Background We evaluated clinical and functional outcomes following salvage total laryngectomy (STL). Methods Retrospective review of 218 patients who underwent STL between 1994 and 2014. Results Seventy percent of patients originally had T1–2, N0 tumors and 73% had definitive external beam radiation therapy (EBRT) alone. A majority utilized TEP (77%) and were gastrostomy free (80%) at last follow up. The 5-year disease control and overall survival rates were 65% and 57%. Patients with disease-free interval (DFI) following initial treatment < 2 years were more likely to develop recurrence (p=0.001) and die of disease (p=0.032) following STL. DFI following EBRT impacted disease control (p<0.001), with 5-year disease control of 92% for >5 year DFI and 60% for <2 year DFI. Conclusion Most patients remain disease-free following STL, achieve intelligible tracheo-esophageal speech and maintain an oral diet. Delayed recurrence following initial treatment portends better survival and may indicate a distinct biological profile.

Introduction: Image-guided surgery (IGS) has gained widespread acceptance in otorhinolaryngology for its applications in sinus and skull base surgery. Although the core concepts of IGS have not changed, advances in image guidance technology, including the incorporation of intraoperative imaging, have the potential to enhance surgical education, allow for more rigorous preoperative planning, and aid in more complete surgery with improved outcomes. Objectives: Provide a clinical update regarding the use of image guidance and intraoperative imaging in the field of rhinology and endoscopic skull base surgery with a focus on current state of the art technologies. Methods: English-language studies published in PubMed, Cochrane, and Embase were searched for articles relating to image-guided sinus surgery, skull base surgery, and intraoperative imaging. Relevant studies were reviewed and critical appraisals were included in this clinical update, highlighting current state of the art advances. Conclusions: As image guidance and intraoperative imaging systems have advanced, their applications in sinus and skull base surgery have expanded. Both technologies offer invaluable real-time feedback on the status and progress of surgery, and thus may help to improve the completeness of surgery and overall outcomes. Recent advances such as augmented and virtual reality offer a window into the future of IGS. Future advancements should aim to enhance the surgeon’s operative experience by improving user satisfaction and ultimately lead to better surgical results.

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Objective Chronic rhinosinusitis (CRS) has been associated with comorbid depression, yet the prevalence of depression among all patients with CRS is not well described. The Patient Health Questionnaire–9 (PHQ-9), a validated instrument for diagnosing depression, has been used to assess depression in a variety of clinical settings. PHQ-9 scores ≥10 are the threshold for a depression diagnosis. The purpose of this study was to assess the prevalence of depression in a rhinology practice and compare the PHQ-9 with the 22-item Sinonasal Outcome Test (SNOT-22). Study Design Retrospective chart review. Setting Tertiary rhinology practice. Subjects and Methods During the 2-month period ending April 30, 2018, all rhinology patients were asked to complete the PHQ-9 and SNOT-22. Results Among 216 patients, 46 (21.3%) had a self-reported history of depression, and 39 (18.1%) had a PHQ-9 score ≥10. Of the 39 patients screening positive for depression, 18 (41.9%) had no history of depression. Comparison of PHQ-9 with overall SNOT-22 score had a Pearson’s coefficient of 0.632 ( P < .005). Logistic regression showed that the highest 2 quintiles of SNOT-22 scores had an odds ratio of 60.6 (95% CI, 9.7-378.3) for a positive depression screen (PHQ-9 score ≥10). Conclusion Depression rates (estimated by PHQ-9 responses) among rhinology patients are similar to chronic disease populations; depression may be underdiagnosed in rhinology patients. Higher SNOT-22 scores were associated with higher PHQ-9 scores. Further studies are warranted to understand the impact of comorbid conditions of depression and CRS in patient quality of life.