Human papillomavirus (HPV), especially HPV16 genotype, is associated with oropharyngeal squamous cell carcinoma (OPSCC). We aim to determine the prevalence and characterize the high-risk (HR)-HPV genotypes in head and neck SCC (HNSCC) in a South-East Asian multi-ethnic society in Singapore and examine its prognostic significance.159 HNSCC archival tissue samples were retrieved and tumour DNA was screened for 18 HR-HPV genotypes using a PCR-based assay (Qiagen, digene HPV genotyping RH test). P16 protein overexpression was identified using immunohistochemistry (IHC). Statistical correlation between clinical outcomes were performed between HPV-positive and negative HNSCC patients.Six HR-HPVs (HPV16, 18, 31, 45, 56, 68) were detected in 90.6% of HNSCC; and 79.9% had multiple HPV genotypes detected. HPV31 and HPV45 were the most prevalent (79.2% and 87.4%, respectively); and HPV16 was predominantly found in OPSCC (p < 0.001). HPV-DNA PCR assay yielded a high sensitivity (96%) but low specificity (11%) when compared to p16 immunohistochemistry as the reference standard.P16-positive HNSCC was predominantly observed in OPSCC (73.7%; p = 0.005); and p16-positive OPSCC exhibited improved overall survival compared to p16-negative OPSCC (p = 0.022). Similarly, smoking and alcohol consumption were poor prognostic factors of overall survival (p = 0.007; p = 0.01) in OPSCC patients.HR-HPVs were identified in 90.6% of HNSCC patients using the HPV-DNA PCR assay. This test had a poor specificity when compared to p16 IHC; making it an unreliable detection technique in selecting patients for radiation dose de-escalation treatment protocol. P16-positive tumor was predominantly found in the oropharynx these patients demonstrated better overall survival than those with p16-negative OPSCC.
Objectives: Myringotomy and ventilation tube insertion is a common otolaryngologic surgical procedure with a steep learning curve for residents. Incorrect placement of incisions and external ear canal trauma are common complications when residents begin learning the procedure. With increasingly conservative guidelines on indications of myringotomy tubes, residents have less opportunities to refine this skill on real patients. The objective is to create a learner-centric myringotomy simulator. Methods: Although the concept of simulation training in myringotomy is not new, we aim to reduce the learning curve by introducing learner-guided features on a simulation model. Some of these include landmarks such as the handle of malleus, the anterior inferior quadrant guide, and modified instruments as part of the simulation. Working with the National University of Singapore, Division of Industrial Design team, a 3-dimensional library of different variants of ear models, including modified ear canals for teaching, was created. We created a platform to house the different components including an auricle, an external ear canal, and a disposable tympanic membrane with landmarks. Results: The model is accurate with realistic consistency to mimic soft tissues encountered in the myringotomy procedure. The simulator allows for variance in anatomy between the side of the ear and also between adult and pediatric sizes. Conclusions: Our model can be used to train otolaryngology residents and will be employed as a proof-of-concept model for the purpose of simulation training.
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