Sex Differences in Health Related Quality of Life in Head & Neck Cancer One Year After Treatment

Background: Head and neck cancer (HNC) makes up about 3% of all cancers and is treated with systemic therapy, radiation, surgery, or a combination of these. HNC treatment can be associated with decreased patient reported health related quality of life (HR-QoL), which can lead to depression. The majority of studies found that females reported worse patient reported HR-QoL than males, however, there were a few that did not have a significant difference in overall patient reported QoL. With the discovery of patient oriented outcomes (PROs) in clinical practice affecting patient satisfaction, provider-patient relationship, and overall patient mortality, it is vital to include PROs in the creation of treatment plans. Objectives: The objectives of this project are to highlight the differences in HR-QoL between men and women. Ultimately, using these PROs clinically will help to improve patient care, augment patient-provider trust, and optimize treatment plans. Using PROs and recognizing where unconscious biases of providers come into play is pinnacle, and this project aims to highlight how men and women\u27s experiences are different in the treatment of HNC. Methods: Participants were given the FACT-H&N instrument one year after treatment for head and neck cancer at a single tertiary academic center to assess different aspects of Hr-QoL. Sex differences were analyzed between the groups. A Wilcoxon Rank Sum test was performed to assess associations with sex and survey responses, as well as to assess associations with total laryngectomy and survey responses. Results: There were 100 participants from a single academic center of which 73% were men and 27% women. Several of the questions had significant differences between men and women: I feel ill (P=0.0299), I am satisfied with my family communication about my illness P=0.0075), I am satisfied with my sex life (P=0.0496), My voice has its usual quality and strength (P=0.0057), I can swallow naturally and easily (P=0.0437), and I can eat solid foods (P=0.0248). There were no significant differences between men and women with laryngectomies. Conclusions: Overall, men felt more ill, were less satisfied with their sex lives, were less likely to feel a normal strength and quality of voice, felt decreased ability to swallow normally, and felt they could not eat solid foods; women were less satisfied with communication about their disease to their families. For those who had undergone laryngectomy, there were no significant differences between men and women. Different aspects of quality of life for men and women are affected by head and neck cancer. Monitoring PROs are becoming increasingly standard of care for patients, and providers need to be equipped understand how to interpret data accordingly and understand the inherent biases

The Impact of Marital Status and Race in Obstructive Sleep Apnea

OBJECTIVES: To examine the difference in survival of obstructive sleep apnea (OSA) based on marital status and race. METHODS: A single academic institution with data collection from 2005 to 2015. Patients with a diagnosis of OSA based on polysomnogram were abstracted from electronic medical records. Patients were classified as married or unmarried. Race was self-reported as White, Black, Asian American, Hispanic/Latinx, Middle Eastern descent, or unrecorded and gathered from the electronic medical record. RESULTS: There were 6200 adults included. Of these, married patients composed 62.7% (n = 3890) of the patients. Patients were 51.3% White (n = 3182), 39.8% (n = 2467) were Black, and 8.9% (n = 551) were other/unrecorded. Married patients had better survival probabilities (p \u3c .0001). Unmarried patients had 2.72 times the risk of death than those who were married (95% CI 1.78-4.20) when examining OSA survival. When examining survival of those on continuous positive airway pressure (CPAP) between married and unmarried patients, those who were unmarried had 2.00 (95% CI 1.58-2.54) times the risk of death than those who were married. Married Black patients demonstrated the best survival probabilities, followed by married White patients (p \u3c .0001). Married patients had lower mean sleep efficiency than those that were unmarried (76.2% and 77.2%, respectively; p = .019). CONCLUSION: Married patients with OSA had increased survival compared to their single counterparts. Married Black patients had the highest survival

Immunolocalization of calcium sensing and transport proteins in the murine endolymphatic sac indicates calciostatic functions within the inner ear

An exceptionally low calcium (Ca2+) concentration in the inner ear endolymph ([Ca2+]endolymph) is crucial for proper auditory and vestibular function. The endolymphatic sac (ES) is believed to critically contribute to the maintenance of this low [Ca2+]endolymph. Here, we investigated the immunohistochemical localization of proteins that are presumably involved in the sensing and transport of extracellular Ca2+ in the murine ES epithelium. Light microscopic and fluorescence immunolabeling in paraffin-embedded murine ES tissue sections (male C57BL/6 mice, 6–8 weeks old) demonstrated the presence of the calcium-sensing receptor CaSR, transient receptor potential cation channel subtypes TRPV5 and TRPV6, sarco/endoplasmic reticulum Ca2+-ATPases SERCA1 and SERCA2, Na+/Ca2+ exchanger NCX2, and plasma membrane Ca2+ ATPases PMCA1 and PMCA4 in ES epithelial cells. These proteins exhibited (i) membranous (apical or basolateral) or cytoplasmic localization patterns, (ii) a proximal-to-distal labeling gradient within the ES, and (iii) different distribution patterns among ES epithelial cell types (mitochondria-rich cells (MRCs) and ribosome-rich cells (RRCs)). Notably, in the inner ear membranous labyrinth, CaSR was exclusively localized in MRCs, suggesting a unique role of the ES epithelium in CaSR-mediated sensing and control of [Ca2+]endolymph. Structural loss of the distal ES, which is consistently observed in Meniere’s disease, may therefore critically disturb [Ca2+]endolymph and contribute to the pathogenesis of Meniere’s disease

Neuronal erythropoietin overexpression is protective against kanamycin-induced hearing loss in mice

Aminoglycosides have detrimental effects on the hair cells of the inner ear, yet these agents indisputably are one of the cornerstones in antibiotic therapy. Hence, there is a demand for strategies to prevent aminoglycoside-induced ototoxicity, which are not available today. In vitro data suggests that the pleiotropic growth factor erythropoietin (EPO) is neuroprotective against aminoglycoside-induced hair cell loss.Here, we use a mouse model with EPO-overexpression in neuronal tissue to evaluate whether EPO could also in vivo protect from aminoglycosideinduced hearing loss. Auditory brainstem response (ABR) thresholds were measured in 12-weeks-old mice before and after treatment with kanamycin for 15 days, which resulted in both C57BL/6 and EPO-transgenic animals in a high-frequency hearing loss. However, ABR threshold shifts in EPOtransgenic mice were significantly lower than in C57BL/6 mice (mean difference in ABR threshold shift 13.6 dB at 32 kHz, 95% CI 3.8 to 23.4 dB, p = 0.003). Correspondingly, quantification of hair cells and spiral ganglion neurons by immunofluorescence revealed that EPO-transgenic mice had a significantly lower hair cell and spiral ganglion neuron loss than C57BL/6 mice. In conclusion, neuronal overexpression of EPO is protective against aminoglycoside-induce hearing loss, which is in accordance with its known neuroprotective effects in other organs, such as the eye or the brain

Clinical Imaging Findings of Vestibular Aqueduct Trauma in a Patient With Posttraumatic Meniere's Syndrome

Posttraumatic Meniere's syndrome is a rare clinical entity. The pathomechanism by which temporal bone trauma leads to fluctuating audiovestibular symptoms, in some cases with a delay of onset many years after trauma, remains elusive. Here, a clinical case and the respective temporal bone imaging data were reviewed to investigate the underlying inner ear pathology. A 44-year-old patient presented with left-sided Meniere's syndrome 34 years after he suffered an ipsilateral temporal bone fracture caused by a car accident. Clinical imaging showed left cochleovestibular hydrops (gadolinium-enhanced MRI) and bony obliteration of the left VA (CT imaging), resulting in discontinuity of the ES. Our findings suggest that a temporal bone fracture with a “retrolabyrinthine” course, traversing the VA, caused intraaqueductal callus bone formation and progressive blockage of the VA. As a result, the extraosseous (distal) endolymphatic sac (eES) became separated from the cochleovestibular labyrinth, an event that presumably underlies endolymphatic hydrops formation and that precipitates the onset of clinical Meniere's symptoms in this case

English translation and validation of the Zurich chronic middle ear inventory (ZCMEI-21-E) assessing quality of life in chronic otitis media: A prospective international multicentre study

Objectives To translate and validate the Zurich Chronic Middle Ear Inventory (ZCMEI‐21) for the English language in order to provide an English instrument to assess health‐related quality of life in chronic otitis media (COM). Design Pilot translation study including cognitive debriefings, prospective multicentre cross‐sectional psychometric validation study. Setting Four tertiary referral centres in three different English‐speaking countries (UK, USA and Australia). Participants Adult patients suffering from COM. Main outcome measures The English translation of the ZCMEI‐21 (ZCMEI‐21‐E) and the five‐level version of the EQ‐5D questionnaire. The EQ‐5D, which constitutes a generic measure of health‐related quality of life, consists of a descriptive system score and a visual analogue scale. Statistical outcomes included single‐item descriptive statistics, internal consistency (Cronbach's α) as an indicator of reliability, as well as construct validity. Results A total of 124 patients suffering from COM were included. The mean age was 50.1 years (SD 16.9 years), and 72 (58.1%) were males. The Cronbach's α of the ZCMEI‐21‐E was 0.91, suggesting an excellent internal consistency. The Spearman's correlation coefficient of the ZCMEI‐21‐E total score was 0.55 (P < 0.0001) for convergent construct validity with EQ‐5D descriptive system score and 0.57 (P < 0.0001) with the EQ‐5D visual analogue scale. Conclusions The ZCMEI‐21‐E is a new validated questionnaire that provides clinicians with a short, comprehensive and reliable instrument to quantify health‐related quality of life in patients suffering from COM. The ZCMEI‐21‐E may be of use in clinical routine as well as in outcome research and monitoring