Preservation of Residual Hearing After Cochlear Implant Surgery With Deep Insertion Electrode Arrays.

OBJECTIVE: To evaluate the hearing preservation (HP) in cochlear implant (CI) recipients who did not fulfill the criteria for electric acoustic stimulation (EAS). STUDY DESIGN: Prospective study SETTING:: Tertiary academic hospital. PATIENTS: Adults undergoing CI with deep insertion electrode arrays who had measurable residual hearing (RH) before surgery. INTERVENTION: Demographic data, surgical technique, pure-tone average, and radiological findings were evaluated. MAIN OUTCOME MEASURE: Pre- and postoperative pure-tone audiometry. A preservation study was therefore performed for the whole range of frequencies (THP), and for low frequencies (LFHP). RESULTS: From the total 25 patients who underwent the surgical procedure, 6 of them (26.08%) did not retain any RH and 17 of them (73.91%) had some degree of HP. A clear association was observed between the use of the atraumatic technique (AT) and the percentage of some degree of HP. In patients who underwent the AT, LFHP was 72.79% and THP was 70.40%. In patients who did not undergo the technique, LFHP was 31.48% (p: 0.003) and THP was 23.50% (p: 0.002). LFHP was complete or partial (more than 25% of initial RH) in 92.3% of patients who underwent AT and in 50% of those who did not. Radiological findings showed that complete insertion is not associated with poorer HP. CONCLUSION: If the appropriate technique is used, preservation of RH is feasible after cochlear implant surgery with deep insertion electrode arrays.

Castleman's disease as an unusual cause for dysphagia and dyspnea in a pediatric patient.

Castleman's disease is a very rare entity in pediatric population and its presentation in the neck is scarcely described in the literature. We present the case of a 10-year-old-girl with an expanding neck mass over several months causing dysphagia and dyspnea. Surgical excision of the mass was performed and the analysis revealed unicentric Castleman's Disease. This is the second largest reported case of neck pediatric CD in the literature, and it presented with a symptomatology that differs from the other cases described. This fact highlights the need to include CD in the differential diagnosis of pediatric neck masses.

Unknown primary cancer of the head and neck: a multidisciplinary approach.

The management of patients with cervical lymph node metastases from an unknown primary cancer (CUP) remains a matter of controversy. Although new advanced diagnostic tools, such as positron emission tomography, have recently been introduced in oncology, the frequency of this tumour entity in clinical practice means it is still relevant. Recently introduced molecular profiling platforms may provide biological classification for the primary tissue of origin as well as insights into the pathophysiology of this clinical entity, including the characterisation of the Epstein-Barr virus and human papilloma virus genomas in the metastatic cervical nodes. Due to the lack of randomised trials, a standard therapy has not been identified yet. Although neck dissection followed by post-operative radiotherapy is the most generally accepted approach, there are other curative options that can be used in some patients: neck dissection alone, nodal excision followed by post-operative radiotherapy or radiotherapy alone. A major controversy remains in the target radiation volumes that range from ipsilateral neck irradiation to prophylactic irradiation of all potential mucosal sites and both sides of the neck. Finally, the administration of concurrent chemotherapy is currently being advised for patients with adverse prognostic factors.