Transoral laser microsurgery as primary treatment for selected T3 glottic and supraglottic cancers.

BACKGROUND: T3 laryngeal cancer encompasses heterogeneous lesions whose treatment is still debated. The purpose of this study was to evaluate transoral laser microsurgery (TLM) in management of selected T3 glottic and supraglottic cancers. METHODS: Fifty-six patients with selected T3 glottic and supraglottic squamous cell carcinomas (SCCs) treated by TLM ± selective neck dissection ± adjuvant therapy were evaluated in terms of overall survival (OS), disease-free survival (DFS), and organ preservation rates. RESULTS: For the entire cohort, 5-year OS and DFS were 63.3% and 72.4%, whereas they were 65.2% and 72.9% for glottic and 59.3% and 76.3% for supraglottic SCC, respectively. No patient required permanent tracheostomy and 1 patient was gastrostomy tube-dependent at last follow-up. CONCLUSION: TLM ± selective neck dissection ± adjuvant (chemo)radiotherapy for selected T3 glottic and supraglottic SCC represents an effective alternative treatment to open partial laryngectomies and nonsurgical organ preservation protocols, particularly in elderly and frail patients. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1107-1112, 2016.

Functional outcomes after different types of transoral supraglottic laryngectomy.

OBJECTIVES/HYPOTHESIS: To seek a correlation between the four types of transoral supraglottic laryngectomies (TSLs) according to the European Laryngological Society (ELS) and postoperative morbidity. STUDY DESIGN: Retrospective case series at an academic institution. METHODS: Chart review was done for 96 patients affected by T1-T3 supraglottic cancers (28 pT1, 46 pT2, 22 pT3) treated by TSL (29 type I, 14 type II, 35 type III, 18 type IV) with CO2 laser. Five-year overall survival (OS), disease-specific survival (DSS), local control with laser alone (LCL), and organ preservation (OP) were calculated by Kaplan-Meier curves. Thirty-six patients were submitted to swallowing evaluation by M. D. Anderson Dysphagia Inventory (MDADI), videoendoscopy of swallow (VEES), and videofluoroscopy (VFS). Hospitalization, tracheotomy, nasogastric feeding tube (NGFT), and complications were compared between type I-II versus III-IV TSLs for the entire series. MDADI and VEES/VFS scores were compared in the subgroup of 36 patients. RESULTS: Five-year OS, DSS, LCL, and OP rates were 69%, 85.9%, 89.2%, and 92.6%. Mean hospitalization was 9 days, tracheotomy was required in 7% of patients, an NGFT was required in 33%, and 11% experienced complications. Type III-IV TSLs were associated with increased hospitalization (P < .001), more NGFTs (P = .001), and 90% of complications (P = .021). Aspiration was seen in 0% and 9% of type I-II TSLs, and in 7% and 43% of type III-IV TSLs by VEES and VFS, respectively. CONCLUSIONS: Type III-IV TSLs present higher morbidity and complications, thus confirming the utility of the ELS classification in preoperative counseling and therapeutic planning. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:1131-1135, 2016.

Nasal tactile sensitivity in allergic rhinitis.

CONCLUSION: These preliminary data show a decrease in nasal tactile sensitivity and point out interesting aspects of the nasal chronic inflammatory condition in allergic rhinitis. OBJECTIVES: The aim of this study was to evaluate the effects of allergic rhinitis on nasal tactile sensitivity during the intercritical period. METHODS: A total of 70 patients aged between 18 and 67 years (average 42 years), with a positive history of allergy caused by seasonal outdoor allergens, were included (group A). Patient outcome was assessed by the nasal monofilament test: a set of 20 Semmes-Weinstein monofilaments was used to detect nasal sensitivity for both nasal cavities. The sensitivity threshold was recorded as the minimum monofilament size with which patients could detect at least two of three stimuli. RESULTS: When compared to the control group (group B), subjects in group A required a significantly (p < 0.05) higher stimulus to trigger a touch response in the monofilament test, for both the inferior (195.1 ± 0.39 mg vs 67.7 ± 0.19 mg) and middle turbinate (108.7 ± 0.23 mg vs 67.7 ± 0.19 mg).