Transcanal endoscopic carbon dioxide laser resection of early-stage (A1-B1) glomus tympanicum tumours: single-centre case series.

OBJECTIVE: To report a single-centre experience in the endoscopic carbon dioxide laser-assisted approach to glomus tympanicum tumours. METHODS: A retrospective case review was conducted of patients diagnosed with class A1 to B1 glomus tympanicum tumours who underwent exclusive transcanal endoscopic carbon dioxide laser surgery. RESULTS: Seven patients fulfilled the inclusion criteria. All patients (100 per cent) were women, with a mean age of 65.4 years (standard deviation, 13.6). There were five A2 tumours, one A1 tumour and one B1 tumour. One patient presented with a delayed tympanic membrane perforation needing myringoplasty on follow up. There were no substantial post-operative complications. The mean hospitalisation time was 9.5 hours (standard deviation, 9.8). The mean follow-up period was 32.7 months (standard deviation, 13.1), with all cases having resolution of pulsatile tinnitus and no tumour recurrence. CONCLUSION: The study provides further evidence on the safety and efficacy of endoscopic carbon dioxide laser surgery as a minimally invasive technique for treating early-stage glomus tympanicum tumours.

Effectiveness and tolerance of electrochemotherapy as palliative therapy for patients with head and neck cancer and malignant melanoma and its relation to early skin reaction.

OBJECTIVES: To evaluate the efficacy and tolerance after the electrochemotherapy treatment for local therapy of cutaneous and subcutaneous metastases of head-and-neck tumors and malignant melanoma refractory to standard therapies, mainly in neck metastasis of squamous cell carcinoma. And, to evaluate the relation of this response according to the skin reaction (healing with ulcer or dry crust). METHODS: prospective pase II, observational clinical study of 56 patients with metastases of head-and-neck squamous cell carcinoma (n=13), papillary thyroid carcinoma (n=4), adenoid cystic carcinoma of parotid gland (n=1) or malignant melanoma (n=37, 5 in head). Patients were treated by electrochemotherapy (application of electrical pulses into the tumor) after the administration of a single intravenous dose of bleomycin. Kaplan-Meier curves were performed. The statistical significance was evaluated using log-rank test; p-value of less than 0.05 was considered as significant. RESULTS: Overall clinical response was observed in 47 patients (84%). Local side effects were mild in all the patients. Ten patients (76.9%) with neck metastasis of squamous cell carcinoma had some degree of response, but only in one was complete. Patients even with only partial response had a higher overall survival than patients without response (p= 0.02). Most of the patients with squamous cell carcinoma had diminution of pain and anxiety. Response rate and overall survival was higher in MM patients (86.5%) than in squamous cell cancer patients (76.9%) (p= 0.043). The healing process (dry crust/ulcer) was not associated with the overall survival (p= 0.86). CONCLUSIONS: Electrochemotherapy is associated a higher overall survival and diminution of pain and anxiety. Therefore, it is an option as palliative treatment for patients with neck metastasis of squamous cell carcinoma refractory to other therapies or even as a concomitant treatment with newer immunotherapies. The type of healing of the surgical wound could not be associated with a higher rate of response or survival. LEVEL OF EVIDENCE: III.

Effectiveness and tolerance of electrochemotherapy as palliative therapy for patients with head and neck cancer and malignant melanoma and its relation to early skin reaction

Abstract Objectives To evaluate the efficacy and tolerance after the electrochemotherapy treatment for local therapy of cutaneous and subcutaneous metastases of head-and-neck tumors and malignant melanoma refractory to standard therapies, mainly in neck metastasis of squamous cell carcinoma. And, to evaluate the relation of this response according to the skin reaction (healing with ulcer or dry crust). Methods prospective pase II, observational clinical study of 56 patients with metastases of head-and-neck squamous cell carcinoma (n = 13), papillary thyroid carcinoma (n = 4), adenoid cystic carcinoma of parotid gland (n = 1) or malignant melanoma (n = 37, 5 in head). Patients were treated by electrochemotherapy (application of electrical pulses into the tumor) after the administration of a single intravenous dose of bleomycin. Kaplan-Meier curves were performed. The statistical significance was evaluated using log-rank test; p-value of less than 0.05 was considered as significant. Results Overall clinical response was observed in 47 patients (84%). Local side effects were mild in all the patients. Ten patients (76.9%) with neck metastasis of squamous cell carcinoma had some degree of response, but only in one was complete. Patients even with only partial response had a higher overall survival than patients without response (p = 0.02). Most of the patients with squamous cell carcinoma had diminution of pain and anxiety. Response rate and overall survival was higher in MM patients (86.5%) than in squamous cell cancer patients (76.9%) (p = 0.043). The healing process (dry crust/ulcer) was not associated with the overall survival (p = 0.86). Conclusions Electrochemotherapy is associated a higher overall survival and diminution of pain and anxiety. Therefore, it is an option as palliative treatment for patients with neck metastasis of squamous cell carcinoma refractory to other therapies or even as a concomitant treatment with newer immunotherapies. The type of healing of the surgical wound could not be associated with a higher rate of response or survival. Level of evidence III.

Normative values for the video Head Impulse Test in children without otoneurologic symptoms and their evolution across childhood by gender.

PURPOSE: The video Head Impulse Test is routinely used to assess semicircular canal function in adults, but to date, pediatric reference values are scarce. This study aimed to explore the vestibulo-ocular reflex (VOR) in healthy children at different development stages and to compare the obtained gain values with reference to those in an adult population. METHODS: This prospective, single-center study recruited 187 children from among patients without otoneurological diseases, healthy relatives of these patients, and staff families from a tertiary hospital. Patients were divided into three groups by age: 3-6 years, 7-10 years, and 11-16 years. The vestibulo-ocular reflex was assessed by video Head Impulse Test, using a device with a high-speed infrared camera and accelerometer (EyeSeeCam®; Interacoustics, Denmark). RESULTS: We found a lower vestibulo-ocular reflex gain of both horizontal canals in the 3-6-year-old group when compared with the other age groups. No increasing trend was found in the horizontal canals from age 7-10 years to age 11-16 years, and no differences were found by sex. CONCLUSION: Gain values in the horizontal canals increased with age until children reached age 7-10 years and matched the normal values for adults.

Vestibulo-ocular reflex assessed with Video Head Impulse Test in children with Vestibular Migraine: Our experience.

Vestibular Migraine in children can mimic other disorders, especially at presentation. Outcome is hard to predict and management may be challenging due to the fact that many of the patients are too young to describe their symptoms and these are not always accompanied by headache. OBJECTIVE: To assess vestibulo-ocular reflex (VOR) in pediatric patients who meet criteria for defined Vestibular Migraine and to compare results to healthy controls. METHODS: Twenty-one patients aged 11-16 years were included in this prospective multicentric study. VOR was assessed using the video Head Impulse Test by EyeSeeCam®(Interacoustics, Denmark). RESULTS: Patients with Vestibular Migraine (VM) have higher values of gain compared to asymptomatic patients. CONCLUSION: Video Head Impulse Test (vHIT) is a useful and relatively fast-to-perform examination in children compared to other vestibular tests. Patients with VM seem to have higher values of gain at vHIT.

The learning curve in transoral laser microsurgery for malignant tumors of the larynx and hypopharynx: parameters for a levelled surgical approach.

The goal of the study was to identify parameters helpful to define a learning curve for laser microsurgery (TLM). 587 patients with malignant tumors of larynx and hypopharynx treated with TLM were divided into groups depending on the number of interventions their surgeons had performed. Outcome measures were obtained for the number of revision surgeries and complications, rates for tumor-free margins, tumor relapse and disease-specific survival rates for early and advanced tumors, serving to evaluate their potential influence on the learning curve. Surgery of early tumors was not influenced by the grade of experience. For locally advanced tumors the learning curve was statistically related to the number of surgeries needed per patient (p = 0.018). The number of overall complications (p = 0.000) and the disease-specific survival rate (p = 0.019) was significantly lower in the "expert" group. The percentage of postoperative bleedings was similar between all groups. Tumor-free margins and tumor relapse were not influenced by experience. In TLM, a learning curve could be observed for locally advanced tumors.

Type III tympanoplasty with titanium total ossicular replacement prosthesis: anatomic and functional results.

OBJECTIVE: To evaluate anatomical and functional results using titanium prostheses in cartilage palisade tympanoplasties. STUDY DESIGN: Retrospective clinical study. Data were collected from patients' charts and clinical review. SETTING: Tertiary referral center. INTERVENTION: Cartilage tympanoplasty with titanium total ossicular replacement prosthesis after tympanoplasty or tympanomastoidectomy in patients operated on between July 1998 and February 2006. MAIN OUTCOME MEASURES: Anatomical results (closure of the perforation, rate of retraction pockets, recurrent cholesteatoma, and extrusion and re-perforation rates) were clinically evaluated. Pure-tone averages of air and bone conduction were analyzed. A postoperative air-bone gap (ABG) of 20 dB or less was taken to represent successful hearing.The hearing outcomes of canal wall up (CWU), canal wall down (CWD), primary and revision surgeries, and 2 groups of a short-term (<12 mo) or long-term (>24 mo) follow-up (f-u) were assessed and compared. RESULTS: Ninety-four cases were observed during the visiting period: 43 (45.7%) underwent primary procedures and 51 (54.3%) underwent revision surgeries. Closure of the tympanic membrane was achieved in 98.9%.Postoperative ABG was 20 dB or lower in 62 (66%) of 93 cases, between 11 and 20 dB in 33 cases (35%), and 10 dB or lower in 29 cases (31%).All cases undergoing CWU had a mean +/- SD postoperative ABG of 14.59 +/- 11.28 dB. There were no statistically significant differences (independent-samples t test, p = 0.5) between these patients and those receiving CWD surgery (15.95 +/- 10 dB).Thirty-eight (68%) of 56 CWD and 24 (64%) of 37 CWU cases achieved a postoperative ABG between 0 and 20 dB (chi = 0.08, p = 0.7, correlation = 0.031).Thirty-three (64.7%) of 51 who underwent revision surgeries and 29 (69%) of 42 who underwent primary procedures had a postoperative ABG between 0 and 20 dB. The difference between the groups was not significant (chi = 0.3, correlation = 0.058, p = 0.5).The mean ABG in the short f-u group was 12.38 +/- 7.34. There was no significant difference regarding long-term f-u after 24 months (11.76 +/- 8.9; Wilcoxon signed-rank test, p = 0.7).We compared the mean postoperative ABG in low hearing frequencies (500 and 1,000 Hz) and high hearing frequencies (2,000 and 4,000 Hz). A better sound transmission was achieved in high frequencies (10.32 +/- 10.6 versus 20.61 +/- 13.73 dB, respectively); the difference was statistically significant (p < 0.001, paired-samples t test). CONCLUSION: Our results suggest that tympanoplasty with titanium total ossicular replacement prosthesis reconstruction offers a stable improvement of the ABG less than 20 dB in 66% of cases, in both short-term and long-term f-u. There were no differences in the results between CWU and CWD or between primary and revision surgery. The titanium prosthesis achieves the best acoustical results for sound transmission at high frequencies (2,000 and 4,000 Hz).