OBJECTIVES To directly compare orthonasal and retronasal olfactory function using the recently introduced odorant containers, which enable retronasal stimulation without gustatory or somatosensory involvement. DESIGN Experimental study employing a within-subjects design. SETTING Laboratory-based olfactory testing facility. PARTICIPANTS Thirty-one healthy young adults (19 females; mean age 29.2 years, SD 5.9). MAIN OUTCOME MEASURES We assessed odour threshold, discrimination and identification with procedures closely adapted from the Sniffin' Sticks test battery, implemented for both routes using odorant containers (instead of Sniffin'Sticks pens). In addition, we obtained global olfactory test scores and odour intensity ratings. RESULTS Compared with orthonasal olfaction, retronasal olfaction was associated with significantly higher threshold scores, indicating lower sensitivity. We did not observe any significant differences between orthonasal and retronasal olfaction in odour discrimination or identification. In turn, a combined TDI score was significantly higher for orthonasal than retronasal stimulation. Odours were also rated as more intense when presented orthonasally. Notably, participants identified one odour (fish) with significantly lower accuracy in the retronasal condition. CONCLUSIONS Retronasally presented odours are perceived as weaker and less detectable than orthonasal odours, despite similar discrimination and identification capacities. These findings highlight perceptual differences between the two olfactory routes and provide experimental validation for the odorant containers method in retronasal testing.
OBJECTIVE Understanding racial disparities in postoperative outcomes after major head and neck surgery is crucial in improving overall cancer survival. This study aims to investigate the association of race on surgical outcomes after major head and neck surgery. METHODS The American College of Surgeon National Surgical Improvement Program is a nationally representative dataset with data collected via systematic sampling methods. Patients who underwent major head and neck cancer surgery were identified between 2014 and 2021 and grouped based on self-reported race/ethnicity. Continuous variables were compared using one-way ANOVA, while categorical variables were analysed using Pearson's chi-square test. Multivariate logistic regression controlled for preoperative factors was performed to identify independent predictors of postoperative outcomes and generate odds ratios. RESULTS 68.2% of the cohort were White, with Black, Hispanic, Asian and unknown/not reported comprising 6.0%, 4.9%, 4.0% and 16.9%, respectively. In multivariate analysis, Black patients compared to White patients had significantly greater odds of experiencing overall complications (OR = 1.73; 95% CI 1.38-2.19), and severe complications (OR = 2.09; 95% CI 1.71-2.56) (definitions provided in Methods section). CONCLUSION Significant racial disparities exist in complications following major head and neck cancer surgery, with a higher rate of complications in Black patients. Further research is required to identify those factors responsible for the disparity.
ABSTRACT Objective To perform a systematic review of rates of malignant transformation of vocal fold leukoplakia as per grades of dysplasia, to support clinician follow‐up strategies and management and to make an assessment on the 2‐tiered system against the previous 3‐tiered system. Data Sources PubMed, Embase, Scopus and Web of Science. Review Methods The JBI critical appraisal tool was used to assess included studies for bias. Rates of and time to malignant transformation were extracted from each study. Results Thirty studies containing 3714 patients with dysplastic lesions were included. Most used WHO 2005 grading, with limited WHO 2017 use. Meta‐analysis of 17 studies showed that under WHO 2005, malignant transformation occurred in 7.3% of patients with mild dysplasia (95% CI: 4.0%–10.6%), 19.2% of patients with moderate dysplasia (95% CI: 12.4%–26.1%) and 29.4% of patients with severe dysplasia or carcinoma in situ (95% CI: 21.4%–37.4%), all p < 0.001. Severe dysplasia carried a higher risk than mild (RR = 2.13; 95% CI 1.67–2.71, p < 0.001) and moderate dysplasia (RR = 1.24; 95% CI 1.01–1.52, p = 0.041); moderate exceeded mild (RR = 1.68; 95% CI 1.31–2.16, p < 0.001). Under WHO 2017, high‐grade exceeded low‐grade dysplasia (RR = 1.94; 95% CI 1.55–2.42, p < 0.001). Conclusion Laryngeal dysplasia is at greater risk of malignant transformation as the grade increases, supporting greater surveillance at higher grades. A layer of follow‐up could be viewed as being lost in the 2017 system with moderate dysplasia maintaining its own risk profile when comparing RRs between high and moderate dysplasia. However, as moderate dysplasia presents a significant risk profile, it can be argued that classifying it as higher grade in the new system has credence. Future studies should standardise follow‐up intervals and data reporting and assess the effect of risk‐factor control.
