Carcinoma in situ of the larynx

A retrospective study of carcinoma in situ of the larynx at the British Columbia Cancer Institute indicates that radiotherapy, using a tumoricidal dose of Co 60, is the treatment of choice for this condition. Between 1940 and 1972, 43 patients with carcinoma in situ of the vocal cords were seen. A follow-up of five years or more was possible in 28 of these cases. Twenty-two were treated primarily with a tumoricidal dose of radiotherapy. Twenty-one of the 22 were free of disease for at least five years. This study, therefore, shows a five-year cure rate of almost 100 percent for patients treated with radiotherapy. It also brings out two further points regarding carcinoma in situ of the larynx; namely, an apparent increase in its incidence, and the presence of co-existing invasive carcinoma in some cases. We feel that since the incidence of laryngeal carcinoma has not increased, this apparent increase probably represents a greater awareness by both the pathologist and the clinician. We have also achieved more accurate diagnosis since the introduction of routine microlaryngoscopy. The single radiotherapy failure in our series was due to failure to diag: Nose co-existing invasive carcinoma. This would seem to be the most likely cause of similar failures reported in the literature. Carcinoma in situ should be managed as follows:

• 1 Any patient found to have carcinoma in situ on laryngeal biopsy must have careful microlaryngoscopy with examination of the hypopharynx, larynx, subglottic larynx, and upper trachea.
• 2 If the lesion is small and confined to one cord, complete stripping of that cord is indicated.
• 3 If both cords are abnormal, stripping and/or careful multiple biopsies are essential.
• 4 If a small localized lesion is found, repeat cord stripping is performed in one month.
• 5 If any biopsy reveals invasive carcinoma, the patient must not be classified as a case of carcinoma in situ.

     

Carcinoma in situ of the glottic larynx

Carcinoma in situ (CIS) is part of the histopathologic spectrum of laryngeal disorders where invasive squamous cell carcinoma is the endpoint of cellular disarray. Few reports consider prognostic indicators that predict which lesions become invasive. Forty-one patients with CIS of the glottic larynx were analyzed for risk factors that would predict invasive cancer. Anterior commissure involvement by CIS resulted in 92% conversion to invasive squamous cell cancer compared to 17% of lesions limited to the mobile fold. Epidermal growth factor receptors were also analyzed and were found not to be helpful in predicting invasion. Lesions of the mobile fold should be removed endoscopically and the patient should be observed closely for recurrence. Anterior commissure involvement that is inaccessible to complete laser ablation should be radiated, and the patient should be observed carefully.     

Nanotechnology in otolaryngology

This article provides a background on nanotechnology and discusses the applications of nanotechnology to medicine, specifically to otolaryngology.     

Meta-analysis in otolaryngology

OBJECTIVE: To examine the results of meta-analyses in otolaryngology and compare these results with the individual component studies that constitute each meta-analysis. DESIGN: A retrospective review of the literature. MAIN OUTCOME MEASURES: Studies that conducted pooled statistical systematic analyses indexed on MEDLINE for the 10-year period from January 1989 to January 1999 were selected for keyword or subject headings of meta-analysis and otolaryngology (N = 22). Analysis consisted of a modified funnel graph depiction of the individual studies that made up each meta-analysis. Each meta-analysis was evaluated for consistency among these individual studies and comparison of the median result with the weighted mean meta-analysis result. In addition, the methodologic quality of each meta-analysis was assessed in terms of the rigor with which component studies were evaluated. RESULTS: Ten (46%) of the 22 meta-analyses did not provide the individual study results that made up their meta-analyses. The results of 10 studies (46%) were similar to the median result of their individual component studies. The results of 2 studies (9%) differed from this median result, with widely heterogeneous component study results. CONCLUSIONS: A large proportion of meta-analyses in otolaryngology (46%) fail to provide the individual study results necessary to analyze the meta-analysis result critically. Most remaining studies do provide results that accurately compare with the median of their component study results. Only a small proportion of meta-analyses were found to have disparate results, and each appropriately discusses the heterogeneity of the individual studies that comprise their meta-analysis.     

Steroids in otolaryngology

Steroids are increasingly being used to treat a wide spectrum of otolaryngological disorders. It is important for ear-nose-throat surgeons to understand the short- and long-term complications associated with steroid use. The aim of this study was to review the role of steroids in common ear-nose-throat disorders. Corticosteroid therapy has been shown to be effective in the management of idiopathic facial nerve palsy, allergic rhinitis, acute sinusitis, sinonasal inflammatory polyposis, and croup. The therapeutic efficacy of steroids in the management of Meniere's disease, sudden idiopathic sensorineural HL, chronic otitis media, and vestibular neuronitis remain controversial.     

Allergy in otolaryngology

Otolaryngologic allergy concerns itself greatly with the teachings and influence of the late French Hansel, M.D., and his principles of optimal dosage. Later Herbert Rinkel, M.D., was to contribute the titration technique which allowed for a more systematic administration of antigens. Other areas such as provocative testing for foods as well as more controversial areas were later developed. These included cytotoxic testing as well as emphasis on clinical ecology techniques. The otolaryngologist has been equipped to handle all phases of nasal problems including allergy by 1. management of obvious surgical problems, 2. symptomatic approach with medical methods, 3. environmental controls when indicated and 4. immunotherapy. The last method includes titration as well as radioimmunoassay techniques (RAST). The author's conjecture regarding the future direction of allergy management from the otolaryngologist's view point is also given. Personal observations and anecdotes of some of the pioneers in the field are included.     

Bioinformatics in otolaryngology

This article reviews the recent literature on microarray analysis, bioinformatics techniques, and genomics in relation to the study of carcinogenesis of head and neck cancers.