Facial Plastic and Reconstructive Surgery

Development and Validation of the Facial Line Distress Scale for Lateral Canthal Lines

Choi K, Kang D, Kang E, Kim S, Lee W, Cho J. Development and Validation of the Facial Line Distress Scale for Lateral Canthal Lines: FINE-LCL. Facial Plast Surg Aesthet Med. Published online April 3, 2024. [Article Link]

The Fine Print About The Fine Lines 

Because the eyes greatly influence the perception of age, the severity of the lateral canthal lines (LCL) has a direct relationship with the process of aging. A cross-sectional study was conducted of 215 patients at a tertiary hospital and two local clinics in Korea between April 18 and June 17, 2022. A 20-question questionnaire, the Facial Line Distress Scale for LCL (FINE-LCL) was created and validated with a focus group of 5 patients. The FINE-LCL was moderately correlated with the appearance appraisal score and body image. Analysis of the accuracy of the FINE-LCL score in predicting the severity of LCL achieved an area under the curve of 0.79. The authors conclude that the FINE-LCL is a reliable and valid patient-reported outcome measure for measuring the severity and burden of LCL. This questionnaire has potential utility not only for screening but also for evaluating the efficacy of treatments for LCL, as it considers the important factor of capturing the patient’s perspective. 

Summary written by Emily Evangelista, University of South Florida Morsani College of Medicine

Head and Neck Surgery

Trends in Oral Tongue Cancer Incidence in the US

Burus T, Damgacioglu H, Huang B, et al. Trends in Oral Tongue Cancer Incidence in the US. JAMA Otolaryngol Head Neck Surg. Published online April 04, 2024. [Article Link]

What are recent trends in oral tongue cancer?

This study investigates recent trends in oral tongue cancer (OTC) rates in the US, with a specific focus on non-Hispanic White women under 50 years old. With OTC rates increasing among young non-smokers, the study aims to determine if this trend continues and if there are variances between early-onset (under 50 years old) and late-onset OTC. Data from 2001 to 2019, utilizing the US Cancer Statistics Public Use Database, shows that while rates among younger women are stabilizing, rates among older women are rapidly rising. This is likely due to a birth cohort effect, which is when distributions of disease arise from exposure effects between different age groups. The examination encompasses various demographic factors, tumor characteristics, and temporal patterns. Findings reveal a notable rise in OTC incidence among non-Hispanic White women aged 50 to 59, surpassing rates in women less than 50 years old. Furthermore, a birth cohort analysis indicates a change in incidence trends among women born post-1980. Predictive models anticipate a significant rise in OTC cases, particularly among older individuals, by 2030-2034. The study emphasizes the necessity for increased awareness and screening among older non-Hispanic White populations, hinting at a potential need to reevaluate OTC risk factors and treatment strategies.

Summary written by Deepthi Akeela, University of the Incarnate Word School of Osteopathic Medicine

Laryngology

Oncological and Functional Outcomes in T3 and T4 Laryngeal Cancer Patients

Nobacht A, Meijer TWH, Oosting SF, et al. Oncological and functional outcomes in T3 and T4 laryngeal cancer patients: choice for larynx preservation or total laryngectomy based on expected laryngeal function. J Laryngol Otol. Published online January 18, 2024. [Article Link]

Is one treatment modality better than the other?

Locally advanced laryngeal carcinomas may be treated with chemoradiotherapy (CRT) or radiotherapy (RT) to preserve laryngeal function. However, laryngeal carcinomas that present with dysphagia or evidence of airway obstruction should be treated with total laryngectomy (TL). This retrospective study aimed to determine oncological and functional outcomes in T3 and T4 laryngeal cancer patients where treatment was guided by expected laryngeal function rather than tumor classification. The study included 189 patients, 130 (69%) with T3 tumors and 59 (31%) with T4 tumors. After a 5-year follow-up, there were no significant differences in disease-specific survival rates (83% for RT, 78% for CRT, 69% for TL, p=.387) or overall survival rates (62% for RT, 54% for CRT, 60% for TL, p=.748) between treatment groups. Larynx preservation rates, as measured by the start of the first therapy until local recurrence or total laryngectomy, were also similar in CRT (86%) and RT (79%) treated patients. CRT, RT, and TL provide comparable survival rates in T3 and T4 laryngeal cancer patients, and functional outcomes do not differ between larynx preservation treatments.

Summary written by Erin Gawel, Jacobs School of Medicine and Biomedical Sciences

Otology and Neurotology Surgery

Pronounced Olfactory Habituation with Age

Hintschich CA, Ma C, Hähner A, Hummel T. Pronounced Olfactory Habituation with Age. Laryngoscope. Published online April 10, 2024.[Article Link]

Sniffing out changing smell patterns

As individuals age, it is believed that there may be a decline in olfactory function. Olfactory habituation, defined as a temporary decrease in olfactory sensitivity due to prolonged exposure to various odors, has garnered attention from researchers aiming to understand changes in olfactory function over time. In a prospective study conducted in Germany, researchers explored the relationship between age and olfactory habituation by selecting 80 participants from both young and old age groups to complete an odor exposure test. The study aimed to assess participants’ ability to habituate to prolonged odors. Using the "Sniffin’ Sticks" test, individual olfactory thresholds for the rose-like odorant phenylethyl alcohol were measured in both nostrils, while a nasal clip delivered continuous odor for varying durations. Overall, this study determined that older adults experience more pronounced ipsilateral nose habituation when subjected to extended odor exposure compared to younger adults (p=0.053). The authors suggest that the stress placed on the olfactory system following exposure to odorants correlates with diminished functionality of the aging sense of smell.

Summary written by Ashwini Sarathy, University of Vermont Larner College of Medicine

Pediatric Otolaryngology

Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children

Fournier I, Caron C, McMurtry CM, et al. Comparison of Tympanostomy Tubes Under Local Anesthesia Versus General Anesthesia for Children. Laryngoscope. 2024;134(5):2422-2429. [Article Link]

Should children undergo tympanostomy tube insertion under local or general anesthesia?

Tympanostomy tube insertion (TTI), commonly used to treat chronic and recurrent ear infections in children, is a procedure traditionally done under general anesthesia (GA). In 2019, the American Academy of Otolaryngology – Head and Neck Surgery released a statement supporting the use of local anesthesia (LA) in clinics for appropriately selected patients, though research on selecting optimal candidates remains limited. This prospective study compared children's pain experiences and parental satisfaction between TTI under LA and GA, with 50 children in each group. Standardized pain scales (Face, Legs, Activity, Cry, Consolability Scale [FLACC] and Children’s Hospital of Eastern Ontario Pain Scale [CHEOPS]) revealed significantly higher pain and distress levels in the LA group at all procedural stages and at the end of the procedure (all p < 0.01). However, rates of minor complications, improvements in quality of life, parental satisfaction post-procedure, and pain one week after surgery, were similar in both groups (all p > 0.05). Despite similar outcomes and parental satisfaction with both anesthesia methods, these findings highlight the critical need for effective pain management strategies in LA use for pediatric TTI.

Summary written by Jonathan Carnino, Boston University Chobanian and Avedisian School of Medicine

Rhinology and Sinus Surgery

Recurrence Morbidity of Olfactory Neuroblastoma

Melder K, Mace JC, Choby G, et al. Recurrence morbidity of olfactory neuroblastoma. Int Forum Allergy Rhinol. Published online April 3, 2024. [Article link]

The Return of Olfactory Neuroblastoma

Olfactory neuroblastoma (ONB) is a rare malignancy of the olfactory epithelium with high survival rates yet high recurrence rates. However, current literature on recurrence patterns of ONB is sparse, necessitating further investigation into prognosis, overall survival (OS), and disease-specific survival (DSS) of recurrent ONB. This retrospective study identified a cohort of 233 patients from February 2005 to April 2021 at nine academic referral centers. Cancer staging, diagnostic imaging, recurrence rates, recurrence sites, time to recurrence, and survival estimates were primary outcomes of interest. When recurrent cases of ONB were compared to a cohort without recurrent ONB, recurrent cases had significantly different cancer stages (p < .001), different imaging characteristics, greater dural involvement and positive margins, and worse DSS with a better DSS in those who had local or neck recurrence compared to those with intracranial or distant recurrence. The results of this study indicate that recurrence of ONB may be associated with a worse prognosis, especially in those with intracranial or distant recurrence. Understanding the specific clinical characteristics that distinguish ONB from recurrent ONB is important for surveilling patients with ONB and patient counseling.

Summary written by Emaan Dawood, Virginia Commonwealth University School of Medicine

Sleep Surgery

Laryngeal Hyposensitivity in Obstructive Sleep Apnea

Callander JK, Kandahari N, Strohl MP, Cheung SW, Chang JL. Laryngeal Hyposensitivity in Obstructive Sleep Apnea. Laryngoscope. Published online March 30, 2024. [Article Link]

Is laryngeal sensitivity diminished in obstructive sleep apnea?

Impaired laryngeal sensation has been thought to play an important role in the pathophysiology of obstructive sleep apnea (OSA) through mechanical inflammation via repetitive collapse of the vocal cords. 38 subjects were enrolled in this study from a tertiary care sleep surgery clinic divided into controls (N=12) without OSA, and the study subjects with OSA (N=26). Endoscopy-directed laryngeal sensation testing was performed by stimulating the medial aryepiglottic fold or arytenoid using Cheung-Bearelly monofilaments after anesthetizing the nasal cavity. Video analysis evaluated the latency time from initial stimulation to response of vocal fold adduction - the laryngeal adductor reflex (LAR). The OSA group had significantly reduced LAR full response rates (32.5% vs. 75.4%, p < 0.001), as well as combined full and partial response rates (50.3% vs 87.1, p < 0.001) when compared to the control group upon monofilament stimuli (32.5% vs. 75.4%, p < 0.001). The OSA group also exhibited a shorter mean latency period for full LAR response, which was positively correlated with OSA disease severity (p = 0.011) based on the apnea-hypopnea index. The study author suggests that alterations to the LAR could be due to decreased somatosensory receptor sensitivity, increased sympathetic tone, and reorganized brain stem function in OSA patients.

Katelin Keenehan’s Takeaway: The control group in this study was screened for OSA, but had not undergone sleep study testing before participating. Further research with controls who have undergone a sleep study may strengthen these results and provide a basis for additional research to treat OSA based on its pathophysiological cause.

Question of the Week Answer

Correct Answer: B

Explanation:
Respiratory papillomatosis is most commonly caused by HPV virus strains 6 and 11. HPV strains 16 and 18 have higher malignant potential but are less commonly associated. HHV 4 is the Epstein-Barr virus, which is associated with nasopharyngeal carcinoma. HHV 8 is Kaposi Sarcoma, a vascular tumor that may present in the head and neck but is commonly seen in immunocompromised individuals. Molluscum Contagiosum Virus can cause raised umbilicated lesions, although it is not directly related to respiratory papillomatosis. 

Reference:
Bachir S, Shah S, Shapiro S, et al. Neurofibromatosis Type 2 (NF2) and the Implications for Vestibular Schwannoma and Meningioma Pathogenesis. Int J Mol Sci. 2021;22(2):690. Published 2021 Jan 12. Available from: [Article Link]