difficult to evaluate the degree of the paralysis through thevideostroboscopy. The author studied voice range profile(VRP) to evaluate patients who have high pitch dysphonia afterthyroidectomy.METHOD: A prospective study was performed with 67 pa-tients who underwent voice examination preoperatively, 1week and 3 months after the thyroidectomy. The patientsincluded 58 females and 9 males. Six female patients showedhigh pitch dysphonia. The patients were classified as the groupof female with no high pitch dysphonia (group A, n�52), thegroup of female with high pitch dysphonia (group B, n�6) andthe group of male (group C, n�9). VRP was performed toidentify the frequency range and the intensity range, Laryngealelectromyogram (EMG) was performed in group B.RESULTS: In Group B, the frequency range was 443.1183.97Hz, 246.6749.41 Hz, 181.3780.13 Hz showing significant de-crease at 1 week and 3 months after the surgery compared tothat of the preoperative result (p�0.05). In addition, the in-tensity range was 22.252.87 dB, 15.252.22 dB, 16.252.63dB respectively showing significant postoperative decrease(p�0.05). EMG of group B showed decreased potential with 3patients, normal potential in 2, and the other patient refused totake the exam. In group A and C, VRP revealed no significantdifference between the preoperative and postoperative results.CONCLUSION: VRP test is a easy and practical test whichdemonstrates decreased frequency range visually and helps toevaluate EBSLN injury within 5 minutes.

VTE in Head & Neck Cancer Patients After Surgery

Neil Gross, MD (presenter); Mark Wax, MD; PeterAndersen, MD

OBJECTIVE: Cancer patients undergoing major surgery areconsidered high risk for venous thromboembolism (VTE). Therisk of VTE in head and neck cancer patients undergoingsurgical ablation is unknown. The purpose of this study was toreport the incidence of VTE in head and neck cancer patientsafter extensive resection and microvascular reconstruction andto explore the impact of VTE on survival.METHOD: Single-institution, retrospective cohort study per-formed between 2007 and 2009; 134 head and neck cancerpatients underwent a total of 139 procedures. All patientsunderwent extensive cancer resection and simultaneous micro-vascular free tissue transfer reconstruction. Demographic, clin-ical and surgical data were abstracted for all cases. The primaryendpoint was identification of confirmed (pulmonary embo-lism, PE; deep venous thrombosis, DVT) or suspicious (acuterespiratory failure, sudden cardiac arrest, leg edema withoutimaging) cases of VTE within 30 days of surgery. The asso-ciation between covariates and VTE were assessed using mul-tivariable logistic regression analysis and Kaplan -Meier sur-vival analysis.

RESULTS: Most patients were male (59%) with head andneck squamous cell carcinoma (76%). The mean patient agewas 65.4 years. A total of eight (5.8%) confirmed or suspiciousVTE were identified; one PE, one DVT, one acute respiratoryfailure, one sudden cardiac arrest, and four cases of leg edema.Risk factors for VTE included older age, female gender, to-bacco smoking, high body mass index (BMI), prior history ofVTE, prolonged operation time, prolonged hospitalization, andperioperative red blood cell transfusion. In the multivariableanalysis, the strongest predictors of VTE were a prior historyof VTE (p�0.04; odds ratio [OR], 25.11; 95% confidenceinterval [CI], 1.13-556.40), red cell transfusion (p�0.009; OR,1.80; CI, 1.16-2.80), high BMI (p�0.015, OR, 1.29, CI, 1.05-1.58), and older age (p�0.046; OR, 1.10; CI, 1.00-1.19). Inmultivariate models, confirmed VTE and suspicious VTE weresignificant predictors of decreased two-year survival (hazardratio�2.87, 95% CI, 1.39-17.08, p � 0.019) and (HR�1.79,95% CI, 1.11-6.50, p � 0.019), respectively, when stratifiedagainst non-VTE patients.CONCLUSION: The incidence of VTE in head and neckcancer patients after major surgery involving microvascularreconstruction, ranged from 1.4% (confirmed) to 5.8% (con-firmed and suspicious). These results suggest that the incidenceof VTE may be underestimated in head and neck cancerpatients after extensive resection and microvascular recon-struction. Prospective studies are needed to define the trueextent of this problem.

WBC Differential Count for Diagnosis of

Lymphadenopathy

Soon-Hyun Ahn, MD, PhD (presenter)

OBJECTIVE: Cervical lymphadenopathy is one of the mostcommon presentations in the head and neck field, and selflimiting reactive hyperplasia or subacute necrotizing lymphad-enitis is frequent. But differential diagnosis of the tuberculouslymphadenitis, metastatic carcinoma, benign mass, and lym-phoma is sometimes not easy, and fine needle aspiration giveslittle information many times. The purpose of this study is toevaluate whether the differential count of white blood cells canhelp the decision making of the necessity of excisional biopsyrather than observation.METHOD: From October 2007 to December 2009, 175 pa-tients were included in study. All patients visited the outpatientclinic due to the cervical lymphandenopathy and performedfine-needle aspiration and complete blood cell count withwhite blood cell differential count.RESULTS: The last diagnosis was reactive hyperplasia in 104patients (59.4%) and subacute necrotizing lymphadenitis in 18patients (10.3%). So 69.7% of patients showed self limitingcourse. There were 19 tuberculous lymphadenitis, 12 benignmass other than lymphadenitis, 13 metastatic carcinoma, andnine lymphoma. The fine needle aspiration biopsy could detectten metastatic carcinoma and four lymphoma, and the detec-

P212 Otolaryngology-Head and Neck Surgery, Vol 143, No 2S2, August 2010

tion rate was 55% for malignant disease and none of thetuberculosis by fine needle aspiration in this group. Among the154 patients of reactive hyperplasia in fine-needle aspirationbiopsy, 64 patients showed neutropenia or lymphocytosis.There were one tuberculous lymphadenitis and three benignmasses without malignancy. In contrast, among the 90 patientswith normal differential count, there were 18 tuberculouslymphadenitis, seven benign mass, and eight malignant tumors.CONCLUSION: The differential count can help the decisionmaking of excisional biopsy in patients whose aspiration cy-tology was benign or reactive hyperplasia.

XIAP Improve Resistance of Hep-2 Cell to Irradiation

Yan Zhang, MD (presenter)

OBJECTIVE: To investigate the effect of XIAP up-regulationby transfection with expression plasmid on hep-2 cells apopto-sis and radiotherapy sensitivity.METHOD: Up-regulating XIAP expression was achieved byexpression vector plasmid (PGEX, PGEX-XIAP, PGEX-XIAP-mut, PGEX-XIAP�t) transfected into hep-2 cells. 48 hrsafter radiation the cell apoptosis rate, inhibition rate and XIAPexpression in the levels of mRNA and protein were tested tofind the relationship between XIAP over expression and cellsensitivity to irradiation. The different effect of the three XIAPgene on cell protection and apoptosis was analyzed.RESULTS: Transfection with vectors with different XIAPfragment, (PGEX, PGEX-XIAP, PGEX-XIAP mut, PGEX-XIAP�t) was conducted to hep-2 cells. 24 hours later cellswere irradiated with 4 Gy ray. 48 hours following irradiationthe XIAP protein FI tested by FCM was 1.10, 1.60, 1.80, 1.87respectively. The cell survival rate was 92.6%, 99.6%, 95.4%,93.4%, and the corresponding cell apoptosis rate was 11.82%,5.72%, 10.36%, 9.71%. This indicates that transfection ofexpression vector plasmid caused significantly increase ofXIAP expression and cell survival and decreased apoptosis.PGEX-XIAP transfection decreased apoptosis most remark-ably with respect to the other expression vectors thoughPGEX-XIAP mut and PGEX-XIAP� t transfection causedhigher XIAP protein level.CONCLUSION: Up-regulation of XIAP expression promotescell survival with decreased apoptosis. Compared with XIAP,XIAP mut and XIAP� t show less effect in promoting cellsurvival after irradiation. Since loss or variation of RINGregion weakened the anti-apoptosis ability of XIAP, the func-tion of RING is to promote apoptosis in hep-2 cells induced byradiation.

Laryngology/Bronchoesophagology

3 Year Follow-Up; NAIM Rehab in Laryngectomized

Patients

Birgit Risberg-Berlin, SLP, PhD (presenter); RiittaMoller, MD, PhD; Anna Ryden, PhD

OBJECTIVE: To assess the long-term results of the NasalAirflow-Inducing Maneuver (NAIM) olfaction rehabilitationin patients with laryngectomy according to changes in olfac-tion, health-related quality of life (HRQL) and communication.

METHOD: University Hospital setting. A new method, theNAIM technique is now available for laryngectomized patientsto regain the ability to smell. 18 patients (15 men and 3women; mean age, 71 years) rehabilitated with NAIM, werelongitudinally followed for 3 years and compared with an ageand gender matched control group with laryngeal cancertreated with radical radiotherapy. HRQL was assessed by theEuropean Organization for Research and Treatment for cancerquality of life questionnaires. Communication was assessed bythe Swedish Self-Evaluation of Communication Experiencesafter Laryngeal Cancer and olfaction by the ScandinavianOdor-Identification Test (SOIT). Changes over time as well astests between pairs of study patients and control patients wereanalyzed with the Fisher nonparametric permutation test formatched pairs.

RESULTS: Thirty-six months after NAIM rehabilitation 14 of18 laryngectomized patients (78%) were smellers according toSOIT results. There were, with one exception (sleep distur-bances), no clinically or statistically significant differencesbetween the study and the control group considering HRQLand mental distress. However, statistical differences werefound between the study and control group concerning changesin communication.

CONCLUSION: Patients who were successfully rehabilitatedconcerning olfaction and communication had an overall goodHRQL and no mental distress. Moreover, we suggest olfactorytraining with NAIM to be integrated into multidisciplinaryrehabilitation programs after total laryngectomy.

A New Device Design for Universal

Tracheoesophageal Puncture

Richard Goode (presenter); Hussein Samji

OBJECTIVE: To describe a new and efficient method oftracheoesophageal puncture using a hybrid device assembledfrom two commercially available puncture kits; to demonstratethe utility of this technique in the performance of primary,secondary, and office-based unsedated procedures.

METHOD: Study Design: Retrospective case review. Years/months study conducted: June 2008 to January 2010. Disease/Condition studied: Malignant neoplasms of the larynx/phar-ynx. Subjects studied: Seven patients who underwent totallaryngectomy for malignancy of the larynx and/or pharynxwho underwent either primary or secondary tracheoesophagealpuncture for voice restoration. Setting: Tertiary academic hos-pital. Intervention: Surgical creation of a tracheoesophagealpuncture and placement of a voice prosthesis. Outcome mea-surements: length of procedure; complications; blood loss.Independent variables: None.

P213Poster Presentations

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