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Purpose: The restoration of speech after an extensive resection of the soft palate has been a challenge faced by both prosthodontists and surgeons. Few comparisons between prosthetic rehabilitations and surgical reconstructions of large soft palate defects exist in equally matched groups of patients. The purpose of this study was to evaluate speech outcomes in patients with soft palate defects that were rehabilitated with either a pharyngeal obturator or surgical reconstruction. Materials and Methods: Nine patients who were treated via prosthetic obturation were compared to nine patients who underwent surgical reconstruction of the oropharynx with a radial forearm free flap and a soft palate insufficiency repair modification. Speech intelligibility data, perceptual ratings of resonance, and aeromechanical measurements of velopharyngeal function were collected. Results: There were no differences in any of the speech outcome measures between the two groups of patients. Conclusion: Future studies should focus on the patient's perspective on rehabilitative options and potential quality of life issues. [ABSTRACT FROM AUTHOR]

PURPOSE: Speech outcome measurements are valuable in guiding treatment and determining the effectiveness of rehabilitation with a maxillary obturator prosthesis in individuals with palatal resection. Although speech outcome data exist in the literature for such patients, relatively few reports have used clinical tools designed to measure the acoustic, physiologic, and perceptual bases of speech. This investigation reports these measures for individuals rehabilitated with a maxillary obturator. MATERIALS AND METHODS: Speech measurements were collected prospectively at three clinical visit times (preoperative, postresection without an obturator, and with a definitive obturator) for 12 patients assigned to three groups based on the extent of their resection (< half the hard palate, > or = half the hard palate, hard and soft palates). Acoustic data were obtained with the Nasometer, aeromechanical data were collected with the PERCI-SARS, and perceptual ratings of speech intelligibility were obtained through listener analysis. RESULTS: Significant differences existed among the three treatments for all dependent variables and revealed that speech without an obturator is significantly different from the preoperative state, while speech with an obturator does not differ significantly from preoperative function. Individuals with soft palate involvement exhibited significantly poorer nasalance values than individuals with involvement of the hard palate only. CONCLUSION: Rehabilitation with a maxillary obturator is successful in restoring preoperative speech function. Rehabilitation of individuals with involvement of the soft palate may be more challenging. [ABSTRACT FROM AUTHOR]

Epstein-Barr virus (EBV) has been shown to be a likely etiologic agent in nasopharyngeal carcinogenesis. Human papillomaviruses (HPVs) have previously been identified in numerous upper aerodigestive tract carcinomas. This pilot study was undertaken to investigate the prevalence of combined EBV and HPV infection in 17 patients with nasopharyngeal carcinoma (NPCA) using polymerase chain reaction (PCR). The primary goal was to determine if the presence of HPV could be correlated with molecular, histologic, or clinical parameters. There were seven patients with undifferentiated NPCA (World Health Organization [WHO] type III) and 10 patients with squamous cell carcinoma (WHO type I). All 17 patients had stage IV disease at presentation. EBV was identified in 15 patients (88.2%), and HPV subtypes were identified in samples from nine patients (52.9%). All HPV-positive cases were also EBV positive. Western blot analysis of six samples showed a high level of expression of c-myc and cdc2 kinase and a low level of p53 protein in NPCAs that contained both HPV and EBV (n = 3). Increased expression of c-myc and cdc2 kinase was seen in the cases that contained EBV only, but to a lesser extent (n = 2). These findings indicate an effect of the virus on cellular proliferation and differentiation. Similarly, an elevated level of Rb protein was found only in the HPV-containing NPCAs. Moderate differentiation (keratinization) occurred in four of eight HPV-negative and none of the nine HPV-positive NPCAs. (All HPV-positive cases were poorly differentiated or undifferentiated.) This difference is statistically significant for this sample size (P < 0.03). There was a trend for the group that was HPV positive to have WHO III histology and for the HPV-negative group to have WHO I. The presence of HPV could not be correlated with any clinical parameters in this small group of patients with advanced disease; however, these data suggest that coexistence of EBV and HPV infection may be a factor in the pathogenesis of NPCA and may have an effect on regulation of cellular proliferation and differentiation. [ABSTRACT FROM AUTHOR]

Use of sympathomimetic topical nasal decongestants to treat nasal obstruction is usually restricted to 3 to 5 days to avoid potential rebound swelling (rhinitis medicamentosa). In this study, 10 healthy volunteers used oxymetazoline (long-acting topical nasal decongestant) nightly for 4 weeks. Subjects who used antihistamines, oral or topical decongestants, or systemic steroids or who had active sinusitis were excluded from the study. Weekly history, physical examination, and anterior rhinomanometry revealed no adverse effects. Eight (80%) subjects developed nightly nasal obstruction a few hours before the evening dose; the obstruction resolved within 48 hours if no more decongestant was used. All subjects remained responsive to oxymetazoline 4 weeks and 8 weeks after the study began. This finding suggests that long-acting decongestants may be safely used for longer than the recommended 3 to 5 days without adverse effects if used once nightly. [ABSTRACT FROM AUTHOR]

Quality of life questionnaires are often used as a measure of outcomes in the head and neck cancer literature. Semi -structured interviews are rarely used and results are not well documented. The current study was designed to compare and contrast quality of life outcomes assessed by a standardized questionnaire and a semi-structured interview. A semi-structured interview and the EORTC QLQ-H&N35 questionnaire were administered to eight patients with hemiglossectomy and reconstruction using an innervated radial forearm free flap. Whereas some of the responses to questions in the semi-structured interviews confirmed EORTCQLQ-H&N35 results, other responses yielded more detail on functional outcomes and quality of life not captured in the standardized instrument. The EORTC QLQ-H&N35 serves as a good screening tool for identifying quality of life issues, but does not adequately assess the breadth or depth of factors related to quality of life outcomes following intervention for head and neck cancer. [ABSTRACT FROM AUTHOR]

In this experiment, acoustic properties of speech sounds produced by a 64-year-old Canadian English-speaking female tongue cancer patient were studied. The patient had undergone a tongue resection of the anterior two-thirds of the tongue, a tongue reconstruction with a radial forearm free fl ap, and treatment with a palatal augmentation prosthesis. The acoustic data included measurements of spectral characteristics analyzed from the vowels /i, I, lambda, u/ and sibilants /s, z, integral / in connected speech samples produced before the tongue resection, taken one year after the resection with a free fl ap reconstruction and two years after the tongue reconstruction while wearing a palatal augmentation prosthesis. Acoustic changes were observed for formant frequencies (F1, F2) of the vowels and the spectral moments (mean, skewness) of the sibilants. Treatment with the augmentation prosthesis resulted in an improvement of the sibilants /s/ and /z/. The effect of the augmentation prosthesis on vowel production was less pronounced in this patient. [ABSTRACT FROM AUTHOR]

Three primary methods to treat laryngeal cancer include radiation therapy, total laryngectomy, and supracricoid laryngectomy. Perceptual assessment to determine the social impact of vocal outcomes related to each treatment was employed to understand the effect that a disordered voice may have on societal perception of patients undergoing these treatments. Forty listeners were recruited to rate the voices of four groups of speakers: individuals treated with radiation therapy; individuals treated with total laryngectomy and rehabilitated with a tracheoesophageal voice prosthesis; individuals treated with supracricoid laryngectomy; and individuals with no history of vocal disorders. The listeners rated the speakers' voices on rating scales with eight descriptors related to the social perception of speech. The ratings were made on 7-point Likert scales. Results indicated that listeners rated the non-surgical groups more positively than the surgical groups on traits such as attractive, clever, sophisticated, and trustworthy. The surgical groups were rated more negatively than non-surgical groups on traits such as scary, annoying, and intimidating. These fi ndings provide insight into how patients undergoing these treatments may be perceived by society. Individuals with total laryngectomies may be at a higher risk of encountering negative social stigmatization in their daily life. [ABSTRACT FROM AUTHOR]

Oral cancer affects approximately 5% of the Canadian population every year. One option for treatment of oropharyngeal cancer includes resection of the diseased tissue with primary reconstruction of the defect using a microvascular free flap, followed by post-operative adjuvant radiation therapy. The aim of reconstructive surgery is to maintain functional speech and swallowing. While the literature provides support for the maintenance of speech intelligibility following reconstructive procedures, certain aspects of resonance may be altered when the palatal structures are involved. Little is known about the effect of such alterations on the perception of speakers who have been treated with microvascular free flap reconstruction. Social perception is a process in which we infer attributes of others, with the speech signal playing an integral part in attribution. The purpose of this study was to explore the social perceptions formed about speakers both before and after surgery for oropharyngeal cancer. The results of this study revealed that positive perceptions of speakers significantly diminished as a result of surgery and negative perceptions increased. Certain variables, such as degree of resection of the soft palate and base of tongue, and sex of the speaker, had influence on the results. This research suggests that intelligibility measurements of speech, although useful, do not provide a complete indication of the social impact of reconstructive surgery on patients with oropharyngeal resections. [ABSTRACT FROM AUTHOR]