Using tracheoesophageal speech after total laryngectomy is associated with durable improvements in quality of life and functional outcomes in veterans. Tracheoesophageal voice restoration should be attempted whenever technically feasible in patients that meet the complex psychosocial and physical requirements to appropriately utilize TE speech.
Swallowing screening is critical in rapid identification of risk of aspiration in patients presenting with acute stroke symptoms. Accuracy in judgments is vital for the success of the screening. This study examined speech-language pathologists' (SLPs) reliability in interpreting screening items. Swallowing screening was completed in 75 individuals admitted with stroke symptoms. Screening items evaluated were lethargy, dysarthria, wet voice unrelated to swallowing, abnormal volitional cough, and cough, throat clear, wet voice after swallowing, and inability to continuously drink with ingestion of 5 and 90 ml water. Two SLPs, each with more than 10 years of experience, made simultaneous independent judgments of the same observations obtained from the screening. Overall, generally high agreement was identified between the SLPs (k[SE] = 0.83[0.03]). Individual kappas ranged from 0.38 (fair) for non-swallowing wet voice to 0.95 (almost perfect) for cough after swallow, with one item omitted due to minimal variation. SLPs demonstrate high reliability in swallowing screening. Results, however, indicate some potential variability. Items associated with trial swallows had the highest reliability, whereas items related to judgments of speech and voice quality had the lowest. Although SLPs have dedicated training and ample opportunity to practice, differences in agreement are evident. Routine practice in hospital departments is recommended to establish and maintain sensitive perceptual discrimination. If other professionals are to provide swallowing screening, knowledge of SLPs' reliability levels must be considered when identifying screening items, creating education modules, and determining acceptable levels of agreement.
A total of 237 patients were treated over a period of five years for anorectal abscesses. Wide circular opening with removal of all purulent foci and necroses from outside had been preferred, because almost only "late forms" of anorectal inflammatory processes (perianal and ischiorectal abscesses) were seen. Sphincterotomy was possible in only a few patients. Postoperative fistulae occurred in 14% of the patients.
Presentation schedule is subject to change. For the most up-to-date information, visit www.entnet.org/annual_meeting. This study aims to: (1) Describe surgical outcomes of superficial versus total parotidectomy, and (2) describe surgical outcomes of observation versus cervical lymphadenectomy in patients with a N0 neck.Methods: Records of 129 consecutive patients with nonmetastatic primary parotid cancer treated from 1988 to 2010 at the University of Utah and Intermountain Healthcare were reviewed. Treatment was superficial (47%) or total (53%) parotidectomy, 31% underwent concurrent cervical lymphadenectomy, and 67% received adjuvant radiotherapy due to high-risk features. Patient demographics, tumor characteristics, surgical treatments, and oncologic outcomes were statistically analyzed.Results: Average age at diagnosis was 52 years. Mean follow-up was 7.4 years. Patient demographics, tumor grade, and histology were not predictive of recurrence or survival. Matching patients with Stage I/II disease (n = 74) and comparing superficial versus total parotidectomy, there was no difference in 5-year disease free rate, and 5-and 10-year overall survival rates (85%, 95%, and 88% versus 84%, 84% and 67%, respectively). Also, for Stage III (n = 18) and IV (n =33) disease there was no difference. For 101 patients with a N0 neck, 81 were observed and 20 underwent an elective cervical lymphadenectomy; there was no difference in outcomes (76%, 85%, and 72% versus 73%, 87%, and 67%, respectively).Conclusions: Treatment of primary parotid cancer requires meticulous surgical dissection and gross tumor resection; however, superficial versus total parotidectomy or observation versus elective cervical lymphadenectomy does not affect tumor recurrence rates or overall survival outcomes.
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