The epidemiology of laryngeal cancer in Brazil

Exploring the protective association between COVID-19 infection and laryngeal cancer: insights from a Mendelian randomization study

Introduction

Viral infections have been implicated as a risk factor for laryngeal cancer. Given the possible effects of Corona virus disease 2019 (COVID-19) on the laryngeal tissue, we investigated the causal link between COVID-19 and laryngeal cancer using a two-sample Mendelian randomization (MR) approach.

Methods

We utilized genetic data from the 5th Genome-wide association studies (GWAS) edition of the COVID-19 Host Genetics Initiative (published on January 18, 2021) and a large-scale laryngeal cancer GWAS comprising 180 cases and 218,612 controls of European ancestry. We applied inverse variance weighting, MR Egger, and weighted median methods to infer causality. We performed sensitivity analysis using the "leave-one-out" method to verify robustness.

Results

We found no evidence of a causal association between gene-predicted COVID-19 and laryngeal cancer [Odds ratio (OR)=0.24 (95% Confidence intervals (CI), 0.05-1.26), P=0.09]. However, we observed significant inverse associations between gene-predicted COVID-19 hospitalization [OR=0.51 (95% CI, 0.28-0.95), P=0.03] and severe patients [OR=0.62 (95% CI, 0.43-0.90), P=0.01] and laryngeal cancer. Notably, the study detected important genetic variants, such as rs13050728, that modulate the expression of interferon alpha receptor 2 (IFNAR2), indicating possible roles for immune response pathways in both COVID-19 and cancer.

Discussion

This study reveals a potential interaction between COVID-19 severity, genetic factors, and laryngeal cancer, underscoring the importance of investigating the immune response mechanisms in both conditions. These findings contribute to the understanding of the complex interactions between COVID-19 and laryngeal cancer and may guide future research on the role of immune response, particularly involving IFNAR2.

The Relationship Between Voice Handicap Index and Voice-Related Quality of Life in Patients with Early Laryngeal Cancer

Introduction

Voice production can be affected in early laryngeal cancer. The purpose of this study was to investigate the correlation between Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-RQOL) among patients with early laryngeal cancer.

Methods

Twenty-seven patients with early laryngeal cancer (T1, T2) and a mean age of 59.35 ± 7.77 years who were visited in Amir-Alam hospital, took part in this study. After a diagnosis of early laryngeal cancer by a laryngologist, the patients filled out the Persian versions of the VHI and V-RQOL questionnaires.

Results

The results showed the mean total score of VHI and V-RQOL were 65.94 ± 14.21 and 48.64 ± 9.75% in patients with early laryngeal cancer, respectively. These results indicated the total and subscales' scores of VHI increased while the scores of VRQOL decreased. The Pearson correlation between total scores of the VHI and V-RQOL was - 90. Also, there was a negative significant correlation between total and subscales' scores of VH and VRQOL (r Pearson= -0.46 to -0.90, p ≤ 0.05).

Conclusion

Our findings demonstrated decreased quality of life related to voice in patients with laryngeal cancer who were in the early stages of tumor growth (T1, T2). Regarding the high negative significant correlation between results of VHI and V-RQOL in patients with early laryngeal cancer, both questionnaires can be used instead of each other for saving time in voice clinics.

Circ_0023028 contributes to the progression of laryngeal squamous cell carcinoma by upregulating LASP1 through miR-486-3p

Circular RNAs (circRNAs) are implicated in the tumorigenesis of human cancers. However, the effects of circRNAs on laryngeal squamous cell carcinoma (LSCC) are largely unknown. Here, we aimed to explore the roles of circ_0023028 in LSCC development. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to measure circ_0023028, miR-486-3p, and Lin-Isl-Mec (LIM) and SH3 domain protein 1 (LASP1) mRNA. The characteristics of circ_0023028 were determined by RNase R digestion assay and Actinomycin D assay. Cell Counting Kit-8 (CCK-8) assay and colony formation assay were utilized for cell proliferation. Transwell assay was adopted for cell invasion and migration. Flow cytometry analysis was carried out to analyze cell cycle and apoptosis. RNA pull-down assay and dual-luciferase reporter assay were used to explore the association between miR-486-3p and circ_0023028 or LASP1. Western blot assay was adopted to measure LASP1 protein level. Murine xenograft model was executed to investigate the function of circ_0023028 in vivo. High expression of circ_0023028 was observed in LSCC tissues and cells. Circ_0023028 was stable and possessed a loop structure. Circ_0023028 silencing suppressed LSCC cell proliferation, metastasis and cell cycle process and induced apoptosis in vitro and hampered tumor growth in vivo. Further mechanism analysis demonstrated that circ_0023028 could sponge miR-486-3p to regulate LASP1 expression in LSCC cells. The malignant behaviors of LSCC cells mediated by circ_0023028 knockdown were rescued by the inhibition of miR-486-3p. Moreover, miR-486-3p suppressed LSCC cell progression via binding to LASP1. Circ_0023028 knockdown might impede the progression of LSCC by regulating miR-486-3p/LASP1 axis, which could provide a novel insight on the mechanism of LSCC progression.

Audiological assessment and otoacoustic emissions in patients with head and neck cancer

ABSTRACT Purpose: to describe the audiological and otoacoustic emission findings in patients who had head and neck cancer and compare them with individuals without the disease. Methods: a comparative, cross-sectional, observational study encompassing two groups: Study: individuals with a history of head and neck cancer, submitted to chemotherapy and/or radiotherapy; Control: individuals without the disease. The sample comprised 23 individuals in each group, matched for age and gender. Procedures in which the groups were compared: meatoscopy; pure-tone threshold and high-frequency audiometry; speech audiometry; transient-evoked otoacoustic emissions. Statistical tests: Pearson’s chi-square; Fisher’s exact; two-proportion Z-test; Wilcoxon; Mann-Whitney; Student’s t-test. Results: the comparison between the groups revealed statistically significant differences at the 3, 6, 8, 10, and 12.5 kHz frequencies in the pure-tone threshold audiometry, with better pure-tone auditory thresholds in the control group. No significant differences were observed between the groups in the otoacoustic emissions regarding the general response and frequency band. Conclusion: individuals with a history of head and neck cancer had higher pure-tone auditory thresholds than their controls, especially at the higher frequencies. This evidences the deleterious effect of ototoxicity on the peripheral auditory system of adults. The otoacoustic emissions were similar in the two groups.

Hsa_circ_0042666 inhibits proliferation and invasion via regulating miR-223/TGFBR3 axis in laryngeal squamous cell carcinoma

Circular RNAs (circRNAs) have been reported to play critical roles in tumorigenesis. However, the roles of circRNAs in laryngeal squamous cell carcinoma (LSCC) are still largely unknown. In our present study, we identified a novel circRNA hsa_circ_0042666, which was poorly expressed in LSCC. Low hsa_circ_0042666 expression was closely associated with advanced tumor stage, lymph-node metastasis, and poor overall survival. In vitro function assays, we showed that hsa_circ_0042666 dramatically reduced LSCC cells proliferation and invasion in vitro. In mechanism, our data indicated that hsa_circ_0042666 could competitively bind to miR-223 as a miRNA sponge to regulate TGFBR3 expression in LSCC progression. Altogether, these findings elucidated that hsa_circ_0042666 regulated LSCC cells proliferation and invasion by miR-223/TGFBR3 axis, which might provide a therapeutic strategy for the treatment of LSCC.

Fração de câncer de cabeça e pescoço atribuível ao tabaco e ao álcool em cidades de três regiões brasileiras

RESUMO: Objetivo: Estimar a fração de câncer de cabeça e pescoço (CCP) atribuível ao tabaco e ao álcool em cidades das regiões Centro-Oeste, Sudeste E Sul do Brasil. Métodos: Estudo caso-controle com 1.594 casos de CCP e 1.292 controles hospitalares. A associação de CCP com tabaco e álcool foi estimada pela odds ratio e intervalos de confiança de 95% via regressão logística não condicional, ajustada por idade, sexo, escolaridade, consumo de frutas e legumes, consumo de bebidas alcoólicas (para examinar o efeito do tabaco) e tabagismo (para examinar o efeito do álcool). As proporções de CCP atribuíveis ao tabaco e ao álcool foram estimadas pelo cálculo da fração atribuível (FA). Foram realizadas estimativas separadas para Goiânia (Centro-Oeste), Rio de Janeiro e São Paulo (Sudeste) e Pelotas e Porto Alegre (Sul). Resultados: A fração de CCP atribuível ao tabagismo foi discretamente mais elevada em Goiânia (FA = 90%) em comparação às cidades do Sudeste (FA = 87%) e do Sul (FA = 86%). A fração de CCP atribuível ao consumo de bebidas alcoólicas apresentou resultados similares e mais altos nas cidades do Sudeste (FA = 78%) e Sul (FA = 77%) em comparação a Goiânia (FA = 62%). Conclusão: As frações de CCP atribuíveis ao tabagismo foram mais expressivas do que para o consumo de álcool. Embora com discretas distinções entre si, as FA para tabaco e álcool observadas nas cidades das três regiões brasileiras foram semelhantes às obtidas em estudos em outras regiões da América Latina, porém, mais altas que em outras partes do mundo.

Patient Concerns Inventory for head and neck cancer: Brazilian cultural adaptation

Objective:

The purpose of this study was to translate, culturally validate and evaluate the Patients Concerns Inventory - Head and Neck (PCI-H&N) in a consecutive series of Brazilian patients.

Method:

This study included adult patients treated for upper aerodigestive tract (UADT) cancer. The translation and cultural adaptation of the PCI-H&N followed internationally accepted guidelines and included a pretest sample of patients that completed the first Brazilian Portuguese version of the PCI. Use, feasibility and acceptability of the PCI were tested subsequently in a consecutive series of UADT cancer patients that completed the final Brazilian Portuguese version of the PCI and a Brazilian Portuguese version of the University of Washington Quality of Life Questionnaire (UW-QOL). Associations between physical and socio-emotional composite scores from the UW-QOL and the PCI were analyzed.

Results:

Twenty (20) patients participated in the pretest survey (translation and cultural adaptation process), and 84 patients were analyzed in the cultural validation study. Issues most selected were: fear of cancer returning, dry mouth, chewing/eating, speech/voice/being understood, swallowing, dental health/teeth, anxiety, fatigue/tiredness, taste, and fear of adverse events. The three specialists most selected by the patients for further consultation were speech therapist, dentist and psychologist. Statistically significant relationships between PCI and UW-QOL were found.

Conclusion:

The translation and cultural adaptation of the PCI into Brazilian Portuguese language was successful, and the results demonstrate its feasibility and usefulness, making this a valuable tool for use among the Brazilian head and neck cancer population.

Autofluorescence spectroscopy in the differentiation of laryngeal epithelial lesions - preliminary results

Conclusions Autofluorescence spectroscopy may be a supporting tool for differential diagnosis of changes in laryngeal epithelium. Objectives Early detection and differential diagnosis of proliferative changes in the larynx are still a challenge for laryngologists. The aim of the study was to evaluate the autofluorescence spectroscopy technique to in vitro differential diagnosis of pathological changes in the epithelium of the larynx. Methods Forty-two patients aged 34-79 years were included in the study. The fifty-two tissue specimens, including 10 samples of cancerous lesion, 10 adjacent normal tissue, 10 chronic inflammation, eight cyst, three leukoplakia, four polyp, and seven Reinke's edema, were obtained during laryngological procedures. All tissue samples were independently diagnosed histopathologically. The autofluorescence emission spectra at two excitation wavelengths, 290 nm and 370 nm, were measured for every sample studied. Results The autofluorescence signals of cancerous tissue samples at both excitations exhibited identical emission band shapes of much lower intensities at their maxima as compared to the adjacent healthy tissue samples studied. The autofluorescence spectra intensities of cancerous and normal tissues varied inter-individually. Evident differences in autofluorescence intensities and its band shapes of different pathological laryngeal changes at the 290 nm excitations were demonstrated.

Acuidade olfatória e qualidade de vida após a laringectomia total

RESUMO: Objetivo: identificar a prevalência e os fatores associados às alterações do olfato e descrever a qualidade de vida após a laringectomia total. Métodos: estudo transversal para avaliar a acuidade olfatória e a qualidade de vida de laringectomizados totais no Instituto Nacional de Câncer por meio da aplicação do Teste de Identificação do Olfato da Universidade da Pensilvânia, do Questionário de Qualidade de Vida da Universidade de Washington e do Questionário sobre a Acuidade Olfatória Pré-Reabilitação do Olfato. Resultados: foram avaliados 48 laringectomizados totais, sendo 39 do sexo masculino e 9 do sexo feminino, com idade média de 62 anos e tempo médio de 5,6 anos desde a laringectomia total. No Teste de Identificação do Olfato a pontuação média foi de 17,9. De acordo com a classificação do olfato no teste, a maioria dos participantes apresentou algum grau de alteração, sendo que apenas 2 indivíduos tiveram o olfato considerado dentro da normalidade. No Questionário de Qualidade de vida da Universidade de Washington, o escore composto foi 80,47. Os domínios que apresentaram as médias de pontos mais baixas foram paladar, saliva e fala. No questionário sobre a acuidade olfatória pré-reabilitação do olfato, a maioria dos participantes consideraram seu olfato de ruim a razoável. 21 indivíduos relataram apresentar algum grau de dificuldade em suas atividades de vida diária em decorrência de alterações do olfato. Conclusão: os laringectomizados totais apresentaram alta prevalência de alterações do olfato, com comprometimentos relacionados às suas atividades de vida diária.

Effect of airway dynamics on the development of larynx cancer

OBJECTIVES/HYPOTHESIS

This study aimed to investigate and measure airway dynamics in anatomical regions where laryngeal cancer was most common in comparison to other regions of the larynx, thereby determining the effect of airway dynamics on the development of laryngeal cancer.

STUDY DESIGN AND METHODS

Pulmonary function test airflow data and larynx anatomy measurement data obtained by three-dimensional computed tomography. A healthy male adult was modeled by simulation using the ANSYS program. Analysis of air flow rates, pressure, and force were also made.

RESULTS

The supraglottic region average pressure was higher when compared to the subglottic region and clearly lower when compared to the glottic region. The subglottic had the lowest pressure and force levels. The glottic region was the first ranked location for laryngeal cancer; the supraglottic region was the second; and the frequency of laryngeal cancer was much lower in the subglottic region. Our data suggests that the high pressure and force contribute to an increased amount of contact and interaction between toxic particles and mucosa and to increased diffusion of the particles, leading to an increased carcinogenic effect and frequency of cancer.

CONCLUSION

Laryngeal cancer was found more frequently in regions with an increased pressure and force stress and reduced air velocity, with a subsequent increase in penetration of the inhaled toxic agents. These findings demonstrate the importance of basic physical fluid mechanics in cancer pathogenesis.

LEVEL OF EVIDENCE

NA. Laryngoscope, 126:1136-1142, 2016.

Classification models based on the level of metals in hair and nails of laryngeal cancer patients: diagnosis support or rather speculation?

Several larynx cancer prediction models were built and each was weighted according to their performance.

Laryngeal cancer in Kazakhstan - ethnic, age and gender differences over time

The purpose of the present study was to provide an assessment of the incidence of cancer of the larynx in Kazakhstan with especial attention to ethnicity and gender, as well as age. The retrospective design covered all new cases of laryngeal cancer in 11 years (1999-2009). The total number was 4,967 cases, 4,535 (91.3%) in males and 432 (8.7%) in women, with a gender ratio of 10.5:1. Patients of Kazakh (31.2%) and Russian (51.4%) ethnicity accounted for the vast majority (82.6%), with Russians predominating in both sexes, but particularly in females. Age peak in Kazakhs was 70 years and older (14.6 ± 0.70/0000), and in Russians was 60-69 years (21.6 ± 1.30/0000). In the dynamics, the rates had the tendency to decrease more markedly in Russian than Kazakh men, especially in the younger groups, while increase was noted in the youngest females of both ethnicities, but again greater in Russians, presumably reflecting change in underlying lifestyle factors.

Amplitude and speed of masticatory movements in total laryngectomy patients

INTRODUCTION

Laryngectomy is a surgical procedure that aims to remove the hyoid bone and the larynx and its muscles; it is inferred that a destabilization of the hyoid-mandibular axis will occur, consequently changing chewing.

OBJECTIVE

To characterize the amplitude and speed of chewing in laryngectomies and to compare them with two groups of non-laryngectomized individuals differentiated by age.

METHOD

72 volunteers were divided into three groups: (A) 32 volunteers, mean age 22.3 years, 17 females; (B) 20 volunteers, mean age 53.2 years, 10 females, and (C) 20 volunteers who underwent total laryngectomy, mean age 61.5 years, one female. Electrognathography, a method that tracks and measures millimeter jaw movements, was used for evaluation.

RESULTS

Significant differences were observed between groups A and C in masticatory amplitude and speed.

CONCLUSION

Age, and adaptive and compensatory changes appear to explain chewing better than factors related to total laryngectomy.

Practice of laryngectomy rehabilitation interventions: a perspective from South America

PURPOSE OF REVIEW

Treatment of laryngeal cancer will depend on several factors, including tumor factors, patient factors, as well as the technical resource and expertise of the surgical team and treatment center. In developing countries, most patients have their diagnosis performed at advanced stages, with a significant proportion at very advanced locoregionally, which results in a limitation to the use of organ-preserving approaches. A total laryngectomy is still the most frequent treatment for larynx cancer patients. The rehabilitation in such scenarios can be more demanding and can cost more compared with developed countries.

RECENT FINDINGS

For early-stage tumors, function-preserving strategies are mandatory, and can include partial laryngectomies and radiation therapy. In such cases, functional rehabilitation usually is easily achieved, with lower negative impact on the patient's daily life. For advanced tumor stages, a treatment shift toward a more conservative management has been observed. However, the success rates of organ-preserving strategies, mainly with chemoradiation approaches, will rely on a rigorous patient selection process.

SUMMARY

The rehabilitation of laryngectomy patients in developing countries can be more demanding and can cost more compared with developed countries. In such scenarios, some strategies can be employed by the multidisciplinary team, mainly by the surgical and speech-pathology teams, aiming to decrease the costs involved in the rehabilitation of total laryngectomy patients in developing countries.

Epidemiological evaluation of laryngeal cancer incidence in Kazakhstan for the years 1999-2009

The purpose was to provide a descriptive epidemiological assessment of the incidence of cancer of the larynx in Kazakhstan and spatial evaluation with gender characteristics. This retrospective study covered all new cases of laryngeal cancer in 11 years (1999-2009). The total number was 4,967 cases, 4,535 (91.3%) in males and 432 (8.7%) in women, with a ratio of 10.5:1. The higher incidence in men compared to women was evident in all age groups, the differences being statistically significant (p<0.05). At the same time revealed a unimodal growth with age, peaking at 70 years and older both sexes. In the dynamics, incidence rates of laryngeal cancer demonstrated a tendency to decrease, in women (T=-6.7%) this being more pronounced than in men (T=-3.3%). Levels were determined to produce cartograms of cancer of the larynx for male and female populations, clear geographical variation being evidenced. The data are discussed with reference to possible risk factors.

Limits on quality of life in communication after total laryngectomy

Introduction: Among people affected by cancer, the impairment of quality of life of people affected by cancer can cause have devastating effects. The self-image of patients after post-laryngectomyzed patients may be find themselves compromised, affecting the quality of life in this population.

Objective: To characterize quality of life in related to communication in people who have undergone went total laryngectomy surgery.

Methods: This is an observational study, with a cross-sectional and descriptive series.

Design of series study. The sample were comprised 15 patients interviewed the period from January to February of 2011. We used the Quality Protocol for Life Communication in Post-laryngectomy adapted from Bertocello (2004); which this questionnaire contains 55 questions. The protocol was organized from the nature of using responses classified as positive and negative aspects, proposals in with respect to five 5 communication domains: family relationships, social relationships, personal analysis; morphofunctional aspect, and use of writing. To promote and guarantee the autonomy of the respondents, was examiners made use of used assistive technology with the Visual Response Scale.

Results: The responses that total laryngectomy compromises the quality of life in communication amounted to 463 occurrences (65.7%), and that who responses suggesting good quality of life were represented with amounted to 242 occurrences (34.3%), from a total of 705 occurrencesresponses. From Among the five 5 Communication domains, four 4 had percentages of above 63% for occurrences of negative content for impact on communication. Appearance Morphofunctional appearance gave the had the highest percentage of negative content, amounting to 77.3% of cases.

Conclusions: The results showed important limitations of a personal and social nature due to poor communication with their peers. Thus, there is a need for multidisciplinary interventions that aim to minimize the entrapment of negative impact on these people communication among these patients.

Possible implication of Mdm2 as a prognostic marker in invasive laryngeal carcinoma

Laryngeal squamous cell carcinoma is one of the most common malignant neoplasms of the head and neck. In Brazil, laryngeal tumors represent 2% of all cancers and are associated with approximately 3,000 deaths annually. Human papillomavirus (HPV) has been reported to play an important role in the etiology of laryngeal cancer. The aim of the present study was to evaluate the expression of p53, p27, and Mdm2 in laryngeal carcinomas. Sixty-three larynx biopsies were selected for the study, including 9 in situ laryngeal carcinomas, 27 laryngeal carcinomas without metastasis and 27 laryngeal carcinomas with metastasis. Twenty-seven cervical lymph nodes from patients with metastatic lesions were also evaluated. The expression levels of p53, p27, and Mdm2 were assessed by immunohistochemistry using a computer-assisted system. HPV detection and typing were performed using PCR, and the HPV types that were evaluated included HPV 6, 11, 16, 18, 31 and 33. Out of 63 patients, 53 (84.1%) were positive for β-globin (internal control), and 10 (15.9%) were β-globin negative and therefore excluded from the evaluation. Thus, 7 (13.2%) out of 53 patients were HPV positive, and 46 (86.8%) out of 53 patients were HPV negative. Statistically significant differences (p < 0.05) in Mdm2 expression levels were observed in the in situ laryngeal carcinoma samples compared with the laryngeal carcinoma samples with metastasis. No statistically significant differences (p > 0.05) in either p53 or p27 expression levels were detected. These findings suggest that Mdm2 may be associated with the invasiveness and aggressiveness of laryngeal carcinomas.

Clinical and epidemiological characteristics of patients in the head and neck surgery department of a university hospital

CONTEXT AND OBJECTIVES

Head and neck cancer is the fifth most common type of cancer worldwide. The objective of this study was to evaluate the clinical and epidemiological parameters in a head and neck surgery service.

DESIGN AND SETTING

Cross-sectional study using patients' records, developed in otolaryngology and head and neck department of a university hospital in the northwest of the state of São Paulo.

METHODS

A total of 995 patients in the head and neck surgery service between January 2000 and May 2010 were evaluated. The variables analyzed included: age, gender, skin color, tobacco and alcohol consumption, primary site, staging and histological tumor type, treatment and number of deaths.

RESULTS

The disease was more frequent among men (79.70%), smokers (75.15%) and alcohol abusers (58.25%). The most representative sites were oral cavity (29.65%) and larynx (24.12%) for the primary site; squamous cell carcinoma (84.92%) was the most frequent histological type, and surgery (29.04%) and radiotherapy (14.19%) were the most common treatments.

CONCLUSION

The cancer that affects patients assisted by the head and neck surgery service occurs mainly men, smokers and alcohol abusers, and the oral cavity and larynx are the sites with the highest incidence. The high rate of patients with stages III and IV indicates late diagnosis by the treatment centers, which reflects the need for prevention education campaigns for early diagnosis of the disease.

The effects of cigarette smoking on the female voice

To investigate voice changes as they develop over time due to cigarette smoking, women who never smoked (NS), women who smoked less than 10 years (S1), and women who smoked 10 or more years (S2) were compared. Acoustic (fundamental frequency, jitter, shimmer, signal-to-noise ratio), electroglottographic (open, closing, and speed quotients), aerodynamic (subglottal pressure, airflow, laryngeal airway resistance), and perceptual measures were obtained. Fundamental frequency and open quotient significantly decreased and speed quotient significantly increased in S1 and S2; jitter and shimmer significantly increased in S2 only. NS were perceived as non-smokers more reliably than S1 and S2 as smokers. Fundamental frequency, open quotient, and speed quotient were the most sensitive indicators of smoking effects on the female voice.

Reabilitação das funções do olfato e do paladar em laringectomizados totais: revisão sistemática

TEMA: na laringectomia total ocorre a transferência do fluxo aéreo nasal definitivamente ao traqueostoma, podendo provocar diminuição na percepção do olfato e do paladar. Recentemente tem sido desenvolvidos métodos de intervenção a fim de melhorar a performance olfativa e gustativa em laringectomizados, embora sejam escassos os estudos que abordam esse tema. OBJETIVO: rever de forma sistemática as evidências de como as técnicas envolvidas na reabilitação das funções do olfato e do paladar tem efeito em indivíduos laringectomizados totais. CONCLUSÃO: nesta revisão todos os estudos selecionados demonstraram eficácia na utilização de técnicas de reabilitação para a função do olfato em laringectomizados totais. Para o paladar não houve propostas para intervir diretamente nesta função.

Alterações e avaliação das funções do olfato e do paladar em laringectomizados totais: revisão sistemática

O objetivo desse estudo foi rever de forma sistemática as alterações nas funções do olfato e do paladar em indivíduos submetidos à laringectomia total, bem como identificar na literatura os aspectos envolvidos na avaliação dessas funções nesta população. Foi realizada uma revisão sistemática a partir das bases de dados MedLine, LILACS e SciELO, tendo a busca de dados ocorrida em outubro/2010. Foram encontrados 84 artigos a partir da busca de descritores e termo livre, sendo 79 da Medline, via Pubmed, e cinco da LILACS e da SciELO. Destes, foram selecionados 16 artigos. A maioria dos estudos, nesta revisão, atestou diminuição das funções sensoriais do olfato e do paladar em indivíduos submetidos à laringectomia total e, embora haja consenso com relação aos prejuízos causados a essas funções pela interrupção do fluxo aéreo nasal, ainda não é possível evidenciar minuciosamente os mecanismos e estruturas envolvidas, principalmente no que se refere às alterações da mucosa olfatória

[Vocal care: question of prevention and health]

Planned by Brazilian doctors, the National Week of the Voice (Semana Nacional da Voz) conquered the world due to the huge reached success. This study has the objective to demonstrate the results reached during the 9th National Week of the Voice (9ª Semana Nacional da Voz) that took place in the Hospital das Clínicas of the Federal University of Goiás. During the event, 125 patients had been selected by the phonoaudiology team and manually filled a questionnaire elaborated for the campaign in the validity of possible pharyngolaryngeal alterations. The patients had been examined by the otorhinolaryngologist using indirect laryngoscopy and, when necessary, submitted to videolaryngoscopy. After medical evaluation, it was observed that 52 people (41.6%) had presented alterations in the speech organs or in proximal regions, in one patient paralysis of left vocal fold was detected and one patient presented tumoral injury. Considering all the patients attended, only one presented malignant neoplasm (squamous cell carcinoma), confirmed later by biopsy.

Comportamento dos músculos cervicais em indivíduos com fala esofágica e laringe artificial

OBJETIVO: avaliar através da eletromiografia de superfície o comportamento dos músculos esternocleidomastóideo e paraespinhais cervicais bilateralmente em pacientes que se comunicam por meio da fala esofágica e laringe artificial, para determinar se o tipo de voz utilizada altera o comportamento dos músculos cervicais. MÉTODOS: foram avaliados dez voluntários (duas mulheres e oito homens), idade média de 49,7 anos, com laringectomia total, tempo de pós-operatório médio de 2,6 anos, com limitação dos movimentos do pescoço, divididos em dois grupos: grupo 1: cinco voluntários (laringe artificial); grupo 2: cinco voluntários (voz esofágica); grupo 3 controle (sete voluntários). RESULTADOS: na fonação não houve alteração no padrão de ativação muscular dos indivíduos que utilizam a voz esofágica e a laringe artificial, com relação ao grupo controle. No entanto, na condição de repouso houve diferença significativa, comparando-se os valores médios de Root Mean Square dos grupos 1 e 2 com o grupo 3, para o músculo esternocleidomastóideo direito e para os músculos paraespinhais cervicais direito. CONCLUSÃO: o tipo de opção vocal não interferiu no padrão de ativação muscular durante a fonação, bem como não existiu diferença no padrão de ativação muscular na fonação dos voluntários quando comparados a indivíduos sem intercorrências no aparelho fonador.

The epidemiology of laryngeal cancer in a country on the esophageal cancer belt

OBJECTIVE

Laryngeal cancer is one of the most common malignant neoplasms of the head and neck and occurs predominantly in males. Squamous cell carcinomas arising in the glottic region are the most common of all laryngeal cancers and more prevalent than the supraglottic ones. But this pattern is reverse in some countries. This study was done to investigate the epidemiologic aspect of this subject in Iran.

STUDY DESIGN

Cross-sectional study

SUBJECTS AND METHODS

During a ten-year period from 1997 to 2007, all patients referred to two tertiary referral hospitals with a diagnosis of laryngeal cancer were enrolled in this study.

RESULTS

Laryngeal cancer was diagnosed in a total of 453 patients and confirmed histologically. The average patient age was 59.92 years. Men outnumbered women (9.5:1). Four hundred patients (88.5%) were tobacco smokers. The primary location of the tumor was supraglottic in 221 (49%) cases, followed by glottic in 163 (36.2%), transglottic (the tumor involved all regions of the larynx and the origin was unspecified) in 60 (13.3%), and subglottic in 7 (1.6%).

CONCLUSION

In our series, although we excluded transglottic tumors, the supraglottic tumor was dominant and the ratio of supraglottic to glottic tumors was 1.36. This is compatible with results from countries with a reverse ratio.

Relationship between a family history of malignancy and the incidence of laryngeal carcinoma in the Liaoning province of China

OBJECTIVE

The purpose of this study was to determine the contribution of family history of malignancy to the incidence of laryngeal squamous cell carcinoma.

DESIGN

We performed a retrospective review of classified statistics from the detailed information of cases and matched controls.

SETTING

First Hospital of China Medical University in the Liaoning province of China, between October 2005 and November 2007.

PARTICIPANTS

A total of 288 previously untreated patients with laryngeal cancer and 296 control subjects with non-malignant diseases were analysed by use of a hospital-based case-control study.

MAIN OUTCOME MEASURES

Incidence rates and family history of malignancy.

RESULTS

Single-factor logistic regression analysis indicated that the odds ratio value of a family history of malignancy was 2.0 (95% confidence interval: 1.3-3.2). Multiple logistic regression analysis confirmed this result, with an odds ratio value of 2.3 (95% confidence interval: 1.2-4.5). There was significant association between a family history of malignancy and the development of laryngeal squamous cell carcinoma.

CONCLUSIONS

A family history of malignancy plays an important role in and is an independent risk factor for the incidence of laryngeal carcinoma.

Galectin-3 overexpression in invasive laryngeal carcinoma, assessed by computer-assisted analysis

The larynx is the most common site of malignancy in the upper aerodigestive tract. In Brazil, malignant laryngeal lesions represent 2% of all cancers, with approximately 3000 annual deaths. The association between human papillomavirus (HPV) and laryngeal cancer is still controversial. The aim of the present retrospective study was to determine the expression of galectin-3 immunoperoxidase in laryngeal carcinoma by examining paraffin-embedded larynx biopsies from 65 patients, 10 in situ laryngeal carcinomas, 27 laryngeal carcinomas without metastases, and 28 with metastases. Twenty-eight cervical lymph nodes from patients with metastatic lesions were also evaluated. Nested PCR was performed to detect and type HPV DNA. Galectin-3 expression was assessed by immunohistochemistry using a computer-assisted system. Among 65 patients, 55 (84.6%) were positive to beta-globin (internal control); 10 (15.4%) patients were beta-globin negative and were excluded from the HPV evaluation. Thus, 7 (12.7%) out of 55 patients were HPV positive and 48 (87.3%) out of 55 patients were HPV negative. High expression of galectin-3 was observed in invasive laryngeal tumors, suggesting that galectin-3 could be associated with the invasiveness and aggressiveness of laryngeal carcinomas.

The primary study on influence of fitness camps on rehabilitation efficiency of full laryngectomy patients

The objective of this study was to estimate the efficiency of exercise driven rehabilitation procedure after laryngectomy. A retrospective review of case notes from the Ludwig Rydygier Hospital, Bydgoszcz, Poland archives was performed. The setting was the Rehabilitation Unit in Department of Occupational Therapy and Rehabilitation of Collegium Medicum, Nicolas Copernicus University, Poland. Thirty male laryngectomy patients with no signs of recurrence were analyzed using modified Harvard Step Test. Also, t-test, Wilcoxon u-paired test and Friedman analysis of variance analyses were performed. A significant increase in the level of physical fitness was observed. The test results showed high effectiveness of rehabilitation camps in respect to the improvement in both physical efficiency and physical exertion tolerance.

Pharyngocutaneous fistulae after total laryngectomy: a systematic review

Nursing care to patients after total laryngectomy should be based on scientific knowledge. Evidence-based practice is a type of approach that stimulates the use of research results in clinical practice. This study presents a systematic review that aimed to identify the main treatments for pharyngocutaneous fistulae after total laryngectomy. Articles were selected from five databases: Pubmed, Cinahl, Biomednet Research Tools, Cochrane Library and Lilacs. The review sample consisted of 37 articles. After analyzing the articles included in the review, results showed that conservative treatment is commonly used for pharyngocutaneous fistulae, recommending intensive hygiene and wound treatment. The use of research results in clinical practice will grant greater consistency to nurses' actions in care for patients with pharyngocutaneous fistulae.

Avaliação epidemiológica de pacientes com câncer de cabeça e pescoço em um hospital universitário do noroeste do estado de São Paulo

No mundo, aproximadamente 200 mil casos novos de câncer de cabeça e pescoço são diagnosticados anualmente. Uma média de 13.470 casos novos de câncer de cavidade oral por 100 mil habitantes é observada no Brasil. OBJETIVO: Analisar os aspectos clínicos e epidemiológicos dos pacientes atendidos no Serviço de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço em um hospital universitário do Noroeste do Estado de São Paulo, Brasil. CASUÍSTICA E MÉTODOS: Foram analisados os dados de 427 pacientes atendidos no período de 2000 a 2005. As variáveis analisadas incluíram idade, sexo, profissão, cor da pele, hábitos tabagista e etilista, sítio primário de tumor, estadiamento clínico, grau de diferenciação histológica e sobrevida. Os dados foram analisados por estatística descritiva exploratória. RESULTADOS: Houve predomínio de homens (86%), cor da pele branca (90%), tabagistas (83,37%), etilistas (65,80%) com idade média de 61 anos, sendo que 24,25% dos homens realizavam atividades rurais e 60% das mulheres, atividades domésticas. O sítio primário de tumor mais freqüente foi a cavidade oral, com o tipo histológico espinocelular. Observou-se 164 óbitos. CONCLUSÃO: Esse levantamento contribuiu para traçar um perfil dos pacientes atendidos no hospital e, sobretudo contribuir com os programas de prevenção para esta doença.

Epidemiologic evaluation of head and neck patients in a university hospital of Northwestern São Paulo State

Head and neck cancer accounts for nearly 200.000 new cases worldwide. A mean of 13.470 new cases of cancer in the oral cavity for 100.000 inhabitants is observed in Brazil.

Aim

To analyze clinical and epidemiological aspects in patients consulted in the Otorhinolaryngology and Head and Neck Surgery ward in a University hospital of Northwestern São Paulo, Brazil.

Materials and Methods

A total of 427 patients consulted in the hospital in the period from 2000 to 2005 were investigated. The variables analyzed included: age, gender, occupation, skin color, tobacco and alcohol consumption, primary site of the tumor, clinical staging, degree of histological differentiation and outcome. The data was analyzed by descriptive and exploratory statistics.

Results

Prevalence was found among men (86%), white color (90%), smokers (83.37%), and alcoholics (65.80%); the average age was 61 years, 24.25% of men were farmers and 60% of women, housekeepers. Primary site of tumor was usually in the oral cavity (35.37%), with histological squamous cell. The incidence of deaths was 164.

Conclusion

This study has provided the profile of the patients assisted in this hospital; moreover, it has contributed to outline further programs for preventing this disease.