Setting: Department of Otolaryngology, University of Michigan Health System; Section of Otolaryngology, Dartmouth-Hitchcock Medical Center; Department of Otolaryngology, University of Washington.
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May 2013Synopsis: A total of 1,216 citations were screened by a single author, yielding 23 full text articles for review by two authors. Three prospective clinical studies were identified and included in the final review. The studies differed in selection of macrolide drug, dosing and duration of treatment, while comparator groups also differed, with one study comparing against amoxicillin/clavulanate and two studies comparing against placebo. Overall meta-analysis revealed only one statistically significant, but likely clinically insignificant, improvement in the validated Sino-Nasal Outcome Test (SNOT) scale at 24 weeks. Improvement in unvalidated patient response scales was difficult to assess in light of significant heterogeneity between studies and the potential bias within unvalidated instruments.
Bottom line: The three studies included in this review do not demonstrate evidence for a clinically significant impact of long-term macrolide therapy for treatment of CRS. However, there may be an effect among the subgroup of patients with low serum IgE, though further study is warranted.
Citation: Pynnonen MA, Venkatraman G, Davis GE. Macrolide therapy for chronic rhinosinusitis: a meta-analysis. Otolaryngol Head Neck Surg. 2013;148:366-373.
—Reviewed by Brent Senior, MD
Parotid Gland Lymphoma Consideration in Parotid Lesion Evaluation
Are demographic, clinical and pathologic features of patients with parotid gland lymphoma important for prognosis?
Background: To date, there has not been an analysis of prognostic features of parotid lymphoma using U.S. population data. Non-Hodgkin lymphoma (NHL) accounts for 89 percent of all new cases of lymphoma, while Hodgkin lymphoma (HL) accounts for 11 percent of cases. Otolaryngologists usually assist with diagnosis for patients with parotid masses. This study was designed to examine important demographic, clinical, surgical and pathologic factors that affect survival of patients with parotid gland lymphoma.
Study design: Retrospective cohort study.
Setting: Study of 2,140 patients between 1973 and 2008 using the National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER).
Synopsis: Surveyed patients had a mean age of 64.1 ± 16.8 years, and the number of cases increased with age. Women represented 57.4 percent of cases, and 85.5 percent of surveyed patients were white. Nearly all cases were NHL, and the most common NHL subtypes were marginal zone B-cell lymphoma (27.9 percent), follicular lymphoma (25.8 percent) and diffuse large B-cell lymphoma (23.7 percent). Most surveyed patients presented with stage I (49.8 percent) and stage II (21.0 percent) disease. The majority of patients (71.4 percent) received some kind of surgical procedure (associated with a 35 percent lower risk of death); the most common procedure was parotidectomy (75.7 percent). Radiation was given to 39 percent of patients and was associated with improved survival. In addition, patients diagnosed between the years 2000 and 2008 had a 37 percent lower risk of death. Those with stage IV disease had 1.58 times the risk of death compared with those who had stage I disease. Median survival time was determined for stages I (12.3 years), II (9.1 years), III (8.3 years) and IV (8.0 years); HL patients had the longest survival. The risk of death from parotid lymphoma increased with age, gender and disease stage. Limitations included lack of detailed clinical information within SEER and lack of reliably recorded chemotherapy data.