Literature Review: A Roundup of Important Recent Studies

Setting: Department of Otolaryngology–Head and Neck Surgery and Masonic Cancer Center, Division of Biostatistics, University of Minnesota, Minneapolis.

Synopsis: Individual cases were matched to individual controls on tumor site, tumor stage (I to IV) and gender. The cases had an average diagnosis age of 38.2 years; the controls had an average diagnosis age of 61.3 years. The cases and controls had similar comorbidities (heart disease, stroke, lung disease, arthritis, immunosuppression, previous malignancy), but the control group included more diabetics. Both groups had similar use of alcohol, marijuana and non-cigarette tobacco products. The case group underwent neck dissection at a statistically significant greater rate than controls. Both groups were likely not different in positive margins, perineural invasion, vascular invasion, positive nodes and extracapsular extension; five-year overall survival was not statistically different between the groups. After adjusting for confounding variables, the case group had a higher disease-free survival than the controls, with a risk ratio of 0.43. According to study authors, the data suggest that the cases experienced similar rates of recurrence to those experienced by the controls, but these recurrences took longer to arise. Limitations included too few matched pairs where both cases and controls had data on a second recurrence, a small sample size and possible deficiencies present in the medical record, particularly for HPV information.

Bottom line: Overall survival was marginally better for all young patients, and disease-free survival was significantly better.

Citation: Lassig AA, Lindgren BR, Fernandes P, et al. The effect of young age on outcomes in head and neck cancer. Laryngoscope. 2013;123:1896-1902.

—Reviewed by Amy Eckner

CT Scan Use for Diagnosing CRS Remains Steady

What are the trends in the use of computed tomography (CT) scanning in the diagnosis of chronic rhinosinusitis (CRS)?

Background: Current evidence-based guidelines recommend paranasal sinus CT to verify diagnosis of CRS, but CT involves a number of resources, including patient time, additional costs and patient exposure to ionizing radiation. These factors need to be considered and CT scan use needs to be tracked in all medical specialties, including otolaryngology.

Study design: Cross-sectional analysis of a national health care database from 2005 to 2010. All visits to otolaryngologists with a chronic sinonasal diagnosis code (e.g., chronic sinusitis, chronic rhinitis, allergic rhinitis and septal deviation) were extracted.

Setting: National Ambulatory Medical Care Survey database.

Synopsis: Over the five-year course of the study, there were an estimated 31.1 ± 2.8 million otolaryngology visits for one of the selected sinonasal diagnoses; there were 819 unweighted visits coded for CRS, 639 for allergic rhinitis, 339 for nasal septal deviation, 249 for chronic rhinitis and 53 for nasal polyps. The average patient age was 43.2 ± 0.6 years and patients were predominantly female (57.1 ± 1.8 percent). Overall, 10.4 ± 2.2 percent of sinonasal diagnosis visits involved the use of CT scans, ranging from 8.4 ± 3.0 percent in 2007 to 12.3 ± 2.6 percent in 2008; in 2010, 11.7 ± 2.9 percent of visits included CT scanning. Overall, there was no statistically significant difference in CT rates over the time period of the study, although there was a slight increase in the overall CT scan rate among otolaryngologists from 2007 to 2008. The author hypothesizes that this might have to do with the publication of the adult sinusitis clinical practice guideline in 2007 and the emerging economy after a significant U.S. recession in 2008. Study limitations included the possibility of introduced errors, because the study relies upon diagnosis codes selected by clinicians, the fact that the CT scan ordering rates are based on visit rates and not per individual patient, and the fact that the NAMCS data reflect current practice in nonacademic, noninstitutional otolaryngologic settings.