Background Sinonasal squamous cell carcinoma SNSCC is a rare malignancy that poses management challenges Although surgery and chemoradiation therapy CRT remain therapeutic mainstays induction chemotherapy IC has emerged as a useful adjunct with locally advanced disease This study used the National Cancer Data Base NCDB to examine treatment outcomes for patients diagnosed with SNSCC Methods The NCDB -was queried for cases with SNSCC Multivariate hazard regression modeling was used to identify significant predictors of -month and -month overall survival OS including treatment modality Results A total of patients with SNSCC met inclusion criteria including patients treated with surgery ± adjuvant therapy treated with definitive radiotherapy RT or CRT who underwent IC followed by definitive CRT and who received IC followed by surgery and adjuvant therapy Hazard modeling for confirmed treatment modality significantly associated p < with OS a er adjustment Patients who received surgical intervention ± adjuvant therapy had lower -month and -month mortality risk compared to definitive RT or CRT hazard ratio HR ≥ p < or IC followed by definitive CRT HR ≥ p < Compared to primary surgery ± adjuvant therapy patients undergoing IC then surgery had similar -month and -month OS p ≥ a er adjustment Conclusion Multimodality therapy including surgical intervention associates with improved OS a er multifactorial adjustments IC followed by surgery associated with improved OS compared to IC followed by CRT and CRT alone Study results highlight the utility of surgery toward optimizing OS in patients with SNSCC and demonstrates the potential utility of IC when primary surgical management is not preferred © 2020 ARS-AAOA, LLC.
IMPORTANCERecent studies suggest that theophylline added to saline nasal irrigation (SNI) can be an effective treatment for postviral olfactory dysfunction (OD), a growing public health concern during the COVID-19 pandemic.OBJECTIVE To evaluate the efficacy and safety of theophylline added to SNI compared with placebo for COVID-19-related OD. DESIGN, SETTING, AND PARTICIPANTSThis triple-blinded, placebo-controlled, phase 2 randomized clinical trial was conducted virtually between March 15 and August 31, 2021. Adults residing in Missouri or Illinois were recruited during this time period if they had OD persisting for 3 to 12 months following suspected COVID-19 infection. Data analysis was conducted from October to December 2021.INTERVENTIONS Saline sinus rinse kits and bottles of identical-appearing capsules with either 400 mg of theophylline (treatment) or 500 mg of lactose powder (control) were mailed to consenting study participants. Participants were instructed to dissolve the capsule contents into the saline rinse and use the solution to irrigate their nasal cavities in the morning and at night for 6 weeks. MAIN OUTCOMES AND MEASURESThe primary outcome was the difference in the rate of responders between the treatment and the control arms, defined as a response of at least slightly better improvement in the Clinical Global Impression-Improvement scale posttreatment. Secondary outcome measures included changes in the University of Pennsylvania Smell Identification Test (UPSIT), the Questionnaire for Olfactory Disorders, the 36-Item Short Form Health Survey on general health, and COVID-19-related questions.RESULTS A total of 51 participants were enrolled in the study; the mean (SD) age was 46.0 (13.1) years, and 36 (71%) participants were women. Participants were randomized to SNI with theophylline (n = 26) or to SNI with placebo (n = 25). Forty-five participants completed the study. At the end of treatment, 13 (59%) participants in the theophylline arm reported at least slight improvement in the Clinical Global Impression-Improvement scale (responders) compared with 10 (43%) in the placebo arm (absolute difference, 15.6%; 95% CI, −13.2% to 44.5%). The median difference for the UPSIT change between baseline and 6 weeks was 3.0 (95% CI, −1.0 to 7.0) for participants in the theophylline arm and 0.0 (95% CI, −2.0 to 6.0) for participants in the placebo arm. Mixed-model analysis revealed that the change in UPSIT scores through study assessments was not statistically significantly different between the 2 study arms. Eleven (50%) participants in the theophylline arm and 6 (26%) in the placebo arm had a change of 4 or more points in UPSIT scores from baseline to 6 weeks. The difference in the rate of responders as measured by the UPSIT was 24% (95% CI, −4% to 52%) in favor of theophylline.CONCLUSIONS AND RELEVANCE This randomized clinical trial suggests that the clinical benefit of theophylline nasal irrigations on olfaction in participants with COVID-19-related OD is inconclusive, though suggested by subjective asses...
Objective (1) Understand attitudes of otolaryngology residency applicants regarding gender and racial diversity within programs. (2) Examine how program diversity affects applicant decisions during the residency match. (3) Compare the importance of racial and ethnic program diversity among applicants. Study Design Web-based survey distributed in February and March 2019. Setting Tertiary care university setting. Subjects and Methods An anonymous web-based survey was distributed to 418 applicants in the 2019 otolaryngology match. Respondents were queried about the importance of program diversity and its effects on the match process. Ratings were based on a scale of 1 to 5 (with 5 being extremely important or significant effect). Results The response rate was 35%; 53% of responders were male; and 59% were white, 25% Asian, 6% black, and 6% Hispanic/Latino. Applicants rated the importance of having female faculty and residents as 4.1 (SD = 1.1) and 4.2 (SD = 1.1), respectively. Applicants rated the importance of having diverse faculty and residents as 3.9 (SD = 1.1) and 4 (SD = 1.2). Overall, 7.6% of applicants canceled interviews due to a lack of female residents and 5.5% due to a lack of female faculty; furthermore, 5.5% of applicants canceled interviews due to a lack of diverse residents and 4.9% due to a lack of diverse faculty. Female and nonwhite applicants prioritized females and diversity within programs more so than male and white applicants. Conclusions Although residency applicants felt that program diversity was important, this did not significantly affect decision making during the match process, likely due to the competitive nature of the match. Women and nonwhite applicants prioritized program diversity more than white male applicants.
IMPORTANCECurrent tools for diagnosis of olfactory dysfunction (OD) are costly, time-consuming, and often require clinician administration.OBJECTIVE To develop and validate a simple screening assessment for OD using common household items. DESIGN, SETTING, AND PARTICIPANTSThis fully virtual diagnostic study included adults with self-reported OD from any cause throughout the US.
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