Objectives/Hypothesis To further improve the quality of head and neck cancer (HNC) care, we developed a composite measure defined as "textbook outcome" (TO). Methods We analyzed a retrospective... Show moreObjectives/Hypothesis To further improve the quality of head and neck cancer (HNC) care, we developed a composite measure defined as "textbook outcome" (TO). Methods We analyzed a retrospective cohort of patients after curvative-intent primary surgery, radiotherapy (RT), or chemoradiation (CRT) for HNC between 2015 and 2018 at the Netherlands Cancer Institute. TO was defined as 1) the start of treatment within 30 days, 2a) satisfactory pathologic outcomes, without 30-day postoperative complications, for the surgically treated group, and 2b), for RT and CRT patients, no unexpected or prolonged hospitalization and toxicity after the completion of treatment as planned. Results In total, 392 patients with HNC were included. An overall TO was achieved in 9.6% of patients after surgery, 20.6% after RT, and 2.2% after CRT. Two indicators (margins >5 mm and start treatment <30 days) reduced TO radically for both groups. Conclusion TO can aid the evaluation of the quality of care for HNC patients and guide improvement processes. Level of Evidence 3 Laryngoscope, 2021 Show less
Objectives/Hypothesis The current gold standard of therapy for adductor spasmodic dysphonia (AdSD) is injection of botulinum toxin A (BTX) in the adductor musculature. A surgical procedure could... Show moreObjectives/Hypothesis The current gold standard of therapy for adductor spasmodic dysphonia (AdSD) is injection of botulinum toxin A (BTX) in the adductor musculature. A surgical procedure could potentially offer more stable and long-lasting voice quality. In this study, we report the long-term results of endoscopic laser thyroarytenoid (TA) myoneurectomy versus BTX treatment in the same patients with AdSD.Study Design Retrospective case series.Methods Between July 2013 and September 2016, a total of 22 patients with AdSD were included. Voice outcomes were measured using the Voice Handicap Index and a Likert-scale patient-reported voice questionnaire. Data were obtained for each patient at four time points: preoperatively with and without BTX and twice postoperatively at 3 months (short term) and 12 months (long term).Results No statistically significant differences were found between voice outcome after BTX injection and the short- and long-term postoperative voice outcomes for the group as a whole. During postoperative follow-up, 10 of the 22 patients (45%) needed a second procedure after an average of 18 months (interquartile range, 13-22 months) due to recurrence of their original voice problem.Conclusions The TA myoneurectomy showed encouraging results, comparable to BTX after follow-up of 12 months for the group as a whole. However, after good results initially, voice deterioration was seen in 45% of the patients who all underwent a second procedure. These preliminary results provide important insights into the value of TA myoneurectomy as a potential definite treatment for a select group of patients with AdSD. Further research might explore long-term results after revision surgery.Level of Evidence 4Laryngoscope, 130:741-746, 2020 Show less
Zon, A. van; Smulders, Y.E.; Stegeman, I.; Ramakers, G.G.J.; Kraaijenga, V.J.C.; Koenraads, S.P.C.; ... ; Grolman, W. 2017
Objectives/HypothesisThe purpose of this study was to determine whether concomitant chemoradiation (CCRT)-induced hearing loss is progressive over time or not.Study DesignLong-term (LT) follow-up... Show moreObjectives/HypothesisThe purpose of this study was to determine whether concomitant chemoradiation (CCRT)-induced hearing loss is progressive over time or not.Study DesignLong-term (LT) follow-up study.MethodsBetween 1999 and 2004, 158 patients with head and neck cancer were treated with intravenous (IV) CCRT (n=80) or intraarterial CCRT (n=78). Audiometry was performed before, short-term (ST), and LT posttreatment. Differences in hearing were assessed with a multivariable linear regression analysis, incorporating the effect of aging.ResultsLong-term audiometry (median 4.5 years) was available in 67 patients (42%). At ST follow-up, a deterioration of 21.6 decibel was seen compared to baseline at pure-tone averages (PTA) 8-10-12.5 kHz. At LT follow-up, this deterioration further increased with 5 decibel (P = 0.005). Only in CCRT-IV patients was a significant progressive treatment-induced hearing loss seen, at PTA 8-10-12.5 kHz (P = 0.005), PTA 1-2-4 kHz air conduction (P = 0.014), and PTA 0.5-1-2 kHz bone conduction (P = 0.045).ConclusionCCRT-induced hearing impairment was progressive over time, especially in higher frequencies and only in CCRT-IV patients, with a modest deterioration of 5 decibel 4.5 years post-treatment.Level of Evidence4. Laryngoscope, 124:2720-2725, 2014 Show less
Objectives/Hypothesis: To study to what extent it is possible to achieve identical insertion depths and to maintain the same performance after cochlear reimplantation. Study Design: Outcome... Show moreObjectives/Hypothesis: To study to what extent it is possible to achieve identical insertion depths and to maintain the same performance after cochlear reimplantation. Study Design: Outcome research on a retrospective case series in a tertiary university referral center. Methods: Data were collected for 12 adults and three children who underwent reimplantation during the last 3 years with a new HiRes90K device with Hi Focus 1J electrode owing to failure of the feed-through seal. Multislice computed tomography scans were used to compare positions of the original and newly placed electrode arrays. The speech-perception scores on a consonant-vowel-consonant word test before and after reimplantation were compared. Results: All reimplantations were successfully performed by two experienced cochlear implantation surgeons, and no complications were observed. Postoperative imaging showed that the average displacement of the new implant was only 0.59 mm. Reactivation of the implant gave immediate open set speech understanding in all patients, and speech perception rapidly returned to the previous level obtained with the original implant within weeks; it was even significantly better at the 3-month follow-up. No relation was found between changes in performance and the amount of displacement of the electrode array. Conclusions: After cochlear reimplantation with the same device, electrode-array position can be accurately replicated and speech perception can be regained or even improved within weeks. Show less
Introduction: The causes of Permanent Childhood Hearing Impairment (PCHI) are often quoted as being hereditary in 50%, acquired in 25%, and unknown in 25% of cases. Interest in the causes of PCHI... Show moreIntroduction: The causes of Permanent Childhood Hearing Impairment (PCHI) are often quoted as being hereditary in 50%, acquired in 25%, and unknown in 25% of cases. Interest in the causes of PCHI has grown recently due to increasing diagnostic possibilities. We investigated the evidence for the reported distribution of these causes. Methods: Population-based study and a systematic review. Inclusion criteria for population-based study: children born between 2003 and 2005, resident in The Netherlands at birth, known at an Audiology Center with PCHI at the age of 3-5 years. The causes of PCHI were determined prospectively by detection of congenital cytomegalovirus on dried blood spots and/or genetic diagnostic investigations in addition to reviewing data from medical records. A systematic review was carried out using three terms (hearing loss, infant, and etiology) and limited to articles published between January 1997 and July 2009. Main outcome measures were: the (weighted) proportions of the various causes of PCHI following diagnostic investigations. Results: In the study-population (n = 185) a hereditary cause was found in 38.9%, acquired cause in 29.7%, miscellaneous cause in 7.1%, and the cause remained unknown in 24.3%. The systematic review of the literature (n = 9 articles) resulted in a weighted mean of 30.4% hereditary, 19.2% acquired, and 48.3% unknown causes of PCHI. Discussion: The systematic review and the results of the population-based study provided little support for the generally accepted distribution of causes of PCHI. Show less
INTRODUCTION The causes of Permanent Childhood Hearing Impairment (PCHI) are often quoted as being hereditary in 50%, acquired in 25%, and unknown in 25% of cases. Interest in the causes of PCHI... Show moreINTRODUCTION The causes of Permanent Childhood Hearing Impairment (PCHI) are often quoted as being hereditary in 50%, acquired in 25%, and unknown in 25% of cases. Interest in the causes of PCHI has grown recently due to increasing diagnostic possibilities. We investigated the evidence for the reported distribution of these causes. METHODS Population-based study and a systematic review. Inclusion criteria for population-based study: children born between 2003 and 2005, resident in The Netherlands at birth, known at an Audiology Center with PCHI at the age of 3-5 years. The causes of PCHI were determined prospectively by detection of congenital cytomegalovirus on dried blood spots and/or genetic diagnostic investigations in addition to reviewing data from medical records. A systematic review was carried out using three terms (hearing loss, infant, and etiology) and limited to articles published between January 1997 and July 2009. Main outcome measures were: the (weighted) proportions of the various causes of PCHI following diagnostic investigations. RESULTS In the study-population (n = 185) a hereditary cause was found in 38.9%, acquired cause in 29.7%, miscellaneous cause in 7.1%, and the cause remained unknown in 24.3%. The systematic review of the literature (n = 9 articles) resulted in a weighted mean of 30.4% hereditary, 19.2% acquired, and 48.3% unknown causes of PCHI. DISCUSSION The systematic review and the results of the population-based study provided little support for the generally accepted distribution of causes of PCHI. Show less
