Development of otology specific outcome measure:Ear Outcome Survey-16 (EOS-16)

Purpose An important outcome measure of patient care is the impact on the patient’s health-related quality of life(HRQoL).Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms,hearing problems,psychosocial impact,and the need for care.The optimal length of the recall period has not been studied.For these reasons,a new survey is needed that would cover most chronic ear diseases.Methods A preliminary 24-item survey(EOS-24)was created.Untreated adult patients(included n=186)with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument.The recruiting otologists evaluated the severity of the disease and the disability caused by it.A control group was recruited.Based on the patients’responses in different diagnosis groups,the items were reduced according to pre-defined criteria.The resulting survey was validated using a thorough statistical analysis.Results The relevance and necessity of the original 24 items were thoroughly investigated,leading to the exclusion of 8 items and the modification of 1.The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups,thus constituting the final instrument,EOS-16.The most suitable recall period was three months.Conclusions EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population.The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.

Evaluation of pure-tone audiometric protocols in vestibular schwannoma screening

The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics.We retrospectively analyzed presenting symptoms,pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols(AAO-HNS,AMCLASS-A/B,Charing Cross,Cueva,DOH,Nashville,Oxford,Rule3000,Schlauch,Seattle,Sunderland)for sensitivity and specificity.Results were pooled with data from five other studies,and analysis of sensitivity,specificity and positive likelihood ratio(LR+)for each protocol was performed.Our results show that protocols with significantly higher sensitivity(AMCLASS-A/B,Nashville)show also significantly lowest specificity,and tend to have low association(positive likelihood ratio,LR+)to the VS.The highest LR+was found for protocols AAO-HNS,Rule3000 and Seattle.In conclusions,knowing their properties,screening protocols are simple decision-making tools in VS diagnostic.To use the advantage of the highest sensitivity,protocols AMCLASS-A+B or Nashville can be of choice.For more reasonable approach,applying the protocols with high LR+(AAO-HNS,Rule3000,Seattle)may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.

Photoimmunotherapy for Local Recurrence of Nasopharyngeal Carcinoma: A Case Report

Photoimmunotherapy (PIT), developed by the National Cancer Institute, involves Cetuximab sarotalocan sodium infusion followed by laser irradiation. PIT exerts specific antitumor effects on a variety of carcinomas that express epidermal growth factor receptors. PIT is a new cancer treatment option approved by Japan ahead of other countries worldwide. As of 2022, PIT is indicated in “unresectable, locally advanced, or locally recurrent head and neck cancer, with priority given to standard treatments such as chemotherapy when available”. The conventional treatment for unresectable locally advanced or locally recurrent head and neck cancer is palliative. Whether photoimmunotherapy can be curative for unresectable locally advanced head and neck cancers depends on the case. Herein, we report a case of locally recurrent nasopharyngeal carcinoma, treated with photoimmunotherapy via the nasal cavity, along with a literature review. Preoperative simulation provided considerable information on device selection, numbers of devices, and availability of working space. As a result, a complete response was obtained following a cylindrical diffuser puncture. Cases of local recurrence of nasopharyngeal carcinoma are considered a good indication for PIT. However, since the follow-up period after treatment was short in this case, we will continue to conduct strict follow-ups and accumulate more cases.

Case Report of a Clear-Cell Variant of Follicular Thyroid Carcinoma

Clear-cell variants of follicular carcinoma are rare subtypes of thyroid cancer. There is no unified view of the histopathological features of clear cell variants, but follicular carcinomas composed predominantly of clear cells are distinguished from clear cell variants. In clinical practice, it is important to determine whether clear cell variants arise primarily from the thyroid gland or are thyroid metastases of other clear cell carcinomas, such as renal cell carcinoma. We present a case in which a patient with initially suspected anaplastic thyroid carcinoma due to a rapidly progressive anterior neck mass was diagnosed with a clear cell variant of follicular carcinoma after a tissue biopsy. The patient was treated with lenvatinib, then his performance status improved, and he was discharged from the hospital. On day 188 after discharge, a contrast-enhanced computed tomography (CECT) scan of the neck showed further shrinkage of the tumor. However, a CECT scan of the chest revealed multiple lung metastases. On day 233 after discharge, the patient developed severe pneumonia resulting from tracheal rupture due to intratumoral necrosis. It was difficult to decide whether lenvatinib should have been discontinued or reduced when lung metastasis appeared. It is necessary to accumulate additional cases to make informed decisions about continuing lenvatinib therapy.

A Case of Secretory Carcinoma That Occurred in the Buccal Submucosa

Secretory carcinoma (SC) is a malignant salivary gland tumor that has been first reported by Skalova et al. in 2010. Histologically, it shows solidity infiltrated with very small cystic cavities and cribriform and papillary features and includes periodic acid-Schiff stain-positive, acid-fast secretions. The cells have oval nuclei, and vacuolated cytoplasm and foamy secretions are seen. Anaplasia is not strong and mitotic figures are rarely seen. These features closely resemble AciCC. Immunohistologically, it is thought to be positive for S-100 protein, vimentin, and mammaglobin and negative for DOG1. The presence of the ETV6-NTRK3 fusion gene is essential in diagnosing secretory carcinoma. In this report, we describe a case of SC in a 52-year-old woman. She was referred to our center because of a mass in left buccal mucosa. A soft and elastic submucosal mass measuring approximately 10 mm × 10 mm in size with a smooth surface was seen in the buccal mucosa in an area corresponding to the left mandibular canine to premolars. The imaging findings revealed that a high-intensity lesion was seen on T2-weighted images. Immunohistochemicalstaing for S-100 protein and vimentin were positive. Furthermore, genetic examination detected the presence of the ETV6-NTRK3 fusion gene. Based on these findings, the definitive diagnosis was secretory carcinoma.

Biomarkers associated with immune-related adverse events induced by immune checkpoint inhibitors

Immune checkpoint inhibitors(ICIs)constitute a pivotal class of immunotherapeutic drugs in cancer treatment.However,their widespread clinical application has led to a notable surge in immune-related adverse events(irAEs),significantly affecting the efficacy and survival rates of patients undergoing ICI therapy.While conventional hematological and imaging tests are adept at detecting organ-specific toxicities,distinguishing adverse reactions from those induced by viruses,bacteria,or immune diseases remains a formidable challenge.Consequently,there exists an urgent imperative for reliable biomarkers capable of accurately predicting or diagnosing irAEs.Thus,a thorough review of existing studies on irAEs biomarkers is indispensable.Our review commences by providing a succinct over-view of major irAEs,followed by a comprehensive summary of irAEs biomarkers across various dimensions.Furthermore,we delve into innovative methodologies such as machine learning,single-cell RNA sequencing,multiomics analysis,and gut microbiota profiling to identify novel,robust biomarkers that can facilitate precise irAEs diagnosis or prediction.Lastly,this review furnishes a concise exposition of irAEs mechanisms to augment understanding of irAEs prediction,diagnosis,and treatment strategies.

The status of Eustachian tube balloon dilations in Nordic countries

There is no unanimous consensus for indications of eustachian tube balloon dilation(ETBD).Nordic countries have relatively similar hospital organizations and treatment guidelines.Therefore,it was logical to organize a consensus meeting of ETBD.The symposium:Nordic Experiences on Eustachian Tube Balloon Dilation,in Copenhagen,30-31 March,2017.The panellists from Denmark,Finland,Norway and Sweden and the attendees of the meeting agreed a consensus on the following issues:Candidates,Definition of Eustachian Tube Dysfunction,Diagnostic Work up,Differential Diagnosis,Contraindications,ETBD Procedure,Complications,Follow-up,and Outcomes.The article also presents the status for ETBD in each of these countries.Thereafter the consensus statement has been discussed in the national societies and meetings for ear surgeons in each of these countries.It can be assumed that surgeons in the hospitals of these Nordic countries generally follow the recommendations from the consensus meeting.

CACA guidelines for holistic integrative management of thyroid cancer

Purpose:In recent years,thyroid cancer is a common clinical problem.Since guidelines for the diagnosis and treatment of thyroid nodules and diferentiated thyroid cancer were revised in 2012,signifcant scientifc advances have occurred in the feld.The aim of this guidelines is to inform clinicians,researchers,patients and health policy makers on published evidence and expert consensus relating to the diagnosis and management of thyroid malignancy.Methods:In order to better promote the clinical management of thyroid cancer in China,Chinese Association of Thyroid Oncology(CATO)organized relevant experts to write these guidelines based on latest relevant literatures and clinical experience of multiple centers.The specifc clinical issues and topics addressed in these guidelines were based on published evidence,prior versions of the Chinese guidelines and expert consensus.Results and conclusion:The guidelines provide recommendations for the management of diferent types of thyroid carcinoma,including papillary,follicular,medullary,and anaplastic carcinomas.