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Introduction Counties Manukau Health Otolaryngology programme for general practitioners with special interest (GPwSI) was developed to provide a group of GPs with tools to manage low complexity, secondary otolaryngology (ORL) problems in their local communities. After clinical triaging, the medical records were retrieved to assess patient outcomes from community (GPwSI) review. This programme provides an example of how the aims of the Health NZ reforms may work in practice, by bridging primary and secondary services. Aim To assess whether the GPwSI programme provides patients with suitable specialty care in the community, compared to a specialised, hospital outpatient otolaryngology clinic (OPC). Methods This is a retrospective study of patients with an assigned priority of three (non-urgent) referred to Middlemore Hospital for a first specialist assessment (FSA) during 2018–19. Results Of the 6231 patients referred, one-fifth (22%) were directed to the GPwSI service, and the remainder (78%) were arranged to be seen in the OPC. GPwSI patients were more likely to be seen for their FSA earlier than OPC patients (RR 1.55, 95% CI 1.46–1.64, P   Discussion Patients being seen through the GPwSI programme are suitably managed in the community, more efficiently than if they were to be seen in an outpatient specialist clinic.

Objectives: This qualitative systematic review evaluates the evidence in support of the use of oral corticosteroids in patients undergoing sialendoscopy for the treatment of obstructive sialadenitis.Design: Qualitative systematic review.Methods: A literature search was conducted from January 1985 and September 2020. Inclusion criteria embraced peer-reviewed articles in which adult patients undergoing interventional sialendoscopy for obstructive salivary gland disease received oral corticosteroids. The results were initially screened based on title and abstract, and the remaining articles were reviewed for eligibility.Results: About 218 papers were selected by title and abstract, 96 were selected for full-text review, and 9 met the inclusion criteria. Eight published reports were retrospective observational studies and 1 was a prospective comparative study. Overall, the heterogeneity of clinical data stood out in this systematic review. The pooled success rate in the studies was 873/979 (89%). Only 5 studies described a rationale for oral corticosteroid use as part of the post-operative management. In 4 studies, a prednisone total daily dose of 40 to 50 mg was used. One study clearly showed a lower recurrence rate in patients who received oral steroids for more than 7 days in addition to sialendoscopy for management of ductal stenoses.Conclusion: This systematic review showed that most centers that prescribe oral corticosteroids after sialendoscopy are unaware of the specific results with this treatment. For ductal stenoses, only 1 paper clearly showed the benefits of oral corticosteroids after sialendoscopy but more high-quality evidence is required in the form of a comparative study or randomized controlled trial, with appropriate long-term follow up.

Background: To review experience with partial superficial parotidectomy (PSP) and retrograde dissection of the facial nerve as a treatment for benign parotid tumors.Methods: Retrospective cohort study of all patients presenting with a suspected benign primary parotid tumor undergoing parotid surgery.Results: There were 214 cases retrieved. Postoperative facial nerve weakness occurred in 33% of patients; all were temporary. Increased extent of surgical resection (P< .001), deeper tumors (P= .05), and close tumor proximity to the facial nerve (P= .007) significantly correlated with postoperative facial weakness. The surgical margin was clear in 54%; 31% had capsule exposed in at least 1 point, and 13.5% had tumor at the margin. Cases with close proximity of tumor to facial nerve were more likely to have tumor at the margin (P= .034).Conclusion: Partial superficial parotidectomy with retrograde dissection is a suitable method for benign appearing parotid tumors.

This review addresses the issue of direct extra-capsular invasion of thyroid cancer; this may occur in several ways and to varying degrees. The evidence regarding the prognostic and treatment implications of extra-thyroidal spread is examined. The phenomenon is most common in papillary carcinoma of the thyroid and that is the focus for this review. Less common, but more aggressive tumours (medullary and anaplastic carcinoma) are not considered here.

Discusses ways for treating and managing hoarseness. Examples of surgical and non-surgical techniques for treating hoarseness; Points relating to voice symptoms that should be elicited; Importance of determining the medical history and physical state of a patient; Guide for the physical examination of a patient suffering from hoarseness.

OBJECTIVE To assess whether pretreatment and posttreatment quality of life (QOL) is associated with long-term survival in patients with head and neck cancer. DESIGN Ten-year follow-up of an inception cohort. SETTING Regional tertiary referral center. PATIENTS The study included 200 consecutive patients with primary epithelial head and neck cancer. INTERVENTIONS Quality of life and several recognized risk factors for death were assessed prospectively using the Auckland QOL questionnaire before treatment and 12 months after treatment; survival was determined at 10 years. MAIN OUTCOME MEASURES Survival and odds of death (hazards ratio) were measured. RESULTS At 10 years, 136 patients (68%) were deceased, 48 patients (24%) were alive, and the status of 16 patients (8%) was unknown. Median survival was 6 years (interquartile range, 4.4-7.7). Before treatment, patients with low QOL had no significantly increased odds of death (hazard ratio, 1.4; 95% confidence interval, 0.8-2.4). In contrast, after treatment, patients with low QOL at 1 year had significantly increased odds of death (2.5; 95% confidence interval, 1.4-4.3; P = .001) even after adjustment for covariates. CONCLUSIONS Findings suggest potential survival benefits from improvements in QOL. However, the observed associations between survival benefit and QOL at 1 year may be confounded by comorbidity, which was not measured and deserves further investigation.Arch Otolaryngol Head Neck Surg. 2006;132:27-31--

Insertion of ventilation tubes is regarded as a simple, effective and safe treatment for recurrent otitis media or prolonged middle-ear effusions. We conducted a prospective observational study of 112 children to ascertain what early post-operative complications were experienced. Our findings were consistent with previously published figures for post-surgical otorrhoea and obstruction rates, at 13.5 per cent and 4 per cent (by ear), respectively, using intra-operative administration of antibiotic/steroid ear drops. We identified unique characteristics of differing ethnic groups with regard to findings at surgery and post-operative outcomes. There was a tendency for grommets placed in the left ear to be extruded early and Maori andPacific Islanders were significantly more likely to have a non-functioning tube (blocked or extruded) in the early post-operative period. Overall, one in four children developed a post-operative complication (otorrhoea or non-functioning tube) suggesting that early and close follow up may allow timely identification and intervention where required.

To review the rationale and evidence for maintaining clinical contact with patients who have received curative treatment for head and neck cancer.

ObjectivesTo examine quality‐of‐life (QL) changes that occur over time among patients treated for head and neck cancer and to compare QL outcomes in two geographically separate and culturally distinct populations.

ObjectivesThe purposes of this study were to examine the quality of life (QL) of patients who received treatment for cancer of the parotid or temporal region, and to identify factors contributing to it. The relationships between clinician‐based measures of treatment outcome and the patient‐based counterparts were also evaluated.

The population in New Zealand is a heterogeneous mix of Caucasians (80%), Maori (9%), and Polynesians (10%). It is believed that the Polynesians are of Chinese descent and may harbor the same high incidence of nasopharyngeal carcinoma (NPC). In addition, it is not known whether the Epstein-Barr virus (EBV) is as closely associated with the development of NPC in Polynesians as it is in those of Chinese origin. This study reexamines the associative correlation between EBV and NPC with two methods of genetic detection, polymerase chain reaction (PCR) and in-situ hybridization (ISH). In addition, geographic heterogeneity was analyzed to determine whether there are differences in the prevalence of EBV in NPCs among the ethnic mixed populations found in New Zealand. Nasopharyngeal biopsy specimens from 20 patients with NPC and 36 controls were obtained from Auckland. With PCR, EBNA-1, a genomic sequence of EBV in NPC samples was able to be detected with 76.5% sensitivity and 96.7% specificity. By use of ISH, EBV was detected in NPC tissue with 82.4% sensitivity and 100% specificity. There seems to be no geoanthropologic differences in terms of the association of EBV with NPC. © 2000 John Wiley & Sons, Inc. Head Neck 22: 505–508, 2000.

A review of a combined gastroenterology and laryngology clinic was conducted to determine the effectiveness of treatment and the predictive value of clinical findings and investigations.Data were collected prospectively. Investigations were performed according to clinical criteria. Patients with symptoms suspected to be due to laryngopharyngeal reflux (based on a positive oesophageal pH test and/or changes on videolaryngoscopy consistent with posterior laryngitis) were treated with omeprazole for at least two to three months.There were 87 patients; the most common symptoms were cough (38 per cent) and hoarseness (36 per cent); 77 per cent had some symptoms suggestive of gastro-oesophageal reflux. Sixty-seven patients were given omeprazole. A good response to laryngo-pharyngeal symptoms was seen in 37 patients (55 per cent). The presence of reflux symptoms was not a predictor of a good response. Increasing severity of oesophageal acid exposure over the 24 hours of pH testing was associated with a better symptom response (Spearman rank correlation, p = 0.01). Posterior laryngitis was not associated with the response to treatment, although there was a trend towards an association between improvement in laryngitis (after treatment) and improvement in symptoms (p = 0.08).The response to proton pump inhibitors was lower than other published results. Oesophageal pH monitoring may have a role in predicting which patients will respond to proton pump inhibitors. This study does not support the decision to treat with anti-secretory therapy, based only on the presence of posterior laryngitis.

In this review clinical outcomes are considered in terms of three categories observer-based outcomes, measurement-based outcomes, and patient-based outcomes. Observer-and measurement-based outcomes are important but do not necessarily reflect patients’ perceptions. Some false assumptions persist in this regard when reporting outcomes of surgery for head and neck cancer. Although it is important to measure and observe real differences in outcome, it still needs to be shown that these changes make a difference from the patients’ point of view. This paper examines these issues in relation to recent reports of treatment for laryngeal cancer, oral cancer, metastatic neck disease, and cancer of the parotid region.

Little is known about the epidemiology of pain in head and neck cancer, the effects of curative treatment on this pain, and the impact that pain experience may have on patients' quality of life (QL). The prevalence and severity of pain was studied in 93 patients who were first seen with a diagnosis of head and neck cancer, were treated, and remained disease free at two years. QL assessment utilised the life-satisfaction scale and the General Health Questionnaire as specific measures. Pain was assessed by a linear analogue scale anchored by words and numbers. Forty-eight percent had head and neck pain when first seen, whereas only 25% and 26% had such pain at 12 and 24 months. Approximately 8% of patients rated the pain as “severe” when first seen, whereas 3% had severe pain at 12 months and 4% at 2 years. The prevalence of shoulder and arm pain increased from 14% at diagnosis to 37% at a year and 26% at 24 months, but the percentage of patients with severe pain at any stage postoperatively was only 5% and 2%, respectively. Any pain (pain in either in the head and neck or shoulder and arm or both) at 2 years was strongly predicted by earlier posttreatment pain (at 3 months or at 12 months.) Shoulder and arm pain at 2 years was strongly correlated with surgical treatment of the neck, although no difference in pain experience was noted between those who had radical neck dissections and those who had more conservative procedures. There was no correlation between radiotherapy to the neck and subsequent shoulder and arm pain. Pain had an adverse effect on the general well-being and psychological distress of head and neck cancer patients who were free of disease. Pain is common among those presenting with curable head and neck cancer. Pain can be reduced by curative treatment but neck dissection may cause increased shoulder and arm pain. Ongoing pain is predictable and impacts adversely on patients QL. © 1999 John Wiley & Sons, Inc. Head Neck 21: 531–537, 1999.

OBJECTIVE: To review the relationship between tumor thickness and the subsequent development of cervical nodal metastases in 26 patients with stage I and II carcinomas of the oral tongue. METHODS: The histologic features of 26 consecutive patients treated for squamous carcinoma of the oral tongue were reviewed "blindly" by a pathologist, and the variables were correlated with clinical outcome. RESULTS: No association between tumor thickness and nodal metastases was found. Perineural infiltration was the only factor to approach statistical significance. There was also no statistically significant correlation between tumor thickness and patient survival. CONCLUSIONS: The histologic factors considered herein probably should be controlled for when comparing results of treatment of cancer of the oral tongue.(Arch Otolaryngol Head Neck Surg. 1994;120:717-720)

Background:

The need to account for the cost of care is being imposed on clinicians by the corporate purchasers of health care. The cost-effectiveness of treatment for laryngeal cancer should be based on measurable and relevant clinical outcomes. Quality-of-life (QL) is a very important outcome, especially if survival is similar between two treatments. Using QL data gathered prospectively from a group of 46 patients with glottic cancer, the effects of radiotherapy (RT) are compared with those of surgery (total laryngectomy). Surgery results in greater measurable dysfunction, especially of speech, but with respect to psychological functioning and general well-being, there are no major QL differences between patients treated surgically and those receiving RT. Cost-effectiveness of surgery, from the perspective of patient-based QL outcome, is very similar to that for RT in advanced cancer of the larynx. Each center needs to carefully consider its outcomes and overall average costs per patient before deciding which treatment regimen is to be preferred. These results have implications for the organ-sparing regimens in the treatment of advanced laryngeal cancer. © 1997 John Wiley & Sons, Inc. Head Neck 19: 243–250 1997.

The plunging ranula is a relatively uncommon phenomenon which represents a mucus escape reaction occurring from disruption of the sublingual salivary gland. We present a series of 20 patients managed at Green Lane Hospital (Auckland, New Zealand) over a 9-year period. A retrospective review of 13 patients with this condition was undertaken, and a prospective study was conducted on 7 patients. Information was collected on age, sex, ethnic origin, history of onset, predisposing factors, treatment, and outcome of treatment. The patients were all young adults with a median age of 31 years. The sex distribution was relatively equal, with 11 men and 9 women. All patients were Maori or Pacific Island Polynesians. Six patients gave a clear history of preceding trauma to the neck or oral cavity. Two recurrences were seen, both in patients who had had the sublingual gland excised via a cervical approach. Five patients sustained lingual nerve damage during surgery. Full function recovered in four patients, but the complication was still present in the fifth patient at 2 years, after which he was lost to follow-up. Plunging ranulas appear to occur with greater incidence in the Maori and Pacific Island Polynesian populations. The precise etiology of their predisposition is unknown, although local trauma or inherent mylohyoid dehiscences may play important roles. Removal of the sublingual gland via either a cervical or intraoral approach is important in the management of this condition. Excision of the pseudocyst is probably unnecessary and places surrounding structures at risk of damage, but a biopsy of the pseudocyst wall is important to confirm the diagnosis. © 1998 John Wiley & Sons, Inc. Head Neck 20: 63–68, 1998.

A multiplefixed-interval 1-min. schedule of reinforcement was used to evaluate response rates maintained by various concentrations of honey as compared to 50% concentrations of sweetened condensed milk in groups of rats. The response rates generally increased on the lever associated with honey as the honey concentration increased. These rates varied from substantially less to substantially more than that controlled by milk. The response rates on the lever associated with sweetened condensed milk remained fairly stable, the only clear exception being in the group that compared the milk solution to 0% honey (water). In that case, the milk solution controlled almost twice âs many responses as in the remaining comparisons. The lever associated with the schedule which controlled the higher response rate when it was in effect also controlled the greater number of errors, or responses when that schedule was not in effect. It was pointed out that honey could be considered as a replacement for sweetened condensed milk as a reinforcer, since honey is a similarly manipulable reinforcer and has the additional advantage that it does not spoil as easily as sweetened condensed milk.

Objectives:We performed a prospective observational study to estimate the prevalence of vitamin D deficiency in patients attending a general otolaryngology clinic in South Auckland, New Zealand.Methods:From July 21, 2008, to August 7, 2008, all new patients presenting to otolaryngology clinics at which one of the authors (D.R.) was present had their vitamin D status assessed by measurement of their plasma 25-hydroxyvitamin D [25(OH)D] level.Results:Of 48 patients, 2% had 25(OH)D levels of 17.5 nmol/L or less (a level associated with osteomalacia), 58% had 25(OH)D levels of 50 nmol/L or less (a level associated with vitamin D deficiency), and 100% had 25(OH)D levels of 80 nmol/L or less.Conclusions:Most of the patients attending a general otolaryngology clinic in South Auckland are vitamin D–deficient. It is unclear whether low vitamin D levels are associated more directly with otolaryngological disorders or skin type, because the small size of this study and the broad range of conditions seen precluded a meaningful statistical analysis. Further research into the relationship of vitamin D to specific otolaryngological presentations is required.

The diagnosis of fungal laryngitis is often overlooked in systemically immunocompetent patients because it is commonly considered a disease of the immunocompromised, and because it often mimics, clinically and histologically, more common and more serious conditions e.g. leukoplakia. A high index of suspicion is required to make the diagnosis, and should be considered in any immunocompetent patient with persistent or refractory laryngitis and factors predisposing to local mucosal barrier impairment e.g. gastropharyngeal reflux, smoking or inhaled steroid use. In such cases, demonstration of hyperkeratosis, particularly if associated with intraepithelial neutrophils, on biopsy should trigger a search for fungal elements using specialized stains. Prolonged treatment by systemic antimycotics is required. Treatment should also include the elimination of any predisposing factors, as failure to do so may result in difficulty with disease eradication or recurrence of the condition.

Thrombelastography (TEG) was first introduced in 1948 by Hartert and is now used to examine coagulation in a wide range of clinical research settings. TEG measures the elastic properties of whole blood clots as they are formed. A graphic profile of the clot analysis is produced on a chart recorder. Manual evaluation of the graphic profile provides useful information regarding the status of coagulation. The basic theory and technology is demonstrated through this poster presentation.

To the Editor.—In the November Archives (1982;108:697-699) Edström et al provided us with an important study in which they demonstrated an increased glucose utilization and turnover in malnourished patients with cancer when compared with malnourished patients free of malignant disease. Some aspects of this work, however, are open to criticism.It is difficult to know what the authors mean by malnutrition, because no preliminary biochemical or anthropometric assessment of the nutritional state1 of the patients was given. It is therefore impossible to know how comparable the two groups were (those patients fed parenterally as opposed to those patients given enteral nutrition, or those patients with malignant neoplasms compared with those patients without). The 12 malnourished patients without cancer were matched with the 26 patients with cancer only with respect to age and activity. No data were given of previous food intake either before or after the onset of

To the Editor.—We were surprised to read in the November Archives that Som et al1 were unable to find any previously reported cases of pneumocele of the sphenoid sinus. We were also surprised that they did not mention pneumocele of the frontal sinus, a condition that was reviewed as a well-recognized entity many years ago.2A patient with pneumocele of the sphenoid sinus was seen in our department and the case reported in detail ten years ago.3 The pneumocele manifested as a persistent, painless swelling of the forehead following an acute, painful episode five months previously. Because of a communication between the frontal and sphenoidal sinuses, the sphenoid sinus was also expanded, giving rise to a combined frontal-sphenoidal pneumocele. The roentgenographic appearances of the sphenoid sinus were similar to those described in the article by Som et al, although the pathogenesis was different. Surgery was curative.