Carcinosarcoma of the nasal cavity and paranasal sinuses:Review of the national cancer database

Background:Carcinosarcomas are rare,aggressive malignancies that can arise in the nasal cavity and paranasal sinuses.There are limited outcome data available.Accordingly,we sought to use the National Cancer Database(NCDB)to characterize patient demographics and outcomes.Method:A retrospective analysis of the NCDB from 2004 to 2016 for patients with sinonasal carcinosarcoma was conducted.Results:Thirty patients were included.The patients were predominantly male(n=20),white(n=23),and privately insured(n=15),with an average age of 62.4 years.The nasal cavity was the most common subsite(n=14),followed by the maxillary sinus(n=8).Most patient were treated with surgery followed by radiation(n=23),with the remaining undergoing surgery alone(n=4),radiation alone(n=2),or no treatment(n=1).One-third(n=10)received adjuvant chemotherapy.The 1-and 5-year overall survival(OS)in the cohort were 79.2%and 43.3%,respectively.Univariate log-rank testing showed OS varied based on intervention(P<0.029),sex(P<0.042),and age(P<0.025),while on multivariate analysis none of these factors independently predicted OS.Conclusions:We describe the demographics and presenting features of a national cohort of sinonasal carcinosarcoma patients.Future research is needed to identify predictors of overall survival,and to assess the optimal roles for radiation and systemic chemotherapy.

Predictors of nodal metastasis in sinonasal squamous cell carcinoma:A national cancer database analysis

Objective:We present the largest population based study of sinonasal squamous cell carcinoma(SCC)to identify risk factors for presentation with nodal metastasis.Methods:The National Cancer Database(NCDB)was used for this study.Location codes corresponding to the nasal cavity and paranasal sinuses and histology codes representing SCC malignancy were queried.Logistic regression analysis was performed to identify factors associated with presentation with nodal metastasis.Results:6448 cases met inclusion criteria.Nodal metastasis at presentation was seen in 13.2%of patients,with the sinus subsite(19.3%)being a significant risk factor for nodal metastasis at presentation when compared to the nasal cavity(7.9%).Logistic regression analysis showed black,uninsured and Medicaid patients were more likely than white and privately insured patients,respectively,to present with nodal metastasis.Conclusions:In sinonasal SCC,the sinus subsite has a significantly increased risk of nodal metastasis compared to the nasal cavity.Black race,uninsured and Medicaid patients are more likely to have nodal metastasis at presentation.

Endoscopic sinus surgery and aspirin desensitization improve otologic-specific SNOT-22 scores

Objective:There are few studies evaluating the impact of Aspirin-exacerbated respiratory disease(AERD)treatment on otologic symptoms.The aim of this study is to evaluate the effects of endoscopic sinus surgery(ESS)and aspirin desensitization(AD)on otologic symptoms in subjects with AERD.Methods:Retrospective chart review of adult patients diagnosed with AERD at our tertiary Care Academic Medical Center-Otorhinolaryngology Department.Charts of adult patients diagnosed with AERD who underwent ESS and ASA desensitization at our institution’s AERD Center from 2016 to 2019 were reviewed.Sino-Nasal Outcomes Test 22-item survey(SNOT-22)scores were evaluated for patients at various time points including:pre-surgery,post-surgery/pre-aspirin desensitization,and various times post-desensitization up to>12 months.Within the SNOT-22,otologic-specific subdomain scores were evaluated at similar time points.Patients on immunomodulatory medications other than corticosteroids were excluded from analysis.Results:SNOT-22 scores were analyzed for 121 patients.There was a significant improvement in overall SNOT scores from pre-surgery(44.62)to post surgery/pre-desensitization(23.34)(P<0.0005).Similarly,SNOT-22 otologic-specific scores also improved after surgery prior to desensitization(3.19-2.04)(P=0.005).Following AD,the improvement in the overall SNOT-22 continued to improve for up to 12 months(P<0.005).While the otologic-specific SNOT-22 scores remained stable after surgery and ASA desensitization.Conclusion:ESS and AD reduce otologic-specific SNOT-22 scores and parallel trends in overall SNOT-22 scores.The effect of treatment is durable over the course of 12 months.Future work should aim to correlate otologic SNOT-22 scores with objective otologic data.

Innovations in otorhinolaryngology in the age of COVID-19: A systematic literature review

Objective: Otolaryngologists are at increased occupational risk of Coronavirus Disease 2019 (COVID-19) infection due to exposure from respiratory droplets and aerosols generated during otologic, nasal, and oropharyngeal examinations and procedures. There have been a variety of guidelines and precautions developed to help mitigate this risk. While many reviews have focused on the personal protective equipment (PPE) and preparation guidelines for surgery in the COVID-19 era, none have focused on the more creative and unusual solutions designed to limit viral transmission. This review aims to fill that need.Data Sources: PubMed, Ovid/Medline, and ScopusMethods: A comprehensive review of literature was performed on September 28, 2020 using PubMed, Ovid/Medline, and Scopus databases. All English-language studies were included if they proposed or assessed novel interventions developed for Otolaryngology practice during the COVID-19 pandemic. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.Results: A total of 41 papers met inclusion criteria and were organized into 5 categories ("General Recommendations for Otolaryngologic Surgery’, "Equipment Shortage Solutions’, "Airway Procedures’, "Nasal Endoscopy and Skull Base Procedures’, and "Otologic Procedures’). Articles were summarized, highlighting the innovations created and evaluated during the COVID-19 pandemic. Creative solutions such as application of topical viricidal agents, make-shift mask filters, three-dimensional (3-D) printable adapters for headlights, aerosol containing separation boxes, and a variety of new draping techniques have been developed to limit the risk of COVID-19 transmission.Conclusions: Persistent risk of COVID-19 exposure remains high. Thus, there is an increased need for solutions that mitigate the risk of viral transmission during office procedures and surgeries, especially given that most COVID-19 positive patients present asymptomatically. This review examines and organizes creative solutions that have been proposed and utilized in the otolaryngology. These solutions have a potential to minimize the risk of viral transmission in the current clinical environment and to create safer outpatient and operating room conditions for patients and healthcare staff.

Recurrent glomangioma("true"glomus tumor)of the middle ear and mastoid

Objective:To review current literature and experience with glomangiomas,or true glomus tumors of the middle ear and mastoid as well asto report on the exceptionally rare case of a glomangiomastemming from the middle ear space with multiple recurrences.Methods:Review of existing world literature and description of personal experience with rare cases of a glomangioma of the middle ear and mastoid.Results:Review of existing literature revealed two cases of patients presenting with tinnitus and hearing loss refractory to medical management.Both patients were ultimately diagnosed with glomangioma on histopathology.Complete surgical excision is thought to be curative.Patient:A 36-year-old woman presented with a rare case of a glomangioma of the middle ear presenting with unilateral hearing loss.She was noted to have a mass behind the tympanic membrane.Imaging revealed a diffuse mass filling the mastoid air cells.Imaging characteristics and histology were consistent with a glomangioma.Intervention:Initial resection via mastoidectomy using a postauricular approach.The tympanic membrane was reconstructed with temporalis tissue.Follow-up revision tympanomas-toidectomy was performed upon recurrence of disease.The chorda tympani were sacrificed due to tumor involvement.The incus and head of the malleus were removed to gain better access to the tumor.The ossicular chain was reconstructed with a Goldenberg Total Ossicular Prosthesis.Main outcome measure:Recurrence of disease.Follow-up:In the 67 months since her most recent surgery,there has been no evidence of recurrence by CT or physical exam.Conclusion:Glomangioma of the middle ear represents an exceptionally rare entity that can present in a similar fashion to a paraganglioma.