Influence of Cochlear Implantation on Postural Control and Risk of Falls.

BACKGROUND: Cochlear implantation is an important method of hearing rehabilitation. Earlier studies have shown the influence of implantation on the vestibular system. However, until now, the effect of hearing rehabilitation with cochlear implants (CI) on postural control and body stability has not been sufficiently studied. OBJECTIVE: To analyse the effect of hearing rehabilitation with activated CI and different sound inputs (music, speech text, and white noise) on postural control and risk of falls after implantation. METHODS: This was a prospective clinical trial that included 33 adult patients with at least 6 months' use of a CI (mean time after implantation = 23 months). All patients underwent a standard or geriatric (for patients >60 years) balancing deficit test protocol with a mobile posturography system (VertiGuard®) in different situations (CI deactivated/activated and different sound inputs). As the main outcome measure, the risk of falls (%) after each protocol was calculated by evaluating body sway both forward to backward and side to side (°/s). RESULTS: With the CI deactivated, the mean risk of falls was 45.5%. After activation of the CI, there was a small decrease in the mean risk of falls, but it was statistically significant. With an additional sound input (music or speech text) this decrease was more pronounced: 42.0 and 42.4%, respectively. This effect seems to be more pronounced in older patients. Regarding the individual patients, 72% had an improvement in the risk of falls with an activated CI, and 28% had a slight deterioration. An activated CI accompanied by sound input (music) further improved the individual risk of falls. CONCLUSIONS: Compared with prior research, this study found that the risk of falls after implantation decreased over a longer time period. Furthermore, the use of a CI and different sound inputs had a positive effect on postural control. These findings support the need for optimal hearing rehabilitation, especially in elderly patients. Although this effect is relatively small, it is important to consider for further studies that rehabilitation with CI may reduce the risk of falls. While the auditory system supposedly contributes to postural control only to a small degree and the mechanism is still poorly understood, further studies with bigger samples are warranted to clarify these effects.

Oncologic results of transoral laser microsurgery for squamous cell carcinoma of the posterior pharyngeal wall.

BACKGROUND: The purpose of this study was to evaluate oncologic outcomes of transoral laser microsurgery (TLM) in patients with cancer of the oropharyngeal and/or hypopharyngeal posterior wall. METHODS: Between August 1986 and December 2006, 25 patients (oropharyngeal n = 12; hypopharyngeal n = 13) were treated by primary CO2 laser microsurgery. Treatment was exclusively TLM with or without selective neck dissection in 12 cases (48%); TLM with adjuvant (chemo)radiotherapy was performed in 13 cases (52%). RESULTS: Data were analyzed by using the Kaplan-Meier method. The median follow-up was 41.6 months. The 5-year overall, recurrence-free, and disease-specific survival rates for stages I/II were 36,5%, 60,0%, and 87,5% and for stages III/IVa 41,2%, 36,4%, and 56,3%, respectively. CONCLUSION: With respect to local control and survival, results are comparable to conventional surgery.

Oncologic and functional results after transoral laser microsurgery of tongue base carcinoma.

The objective of the study was to determine the oncological and functional results in patients after excision of tongue base carcinoma by transoral laser microsurgery. A retrospective unicenter study performed between 1986 and 2007. 82 patients with previously untreated squamous cell carcinoma of the tongue base (T1-4, N0-2, M0) underwent transoral laser surgery with curative intent. Stage distribution was as follows: stage I, 1 case (1 %): stage II, 6 cases (7 %): stage III, 14 cases (17 %): stage IV 61 cases (75 %). Main outcome measures are local control rate, overall survival, recurrence-free survival, complications, and feeding tube dependence. The results were Kaplan-Meier 5-year local control rate for all patients was 84 %. T-stage-related local control rate after 5 years was 94 % for stage I-II, 78 % for stage III and 81 % for stage IV. 5-year overall survival and recurrence-free survival were 59 and 69 %, respectively. UICC stage-related overall survival and recurrence-free survival were 70 and 86 % for stage I-II, 44 and 54 % for stage III and 58 and 69 % for stage IV. Postoperative bleeding at the primary tumor site occurred in 9 patients (11 %). Gastrostomy tubes remained in place permanently in 5 patients (6 %). Primary transoral laser microsurgery of tongue base carcinoma offers convincing oncological and functional results comparable to other treatment modalities, e.g., radio(chemo)therapy but has lower rates of morbidity.