External auditory canal cancer is an extremely rare disease entity, with an annual incidence of 1 per million populations. The main histopathological type is squamous cell carcinoma (SCC), accounting for up to 90% of cases, with adenoid-cystic carcinoma and adenocarcinoma accounting for the remaining cases. Due to the rarity of the disease and difficulty in surgical treatment arising from the complex anatomy of the temporal bone, no general consensus has been arrived yet on the optimal treatment protocol. In this manuscript, we discuss the short-term outcomes of the management for SCC of the external auditory canal, mainly by surgical resection, at our institution. A total of 35 cases, initially managed at our institute from July 2015 to April 2019, were enrolled. Of the 35 patients, 27 were treated primarily by surgery (including 18 cases of lateral temporal bone resections, 7 cases of subtotal temporal bone resections, and 2 cases of partial resections) (primary surgical treatment group). Non-surgical treatments consisted of CRT with TPF (n=6) (TPF-RT group). Analyses revealed no statistically significant difference of the overall survival (OS), disease-specific survival (DSS) of, disease-free survival (DFS) between the primary surgical treatment and TPF-RT groups. In the primary surgical treatment group, postoperative recurrences occurred relatively early, usually within a year of surgery. Also, none of the age, sex, surgical procedures employed, disease stage, and postoperative radiation therapy have any significant influence on the DFS in this group. On the other hand, positive surgical margin, determined by postoperative histopathology, was associated with significantly poorer outcomes. Patients with postoperative recurrence consisted of 2 cases who showed preoperative rapid progression, and 3 with recurrent neck lymph node metastasis. Among the cases with advanced disease also, no statistically significant differences in the outcomes were observed between the primary surgical treatment and TPF-RT groups. While surgical treatment was associated with relatively good outcomes, in these cases, the highly invasive nature of extended surgery supports the selection of TPF-RT for these cases. Further accumulation of cases and evaluation of the long-term outcomes will be expected to provide evidence to establish a standardized treatment protocol for SCC of the external auditory canal.
Elementary and junior high schools carry out annual health examinations, including otorhinolaryngological checkups, for their students in Japan. We examined children who were referred to us with suspected hearing impairment on the basis of the results of otorhinolaryngological checkups conducted at elementary or junior high schools. The subjects were 201 children (86 boys and 115 girls) with an average age of 8.6 years. Audiological examination revealed bilateral sensorineural hearing loss in 17 cases (8%), bilateral conductive hearing loss in seven cases (3%), unilateral sensorineural hearing loss in 42 cases (21%), unilateral conductive hearing loss in 30 cases (15%), unilateral sensorineural hearing loss with functional hearing loss in one case (1%), and functional hearing loss in 58 cases (29%). No abnormalities were found in 46 cases (23%) Seven children with bilateral sensorineural hearing loss and 16 children with unilateral sensorineural hearing loss had been cleared by newborn hearing screening. Hearing aid use was recommended for 12 cases with bilateral sensorineural hearing loss; although seven of the cases wore them, the remaining five refused. Surgeries were performed in one case with bilateral conductive hearing loss caused by middle ear malformations, three cases with unilateral conductive hearing loss caused by middle ear malformations, six cases with unilateral middle ear cholesteatoma, and one case with cholesterol granuloma in the middle ear of one side. Functional hearing loss was common in girls aged 7-8 years. With the expansion of newborn hearing screening and infant health examinations, pediatric hearing loss is being detected earlier than ever before. However, school otorhinolaryngological checkups are still an important opportunity to identify and treat school children with hearing loss.
In adult patients with acute rhinosinusitis, living with a group of nursery school children and children of that age group is regarded as a risk factor for the development of drug-resistant Streptococcus pneumoniae (DRSP). Changes have been observed in the rates of detection of S. pneumoniae in these infants before and after introduction of the pneumococcal conjugate vaccine (PCV). It has been reported that the frequency of DRSP detection in infants decreased significantly after introduction of the vaccine. Prior to introduction of the vaccine, the frequency of detection of DRSP in nursery school children was higher than that in the non-enrolled children. Furthermore, the frequency of detection of DRSP was higher in nursery school children <2 years of age as compared to those aged ≥
2 years. However, after introduction of the vaccine, these differences disappeared. I retrospectively investigated the detection frequency of DRSP in adult cases of acute rhinosinusitis associated with these trends with respect to that in infants and changes in the background factors for DRSP detection. The participants comprised 188 patients with acute rhinosinusitis in whom S. pneumoniae was detected between 2007 and 2009 (period I), prior to introduction of the PCV, and 202 persons enrolled three years after the introduction of PCV13, from 2017 to 2019 (period II). The results indicated that in period II, the frequency of detection of DRSP was significantly lower and that living with a group of nursery school children and children of this age group was no longer a risk factor for the detection of DRSP. Although herd immunity could be a cause for these trends, it is necessary to examine the relationship between the serotypes covered by PCV and the serotypes of S. pneumoniae detected in the adult patients with acute rhinosinusitis.
Recently, there has been a remarkable increase in the demand for vascular access devices for administration of chemotherapy in patients with head and neck cancers. Peripherally inserted central catheters (PICCs) are reportedly safe and are associated with a low risk of fatal complications during and after implantation; however, only a few reports have focused on the technical procedural aspects of implantation. Herein, we compared the differences in the catheter tip positioning and complications arising after PICC implantation.
We conducted a retrospective analysis of 172 PICC implantations in 145 head and neck cancer patients. PICCs were inserted into the left and right sides in 136 and 36 patients, respectively. The median duration of implantation was 65 days. X-ray data on the catheter tip position during and after catheter insertion were available for 137 implantations in 121 patients. The tip position was defined as follows: Zone A, lower half of the superior vena cava and upper right atrium; Zone B, upper half of the superior vena cava and left brachiocephalic vein; Zone C, left brachiocephalic vein. Zone A and Zone B are considered as being appropriate positions. Among the right-sided implantations, the tip positioning during implantation was proper (Zone A or B) in 33 cases (100%) and the tip position after implantation was proper in 30 cases (91%). Among the left-sided implantations, the tip positioning during implantation was proper in 97 cases (93%) and the tip position after implantation was proper in 82 cases (79%). There was a significant difference in the percentage of patients showing proper catheter tip position between during and after implantation in the case of left-sided implantations (p=0.001), but not in the case of right-sided implantations. Furthermore, there was no significant difference in the incidence of other catheter-related complications.
During implantation, the rate of Zone A placement was lower in left-sided PICC implantations, because of contact of the catheter tip with the right lateral wall of the superior vena cava. Furthermore, after implantation, changes in the body and limb position would also make it difficult for the catheter tip to remain in the appropriate Zone A and B positions in left-sided implantations. Since inappropriate catheter tip position may be a risk factor for delayed superior vena cava wall injury and thrombosis, right-sided PICC implantation is considered to be preferable.
The voice prosthesis, provox®, is widely used for voice restoration after total laryngectomy. We conducted a retrospective review of the medical records of 53 head and neck cancer patients who received provox® placement between June 2008 and May 2019. The voice restoration rate and incidence of complications were analyzed. Factors associated with successful voice restoration and development of complications were also examined.
The median age of the patients was 68 years; 50 (94.3%) were male and 3 (5.7%) were female; 27 patients (50.9%) received prior radiotherapy; 11 patients underwent primary provox® placement, at the same time as the laryngectomy, while 42 patients (79.2%) received secondary placement, at a later time after laryngectomy. Overall, 33 patients received intervention by a speech-language therapist (ST) (62.3%). According to the Performance Status Scale for Head and Neck Cancer (PSS-HN), successful voice restoration was achieved in 47 patients (88.7%). The voice restoration rate was significantly higher in the patient group that received intervention by a ST (96.7%) as compared to that in the patient group that did not receive ST intervention (76.2%) (p=0.0307). Thirteen patients (24.5%) needed re-hospitalization for complications related to provox®. Neither irradiation nor the timing of provox® placement (primary or secondary) affected the complication rate.
The rate of voice restoration with provox® placement after laryngectomy was favorable, and ST intervention significantly improved the rate of voice restoration. Complications requiring hospitalization (24.5%) were comparable to previous reports. Increasing the number of facilities that can manage the complications and educating other medical institutions, physicians, and professionals about provox® are some important issues that need to be addressed in the future.