-
Anti-cancer Drugs Feb 2023The incidence of radiation-induced secondary primary tumors (SPTs) is estimated to be between 1 and 20%. The oropharynx is not a common site for postradiotherapy head...
The incidence of radiation-induced secondary primary tumors (SPTs) is estimated to be between 1 and 20%. The oropharynx is not a common site for postradiotherapy head and neck SPTs. We describe the cases of eight patients, each with an SPT of the oropharynx. These developed after a long median latency of 17.7 years with each receiving two-dimensional radiation therapy and delivery of at least 5000 cGy per pharynx, except for one who was treated with IMRT. Tumor histological commonalities revealed squamous cell carcinoma p16 negative staining, local invasion, and limited lymphatic spread, with posterior wall of the oropharynx and the base of the tongue being the most common locations. Limited and challenging treatment options have been reported such as surgery, reirradiation, or clinical trials. Radiation-induced SP oropharyngeal carcinoma has unique clinical and pathological features. Patients with this disease have limited treatment options, which should be discussed in a multidisciplinary tumor board meeting. For this population, lifelong follow-up may help in early diagnosis and improve outcomes.
Topics: Humans; Head and Neck Neoplasms; Carcinoma, Squamous Cell; Oropharynx; Retrospective Studies
PubMed: 36730617
DOI: 10.1097/CAD.0000000000001411 -
Annals of the New York Academy of... Dec 2020Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive... (Review)
Review
Swallowing complaints are common and may have significant consequences for nutrition and pulmonary health. Etiology varies and different aspects of the deglutitive system may be affected. A thorough assessment from the oral cavity to the stomach will provide physiologic information that enables specific targeted management plans to be devised. Although the swallow trajectory bridges anatomic areas, there has previously been a tendency to compartmentalize assessment and treatment by arbitrary anatomic boundaries. It is now clear that this approach fails to appreciate the complexity of swallow mechanics and that systems (oral, pharyngeal, esophageal, and pulmonary) are intertwined and codependent. Swallowing specialists from different backgrounds and with complementary skill sets form a multidisciplinary team that can provide insight and address multiple areas of management. With the advent of new tools for instrumental evaluation, such as manometry, targeted rehabilitative strategies can be informed by physiology, increased in precision and breadth, and assessed quantitatively. Surgical approaches have evolved toward endoscopic techniques, and food technology is expanding options in dietary management. The multidisciplinary team is core to managing this varied and often neglected patient population. This review is for clinicians treating swallowing disorders and will explore the selected aspects of the assessment and management of pharyngoesophageal swallowing disorders.
Topics: Deglutition; Esophageal Motility Disorders; Esophagus; Humans; Manometry; Oropharynx
PubMed: 32794195
DOI: 10.1111/nyas.14456 -
Sexually Transmitted Infections Sep 2021This prospective cohort study aimed to determine the natural history and incidence of oropharyngeal gonorrhoea and chlamydia among a cohort of men who have sex with men...
OBJECTIVES
This prospective cohort study aimed to determine the natural history and incidence of oropharyngeal gonorrhoea and chlamydia among a cohort of men who have sex with men (MSM) over a 12-week period, and to examine risk factors associated with incident oropharyngeal infections.
METHODS
MSM either aged ≥18 years and had a diagnosis of oropharyngeal gonorrhoea by nucleic acid amplification test (NAAT) in the past 3 months or aged 18-35 years who were HIV-negative taking pre-exposure prophylaxis (PrEP) were eligible for this study. Enrolled men were followed up for 12 weeks. Oropharyngeal swabs were collected at week 0 (baseline) and week 12 (end of study). Between these time points, weekly saliva specimens and the number of tongue kissing, penile-oral and insertive rimming partners were collected by post. Oropharyngeal swabs and saliva specimens were tested by NAAT for and . Poisson regression was performed to examine the risk factors (weekly number of partners) associated with incident oropharyngeal gonorrhoea.
RESULTS
A total of 100 MSM were recruited. The incidence of oropharyngeal gonorrhoea and chlamydia was 62 (95% CI 37 to 105) and 9 (95% CI 2 to 35)/100 person-years, respectively. The median duration of incident oropharyngeal infection with gonorrhoea was 28 days (IQR=21-36, n=7). The incidence rate ratio (IRR) for oropharyngeal gonorrhoea increased with an increased number of kissing partners (IRR=1.08; 95% CI 1.03 to 1.12) an increased number of penile-oral sex partners (IRR=1.07, 95% CI 1.01 to 1.14) but not with an increased number of insertive rimming partners (IRR=1.11, 95% CI 0.96 to 1.29) or other demographic factors. The IRR and duration of incident oropharyngeal chlamydia were not calculated due to the small number of cases (n=2).
CONCLUSIONS
MSM have a high incidence of oropharyngeal gonorrhoea and the median duration of infection was less than 3 months.
Topics: Adolescent; Adult; Australia; Chlamydia Infections; Chlamydia trachomatis; Gonorrhea; Homosexuality, Male; Humans; Incidence; Male; Neisseria gonorrhoeae; Oropharynx; Prospective Studies; Risk Factors; Saliva; Sexual Behavior; Sexual Partners; Young Adult
PubMed: 33208509
DOI: 10.1136/sextrans-2020-054764 -
The Lancet. Infectious Diseases Oct 2019Data from mathematical models suggest that kissing and saliva exchange during sexual activity might be major contributors to community gonorrhoea morbidity. Although... (Review)
Review
Data from mathematical models suggest that kissing and saliva exchange during sexual activity might be major contributors to community gonorrhoea morbidity. Although there is little evidence to support this, it provokes discussion of the potential role of the oropharynx in gonorrhoea control. Improved sensitivity and ease of diagnostic testing, as well as increased screening for extragenital infections among men who have sex with men, have increased awareness of the high frequency of oropharyngeal gonorrhoea. However, there are insufficient data to determine the mechanisms of transmission for these infections. Innovative studies that use quantitative microbiological techniques are needed to accurately assess how oral gonorrhoea or saliva exchange in infected people contribute to the morbidity of gonorrhoea in the community. More empirical data on pharyngeal gonorrhoea infections, and the role of transmission to and from the oropharynx, are needed to inform prevention planning.
Topics: Female; Gonorrhea; Homosexuality, Male; Humans; Male; Models, Biological; Neisseria gonorrhoeae; Oropharynx; Pharyngitis; Prevalence; Risk; Saliva; Sexual Partners; Sexual and Gender Minorities
PubMed: 31324518
DOI: 10.1016/S1473-3099(19)30306-8 -
Signal Transduction and Targeted Therapy May 2021COVID-19 remains a serious emerging global health problem, and little is known about the role of oropharynx commensal microbes in infection susceptibility and severity....
COVID-19 remains a serious emerging global health problem, and little is known about the role of oropharynx commensal microbes in infection susceptibility and severity. Here, we present the oropharyngeal microbiota characteristics identified by shotgun metagenomic sequencing analyses of oropharynx swab specimens from 31 COVID-19 patients, 29 influenza B patients, and 28 healthy controls. Our results revealed a distinct oropharyngeal microbiota composition in the COVID-19 patients, characterized by enrichment of opportunistic pathogens such as Veillonella and Megasphaera and depletion of Pseudopropionibacterium, Rothia, and Streptococcus. Based on the relative abundance of the oropharyngeal microbiome, we built a microbial classifier to distinguish COVID-19 patients from flu patients and healthy controls with an AUC of 0.889, in which Veillonella was identified as the most prominent biomarker for COVID-19 group. Several members of the genus Veillonella, especially Veillonella parvula which was highly enriched in the oropharynx of our COVID-19 patients, were also overrepresented in the BALF of COVID-19 patients, indicating that the oral cavity acts as a natural reservoir for pathogens to induce co-infections in the lungs of COVID-19 patients. We also found the increased ratios of Klebsiella sp., Acinetobacter sp., and Serratia sp. were correlated with both disease severity and elevated systemic inflammation markers (neutrophil-lymphocyte ratio, NLR), suggesting that these oropharynx microbiota alterations may impact COVID-19 severity by influencing the inflammatory response. Moreover, the oropharyngeal microbiome of COVID-19 patients exhibited a significant enrichment in amino acid metabolism and xenobiotic biodegradation and metabolism. In addition, all 26 drug classes of antimicrobial resistance genes were detected in the COVID-19 group, and were significantly enriched in critical cases. In conclusion, we found that oropharyngeal microbiota alterations and functional differences were associated with COVID-19 severity.
Topics: Adult; Bacteria; COVID-19; Female; Humans; Male; Metagenomics; Microbiota; Middle Aged; Oropharynx; SARS-CoV-2
PubMed: 33986253
DOI: 10.1038/s41392-021-00614-3 -
Sexually Transmitted Infections Mar 2021Women attending STI clinics are not routinely tested for oropharyngeal (CT) infections. We aimed to assess spontaneous clearance of oropharyngeal CT and cure after...
OBJECTIVES
Women attending STI clinics are not routinely tested for oropharyngeal (CT) infections. We aimed to assess spontaneous clearance of oropharyngeal CT and cure after antibiotic treatment in women.
METHODS
Women with vaginal or rectal CT (n=560) were recruited at STI clinics in 2016-2017, as part of the FemCure study (prospective cohort study). We included participants' data from week -1, that is, the diagnosis at initial visit, when clinics applied selective oropharyngeal testing. At week -1, a total of 241 women were oropharyngeally tested (30 positive) and 319 were untested. All FemCure participants provided nurse-collected oropharyngeal samples at study enrolment, that is, week 0, just prior to treatment (n=560), and after treatment at weeks 4 (n=449), 8 (n=433) and 12 (n=427). Samples were tested by nucleic acid amplification test, and at week 0 also by viability testing by viability PCR. Proportions of oropharyngeal CT test results were presented to represent spontaneous clearance and cure.
RESULTS
Of 30 women diagnosed with oropharyngeal CT at week -1, fifteen (50%) were negative at week 0 after a median of 9 days, that is, 'spontaneous clearance'. At week 0, a total of 560 participants were tested, and 46 (8.8%) were oropharyngeal CT positive; 12 of them (26.1%) had viable CT. Of the 46 positive, 36 women had an oropharyngeal test after treatment; 97.2% (35/36) were negative at week 4, that is, 'cure'. Of all women with follow-up visits, the proportion of oropharyngeal CT positive was between 0.5% and 1.6% between weeks 4 and 12. Of those not tested at week -1 (n=319), 8.5% (n=27) were oropharyngeal positive at week 0.
CONCLUSIONS
The clinical importance of oropharyngeal CT in women is debated. We demonstrated that spontaneous clearance of oropharyngeal CT among women is common; of those who did not clear for CT, three-quarters had non-viable CT. After regular treatment with azithromycin or doxycycline, cure rate (97%) of oropharyngeal CT is excellent.
TRIAL REGISTRATION NUMBER
NCT02694497.
Topics: Anti-Bacterial Agents; Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Microbial Viability; Netherlands; Oropharynx; Prospective Studies; Rectum; Vagina; Young Adult
PubMed: 32737209
DOI: 10.1136/sextrans-2020-054558 -
Emerging Microbes & Infections Dec 2023Little is known about alternation and difference in gut microbiota between patients with mild and severe hand, foot, and mouth disease (HFMD). We investigated the...
Little is known about alternation and difference in gut microbiota between patients with mild and severe hand, foot, and mouth disease (HFMD). We investigated the differences in gut and oropharynx microbiota between mild and severe HFMD in young children and changes in bacterial profiles as the disease progresses from acute to convalescent phase. Forty-two patients with confirmed HFMD were studied, among which 32 had severe HFMD and 10 had mild HFMD. First rectal swabs were collected from all patients at an average of 2 days (acute phase) after the onset of symptoms, and second rectal swabs were collected from 8 severe patients at day 9 (convalescent phase) after the onset. Oropharyngeal swabs were obtained from 10 patients in the acute phase and 6 in the convalescent phase. 16S rRNA sequencing was performed for all 70 samples. Compared with mild HFMD, severe HFMD exhibited significantly decreased diversity and richness of gut microbiota. Gut microbiota bacterial profiles observed in the acute and convalescent phases resembled each other but differed from those in mild cases. Additionally, 50% of patients with severe HFMD in the acute phase harboured a dominant pathobiontic bacterial genus. However, none of the patients with mild HFMD had such bacteria. Similar bacterial compositions in oropharynx microbiota were detected between mild and severe cases. Our findings indicate that severe HFMD exhibits significantly impaired diversity of gut microbiota and frequent gut and oropharyngeal inflammation-inducing bacteria. However, the results should be interpreted with caution as the number of subjects was limited.
Topics: Humans; Child; Infant; Child, Preschool; Hand, Foot and Mouth Disease; RNA, Ribosomal, 16S; Inflammation; Gastrointestinal Microbiome; Bacteria; Oropharynx; China
PubMed: 36927539
DOI: 10.1080/22221751.2023.2192819 -
Ear, Nose, & Throat Journal Aug 2021Incidental papillomas of the pharynx can be found while examining the nasopharynx, oropharynx, and hypopharynx for other disorders of the head and neck. Purpose of the...
INTRODUCTION
Incidental papillomas of the pharynx can be found while examining the nasopharynx, oropharynx, and hypopharynx for other disorders of the head and neck. Purpose of the study is to explore the location, biopsy protocol, and decision to perform office-based versus operative management via potassium titanyl phosphate (KTP) laser when an oropharyngeal papilloma is discovered incidentally.
METHODS
A retrospective review of the senior author's patient population was performed using Current Procedural Terminology and/or codes to identify patients who had KTP laser removal of incidental oropharyngeal papillomas. Patients were included based on the incidental nature of the papilloma and confirmed pathology report of squamous papilloma. Demographics, presenting complaint, lesion location, pathological analysis, type of intervention, and outcomes were recorded. When available, human papillomavirus (HPV) subtype was noted.
RESULTS
A total of 26 cases were identified, 13 females and 13 males. The median age at time of surgery was 58 years (range: 21-77). The most common presenting symptoms were difficulty swallowing and throat pain. The most common locations were the base of tongue, uvula, tonsils, and the soft palate. Of the 26 patients, 23 patients received KTP laser ablation therapy as an office-based procedure, while the remaining 3 were performed under general anesthesia in the operating room. Only 5 patients had a recorded recurrence that required reoperation. There were no operative or postoperative complications. There were 16 biopsy samples tested for HPV, where 12 were negative for HPV and 4 were positive for HPV.
CONCLUSION
Oropharyngeal papillomas, when present, can be found incidentally during examination of the oropharynx for other symptoms. Office-based biopsy and KTP laser is a safe and efficient means of identifying and removing most oropharyngeal papillomas.
Topics: Adult; Aged; Ambulatory Surgical Procedures; Biopsy; Clinical Decision-Making; Deglutition Disorders; Female; Humans; Incidental Findings; Lasers, Solid-State; Male; Middle Aged; Oropharyngeal Neoplasms; Oropharynx; Papilloma; Retrospective Studies; Young Adult
PubMed: 31581834
DOI: 10.1177/0145561319871228 -
American Journal of Otolaryngology 2023Venous malformations (VMs) are congenital vascular lesions caused by enlarged and ectatic venous channels. Current methods of treatment for VMs involve a combination of...
BACKGROUND
Venous malformations (VMs) are congenital vascular lesions caused by enlarged and ectatic venous channels. Current methods of treatment for VMs involve a combination of sclerotherapy, laser therapy, and surgical resection. While sclerotherapy remains the most commonly used treatment for small VMs, surgery remains an important tool for isolated VMs or larger VMs with higher flow due to potential local and systemic side effects associated with the use of certain sclerosing agents.
METHODS/RESULTS
Here we present a case of a patient with a naso- and oropharyngeal venous malformation which was successfully resected with endoscopic-assisted transoral surgery.
CONCLUSIONS
This is a low-fingerprint technique to tumors of the oropharynx with excellent visualization and maneuverability in cases where TORS is not an option. This technique does not require palate splitting or excessive retraction, allows multiple surgeons to work simultaneously, and is associated with significantly lower morbidity than transcervical techniques.
LEVEL OF EVIDENCE
N/A.
Topics: Humans; Sclerosing Solutions; Oropharynx; Sclerotherapy; Laser Therapy; Vascular Malformations; Treatment Outcome
PubMed: 36628911
DOI: 10.1016/j.amjoto.2022.103784 -
Danish Medical Journal Apr 2021The reference test to evaluate patients with suspected respiratory virus infection is a real-time reverse transcription-polymerase chain reaction (RT-PCR) from a... (Comparative Study)
Comparative Study
INTRODUCTION
The reference test to evaluate patients with suspected respiratory virus infection is a real-time reverse transcription-polymerase chain reaction (RT-PCR) from a nasopharyngeal swab (NPS). However, other specimen collection methods such as an oropharyngeal swab (OPS) or saliva specimen are also used for SARS-CoV-2 testing during the ongoing COVID-19 pandemic. However, it remains unclear if rates of SARS-CoV-2 detection differ between sampling methods. This study will compare the rates of SARS-CoV-2 detection by saliva, OPS, and NPS sampling in a public setting.
METHODS
Individuals referred for outpatient SARS-CoV-2 testing will be invited to participate in a prospective clinical study. They will have saliva, OPS and NPS specimens collected that will be analysed separately for SARS-CoV-2 RNA by RT-PCR. The rate of SARS-CoV-2 detection in saliva, OPS and NPS will be compared using a logistic regression mixed-effect model analysis. A sample of 19,110 participants is required at an expected 1.5% test-positive rate in order to detect a 25.6% difference. The total sample size will be adjusted as the test-positive rate changes.
CONCLUSIONS
This study will provide evidence for the optimal site of specimen collection to detect SARS-CoV-2. The results may help guide the health authorities.
FUNDING
This is an investigator-initiated trial based on an unrestricted grant from the Novo Nordisk Foundation and the Aage og Johanne Louis-Hansens Fond. The foundations have had no say in the decisions on study design or reporting.
TRIAL REGISTRATION
ClinicalTrials.gov (ID: NCT04715607).
Topics: COVID-19; COVID-19 Nucleic Acid Testing; Humans; Logistic Models; Nasopharynx; Oropharynx; Reverse Transcriptase Polymerase Chain Reaction; SARS-CoV-2; Saliva; Specimen Handling
PubMed: 33832565
DOI: No ID Found