Philip C. Doyle

Early-stage squamous cell carcinoma of the oropharynx: Radiotherapy vs. Trans-Oral Robotic Surgery (ORATOR) – study protocol for a randomized phase II trial

BackgroundThe incidence of oropharyngeal squamous cell carcinoma (OPSCC) has markedly increased over the last three decades due to newly found associations with human papillomavirus (HPV) infection. Primary radiotherapy (RT) is the treatment of choice for OPSCC at most centers, and over the last decade, the addition of concurrent chemotherapy has led to a significant improvement in survival, but at the cost of increased acute and late toxicity. Transoral robotic surgery (TORS) has emerged as a promising alternative treatment, with preliminary case series demonstrating encouraging oncologic, functional, and quality of life (QOL) outcomes. However, comparisons of TORS and RT in a non-randomized fashion are susceptible to bias. The goal of this randomized phase II study is to compare QOL, functional outcomes, toxicity profiles, and survival following primary RT (± chemotherapy) vs. TORS (± adjuvant [chemo] RT) in patients with OPSCC.Methods/DesignThe target patient population comprises OPSCC patients who would be unlikely to require chemotherapy post-resection: Tumor stage T1-T2 with likely negative margins at surgery; Nodal stage N0-2, ≤3 cm in size, with no evidence of extranodal extension on imaging. Participants will be randomized in a 1:1 ratio between Arm 1 (RT ± chemotherapy) and Arm 2 (TORS ± adjuvant [chemo] RT). In Arm 1, patients with N0 disease will receive RT alone, whereas N1-2 patients will receive concurrent chemoradiation. In Arm 2, patients will undergo TORS along with selective neck dissections, which may be staged. Pathologic high-risk features will be used to determine the requirement for adjuvant radiotherapy +/- chemotherapy. The primary endpoint is QOL score using the M.D. Anderson Dysphagia Inventory (MDADI), with secondary endpoints including survival, toxicity, other QOL outcomes, and swallowing function. A sample of 68 patients is required.DiscussionThis study, if successful, will provide a much-needed randomized comparison of the conventional strategy of primary RT vs. the novel strategy of primary TORS. The trial is designed to provide a definitive QOL comparison between the two arms, and to inform the design of an eventual phase III trial for survival outcomes.Trial registrationNCT01590355

Direct magnitude estimation and interval scaling of pleasantness and severity in dysphonic and normal speakers

The purpose of this study was to determine the validity of voice pleasantness and overall voice severity ratings of dysphonic and normal speakers using direct magnitude estimation (DME) and equal-appearing interval (EAI) auditory-perceptual scaling procedures. Twelve naive listeners perceptually evaluated voice pleasantness and severity from connected speech samples produced by 24 adult dysphonic speakers and 6 normal adult speakers. A statistical comparison of the two auditory-perceptual scales yielded a linear relationship representative of a metathetic continuum for voice pleasantness. A statistical relationship that is consistent with a prothetic continuum was revealed for ratings of voice severity. These data provide support for the use of either DME or EAI scales when making auditory-perceptual judgments of pleasantness, but only DME scales when judging overall voice severity for dysphonic speakers. These results suggest further psychophysical study of perceptual dimensions of voice and speech must be undertaken in order to avoid the inappropriate and invalid use of EAI scales used in the auditory-perceptual evaluation of the normal and dysphonic voice.

Computerized speech recognition: influence of intelligibility and perceptual consistency on recognition accuracy

The effects of intelligibility and consistency on the recognition accuracy of a speaker-adaptable speech recognition system (IBM VoiceType Version 1.0) were evaluated. Six participants who had dysarthria of speech across three severity levels (i.e., mild, moderate, severe) and six age- and gender-matched peers without speech impairments participated in the study. Productions of sentences were evaluated across five assessment sessions. Recognition accuracy was significantly higher for the speakers in the control group than for the speakers with dysarthria across severity levels. High levels of intelligibility correlated significantly with high recognition accuracy scores. Perceptual rankings of speech consistency did not correlate significantly with recognition accuracy scores. Results suggest that for speaker-adaptable systems, the more intelligible a speaker, the greater his or her success with the voice recognition system. Results also suggest that perceived inconsistencies in the speech productions of ...

Voice‐related quality of life (V‐RQOL) outcomes in laryngectomees

Laryngeal cancer has a significant impact on patients. This study compared the Voice‐Related Quality of Life (V‐RQOL) outcomes specific to 3 different postlaryngectomy voice rehabilitation methods.

Broadening our understanding: Approaching falls as a stigmatizing topic for older adults

This theoretical paper aims to demonstrate that our current understanding of falls in older adulthood can be improved by viewing falls as a stigmatizing topic. Existing empirical research alludes to the stigmatization of falls for older adults, but until now the explicit link between the study of falls and stigma has not been made. After applying the concepts of identity threat, modified labeling theory, and attribution theory, the research implications of stigma on an older adults willingness to report and discuss falls will be outlined. As many research investigations use the number of prior falls to assign individuals to study groups, the influence of stigma may be widespread and confounding research findings. By better recognizing and understanding the contribution of stigma to the willingness of older adults to report and discuss falls, we will be better able to mitigate its effects.

Interactive computer-based simulator for training in blade navigation and targeting in myringotomy

A virtual-reality simulator was developed for the training of Otolaryngology (Ear-Nose-Throat) surgical residents to perform myringotomy, a relatively common surgical procedure in which an incision is made in the eardrum mainly to treat middle-ear infections. The simulator presents the trainee with a three-dimensional (3D) virtual model of the ear that can be viewed through a mock surgical microscope consisting of a stereo visor mounted on a custom-designed stand. The trainee interacts with the virtual ear using a real myringotomy blade, the movements of which are tracked in real time using a stereo optical tracker. Interactions of the blade with virtual tissues are calculated and rendered on the visor using freely available physics and graphics software engines. Six experienced surgical residents and surgeons assessed the effectiveness of the simulator as a viable training tool by completing a questionnaire designed specifically for this study after using the simulator. Surgeons and residents were positively impressed by the simulator as a training tool and would recommend its use as part of training.

Virtual reality myringotomy simulation with real-time deformation: Development and validity testing†‡

Surgical simulation is becoming an increasingly common training tool in residency programs. The first objective was to implement real‐time soft‐tissue deformation and cutting into a virtual reality myringotomy simulator. The second objective was to test the various implemented incision algorithms to determine which most accurately represents the tympanic membrane during myringotomy.

The ICF as a framework for interdisciplinary doctoral education in rehabilitation: Implications for speech-language pathology

This paper describes the use of the International Classification of Functioning, Disability and Health (ICF) as an educational framework for the development of the Doctoral Programme in Rehabilitation Sciences at the University of Western Ontario in London, Canada. The ICF and the concepts underlying disability and universalism provided the framework from which the programme evolved. As a result, this interdisciplinary programme was facilitated through use of the ICF and efforts to present a common language. We believe that this framework was essential in providing an enriched educational environment for graduate students. Details of the programmes structure, its requirements, and the optimized opportunities for interdisciplinary academic study are described. Additionally, we address coursework and the explicitly designed opportunity for developing a programme of independent research for each student. This includes discussion concerning a new vision for comprehensive examination that provides an ideal opportunity for those interested in communication disorders. Finally, we reflect on both the successes and challenges that have been faced by our programme including student perceptions and the suitability of this educational model for addressing larger and more complex questions specific to functioning and disability in the context of the traditional academic environment.

Auditory-Perceptual Speech Outcomes and Quality of Life after Total Laryngectomy

Objective (1) To determine potential relationships between speech intelligibility, acceptability, and self-reported quality of life (QOL) after total laryngectomy and (2) to determine whether relationships are stronger when QOL is measured by a head and neck cancer–specific or discipline-specific QOL scale. Study Design Cross-sectional. Setting University-based laboratory and speech clinic. Subjects and Methods Twenty-five laryngectomized individuals completed disease-specific (University of Washington Quality of Life; UW-QOL) and discipline-specific (Voice Handicap Index–10; VHI-10) QOL scales. They also provided audio recordings that included the Sentence Intelligibility Test (SIT) and a reading passage. Thirty-three listeners transcribed the SIT sentences to yield intelligibility scores. Fifteen additional listeners judged speech acceptability of the reading passage using rating scales. Results The QOL scores were moderate across the UW-QOL physical (mean = 77.63) and social-emotional (mean = 78.02) subscales and the VHI-10 (mean = 17.91). Speech acceptability and intelligibility varied across the samples, with acceptability only moderately related to intelligibility (r = 0.41, P < .05). Relationships were weak between ratings of intelligibility and self-reported QOL (range, r = 0.00-0.22) and weak to moderate between acceptability with QOL (range, r = 0.01-0.46). The only statistically significant, but moderate, relationship was found between speech acceptability with the UW-QOL speech subscore (r = 0.46, P < .05). Conclusion Listeners’ ratings of speech acceptability and intelligibility were not strongly predictive of disease-specific or voice-related QOL, suggesting that listener-rated and patient-reported outcomes are complementary.

Otolaryngology - Head and Neck Surgeon unemployment in Canada: a cross-sectional survey of graduating Otolaryngology - Head and Neck Surgery residents

ObjectiveRecently graduated Otolaryngology - Head and Neck Surgeons (OTO-HNS) are facing an employment crisis. To date, there has been no systematic evaluation of the factors contributing to this situation, graduating OTO-HNS trainee employment rates, nor the employment concerns of these graduating residents. This investigation sought to empirically evaluate prospective OTO-HNS graduate employment, identify factors contributing to this situation, and provide suggestions going forward.MethodsA cross-sectional survey of the 2014 graduating cohort of OTO-HNS residents was conducted 6-months prior to graduation, and immediately following residency graduation. Surveyed items focused on the demographics of the graduating cohort, their future training and employment plans, and their concerns relative to the OTO-HNS employment situation.ResultsAll twenty-nine Canadian medical school graduated OTO-HNS residents completed the initial survey, with 93% responding at the completion of residency. Only 6 (22%) indicated confirmed employment following residency training. 78% indicated that they were pursuing fellowship training. 90% identified the pursuit of fellowship training as a moderately influenced by limited job opportunities. The ability to find and secure full-time employment, losing technical skills if underemployed/unemployed, and being required to consider working in a less-desired city/province were most concerning. 34% of the residents felt that they were appropriately counseled during their residency training about employment. 90% felt that greater efforts should be made to proactively match residency-training positions to forecasted job opportunities.ConclusionsCanadian OTO-HN Surgeons lack confirmed employment, are choosing to pursue fellowship training to defer employment, and are facing startling levels of under- and unemployment. A multitude of factors have contributed to this situation and immediate action is required to rectify this slowly evolving catastrophe.