Temporal bone carcinoma: Treatment patterns and survival.

OBJECTIVES/HYPOTHESIS: Carcinomas of the temporal bone are rare, and appropriate treatment, staging, and survival data are limited. This study evaluates clinical characteristics and survival rates for patients with temporal bone carcinoma treated with resection at a single tertiary-care institution, with a focus on the outcomes of patients with locally advanced disease including skull base and/or dural invasion. STUDY DESIGN: Retrospective chart review. METHODS: Demographic, tumor-specific, and survival data were collected for patients with primary carcinomas of the external auditory canal with involvement of the temporal bone from 2003 to 2015. All patients were staged according to the modified Pittsburgh system. Kaplan-Meier and logistic regression analysis were used to calculate factor-specific survival outcomes. RESULTS: Sixty-seven patients met inclusion criteria; 85% were male. There were 43 squamous cell carcinomas (64%) and 24 basal cell carcinomas (BCCs) (36%). Tumor stage was 24 (36%) T2, 12 (18%) T3, and 31 (46%) T4 tumors; 53% had recurrent disease. Surgical management included 49 lateral temporal bone resections and 18 subtotal temporal bone resections. Kaplan-Meier analyses revealed more favorable 5-year survival rates associated with BCC histology (P = .01), lateral temporal bone resection compared to subtotal temporal bone resection (P < .01), lack of immunocompromise (P = .04), and absence of perineural/lymphovascular invasion (P = .01). Multivariate regression analysis did not yield statistically significant results. CONCLUSIONS: Factors predictive of more favorable survival include lack of immunocompromise, BCC histology, absence of perineural/lymphovascular invasion, and disease extent amenable to lateral temporal bone resection. Dural invasion is not an absolute contraindication to surgery, with a subset of patients surviving >5 years. LEVEL OF EVIDENCE: 3 Laryngoscope, 130:E11-E20, 2020.

Health-Related Internet Use Among Otolaryngology Patients.

OBJECTIVE: The association between online health resources use in specific otolaryngology patients is poorly understood. To better understand health-related Internet use by otolaryngology patients, we surveyed first-visit patients at academic and private practice clinics in Iowa. METHODS: Data on socioeconomic status, access, and utilization of online resources were collected. Age distributions were compared by t test, and categorical variables were compared by chi-square analysis. Multivariate logistic regression was used to estimate odds ratios for association between independent variables (age, sex, educational attainment, otolaryngology subspecialty, etc). RESULTS: Data showed that 8.7% lacked Internet access; an additional 5.4% reported access only in a public place or at work. Younger, more educated, and more urban patients reported higher rates of Internet access. Among university patients, patients seeing head and neck oncologists were most likely to report no Internet access (10.9%). Just over one-third of patients used the Internet to research their health condition prior to their appointment. CONCLUSIONS: Internet access was far from universal among this large cohort of otolaryngology outpatients. Head and neck cancer (HNC) patients report the least online access among all otolaryngology subspecialties. Providers should consider nonelectronic patient resources for older, more rural, less educated, and HNC patient populations as online/electronic methods of communication may not be accessible to these groups.

Reconstruction Outcomes Following Lateral Skull Base Resection.

OBJECTIVE: Compare reconstruction outcomes for various lateral skull base closure techniques. STUDY DESIGN: Retrospective medical records review. SETTING: University-based tertiary referral center. PATIENTS: Patients who underwent resections of tumors involving the lateral skull base requiring reconstruction beyond primary closure. INTERVENTION(S): Reconstructive techniques, from rotational flaps to free tissue transfer. MAIN OUTCOME MEASURE(S): Outcome data including wound complications, cerebrospinal fluid (CSF) leakage, and need for surgical revision were tabulated. RESULTS: Eighty-six patients underwent lateral skull base tumor resection and reconstruction. Procedures were primarily lateral temporal bone resections but also included subtotal temporal bone, total temporal bone, and infratemporal fossa resections. Cutaneous malignancy was the most common resection indication (83%) and the temporalis rotational flap was the most commonly employed reconstructive option (30%). When free tissue transfer techniques were used, the radial forearm, anterolateral thigh, and latissimus dorsi were the most frequent donor sites. Patients with T2 disease were more likely to undergo temporalis flaps, whereas patients with T4 disease were more likely to undergo free flap reconstruction. Major complications were uncommon (∼8%), the most frequent being stroke (∼3%). The postoperative wound complication rate was approximately 45%. The majority involved minor dehiscences and were managed conservatively. Patients with T4 disease were more likely to have wound complications (p < 0.05). Radial forearm free flaps were less likely to have wound complications when compared with other reconstruction techniques (p < 0.05). CONCLUSIONS: Many factors go into planning lateral skull base reconstruction. Free flaps were more often used for T4 disease. Radial forearm free flaps tended to have lower wound complication rates when compared with other techniques.

Utility of peak inspiratory flow in managing subglottic stenosis.

OBJECTIVES: To identify the utility of peak inspiratory flow (PIF) in the assessment and management of subglottic stenosis through correlation of clinical presentation with PIF. STUDY DESIGN: Case report. METHODS: Review of the clinical course of a 31-year-old woman with the diagnosis of granulomatosis with polyangiitis. Repeated PIF measurements at clinic visits were obtained over a 30-month follow-up. RESULTS: Twenty-seven PIF measurements were obtained at 31 otolaryngology clinic visits. Correlations were identified between low PIF measurements with the clinical symptom shortness of breath (2.04±0.38 L/s, n=10), clinically recorded stridor at rest (1.64±0.41 L/s, n=3), and urgent operative intervention (1.60±0.23 L/s, n=5). Correlations were identified between high PIF measurement with patient report of normal breathing (3.07±0.35 L/s, n=16) and clinical observation of absence of stridor at rest (2.81±0.32 L/s, n=23). There was a statistically significant difference in the patient's PIF values with patient-documented shortness of breath vs no shortness of breath (P=.001) and clinician-noted stridor vs no stridor (P=.017). CONCLUSION: Peak inspiratory flow measurements correlate with degree of airway compromise and are helpful to monitor the degree of airway obstruction and document response to treatment.

Primary culture of human vestibular schwannomas.

Vestibular schwannomas (VSs) represent Schwann cell (SC) tumors of the vestibular nerve, compromising 10% of all intracranial neoplasms. VSs occur in either sporadic or familial (neurofibromatosis type 2, NF2) forms, both associated with inactivating defects in the NF2 tumor suppressor gene. Treatment for VSs is generally surgical resection or radiosurgery, however the morbidity of such procedures has driven investigations into less invasive treatments. Historically, lack of access to fresh tissue specimens and the fact that schwannoma cells are not immortalized have significantly hampered the use of primary cultures for investigation of schwannoma tumorigenesis. To overcome the limited supply of primary cultures, the immortalized HEI193 VS cell line was generated by transduction with HPV E6 and E7 oncogenes. This oncogenic transduction introduced significant molecular and phenotypic alterations to the cells, which limit their use as a model for human schwannoma tumors. We therefore illustrate a simplified, reproducible protocol for culture of primary human VS cells. This easily mastered technique allows for molecular and cellular investigations that more accurately recapitulate the complexity of VS disease.

Shell retention with a cemented acetabular liner.

The authors reviewed the indications, technique, and results of cementing an acetabular liner into a well-fixed cementless acetabular shell. Indications for this procedure include a worn acetabular liner in a well-fixed cementless acetabular shell as well as an unstable total hip construct where the shell is secured. To perform such a procedure, an adequate shell diameter is necessary to accept an acetabular liner that will enable 2 mm of cement mantle around it. If the shell has screw holes, there is no need to score the acetabular shell, but otherwise the acetabular shell must be scored to a 1-mm depth in a spiderweb configuration. As for the acetabular liner, it too must be scored to a 1-mm depth in a spiderweb configuration (which enhances torsional stability) as well as a circular configuration to provide optimal lever-out strength. We have evaluated 31 constrained liners and 30 nonconstrained liners with this preparation. The failure rate in the constrained liner series was 6%, and no failures occurred in the nonconstrained series. One dislocation occurred in the nonconstrained series where patients were typically placed in a brace or cast for 6 weeks. This option should be considered in cases with worn-through acetabular liners for unstable configurations when the acetabular shell is well fixed and is of adequate diameter to accept such a construct.