Raymond L. Weiss

Distant metastases from head and neck squamous cell carcinomas

Distant metastases (DMs) occurred in 83 (11.4%) of 727 retrospectively studied head and neck cancer patients. Primary tumor location and initial treatment did not influence DM development; larger primaries (P<.04) or more extensive neck disease (P<.007) more often caused DMs. Initial diagnosis to DMs averaged 11.7 months (range, 0 to 60 months), with 84% diagnosed within 24 months. With the exception of laryngeal primaries, no facet of tumor, host, or initial treatment influenced where or how rapidly DMs developed. Lung was the most common DM site (83.4%), then bone (31.1%) and liver (6.0%). Survival with DMs averaged 4.3 months (range, 1 day to 2.7 years); 86.7% died within 1 year. This report yields the following conclusions: 1. Initial tumor size and neck disease are the only predictors of DMs. 2. DMs usually occur within 2 years of the initial diagnosis. 3. Lung is the most common DM site, making chest x‐ray the most effective DM screen. 4. Survival with DMs is usually less than a year.

Safety and outcomes of balloon catheter sinusotomy: A multicenter 24-week analysis in 115 patients

OBJECTIVE: The aim of this study was to further evaluate the safety and effectiveness of balloon catheter devices to dilate obstructed sinus ostia/perform sinusotomy. METHODS: Through a prospective, multicenter evaluation, safety was assessed by rate of adverse events, patency was determined by endoscopic examination, and sinus symptoms were determined by the Sino-Nasal Outcome Test (SNOT 20). RESULTS: At the conclusion of the 24-week analysis, endoscopy determined that the sinusotomy was patent in 80.5% (247 of 307) sinuses and nonpatent in 1.6% (5 of 307), and could not determine ostial patency status in 17.9% (55 of 307). Of the ostia visualized on endoscopy, 98% were patent (247 of 252), while 2% (5 of 252) were considered nonpatent. SNOT 20 scores showed consistent symptomatic improvement over baseline. Revision treatment was required in 3 sinuses (3 of 307 sinuses, 0.98%) in 3 patients (3 of 109 patients, 2.75%). CONCLUSION: Balloon catheter technology appears safe and effective in relieving ostial obstruction. Patients were pleased and indicated that they experienced symptomatic improvement.

Long-term outcome analysis of balloon catheter sinusotomy: Two-year follow-up

Objective Assess two-year postoperative clinical outcomes for patients receiving balloon catheter sinusotomy. Methods Patients who had sinus ostia dilated with balloon catheters were prospectively evaluated two years after surgery by Sinonasal Outcome Test (SNOT-20) and computed tomographic (CT) scan. Results Sixty-five patients (195 ballooned sinuses) were followed for two years after surgery, including 34 “balloon-only” patients and 31 “hybrid” patients. SNOT-20 symptom scores were significantly improved from baseline (0.87 vs 2.17 baseline, P < 0.001) and stable compared to six months and one year; this was the case for both balloon-only (1.09 vs 2.09, P < 0.001) and hybrid (0.64 vs 2.26, P < 0.001) patients. Lund-MacKay CT scores were significantly improved from baseline (2.69 vs 9.66, P < 0.001) and stable compared to one year, confirmed for both balloon-only (1.75 vs 5.67, P < 0.015) and hybrid (3.25 vs 12.05, P < 0.001) subsets of patients. A total of 85% of patients reported improvement of their sinus symptoms, with 15% same and 0% worsened. Revision treatment was required in seven of 195 sinuses (3.6%) in six of 65 patients (9.2%). Conclusion Patients who receive balloon catheter sinusotomy in endoscopic sinus surgery have significant improvement in symptoms two years after surgery. Radiographic evidence also confirms resolution of disease after two years. This demonstrates durability of clinical results previously reported at 24 weeks and one year after surgery.

Multicenter registry of balloon catheter sinusotomy outcomes for 1,036 patients.

Objectives: This study assesses the safety and effectiveness of balloon catheters used as instruments in sinus surgery in a “real-world” multicenter registry of 1,036 patients across 27 US otolaryngology practices. Methods: Data were collected by standardized chart review with centralized database administration for all consecutive functional endoscopic sinus surgeries that included the use of balloon catheters across the 18-month time period from December 2005 to May 2007. Results: Balloon catheters were used in 3,276 peripheral (maxillary, frontal, and sphenoid) sinuses, for an average of 3.2 sinuses per patient. There were no major adverse events related to the use of balloon catheter instruments. The revision rate was 1.3% of sinuses treated with a balloon catheter after an average follow-up of 40.2 weeks. Sinus symptoms were improved in 95.2%, unchanged in 3.8%, and worse in 1.0% of patients. Postoperative sinus infections were significantly less frequent and less severe compared to infections before surgery. The results were consistent across all patient categories, including balloon-only patients and revision patients. Conclusions: Use of balloon catheters as instruments in sinus surgery appears to be relatively safe and effective and to improve the patients quality of life. The results are consistent and generalizable across a wide range of sinusitis patients and physician practices. The complication rates, revision rates, and patient symptom improvement rates all compare favorably with previously reported results of functional endoscopic sinus surgery.

Balloon catheter sinusotomy: one-year follow-up--outcomes and role in functional endoscopic sinus surgery.

Objective The primary objective was to assess the long-term effectiveness of balloon catheter sinusotomy. Methods Patients who had sinus ostia dilated with balloon catheters were prospectively evaluated 1 year after surgery with nasal endoscopy, a CT scan, and the Sino-Nasal Outcome Test (SNOT-20). Results Sixty-six patients (202 sinuses) were examined. One hundred seventy-two of 202 sinus ostia (85%) were endoscopically patent, 1 percent (2/202) were nonpatent, and ostial patency could not be determined by endoscopy in 28 of 202 (14%). In these “indeterminate” sinuses, the CT scans were normal in 13, implying functional patency in 91.6 percent of sinuses (185/202). Sinus CT scan scores were 1.95 at 1 year versus 8.89 at baseline (P < 0.001), and 1-year SNOT-20 scores (0.91) were significantly improved from baseline (2.14, P < 0.0001). Conclusion Balloon catheter sinusotomy results were durable over the study period, showing long-term effectiveness.

Patient and surgeon radiation exposure in balloon catheter sinus ostial dilation

OBJECTIVE: The aim of this study was to determine the extent of radiation exposure to the patient and the surgeon in balloon catheter dilation. METHODS: Dosimeters were used to record radiation exposure to both patients and surgeons. The mean radiation dose per sinus treated and per patient treated was calculated for each dosimeter location. RESULTS: The mean patient dose (108 sinuses treated in 34 patients), was 0.32 mSv per sinus and 1.02 mSv per patient over the eye and 1.33 mSv per sinus and 4.22 mSv per patient over the temple. The average total fluoroscopy time was 3.6 minutes per patient. The average number of sinuses treated was 3.2. The mean surgeon dose at the chest (254 sinuses in 89 patients) was 0.025 mSv per sinus and 0.072 mSv per patient. The mean surgeon dose at the hand (182 sinuses in 68 patients) was 0.009 mSv per sinus and 0.023 mSv per patient. CONCLUSIONS: The use of fluoroscopy in balloon catheter dilation exposes both the patient and surgeon to very low doses of radiation.

MANAGEMENT OF THE THYROID ISTHMUS IN TRACHEOSTOMY : A PROSPECTIVE AND RETROSPECTIVE STUDY

The thyroid isthmus is often encountered while a tracheostomy is being performed. This study details retrospective and prospective comparison of electrocautery division of the isthmus with older techniques. In this study, electrocautery division of the thyroid isthmus during tracheostomy is faster and as safe as other techniques with respect to blood loss, perioperative complications, and airway outcome.

Balloon dilation of the eustachian tube for dilatory dysfunction: A randomized controlled trial

To assess balloon dilation of the Eustachian tube with Eustachian tube balloon catheter in conjunction with medical management as treatment for Eustachian tube dilatory dysfunction.

Reply to letter to the editor from Dale Rice, MD:

I read with interest the article by Bolger et al, entitled “Safety and outcomes of balloon catheter sinusotomy; A multicenter 24-week analysis in 115 patients” (Otolaryngol Head Neck Surg 2007;137:10-20). Although this technology may have a small role to play in chronic sinus disease, that role has yet to be determined. Many agree with Nick Jones, MD, that this may be a technology looking for a disease. All would agree, however, that the ethmoid sinus is the key to chronic rhinosinusitis that requires surgical intervention. Balloon catheter sinusotomy does not deal with the ethmoid sinus at all. For five years now, when doing endoscopic sinus surgery, if I can see the maxillary ostium, regardless of its size, I do not do any kind of manipulation of that ostium. Over these five years, I have not yet had to go back and do a sinusotomy. The same is true of the frontal and sphenoid sinuses. Further, from reading this article and others, it may well be that these sinuses needed, if anything, only suctioning and irrigation. There are several other small issues to consider. The first is the short follow-up. My understanding of wound healing, particularly from a circumferential injury, is that it continues on beyond 24 weeks. In this study with a decrease in ostial patency between 12 and 24 weeks, I wonder if the decrease would continue. If one compares Figure 1B to Figure 8, it is clear that bone has been removed from the superior maxillary ostium, rather than fractured and molded. As to the frontal sinus ostium, it is well known that the bone is quite dense anteriorly and less so posteriorly. It would seem that if circumferential pressure were applied here to a sufficient extent to fracture the bone it would more likely occur posteriorly than anteriorly. In addition, it is difficult to believe that a short period of increased pressure, short of fracturing the bone, would actually mold bone. It would appear that balloon catheter sinusotomy is yet another instrument for enlarging a sinus ostium when it needs to be enlarged. This would seem to be an unusual circumstance in most cases of chronic rhinosinusitis. Dale H. Rice, MD Tiber/Alpert Professor and Chair* From the Department of Otolaryngology-Head and Neck Surgery University of Southern California. Corresponding author: Dale H. Rice, MD, University of Southern California, Otolaryngology-Head and Neck Surgery, Room 4136, 1200 N State, Los Angeles, CA 90033. E-mail address: dhrice@usc.edu. FINANCIAL DISCLOSURE

9:08 AM: The Effects of Hyperbaric Oxygenation on Exiting Oral Mucosal Carcinoma

Hyperbaric oxygen (HBO) has been considered an important adjunct to the treatment of patients with head and neck cancer with wound healing problems. There is lack of consensus in the existing literature concerning the use of HBO in head and neck cancer. Clinical observations and laboratory work have caused interest in that hyperbaric oxygen therapy may accelerate tumor growth. This study evaluated the effect of HBO on existing oral mucosal carcinoma. We selected a prudent animal model of squamous cell carcinoma of the oral cavity. Squamous cell carcinoma can be chemically induced in 8 to 12 weeks by repeated application of carcinogen dimethylbenzanthracene (DMBA) in Golden Syrian hamsters. Eighty-four 6-week-old Golden Syrian hamsters were divided into four groups that underwent application of 0.5% solution of DMBA at the right buccal pouch. Groups were classified as follows: Group I: HBO treatments to 2.0 ATM abs.; Group II: 100% oxygen, at 1 ATM abs.; Group III: 2.0 ATM abs. at room air; and Group IV: room air at ATM abs. This study suggests that HBO has a stimulatory effect during the proliferative phase of carcinoma on this animal model; affecting rate of growth, the size, the morphology and the number of tumors identified.