Rates of symptomatology are lower in recurrent sinonasal malignancy than in other recurrent cancers of the head and neck: a multi‐institutional study
Alan D. WorkmanNathalia VelasquezNayel KhanNicole A. BorchardEdward C. KuanJames N. PalmerEric WangZara M. PatelNithin D. Adappa
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Sinonasal malignancies are a rare subset of head and neck tumors, and surveillance strategies after definitive tumor treatment are often generalized from those for overall head and neck cancer outcomes data. However, recent literature suggests that the posttreatment period in sinonasal cancer is fundamentally different and a more tailored surveillance approach may be beneficial. Although rates of symptomatology are high in head and neck cancer recurrence and patient-driven follow-up is common, rates of symptomatology are unknown in sinonasal cancer specifically.Patients with recurrence of sinonasal malignancy were identified at 3 academic rhinology and skull base surgery centers. Demographic, tumor, and treatment data were collected. Rates of symptomatology at presentation were tabulated and examined in the context of several other variables.Fifty-five patients had recurrence of sinonasal malignancy after definitive treatment. Fifty-one percent of patients had no suspicious symptoms at the time of tumor recurrence, with an average time to recurrence of 33 months. Male patients and patients with stage IVA or lower disease were significantly more likely to be asymptomatic at the time of recurrence (p < 0.05).Patients with sinonasal malignancy have a much lower rate of symptomatology during tumor recurrence than that observed in head and neck cancer overall. Furthermore, time to recurrence is substantially longer, as a majority of head and neck cancer recurrences occur in the first 12 months after treatment. These differences highlight the need for more tailored surveillance paradigms in asymptomatic patients with a history of a definitively treated sinonasal neoplasm.Keywords:
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The frequency of accessory sinus ostia (ASO) has been estimated at between four and 50 per cent in the findings of studies designed for other purposes or from uncontrolled observations. The literature revealed no study specifically designed to determine the prevalence of ASO. We have carried out a prospective cohort study to measure the prevalence of ASO. The prevalence of ASO was determined in rhinology clinic patients and general ENT clinic controls. Overall ASO occurred in four per cent. Seven per cent of rhinology patients and two per cent of controls had ASO. Of the rhinology patients with rhinitis or sinusitis, eight per cent exhibited ASO. The overall prevalence in this study is lower than most quoted figures in the literature. There was increased prevalence of ASO in patients with rhinitis or sinusitis compared to controls. (p<0.05) This study should be regarded as a pilot study and further investigations of the relationship between ASO and nasal disease is merited.
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The past few years have witnessed several noteworthy advances in the field of rhinology in general and in the treatment of chronic sinusitis in particular. Many of these advances can be classified into three major trends: technology, techniques, and tissue eosinophilia.
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X-rays in the present day context is considered to be outdated by Rhinologists. CT scan images have replaced conventional x-ray imaging. Current concensus is that still x-rays have a role in the field of rhinology. Its inherent advantages like easy availability, cost effectiveness makes this investigation still relevant in the present day scenario. Bony lesions involving nose and sinuses, can be evalutated with reasonable degree of accuracy by performing conventional radiographs. Air present inside the paranasal sinuses serve as excellent contrast medium for plain x-ray evaluation. Pathologies involving paranasal sinuses encroach upon these air spaces causing alterations in their translucency.
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• We provide an update on the current status of chemotherapy in the treatment of head and neck cancer. The role of the otolaryngology—head and neck surgeon in this important clinical research is underscored. Those involved with treating patients with head and neck cancer must understand the mechanisms of clinical cancer research. Physicians in academic and community settings can be intimately involved in this treatment. (Arch Otolaryngol Head Neck Surg. 1991;117:498-501)
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Subspecialty caseloads logged by otolaryngology residents over the last 15 years is currently unknown. This study examines the trends at the national level.Otolaryngology case log data was collected from the Accreditation Council for Graduate Medical Education (ACGME) from 2005 to 2019. Data were categorized according to the following surgical subspecialties: pediatrics, rhinology/skull base, head and neck, facial plastics, otology, and laryngology. Linear regression analyses were performed for each procedure within each subspecialty, total subspecialty means, and total caseload means across all years.Overall surgical volume significantly increased between 2005 and 2019 (P < .0001); however, there was a significant decline in pediatrics procedures (R2 = 0.80, P < .0001). Rhinology/skull base procedures increased the most drastically (R2 = 0.96, P < .0001).While total mean resident case logs have steadily increased between 2005 and 2019, pediatric cases have declined substantially due to fewer tympanostomy tube insertions and adenotonsillectomies. Rhinology/skull base procedures have increased most significantly secondary to an increase in endoscopic sinus surgeries. Despite changes in case volume amongst specialties, the annual increase in resident case load suggests that otolaryngology residents are meeting the demands of their graduate medical training.
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To investigate rhinology-related malpractice claims with the aim of optimising safe practice.The database of the National Institute of Forensic Medicine was reviewed. In total, 241 otorhinolaryngology malpractice case reports dating from 2005 to 2012 were evaluated, and 83 malpractice cases related to rhinology treatments were separated.There was no significant difference between the number of male (n = 42) and female (n = 41) claimants. The mean patient age was 32.07 ± 10.53 years (range, 10-75 years). Seventy-nine cases involved surgical treatment in rhinology. The most common complaints were: unsatisfactory cosmetic results (n = 30), optic nerve injury (n = 10), septal perforation (n = 9) and intracranial penetration (n = 4). Malpractice was detected in 21 cases (25.3 per cent). No delinquency was found in 62 cases (74.7 per cent).Physicians should be aware of legal consequences related to rhinology practice. Further study is needed on this topic, as well as interdisciplinary collaboration, to ensure best practices and to avoid litigation.
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This book emphasizes on five different sections of rhinology, namely, 'Surgical Anatomy', 'Dental-Related Diseases', 'Radiological Imaging', 'Nasal Spaces' and 'Surgical Training'. It incorporates new clinical and research developments as well as future perspectives in the ever-expanding field of rhinology. I dedicate this book to those of you who pick up the torch and by continued research, close clinical observation and the high quality of clinical care as well as publication and selfless teaching, further advance knowledge in rhinology from this point forward. This is intended to be a guide for other books to follow. General otolaryngologist, rhinologist, researchers, specialists, trainees and general practitioners with interest in otolaryngology will find this book useful and interesting.
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Objective Investigate the best predictor of performance of otolaryngology trainees in a rhinology skills lab. Method Cross‐sectional study carried out in February 2012 where 15 trainees from the London otolaryngology training program (year 3‐5) were asked to complete 9 operative tasks on a sheep head model and were assessed by 5 experts on task‐specific and global performance using a previously validated tool. We tested 7 factors as predictors of performance including time (months) in surgical training, time in otolaryngology training and time in rhinology sub‐speciality training, practical rhinology courses attended, total rhinology procedures, procedures as main operating surgeon, and precourse operative global scores from video recordings. Results The task‐specific and global scores correlated well (Pearson 0.66). Six out of the 7 factors did not show correlation with performance at the skills lab (time in surgery, time in otolaryngology, time in rhinology, number of courses, total procedures, and procedures performed, Pearson: 0.19, 0.12, 0.3, 0.11, 0.28, and 0.13, respectively). The only measure that correlated well is precourse performance scored blindly and independently using the same tool based on video recordings of trainees operative procedures (Pearson: 0.62) Conclusion Predicting surgical performance is a multi‐factorial complex process. The assessment process including the tool and assessors have been validated further by showing consistency in scoring the same trainee twice, before and during the course as well as good correlation between task‐specific and global assessment. Previously acquired skills have the highest predictive value.
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