Purpose
The skull base inventory (SBI) was developed to better assess health-related quality of life (HR-QOL) in patients with anterior and central skull base neoplasms treated by endoscopic and open ...approaches. The primary objective of this study was to prospectively assess the psychometric properties of the SBI.
Methods
This study is part of a multi-center study of patients undergoing endoscopic and open procedures completed between 2012 and 2018. Participants were eligible if they were over 18 years of age; had benign or malignant anterior, antero-lateral, or central skull base tumors; and required either an open or endoscopic skull base surgical approach. In order to assess the psychometric properties of the SBI, patients completed the instrument at six time points (preoperative, 2 weeks, 3 months, 6 months, 12 months postoperative). Patients also completed the Anterior Skull Base (ASB) questionnaire and the Sinonasal Outcome Test (SNOT-22) to allow comparison to the SBI.
Results
One hundred and eighty-seven patients were included across five centers, with 121 having an endoscopic procedure. Internal consistency (Cronbach’s alpha = 0.95) and test–retest at 12 months and 12 months plus 2 weeks (intraclass correlation > 0.90) were excellent. Concurrent validity was demonstrated by very strong correlation between total SBI scores and ASB scores (
r
= 0.810 to 0.869,
p
< 0.001) and moderate correlation between nasal domain SBI scores and SNOT-22 scores (
r
= − 0.616 to − 0.738,
p
< 0.001). Convergent validity was demonstrated by moderate correlation between change in SBI scores and global QOL change (
r
s
= 0.4942,
p
< 0.001). The minimally important clinical difference (global HR-QOL change of “a little better” or “a little worse”) was 6.0.
Conclusion
The SBI questionnaire is reliable and valid for patients treated by both endoscopic and open approaches and can be used for assessment of HR-QOL in these settings.
Purpose
The extent to which patients with laryngeal trauma undergo investigation and intervention is largely unknown. The objective of this study was to therefore determine the association between ...hospital volume and processes of care in patients sustaining laryngeal trauma.
Methods
This retrospective cohort study used the American College of Surgeons Trauma Quality Improvement Program database. Adult patients (≥ 18) who sustained traumatic laryngeal injuries between 2012 and 2016 were eligible. The exposure of interest was average annual laryngeal trauma volume categorized into quartiles. The primary and secondary outcomes of interest were the performances of diagnostic and therapeutic laryngeal procedures respectively. Multivariable logistic regression under a generalized estimating equations approach was utilized.
Results
In total, 1164 patients were included. The average number of laryngeal trauma cases per hospital ranged from 0.2 to 7.2 per year. Diagnostic procedures were performed in 31% of patients and therapeutic in 19%. In patients with severe laryngeal injuries, diagnostic procedures were performed on a higher proportion of patients at high volume centers than low volume centers (46% vs 25%). In adjusted analysis, volume was not associated with the performance of diagnostic procedures. Patients treated at centers in the second (OR 1.94 95% CI 1.29–2.90) and third (OR 1.67 95% CI 1.08–2.57) volume quartiles had higher odds of undergoing a therapeutic procedure compared to the lowest volume quartile.
Conclusion
Hospital volume may be associated with processes of care in laryngeal trauma. Additional research is required to investigate how these findings relate to patient and health system outcomes.
Our objectives were to review all reported cases of late flap failure in head and neck surgery and describe any relevant patterns. We conducted a systematic review of all published cases of free flap ...failure after postoperative day 7 in head and neck surgery from January 1990 to January 2018. Data were collected with respect to flap type, site of reconstruction, reason for failure, and time to failure. A total of 45 cases of late free flap failure in the head and neck were identified. Among the 34 cases in which the necessary data were available for analysis, 50% of late failures occurred between postoperative day 7 and 14. Common reasons for failure were abscess and vascular compromise. We conclude that most late flap failures occur in the second postoperative week. In patients with risk factors for flap failure, close monitoring for up to 14 days after surgery could detect flap compromise before the flap is lost.
Le trouble du traitement auditif relié à la spatialité se manifeste par une difficulté à comprendre la parole dans un environnement bruyant, et ce, malgré des résultats normaux aux tests ...audiométriques standards. La proportion d'enfants ayant un trouble du traitement auditif relié à la spatialité est significativement plus élevée chez ceux ayant un historique d'otites moyennes survenues durant les premières années de vie. Ajoutons que la prévalence et la durée des otites moyennes sont significativement plus élevées chez les enfants ayant une fissure palatine que chez les enfants provenant de la population générale. La présente étude visait donc à déterminer la prévalence d'enfants ayant un trouble du traitement auditif relié à la spatialité au sein des enfants ayant une fissure palatine. Des enfants ayant une fissure palatine âgés entre 6 et 16 ans ont été recrutés dans une clinique de fissure palatine. Les enfants ayant des audiogrammes normaux, en l'absence d'un problème otologique, d'un trouble de communication ou d'une déficience intellectuelle, ont été inclus dans l'étude. Huit (40%) des 20 enfants qui respectaient les critères d'inclusion avaient un trouble du traitement auditif relié à la spatialité en utilisant le test Listening in SpatializedNoise-Sentences. Quatre autres enfants avaient une perte du ratio signal/bruit supérieure à 2 dB par rapport à la moyenne, ce qui représente une perte importante de l'intelligibilité de la parole. Une intervention utilisant le programme Listening in Spatialized Noise & Learning a été offerte à trois des enfants; tous en ont grandement bénéficié. La présence d'un trouble du traitement auditif relié à la spatialité peut porter préjudice aux enfants en étant atteints, et ce, particulièrement à l'âge scolaire. Ajoutons que sa prévalence est élevée chez les enfants ayant une fissure palatine. Étant donné qu'un programme d'intervention a récemment été développé pour ce trouble, une identification et une intervention rapides peuvent améliorer l'expérience d'apprentissage des enfants ayant un trouble du traitement auditif relié à la spatialité. Spatial Processing Disorder is manifested as difficulty understanding speech in a noisy environment despite normal standard audiometric results. Rates of Spatial Processing Disorder are significantly higher in children who have a history of otitis media in early childhood, and the prevalence and duration of otitis media in children with cleft palate are significantly higher than the general population. Therefore, this study aimed to determine the prevalence of Spatial Processing Disorder in this vulnerable population. Children with cleft palate aged between 6 and 16 were recruited from a cleft palate clinic. Those with normal audiograms and absence of ear disease, communication disorders, or intellectual disability were included in the study. Eight (40%) of the 20 children who met inclusion criteria were found to have Spatial Processing Disorder using the Listening in Spatialized Noise-Sentences diagnostic standard. Four additional patients were found to have signal-to-noise ratio losses greater than 2 dB from the mean, representing substantial loss in speech intelligibility. Three children underwent remediation using the Listening in Spatialized Noise & Learning program; all saw substantial benefit. Spatial Processing Disorder may be of detriment particularly in school-aged children and is highly prevalent in those with cleft palate. As therapy for this disorder has recently been developed, prompt identification and intervention may improve the learning experience of affected children. KEYWORDS SPATIAL PROCESSING DISORDER AUDITORY PROCESSING DISORDER CLEFT PALATE OTITIS MEDIA WITH EFFUSION
Le trouble du traitement auditif relié à la spatialité se manifeste par une difficulté à comprendre la parole dans un environnement bruyant, et ce, malgré des résultats normaux aux tests ...audiométriques standards. La proportion d'enfants ayant un trouble du traitement auditif relié à la spatialité est significativement plus élevée chez ceux ayant un historique d'otites moyennes survenues durant les premières années de vie. Ajoutons que la prévalence et la durée des otites moyennes sont significativement plus élevées chez les enfants ayant une fissure palatine que chez les enfants provenant de la population générale. La présente étude visait donc à déterminer la prévalence d'enfants ayant un trouble du traitement auditif relié à la spatialité au sein des enfants ayant une fissure palatine. Des enfants ayant une fissure palatine âgés entre 6 et 16 ans ont été recrutés dans une clinique de fissure palatine. Les enfants ayant des audiogrammes normaux, en l'absence d'un problème otologique, d'un trouble de communication ou d'une déficience intellectuelle, ont été inclus dans l'étude. Huit (40%) des 20 enfants qui respectaient les critères d'inclusion avaient un trouble du traitement auditif relié à la spatialité en utilisant le test Listening in SpatializedNoise-Sentences. Quatre autres enfants avaient une perte du ratio signal/bruit supérieure à 2 dB par rapport à la moyenne, ce qui représente une perte importante de l'intelligibilité de la parole. Une intervention utilisant le programme Listening in Spatialized Noise & Learning a été offerte à trois des enfants; tous en ont grandement bénéficié. La présence d'un trouble du traitement auditif relié à la spatialité peut porter préjudice aux enfants en étant atteints, et ce, particulièrement à l'âge scolaire. Ajoutons que sa prévalence est élevée chez les enfants ayant une fissure palatine. Étant donné qu'un programme d'intervention a récemment été développé pour ce trouble, une identification et une intervention rapides peuvent améliorer l'expérience d'apprentissage des enfants ayant un trouble du traitement auditif relié à la spatialité.
Spatial Processing Disorder is manifested as difficulty understanding speech in a noisy environment despite normal standard audiometric results. Rates of Spatial Processing Disorder are significantly ...higher in children who have a history of otitis media in early childhood, and the prevalence and duration of otitis media in children with cleft palate are significantly higher than the general population. Therefore, this study aimed to determine the prevalence of Spatial Processing Disorder in this vulnerable population. Children with cleft palate aged between 6 and 16 were recruited from a cleft palate clinic. Those with normal audiograms and absence of ear disease, communication disorders, or intellectual disability were included in the study. Eight (40%) of the 20 children who met inclusion criteria were found to have Spatial Processing Disorder using the Listening in Spatialized Noise-Sentences diagnostic standard. Four additional patients were found to have signal-to-noise ratio losses greater than 2 dB from the mean, representing substantial loss in speech intelligibility. Three children underwent remediation using the Listening in Spatialized Noise & Learning program; all saw substantial benefit. Spatial Processing Disorder may be of detriment particularly in schoolaged children and is highly prevalent in those with cleft palate. As therapy for this disorder has recently been developed, prompt identification and intervention may improve the learning experience of affected children.
•The differential diagnosis for neck masses is broad and includes neoplastic, infectious, and anatomic considerations.•Bronchopulmonary neuroendocrine tumors are known to metastasize to the head and ...neck.•This report is the first of ileal neuroendocrine tumor metastasis to the submandibular gland.
Neuroendocrine tumors (NETs) of small intestinal origin are generally slow-growing tumors with a relatively high propensity for metastases to surrounding organs and lymphatic tissue. We present the first case of an ileal NET metastasizing to the submandibular gland in a woman with metastatic carcinoid syndrome.
A 55-year-old female presented with a four-month history of a palpable, left-sided neck mass. The patient had a history of metastatic neuroendocrine tumor of ileal origin, initially treated with primary resection 4.5 years previously, with known subdiaphragmatic metastases to the liver, mesenteric nodes, and peritoneum. Four years following primary resection she developed carcinoid syndrome leading to therapy with radiolabelled metaiodobenzylguanidine (MIBG), as well as telotristat etiprate in the context of a clinical trial due to progressive symptoms. A fine needle aspiration biopsy of the neck mass revealed an immunohistochemical staining pattern consistent with ileal NET. The patient underwent a left level 1b neck dissection and submandibular gland excision. Pathology was consistent with metastastic ileal NET.
We report the first case of ileal NET metastasis to the submandibular gland. Familiarity with the carcinoid syndrome and associated physiology should be maintained as it can affect the head and neck on rare occasions. Maintaining a broad differential is key in diagnosis of undifferentiated neck masses.
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