Past Research
CT Imaging for Sinusitis - Reformatted vs. Direct Coronal Imaging
Direct coronal CT images are important in both the evaluation and surgical planning for sinus disease. The coronal plan allows clear imaging of the medial orbital wall, the skull base, the uncinate process, and the ethmoid labyrinth, all key landmarks in sinus surgery. Axial images may be reformatted for coronal visualization, but these reformatted images may contain significant artifact or lack the resolution for accurate evaluation of the key sinus landmarks. As many patients undergo axial imaging for image guidance procedures, this study aims to determine whether direct coronal imaging adds significant information when compared to reformatted coronal imaging for surgical planning and intraoperative use.
A ChemoSensory Questionnaire (CSQ) for Patients Treated for Cancer of the Head and NeckObjective:
To investigate primary chemosensory issues experienced by patients who undergo treatment for cancer of the head and neck and to develop and assess a ChemoSensory Questionnaire (CSQ).
Design: Cross sectional survey for questionnaire development and testing.
Methods: Literature, expert opinion and focus group methodology were used to identify aspects of smell and taste affecting patients before, during, and after therapy for cancer of the head and neck. A draft instrument was compiled, reviewed and revised. The revised instrument was administered along with a demographic and clinical form, the SF-12, the Performance Status Survey, and the University of Michigan Head and Neck Quality of Life Questionnaire to a sample of patients. Following item and scale analyses and reductions, a final instrument was assembled. Construct validity and test-retest reliability were assessed. Results: 206 patients were included in the study. The final survey instrument consisted of 8 items, 4 on smell and 4 on taste. Cronbach’s alpha was 0.89 for the smell scale and 0.78 for the taste scale. Correlations with other HRQOL scales ranged from 0.20 to 0.64 for the taste scale and from 0.10 to 0.33 for the smell scale. Good construct validity of the CSQ scores was demonstrated.
Conclusions: Treatment for head and neck cancer negatively impacts smell and taste. A survey instrument was developed to evaluate chemosensory function that is simple to administer and brief. This instrument will be of value in identifying factors that contribute to chemosensory disturbance and may serve as a guide for planning treatment regimens that minimize such disturbance.
Additional studies are planned to prospectively assess chemosensory disturbance in patients treated for cancer of the head and neck.
AdvaCoat™ Sinus Gel Study
Chronic rhinosinusitis (CRS) is a very common condition, affecting 35 million Americans each year. Functional endoscopic sinus surgery (FESS) is a minimally invasive surgical procedure that opens up the sinus and alleviates the symptoms of CRS patients. A common unwanted side effect of the FESS procedure is the formation of adhesions between the septum and the middle turbinate, preventing proper ventilation and drainage from the paranasal sinuses. Clinically, relevant adhesions form in 5-20% of all patients undergoing FESS procedures.
The purpose of this study is to evaluate the safety and effectiveness of AdvaCoat™ sinus gel; a nasal dressing that conforms to mucosal surfaces and prevents adhesion formation following endoscopic ethmoid sinus surgery. AdvaCoat™ is a bioresorbable hyaluronan gel, thus eliminating the pain and tissue abrasion caused by removal of non-absorbable nasal packing. In addition to preventing scars, AdvaCoat™ serves as an adjunct to aid in the natural healing process by controlling bleeding and minimizing edema. This prospective, multi-center, randomized, controlled study will also be compared to MeroGel® Injectable, a commercially approved absorbable nasal dressing.
Acupuncture for the Treatment of Chronic Sinusitis
Chronic sinusitis is a common disease, with over 34 million cases in the United States alone. Patients suffer significant morbidity reporting a quality of life similar to that seen in patients with chronic heart disease, angina pectoris, and chronic obstructive pulmonary disease. Conventional approaches utilized in western medicine include medications such as antibiotics and steroids with surgery as an adjunctive treatment in selected cases. While patients experience significant relief from such treatments, relapses do occur and many patients seek treatment outside of traditional western medicine.
Despite the large number of patients seeking treatment for chronic sinus/nasal symptoms, very little information exists regarding the treatment patterns and efficacy of complementary treatment. In an effort to improve understanding of the role of acupuncture in the treatment of chronic sinusitis, the Center is collaborating with the UCSF Osher Center for Integrative Medicine. Ongoing projects include a survey of Bay Area acupuncturists regarding their treatment practices and beliefs about the role of acupuncture in the treatment of sinus/nasal symptoms. A prospective, randomized study is underway to evaluate the efficacy of acupuncture in the treatment of chronic sinusitis. Outcome measures will include general and disease specific questionnaires as well as CT scans and standardized endoscopic evaluations.
HIV and Squamous Cell Carcinoma of the Head and Neck - A Clinical Study
Squamous cell carcinoma (SCC) is the most common malignancy of the upper areodigestive tract (UADT). Patients with UADT SCC appear to have a more rapidly progressive clinical course. Previously studies have suggested a younger age of onset and worse prognosis for HIV-positive patients with UADT SCC when compared with their HIV-negative counterparts. The goal of this study is to examine and compare the clinical course of HIV-positive and HIV-negative patients with UADT SCC through case control comparison.
Endoscopic Post-Cricoid Advancement Flap for Posterior Glottic Stenosis
Posterior glottic stenosis represents a challenging clinical condition for which numerous procedures are available to improve airway obstruction. The endoscopic postcricoid advancement flap has been described as useful adjunct for treatment of posterior glottic stenosis, employing an endoscopic method for placing vascularized tissue in the posterior glottis to prevent scar re-formation. The procedure minimizes trauma through use of an endoscopic approach rather than a midline thyrotomy and can be performed with available microlaryngeal equipment by surgeons familiar with laryngeal microsurgery. A review of the application of this technique is being performed to better identify patients with posterior glottic stenosis who are appropriate candidates for the procedure.
Impact of socioeconomic status on the diagnosis to treatment interval in Waldeyer's ring carcinoma.
OBJECTIVE: To examine the impact of socioeconomic status on the diagnosis to treatment interval in Waldeyer's ring cancers by comparing the experience of a public hospital and an academic tertiary care medical center.
DESIGN: Retrospective review.
SETTING: Otolaryngology clinic of a public hospital and an academic medical center.
PATIENTS: One hundred seven patients with Waldeyer's ring carcinoma who were diagnosed and treated at San Francisco General Hospital (SFGH) or at the University of California, San Francisco Medical Center (UCSFMC) from January 1995 through December 2000 were included in the study. The same departments of otolaryngology-head and neck surgery and radiation oncology staff both hospitals. All radiation therapy was provided at UCSFMC. Patients included in the study had a histologic diagnosis of Waldeyer's ring carcinoma, primary treatment with radiation, and no prior treatment of Waldeyer's ring carcinoma.
MAIN OUTCOME MEASURES: The time of diagnosis to start of radiation therapy, dose of radiation, number of treatment days, duration of treatment, and 1 and 3 year survival were recorded. Differences between the two groups were analyzed using Student's t test. RESULTS: The time course from diagnosis of nasopharyngeal carcinoma to start of radiation therapy was 56 days at SFGH compared with 34 days at UCSFMC. This difference was statistically significant (P = .0001). Difference in diagnosis to treatment intervals for base of tongue cancer was also significant at 66 days at SFGH compared with 31 days at UCSFMC (P = .0038). For cancer of the tonsil, the diagnosis to treatment interval was 70 days at SFGH versus 40 days at UCSFMC (P = .0005). Dose of radiation, number of days of treatment, and duration of treatment were not statistically different. Only patients with cancer of the tonsil demonstrated a statistically significant difference in 3 year survival (P = .0175).
CONCLUSION: Although radiation therapy delivery appears similar between the public and tertiary care medical centers, there appears to be a statistically significant delay in the initiation of therapy for patients at the public institution. It is possible that this influences 3 year survival in cancer of the tonsil.
Additional studies are planned to prospectively evaluate the reasons for the increased DTI for patients at SFGH.