Sarah E. Mowry

Quality of life outcomes in laryngeal and oropharyngeal cancer patients after chemoradiation

OBJECTIVE: The purpose of this study was to compare quality of life issues in patients with advanced laryngeal versus oropharyngeal cancer after treatment with chemoradiation. DESIGN: A cohort study of 31 patients with laryngeal or oropharyngeal squamous cell carcinoma treated with chemoradiation completed the University of Washington quality of life instrument version 4 (UW-QOL v4). Statistical analysis was performed with Wilcoxon rank sum and chi-square tests. SETTING: Academic tertiary care center. RESULTS: Both groups reported similar impairment in the domains of swallowing, chewing, and taste. Oropharyngeal cancer patients reported significantly worse quality of life in the domain of saliva (P < 0.007). CONCLUSION: Swallowing, chewing, and taste were adversely affected by chemoradiation for both groups. Oropharyngeal patients experienced significantly worse problems with saliva than laryngeal patients. These patients reported high levels of satisfaction with health-related quality of life issues. SIGNIFICANCE: Specific head and neck subsites have different morbidities when treated with primary chemoradiation for advanced tumors.

Immunohistochemical analysis and Epstein-Barr virus in the tonsils of transplant recipients and healthy controls.

OBJECTIVE To compare lymphocyte immunohistochemical markers and staining for Epstein-Barr virus (EBV) in tonsillectomy specimens from healthy children and pediatric transplant recipients. DESIGN Analysis of pathology specimens. SETTING Tertiary care medical center. PATIENTS Consecutive sample of tonsillectomy specimens from 60 pediatric solid organ transplant recipients and 60 healthy children. INTERVENTION Immunohistochemical staining of tonsillectomy specimens for kappa and lambda light chains, B and T lymphocytes, EBV-encoded small nuclear RNA (EBV-EBER), and EBV-encoded latent membrane protein (EBV-LMP). MAIN OUTCOME MEASURE Detection of a difference in EBV activity in transplant recipients vs healthy controls. RESULTS There was 1 case of posttransplantation lymphoproliferative disorder (PTLD). All other tonsillectomy specimens from both groups demonstrated follicular hyperplasia. Tonsillectomy specimens from both groups were polyclonal, expressing kappa and lambda light-chain activity, including the case of PTLD. The number of specimens staining positive for CD3 activity, a marker of T lymphocytes, was reduced in the transplant group (85%), compared with 100% in the control group (P < .01). EBV-EBER is a nuclear stain indicating active EBV infection, whereas EBV-LMP staining denotes latent infection. Twenty-seven of 60 transplant specimens (45%) demonstrated EBV-EBER activity compared with 0 of 60 control specimens (P < .001). EBV-LMP activity was equal in both groups. CONCLUSIONS Adenotonsillar hypertrophy in transplant recipients with no prior exposure to EBV may be a sign of active EBV infection. A high incidence of EBV-EBER was found in the tonsils of transplant recipients. Active adenotonsillar EBV infection in the setting of T-lymphocyte suppression in transplant recipients may be a potential early precursor of PTLD.

Gorham-Stout disease of the temporal bone.

Gorham‐Stout (GS) disease is a rare disease of the bone and is also known as massive osteolysis. Less than 200 cases have been reported in the world literature. A 29‐year‐old female with a diagnosis of GS disease was identified. She complained of aural fullness and tinnitus bilaterally. Demineralization and moth‐eaten changes of the osseous structures of the skull base and posterior fossa were prominent. The left mastoid air cells were opacified and erosion extended to the left jugular foramen, left hypoglossal canal, left stylomastoid process, and left eustachian tube. The radiographic findings and brief literature review are presented. Laryngoscope, 2010

The Influence of Support Groups on Quality of Life in Head and Neck Cancer Patients

Objective. To compare quality of life in head and neck cancer (HNC) patients following treatment. Methods. The Short Form-36 Version 2 (SF-36v2) was utilized to measure patient quality of life. Results. For all 8 parameters measured by the SF-36V2, HNC patients had lower mean scores than the US population means. Support group patients had significantly worse scores than US population norms in role-physical, social functioning, and role-emotional. There were no significant differences between support group and control patients for the 8 parameters measured by the SF-36v2. Conclusions. HNC patients report significantly worse quality of life than US population norms in several physical and emotional areas. Our study did not demonstrate improved quality of life for support group patients. The increased incidence of oropharyngeal cancer and chemotherapy treatment in the support group patients in our study were factors which were likely to have lowered the overall scores in these patients.

Pathologic Features of Non-Invasive Fungal Rhinosinusitis

The purposes of this study were to quanititate and correlate the findings of pathologic specimens and fungal culture in patients with a diagnosis of allergic fungal rhinosinusitis. Seventeen patients were identified between 2003 and 2005 with noninvasive fungal rhinosinusitis. Surgical specimens were analyzed via routine and special pathologic processing and compared to the microbiological results of fungal cultures of these same surgical specimens. Eleven patients (65%) had a positive fungal culture, and 10 patients (59%) had a positive fungal stain. The most characteristic pathologic feature was the presence of allergic fungal mucin. This consisted of inspissated basophilic mucin with alternating areas of large numbers of eosinophils. There is a broad spectrum of pathologic changes found in specimens suspected of Eosinophilic fungal rhinosinusitis. Fungal cultures do not always correspond to these pathologic changes. A high index of suspicion is necessary to make this diagnosis and provide adequate treatment.

S127 – Idiopathic Facial Nerve Paralysis: Analysis of 3T MRI Images

Objectives 1) To describe the findings on 3 Tesla (T) MRI in patients with idiopathic facial nerve paralysis (IFP). 2) To compare 3T MRI and 1.5 T MRI images of the facial nerve in patients with and without facial paralysis. Methods A retrospective review of 3T MRI image from 2005–2008 for temporal bone imaging revealed 123 patients; 4 patients underwent imaging for facial paralysis. Images from 3T MRI and 1.5T MRI for these 4 patients were retrospectively assessed by a board-certified neuroradiologist and otolaryngologist blinded to the affected side and compared to normative controls. Results All patients with facial palsy demonstrated significant enhancement of the affected nerve on post-gadolinium T1 weighted images. In 3 patients with residual facial weakness (>12 months) demonstrated facial nerve enhancement at the geniculate ganglion and descending portions. In 1 patient, despite resolution of IFP, the nerve continued to enhance at the geniculate ganglion and descending portion of the facial nerve compared to the contralateral nerve. The 3T MRI images demonstrated improved visualization of the entire course of the facial nerve in both normal and IFP patients. Interestingly, in both normal and affected patients, the uninvolved facial nerve also demonstrated slight contrast enhancement throughout its entire course, although not as pronounced as the affected side. Conclusions 3T imaging provides significantly improved visualization of the temporal facial nerve in both normal and patients with IFP. Gadolinium enhanced 3T imaging allowed better anatomical delineation of both normal and affected facial nerves when compared to 1.5T MRI.

Emerging Trends in the Management of Laryngeal Rhabdomyosarcoma

The intent of our study was simply to report our findings on a unique subset of patients. Full airway evaluation in these chil-dren is based on the concern that young children (<3 years old) who present with sleep-disordered breathing (SDB) might have a synchronous airway lesion (SAL) contributing to the obstruction and early presentation. Direct laryngoscopy and bronchoscopy (DLB) was performed at the time of the adenoidectomy ± tonsillectomy (A±T). Similar studies have addressed this topic in children even younger (<18 months old).

Improved Quality of Life in Patients Treated with ChemoIMRT

Objective To identify differences in quality of life between patients with advanced oropharyngeal cancer following traditional opposed port chemoradiation (CRT) vs. chemotherapy with intensity modulated radiation therapy (CIMRT). Methods A cohort study from academic tertiary referral center was performed. 50 patients were identified from an institutional database of patients who had undergone primary chemotherapy and radiation (traditional or IMRT) for advanced oropharyngeal carcinoma. Patients responded via mail using the University of Washington quality of life instrument version 4 (UW-QOLv4). Data was analyzed using chi-square and Wilcoxon tests. Results 17 CRT patients responded (57%), and 14 CI-MRT patients responded (70%). Patients completed the survey between 9 and 44 months following end of treatment. When adjusted for tumor stage and time since treatment, CIMRT patients reported improved appearance (p = 0.05), chewing (p = 0.02), and mood (p = 0.01). There was a trend toward significance for improved activity (p = 0.07), recreation (p = 0.07), and anxiety (p = 0.08). There were no differences between the 2 groups for saliva, taste, shoulder function, speech, and swallowing. There was a trend for significance for improved overall quality of life in patients who had undergone CIMRT (p = 0.06). Conclusions Many patients with advanced oropharyngeal carcinoma are being treated with primary chemoradiation. CIMRT results in improved quality of life for some domains but surprisingly not for swallowing or saliva. Patients undergoing CIMRT also report slightly better quality of life overall when compared to patients receiving more traditional forms of radiation therapy.

P130: Migraine-Associated Hearing Loss after General Anesthesia

Age and sex distribution, success rate of hearing improvement, mean of postoperative air-bone gap, and rate of middle ear adhesion were analysed according to the type of surgery. RESULTS: At three months after surgery, success rates of hearing improvement were 37.0%, 51.4%, and 57.1% for CTTIII, SCT, and PORPT, respectively. Means of postoperative ABG in the above listed order were 25.1dB, 19.4dB, and 17.2dB, respectively. Hearing results were statistically better in POPRT when compared with other groups. At one year after surgery, success rates of hearing improvement were 21.1%, 35.5%, and 64.7% in CTTIII, SCT, and PORPT, respectively. Means of postoperative ABG in the above listed order were 29.1%, 20.3dB, and 16.7dB, respectively. Hearing results were statistically better in PORPT compared with other groups. Rates of middle ear adhesion were 23.1%, 54.5% in CTTIII, tympanoplasty using strut, respectively. CONCLUSIONS: In cases with intact stapes in CWD tympanoplasty, it was concluded that tympanoplasty using strut is more useful for hearing improvement and prevention of middle ear adhesion than classical tympanoplasty type III; for the strut material, PORP was more effective than autologous materials.