Effects of Smoking on Eustachian Tube and Hearing.

OBJECTIVE: The purpose of this study was to evaluate the effect of tobacco use on the Eustachian tube and inner ear function. STUDY DESIGN: Case-control study. SUBJECTS AND SETTINGS: Thirty-one nonsmoking volunteers and 34 smoking subjects recruited in an University Hospital, submitted to an audiological evaluation including pure tone audiometry, basal tympanogram, stapedial reflexes analysis, and nine-step eustachian tube (ET) function test. RESULTS: Pure Tone Average (PTA) threshold at all frequencies tested was 12.5 dB in smokers and 3.7 in nonsmoking subjects. Nine smokers (27%) presented some degree of hearing loss versus none in the nonsmoker group. Linear regression analysis showed a higher degree of sensorineural hearing loss with age in smokers. Among the smokers, 20 subjects (59%) presented an impaired tubal function for the nine-step inflation/deflation tympanometric test, while only 6 (19%) subjects in the group of nonsmokers showed a tubal dysfunction. CONCLUSION: Tobacco use may reduce the ability to hear, mainly causing a sensorineural hearing loss for higher frequencies. We also found the presence of a high number of smokers suffering from tubal dysfunction. This has an important clinical relevance, not only because smoking increases the incidence of middle ear diseases, but also because tubal dysfunction may cause nonspecific symptoms characterised by ear fullness and difficulties in middle ear equalisation.

Oral squamous cell carcinoma in a patient treated with long-term pegylated liposomal doxorubicin for recurrent ovarian cancer.

We present a case of a woman who developed an oral squamous cell carcinoma (SCC) after being treated for a recurrent ovarian carcinoma with subtotal gastric resection and adjuvant pegylated liposomal doxorubicin (PLD). She received six cycles of PLD induction and maintenance therapy, which was continued for 5 years. She was free from disease at the following visits but 3 years later she developed SCC of her left inferior edentulous gums. The patient was negative for human papillomavirus and had never smoked in her life or had a history of alcohol use or any other environmental risk factors. PLD is known to accumulate in eccrine glands of the hands and the feet and in the oral mucosa, therefore causing skin toxicity and mucositis. It is conceivable that this specific biodistribution to the oral mucosa may be responsible for the onset of SCC.

Review of histologic and immunohistochemical features of spindle cell carcinomas (carcinosarcomas) of the larynx.

BACKGROUND: Laryngeal carcinosarcomas pose a significant diagnostic challenge to the pathologist; differential diagnosis needs histochemical and immunohistochemical investigations. MATERIALS AND METHODS: A retrospective review of charts of the pathology database was performed by a search for carcinosarcoma cases. Immunohistochemistry was performed on the representative paraffin blocks in all cases. RESULTS: This study included a total of 5 cases of carcinosarcomas of the larynx. The sarcomatoid component of the tumor was arranged in various patterns mimicking mesenchymal malignancies. Tumor cells were seen arranged in fascicles (a patient), in a storiform (3 patients), or in a solid (a case) pattern. The epithelial markers EMA and AE1/AE3 were positive in all 5 patients, as well as vimentin and CK34betaE12. DISCUSSION: Immunohistochemical studies of epithelial and mesenchymal markers (such as AE1/AE3, epithelial membrane antigens, vimentin, desmin, and S-100) are fundamental to diagnose the tumor, although they may widely vary.

The management of an orbital diffuse large B-cell lymphoma.

BACKGROUND: The orbit represents a rare site of presentation of non-Hodgkin lymphoma. The diagnosis and management of orbital lymphomas may be challenging because these neoplasms present few specific features. METHODS: A 69-year-old woman presented with painless swelling of the left lower eyelid of 5 years' duration. Magnetic resonance imaging and incisional biopsy were necessary to establish a diagnosis of orbital diffuse large B-cell lymphoma. Staging was completed, thanks to a computed tomographic study of the chest and abdomen. RESULTS: The patient underwent systemic chemotherapy with 1 regimen (doxorubicin, vincristine, prednisone, 6-mercaptopurine, and methotrexate), followed by 1 R-COMP-14 regimen (rituximab, cyclophosphamide, nonpegylated liposome-encapsulated doxorubicin, vincristine, and prednisone). Complete resolution of the disease was obtained. CONCLUSIONS: Although not typically performed by the head and neck surgeon, an understanding of the staging process is crucial for multidisciplinary management of orbital lymphomas.

Prevalence and characteristics of HPV infection in oropharyngeal cancer.

BACKGROUND: The purpose of this prospective study was to analyze the human papillomavirus (HPV) infection status and its impact on the outcome in a consecutive series of patients affected by oropharyngeal cancer. METHODS: The specimens of consecutive subjects surgically treated for oropharyngeal squamous cell carcinoma were obtained. Samples were collected by broom-type cell sampling devices and they underwent the Roche Linear Array HPV Genotyping Test to identify the presence of HPV types. RESULTS: In all, 52 patients were enrolled. The presence of HPV was detected in 13 samples, with HPV type 16 as the most frequently encountered type. Statistically significant associations were found between HPV-positive patients and a higher tumor grading (P < 0.05), and between HPV-positive patients and a higher number of negative prognostic factors (P < 0.05). CONCLUSIONS: A subset of oropharyngeal squamous cell carcinomas with a higher tumor grading is strongly linked to HPV16 infection.

Virtual endoscopy of laryngeal carcinoma: is it useful?

OBJECTIVE: To compare virtual endoscopy (VE) with flexible endoscopy in patients with cancer of the larynx. STUDY DESIGN AND SETTINGS: This prospective study includes 24 patients with proven cancer of the larynx. Patients underwent spiral CT according to our standard protocol for upper airway imaging. This same set of axial scans was transferred to a dedicated workstation to obtain VE images. Results of VE were compared with the findings of flexible endoscopy. RESULTS: Quality of the examination was good in 96% of the patients. VE identified all exophytic lesions. Two small flat lesions could be observed as slightly enhanced plaques only on the axial scans. Subglottic extension was correctly demonstrated in all cases by associating VE to the axial scans. CONCLUSION: VE shows high sensitivity in the identification of exophytic lesions of the larynx and can establish relationships between cancer and nearby structures. It can be performed in the presence of severe stenosis and does not require sedation and additional scanning. On the other hand, VE show limits in the identification of flat lesions and does not allow biopsies and functional imaging to be performed. SIGNIFICANCE: VE is a useful tool for staging and presurgery treatment of cancer of the larynx.

Paclitaxel and carboplatin in neo-adjuvant and concomitant chemoradiotherapy in locally advanced head and neck squamous cell carcinoma.

AIM AND BACKGROUND: To evaluate feasibility of neoadjuvant chemotherapy (NA-CT) followed by CT + radiotherapy (RT) in locally advanced or unresectable head and neck squamous cell carcinoma (HNSCC). METHODS: 22 HNSCC patients were enrolled (18 males, 4 females; median age, 59.5 years; median ECOG PS, 1). Sites of disease: oral cavity, 18.2%; oropharynx, 40.9%; hypopharynx, 18.2%; larynx, 4.6%, multiple sites, 18.2%. T (tumor) category: T2, 13.6%; T3, 31.8%; T4, 54.5%. N (nodes) category: NO, 9.1%; N1, 18.1%; N2, 40.9%; N3, 31.8%. Stage: III, 4.6%; IVA, 63.6%; IVB, 31.8%. Induction carboplatin (AUC = 6) and paclitaxel (200 mg/m2) x 3 cycles (q21 days) were given. Responders received definitive radiotherapy with concurrent carboplatin (35 mg/m2/day from days 1 to 5 in weeks 1, 3, 5 and 7) and paclitaxel (50 mg/m2 on days 10, 24 and 38). Patients with node involvement were suggested to undergo postradiotherapy neck dissection. RESULTS: NA-CT. 97% of planned chemotherapy cycles were administered. Prevalent toxicity was hematologic: 50% G4 neutropenia and 31.8% G3, one neutropenic fever. All patients had alopecia. Complete responses in T and N were 4 (18.2%) and 3 (15%), respectively. Partial responses were 13(59%) and 9 (45%). There was 1 progressive disease. CT + RT. 79.9% of planned cycles of CT were administered. In 19 patients (86.4%) more than 50% of planned cycles of CT were completed. Median dose of RT was 70.2 Gy on T/N+ and 54 Gy on NO. Limiting toxicity was mucositis in 77.3%, followed by neutropenia (59.1% G3-G4). Median weight loss was 4.9%.18.2% of patients required hospitalization. Complete responses in T and N were 15 (68.1%) and 8 (40%), respectively. Partial responses were 5 (22.7%) and 7 (35%). CONCLUSIONS: The preliminary results of this study are encouraging, despite the toxicity. Adequate follow-up is required to evaluate efficacy in terms of local-regional control and overall survival.