[Surgical Risk Profile and Audiological Outcome in the Elderly after Cochlea-implantation]. / Operatives Risikoprofil und Hör-Spracherfolg bei älteren Cochlea-Implantat-Patienten.

BACKGROUND: The number of elderly patients with indication for cochlear implantation is increasing. Our aim was to investigate whether seniors with cochlea implants differ from younger patients with regard to hearing improvement, surgical complications and rehabilitation. PATIENTS AND METHODS: Patients older than 60 years (ys) having received a cochlea implant in 2007-2012 were included (Group I 60-70 ys; Group II <70 ys). Preoperative risk factors according to ASA-Criteria and postoperative complications were analyzed. Improvements in quality of live were evaluated by questionnaire. Audiological outcome was tested by Freiburger speech test and OLSA sentence test with background noise. Patients with comparable conditions for cochlea implantation between 40 and 59 years of age served as control group (Group K). RESULTS: Patient cohort consisted of 94 patients, 29 of which being older than 70 years. Severe complications were inexistent postoperatively. Gr. II achieved a speech perception for numbers of 95% (65 dB) and 50% (65 dB) for monosyllables. The speech perception in Gr. II was not significantly different from Gr. I or K. According to the quality of life test all groups experienced an improvement in their social life. CONCLUSION: Old age itself is no contraindication to cochlea implantation. It has little influence on the postoperative speech perception even though the learning curve of the elderly rises slower. However, careful assessment with regard to surgical risk factors and expected outcome is necessary.

[Molecular approaches to systemic therapy of adenoid cystic carcinoma of the head and neck area]. / Molekulare Ansatzpunkte für systemische Therapien adenoidzystischer Karzinome im Kopf-Hals-Bereich.

The adenoid cystic carcinoma (ACC) is a neurotropic salivary gland tumor with a high blood-borne metastasis tendency. The treatment of choice for localized disease consists of radical surgical resection and, depending on resection status, adjuvant radiotherapy. Due to the high recurrence rate with limited local therapeutic options and frequent occurrence of distant metastases, one is confronted inevitably with the search for an adequate systemic therapy. ACC shows little response to a variety of chemotherapeutic agents, partial or complete remissions are extremely rare. Beside classical chemotherapies, immunotherapeutics and targeted therapies with more favorable side effect profiles were tested in trials, but due to the small number of patients, a definitive statement on the effectiveness can be hardly made. This results in the need for prospective multicenter studies that allow clear recommendations for systemic therapy of the tumor. The present paper gives an overview of the sub-cellular and genetic characteristics of ACC, which represent possible targets for systemic therapies and have partly already been included in running clinical trials.