Is a chlorine dioxide wiping procedure suitable for the high-level disinfection of nasendoscopes?

BACKGROUND

Nasendoscopes are widely used in the outpatient ENT setting. Their reprocessing requires high-level disinfection (HLD). Recently, a wiping procedure using chlorine dioxide (ClO₂) has been proposed as an alternative to HLD traditional procedures.

OBJECTIVE

To assess the effectiveness of the HLD wiping procedure versus soaking procedure on a contaminated nasendoscope.

METHOD

A nasendoscope was contaminated with four strains of bacteria and Bacillus subtilis spores. After HLD either with the wiping procedure or with the soaking procedure (PA), the reduction of the initial contamination was determined.

FINDINGS

The wiping procedure with ClO₂ displayed more than 5 log reduction for vegetative bacteria after 30 s contact time (CT) and 4 log reduction on B. subtilis spores after 2 min CT. The soaking procedure with PA displayed similar results on planktonic bacteria after 10 min CT but the log reduction of B. subtilis remained below 4.

CONCLUSION

The ClO₂ wiping procedure showed bactericidal and sporicidal efficacy on a contaminated nasendoscope in a shorter time compared to the PA soaking procedure. Thus, ClO₂ wiping procedure might be considered as an alternative to the traditional HLD procedure for nasendoscopes.

Comparison of endoscopic and external resections for sinonasal instestinal-type adenocarcinoma

Endoscopic sinus surgery (ESS) is considered as a valid option in the management of nasal adenocarcinoma (ADC). Comparative studies with open approaches are still required. A monocentric retrospective study was carried out from May 2002 to December 2013, including 43 patients with intestinal-type adenocarcinoma of the ethmoid sinus. Non-resectable tumours or recurrences were excluded. Before 2008, open approach with lateral rhinotomy (LR) was performed as the gold standard of treatment. From 2008, ESS was systematically used as a first-line option as long as a complete resection was achievable. Adjuvant radiation therapy was delivered (RT) for all the patients. LR and ESS were performed in, respectively, 23 and 20 patients. The two groups were comparable in terms of age, occupational dust exposure, histopathological subtypes, and T stage based on the pathological assessment of the specimen (10 pT2, 26 pT3, 2 pT4a, and 5 pT4b). The tumour origin was mainly located in the olfactory cleft with the involvement of the cribriform plate in 60 % of patients. No major complication was observed in ESS group with a reduced hospital stay (5.6 vs 7.6 days). The disease-free survival was not different between LR and ESS groups over a mean follow-up period of 6.6 years. Even for local advanced stages with skull base involvement, we confirm the reliability and the advantages of ESS in terms of oncological outcomes and morbidity. We advocate complete excision of the olfactory cleft to ensure an appropriate control of the tumoral origin.

Oncologic outcomes of patients with positive margins after laser cordectomy for T1 and T2 glottic squamous cell carcinoma

BACKGROUND

The oncologic impact of surgical margins after transoral laser microsurgery (TLM) for T1 and T2 glottic carcinoma is controversial. The purpose of this study was to assess the prognostic value of margin status in terms of local control.

METHODS

Records of 266 patients treated from 1990 to 2013 were evaluated. Patients with previous cordectomy or without preoperative CT scan were excluded from the study.

RESULTS

A total 110 patients (85 T1a, 8 T1b, and 17 T2) were enrolled. A local recurrence was observed in 23 patients. Five-year disease-free survival was significantly impaired in patients with positive margins (p = .009) and in patients with deep involvement of the vocal muscle (p = .004).

CONCLUSION

The present study shows that invaded margin is a factor of poor local control even though laser vaporization was systematically applied after resection. In case of deep vocal fold involvement, TLM should be extended beyond the vocal muscle to improve local control. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1804-1809, 2016.

Human epidermal growth factor receptor 3 in head and neck squamous cell carcinomas

Human epidermal growth factor receptor 3 (HER3) is a member of the human epidermal growth factor receptor (HER) family. The main characteristic of HER3 is that it does not possess tyrosine kinase activity, unlike other HERs. The role of HER3 in tumorigenesis has now been recognized, particularly in head and neck squamous cell carcinomas (HNSCCs). Despite conflicting studies, HER3 was found to be overexpressed in HNSCC samples, and correlates with disease progression and poor survival, especially when it is coexpressed with other HERs. HER3 is a significant factor in HNSCC treatment resistance. Indeed, HER3 is a major mechanism described for cetuximab resistance because of modification of epidermal growth factor receptor (EGFR) internalization and by phosphotidylinositol-3-kinase (PI3K)/AKT signaling pathway activation. HER3 also affects resistance to tyrosine kinase inhibitors (TKIs) and thereby promotes treatment escape and radiotherapy resistance by activation of the survival signaling pathway. To counteract this, pharmacologic inhibitors of HER3 are currently in development and could significantly improve HNSCC treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2412-E2418, 2016.

Olfactory cleft opacity and CT score are predictive factors of smell recovery after surgery in nasal polyposis

OBJECTIVES

To assess subjective improvement of olfactory function following endoscopic sinus surgery (ESS) in chronic rhinosinusitis associated with nasal polyps (CRSwNP) and to analyse factors of recovery with the European Test of Olfactory Capabilities (ETOC).

METHODS

We carried out a prospective study of 30 patients with CRSwNP from November 2011 to April 2013. The ETOC was filled the day before surgery and in the short term follow-up. Sixteen suprathreshold odorants with a detection task and a forced choice verbal identification task were tested.

RESULTS

The mean composite score (MCS) improved at 3 and 6 months. The preoperative MCS was correlated to the Lund-Mackay score and to the olfactory cleft opacification on preoperative computed tomography (CT) scan. Multivariate linear regression modelling of patients with preoperative anosmia showed that the olfactory recovery at 3 months was predicted by the preoperative Lund-Mackay score and the age, and at 6 months by the preoperative Lund-Mackay score.

CONCLUSION

With a convenient psychophysical test, we showed that olfactory cleft opacification and CT scan score could be predictive factors of olfaction disorder severity and improvement after ESS in CRSwNP. These results need to be strengthened in the long term with a larger panel of patients.

French Society of ENT (SFORL) guidelines for care pathway organization in head and neck oncology (short version). Early management of head and neck cancer

Early management in oncology is based on coordination and high-quality exchange between the various health-care partners. The present guidelines are based on a literature search with levels of evidence. Treatment waiting time can be optimized by performing assessment as early as possible (Expert opinion), to limit the interval (ideally, less than 4 weeks) between first consultation and data collection. In the first specialist consultation, diagnostic work-up should be scheduled and the data required for management should be determined (Grade B). Work-up may be conducted on a day-care basis or with conventional admission (Expert opinion). The patient's medico-social context should be taken into account from the outset, with social work involvement whenever necessary (Expert opinion). Pain and nutritional management should be planned for (Grade A) and realistic therapeutic education be provided (Expert opinion). Community-hospital teamwork for supportive care should be optimized (Expert opinion). Management should be early and multidisciplinary, to shorten delay between diagnosis and treatment initiation.

Guidelines (short version) of the French Otorhinolaryngology - Head and Neck Surgery Society (SFORL) on patient pathway organization in ENT: The therapeutic decision-making process

OBJECTIVES

The authors present the guidelines of the French Otorhinolaryngology - Head and Neck Surgery Society (SFORL) for patient pathway organization in head and neck cancer, and in particular for multidisciplinary team meetings. The present article concerns the therapeutic decision-making process.

METHODS

A multidisciplinary work group was entrusted with a review of the scientific literature on the above topic. Guidelines were drawn up, based on the articles retrieved and the group members' individual experience. They were then read over by an editorial group independent of the work group. The final version was established in a coordination meeting. The guidelines were graded as A, B, C or expert opinion, by decreasing level of evidence.

RESULTS

It is recommended that: an organ specialist should contribute to all multidisciplinary meetings on head and neck cancer; all members of the multidisciplinary meeting should have specific knowledge in head and neck cancer; any referring physician who does not follow the multidisciplinary meeting's advice should justify that decision; there should be sufficient time to prepare, discuss and sum up the cases dealt with in the multidisciplinary team meeting.

Histopathological classification of refractory chronic rhinosinusitis with nasal polyps

OBJECTIVE

To delineate the histopathological characteristics of nasal mucosa in refractory chronic rhinosinusitis with nasal polyps (CRSwNP) in order to demonstrate subtypes of nasal polyps and their potential relation with lower airway comorbidity.

STUDY DESIGN

Clinical- and pathological-based cross-sectional study Methods: Nasal polyp specimens were prospectively collected from patients with refractory CRSwNP referred to our institution for endoscopic sinus surgery. Oral and topical steroids were stopped 1 month before surgery. The pathological analysis was conducted by 2 independent reviewers with light microscopy on Hematoxylin-Eosin-Saffron stained slides. Each observer fulfilled a standardized protocol with cell count and stromal characterization on the most representative field. Mean grading scores were established. Morphological aspects were compared with the cell distribution and the clinical conditions.

RESULTS

Among 36 patients, three subtypes of nasal polyps were depicted: eosinophilic edematous (64%), fibrous (9%) and intermediate with mixed edematous and collagen stromal structure (27%). Basement membrane thickening and seromucous gland hyperplasia were observed in the fibrosis sub-type (p<0.03). Eosinophilic mucosal infiltrate was significantly increased (p=0.026) in patients with concomitant pulmonary disease (n=21). Nasal polyp distribution was not influenced by asthma, allergy, previous surgery and smoking.

CONCLUSION

Our 3-subtype classification of refractory CRSwNP in Caucasian population shows a predominant edematous structure whatever the clinical conditions may have been. Eosinophilia as a major factor of adaptive immune response in nasal inflammation is a feature of concomitant pulmonary disease. Further studies concerning mucosal remodelling and outcome assessment after sinus surgery are required to evaluate the impact of our classification on a daily basis.

Immune profile modulation of blood and mucosal eosinophils in nasal polyposis with concomitant asthma

BACKGROUND

Chronic rhinosinusitis with nasal polyps (CRSwNP) is frequently associated with asthma. Mucosal eosinophil (EO) infiltrate has been found to correlate with asthma and disease severity but not necessarily in every patient. Other multifactorial immune processes are required to determine disease endotypes and response to treatment.

OBJECTIVE

To evaluate EO immunomodulation for migration and survival in accordance with inflammatory protein profiles and asthmatic status in CRSwNP.

METHODS

Ninety-three patients (47 with asthma) with CRSwNP were included. Each patient was staged clinically according to symptom severity and polyp size. Nasal secretions were collected to establish a cytokine profile. The EOs were purified from blood samples and nasal polyps to delineate specific immunophenotypes by flow cytometry and determine in vitro EO survival in relation to asthmatic status.

RESULTS

The CRSwNP in patients with asthma was characterized by eosinophilia and a high level of interleukin (IL)-5 in nasal secretions. Although EOs exhibited activation profiles after mucosal migration, there was relative down-expression of IL-5 receptor-α (IL-5Rα) on nasal EOs in patients with asthma. The EO culture with IL-5 and IL-9 showed an antiapoptotic effect in patients with asthma through IL-5Rα modulation.

CONCLUSION

Mucosal eosinophilia seems to be induced by EO nasal trapping through modulation of adhesion receptors. In patients with asthma, EO involvement is enhanced by the antiapoptotic synergistic action of T-helper cell type 2 cytokines on IL-5Rα expression. This study shows for the first time that IL-9 is involved in EO homeostasis in CRSwNP and could explain the low benefit of anti-IL-5 therapy for some patients with asthma and nasal polyposis.

Epidemiology, prognosis and treatment of simultaneous squamous cell carcinomas of the oral cavity and hypopharynx

OBJECTIVE

The study was designed to assess the prevalence, management and survival of patients with simultaneous squamous cell carcinomas of the oral cavity and hypopharynx (OC/HP).

MATERIAL AND METHODS

A multicenter, retrospective study (2 university hospitals) was conducted between 2003 and 2007 on a series of 96 patients with simultaneous squamous cell cancers of the OC/HP.

RESULTS

A total of 88 men and 8 women were included in the study: 81 patients presented double sites, 14 presented triple sites and one presented quadruple sites. The tumour sites most frequently observed were: hypopharynx in 61% of cases (involving the pyriform sinus in 42% of cases) and the oropharynx in 59% of cases (involving the palatine tonsil in 30% of cases). Upper aerodigestive tract endoscopy under general anaesthesia revealed a simultaneous lesion not suspected on clinical examination in 45% of patients: the site discovered on endoscopy was hypopharyngeal in 2 out of 3 cases; the tumour was classified T1 or T2 in 95.5% of cases. Patients treated simultaneously for all sites had a better prognosis than patients in whom each tumour was treated separately. The 5-year specific survival was 34% and the 5-year overall survival was 28%.

CONCLUSION

The prevalence of simultaneous squamous cell carcinomas of the oral cavity and hypopharynx ranges between 1 to 7.4% in the literature and was 4.6% in the present series. A common treatment strategy for each of the patient's tumours appears to be superior to the current theoretical approach that consists of considering each tumour separately.

European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer

It is accepted that the follow-up of patients who had treatment for laryngeal cancer is a fundamental part of their care. The reasons of post-treatment follow-up include evaluation of treatment response, early identification of recurrence, early detection of new primary tumours, monitoring and management of complications, optimisation of rehabilitation, promotion smoking and excessive alcohol cessation, provision of support to patients and their families, patient counselling and education. Controversies exist in how these aims are achieved. Increasing efforts are being made to rationalise the structure and timing of head and neck cancer follow-up clinics. The aim of this document is to analyse the current evidence for the need to follow up patients who have been treated for LC and provide an up to date, evidence-based statement which is meaningful and applicable to all European Health Care Systems. A working group of the Head and Neck Cancer Committee of the ELS was constituted in 2009. A review of the current published literature on the management and follow-up of laryngeal cancer was undertaken and statements are made based on critical appraisal of the literature and best current evidence. Category recommendations were based on the Oxford Centre for Evidence-Based Medicine. Statements include: length, frequency, setting, type of health professional, clinical assessment, screening investigations, patient's education, second primary tumours, and mode of treatment considerations including radiotherapy, chemo-radiation therapy, transoral surgery and open surgery. It also addresses specific recommendations regarding patients with persistent pain, new imaging techniques, tumour markers and narrow band imaging.

Pilot study of submucosal radiofrequency for epistaxis in hereditary hemorrhagic telangiectasia

OBJECTIVE

To assess the safety and efficacy of submucosal radiofrequency (RF) treatment for hereditary hemorrhagic telangiectasia (HHT) with mild or moderate epistaxis.

METHODOLOGY

We carried out a prospective pilot study of 16 consecutive patients with HHT-related epistaxis from June 2010 to April 2012. Under local anesthesia, RF was applied to one or both sides of the nose from the columella beneath the septal mucosal (50 joules per puncture). Patients were sent a questionnaire at least six months after the procedure.

RESULTS

RF under local anesthesia was well tolerated, according to visual analog scale scores. Neither crusting nor pain was reported one week after the intervention. The frequency of epistaxis per day and per month was significantly lower after RF. The duration of bleeding also decreased from more than 10 minutes to less than 5 minutes in two thirds of patients. Thirteen of the 16 patients were satisfied with the technique and would request it for subsequent procedures to treat repeated bleeding.

CONCLUSION

Submucosal RF treatment for HHT is a safe, well tolerated procedure with significant efficacy in the short term. It should be considered as an alternative technique for managing HHT-related epistaxis, although long-term results remain to be evaluated.

Pilot study of submucosal radiofrequency for epistaxis in hereditary hemorrhagic telangiectasia

Objective: To assess the safety and efficacy of submucosal radiofrequency (RF) treatment for hereditary hemorrhagic telangiectasia (HHT) with mild or moderate epistaxis. Methodology: We carried out a prospective pilot study of 16 consecutive patients with HHT-related epistaxis from June 2010 to April 2012. Under local anesthesia, RF was applied to one or both sides of the nose from the columella beneath the septal mucosal (50 joules per puncture). Patients were sent a questionnaire at least six months after the procedure. Results: RF under local anesthesia was well tolerated, according to visual analog scale scores. Neither crusting nor pain was reported one week after the intervention. The frequency of epistaxis per day and per month was significantly lower after RF. The duration of bleeding also decreased from more than 10 minutes to less than 5 minutes in two thirds of patients. Thirteen of the 16 patients were satisfied with the technique and would request it for subsequent procedures to treat repeated bleeding. Conclusion: Submucosal RF treatment for HHT is a safe, well tolerated procedure with significant efficacy in the short term. It should be considered as an alternative technique for managing HHT-related epistaxis, although long-term results remain to be evaluated.

Induction Chemotherapy Followed by Either Chemoradiotherapy or Bioradiotherapy for Larynx Preservation: The TREMPLIN Randomized Phase II Study

Purpose

To compare the efficacy and safety of induction chemotherapy (ICT) followed by chemoradiotherapy (CRT) or bioradiotherapy (BRT) for larynx preservation (LP).

Patients and Methods

Previously untreated patients with stage III to IV larynx/hypopharynx squamous cell carcinoma received three cycles of ICT—docetaxel and cisplatin 75 mg/m2 each on day 1 and fluorouracil 750 mg/m2 per day on days 1 through 5. Poor responders (< 50% response) underwent salvage surgery. Responders (≥ 50% response) were randomly assigned to conventional radiotherapy (RT; 70 Gy) with concurrent cisplatin 100 mg/m2 per day on days 1, 22, and 43 of RT (arm A) or concurrent cetuximab 400 mg/m2 loading dose and 250 mg/m2 per week during RT (arm B). Primary end point was LP at 3 months. Secondary end points were larynx function preservation (LFP) and overall survival (OS) at 18 months.

Results

Of the 153 enrolled patients, 116 were randomly assigned after ICT (60, arm A; 56, arm B). Overall toxicity of both CRT and BRT was substantial following ICT. However, treatment compliance was higher in the BRT arm. In an intent-to-treat analysis, there was no significant difference in LP at 3 months between arms A and B (95% and 93%, respectively), LFP (87% and 82%, respectively), and OS at 18 months (92% and 89%, respectively). There were fewer local treatment failures in arm A than in arm B; salvage surgery was feasible in arm B only.

Conclusion

There is no evidence that one treatment was superior to the other or could improve the outcome reported with ICT followed by RT alone (French Groupe Oncologie Radiothérapie Tête et Cou [GORTEC] 2000-01 trial [Induction CT by Cisplatin, 5FU With or Without Docetaxel in Patients With T3 and T4 Larynx and Hypopharynx Carcinoma]). The protocol that can best compare with RT alone after ICT is still to be determined.

Macrophage migration inhibitory factor in head and neck squamous cell carcinoma: clinical and experimental studies

PURPOSE

The present in vivo/in vitro study was undertaken in order to evaluate the importance of macrophage migration inhibitory factor (MIF) in the progression of head and neck squamous cell carcinoma (HNSCC).

METHODS

Tumor tissue expression (MIF immunostaining) and plasma levels (ELISA) of MIF were determined in HNSCC patients and correlated with tumor recurrence and metastasis, and overall survival. Furthermore, the impact of MIF expression on cell proliferation and anticancer drug sensitivity was examined in murine squamous carcinoma cell line SCCVII after MIF knockdown (MIF-KD).

RESULTS

As revealed by quantitative analysis of MIF immunostaining, tumor progression was accompanied by an increase in mean optical density (MOD) and labeling index (LI). Likewise, an elevation of MIF serum levels was noted in HNSCC patients (n = 66) versus healthy individuals (n = 16). Interestingly, comparison of laryngeal carcinoma patients on the basis of MIF tissue expression (high expression, LI ≥ 47, versus low expression, LI < 47) disclosed a significant difference between disease-free survival curves for local and nodal recurrence, and overall survival curve. In vitro, MIF knockdown in murine SCCVII cells resulted in reduced cell proliferation and a decrease in cell motility. In mice inoculated with SCCVII cells, MIF-KD tumors grew more slowly and also appeared more sensitive to chemotherapy.

CONCLUSIONS

Both clinical observations and experimental data suggest that MIF plays a pivotal role in the progression of HNSCC.