEDLINE, PsycINFO, BNI, CINAHL, HEALTH BUSINESS ELITE, CENTRAL and Cochrane Ear, Nose and Throat disorders groups trials register using a combination of MeSH. The date of last search was October 2014. Study Selection and Data Extraction Two hundred five studies (104 in decade I and 101 in decade II) were evaluated to report trends in the management of this condition, the differing levels of evidence published for each treatment modality, evaluate whether the guidelines published by the AAOHNS-Committee on Hearing and Equilibrium had been correctly employed, and whether the randomized controlled trials (RCTs) were compliant with the CONSORT guidelines. Results The number of published RCTs almost tripled from decade I (1994–2003) to decade II (2004–2103). There was a significant decline in the use of surgical intervention (p = 0.013); however, the number of studies involving the use of intratympanic injection remained largely unchanged. There was a shift in the level of evidence in published studies; studies with level 1 evidence tripled from decade I to II (4.8 to 17.8%, respectively) (p = 0.03); however, compliance with the AAOHNS-CHE criteria for reporting treatment outcomes and the CONSORT checklist was still poor. Conclusion Although the evidence base on published literature on MS/D has improved over the last decade with an increase in emphasis on RCTs and quality of life (QoL) studies, a significant number of studies failed to follow AAOHNS-CHE criteria for reporting treatment outcome and the CONSORT criteria for reporting RCTs.

The benefit of silicone stents in primary endonasal dacryocystorhinostomy: a systematic review and meta-analysis.

To critically evaluate the evidence comparing success rates of endonasal dacryocystorhinostomy (EN‐DCR) with and without silicone tubing and to thus determine whether silicone intubation is beneficial in primary EN‐DCR.

Hypopharyngeal foreign body masquerading as malignancy.

Foreign body ingestion in dental and ENT practice is a commonly encountered emergency. In most cases, particularly in adults, there is a definite history of its ingestion, the nature of the foreign body is usually identifiable and the patient almost always presents immediately. We report an unusual case of an elderly patient with a six month history of progressive dysphagia referred to us by the physicians after investigations which were highly suggestive of a hypopharyngeal malignancy. Surprisingly when a biopsy was attempted, the hypopharyngeal mass turned out to be a dental plate. Dentists and otolaryngologists should be aware that pharyngeal foreign bodies can present without a positive history and can have a clinical presentation mimicking malignancy. A history of head injury, dementia, alcohol and drug abuse should be specifically excluded. A routine examination of a patient with dysphagia should include eliciting a specific history of wearing dentures and examination of teeth. In future designs for dental plates, bridges and crowns the use of a radio opaque material should be considered.

Paraganglioma of the skull base presenting as nasal polyps

The authors report a case of paraganglioma of the skull base presenting as nasal polyps. A 29‐year‐old patient presented with epistaxis and was found to have nasal polyps. The patient underwent a nasal polypectomy. After pathology showed an unusual appearance, the mass was subsequently excised endoscopically using radiofrequency coblation, and it was found to be originating from the skull base. The diagnosis was made using a combination of clinical findings, radiology, and histopathology examination. It is important to consider paraganglioma in the differential diagnosis of unusual tumors of the nose and skull base. Laryngoscope, 2013

Hemoglobin Monitoring in Head and Neck Cancer Patients Undergoing Radiotherapy

Objectives Anemia is a well-recognized factor for local recurrence and decreased survival in cancer patients undergoing radiotherapy. Additionally, lower hemoglobin (Hb) levels have a negative impact on radiotherapy efficacy and response rates. The objective of this audit was to investigate how frequently Hb levels were observed in head and neck cancer patients receiving radiotherapy within a multidisciplinary team setting. Methods We performed a retrospective first-cycle audit in a university hospital in Glasgow that is a tertiary referral center for head and neck cancer. Included were 78 patients with head and neck cancer who were undergoing radiotherapy. Online laboratory services and clinical case sheets were checked for each patient to monitor the frequency of observation of Hb levels before, during, and after radiotherapy. Results Of these 78 patients, only 49 had their Hb level checked before radiotherapy treatment, only 9 during radiotherapy, and only 27 after completion of radiotherapy treatment (p < 0.0001). Of the 49 patients with preradiotherapy Hb levels available, 24% were found to be anemic; none of these patients had their Hb monitored during radiotherapy, and only 4 had Hb levels recorded after completion of treatment. Conclusions This audit has highlighted that despite evidence emphasizing that anemia in cancer is an independent prognostic factor for recurrence, there is no formal protocol for Hb monitoring in head and neck cancer patients undergoing radiotherapy. The audit has also demonstrated that Hb monitoring is infrequently performed and that subsequent observation of the Hb level is suboptimal.

The SIGN 104 guideline (2014) for topical antibiotic prophylaxis during grommet insertion: Misguided?

We write to express both concern and surprise at the updated SIGN (Scottish Intercollegiate guidelines network) guideline 104 (2014) for antibiotic prophylaxis [1]. The original SIGN guideline 104 (2008)[2] recommended the use of a single dose of prophylactic topical antibiotic during grommet insertion based on 3 RCTs one of which showed no difference in outcome in the use of antibiotic and saline drops. Two of the 3 studies used Ciprofloxacin and Ofloxacin, neither of which is licensed for use in the United Kingdom. This article is protected by copyright. All rights reserved.

In reference to systematic review and meta-analysis of Meniett therapy for Meniere's disease: Syed and Rutka

We have read with interest the article by Ahsan et al recently published in your journal. Having reviewed the same subject recently, we were surprised to see the author’s conclusions, and there are discrepancies in the review that we would like to highlight. The authors have combined studies of various qualities [randomized and non randomized] for a meta-analysis, which increase the possibility of selection and reporting bias in the nonrandomized studies and thus questions the quality of the analysis. In their analysis, the authors only included one of the four randomized controlled trials by Gates et al., which only reported the frequency of attacks on followup and reported a significant difference at 1, 2, 3, and 4 months. However, the groups were not comparable in frequency prior to randomization. Sufficient data was available from Gates et al. for this calculation to be made. Time as a variable caused a significant reduction in vertigo attacks in both the placebo device and Meniett groups (0.13 and 0.10, P 5 0.004–0.008). However, there was no difference in the reduction in frequency of vertigo attacks between the treatment group and placebo device (P 5 0.098–0.80). The exception to this was at 3 months, where there is a significant difference between the Meniett and placebo device (P 5 0.03.). A nonvalidated outcome of summation of categorical data over a follow-up period was reported as the main significant finding, but again no comparison was made with preintervention summed data. Thus, including this study in the meta-analysis without a quality and statistical assessment questions the results and conclusions drawn. Although there are various hypotheses on how the Meniett device can alter middle ear pressure and have an effect on vertigo, there is no rational explanation of how the device can improve hearing, particularly when Meniere’s is characterized by fluctuations in hearing; thus, improvement in hearing attributed to using the device should be disregarded. Two recent systematic reviews, including a Cochrane review that analyzed randomized controlled studies, have concluded that there is no evidence to support the use of the device in Meniere’s disease/syndrome; thus, the conclusions made by Ahsan et al. in their article, made largely on the basis of nonrandomized and retrospective studies, are unfounded.